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Navegando por Palavras-chave "Health management"

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Adaptação do modelo de avaliação da qualidade e melhoria do desempenho americano à realidade brasileira
(Universidade Federal de São Paulo (UNIFESP), 2017-08-31) Lazarini, Leticia de Fatima [UNIFESP]; Roza, Bartira de Aguiar [UNIFESP]; http://lattes.cnpq.br/9255434835123749; http://lattes.cnpq.br/4237856314712517; Universidade Federal de São Paulo (UNIFESP)
Objetivo: Realizar a adaptação cultural para o português brasileiro, instrumento de Avaliação da qualidade e melhoria do desempenho dos Estados Unidos da América à realidade brasileira. Método: Pesquisa metodológica desenvolvida para validar o instrumento que visa medir a qualidade e o desenvolvimento das equipes transplantadoras. O instrumento utilizado para tradução foi o Instrumento Quality assessment and Performance Improvement (QAPI). A planilha QAPI é utilizada para determinar a conformidade dos programas de transplante com a legislação vigente e os regulamentos técnicos da área de transplante. Para a validação deste instrumento foi realizada a proposta de Beaton et al que prevê as seguintes etapas: tradução, síntese, backtranslation, revisão por comitê de especialistas e pré-teste. Para se avaliar as concordâncias entre os cinco juízes das percepções sobre Relevância, Precisão, Clareza, Objetividade, Sequência de Tópicos e aspectos de Equivalência (Semântica, Idiomática, Cultural e Conceitual) foram apresentados os coeficientes Kappa para múltiplos juízes (8). Foram analisadas as concordâncias considerando-se, tal qual para o Índice de Validação de Conteúdo, as respostas “4” e “5” como sendo “importante”. Para todos os testes estatísticos foram adotados um nível de significância de 5%. Resultado: Os resultados da adaptação do instrumento QAPI- Brasil mostram que, no questionário como um todo, houve 97,5% de equivalência semântica e idiomática e 99,1% de equivalência cultural e conceitual. Para os blocos nos quais foram possíveis de se realizar o cálculo do Kappa, as concordâncias mostraram-se pobres. Entretanto, as concordâncias observadas entre os juízes sobre as adequações de semântica, idiomática, cultural e conceitual dos blocos de identificação, parte 1, parte 2 e final, bem como a adequação cultural e conceitual da parte, foram de 100,0%. Para a validação de conteúdo também foi analisada a Relevância, precisão, Clareza, Objetividade de cada questão e a Sequência de Tópicos. Valores de IVC para relevância e sequência de tópicos de pelo menos 0,80 para todos os blocos. De uma forma geral, a clareza apresentou mais blocos com IVC inadequado – apenas a parte 2, parte 5 e final apresentaram valores que variaram de 0,80 a 1,00. Já o Índice de Validação de Conteúdo para Precisão e Objetividade mostraram-se adequados para identificação, parte 2, parte 5 e final. Para o pré-teste 80% dos profissionais elogiaram o questionário e o classificaram como de grande relevância para o Transplante no Brasil. Cerca de 30% dos profissionais classificaram o questionário como muito extenso para ser preenchido mensalmente. Os profissionais de São Paulo - capital e interior, apresentaram maior facilidade em responder o questionário uniformemente e sem dúvidas. Para 20% dos profissionais que responderam o questionário, as questões relacionadas a eventos adversos não foram respondidas, pois o programa não dispunha dos dados. Conclusão: o questionário de Avaliação da qualidade e melhoria do desempenho americano está traduzido, adaptado e seu conteúdo validado à realidade brasileira.
