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Previous issue date: 2018-03-26 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Complex sociotechnical systems are those where humans need to handle with variabilities and adapt their operations to maintain acceptable levels of efficiency and thoroughness. Hospitals of complete care are examples of such systems, due to its necessities of highly specialized work force, the use of intensive wealth and technology. These organizations are characterized by their external and internal variabilities. The external variabilities are, in a hospital, the climate changes, the unknown diseases and the uncertainty in the quantity and necessities of the incoming patients. In the other side, the internal variabilities are related to the resource management, the time and results pressure and the conflicting goals. Due to that, losses are created and reflect on efficiency and thoroughness performances. The literature has driven researches in sociotechnical systems seeking to analyze their activities. The FRAM method is being used as a tool to model and analyze those activities. In this way, the aim of this research is to characterize a complex sociotechnical system in relation to its variabilities, conflicting goals, and wastes in the activities and its relations with the system?s integrated operations. To do that, we took as the analyzed object, the average length of stay of patients in the Brazilian public health (SUS) hospitalization of a University hospital. The beginning of the analysis is the discharge of a patient in an entry unit to the hospitalization. The end of the analysis is the final discharge of the patient and the preparing of its bed to another patient. The hospitalization system seems to be good to a study that aims to analyze variabilities, because it represents a significant amount of the challenges of a hospital and it is inside the boundaries of a tractable study. The explorative and qualitative inquiry method and the FRAM modeling allowed the identification of a 66-function model that represents the hospitalization system. From this model, we selected three instantiations for the further analysis. These instantiations were selected because represented a significative amount of wastes when analyzed through the lens of Lean Systems. The model and instantiations generated an inventory of wastes, ETTOs and variabilities. The analysis was conducted in a way to identify were decision-makers must choose between production and protection. These decision points are characterized by presenting resonant variabilities in the system, which generates wastes in other functions (e.g. waiting, inappropriate processing, etc.). Therefore, looking for Integrated Operations, we tried to identify points of the system?s structure that could influence those variabilities and wastes. The main theoretical contribution of this research is the proposition of a method to investigate wastes, ETTOs and variabilities associated to functions in a FRAM modeling. We also propose
a new approach of analyzing integrated operations in a FRAM modeling. In the same way, pragmatic contributions pointed out to the need of a better resource management in the hospital. This could make the system?s activities more efficient without interfering in its resilience. Future studies could reply this method in other contexts looking for validation. Deeping the data gathering in the researched hospital could result in better understanding of each essential function identified. Furthermore, replying this research in other Hospital could lead to recommendations in the contractual level of the Public Health Services (SUS). / Sistemas sociot?cnicos complexos s?o sistemas onde seres humanos necessitam lidar com variabilidades e adaptar suas opera??es de forma a manter n?veis satisfat?rios de efici?ncia e cuidado. Hospitais de atendimento completo s?o um exemplo de tais sistemas dadas suas necessidades de m?o de obra altamente especializada, utiliza??o de tecnologia e capital intensivo. Tais organiza??es s?o caracterizadas por apresentarem variabilidades externas, como varia??es clim?ticas, patologias pouco conhecidas e imprecis?o da quantidade de pacientes que ir?o necessitar de atendimento hospitalar; e variabilidades internas, relacionadas ? gest?o dos recursos escassos, ? press?o por tempo e produ??o e aos conflitos de metas. Essas variabilidades causam perdas que refletem em sua performance de seguran?a e efici?ncia. A literatura tem apontado caminhos de pesquisa em sistemas sociot?cnicos complexos por meio da an?lise das atividades de tais sistemas. Para isso, a ferramenta FRAM tem sido usada como forma de modelar tais atividades e analis?-las. Dessa forma, o objetivo deste trabalho foi caracterizar um sistema sociot?cnico complexo com rela??o a suas variabilidades, seus conflitos de metas, as perdas ocorridas nas atividades e a rela??o disso com suas opera??es integradas. Para isso, tomou-se como objeto de estudo o tempo de perman?ncia de interna??o de pacientes do SUS em um hospital universit?rio. O sistema de interna??o hospitalar se mostrou adequado para um estudo de an?lise da variabilidade por representar uma amostra significativa dos desafios de um hospital e estar dentro dos limites trat?veis para um estudo dessa natureza. O m?todo qualitativo, explorat?rio e a modelagem FRAM permitiram a identifica??o de 66 fun??es do sistema de interna??o. Do modelo representativo das atividades desse sistema, tr?s instancia??es foram destacadas para as an?lises do trabalho. As instancia??es selecionadas foram as que mais apresentaram desperd?cios, analisados pela ?tica das perdas do Sistema Toyota de Produ??o. As modelagens e as instancia??es geraram invent?rios com as perdas, ETTOs e variabilidades associadas ?s fun??es. As an?lises foram conduzidas de forma a identificar pontos onde a estrutura do sistema faz com que os gestores tomem decis?es conflitantes (entre produ??o e prote??o). Esses pontos de decis?o se caracterizam por apresentar variabilidades ressonantes no sistema que, por sua vez, geram desperd?cios em outras fun??es (e.g. espera, processamento inapropriado, entre outros). Posteriormente, sob uma ?tica de Opera??es Integradas, buscou-se identificar como a estrutura operacional do sistema poderia estar influenciando essas variabilidades, desperd?cios e conflitos de metas. A principal contribui??o te?rica deste trabalho ? a proposi??o de um m?todo para inventariar perdas,
conflitos de metas e variabilidades associadas a fun??es de uma modelagem FRAM. Tamb?m, contribuiu-se com uma nova aproxima??o ? modelagem FRAM como uma ferramenta para a an?lise de opera??es integradas. Da mesma forma, contribui??es pr?ticas apontam para a necessidade de melhor gest?o dos recursos do hospital, de forma a tornar as atividades mais eficientes, por?m sem interferir nos pontos de resili?ncia do sistema. Ficam como sugest?es de futuros estudos a replica??o do m?todo em outros contextos como forma de valida??o; o aprofundamento das coletas de dados no hospital pesquisado; e a replica??o em outros hospitais para gerar recomenda??es a n?vel de gest?o e contratualiza??o do SUS.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8148 |
| Date | 26 March 2018 |
| Creators | Lando, Felipe |
| Contributors | Henriqson, ?der |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Administra??o e Neg?cios, PUCRS, Brasil, Escola de Neg?cios |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 3244129067093836374, 500, 500, 500, 600, 944455694546435801, 8024035432632778221, 2075167498588264571 |
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