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- ItemAcesso aberto (Open Access)Analysing the use of a computerized system by hospital managers(Univ Fed Sao Paulo, Dept Enfermagen, 2018) dos Santos, Marlene Cristina [UNIFESP]; Marin, Heimar de Fatima [UNIFESP]Objective: To analyze the use of a computerized system by hospital managers, evaluating their satisfaction related to the usefulness and ease of use of system. Methods: Case study, with a non-ex perimental design, conducted in a general hospital. The instrument used was based on the technological acceptance model. The population was composed of 63 managers and, based on the inclusion criteria, 60 managers were included in the study sample. Results: The system was considered useful by 90.5% of managers, while 84.7% agreed on its ease of use. The analyzed external variables (age, ease of using the technology, provision of training and technical support, computer availability, and favorability of use), showed an influence on satisfaction with the ease of use. The age and provided training did not influence satisfaction on the usefulness of the system. Conclusion: The managers showed greater satisfaction with the usefulness of the system when compared to the ease of use, due to the characteristics of the system and the institution.
- ItemAcesso aberto (Open Access)Avaliação da Maturidade Organizacional em Gerenciamento de Projetos (OPM3®) em Saúde(Universidade Federal de São Paulo (UNIFESP), 2008-11-26) Santos, Luis Augusto dos [UNIFESP]; Marin, Heimar de Fatima [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This work verify the capacity of an organization to undertake projects, and as to identify if the organization it has processes of management and as to implement this project management through currently accepted of world-wide form. For in such a way, the application of model OPM3® in health organization was carried through, which consists of an applicatory one of software with 151 questions that elaborates reports and graphs of the existence or not of these best practices. Applied in a multinational organization, recognized internationally as of excellence in management project, getting one high degree of maturity that can serve as maker for other organizations.
- ItemAcesso aberto (Open Access)Entre a intenção e o ato: uma análise da política de contratualização dos hospitais de ensino (2004-2010)(Universidade Federal de São Paulo (UNIFESP), 2011-02-22) Chioro, Arthur [UNIFESP]; Cecilio, Luiz Carlos de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: The Teaching Hospital Restructuring Program, comprising hospital-related certification and configuration of agreements, was introduced in 2004 by the Brazilian Government. It is one of the strategies to handle the crisis in this sector as it brings forth new funding, management and relationship standards between teaching hospitals and the health system by executing agreements with the local manager of the Brazilian National Health Care System (Sistema Único de Saúde – SUS). Methodology: the research was carried out in four hospitals belonging to the first group to enter into an agreement in 2004 under different legal regimes and selected through a drawing process. The initial motivation was to analyze possible changes found in the daily life of the teaching hospitals deriving from such government policy, in an attempt to characterize the role played by different institutional actors towards this policy, in addition to managers’ protagonism and the difficulties found in its implementation. Therefore, documents were analyzed and 32 interviews were performed with hospital managers, SUS managers, and managers from the federal ministries responsible for the formulation and performance of the contracting policy. Implication Analysis: The author’s implication with the object of study is openly dealt with as the research is conducted (The author coordinated policy formulation and initial implementation). The main methodological challenge was getting through an “epistemological displacement” from the governmental position occupied by the subject in the past to the actual position of an epistemic subject in order to explicitly deal with such “contamination-relationship” and try to construct “alterity relationships” that might lead to understanding the configuration of agreements as viewed by the actors who were responsible for its effective implementation. Data Analysis: starting from the construction of empirical mirror-categories (as they merely “reflect” elements contained in the policy evaluation grid) and novelty-categories (encompassing unpredictable aspects in the original policy formulation), equations were thought of for each hospital. These equations always comprised the same categories, though denoting the different intensities that they would gradually present, as well as different connecting forces between them. The analysis was accomplished within three different analytical plans. The first contains a characterization of changes occurred as the configuration of agreements began. The political guidelines regarding assistance, management, education in health, technological evaluation and incorporation were taken as a point of reference. The second plan analyzes the bets that were implicit placed during the formulation of the configuration of agreements, when indications about its non-explicit theoretical-conceptual bases were pursued. Now, on a deeper abstractional level, the third plan develops a theoretical reflection on the theme of reason and rationality in modern times, in an attempt to find connections with the instrumental rationality found in the hegemonic structural-functionalist paradigm of organizational studies and interventions and, as pointed by the study, in the formulation of the teaching hospital agreement configuration policy itself. Results: In the first analytical plan, the most visible progress made by the configuration of agreements was the change in the funding profile, resulting in financial as well as economic balance and the fight against indebtedness, although with diverse intensities and reflections for the hospitals under study. However, guidelines for teaching, permanent education, technological incorporation and research, which were fundamental for the production of a new teaching hospital, stood for clearly “forgotten” purposes as the policy was introduced. In addition, it was not capable of providing considerable changes in relation to management and health care qualification. A second analytical plan provides the analysis of the implicit political bets and their different accomplishment rates. The expectation of inducing a new management rationality from a government policy was not fulfilled as the complexity of the teaching hospital micropolitics was underestimated. The idealized participation arrangements that were strongly inspired in the production of actors – who emphasized the need to “constitute collective subjects” through the horizontalization and democratization of relationships among workers, users and managers – are faced with operational difficulties so they do not produce a new management logic for the teaching hospitals. Therefore, the contracting policy ends up reproducing the usual conservative behavior found in public management – a specific, instrumental rationality that emphasizes administrative action and excessive standardization. The third analytical plan promotes a theoretical discussion about the concept of reason in modern times, particularly about what has been called, since Max Weber, as the “increasing rationalization of society”. It is within such a theoretical-conceptual frame that intelligibility towards the so-called increasing rationalization of medical-hospital practices is searched for. This is characterized by the ideal operation of hospitals known as "scientific", efficient, predictable, and parameterized by the market and its criteria of competition and survival. This new “rationalized hospital” presents the “dream hospital" of all interviewed managers, either in public or private sectors, as they surprisingly identified it as being the hospital desired by the contracting policy! All that points to the complexity that is inherent to the formulation of governmental policies, mainly the moment of their implementation by actors in their real acting conditions. Studies and interventions are therefore critical to dispute other senses for hospital management. These should not be the ones as shaped by instrumental rationality, which goes on establishing a unique and triumphant possible rationality, bringing forth the theoretical as well as political fight against the extreme functionalization and homogenization of the ways to promote management and its unique truth. Back to the Start: the study is concluded through reflections presented by the author, who was faced into a new displacement at the end of the research, due to political as well as professional reasons, this time as a local SUS manager, as he became responsible for the introduction – in act – of a configuration of agreements policy in local teaching hospitals.