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Análise da metodologia de avaliação de impacto à saúde no Brasil com enfoque a grandes empreendimentos e políticas públicas
(Universidade Federal de São Paulo (UNIFESP), 2017-04-24) Abe, Karina Camasmie [UNIFESP]; Miraglia, Simone Georges El Khouri [UNIFESP]; Saldiva, Paulo Hilário do Nascimento; http://lattes.cnpq.br/5450805572417395; http://lattes.cnpq.br/6423311971848669; http://lattes.cnpq.br/8719750781707977; Universidade Federal de São Paulo (UNIFESP)
Introduction: Health Impact Assessment (HIA) is a methodology standardized by the World Health Organization, which aims to insert the health sector in the development of strategies and public enterprises and policies planning, favoring decision-making and better resources allocation and capital investment. Objectives: This work aimed to analyze the AIS methodology applicability, contextualizing into the Brazilian environment and applying it to two case studies, one of which is the analysis of a public policy, in this case, the Pollution Control Program (PROCONVE) and the other, the analysis of large enterprises, in this case, the Rondônia hydroelectric plants, located on the Madeira River. Methods: A narrative review was conducted in order to evaluate the AIS methodology applicability in Brazil. The methodology used in the PROCONVE case study was descriptive analysis, generalized Poisson linear regression, relative risk and economic valuation through DALY (Disability Adjusted Life Years). The study site was the municipality of São Paulo between 2000 and 2011, analyzing the association between air pollutants and outcomes in morbidity and cardiorespiratory mortality. The second study addressed the impacts of the construction of two hydroelectric dams on the Madeira River, and a bibliographic review was carried out to build a network of impacts. In order to apply HIA for the characterization of one of the impacts identified in the network, descriptive analysis, segmented regression and economic analysis of the defensive costs for the health system due to the incidence of dengue were conducted. Results: The main results of the PROCONVE case study included associations between pollutants and health outcomes, particulate matter (PM) associated with cardiovascular and respiratory mortality. In addition to the mortality result, most of the pollutants showed a downward trend throughout the study period. The application of HIA in the predictive scenarios showed the importance of reducing pollutant concentrations to obtain years of life and financial resources. According to the assessment, air pollution was responsible for a cost of over US $ 3 billion in the analyzed period, only due to cardiorespiratory mortality. In relation to the results of the hydroelectric study, it was possible to determine an association between the beginning of the construction of the projects and the increase of dengue incidence in the State of Rondônia, which tripled health expenditures for this disease, reaching an annual average of R $ 22 , 4 million in the period after the beginning of the works. Conclusion: 21 The application of HIA for both case studies has proved to be an organized, standardized and transparent way of assessing the effects of both a public policy and a major infrastructure project. For the case study of PROCONVE, it is suggested the immediate revision of the air quality standards in Brazil, while for the study of hydroelectric plants, it is suggested the insertion of HIA in the environmental licensing. Based on the analysis of the application of HIA for both studies, the institutionalization of this methodology, considering Brazilian environment peculiarities, contextualizing it to the local population groups, the availability of reliable data and with the intention of promoting a Relationship between stakeholders and decision makers.
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Análise do gerenciamento de pacientes crônicos atendidos por operadora de saúde suplementar
(Universidade Federal de São Paulo (UNIFESP), 2017-06-29) Sousa, Gilmar Oliveira de [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Araújo, Maria Conceição Filgueiras Ferraz; http://lattes.cnpq.br/3787335681398461; http://lattes.cnpq.br/1924137485244907; http://lattes.cnpq.br/5041200088050207; Universidade Federal de São Paulo (UNIFESP)
This study was carried out in a health care program of a supplementary health care provider in the southern region of Bahia, comprising a multidisciplinary team. It is a retrospective, documentary research with a quantitative approach. Data were collected in 2016 for the years 2012-2015. With the general objective of analyzing the home care program managed by a health care provider in Itabuna-Bahia and as specific objectives: to characterize the sociodemographic and clinical profile of the beneficiaries served by the program; To know the costs / year by period of the program, aiming at a better operationalization of the resources invested in the health management of the assisted population. Considering to obtain the results with effectiveness and efficiency, obtaining strategies of interventions, with actuation and valorization of the autonomy of Nursing in this process. In this study, ethical aspects were observed, preceded by the approval of the Unifesp Ethics Committee resolution number 1,592,711 / 2016 and CEP / UESC protocol number 822.937 / 2015. Results: In this period, 300 patients with chronic diseases, including diabetes, Alzheimer's disease, hypertension, chronic obstructive pulmonary disease (COPD) and / or patients underwent complex procedures (neurological and traumatologic surgeries, among others). The majority of beneficiaries attended by the program were female (59.67%); With 70 years or more (59%). As for incomplete first grade schooling was (33%); High school (22%); Higher education level (4.33%); And the family wage range between 2 to 3 minimum wages (30%), 3 to 5 minimum wages (18.33%) and retirees (49%). In relation to the costs of the health care provider with its users before and after insertion in the health care program (PAS) in the health management modality, a significant reduction of these costs is noticed. Before the PAS annual value of R $ 747,036.65 and after the PAS after the first year was R $ 281,276.42, a percentage reduction of the cost of 62.35%. Conclusion: The importance and efficacy of a chronic patient management program was observed not only for the financial health of a supplementary health care provider, but also for the health management of a population that still lacks technical and educational resources. Can make the difference in their walk in search of a quality of life and a longevity with security and using only basic resources, but primordial for their health. This study, although limited in scope, shows that a health management program in the region, in the current context of human aging, is of fundamental importance, especially for the bedridden patient. Without this, the increase in the cost of any health care provider is notorious, since the patient is adrift in the knowledge of health care, reducing the quality of life deficit, further increasing the cost of worsening health.
