Práticas de governança e inovações para o enfrentamento da resistência antimicrobiana em hospital público de ensino

Abstract

Objective: To develop an empirical theoretical model of governance practices and innovations to address antimicrobial resistance in a public teaching hospital. Theoretical basis: Tackling antimicrobial resistance is a global public policy concern. A worsening of the situation has been observed as a result of the Covid-19 pandemic. In addition to infection control challenges, the ability of public teaching hospitals to respond in their governance system has been questioned. Methodology: This is the elaboration of an empirical theoretical model resulting from the triangulation of the findings of an action research conducted by Convergent Care Research. A hospital documentary analysis of public governance practices in tackling antimicrobial resistance in a teaching hospital of the single health system was carried out between March and April/23. A scoping review was conducted according to the international PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol with the following question: 'What strategic innovations are being implemented in the management of AMR in teaching hospitals', using the databases Lilacs, PubMed, Cochrane Library, Embase, Web Of Science and Scopus, carried out in March/23. In addition, semi-structured interviews using a qualitative approach following contextualised content analysis were conducted with hospital stakeholders, characterised by 13 leaders working in mandatory and advisory hospital committees, between September and November 2023, asking: 'What are the challenges for hospital leadership in tackling antimicrobial resistance?' And: 'What are the prospects for innovation in hospital governance in tackling antimicrobial resistance?' Results: Document analysis: Results A total of 1,567 documents were analysed, 86 of which contained content related to the fight against antimicrobial resistance.We found that the Hospital de Clínicas da Universidade do Triângulo Mineiro uses governance practices to combat AR. Scoping review: the research resulted in a final sample of 17 articles published in indexed health journals that can support the dissemination and uptake of innovations in the management of antimicrobial resistance in teaching hospitals and have an impact on the better development of local, national and global policies, contributing to the policy agenda for tackling antimicrobial resistance. Semi-structured interviews: resulted in broad stakeholder engagement The following were highlighted: a) Challenges: promoting strategic management involving dialogue within and outside the public teaching hospital; developing the hospital's health teams to promote leadership in tackling antimicrobial resistance; and innovation in processes, routines and products in the face of risk management for the sustainability of the institution. B) Innovations: evidence-based decision making in the service; use of research in practice; antimicrobial stewardship; development of healthcare teams; patient-centred and timely care. In this way, the triangulation of findings supported the construction of the theoretical model, which has as its inputs (strategic management; internal and extramural dialogic management; leadership development; training of health care teams; innovations; risk management and economic sustainability; evidence-based decision-making in the service; use of research in practice; antimicrobial stewardship; development of health care teams; patient-centred and timely care); institutional plan/strategic master plan; institutional committees for prescription control; quality indicators; timely diagnostic detection; information technology; professional education and training; reinforcement of precautions; cleaning and disinfection), outputs (practices related to responsiveness, evidence-based practices and innovations, and hospital practices and routines) and controls (overall infection rate and clean surgery, ICU wound density and adult ICU antimicrobial resistance profile) Originality and Relevance: There are important gaps in the governance of public teaching hospitals, particularly in the integrated health system. The development of the theoretical-empirical model made it possible to identify important aspects of hospital governance in a real context The results of this dissertation, in terms of originality, are organised into a published scientific article on innovations in the management of antimicrobial resistance and a technical scientific report describing the action research (convergent care research) that culminated in the development of the theoretical-empirical model. Practical contributions: The important potential of this research was that the combination of methods made it possible to understand the local context and its relevance to the current global challenges of antimicrobial resistance. It also allowed local leaders (stakeholders) to present their perspectives - so that the model was built closer to the real scenario than the ideal - a contextualised model By getting closer to the scenario, it was possible to identify expanded practices and innovations in hospital governance In general, the content analysed contributes to guiding local hospital response capacity and potentially to aligning the network of teaching hospitals in the Unified Health System in terms of their governance challenges Thus, it contributes to strengthening the political agenda, global and local greements in the face of this growing global health threat.