Sofrimento moral de enfermeiros gerentes em um hospital universitário / Nurse managers' moral suffering in a university hospital / Sufrimiento moral en enfermeros gerentes de un hospital universitario

Objetivo: Descrever situações geradoras e elementos envolvidos no processo de sofrimento moral na experiência de enfermeiros gerentes de um hospital público do sul do Brasil. Método: Estudo descritivo e exploratório de abordagem qualitativa, realizado durante o período de março a setembro de 2014 cujas informações foram coletadas mediante entrevista semiestruturada. Participaram da pesquisa 17 enfermeiros gerentes. Os dados foram organizados no software Atlas.Ti© e analisados segundo a técnica de análise textual discursiva. Resultados: Emergiram três categorias: Organização e Condições de trabalho, Gestão de Pessoas e O Ser Gerente. Conclusão: Constatou-se que os gerentes vivenciam o sofrimento moral decorrente de situações conflituosas relacionadas às condições de trabalho, profissionais insubordinados, falta de autonomia, assédio moral e as múltiplas faces da função gerencial. Assim, buscou-se contribuir para área da saúde, nos aspectos de sensibilizar moralmente os profissionais para as atividades que desempenham e no tocante ao sofrimento moral

Objective: Describe generating situations and elements involved in moral distress process in nurse managers experience of a public hospital in southern Brazil. Method: Descriptive and exploratory study, nature of qualitative approach, conducted from march 2014 to september 2014 and whose information was collected through semi-structured interview. There was a participation of 17 nurses managers. Data were organized in the software Atlas. Ti© and analyzed according to the technique of discursive and textual analysis. Results: Three categories emerged: Organization and working conditions, People management, and Being the Manager. Conclusions: It was found that the managers experience moral distress arise from conflicting situations related to working conditions, insubordinate professionals, lacking of autonomy, psychological harassment and the multiple faces of the managerial function. Accordingly, it was sought to contribute to the health area, in the aspects of morally sensing the professionals for the activities they perform and regarding moral distress

Objetivo: Describir la generación de situaciones y elementos relacionados con el proceso de sufrimiento moral en enfermeros gerentes de un hospital público en el sur de Brasil. Método: Estudio descriptivo y exploratorio de enfoque cualitativo, realizado durante el período de marzo a septiembre de 2014 y cuyas informaciones fueron obtenidas por medio de entrevista semiestructurada. Participaron de la investigación 17 enfermeros gerentes. Los datos fueron organizados en el software Atlas.Ti© y analizados de acuerdo con el método de análisis textual discursiva. Resultados: Se desarrollarán tres categorías: Organización y Condiciones de trabajo, Gestión de personas, y el Ser Gerente. Conclusión: Se concluyó que los gerentes experimentan el sufrimiento moral resultante de situaciones conflictivas relacionadas con las condiciones de trabajo, profesionales insubordinados, falta de autonomía, acoso moral y las múltiples facetas de la función gerencial. Así, se buscó contribuir al área de la salud, en los aspectos de sensibilizar moralmente a los profesionales para las actividades que desempeñan y en lo tocante al sufrimiento moral

The role of frontline RNs in the selection of an electronic medical record business partner.

Frontline RNs knowledgeable in the strategic objectives of their organization made a difference in the selection of an electronic medical record business partner for a large, complex healthcare system. Their impact was significant because of the chief nurse executive's personal articulation of the organization's strategic goals and of her investment in their education. These factors provided the frontline RNs with a foundational base of knowledge about a variety of electronic medical record systems. The preparation and exposure enabled the frontline RNs to make a valuable contribution to the selection of an electronic medical record business partner. The RNs were a major force in affecting philosophical change from the organization's original pursuit of "best-of-breed" interfaced systems to a fully integrated, "best-of-class" vendor business partner. The learning experiences of the frontline RNs are explored to answer the following question: Why must frontline RNs play a key role in this process?

Getting the board on board: Engaging hospital boards in quality and patient safety.

BACKGROUND: Transformational change in health care calls on hospital boards of trustees to engage in quality ata level that has never been asked before. Yet little research has been conducted regarding the role of hospital governance in quality. METHODS: Interviews were conducted with chief executive officers (CEOs) and board chairpersons from aconvenient sample of 30 hospitals, representing 14 states across the United States. The interviews were 30 to 45 minutes in length and included approximately 30 questions that were open-ended and ratings based. RESULTS: The level of knowledge of landmark Institute of Medicine (IOM) quality reports among CEOs and board chairs was remarkably low. Conversely, board chairs and CEOs were well attuned to public reporting of quality information. There were significant differences between the CEOs' perception of the level of knowledge of their board chairs and the board chairs' self-perception. There was a mild association between board engagement in quality and hospital performance asdefined by their rates in their composite measure of heart failure, heart attack, and pneumonia. DISCUSSION: The engagement of hospital boards inquality can be enhanced by (1) increasing education on quality to increase the board's quality literacy; (2) improving the framing of an agenda for quality; (3) more quality planning, focus, and incentives for leadership and governance for quality improvement; and (4) greater focus on the patients. Implementing these steps can improve a hospital's overall performance.