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Campos de intervenções organizacionais: a contribuição das ciências humanas para uma leitura crítica das propostas de gestão das organizações de saúde
(UNESP, 2007-12-01) Lins, Auristela Maciel; Cecilio, Luiz Carlos de Oliveira [UNIFESP]; Universidade de Brasília Faculdade de Saúde Departamento de Saúde Coletiva; Universidade Federal de São Paulo (UNIFESP)
This article aims at presenting an analytical frame to be used by organization researchers, health managers, and health evaluators as a guide to promote critical analysis of organizational interventions usually presented as powerful management tools for changing undesirable situations. The current analytical scheme stems from a research on doctoral theses submitted from 2000 through 2004 in major Brazilian universities. It was intended to identify the main paradigms used in such recent academic work. It comprises ideal types known as organizational intervention fields based on some theoretical productions in the area of Human Sciences.
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Construção e validação de um instrumento de avaliação de cursos modalidade a distância
(Universidade Federal de São Paulo (UNIFESP), 2017-08-31) Okagawa, Fabiana Silva [UNIFESP]; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; http://lattes.cnpq.br/8695765272291430; http://lattes.cnpq.br/3403351479831430; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVES: To construct and validate an instrument of evaluation of higher level courses offered in the distance modality. METHODS: This is a methodological research with a quantitative approach guided by Pasquali's theoretical framework and composed of two stages. The first stage selected quality criteria of distance learning courses for the construction of the pre-test with the project approved through the Triangulation of Experts and as questions by the Delphi Method. On the second stage, it was applied in two lato sensu courses of specialization offered by distance. The analysis of the data, as continuous measurements, were presented from averages, standard deviations and measures of position and profile of the participants, as well as items that used Likert scales (1 to 4) for absolute and related frequencies. The reliability of the scale was verified through Confirmatory Factor Analysis and a discriminant validity of the constructs through observations on the scale of 0 to 10 of course indication by Spearman's Correlation. RESULTS: Eleven references (national and international) gave rise to the pre-test composed by 70 criteria and stratified into six categories. The validation of the construction changed, excluded and inserted new criteria, giving rise to a instrument composed by 60 questions that was submitted to the expert panel. In the first Cycle Delphi 17 judges validated 55 (91.6%) questions and suggested inclusion of one. In the second cycle 12 judges validated the others. Cronbach's alphas were 0.93 and 0.80, respectively. The total number of responses analyzed after applying the instrument in the two courses was 221, however, not always the subjects answered all the questions proposed. The first course covered the six categories of the instrument and the second only four, since its pedagogical structure does not include the presence of teachers and tutors. After adjusting the instrument, the adjustment indexes were more favorable (CFI = 0.806, TLI = 0.770 and RMSEA = 0.088). The positive association between the variables was found, the best mean (p < 5%) refers to the correlation between the practical aspects of the course and the indication by the students. CONCLUSION: This study produced a validated, and reliable instrument for the evaluation of higher level courses offered at a distance, which can be applied in courses with different pedagogical designs and is not limited to a specific area of knowledge.
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Da gestão por competências às competências gerenciais do enfermeiro
(Associação Brasileira de Enfermagem, 2010-12-01) Furukawa, Patrícia De Oliveira [UNIFESP]; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
This article is a literature review that aimed to collect more information about the competencies management, understand the concepts of profile and competencies in the managing people; understand the issue of professional competence and its relationship with the organization's competencies; and finally identify the managerial competencies necessary to work of the nurse on the aspect of the labor market. The literature showed that the concept of competence shows great results when applied in the people management arena. It also can provide in the context of health services, benefits for the organizations and for the professionals and patients. For that, it's required that health services to take the ownership of this knowledge as possibility to achieve better results, as well as educational institutions and nurses that seek for information and training to achieve the challenges of the profession and the labor market.
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O difícil acesso a serviços de média complexidade do SUS: o caso da cidade de São Paulo, Brasil
(IMS-UERJ, 2010-01-01) Spedo, Sandra Maria [UNIFESP]; Pinto, Nicanor Rodrigues da Silva [UNIFESP]; Tanaka, Oswaldo Yoshimi; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
The population access to the secondary health care services is being pointed, by managers and researchers, as one of the challenges to the implementation of integrality in the Brazilian National Health System (SUS). This paper aims to evaluate the mechanisms used by SUS manager's, in the city of São Paulo, to guarantee medical assistance, from 2005 to 2008. The strategy of case study was chosen, using as data sources such as managers interviews, focus groups with SUS users, and participative observation. Thematic analysis was performed on health services organization, with theoretical references of the integrality concept. We tried to describe the path covered by the users to have access to the services, based on the view of users and managers. Secondary health care services were identified by managers as the neck of a bottle and one of the main obstacle to the SUS integrality. To overcome this situation, the municipal manager invested in the computerization of services, as an isolated step, and still, without considering user´s needs. However, this technological incorporation had low impact on the improvement of the population access to the secondary health care services, which was confirmed by user's source. It is argued that to face such complex problem it will be necessary to articulate actions, not only in health politics but also in health services organization and also in the (re)organization of the working process in any other level of the health system.
