TECHNOLOGY FOR SAFE CARE IN CATASTROPHIC SITUATIONS: PROTOTYPE MEDIATED BY SOFT DESIGN SCIENCE RESEARCH

TECNOLOGIA PARA SEGURIDAD DEL CUIDADO EN SITUACIONES CATASTRÓFICAS: PROTOTIPO MEDIADO POR LA SOFT DESIGN SCIENCE RESEARCH

ABSTRACT

Objective:

to produce technology that promotes safe hospital care in catastrophic situations.

Method:

an applied study carried out in a public hospital located in Brazil's Midwest region, between September 2020 and August 2021, using Soft Design Science Research in seven stages: outlining the problem, with descriptive analysis of hospital indicators; explaining the problem as a specific set of requirements, through the application of scales with 108 health professionals and 75 nursing staff, and descriptive and inferential analysis; generalizing the problem, through a scope review to systematize a class of problems; structuring the components of the solution through a workshop guided by design thinking; comparing the specific problem and general requirements to align the solution; defining the solution; building the solution.

Results:

immersion in the problem revealed outcomes that heralded the worsening of patients' health conditions and the negative perception of workers and managers regarding the safety climate in catastrophic situations, accentuated by the nursing team's dissatisfaction with the support offered by the organization. The projection of this scenario was essential for the systematization of security-enhancing solutions already produced for this purpose, and for carrying out design-oriented experiments in alignment, structuring, prototyping and iteration of the prototype built.

Conclusion:

a Rapid Response Team has been set up which, in catastrophic situations, makes it possible to intervene when the patient's clinical condition worsens, which helps to increase the survival rate and promotes safety.

DESCRIPTORS:
Hospital management; Health technologies; Technological innovation; Patient safety; Diffusion of innovations; Hospital rapid response team; Natural disasters; Technological development and innovation projects

RESUMEN

Objetivo:

producir tecnología que promueva la seguridad del cuidado en la atención hospitalaria en situaciones catastróficas.

Método:

investigación aplicada realizada en un hospital público ubicado en la región Centro-Oeste de Brasil, entre los meses de septiembre de 2020 y agosto de 2021, mediante la aplicación de la Soft Design Science Research, en siete etapas: perfilamiento del problema, con análisis descriptivo de indicadores hospitalarios; explicación del problema como un conjunto específico de requisitos, mediante la aplicación de escalas con 108 profesionales de la salud y 75 profesionales de enfermería, y análisis descriptivo e inferencial; generalización del problema, mediante revisión de alcance para sistematizar una clase de problemas; estructuración de los componentes de la solución a través de un taller guiado por el design thinking; comparación entre el problema específico y los requisitos generales para alinear la solución; definición de la solución; construcción de la solución.

Resultados:

la inmersión en el problema reveló resultados que anuncian el empeoramiento de las condiciones de salud de los pacientes y la percepción negativa de trabajadores y gestores sobre el clima de seguridad en situaciones catastróficas, acentuada por la insatisfacción del equipo de enfermería con el soporte ofrecido por la organización. La proyección de este escenario fue fundamental para sistematizar las soluciones que potencien la seguridad, ya producidas para este fin, y para realizar experimentos orientados al diseño, alineación, estructuración, prototipado e iteración del prototipo construido.

Conclusión:

se formó un Equipo de Respuesta Rápida que, en situaciones catastróficas, permite intervenir ante el empeoramiento de las condiciones clínicas del paciente, lo que favorece el aumento de la tasa de supervivencia y brinda seguridad.

DESCRIPTORES:
Gestión hospitalaria; Tecnologías sanitarias; Innovaciones tecnológicas; Seguridad del paciente; Difusión de innovaciones; Equipo de respuesta rápida hospitalaria; Catástrofes naturales; Proyectos de desarrollo tecnológico e innovación

RESUMO

Objetivo:

produzir tecnologia propulsora de segurança do cuidado na atenção hospitalar em situações catastróficas.

Método:

pesquisa de natureza aplicada realizada em um hospital público situado na região centro-oeste, Brasil, entre os meses de setembro de 2020 a agosto de 2021, por meio da aplicação da Soft Design Science Research, em sete etapas: delineamento do problema, com análise descritiva de indicadores hospitalares; explicitação do problema como um conjunto específico de requisitos, mediante aplicação de escalas com 108 profissionais de saúde e 75 de enfermagem, e análise descritiva e inferencial; generalização do problema, através de revisão de escopo para sistematização de uma classe de problemas; estruturação dos componentes da solução por meio de workshop orientado pelo design thinking; comparação entre o problema específico e requisitos gerais para alinhamento da solução; definição da solução; construção da solução.

Resultados:

a imersão no problema evidenciou desfechos que anunciam o agravamento da condição de saúde dos pacientes e percepção negativa de trabalhadores e gestores em relação ao clima de segurança em situações catastróficas, acentuado pela insatisfação da equipe de enfermagem com o suporte oferecido pela organização. A projeção deste cenário foi essencial para sistematização de soluções potencializadoras de segurança já produzidas com esta finalidade, e para a realização de experimentações orientadas pelo design, em alinhamento, estruturação, prototipagem e iteração do protótipo construído.

