Inovação e hospitais universitários: um estudo de caso

Malik, Ana Maria
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Introduction: Innovation in services includes implementation of advances or technological processes in care or teaching services, aiming at adjustments and improvements. Objective: To analyze how the adoption of health innovation results in changes in management and care production at the University Hospital (“UH”). Methods: Review of the scientific literature on topics of university hospitals management - UHs, interactions with Health Systems, and on the impact of innovation in its three mandatory axes (healthcare, research and teaching). Two methodological approaches were used: (i) literature review on innovation and on a specific example, robotic surgery; and (ii) analysis of the case study of this adoption in this university hospital. Results: The reviewed scientific literature presents the accelerated evolution of incremental and disruptive innovations in the last decades. High-cost structural innovations and healthtechs are reinventing and improving hospital processes and services. Although the Unified Health System, SUS, legislated increased responsibilities for the UHs, its funding was not adequately adjusted. This dynamic and pressure to incorporate innovations challenges UHs to ensure sustainability in delivering teaching, research, and healthcare results. Some management results of this adoption of the Robotic Surgery Program were evaluated through the post facto analysis of the data from the original controlled study, compared to conventional, open, or laparoscopic surgeries, in subprojects. The use of healthcare resources was significantly higher for robotic surgeries in half of the subprojects. The highest proportion of costs occurs in the intraoperative period. The value of dedicated disposables used with the robot (manufacturer's monopoly) is high, resulting in a higher cost trend than conventional (control) surgeries. However, there were gains in institutional prestige, installed physical capacity and specialized know-how, which have innovated in the teaching program and expanded research opportunities. However, responsibilities in hospital management were increased and the initial planning of the study was partial, without predicting the subsequent regular program in the SUS. Pressure, negotiations, and hospital debts to continue the unfunded care program have expanded. This highlighted the importance of the vision of the future that hospital managers should possess. Conclusion: Innovations may lead to evolution and renewal but increase institutional costs and expenses for the Health System. In this case study, there are still controversies about the clinical relevance of the additional benefits, which this study has not yet conclusively resolved. There were institutional gains in the missions of researching and teaching the state of the art. There is greater surgical capacity installed. More beds available provide greater healthcare resolution. Human resources are more comfortable and experienced. However, for patients, this has not yet influenced overall survival or cancer progression-free survival. In addition, the healthcare program costs raised since robotic surgery adoption. In 2021, the Health Ministry again ruled out the prospect of funding. The case of adopting innovation, as in this example, challenges hospital managers to innovate in methods to manage real-life data and anticipate the political-economic context determinants of the health sector. Documenting and disseminating knowledge and experiences can allow advances in Hospital Administration.

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