Notificações de não conformidades como indutoras de mudanças em saúde: um estudo de caso a partir de lideranças de um hospital filantrópico

Abstract

The object of this study is notifications of nonconformities as a management aid tool for implementing changes, whether in processes or organizational routines. Non-conformity is the delivery of a product or service without meeting the technical specifications imposed by the customer, the pre-established requirements of regulatory standards, supervisory bodies, quality certifications or even the guidelines and procedures of the organizations themselves. While change, in the organizational context, is characterized as a significant modification in processes, products, people, structure or culture, capable of affecting the majority of the organization's members and whose principle is to promote the improvement of organizational performance. The non-conformity notification systems are considered important quality tools, they enable the identification of operational failures, which is why they are often understood as instruments that encourage punishment rather than being seen as promoting the identification of process improvements. Leadership, in turn, plays a fundamental role in the process of cultural change between teams to transform this punitive view of non-conformities, as it promotes, engages and contributes to their participation in process improvement changes. Healthcare leaders play an essential role in promoting an organizational environment of synergistic action in which a culture of quality and patient safety is encouraged, with a focus on preventing harm to patients while they are in the care of healthcare services, considering this to be a complex and sensitive segment dedicated to taking care of the most precious asset of human beings, which is the life. The research is characterized as a case study with a hybrid approach as a methodological research strategy (quantitative and qualitative). We chose this method because it is limited to investigating a specific hospital unit, seeking to understand the social phenomena present there, in its social context. We used sources of evidence from non-conformity notification databases to prepare the institution's epidemiological profile and in-depth interviews carried out with two leaders of the diagnostic imaging and laboratory analysis services to obtain their perceptions about the non-conformity notification system. In the interviews, we investigated the life trajectories and the leadership exercises and how leaders use notifications of non-conformities to implement changes with a focus on improving processes and promoting the quality and safety of the services provided. The results demonstrated that the non-conformity notification system is an important tool to help leaders identify potential opportunities for changes that could result in process improvements, but to be recognized as such the healthcare institution needs to foster an organizational culture focused on the change process, investing in leader training programs, especially those newly entering the role; in training and developing its leaders in quality tools and improvement cycles.