In an interview with Jornal Economico, Diogo Fernandez Silva, founder of Nobox, considered the government’s desire to “implement a new model of decentralized management of enterprises, with greater responsibility and independence of boards of directors” as positive. But it still leaves some caveats.
They recently launched E-book “How can the potential of ULS be turned into reality?” What is your goal?
The aim of this guide is to stimulate ULS departments to build on the momentum behind the creation of this new organizational model to promote greater integration of care, with better coordination between different services and between hospital care and primary health care, with greater emphasis on the active role that the patient must play in this Processes.
Essentially, through this guide we seek to share a set of ideas and good practices that facilitate the work of those leading this transformation, highlighting the topics that are most important for its success, such as the effective engagement of clinical leaders, teams and patients, but mainly how to implement a new culture of clinical innovation. and administrative, which allow us to rethink the way we deliver health care.
Why launch this E-book In partnership with the Portuguese Association of Hospital Directors, the National Association of Family Health Units and the Portuguese Association of Integrated Care?
Integrating different levels of care into ULS is one of the most important factors for its potential success, but also one of the most important barriers to overcome. We now have different cultures working together in the same structure, and it is essential to start breaking down silos and creating bridges of proximity and collaboration, facilitating and enhancing the coordination and integration needed in care.
In this sense, we believe it is important that this guide also reinforces the message of cooperation and commitment on a common path around shared ideas and visions. It made perfect sense to include here the associations representing USF (USF-AN), Hospital Administrators (APAH) and Care Integrators (PAFIC), whom we would also like to thank for their willingness to embrace this initiative and contribute many suggestions and ideas to accelerate this transformation.
The ULS changeover process began in January. It’s been five months. And it happened comment How is it going
It is important to highlight that this process of change requires time and that its results will take time to emerge, as one of the foundations of the new model is to focus more on long-term health management, and to seek an increased focus on health. Value provided to the population (years of healthy life), removing excessive focus on production (more consultations and surgeries).
However, in a way, this shift opened the doors a bit to innovation, as it saw ULS teams enthusiastically testing and implementing new initiatives, focusing on creating integrated patient pathways, and improving coordination between hospital and primary care teams, among other things.
Despite this, the transformation process has been characterized by different rhythms in different institutions. In general, soon after such a change, it is natural that the aspects addressed initially will focus on the more structural aspects associated with the merger of teams, the selection of new leaders, new workplaces, new procedures, among others. We hope that the process will continue and gain more strength in aspects related to clinical innovation, reorganization and improvement of care delivery pathways.
The new health minister criticizes the ULS management and even asks the executive management to explain the reform. Could a decline be a possibility?
There is no doubt that the current political situation, with many open points regarding the future, determines the next steps.
With the dismissal of the Executive Directorate of the SNS, linked to the different vision offered by the Trusteeship regarding ULS, we would like to highlight three main points regarding this issue: First, evidence is essential for decision-making, but the success of a change like ULS depends more on initiative, planning and team involvement than Its reliance on certainty about which model is correct or safe. Unfortunately, the success of applying a regulatory model in one place does not guarantee the success of that model applied in another context. Second, the absence of a long-term strategic vision is detrimental to the work of organizations – in fact, this lack of an integrated and continuous vision is one of the main reasons for the difficulty of formulating and the rigidity of the social networking system and its institutions. To feel lost; Third, there are issues that need to be addressed by the current ULS model, namely the asymmetry between district hospitals and university hospitals, which receive patients from different locations and face different challenges in both settings. By agreeing with the global ULS model, there are adjustments to local realities that must be made, but this does not mean that the process must be reversed.
The government program has already provided for a review of the layout of ULS, with “particular focus on those that are part of university hospitals” (one of the main criticisms of the current minister, as she sees this inclusion as exacerbating the lack of funding for these units). What is the main concern regarding this administration?
In theory, geographic population-indexed funding for ULS harms funding for ULS that receive patients outside its area of influence. Moreover, there are other types of expenses, namely those related to teaching, training and research, which vary equally between entities. However, it is also true that peripheral ULS present other budgetary issues, relating, for example, to patient transport or surrounding support structures. Instead of reversing the model, it might make more sense to ask: What specific projects can or should be developed in ULS, with their funding channels, to bridge these differences in context between different types of ULS?
Are there more concerns due to the fact that some hospitals are ULS listed and others are not?
Although few in number, there are some hospitals that are not part of ULS, namely the three oncology institutes (IPO Porto, Coimbra and Lisbon) and the Cascais Hospital. Given the number of hospitals in the country, it is still a small number and represents two groups: Oncology institutes, which receive patients from a wide geographical area, extending beyond the cities in which they are located, and with great complexity in terms of the number of hospitals. Cases dealt with; It is the latest health partnership between the public and private sectors in the country. Since these are exceptional cases, we believe that correlating them with the ULS generated should be one of the goals of revising this model.
The government program also foresees a “sustained increase in USF Model B throughout the national territory” and “USF Model C pilot projects.”
Model B USFs have led the way in terms of improving care simultaneously with greater motivation for professionals, and it is necessary to expand this model to the entire country. The barriers that existed to mainstreaming USF B were nonsense and only contributed to discouraging primary care workers and limiting patients’ access to quality care. However, it is necessary to continue improving and innovating, striving to give healthcare teams more effective time with users, reducing bureaucracy and increasing the type of responses available to users, such as nutrition, psychology, dentistry, physical exercise and others.
How do you evaluate the new government’s priorities in the health sector?
Regarding the State Health Program, we positively emphasize the desire to implement a new model of decentralized management of enterprises, with greater responsibility and independence of boards of directors, and thus leadership and intermediate management. Successful implementation of this measure is crucial to modernizing the organization of services, seeking to give more autonomy and responsibility to clinical teams and services to adapt the work of units to the communities in which they are located.
What goals should be a priority for ULS?
We are convinced that integration of care between primary health care and hospital units, as well as with the communities themselves, is the main goal of ULS. Viewing the patient’s health as a continuum, as a whole, allows for easier, smoother and more direct access, while at the same time receiving care at the various necessary levels.
What scope is there for innovation in this ULS? Should this be the priority focus?
Without innovation, without creating new ways to deliver care in a clear way, the goal of ULS will not be achieved. In fact, our guide includes several suggestions focused on promoting innovation in ULS, which should include not only a management component, but also, and most importantly, a clinical component, highlighting that this is not only done through the integration of new technologies, But also by innovating hospital processes and the patient journey and improving team work.
The doctors’ union came out to criticize, saying the transition from ARS to ULS was “poorly prepared, poorly prepared and carried out in an uncoordinated manner”, which affected medical training. What improvements need to be made, so that medical training is a key aspect of these units?
Medical training is currently threatened by deteriorating health care conditions in hospitals. On the one hand, the decrease in the number of professionals associated with a large number of trainee doctors harms the quality of training; On the other hand, trainee doctors are used to ensure the functioning of services, especially emergency services. Becoming a ULS, in and of itself, does not affect training, but if implemented well, it may have the potential to improve conditions.