Conclusão:

produziu-se um Time de Resposta Rápida que, em situações catastróficas, permite intervir frente ao agravamento de condições clínicas do paciente, o que favorece a ampliação da taxa de sobrevida e é propulsor de segurança.

DESCRITORES:
Gestão hospitalar; Tecnologias em saúde; Inovações tecnológicas; Segurança do paciente; Difusão de inovações; Equipe de respostas rápidas de hospitais; Catástrofes naturais; Projetos de desenvolvimento tecnológico e inovação

INTRODUCTION

The notion of quality in health, given its complex, polysemic and multifaceted nature, requires, among other things, efficacy, effectiveness and optimization of processes, with equity and safety in the actions undertaken. It is in this context that safe care becomes a fundamental part of quality, since there is no way to provide safe care without quality care1.

In view of this, strategies have been applied that aim to standardize processes, by recognizing risks in order to plan care with a focus on mitigating errors, guidelines based on the best evidence, and management actions that foster a safety culture in the professional practice context2^-3, and it is important to engage and commit the stakeholders, i.e. the artifact's users - the management, the professionals and the patients' help - in the production of care for this purpose3^-4.

However, in catastrophic situations, such as the COVID-19 pandemic, there is a context of overload in the health system, with a shortage of hospital beds, protective equipment and medical-hospital technologies5^-6, as well as a sudden increase in demand, with a consequent work overload for professionals7. This overload makes health professionals more likely to make mistakes in their care processes, such as medication errors and inadequate treatment administration8, compromising the safety climate9 and the quality of care10.

Furthermore, in disaster situations, the conditions of uncertainty in the decision-making process of health managers increase, culminating in serious threats to the balance of systems11. It is imperative to reorient care practices, adopting specific measures to ensure effective care and maintain safety and quality12, while reducing risks.

In the midst of so many obstacles, which contribute to the growing number of adverse events, the effective management of hospital care in catastrophic situations, in order to control aggravations and guarantee the minimum possible risk in clinical procedures, is crucial. It is therefore important to create and develop micro-management technologies with a view to boosting the quality and safety of care, in order to add value to assistance, and, consequently, contribute to the advancement of practices in health services. There is therefore an urgent need to develop studies that, in addition to pure, traditional scientific approaches, are conducive to practical applicability in solving problems in real contexts in healthcare organizations.

Design Science, a science that aims to design innovative solutions with a view to developing new technologies to solve problems13, is a promising approach to this goal and one that allows us to minimize the gap between research undertaken in the academic sphere and practice in healthcare organizations. This justifies the development of a study with this scope, since the adoption of measures to enhance quality and safety in hospital care makes it possible to improve health guidelines and actions, which can be effectively managed, depending on the solutions adopted14.

Considering that catastrophic events have been a reality in the context of the contemporary health sector, and that there is a need to concretely transpose the principles of safe care into hospital practice, the production of technological innovations towards safer care tends to be valuable. Thus, it is postulated that scientific studies that enable feasible technologies to be applied in hospital care tend to contribute objectively to the problem stated, which favors the advancement of practices and science in health and nursing.

Based on these premises, the question arises: what technologies that promote safety in hospital care can be produced through Design Science for use in disaster situations? To this end, the aim of this study is to produce technology that promotes safety in hospital care in catastrophic situations.

METHOD

This is an applied study, anchored in the methodological framework of Soft Design Science Research (SDSR)15, an approach based on exploring real problems in organizations and systematically finding the most appropriate solutions for their context, with a view to proposing technological innovations13.

The Design Science Research methodology seeks to identify solutions to new problems or to present innovative and more efficient solutions to problems that have already been solved through the creation of an artifact and the systematization of the process that accompanies this creation16.

The Soft Design Science Research methodology brings together concepts from two different approaches, Design Science Research (DSR) and Soft System Methodology (SSM)15. Both are based on understanding and reasoning about the problem, guided by design, with the aim of producing technological artifacts that are relevant to the context experienced13.

Therefore, for the purposes of this study, artifacts are considered to be artificial or natural objects structured from the organization of internal environment components to achieve objectives in a given external environmen13.

The study was carried out in a medium-sized federal public university hospital, located in a municipality in Brazil's Midwest region, from September 2020 to August 2021. In operationalizing its stages, the SDSR (Figure 1) takes into account the various contextual aspects involved in experimenting with design techniques and tools, with a view to developing, instantiating, evaluating and iterating a technological artifact15.

Figure 1 -
Soft Design Science Research operationalization stages.

Stage 1 consisted of outlining the specific problem, at which point an analysis was made of the real situation in the hospital context under investigation, in recognition of an existing problem15. To this end, we analyzed indicators related to the safety of care in hospital care, with the intention of comparing the pre-pandemic period with the pandemic context that was experienced in the period studied, through notifications and indicators for the period from July 2019 to August 2020, excluding notifications and incomplete data. This data was organized in a Microsoft Excel® spreadsheet and analyzed using basic statistics.