- ItemAcesso aberto (Open Access)Erros de medicação: tipos, fatores causais e providências tomadas em quatro hospitais brasileiros(Universidade de São Paulo, Escola de Enfermagem, 2006-12-01) Miasso, Adriana Inocenti; Grou, Cris Renata; Cassiani, Silvia Helena de Bortoli; Silva, Ana Elisa Bauer de Camargo; Fakih, Flávio Trevisan [UNIFESP]; Universidade de São Paulo (USP); UFGO; Universidade Federal de São Paulo (UNIFESP)This study analyzed the causes, types, administrative measures taken and suggestions concerning medication errors according to the perspective of professionals involved with the medication systems in four Brazilian hospitals. It is an exploratory, survey-type, multicentric study. The sample consisted of professionals from the medical clinic and pharmacy in the above-mentioned hospitals. Semi-structured interviews were used for data collection. Results showed that the most frequently error types mentioned by the professionals were related to medication ordering/transcription. Lack of attention, individual mistakes and problems in service management were the major causes of errors. Reports were the main measures taken in view of errors, and changes in individual attitudes were the most frequently mentioned form to prevent them.
- ItemAcesso aberto (Open Access)História da evolução da qualidade hospitalar: dos padrões a acreditação(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2005-06-01) Feldman, Liliane Bauer; Gatto, Maria Alice Fortes; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; Consultoria Saúde Brasil Responsabilidade Profissional/ Hospitalar e Gerenciamento de Riscos; UNG Curso de Pós-graduação; Universidade Federal de São Paulo (UNIFESP)This work contemplates the literature revision of Quality Standardization and the evaluation process by means of Hospital Accreditation literature. A historic resume have been worked out, about the beginnings of quality evaluation within the health services, from the Hospital Standardization Program, elaborated by the American Surgeons College, in the middle of 1924, to the creation of ONA - National Accreditation Organization, who has as main goals the installation and implementation of a health assistance permanent improvement process, thus stimulating the services to reach higher quality standards. After a reflection exercise, it was considered that, in the evaluation of services, it's necessary to seek a higher value of the assistentials results, as well as the elaboration of more equanimous patterns in the structure, processes and results of the assistential quality.
- ItemAcesso aberto (Open Access)Os médicos e a racionalização das práticas hospitalares: novos limites para a liberdade profissional?(Universidade Federal de São Paulo (UNIFESP), 2010-04-28) Abou Jamra, Carolina Chaccur [UNIFESP]; Cecilio, Luiz Carlos de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Brazilian hospitals, either in public or private sectors, have experienced a remarkable rationalization process in their practices through strategies aimed at regulate, discipline and control the diverse dimensions of hospital life. Such strategies convey a specific, instrumental rationality that is outlined by the search for greater institutional efficiency and effectiveness. Regarding the existence of a dual system of authorities in hospitals composed by both medical and administrative powers, the introduction of a rationalizing logic by the hospital administration potentially impacts the power of decision-making within the clinical board, whose professionals, on their turn, activate autonomy conservation strategies ultimately concerned with the maintenance of their power in the institution. The present study is aimed at understanding how medical doctors experience and assign meaning to the rationalizing hospital management policies implemented by the management board of a hospital belonging to the State Health Department of São Paulo. This hospital is managed by a university through a formal agreement as a teaching hospital. It is also certified by the National Accreditation Organization as an institution of excellence. As a case study carried out through an analytical qualitative methodology, which, from semi-structured interviews performed with six medical doctors directly concerned with health care, this research is able to identify an apparent paradox involving the evident advancement of the institutional mechanisms of control over medical work as well as the ―subjective‖ perception of such advancements by the physicians, who do not recognize them as limits for their technical autonomy. In addition, it demonstrates how far the resistance of physicians against the rationalizing measures is made in act, when performing their work, when creating informal networks of contact and knowledge, which follow through by producing flows, ways of operation for the hospital, ways of producing care, which go far beyond the rationality, the formalism, and the previsibility as aimed by the administration.