Managing strategic change in healthcare in Brazil: a model to begin the implementation of customer-oriented quality strategies

Abstract

Pressed by a more demanding clients and by higher performance standards established by the Health Department, healthcare organizations in Brazil, especially hospitals, are implementing customer-oriented quality improvement strategies. However, results are well below expectations. This paper presents a model to help guide healthcare organizations throughout the critical buy-in stage of such strategies' implementation. The model emphasizes an ad hoc structure to manage more effectively the changes involved, and a healthcare-specific performance measurement system to drive the implementation process and to align the actions taken. After presenting the research's theoretical basis and methods (quantitative and qualitative), the paper summarizes the pertinent findings of the initial study, namely a survey of 21 leading hospitals. Next, the paper explains the model¿s development, describes its successful pilot test at the hospital of a leading healthcare organization, and presents the most relevant results. It also highlights some context-specific and culturally significant details of the method¿s application.