Analysis of the implementation of an Integrated Responsibility Unit to obesity treatment in Portuguese SNS

Abstract

Introduction: In 2018, the largest hospital in the North of Portugal, Centro Hospitalar Universitário de São João (CHUSJ), faced a high waiting time for outpatient clinic and surgery of obese patients, creating the need to innovate and redesign the way hospitals were organized to better respond to patients. For that reason, in 2019, a new model of healthcare delivery, Integrated Responsibility Units (IRU), with larger autonomy, patients centred, and pay-for-performance was introduced in CHUSJ. Methods: To analyse the results of IRU a retrospective study was designed, comparing the triennium 2016 to 2018, when obesity treatment was incorporated into the General Surgery Department, to the triennium 2019 to 2021, as an Integrated Responsibility Unit. The areas of study were access, production, efficiency, quality, and economic-financial performance. Additionally, to obtain the view of IRU's professionals was performed a survey to determine the evolution of motivation, satisfaction and how the model can be improved in the future. Results: Access to obesity treatment increased over the triennium of implementation of the IRU. A reduction of 66 % in the waiting time for appointments and 34 % for surgery, was observed. In terms of production, stands out a 127 % increase in the number of appointments and 29 % in surgeries. On the financial side, there was a reduction of 83 % in the losses between trienniums. IRU health workers had an increase of 33 % in motivation to a rate of 84%. Conclusion: The constrain in access and lack of efficiency existed in 2018. The IRU model surpassed the objectives proposed. Controlling access, efficiency, improving quality and financial balance. Concurrently, the motivation of health professionals increased. It was demonstrated that Integrated Responsibility Units have the potential to revolutionize medical services with constraints and increase focus on the patient.