Efficiency Losses in Healthcare Organizations Caused by Lack of Interpersonal Relationships

Migowski, Sérgio Almeida; Gavronski, Iuri; Libânio, Cláudia de Souza; Migowski, Eliana Rustick; Duarte, Francisco Dias

doi:10.1590/1982-7849rac2019170396

person Sérgio Almeida Migowski

schoolInstituto Federal de Educação Ciência e Tecnologia do Rio Grande do Sul, Gestão e Negócios, Canoas, RS, Brasil

0000-0002-8328-5368

person Iuri Gavronski

schoolUniversidade do Vale do Rio dos Sinos, Programa de Pós-graduação em Administração, Porto Alegre, RS, Brasil

0000-0002-5301-4954

person Cláudia de Souza Libânio

schoolUniversidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-graduação em Tecnologia da Informação e Gestão em Saúde, Porto Alegre, RS, Brasil

0000-0002-4591-117X

person Eliana Rustick Migowski

schoolUniversidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-graduação em Tecnologia da Informação e Gestão em Saúde, Porto Alegre, RS, BrasilschoolUniversidade Feevale e Faculdade de Desenvolvimento do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brasil

0000-0002-7584-342X

person Francisco Dias Duarte

schoolPontifícia Universidade Católica do Rio Grande do Sul, Faculdade de Biociências, Porto Alegre, RS, Brasil

0000-0002-0707-4905

Sérgio Almeida Migowski, Rua Dra. Maria Zélia Carneiro de Figueiredo, 870-A, Igara III, 92412-240, Canoas, RS, Brasil. E-mail address:
sergiomigowski@gmail.com

Iuri Gavronski, Av. Dr. Nilo Peçanha, 1640, Boa Vista, 91330-002, Porto Alegre, RS, Brasil. E-mail address:
igavronski@unisinos.br

Cláudia de Souza Libânio, Rua Sarmento Leite, 245, 90050-170, Porto Alegre, RS, Brasil. E-mail address:
clasl@terra.com.br

Eliana Rustick Migowski, Rua Luiz Afonso, 84, 90050-310, Porto Alegre, RS, Brasil. E-mail address:
elianamigowski@gmail.com

Francisco Dias Duarte, Av. Ipiranga, 6681, Prédio 50, Partenon, 90619-900, Porto Alegre, RS, Brasil. E-mail address:
francisco@serdil.com.br

Contributions

1st author: article derived from his doctoral thesis, defended in the Graduate Program in Administration.

2nd author: supervisor of the 1st author; helped in all the work, from the dissertation, until in its transformation to article.

3rd author: improvements and adaptations throughout the work (introduction, theoretical increase, etc.) for the publication in the magazine, as well as turned the thesis into an article.

4th author: improvements and adaptations throughout the work (introduction, theoretical increase, etc.) for the publication in the magazine, as well as turned the thesis into an article.

5th author: assisted in the validation of the interviews through analysis of the data to confront the results found by the 1st author.

Conflict of Interest

The authors declare they have no competing interests.

Construct - Integration - Barriers

Representative Data

·Lack of Formal Interaction
·Physician Autonomy
·Sharing of Information
·Organizational Culture
·Formal Leadership Style
·Informal Leadership Style

"The physician has no corporate relationship with the institution … if I don't work here, I'll go somewhere else." (A1)
"we stay in the field of performance or creation and it does not get there where it matters, which is at the patient's bedside." (CF)
"For them not to feel embarrassed, as they are technicians, we tried not to put the nurses together." (CH)
"according to the leadership of that sector, they will guide the employee to have a good relationship with, to be respectful to other colleagues." (AA)
"when you give autonomy to the decision-making process, it is destabilized. The style of the leader and the ones being led influence this." (CF)

Construct - Quality Management - Barriers

Representative Data

·Work Overload
·Physician Autonomy
·Fragmentation of the Care
·Turnover
·Lack of a Service Customization
·Discharge Plan
·Hand Hygiene

"When your unit is over 90, 95% occupied, you notice a great fall in the care indicators." (AC)
"the physician is an autonomous, isolate subject, and has difficulty with working in a team, often does not recognize the importance of teamwork." (CC)
"it is a very high turnover level. Around 7% for a goal of 2.5%." (CF)
"the peculiarities of the patients are not respected … Everything is put into one place". (CK)
"I have no planning or schedule in the surgical room, and so about the patient's discharge". (AK)
"in the hospitalization units, I don't see people washing their hands as often as they should." (CK)
"we know that the medical field is the one who less wash their hands". (AC)

Construct - Leadership - Barriers	Representative Data
·Participation of the Informal Leaderships ·Commitment by Formal Leaderships	"sometimes we stay in the field of performance or creation and it does not get there where it matters, which is at the patient's bedside". (CF) "we need them to buy the idea, and to support it, because if the leadership does not support anything, nothing moves forward". (CH) "And then you discover that there were talents hidden until then". (CA)

Construct - Communication - Barriers

Representative Data

·Profile of the Formal Leaderships
·Distancing Between the Hierarchical Levels
·Organizational Culture
·Fragile Sharing
·Development of the Leaderships

"Some nurses are more resistant to passing forward". (CF)
"the employee feels a certain detachment from the board directors". (BA)
"for example, when the board members walk in, they don't greet the employees. It makes us look invisible". (BA)
"the other nursing technicians accept better when [the order] comes from their peers, which is different when it comes from a nurse because they think the nurse does not know very well their reality". (CH)
"the staff gets it, but it is not as open as we would like it to be and I don't think the institution is as open as we imagine it to be either." (CA)
"and then someday I found out that everybody was using this syringe, and I never heard of that." (BG)
"there is a surgical room cleaning system that is a communication through screaming … whoever shouts louder gets the cleaning staff to arrive quicker." (CK)

Construct - Trust - Barriers

Representative Data

·Handling the Mistake
·Autonomy

"so we learn from our mistakes, but there is also punishment. One thing does not exclude the other." (CG)
"If the mistake was severe or has caused harm to the patient, then I need to be punished and so does the educational process as well." (CB)
"institutionally there is no punishment, but then you surreptitiously see the comments, people judging you". (BA)
"in case the individual is not comfortable in exposing the errors made … everything is concealed." (CA)
"sometimes I can't give so much autonomy, because the individual does not feel prepared". (CF)

Construct - Efficiency - Barriers

Representative Data

· Autonomy
· Bureaucracy
· Failures in Processes
· Discharge Plan
· Average Stay
· Management of the Rooms in the Unit

"I need a fast decision and the decision-making process is slow". (CA)
"We have a huge demand today to fulfill the documents, they make us fill out again everything that was already filled out." (CK)
"each bed in which the terminal cleaning is made has one person, the assistant, who checks all the terminal cleanings, or almost all of them." (CI)
"I see that 99% of the physicians will not plan the hospital discharge … they simple write what they are doing during that day." (AK)
"I'm not worried and I don't believe that other surgeons worry about the average length of stay." (CK)
"the time of entry and exit is not inspected, and we … we even miss the interval of a surgery and this wing stands still".(CK)

[TFN1] Note. Created by the authors.

Efficiency Losses in Healthcare Organizations Caused by Lack of Interpersonal Relationships

Perdas de Eficiência em Organizações de Saúde Causadas pela Falta de Relacionamentos Interpessoais

Abstract