Serviço de fisioterapia em terapia intensiva: proposta de modelo de maturidade e diagnóstico

Abstract

This study aims to propose a maturity model capable of quickly diagnosing intensive care physiotherapy services in search of improvements that add value to the organization and to the health of patients. To this end, Design Science Research was used, a method for constructing and evaluating artifacts that allow transforming situations, improving their conditions. From the first literature review, with the production of bibliometric analysis, it was possible to identify a significant growth in studies on intensive care physiotherapy in adults since 2011, with peaks in 2016 and 2019. Brazil is the country that publishes the most on the topic in the researched segment, which is value generation. To deepen the understanding of physiotherapy management, a new systematic review was carried out, looking at existing systematic reviews. The content found was categorized into structure, processes, people, technology, and results. Thus, some theoretical gaps became evident, such as studies on the physical structure of intensive care units, the adoption of standardized protocols, team management and professional training, and the use of technologies to optimize care and service management. After conducting a survey of the state of the art, we proceeded to survey the state of practice, based on a semi-structured questionnaire, produced based on the five categories mentioned and applied in 20 institutions in the country, with physiotherapist managers. In view of the theoretical and practical findings, a maturity model for physiotherapy in intensive care was formulated, which allows the diagnosis of services that add value and guide the management of health operations, enabling the manager to have a broader and more comprehensive understanding of the performance of his/her unit, thus identifying areas for improvement and driving the growth of physiotherapy in intensive care. To date, 34 institutions from different regions of the country have used the tool, which has proven to be intuitive and easy to use, generating a sense of belonging, autonomy and understanding of the importance of resource adequacy and good management of a physiotherapy service. The first respondents point out that the most immature dimension of the institutions is technology and the most mature is the process dimension. The maturity model serves as a basis for the beginning of a debate on maturity models in value management in intensive care physiotherapy, but also in healthcare in general, allowing for future theoretical developments of this study, as well as management, training and team development projects.