In stage 2, in order to make the problem more explicit, we sought to detail it in the form of a set of requirements15. To this end, an immersion in the investigated context was carried out, in order to take ownership of the problem in the investigative scenario and clarify it. The validated scales Safety Attitude Questionnaire (SAQ) and Nursing Work Index- Revised (NWI-R) were used to assess the patient safety culture in the study setting and the professional practice environment. The sample consisted of a total of 108 health professionals who responded to the SAQ and 75 nursing professionals who responded to the NWI-R. Participants included professionals who had experienced caring for patients with covid-19, regardless of their relationship with the institution, and excluded those who were on leave of any kind.

Participants filled in the structured instrument in the Survey Monkey software, via a link sent through the WhatsApp messaging application. The data was stored in an Excel® spreadsheet, processed in the Statistical Package for Social Science (SPSS), version 21.0, and variables were analyzed using descriptive measures of centrality and dispersion, and comparison tests.

In stage 3, with reasoning oriented towards design experimentation, we sought to generalize the specific problem into a general problem by identifying a class of problems that guided the research in search of better solutions. To this end, a scoping review was carried out in which the measures that enhance the safety of hospital care in epidemic and pandemic contexts were systematized, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), and the PCC strategy (P: population; C: concept; and C: context)17.

The National Library of Medicine (MEDLINE/PubMed), Current Nursing and Allied Health Literature (CINAHL), EMBASE and Web of Science (WOS) databases were consulted during the month of October 2020, using controlled descriptors [Health Science Descriptors (DeCS), Medical Subject Headings (MeSH) and CINAHL Headings] and non-controlled descriptors (keywords) according to the PCC strategy and combinations, according to Boolean operators: “inpatient” OR “hospitalization”; “patient safety”; “pandemics” OR “epidemics” OR “disease, endemic”. Primary studies published in English, Spanish and Portuguese from the year 2000 onwards were included, and articles that did not meet the scope of the review, duplicated or unavailable were excluded.

After identifying the studies, the titles and abstracts were read and then, for inclusion, they were read in full by two independent reviewers. The articles were entered into Microsoft Excel® spreadsheets, designated by the key information in each article, and then the results were grouped and summarized. The analysis systematized the safety-enhancing measures in the care of hospitalized patients in catastrophic situations that already exist and their gaps, with the aim of inducing the necessary requirements for a solution.

Thus, in stage 4, still defining the general problem requirements, an initial attempt was made to systematize the general solution components, in descriptive terms, by communicating and co-producing information related to detailing the main aspects of the technological artifact itself15. To this end, a co-creation workshop was held, guided by the design thinking lens, a human-centered approach that seeks to solve problems through solutions that rely on empathy, collaboration, experimentation and making thoughts and processes tangible, in three phases consisting of inspiration, ideation and prototyping, from exploring the problem to validating the prototype, in an interactive process of trial and error18.

Each phase was carried out in a specific session, in three shifts and on consecutive days, according to the activities shown in Figure 2. Health professionals linked to the hospital's Patient Safety Center were included in this stage, with the exception of those who were away during the period.

Figure 2 -
Operationalization of the co-creation workshop guided by design thinking.

The workshop also served as a basis for the subsequent stages. In step 5 of the SDSR, a comparison was made between steps 4 and 2, i.e. between the requirements of the general problem and the explicitness of the specific problem, so that a specific solution or declarative logic of the solution to be designed could be arrived at. In stage 6, where the definition of a specific solution was sought, the general requirements were stated based on the definition in stage 4, which supported the prototyping of the solution (stage 7) best suited to the reality under study15.

The study was part of the matrix project entitled “Artifacts for implementing clinical management in a university hospital”, duly approved by the Research Ethics Committee (CEP). In accordance with the ethical and legal precepts regarding research with human beings, separate Free and Informed Consent Forms (FICF) were used at all stages of the research, in accordance with Resolution 466/12.

RESULTS

Given the complexity involved in operationalizing the SDSR, the object of this study, the results will be presented according to the stages described in the method, from identifying and outlining the problem to prototyping the technology built. Table 1 summarizes these findings, according to the objectives of each stage and the respective products in each output.

By analyzing the data and the research objective, it is clear that the artifact must be designed to solve problems related to patient safety and quality of care, based on effective communication. Based on the data analysis, as well as the solutions identified during the steps taken, a prototype was created for a Rapid Response Team to promote patient safety in catastrophic situations in hospital care (Table 2).

Table 1 -
Summary of the results produced at each stage of the method. Center-West region, Brazil, 2021.

