A démarche stratégique (gestão estratégica hospitalar): um instrumento de coordenação da prática hospitalar baseado nos custos de oportunidade e na solidariedade

Abstract

Este texto é uma apresentação geral da metodologia de gestão estratégica hospitalar de M. Crémadez e F. Grateau (França), incluindo os objetivos, as fases e as principais ferramentas do enfoque. O trabalho destaca os aspectos microeconômicos do mesmo e suas possibilidades para estruturar redes de serviços através da pactuação de metas e objetivos entre hospitais. Inclui a apresentação de um caso de aplicação do enfoque como instrumento de coordenação regional da especialidade de cirurgia geral dos hospitais de uma área programática (AP-4) da cidade do Rio de Janeiro.

Démarche estratégica em unidade materno infantil hospitalar

“…Analysis of what exists: corresponds to the initial medical and administrative diagnosis, besides including a list of partners, competitors and the design of the network of care. 1 The administrative diagnosis focuses on information concerning physical structure, human resources, demand profi le, among others. The medical diagnosis comprehends the list of pathologies organized according to medical specialties and the technologies utilized by each specialty, in conformity with the complexity; the matrix of pathologies and technologies, and a list of the modalities of care.…”

“…1 Makes it possible to analyze and to organize each segment hierarchically, by pondering multiple criteria. This analysis allows for a prospective vision of how each segment would behave in relation to each criterion.…”

“…The strategic démarche is based on elements of micro economy, of the fi eld of strategy and policy and the area of organizational development and, furthermore, it involves a cultural analysis of the institution. In addition, it proposes to redesign the institutional mission and seeks to attain the insertion of the hospital, in a coordinated manner, within the network of health services (Artmann & Rivera 1 …”

“…In Brazil, it has been applied in some experiences of hospital management and insertion of hospitals in the network as can be verifi ed in Artmann & Rivera 1 The potential of the method must be stressed, particularly for hospital units that, due to their strategic location, should attend to a regional demand. The state hospital chosen as the site of this study has this characteristic.…”

“…The strategic démarche approach strives to articulate rationality in attending to the populations' necessities with the broad participation of actors. It privileges change and learning as intrinsic phenomena that have a permanent character within the organization (Artmann & Rivera 1 …”