Abstract
This study aims to show the methodology of implementation of the Skills Laboratories (Re-AbilityLab) at the Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo. These Skill Labs offer activities to maximize patient performance by promoting specific functional outcomes, which are described in the International Classification of Functionality. The activities are dynamic and carried out by a multidisciplinary team in the areas of health, education, and management. Innovation and strategic aspects of the knowledge economy are structured in the management of this project to enhance the achievement of purposes and results. The implementation process includes solutions adopted, definition of responsibilities, difficulties faced, benefits, functionality of the methods applied, and lessons learned. Mapping the process from the current scenario to the desired contributes to the transition from a care model (linear, refractory, obsolete) to an exponential model of care (intangibles, incremental innovation).
TopIntroduction
The Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo is part of the Lucy Montoro Rehabilitation Network, which was created by the Government of the State of São Paulo, by decree 52,973, of 2008, regulated by Decree 55,739 of 2010 and amended by Decree 58,050 of 2012. The Lucy Montoro Rehabilitation Network aims to provide the best and most advanced rehabilitation treatment for patients with disabling, motor and sensory-motor disabilities. The Network carries out specific rehabilitation programs, according to the characteristics of each patient. The treatments are carried out by a multidisciplinary team in the health area, including physical doctors, nurses, physiotherapists, nutritionists, psychologists, occupational therapists, social workers, physical educators, specific speech therapistsin theareaof management. Currently the Lucy Montoro Network has 6 units in operation, in the State of São Paulo. In addition to internationally promoting the Hospital das Clínicas (HC) brand and the increase in networking between the various actors of the state and municipal health value chain, and its integration into reference and counter-reference networks, which induce the robustness of the business and scientific fabric.
This article presents the implementation of the Skills Laboratories - Re-AbilityLab, focused on specific functional results, and the activities are correlated with the International Classification of Functionality - ICF, where the dynamics of knowledge requires the multidisciplinary team to develop conducts that contemplate creative exchanges between different specialties and areas of knowledge, horizontality of powers, co-responsibilities and self-organization.
These LABs aim to integrate activities through development trails and strengthen the rehabilitation process, valuing and expanding the functional capacity and autonomy of patients, to consolidate therapeutic objectives of patients in the units of the Lucy Montoro Rehabilitation Network. In addition, it describes the implementation process, solutions adopted, attributions and activities developed, difficulties faced, lessons learned, results and benefits. In addition to demonstrating the functionality of the methodology and its strategic formulation (Figure I), structured in agile project management.
Figure 1. Stages of the Strategy Formulation
(elaborated by the authors) Thus, the re-abilitylab proposal is an approach centered on the individual's perception of its functioning in various areas of life, for example: physical, occupational, psychological and social aspects. In this context, it aims to help patients achieve better results, obtain functional independence, autonomy, improving and improving the post-rehabilitation process. It is possible, therefore, to consider part of the scope the modes of knowledge conversion, which aims at the transfer of knowledge and technologies produced by basic science research in new approaches of prevention, diagnosis and treatment to promote health.
In addition, the implanted post-rehabilitation service provide conditions for maintaining the physical and functional health status acquired in rehabilitation by patients. This prevents impairment of your motor and neurological capacity after therapy. Adaptability and technologies are considered the vital forces for this new model of generating health value. In view of this, innovation has added new features to day-to-day practice, to further improve service and make it advantageous for patients. Moreover, the management of knowledge, the valorization of tacit knowledge and the methods for outsourcing knowledge become focuses in the current scenario. The value of knowledge is not new, the novelty is the importance of knowledge as a decisive resource for organizations. Reiterating the statement stated by Davenport and Prusak (1998, p.6) “knowledge is produced in working minds”. So much so that it can be found in the processes, practices and documentation of organizations. The role of knowledge management is to create means to transport, transfer, market or store knowledge. For both Earth (2000, p. 70) notes that:
Knowledge Management is thus intrinsically linked to the ability of companies to use and combine the various sources and types of organizational knowledge to develop specific skills and innovative capacity, which are permanently translated into new products, processes, management systems and market leadership.
Key Terms in this Chapter
Project Methodology: It is the path that will be followed throughout the project execution, the planning implementation of what needs to be executed and in what order.
Disability: Is a comprehensive term for deficiency, activity limitations and participation restrictions. It denotes aspects of the interaction between an individual (with a health conditions) and the contextual factors of that individual (environmental and personal factors).
Agile Project Management: It is a light and minimal intervention approach to project management. That is, the project is all divided into smaller steps, called iteration, which usually last from 2 to 4 weeks and at the end of each step there is a reassessment of the project priorities.
Restrictions of Participation: Problems that an individual may face when engaging in life situations.
Multiprofessional Team: Formed by professionals from different areas. These professionals interrelate and promote a differentiated treatment, seeing the patient as a whole and providing a humanized care.
Rehabilitation: Rehabilitation is a process of consolidation of therapeutic objectives not characterizing an area of professional exclusivity, but rather a proposal of multiprofessional and interdisciplinary action, composed of a set of measures that help people with disabilities or about to acquire disabilities to have and maintain an ideal functionality (physical, sensory, intellectual, psychological and social) in the interaction with their environment, providing the tools they need to achieve independence and self-determination.
Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (IMREA HC FMUSP): Is an entity of the State government, whose objective is to serve people with physical, transient, or permanent disabilities, in need of rehabilitation care, developing their physical, psychological, social, professional and educational potential. IMREA integrates the academic structure of the Faculty of Medicine of USP through the Department of Legal Medicine, Medical Ethics, Social Medicine and Labor and also integrates the Lucy Montoro Rehabilitation Network, governed by Decree No. 55,739 of April 28, 2010.
Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP): Is a hospital complex located in the city of São Paulo and an autarchy of the government of the state of São Paulo, linked to the State Department of Health for administrative coordination purposes, associated with the Faculty of Medicine (FM) of the University of São Paulo (USP) for the purposes of teaching, research and provision of health actions and services for the community.
Functionality: Is a comprehensive term for body functions, body structures, activities and participation. It denotes the positive aspects of the interaction between an individual (with a health conditions) and the contextual factors of that individual (environmental and personal factors).
Deficiencies: Problems in the functions or structures of the body as a significant impairment or loss.
Lucy Montoro Rehabilitation Network: Is a health center for the care of people with physical disabilities or potentially disabling diseases. It was created in 2008 by the Government of the State of São Paulo, through the Departments of Health and The Rights of Persons with Disabilities, and launched by Decree 52.973/08. Its name is a tribute to the former first lady of the state of São Paulo Lucy Montoro, who has done numerous social works at the head of the Social Solidarity Fund of the State of São Paulo - FUSSESP.
Activity: The execution of a task or action by an individual.
Participation In: Involvement in situations of daily life.
Activity Limitations: Difficulties that an individual may encounter in performing activities.
Body Functions: The physiological functions of body systems (including psychological and social functions – bio-psycho-social model).
ICF: International Classification of Functionality, Disability and Health, known as ICF, has as general objective to provide a unified and standardized language as a system of description of health and health-related states.