If there is a reason for complaint regarding health care, whether public or private, that is the waiting time. However, what most people do not know is that it is not just the patients who have to wait. Health professionals often find themselves constrained in the performance of their duties, and are forced to wait to have the information or resources needed to care for patients.
Gustavo Bacelar, researcher at CINTESIS and head of medical information at the spin-off VirtualCare, is working to respond to these situations and “to streamline the system” within the scope of his PhD project in Clinical Research and Health Services ( PDICSS), entitled “A study of implementing Theory of Constraints in healthcare services”.
The first case investigated by the CINTESIS researcher was the Ophthalmology Service of the Santa Luzia Hospital, in Salvador, Brazil. After the implementation of a new process, the number of attended patients increased by more than 50% in four weeks and without any type of financial investment. The novelty of the solution presented by the researcher is in the use of the Theory of Constraints, which defends the identification of the “constraint” (ie, the factor that limits the performance of a system or organization), to subordinate the organization of the process to the work optimization of such “constraint”.
That is, in the case of the Ophthalmology Service of the Brazilian hospital, “the resource that had to be optimized was the doctor”. Thus, the process was reconfigured in order to prevent the doctor from being stopped and too dependent on other professionals, such as nurses and auxiliaries.
“When we started the intervention, there were 12 scheduled and 2 extra consultation appointments. At the end of our intervention and after only four weeks, the number of patients attended increased to 23 (18 scheduled appointments and 5 extra),” says the specialist. In conclusion, there was a 50% increase in the number of scheduled consultations and a 150% increase in the capacity for extraordinary consultations.
“In addition to these more objective results, we have also seen an improvement in the satisfaction of health teams and the quality of care,” explains Gustavo Bacelar, noting that it was not necessary to spend on new equipment or human resources.
“Health services can not afford to have doctors waiting to know who is the next patient they will see. Their time should be used 100% in the benefit of patients,” explains Gustavo Bacelar. For that to happen, “the doctor can not stop because the patients were not properly prepared due to lack of clinical information or because they have to wait for another health professional, namely a nurse,” he adds.
The next intervention of the CINTESIS researcher will target the Obstetrics Service of a large Portuguese hospital. “At a time when the National Health System faces serious challenges regarding the management of its Obstetrics and Maternity Services, the redefinition of the way in which the care of the users is done and its optimization can be a particularly cost-efficient solution”, comments Dr. Gustavo Bacelar, adding that the goal of his project is “to improve the quality of health services in a timely and cost-effective manner, now and in the future.”
It should be noted that the Theory of Constraints has already been used in other countries to improve the efficiency of health services. In the United Kingdom, this theory helped Oxfordshire Radcliffe Hospital increase the percentage of patients who spent less than four hours in emergency services from 50% to 95% in just two months. The same theory has already been used in General and Family Medicine consultations and in Oral and Maxillofacial Surgery Services with very positive indicators. In Portugal, there are no known cases of the application of this method in the health area.