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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.
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Entre o silêncio e a resistência: a educação permanente como dispositivo de gestão
(Universidade Federal de São Paulo (UNIFESP), 2018-11-14) Pezzo, Tiago Henrique [UNIFESP]; Capozzolo, Angela Aparecida [UNIFESP]; http://lattes.cnpq.br/7660336218859464; http://lattes.cnpq.br/0320101071958663; Universidade Federal de São Paulo (UNIFESP)
This Research Is Part Of My Experience As A Local Manager Of A Basic Health Unit (Ubs) And Of The Anxieties Produced When Seeking Changes In Work Processes From Collective Spaces With Professionals In The Mold Of Permanent Education, And To Encounter Silences And Resistances To Change Proposals To Broaden Access And Qualify Care. Health Work Can Not Be Totally Normalized And Controlled, Since It Is Carried Out In The Act Of Meeting With The User, And Changes Can Only Occur With The Involvement Of The Workers. In This Period In The Municipality There Were Significant Investments To Qualify The Health Care Network, With Important Bets In Spaces Of Permanent Education With The Workers, That Were Added To The Unit, But Did Not Seem To Produce The Expected Effects. Thus, The Objective Of This Study Was To Investigate With Managers Of Basic Units The Use Of Permanent Education To Promote Changes In Health Practices And To Explore The Issues Involved In These Processes. For This, A Qualitative, Cartographic-Inspired
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Evolução da Estratégia Saúde da Família em Mato Grosso e sua influência nos indicadores da Atenção Básica em Saúde no período de 2008 a 2015
(Universidade Federal de São Paulo (UNIFESP), 2018-12-17) Fonseca, Juliane Ferreira Andrade da [UNIFESP]; Zucchi, Paola [UNIFESP]; Varela, Patrícia Siqueira [UNIFESP]; Varela, Patricia Siqueira; http://lattes.cnpq.br/0983504754172722; http://lattes.cnpq.br/1949000567939406; http://lattes.cnpq.br/8109883357278447; Universidade Federal de São Paulo (UNIFESP)
Introduction: The Family Health Strategy implemented by the Ministry of Health with principles and concepts of primary health care with the purpose of changing the way services are organized, care practices focused on family and community. The many professionals team in its work process develops activities that will generate indicators that can subsidize the planning of interventions according to the local health needs. Objective: To analyze the influence of the Family Health Strategy on indicators of basic health care according to its structure, process and outcome components in the municipalities of Mato Grosso, from 2008 to 2015. Method: This is an evaluative research, quantitative, retrospective analysis using secondary data from the federal government's official information systems. A matrix was built consisting of structure components (potential population coverage), process (medical consultation, home visit of doctor and nurse, referral to specialist and request for clinical pathology exams) and outcome (hospitalization rate due to causes sensitive to primary care, proportion of live births of mothers with seven or more prenatal consultations and infant mortality coefficient). The descriptive analysis and Spearman Correlation coefficient (rho) were made. Results: The study indicated that the population coverage always remained high, above 83%, the process indicators suggest an improvement in the specialist, a reduction of 49.71 % in the average number of requests for clinical pathology exams, but there was also a reduction of 7.13% in the average home visit in the period studied. There is correlation between the structure and process component and between structure and result. The correlation between population coverage and hospitalization rate for causes sensitive to primary care showed a divergent positive association with other studies. Conclusions: The research showed that with the evolution of the family health strategy there were changes in some indicators of primary care in Mato Grosso demonstrating the accessibility to the service, effectiveness and positive effects on the health of the population. Regarding the correlation of the components of structure and process and of structure and result, it was pointed out to be a management tool for evaluation of the program.