Soft Design Science Research stages		Proposed stage	Results achieved
1	Specific problem	Identify and outline the specific problem.	The hospital care quality and safety, in the context of a pandemic, is compromised, worsening the health condition of patients, with an increase in the number of cases of pressure injuries, mortality and the occurrence of never events.
2	Explaining the problem	Develop understanding from different perspectives of the problem, for a basis for discussion.	The health professionals were satisfied at work and the professional practice environment was favorable. However, professionals' perception of patient safety issues is low.
3	General problem	Mapping solutions that favor safe care in epidemic and pandemic contexts.	Artifacts were identified: constructs (protocols); models (waste management plan); methods (teleservice) and instantiations (checklist for verification and precautions for infected patients).
4	General problem requirements	Search for general solution components and determine the normative issues involved in the construction and application of the artifact.	The prototyped artifact, in the logic of the stakeholders, should: Reduce the risk of nosocomial infection and cross-infection; Organize and systematize procedures and teamwork; Promoting the safety of those involved in care (patients and professionals); Minimize the traffic of people in hospital corridors; Providing safe, quality and timely care in emergency situations; Optimize the response time when implementing actions to deal with a crisis situation; Demand training for professionals; Organizing care flows and protocols; Promote effective communication between the multi-professional team; Reducing errors in patient care; Providing safety when carrying out procedures.
5	Comparison between steps 4 and 2	Explain the requirements of the general problem and the specific problem in order to arrive at a specific solution or declarative logic for the artifact to be designed.	The artifact to be designed must solve: Problems with interprofessional relationships; Low perception of patient safety culture; Communication failures; A shortage of qualified professionals; Improve/increase management participation in patient safety actions.
6	Search for a specific solution	Analyze the data to help design an artifact that solves the problem encountered.	Analytical projection of the proposed artifact: Rapid Response Team.
7	Building the solution	Prototyping a Rapid Response Team for safe hospital care in disaster situations.	Artifact prototype: Rapid Response Team.

Table 2 -
Presentation of the Rapid Response Team artifact. Center-West region, Brazil, 2021.

Artifact: Rapid Response Team (RRT) Safety of hospital care in disaster situations
Objective: to promote safe hospital care in catastrophic situations.
Potential	Justifications based on the results of each Soft Design Science Research stage
It provides safe and specialized care for patients with health conditions at risk.	In pandemic situations, there are failures in care that can cause damage to the patient's health, such as the increase in cases of pressure injuries and the notification of never events. Allocation of inexperienced professionals to the job market and lack of training. A favorable environment for professional nursing practices enhances actions that promote quality and safety in patient care.
It lowers the hospital mortality rate and reduces admissions to the Intensive Care Unit (ICU) due to worsening clinical conditions.	The increase in the demand for critically ill patients on mechanical ventilation and who possibly evolve into Cardiorespiratory Arrest (CRA) is related to the increase in mortality during this period. The implementation of a Rapid Response Team leads to a reduction in hospital mortality.
It contributes to building a culture of safety in the hospital.	Health professionals' perception of the patient safety climate at the site investigated was low. The implementation of a Rapid Response Team can contribute to the implementation of a culture of safe care in the hospital environment.
It optimizes care for critically ill patients in epidemic, pandemic and disaster situations, where ICU beds are scarce.	It was found that one of the main objectives of contingency plans is to optimize ICU beds. The implementation of Rapid Response Team favors the intervention of care at times when the patient's condition is compromised, leading to an improvement in the clinical picture and a reduction in the length of stay in the hospital unit.
STAKEHOLDERS
Strategic actors involved	Justifications based on the results of each Soft Design Science Research stage
Senior management and other hospital managers	The evaluation of the safety culture by the professionals at the hospital investigated identified that one of the items with the lowest score was the management perception. The way in which management is carried out implies the construction or fragility of a safety culture in the hospital environment, since it requires participatory movements.
Raising awareness in the hospital community	Employee engagement makes them feel part of the process and they act in a way that is committed to institutional results, seeking changes/implementations in a proactive way and close to management. The activation of Rapid Response Team by patients and/or their companions can provide better care for patients whose clinical condition deteriorates on the wards.
Patient Safety Center (NSP)	According to RDC nº 36/201319, the Patient Safety Center is the organization within the hospital whose purpose is to monitor the actions implemented in order to promote patient safety. During the artifact co-creation workshop, the Patient Safety Center of the hospital under investigation presented situations in which patient safety is put at risk, as shown in the conceptual map.
The hospital's teaching and research department and people development department.	Articulation between the university hospital and the University, and the people development sector to promote the development of the hospital's professionals through training. The participation of these sectors in the implementation of the RRT is extremely important, since the entire hospital community must be aware of the team's activities and must be trained so that it can be activated in a timely manner. Several studies have presented the training of health professionals as a potential measure for patient safety.
COMPOSITION AND OPERATION
Criteria	Justifications based on the results of each Soft Design Science Research stage
A multi-professional team, with at least one (1) specialist intensivist from each professional category (nurse, physician and physiotherapist).	The composition of Rapid Response Team by intensive care professionals (nurses, physicians and physiotherapists) leads to better results and/or outcomes.
7 days a week, 24 hours a day, in all three shifts.	To guarantee comprehensive, quality care for all patients.
Simulation-based Rapid Response Team training.	Training based on in situ simulation is important for identifying and mitigating latent risks and defects in the hospital's emergency response system.
Carrying out various simulated scenarios.	Testing possibilities of care, organizing the care flow, training the Rapid Response Team and the care team. Improve the way the Rapid Response Team operates. The scoping review found several studies using simulation as a training strategy for implementing protocols, testing workflows and training teams.
Drafting and implementing an institutional protocol for activating the Rapid Response Team.	In order to improve communication between the care team and the Rapid Response Team, as well as the implementation of scales and Rapid Response Team activation devices, so that care is timely and of high quality. In the scoping review carried out to map out the measures to improve patient safety in epidemic/pandemic situations, one of the measures was the implementation of protocols for the Rapid Response Team care/operation, in order to better organize the hospital's actions.
Training for the entire hospital community.	Early recognition of patient signs of worsening and correct activation of the Rapid Response Team, and training of personnel to carry out the activation properly.
Developing communication strategies between Rapid Response Team members and teams.	Implementing effective communication strategies between healthcare professionals is important for improving patient safety and the quality of care.
Working together with IT and Infrastructure to devise ways of activating the Rapid Response Team.	The triggering mechanism is one of the criteria to be implemented well, as it must be easily accessible and known to all the players in the hospital context. The use of tools that can help care teams to identify patients at risk quickly facilitates the response of the Rapid Response Team and enables timely, safe and quality care to be provided to hospitalized patients.
Use a scale for physiological assessment and early detection of physiological changes and clinical deterioration in non-critical patients.	The physiological scoring scale is an important tool for measuring the risk of clinical deterioration in adult patients hospitalized in a ward. Its assessment consists of vital signs parameters that result in different scores, such as the Early Warning Score and its modified version.
Implement indicators to monitor and evaluate the effectiveness of the Rapid Response Team work.	Important for evaluating the benefits and effectiveness of implementing a Rapid Response Team.

