Desafios na institucionalização de controles internos da gestão em um hospital universitário federal

• Autor(a) principal: Fernandes, Carmen Ozores
• Data de Publicação: 2018
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/10856
• topic: Internal control; Institutional theory; HealthCare management; University Hospital; Brazilian Healthcare Public System; Controles internos; Teorias institucionais; Gestão de serviços de saúde; Hospital Universitário Federal; SUS; Ebserh; HUCAM; COSO; Administração Pública; 35

Public management faces a challenge on stablishing an environment favorable to implementation of internal controls within the organization, that´s the core context of this research, by using methods of qualitative analysis, aimed to investigate how had been the implementing of control activities in an university hospital, in the Brazilian State of Espírito Santo, and to answer the research question: “Which are the difficulties on institutionalization of internal controls in the public healthcare field?”. This study had taken place at the University Hospital Cassiano Antonio Moraes (HUCAM), by using techniques of field research, through interviews a group of Hospital public administrators and professionals. Analysis scope is the period of 5 (five) years, from 2013 to 2018, that was a moment of management transition, following the contract signed between Federal University of Espírito Santo (UFES) and the Public Company Empresa Brasileira de Serviços Hospitalares (Ebserh). The objective of this research is to investigate challenge on implementation of internal controls, under perspective of those who participated on that process, based on institutional theories, and on a conceptual basis regarding internal control, represented by COSO document, and regulations issued by Brazilian federal control organizations, such as CGU and TCU. The study aimed to understand the obstacles faced, as well as enablers to adoption of practices of control in HUCAM, which actions is part of 2014 Strategic Plan. The presented result is a diagnostic of current stage of institutionalization process of internal control in essential areas of the Hospital, contributing to a subsidy to management in order to promote adoption of internal control good practices. Interpretation results indicates different approaches that may be required to the stakeholders, depending on the stage of institutionalization process. It was taken a Picture of which aspects contributes to institutionalization of practices of control, where it was discussed elements considered by the interviewers as process enablers and which roadblocks they need to transpose, on this context it was discussed conscious adoption versus enforcement by coercive means. Within the studied situations it was possible verify the process is going through a phase called objectification, in which positive results made easy people to accept the changes, and a sedimentation phase, that´s what is desired. Finally, the results lead to a reflection about institutionalization as a continuous process, that can promote a favorable environment, where individuals are able to review the internal control framework, and to keep activities adjusted to the strategy and to main risks, also considering all the particularities of several professional fields that act as institutional agents in an education hospital. Those results can be a subsidy to public administrators on planning future actions to stimulate the adoption of good practices of internal controls.