The “Health care networks” so brilliantly defended by Eugenio Villaça Mendes, have become the objective of the public system and, recently, also of the private system. Some large private hospitals (philanthropic or not) have gone to primary health care, understanding that these health equipment alone are unable to accompany people, even after discharge, because they do not have, or did not have, as their focus monitoring of graduates. This is all for many reasons, but what stands out for reflection is the epidemiological transition that has been taking place since the beginning of the 21st century. We started to observe the change from acute to chronic conditions. We even kept the term “patient” for chronic cases, which is a mistake because they are people who are living, working, having fun, traveling, even though they are diabetic, hypertensive or have cancer, because then they cannot be considered patients as we previously thought.
The concept of care networks gave fluency to the system in health care because it transformed the individual into the center of attention with integrated and complementary activities in all different units, health or not, because there was a welcome integration with social assistance units, matters related to work, and other forms of society organization.
Now speaking of hospital management. The search now is for “Network management”. The maturation of hospital management goes through profound transformations and difficult to be metabolized by managers in general. It seems that some of the hospital’s internal processes, just because they were so successful until yesterday, cannot even be touched.
The “Health Care Networks” theses already give us fundamental tips on how to implement the concept, with positive and expressive results already reported in research and books. Now it is time to focus on internal networks for better hospital management. As an initial step, it must be understood, which has a quite simple meaning: hospitals do not exist to hospitalize people, but to improve people’s quality of life, hospitalizing is a means and not the end. Otherwise, we can become sellers of procedures and not health. The second step, and it seems more difficult, is to reflect and propose solutions on the following points:
- We are more organized for curative or rehabilitative care and not for the health management of patients with chronic diseases. Another way of speaking, we are more focused on the attention of patients than individuals;
- Manage supply and not result and value;
- Our internal organization is reactive;
- The organization is still organized by qualified sectors, sometimes with the intention of integration without real reflection in practice;
- The hospital organizes by hierarchical levels, which is concerned with designing standard processes and procedures, when executing the performance or the meaning of the deliveries;
- Finally, the payment as discussed by procedure.
The answers are not on the tip of the tongue. And, possibly, they will not be unique depending on the culture of each organization.
Dr. Antônio Antonietto
Medical Director of Hospital Vila Nova Star, President of the ICESP Medical Practices Commission.