DISCUSSION

This study, based on the methodological framework of Soft Design Science Research, which guides research aimed at solving problems, prototyped the Rapid Response Team (RRT) as a solution for safety and quality in hospital care in critical health situations, such as epidemics and pandemics, where safety protocols may be threatened due to the situation of chaos and insecurity8. There is evidence that the implementation of an RRT in the hospital contributes to a higher survival rate20 and favors the intervention of care at times when the patient's condition is compromised, leading to an improvement in the clinical condition and a reduction in the length of stay in hospital20^-21.

Safety and quality of care are fundamental elements in the principles of clinical management, the organizational model used as a theoretical reference in this study, which through the structuring and inseparable elements “management-assistance-education”, aims to promote quality improvements for safe, humanized, continuous and individual-centered health care22^,23. In the light of clinical management, safe, quality care is achieved when there is a reduction in the inherent risks and resulting damage to health professionals, patients and their families, requiring the involvement of all these actors involved in the care production, in order to ensure continuous care, based on the sharing of information and power, continuous surveillance and horizontal follow-up of each case23^-24.

By triangulating the study data, it is clear that the artifact designed is a driver of safety and quality in the care provided, based on effective communication. In this sense, the RRT implementation is considered a favorable strategy for mitigating errors in patient care, allowing for safety in emergency procedures, as well as the safety of the team involved25^-27.

On the international scene, other studies have developed proposals for care teams along the same lines as the RRT: the Rapid Response Team for emergencies occurring in emergency surgeries during the covid-19 pandemic27; the Central Venous Access Teams implemented during the covid-19 pandemic in China25 and the United States26.The artifact proposed here aims to guarantee patient safety by providing quality care, carried out by qualified and trained professionals for this purpose.

The environmental contingencies found in this study showed that the pandemic situation can cause failures in care, problems in communication between health teams and management, and work overload for health teams. These facts corroborate the literature, which points to the inclusion of inexperienced professionals in the job market, the lack of training10, work overload and the insufficient number of professionals28^-29 as challenges to safety and quality in health and as potential factors for care failures.

When evaluating the internal and external context of the environment for which the artifact must be designed, the challenges related to patient safety become evident. The aim of a rapid response team is to deal with situations in which the patient's health is deteriorating, and that rapid, high-quality intervention by qualified professionals, where communication is carried out effectively, can guarantee patient safety in epidemic/pandemic situations, and even in day-to-day patient care20.

Experimentation in design is an inseparable part of the scientific construction process, as it allows ideas to be externalized in such a way that they can be absorbed and complemented by stakeholders the moment they are conceived. In this sense, it consists of a process of thinking and building together, which allows thoughts involved in the process of co-creation to be designed and communicated in a tangible way through prototypes that act as catalysts for innovation30.

