Absenteeism in the Scope of Secondary Care in the Center-South Health Region: Monitoring Strategies, Qualified Communication and Agenda Management

Abstract

Introduction: Secondary Ambulatory Care (AASE) incorporates specialized actions and services of intermediate technological density between primary and tertiary care. This level of care contains specialized services, diagnostic and therapeutic support, in addition to acting as an assistance reference and consultant for Primary Health Care (DISTRITO FEDERAL, 2018). With Ordinance No. 773, of July 19, 2018, the structure of the AASE in the Federal District began to encompass: one board (DIRASE) per health region, linked to the superintendence, comprising the Planning, Monitoring and Evaluation Management with two centers ; and the Management of Secondary Care Services (GSAS), quantified according to the existing outpatient services in each region. Among the main attributions of the GSAS is the responsibility of issuing a monthly report with the absenteeism rate and evaluating the adequacy of referrals from the PHC, based on current flows and protocols. Objectives: The general objective consisted in the implementation of an integrated work process with a view to minimizing the absenteeism rate at the Policlínica do Guará, a service linked to the DIRASE of the Centro-South Health Region and managed by GSAS 2. Method: This is a an experience report on the application of the problematization methodology, based on the Arch of Charles Maguerez, in the practice scenario of the Residency Program in Public Policy Management for Health at ESCS/SES/DF. For the construction of this project, the five stages of the Arch were included: observation of reality; key points; theorizing; hypotheses of solution and application to reality. Results: The reality observed during the practice scenario of the Resident Health Professional at GSAS 2 was based on the challenge of monitoring and evaluating the quality of access to services, in view of the fragility of the instruments that measure their absenteeism. To solve such weaknesses, the implementation of an integrated spreadsheet between the sectors was proposed; ordering the workforce and professional scales; appointment rescheduling flow renegotiations; and monitoring of the absenteeism data produced. Based on the use of the Google DataStudio tool, a panel was constructed that included: the dimensioning of the workforce, professional leaves, scales and absenteeism rate for each specialty. With the visits to the head of the Enrollment, Appointment Scheduling and Patient Records (NMCP) department, the objective was to agree on an integrated work process between the sectors. However, it was necessary to readjust the implementation of the joint worksheet for the agreement to send the data produced by the nucleus to the GSAS 2 monthly. Conclusion: In accordance with Da Costa, Duarte and Vaghetti (2018), a determining factor for the excess of absences at consultations is the long wait or return time for a new query. To this end, it was necessary to introduce monitoring tools that would allow for the prior correction of the problems identified, and that after implementation would produce effects to reduce the absenteeism rate, especially in the context of reality for which this project is intended.