[pt] Apesar dos altos gastos com saúde no Brasil, a qualidade e eficiência operacional nem sempre são alcançadas. Para lidar com essa questão, os gestores hospitalares adotaram o agrupamento de recursos hospitalares como estratégia para reduzir custos. O Centro de Materiais de Esterilização (CME) desempenha um papel crucial, recebendo e esterilizando materiais usados em outras partes do hospital. Essa atividade, embora essencial, é dispendiosa e, portanto, alvo de estudos para redução de custos. A centralização da operação de esterilização em redes é apontada na literatura como uma importante estratégia para redução de custos globais. Essa pesquisa visa desenvolver um modelo para apoiar a decisão de criação de uma unidade centralizadora de esterilização em uma rede de hospitais no Brasil. A metodologia inclui uma revisão de escopo e uma pesquisa ação. A pesquisa contribui para uma maior compreensão dos benefícios da centralização do CME, modelando processos operacionais de uma rede de quatro CME com uma análise crítica e os resultados obtidos com desenvolvimento e aplicação do modelo para definição do cenário de centralização de uma rede de hospitais. Dessa forma, observa-se os benefícios economia de escala, eficiência operacional, maior controle e rastreamento de materiais, entre outros. O modelo proposto diferencia-se dos encontrados na literatura por garantir uma otimização global ao utilizar um modelo único com dados reais. Ele permite uma tomada de decisão real para uma organização de saúde, propondo a abertura de um único CME centralizado para atender os hospitais da rede. / [en] Despite high healthcare spending in Brazil, quality and operational efficiency are not always achieved. To deal with this issue, hospital managers adopted the pooling of hospital resources as a strategy to reduce costs. The Sterilization Centers (SC) plays a crucial role, receiving and sterilizing materials used in other parts of the hospital. This activity, although essential, is expensive and, therefore, the target of studies to reduce costs. The centralization of sterilization operations in networks is highlighted in the literature as an important strategy for reducing global costs. This research aims to develop a model to support the decision to create a centralized sterilization unit in a network of hospitals in Brazil. The methodology includes a scoping review and action research. The research contributes to a greater understanding of the benefits of SC centralization, modeling operational processes of a network of four SCs with a critical analysis and the results obtained with the development and application of the model to define the centralization scenario of a hospital network. In this way, the benefits of economies of scale, operational efficiency, greater control and tracking of materials, among others, are observed. The proposed model differs from those found in the literature by guaranteeing global optimization when using a single model with real data. It allows real decision making for a healthcare organization, proposing the opening of a single centralized SC to serve the network s hospitals.

The concept of Shifting the Balance of Care was first introduced to NHS Scotland in 2005 through the Kerr Report. The key messages from the report were to: ensure sustainable and safe local services, which are supported by the right skills, change the emphasis of care into the community, provide preventative reactive care, and fully integrate the system to tackle the changes, use technology more effectively, and involve the public in finding solutions to change. Following the report, a framework was developed which highlighted and prioritised eight areas of improvement. These areas for improvement are the focus by which this research examines if Operational Research (OR), specifically OR models, can have a positive impact in Shifting the Balance of Care. The research utilises underlying OR methodologies and methods and provides evidence from the literature of the ability of nine selected models to facilitate the Shift in the Balance of Care. A contributing factor to the research is the barriers to implementation of OR models into the NHS. With reference to the literature, the common barriers to implementation of OR models are categorised and used to provide direction to modellers where implementation barriers are more prevalent in some models than in others. The research also provides empirical evidence of three selected models’ (the Lean Methodology, Process Mapping and Simulation, developed over two Case Studies) ability to address and influence the prioritised Improvement Areas, with the addition of a newly developed model: SoApt. The development of SoApt follows the Principles of Model Development derived as a guide to modellers who wish to develop a new model. SoApt is also empirically explored in a Case Study and provides some evidence of the models ability to aid Decision-makers, faced with limited budgets, to choose between options which will Shift the Balance of Care. OR methods and methodologies are examined to ascertain the Roles of Models for each model explored in the Case Studies. Examination of the Roles of Models against the Improvement Areas provided evidence of a models’ ability to address more than one of the priority areas and that models can be used together or sequentially. In addition, with reference to OR methods and methodologies, a theoretical Evaluation Framework is proposed which suggests the User and User Satisfaction is key to the evaluation of a model’s success; positive experiences of the User and Use of the model may help to eliminate some of the barriers to implementation.

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