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Gestão da atenção básica por organizações de saúde no município de São Paulo : uma análise micropolítica
(Universidade Federal de São Paulo (UNIFESP), 2017-06-26) Bragagnolo, Larissa Maria [UNIFESP]; Andreazza, Rosemarie [UNIFESP]; Reis, Ademar Arthur Chioro dos [UNIFESP]; http://lattes.cnpq.br/0107536337908259; http://lattes.cnpq.br/1447772258702244; http://lattes.cnpq.br/0600138582199721; Universidade Federal de São Paulo (UNIFESP)
Introduction: This research focuses the work management in primary care in two basic healthcare units (UBS) done by two different Social Health Organizations (OSS). Objective: analyze the management of two UBS in the municipality of São Paulo managed by OSS. Method: qualitative research, multiple case study type, of a cartographic nature made through participant observation in two UBS in the municipality of São Paulo that resulted in a field journal composed by registers of scenes observed in everyday work. Two shared seminaries held with the subjects of the UBS that are the study object were also adopted. For the material analysis, it was used the “visibility plans” concept, which is something that becomes more prominent or visible/sayable from the scene connections of similar “nature” registered in the journals. The researchers’ estrangement from the team was used as an analyzer of team relations with OSS. Results: the professionals show a well-established relationship with OSS which starts from a big disturbance related the field researchers, and constantly worry about the possibility of the researchers to take part of a control and evaluation strategy. Those professionals are ignorant of the management strategies adopted by OSS, and managerialism is evident. An institutional malaise is exposed, even so professionals support this management model that is why are placed between fear and trust in the relationship with the company. Those professionals also point out that a pronounced rationalization of the practices places care as well as numbers and goals accomplishments in antagonistic positions. However, the professionals estimate the managerialism tools with the illusion they will get past structural issues of health work. This situation constantly places those professionals in a paradox between autonomy and goals. It was also possible to observe managers, the OSS’s spokespeople, having a discourse of valuing numbers and managing UBS based on productivity goals imposed by management instruments of the relationship between OSS and city council. Due to intense adoption of managerialism tools, work is like business logic so the spokespeople support a discourse which does not go beyond common sense about Sistema Único de Saúde (SUS) as well as certain externality. In addition to an identification and greater belonging with public entity they take a position and dispute the OSS management model. It was also possible to identify singularities and regularities among OSS because they are similar when it comes to managerial management and deepening of the entrepreneurship, however they differ in what they represent for their workers. Questionings about the legitimacy of that SUS produced in UBS managed by OSS and possible iniquities related to health from very complex organizational structures are now open.
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Gestão de tecnologias em oftalmologia
(Universidade Federal de São Paulo (UNIFESP), 2016-09-30) Santos, Carla Ribeiro da Silva [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; http://lattes.cnpq.br/6575096591259140; http://lattes.cnpq.br/7298165480041720; Universidade Federal de São Paulo (UNIFESP)
Purpose: Health managers are responsible for planning and controlling health facilities due to the development, incorporation, and use of technologies in health systems, as well as their sustainability deriving from continuous production of goods and services. ANVISA (National Agency of Health Surveillance) introduced the Board Collegiate Resolution (RDC) No. 2 of January 25, 2010, that regulates the management of health technologies as well as the guidelines for the management of the technological park in health facilities. The purpose of this study was to develop a Health Technology Management Plan in ophthalmology according to the guidelines recommended by ANVISA. Methods: The study was based on the equipment and processes of the Secondary Reference Center for Ophthalmology (CERESO) of the Department of Ophthalmology and Visual Sciences, Federal University of São Paulo / EPM, Brazil, in 2014 and was divided into three stages. Step1: Identification and understanding of the Federal Regulation regarding the use of health technologies and their management in clinics and hospitals; Step 2: Identification of ophthalmic equipment and other technologies used at the CERESO in the Department of Ophthalmology and Visual Sciences; Step 3: Development of the Health Technology Management Plan in ophthalmology to meet the requirements of the Brazilian standards. The following equipments were identified in CERESO: optotype projector, slit lamp, Goldmann tonometer, auto-refractor, retinoscope, direct and indirect ophthalmoscopes, lensometer, electric lift chair and refractor. Results: The Health Technology Management Plan for CERESO included: a) the definitions and standardized criteria for each stage for the health technologies management process; b) detailed description of all the technical procedures involved with the technologies in use; c) appointment of a health professional responsible for implementing and monitoring the Management Plan; d) description of the roles and responsibilities of professionals involved in the processes; e) organization of a continuing education program for professionals involved in management activities. Conclusions: The Health Technology Management Plan was successfully developed for the Secondary Reference Center (CERESO) in the Department of Ophthalmology and Visual Sciences. It is a useful management tool and, respecting the characteristics of each service, can be used as a model to meet the Brazilian regulations recommended by ANVISA for public and private services.
