Uso de evidências na tomada de decisão em organizações hospitalares: estudo de caso no HUCAM
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Data
2025-07-21
Autores
Viana, Lorena Lima
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Universidade Federal do Espírito Santo
Resumo
In hospital organizations, decision-making unfolds within a setting marked by transversal organizational structures, high complexity, and processes of evidence cocreation. In this environment, managers engage in varied forms of evidence appropriation and application throughout health-related decision-making. This study aimed to analyze how evidence has been incorporated into the decision-making processes of hospital pharmacy managers, based on a case study conducted at the University Hospital Cassiano Antônio Moraes, affiliated with the Brazilian Hospital Services Company (EBSERH) and the Unified Health System (SUS). The research employed a qualitative, descriptive, and cross-sectional approach, carried out in 2025, and grounded in thematic content analysis. The analytical framework was adapted from the input–process–output–outcome model and organized into seven stages: process initiation, sources of evidence, professional or interprofessional interactions, source analysis, final decision-making, decision implementation, and outcome evaluation. Data were collected through semi-structured interviews with managers and other professionals involved in the hospital pharmacy’s decision-making processes, encompassing diverse functions and types of decisions, both managerial and technical. The findings indicate that evidence use constitutes an interdependent and adaptive practice within the transversal organizational structure. The analysis also revealed a predominant reliance on organizational evidence, mediated by multiple professional and interprofessional interactions. Notably, among the seven stages analyzed, the implementation phase emerged as the central analytical insight, underscoring that decision-making is not the conclusion of the process but rather an intermediate stage—implementation is the endpoint. For evidence-based decisions to be effective, they must be institutionally implementable, operationally feasible, and socially negotiated. The research concludes that evidence supports decision-making by informing managerial and technical choices across various functional levels and is shaped by contextual demands. By empirically and analytically mapping this process, the study contributes to understanding evidence-based management as a complex decision-making practice in the public healthcare context, marked by structural and contextual constraints. Its practical contribution lies in the development of an intervention guide for organizational improvements tailored to hospital managers. The study’s social contribution consists in providing inputs for enhancing hospital management by identifying decision-making practices that value the use of evidence, even under adverse conditions. The findings offer strategic directions for reinforcing organizational efforts toward patient safety, rational use of medications and pharmaceutical supplies, and the advancement of public value within Brazil’s public health system.
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Palavras-chave
Administração pública – processo decisório , Hospitais universitários , Tomada de decisão