Conducting the study in a pandemic context was a limitation, as it may have restricted the prototyping of solutions in other types of disasters. It should be noted that, although the Soft Design Science Research stages set out to design practice, their experimentation recorded reports on practice that may not accurately and in-depth reflect the way in which safe care is implemented in everyday hospital life, which is a limitation, but also a possibility to deepen the findings with other types of study on the same object.

It is also recognized as a limitation that the prototype needs improvements in its design and functionalities, and it is recommended that this artifact be iterated, through a validation study with judges and testing in practice in hospital care with professionals appointed to make up a committee responsible for RRT. In this improvement process, it is recommended that new elements be added to the prototype, such as its virtualization in its application process, and it is recommended that it be tested by means of simulation, with an evaluation of the impacts on the RRT's performance as a way of supporting its incorporation into hospital institutions, with a view to improving safety practices and care in catastrophic situations.

CONCLUSION

It is important and necessary to develop research that is relevant from an organizational point of view, guided by design experimentation and which preserves the rigor that is indispensable to any scientific research, in the light of robust interpretative references, as the Soft Design Science Research proposes. This study could therefore provide new hypotheses for further research to be carried out, with a view to identifying solutions that are relevant to the practice of health services and that will lead to advances in knowledge and the implementation of innovative technologies and practices.

The integration of data from various sources in the operationalization of the Soft Design Science Research stages, and through research that adopted deductive approaches, based on traditional research methodologies to explain the phenomenon under study; inductive, through design thinking experiments that allow us to glimpse the functionality of the solution; and abductive, which suggests how this solution might be; illustrate the potential of this research in the development of technologies and innovation for the advancement of hospital care practices.

Although the prototype has not been tested, it has been co-created by the professionals who will use it and has been evaluated by the managers of the hospital investigated in the iteration process, with a positive evaluation, which represents great potential for boosting safety in hospital care in disaster situations. It is suggested that future research be carried out so that the proposed prototype can be put into practice, tested and adapted to achieve the main objective, which is to guarantee safe, quality care in the hospital setting.