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Graduate distance education in nursing: assessment under students' perspective
(Universidade Federal de São Paulo, Dept Enfermagen, 2015-03-01) Alves, Vera Lucia de Souza; Bohomol, Elena [UNIFESP]; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; Conselho Reg Enfermagem São Paulo; Universidade Federal de São Paulo (UNIFESP)
Objective: To evaluate the distance learning Graduate Nursing Management Program according to the students' perspective.Methods: This exploratory-descriptive study with a quantitative approach involved 484 students who had completed the nursing program. for the assessment we used an instrument divided into the following categories: access location, hours dedicated to the program, professors, mentors, students' expectations and general assessment. Association among numerical variables was done using a Pearson's chi-square test, and measurement reliability was assessed with the Cronbach's alpha coefficient.Results: Main results showed that students felt welcomed by mentors and professors and that two courses helped improve professional performance and development of competencies related to management.Conclusion: Courses were evaluated positively and were perceived as a useful tool for training of nurses aim to support transformation of management scenario of Brazilian nursing.
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Health Impact Assessment (HIA) in Brazil and Latin America: an essential tool for projects, plans and policies
(Univ Estadual Paulista-Unesp, 2018) Abe, Karina Camasmie [UNIFESP]; Miraglia, Simone Georges El Khouri [UNIFESP]
The paper presents a literature review of the application of the Health Impact Assessment (HIA) methodology, disseminated by the World Health Organization in Brazil and Latin America. This study showed that the practice and application of the HA is not common in Brazil or Latin America, as well as the analysis of health impacts is carried out in a superficial way regarding environmental licensing and public policies, indicating the need of the use of specific health impact assessment methodologies, professional training and government initiative. The adoption of HIA in Brazil could serve to avoid adverse health effects and could enhance the positive aspects, as well as to mitigate the negative aspects of projects and public policies, ensuring that people's health is not neglected.
Acesso aberto (Open Access)
The learning about imaging diagnosis technology
(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2014-01-01) Oliveira, Aparecido Ferreira de; Lederman, Henrique Manoel [UNIFESP]; Batista, Nildo Alves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objective To investigate the learning about management of the technology (efficient use, acquisition and maintenance of imaging diagnosis equipment) in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, with a view to improving the education of radiologists. Materials and Methods Exploratory research where residents, faculty staff and tutors of the program were quantitative and qualitatively approached with Likert scale questionnaires (46), and deepening with recorded interviews (18) and categorization based upon meaning units (thematic analysis). Results Among the participants, 66% agreed that they had the opportunity of learning about the use of radiological equipment; for 61% the program should include knowledge on the importance of acquiring equipment; and 72% emphasized the lack of learning about equipment management and maintenance. Conclusion As the major moment in the education of specialists, the medical residency program provides residents with a favorable environment to the learning of the skills required to the future of their professional practice, but with limited emphasis on the management of the technology: efficient use, acquisition and mainly maintenance of equipment, still poorly explored. Both the investigated program and the medical residency in radiology should incorporate, whenever possible, the commitment with the training in supplementary skills related to equipment management, developing the competence of the future radiologists.
Acesso aberto (Open Access)
Mantendo o sonho de incorporar o brinquedo terapêutico no cuidado de enfermagem apesar das dúvidas e dificuldades: vivência de diretoras e supervisoras de educação permanente
(Universidade Federal de São Paulo (UNIFESP), 2014-08-27) Costa, Suely Alves Fonseca [UNIFESP]; Borba, Regina Issuzu Hirooka de [UNIFESP]; Ribeiro, Circéa Amália [UNIFESP]; http://lattes.cnpq.br/2300731487624854; http://lattes.cnpq.br/2024656916005253; http://lattes.cnpq.br/2374298470721938; Universidade Federal de São Paulo (UNIFESP)
