Gestão do conhecimento organizacional baseada em evidências: uma análise do uso de indicadores para avaliação de desempenho em serviços hospitalares

Abstract

This thesis aims to contribute conceptually to current literature by analyzing the relationship among the conceptual fields of Performance Evaluation (Total Quality Management TQM), Knowledge Management (KM), and Evidence-based Management (EBMgt), from the perspective of Strategic Management of Resources in knowledge-intensive business services. Three exploratory studies were conducted in Brazilian hospital organizations in order to analyze how these services can be qualified with an evidence-based knowledge management approach using performance indicators. References on Performance Evaluation (TQM), the application of Information Systems in hospitals, theoretical contributions of EBMgt and constructs concerning the application of KM in hospital services were reviewed for the purpose of performing further content analysis on the subject. This was an essentially phenomenological study based on a three-stage strategy for implementing the methodology. (1) Exploratory Stage A: a study was conducted in nine hospitals participating in the System of Standard Indicators for Hospital Management aiming to develop a qualified theoretical framework for research, to improve survey questions, and to develop an analysis framework adjusted to knowledge-intensive business services (KIBS). (2) Exploratory Stage B: a Case Study (J) in a hospital that operates under common ownership by the Brazilian Ministry of Health and exclusively serves the Brazilian public health system. (3) Exploratory Stage C: a Case Study (K) in a charity hospital that, according to government regulations, allocates 60% of services to the Brazilian public health system and 40% to private patients and health plan/fee for service programs. Primary data were collected through in-depth interviews conducted with hospital managers. Secondary data were abstracted from reports published by both hospitals under study and used to strengthen the analysis of interviews with key people, according to the individual organizational arrangement of each hospital. These two institutions represent most of the historically relevant hospital services offered in Brazil, corroborating the relevance of this study to the applied field. Data analysis was performed using NVIVO9®. Data from Exploratory Stage A provided a basis for the proposal of an Analysis Framework of Performance Indicators for the development of an Organizational Knowledge. The content and associations resulting from Case J showed how Performance Evaluation, knowledge and research can be used as strategic resources by public health organizations. Case K, in turn, revealed the primacy of the TQM model targeting health care and economic sustainability of the services investigated. The conclusions suggest the influence of scientific research and criteria of confidentiality, reliability and credibility on the assessment of hospital performance using a system of indicators (A). In addition, we may assume that issues involving hospitals serving exclusively the Brazilian public health system direct the theoretical debate towards welfare issues (B), whereas issues involving private and nonprofit hospitals lead the theoretical debate to address cost reduction and process efficiency (C).