Healthcare compliance: pioneer experience in a public hospital.

Abstract

INTRODUCTION The judicialization of health is an irreversible reality not only for professionals, but also for public or private institutions, with an exponential increase in actions against public entities, hospitals, and professionals. Such actions can result in indemnification for alleged malpractice, accountability for various illegal acts, in addition to requiring the right to treatments, hospitalizations, and surgeries. The Brazilian National Council of Justice published a report showing a 130% increase in cases involving health-related aspects between 2008 and 2017, compared to a 50% increase in cases in general1. A detailed analysis identified that medications, orthotics, prostheses and auxiliary means, examinations, procedures, and hospitalization beds are the main causes related to the search for judicial guardianship. On the contrary, actions with allegations of medical error represented a higher number than the demands for transplants, for example. Another very sensitive subject is hospital mortality related to the occurrence of preventable adverse events. In a survey by the Institute for Supplementary Health Studies, it was demonstrated that mortality from this cause could be prevented in almost 40% of cases. In addition, the prevention of serious adverse events could provide fence one million beds for hospitalizations for other causes every year2. In addition to the direct and indirect damages caused to patients and families, there is undeniable and enormous financial damage, with the consequent misuse of resources that could be used in the treatment of other patients. Some of the possible causes of this situation may be the lack of hierarchical definitions, tolerance for individualistic measures and practices, poverty in available information, and fear of punishment. Adjunct to these aspects, conducts known to be unethical or even illegal can be taken in professional practice, which should not be seen as mere individual inappropriate conduct, but as systemic problems in hospital institutions3. In this scenario, it is evident that measures need to be adopted to try to prevent or reduce harm, such as the establishment of a non-punitive culture of care security, so that failures are seen as real opportunities for improvement, and the training of health professionals to know and use measures to prevent these failures. It is essential to make professionals aware of the consequences of harmful attitudes, even when they are routine and apparently harmless. As a result, it is urgent to implement a compliance culture in health practices.