Este estudo, de natureza qualitativa, teve como objetivo compreender o significado atribuído pela Diretora de Enfermagem e Supervisora de Educação Permanente de hospitais infantis sobre a utilização do Brinquedo Terapêutico na assistência de enfermagem à criança. O Interacionismo Simbólico foi adotado como referencial teórico e a Teoria fundamentada nos Dados (Grounded Theory) como referencial metodológico. Os dados foram coletados por meio de entrevistas realizadas com cinco Diretoras de Enfermagem e três Supervisoras de Educação Permanente de cinco hospitais infantis do município de São Paulo. A análise comparativa dos dados permitiu a identificação do fenômeno MANTENDO O SONHO DE INCORPORAR O BRINQUEDO TERAPÊUTICO NO CUIDADO DE ENFERMAGEM APESAR DAS DÚVIDAS E DIFICULDADES, e revelou que, para a Diretora de Enfermagem e Supervisora de Educação Permanente, o brincar/Brinquedo Terapêutico é uma ferramenta imprescindível na pediatria; que ela valoriza e reconhece os benefícios de realizar essa atividade junto às crianças hospitalizadas e, assim desenvolve estratégias para incorporá-lo na prática cotidiana do enfermeiro; que neste trajeto vivencia inúmeras dificuldades, entre as quais, falta de tempo, compromisso, e conhecimento dos enfermeiros, assim como, o fato do brincar não ser cultura do enfermeiro, além de ter o receio de criar conflitos com outros profissionais de saúde; mas também interage com algumas situações que favorecem sua implementação como: o fato de alguns enfermeiros terem conhecimento a respeito do Brinquedo Terapêutico e receber apoio da instituição para realizar tal atividade; que ela continua sonhando com o Brinquedo Terapêutico implantado no cuidado à criança. A compreensão dessa experiência oferece subsídios para a enfermagem, no sentido de repensar o modo de cuidar da criança hospitalizada
Acesso aberto (Open Access)
Matriz de competências para gerentes de unidades básicas de saúde com estratégia saúde da família
(Universidade Federal de São Paulo (UNIFESP), 2014-11-26) Rodrigues, Patricia Cruz [UNIFESP]; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; http://lattes.cnpq.br/8695765272291430; http://lattes.cnpq.br/8648324673271735; Universidade Federal de São Paulo (UNIFESP)
Este estudo teve como objetivos identificar o perfil dos gerentes de Unidades Básicas de Saúde (UBS) com Estratégia de Saúde da Família (ESF) do município de São Paulo, identificar as competências necessárias ao processo de trabalho gerencial na ESF sob a ótica destes e propor uma Matriz de Competências (MC) para gerentes de UBS com ESF. Método: Optou-se pela pesquisa exploratória e metodológica com abordagem quantitativa, sendo dividida em 2 etapas. Na primeira etapa que ocorreu de maio a dezembro de 2012, a população foi composta pelos 270 gerentes de UBS com ESF da cidade de São Paulo, resultando em 199 (74%) que responderam o questionário semi-estruturado. Este foi elaborado com dezessete questões com dados de caracterização e uma sobre as cinco competências que os gerentes consideravam mais importantes para o processo de trabalho gerencial na Saúde da Família. Utilizou-se a ferramenta eletrônica Google Docs® para o envio do Termo de Consentimento Livre e Esclarecido (TCLE) e o Questionário, e a análise dos dados foi feita com auxílio da estatística descritiva utilizando o software Microsoft Excel®. Na segunda etapa, foi desenvolvida a pesquisa metodológica para a construção da Matriz de Competências (MC) para os gerentes. Através dos resultados obtidos com os gerentes e extensa revisão de literatura foram apontadas 17 competências, que a seguir foram selecionadas, identificadas as associadas por sobreposição, e descritas as caracterizações da entrega. Resultados: O perfil identificado dos gerentes de UBS com ESF do município de São Paulo foi de mulheres (159=80%), com idade entre 30 e 39 anos (91=46%), enfermeiras (136=68%), formadas de 10 a 20 anos atrás (80=40%), sem pós-graduação em gerenciamento (118=59%) e sem experiência em gestão (109=55%). A maior parte era celetista (175=88%) em instituição parceira/OSS que foram promovidas ao cargo por indicação (87=44%), atua na atenção básica há mais de 10 anos (95=48%), está como gerente há menos de 4 anos (122=61%) e trabalha na mesma UBS há menos de 2 anos (113=57%). O estudo também identificou as XVII principais competências necessárias para o processo de trabalho gerencial da ESF sob a ótica destes gerentes, sendo elas: planejamento e organização (148=74%), liderança (126=63%), trabalho em equipe (124=62%), gestão integrada de processos (84=42%) e desenvolvimento da equipe (82=41%). Uma matriz de competências para gerente de UBS com ESF foi proposta, totalizando-se em sete: (1) gestão do cuidado, (2) gestão de pessoas, (3) gestão de recursos políticos, (4) planejamento e organização, (5) liderança, (6) tomada de decisão e (7) relacionamento interpessoal. Além da definição de cada competência, a caracterização da entrega foi descrita considerando o contexto da ESF, o que trouxe clareza, objetividade e praticidade à esta MC. Conclusão: Foi identificado o perfil dos gerentes de UBS com ESF do município de São Paulo apontando que a maior parte são mulheres, enfermeiras, estão em sua primeira atuação na gestão e sem formação em gerenciamento ou administração. O estudo identificou ainda cinco principais competências necessárias ao processo de trabalho gerencial na ESF sob a ótica destes gerentes, sendo elaborada a Matriz de Competências para gerentes de UBS com ESF. Esta MC oferece subsídios para propostas tanto na educação permanente como nos processos de recrutamento e seleção, possibilitando a reorientação das funções gerenciais neste nível de atenção à saúde.