REFERENCES

• 1. Brás CPDC, Ferreira MMC, Figueiredo MDCABD, Duarte JC. Patient safety culture in nurses’ clinical practice. Rev Latino-Am Enfermagem [ Internet ]. 2023 [cited 2024 Jun 29 ];31:e3837. Available from: https://doi.org/10.1590/1518-8345.6231.3837
  » https://doi.org/10.1590/1518-8345.6231.3837
• 2. Santos EO, Takashi MH. Implantação dos protocolos de segurança do paciente em unidade de terapia intensiva- revisão integrativa. REVISA [ Internet ]. 2023 [cited 2024 Jun 29 ];12(2):260-76. Available from: https://rdcsa.emnuvens.com.br/revista/article/view/135
  » https://rdcsa.emnuvens.com.br/revista/article/view/135
• 3. Lemos GC, Mata LRF, Ribeiro HCTC, Menezes AC, Penha CS, Valadares RMC, et al. Cultura de segurança do paciente em três instituições hospitalares: perspectiva da equipe de enfermagem. Rev Baiana Enferm [ Internet ]. 2022 [cited 2024 Jun 29 ];36. Available from: https://periodicos.ufba.br/index.php/enfermagem/article/view/43393
  » https://periodicos.ufba.br/index.php/enfermagem/article/view/43393
• 4. Siqueira DS, Fayh E. A importância da enfermagem na segurança do paciente no setor de urgência e emergência: uma revisão integrativa. RECISATEC [ Internet ]. 2023 [cited 2024 Jun 29 ];3(7):e37299. Available from: https://recisatec.com.br/index.php/recisatec/article/view/299
  » https://recisatec.com.br/index.php/recisatec/article/view/299
• 5. Vranas KC, Golden SE, Mathews KS, Schutz A, Valley TS, Duggal A, et al. The influence of the COVID-19 pandemic on ICU organization, care processes, and frontline clinician experience a qualitative study. CHEST J [ Internet ]. 2021 [cited 2024 Jul 02 ];160(5):1714-28. Available from: https://doi.org/10.1016/j.chest.2021.05.041
  » https://doi.org/10.1016/j.chest.2021.05.041
• 6. Noronha KVMS, Guedes GR, Turra CM, Andrade MV, Botega L, Nogueira D, et al. Pandemia por COVID-19 no Brasil: análise da demanda e da oferta de leitos hospitalares e equipamentos de ventilação assistida segundo diferentes cenários. Cad Saúde Pública [ Internet ]. 2020 [cited 2024 Jun 30 ];36(6):e00115320. Available from: https://doi.org/10.1590/0102-311X00115320
  » https://doi.org/10.1590/0102-311X00115320
• 7. Turale S, Meechamnan C, Kunaviktikul W. Challenging times: Ethics, nursing and the COVID-19 pandemic. Internat Nurs Review [ Internet ]. 2020 [cited 2024 Jun 30 ];67(2):164-7. Available from: https://doi.org/10.1111/inr.12598.
• 8. Campos B, Mendes D, Anunciação G, Cavalcanti E. Relação da sobrecarga de trabalho da equipe de enfermagem na segurança dos pacientes. Contemporânea [ Internet ]. 2023 [cited 2024 Jun 30 ];3:19327-49. Available from: https://doi.org/10.56083/RCV3N10-145
  » https://doi.org/10.56083/RCV3N10-145
• 9. Costa CJN, D’Artibale EF, Duarte ERM, Ribeiro MRR, Martins ETJ, Ferreira GE. Clima de segurança em saúde no contexto de pandemia da covid-19 em um hospital universitário. Renome [ Internet ]. 2022 [cited 2024 Jun 30 ];10(2):47-56. Available from: https://doi.org/10.46551/rnm23173092202100206
  » https://doi.org/10.46551/rnm23173092202100206
• 10. Costa CJN, Martins ETJ, Ribeiro MRR, Ferreira GE. Qualidade e Segurança no Cuidado em Tempos de Covid-19: Comparação de Indicadores antes e durante a Pandemia. RAHIS [ Internet ]. 2022 [cited 2024 Jun 30 ];19(2):62-77. Available from: https://doi.org/10.21450/rahis.v19i2.6842
  » https://doi.org/10.21450/rahis.v19i2.6842
• 11. Satomi E, Souza PMR, Thomé BC, Reingenheim C, Werebe E, Troster EJ, et al. Alocação justa de recursos médicos escassos durante a pandemia de COVID-19: considerações éticas. Einstein [ Internet ]. 2020 [cited 2024 Jun 30 ];18:eAE5775. Available from: https://doi.org/10.31744/einstein_journal/2020AE5775
  » https://doi.org/10.31744/einstein_journal/2020AE5775
• 12. Barro K, Malone A, Mokede A, Chevance C. Gestion de l’épidémie de la COVID-19 par les établissements publics de santé - analyse de la Fédération hospitalière de France. J Chirurgie Viscérale [ Internet ]. 2020 [cited 2024 Jun 30 ];157(3):20-4. Available from: https://doi.org/10.1016/j.jchirv.2020.04.009
  » https://doi.org/10.1016/j.jchirv.2020.04.009
• 13. Dresch A, Lacerda DP, Antunes J, Valle JA. Design science research: método de pesquisa para avanço da ciência e tecnologia. Porto Alegre, RS(BR): Bookman Editora; 2015.
• 14. Kyhlstedt M, Andersson SW. Diagnostic and digital solutions to address the COVID-19 pandemic: The need for international collaboration to close the gap. Health Poy Technol [ Internet ]. 2020. [cited 2024 Jun 30 ];9(2):126-8. Available from: https://doi.org/10.1016/j.hlpt.2020.04.010
  » https://doi.org/10.1016/j.hlpt.2020.04.010
• 15. Baskerville R, Pries-Heje J, Venable J. Soft Design Science Methodology. In: DESRIST '09: Proceedings of the 4th International Conference on Design Science Research in Information Systems and Technology. Malvern; 2009.
• 16. Jesus AF, Tadini AVW, Pereira CM, Marinho RS, Castro WP, Segundo JES. O uso do método Design Science Research na Ciência da Informação: uma revisão sistemática da literatura. AtoZ [ Internet ]. 2023 [cited 2024 Jun 29 ];12:(1):1-13. Available from: https://doi.org/10.5380/atoz.v12i0.87478
  » https://doi.org/10.5380/atoz.v12i0.87478
• 17. Aromataris E, Munn Z, editors. JBI Reviewer's Manual [ Internet ]. 2020 [cited 2024 Jun 29 ]. Available fromhttps://doi.org/10.46658/JBIRM-19-01