Acesso aberto (Open Access)
Modelo de gestão em bancos de olhos e seu impacto no resultado destas organizações
(Sociedade Brasileira de Oftalmologia, 2012-02-01) Hilgert, Christiana Velloso Rebello [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Instituto Hilton Rocha; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To analyse the management of Sorocaba Eye Bank (BOS) and Santa Casa de Campo Grande Eye Bank (BOSC) with distinct results regarding number of donations using Prêmio Nacional Gestão em Saúde (PNGS) criteria for performance excellence. METHODS: All the personel of the two eye banks were submitted to an interview using the 'Are We Making Progress?' questionnaire from Malcolm Baldrige Quality Program. The questionnaire items were organized by the seven criteria categories, as the PNGS's (Leadership, Strategic Planning, Customer and Market Focus, Measurement, Analysis and Knowledge Management, Human Resource Focus, Process Management, Bussiness Results). The findings were studied upon Fischers' exact test and Non parametric U test (Mann-Whitney) to compare the medium scores between the two Institutions. RESULTS: Twenty-one employees from BOS and 08 from BOSC were submitted to the questionnaire. The Mann-Whitney test showed a higher level of agreement to the questionnaire proposals from BOS than the ones from BOSC in 6 out from the 7 items studied (Leadership, Strategic Planning, Costumer and Market Focus, Human Resource Focus, Process Management, Bussiness Results). There wasn't any statisticaly significant difference related to the criteria Measurement, Analysis and Knowledge Management. The highest difference on the concordance level between the two organizations was related to Process Management (p<0.001). CONCLUSION: The BOS management performance has distinct and statistically significant aspects compared to BOSC, shown on 6 out of 7 criteria studied by the questionnaire used. These data showed that the BOS performance management is closer to internationally accepted concepts of performance excellence, based on both PNGS Criteria and Malcolm Baldrige Quality Program, than BOSC.
Acesso aberto (Open Access)
The nursing staff opinion about the continuous quality improvement program of a university hospital
(Instituto Israelita de Ensino e Pesquisa Albert Einstein, 2014-04-01) Costa, Fernanda Mazzoni da; Greco, Rosangela Maria; Bohomol, Elena [UNIFESP]; Arreguy-Sena, Cristina; Andrade, Vitor Luiz; Universidade Federal de Juiz de Fora; Universidade Federal de São Paulo (UNIFESP)
ObjectiveTo analyze the nursing staff opinion about the continuous quality improvement program at a University Hospital. MethodA descriptive study designed as a case study, analyzing the quality program at a University Hospital, with the opinion of a sample stratified by nursing team category through a self-administered questionnaire, from May to July 2012. The answers were submitted to factor analysis, having the dialectical and historical materialism as the theoretical-methodological reference. ResultThe factor analysis grouped the variables in six factors: working conditions, approval, belongingness, tranquility, interpersonal relations, and private life. With the exception of the factor interpersonal relations, the answers revealed that workers do not have opinion about the proposed questions. Four of the six factors had a predominance of positive answers. ConclusionA high percentage of respondents was not aware of the implications of a quality program. The majority believed that the program influenced positively in their working conditions and in the interpersonal relationships at work and agree with the program; however, they did not feel part of the program, and were not at ease to develop these activities. They did not acknowledge the program interfering in their personal life.
Embargo
Quality function deployment in a public plastic surgery service in Brazil
(Springer-Verlag Berlin Heidelberg, 2013-04-19) Campos, José Lamartine Galvão [UNIFESP]; Veiga, Daniela Francescato [UNIFESP]; Rocha, Luiz Roberto Martins [UNIFESP]; Novo, Neil Ferreira; Veiga-Filho, Joel [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade do Vale do Sapucaí — UNIVÁS
Background Quality function deployment (QFD) is a method used to evaluate and plan the quality of products and services. It is based on the satisfaction of customers, translating their needs into measurable characteristics that meet their expectations. This study aimed to evaluate the quality of a public plastic surgery service using QFD. Methods Eighty-six patients undergoing reconstructive operations in the plastic surgery service of a university affiliated public hospital in Brazil were enrolled. Quality issues required by patients (voice of customer) were correlated with service elements proposed by a multidisciplinary team (voice of organization). Results The requirements considered most important by patients (voice of customer) were “ease of hospital registration” followed by “nursing service.” The requirement considered least important by patients was “schedule for continuity.” The multidisciplinary team (voice of organization) considered “decreasing the number of complaints/month” the highest priority item of projected quality, followed by “increasing the number of satisfied patients.” “Number of patients referred” was considered the lowest priority item. Conclusions The QFD method was successfully applied to evaluate and set a projected quality plan for a public plastic surgery service in Brazil. Level of Evidence: Level III, therapeutic study.

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