  » https://doi.org/10.46658/JBIRM-19-01
• 18. Brown T. Design thinking: uma metodologia poderosa para decretar o fim das velhas ideias. Rio de Janeiro, RJ(BR): Elsevier 2010.
• 19. Ministério da Saúde (BR). Resolução-RDC nº 36, de 25 de julho de 2013. Institui ações para a segurança do paciente em serviços de saúde e dá outras providências [ Internet ]. [cited 2024 Jul 01]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2013/rdc0036_25_07_2013.html
  » https://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2013/rdc0036_25_07_2013.html
• 20. Rocha HAL, Alcântara ACC, Borba Netto FC, Ibiapina FLP, Lopes LA, Rocha SGMO, et al. Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice. Int J Qual Health Care [ Internet ]. 2021 [cited 2021 Sept 30 ];33(1):mzaa114. Available from: https://doi.org/10.1093/intqhc/mzaa114
  » https://doi.org/10.1093/intqhc/mzaa114
• 21. Levy N, Zucco L, Ehrlichman RJ, Hirschberg RE, Johnson SH, Yaffe MB, et al. Development of Rapid Response Capabilities in a Large COVID-19 Alternate Care Site Using Failure Modes and Effect Analysis with In Situ Simulation. Anesthesiology [ Internet ]. 2020 [cited 2024 Jun 29 ];133(5):985-96. Available from: https://doi.org/10.1097/ALN.0000000000003521
  » https://doi.org/10.1097/ALN.0000000000003521
• 22. Padilha RDQ, Gomes R, Lima VV, Soeiro E, Oliveira JMD, Schiesari LMC, et al. Princípios para a gestão da clínica: conectando gestão, atenção à saúde e educação na saúde. Ciênc Saúde Coletiva [ Internet ]. 2018 [cited 2024 Jun 29 ];23(12):4249-57. Available from: https://doi.org/10.1590/1413-812320182312.32262016
  » https://doi.org/10.1590/1413-812320182312.32262016
• 23. Mendes EV. As redes de atenção à saúde. Ciênc Saúde Coletiva [ Internet ]. 2010 [cited 2024 Jun 29 ];15:2297-305. Available from: https://doi.org/10.1590/S1413-81232010000500005
  » https://doi.org/10.1590/S1413-81232010000500005
• 24. Figueiredo FM, Gálvez AMP, Garcia EG, Eiras M. Participação dos pacientes na segurança dos cuidados de saúde: revisão sistemática. Ciênc Saude Coletiva [ Internet ]. 2019 [ cited 2024 Jun 29 ];24:4605-20. Available from: https://doi.org/10.1590/1413-812320182412.08152018
  » https://doi.org/10.1590/1413-812320182412.08152018
• 25. Chun TT, Judelson DR, Rigberg D, Lawrence PF, Cuff R, Shalhub S, et al. Managing central venous access during a health care crisis. J Vasc Surg [ Internet ]. 2020 [cited 2024 Jun 29 ];72(4):1184-95.e3. Available from: https://www.jvascsurg.org/article/S0741-5214(20)31588-3/fulltext
  » https://www.jvascsurg.org/article/S0741-5214(20)31588-3/fulltext
• 26. Sheth PD, Simons JP, Robichaud DI, Ciaranello AL, Schanzer A. Development of a surgical workforce access team in the battle against COVID-19. J Vasc Surg [ Internet ]. 2020 [cited 2024 Jun 29 ];72(2):414-7. Available from: https://doi.org/10.1016/j.jvs.2020.04.493
  » https://doi.org/10.1016/j.jvs.2020.04.493
• 27. Kang Y, Deng L, Zhang D, Wang Y, Wang G, Mei L, et al. A practice of anesthesia scenario design for emergency cesarean section in patients with COVID-19 infection based on the role of standard patient. Biosci Trends [ Internet ]. 2020 [cited 2024 Jun 29 ];14(3):222-6. Available from: https://doi.org/10.5582/bst.2020.03066
  » https://doi.org/10.5582/bst.2020.03066
• 28. Bruyneel A, Gallani MC, Tack J, Hondt A, Canipel S, Franck S, et al. Impact of COVID-19 on nursing time in intensive care units in Belgium. Intensive Crit Care Nurs [ Internet ]. 2021 [cited 2024 Jun 29v;62:102967. Available from: https://doi.org/10.1016/j.iccn.2020.102967
  » https://doi.org/10.1016/j.iccn.2020.102967
• 29. García MC, Molina JG, Férez AF, Medina IMF, Miranda MIV, Lasserrotte MDMJ. “Who Takes Care of Carers?”: Experiences of Intensive Care Unit Nurses in the Acute Phase of the COVID-19 Pandemic. Healthcare [ Internetv. 2024 [cited 2024 Jul 01 ];12(2):162. Available from: https://doi.org/10.3390/healthcare12020162
  » https://doi.org/10.3390/healthcare12020162
• 30. Stein M, Costa R, Gelbcke FL. Enfermagem e design na criação de produtos para a saúde: aproximando áreas e resolvendo problemas. Texto Contexto Enferm [ Internet ]. 2023 [ cited 2024 Jul 01 ];32:e20220160. Available from: https://doi.org/10.1590/1980-265X-TCE-2022-0160pt
  » https://doi.org/10.1590/1980-265X-TCE-2022-0160pt

NOTES

• ORIGIN OF THE ARTICLE

  Article extracted from the thesis - Safety and Quality in Hospital Care in the context of a Pandemic: creation of artifacts for Clinical Management through Soft Design Science Research, presented to the Postgraduate Program in Sciences Applied to Hospital Care, at the Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, in 2021.

• APPROVAL OF ETHICS COMMITTEE IN RESEARCH

  Approved by the Ethics Committee in Research of the Julio Mueller University Hospital, opinion n.º 3.285.978/2019, Certificate of Submission for Ethical Appraisal 09495919.9.0000.5541.

• TRANSLATED BY

  Leonardo Parachú

Edited by

EDITORS

Associated Editors: José Luís Guedes dos Santos, Maria Lígia Bellaguarda.

Editor-in-chief: Elisiane Lorenzini.

Publication Dates

• Publication in this collection
  14 Oct 2024
• Date of issue
  2024

History

• Received
  01 Oct 2023
• Accepted
  17 July 2024