Rural Illinois hospital chief executive officers' perceptions of provider shortages and issues in rural recruitment and retention.

BACKGROUND: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. PURPOSE: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. METHODS: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. FINDINGS: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. CONCLUSIONS: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention.

Acute care hospital strategic priorities: perceptions of challenges, control, competition and collaboration in Ontario's evolving healthcare system.

To explore the current and pending strategic agenda of Ontario hospitals (the largest consumers of the provincial healthcare budget), a survey of Ontario acute care hospital CEOs was conducted in January 2004. The survey, with an 82% response rate, identifies 29 strategic priorities under seven key strategic themes consistent across different hospital types. These themes include (1) human resources cultivation, (2) service integration and partnerships, (3) consumer engagement, (4) corporate governance and management, (5) organizational efficiency and redesign, (6) improved information use for decision-making, (7) patient care management. The extent to which an individual hospital's control over strategic resolutions is perceived may affect multilevel strategic priority-setting and action-planning. In addition to supporting ongoing development of meaningful performance measures and information critical to strategic decision-making, this study's findings may facilitate a better understanding of hospitals' key resource commitments, the extent of competition and collaboration for key resources, the perceived degree of individual control over strategic issue resolution and where systemic resolutions may be required.

Leapfrog Group: a prince in disguise or just another frog?

Executive directors, presidents, chief executive officers of some of the principal nursing organizations, and other nurse leaders in the United States were interviewed to ascertain their reactions to the recommendations of the Leapfrog Group, a coalition of more than 90 companies that employ large numbers of workers in the United States. The Leapfrog Group is concerned with patient safety and was formed in response to the Institute of Medicine's report on health care errors. Three recommendations for urban hospitals focus on computerized physician order entry, evidence-based hospital referral, and the use of intensivists.

Trabalho gerencial e processos intersubjetivos: uma experiência com diretores de hospitais públicos / Managerial work and intersubjective processes: an experimental project with directors of public hospitals

Faz uma reflexäo sobre a experiência do Laboratório de Práticas Gerenciais em Organizaçöes de Saúde, desenvolvida na Escola Nacional de Saúde Pública da Fundaçäo Oswaldo Cruz, como parte de uma linha de trabalho voltada para a análise dos processos intersubjetivos nas organizaçöes, particularmente no âmbito dos serviços públicos de saúde. Trata-se de uma experiência piloto, iniciada em abril de 2000, com diretores de hospitais públicos do Rio de Janeiro, e objetiva possibilitar a esses gestores refletir e explorar suas vivências sobre a dinâmica organizacional, enfocando particularmente os processos de mudança, a incerteza quanto a seus resultados e as dimensöes afetiva, imaginária e inconsciente nas organizaçöes. Desta perpectiva, destacam-se as problemáticas do exercício da liderança e dos limites e possibilidades da construçäo de projetos coletivos. O projeto apóia-se essencialmente na abordagem psicossociológica das organizaçöes, especialmente representada pelas contribuiçöes de Eugène Enriquez, bem como nos aportes da teoria psicanalítica, para a compreensäo dos processos grupais e institucionais. Busca também a interlocuçäo entre estes referenciais teóricos e os do campo organizacional. Neste sentido, as contribuiçöes de Alain Chanlat e Henry Mintzberg também säo uma referência.

Grading the graders: how hospitals in California and New York perceive and interpret their report cards.

BACKGROUND: Concerns about quality of care are increasing as hospitals struggle to lower costs. Hospital report cards are controversial, but little is known about their impact. OBJECTIVES: To determine whether recent hospital report cards are viewed more favorably than pioneering federal efforts; whether a report based on clinical data is viewed more favorably than one based on administrative data; and whether attitudes toward report cards are related to hospital characteristics. DESIGN: Mailed survey of chief executives at 374 California hospitals and 31 New York hospitals listed in report cards on myocardial infarction and coronary bypass mortality. SUBJECTS: Two-hundred-and-seventy-four hospitals in California (73.3% response) and 27 in New York (87.1% response). California hospitals were categorized on ownership, size, occupancy, risk-adjusted mortality, teaching status, patient volume, and surgical capability. MEASURES: Number of hospital units that received or discussed the report card, ratings of its quality, perceptions of its usefulness, and knowledge of its methods. RESULTS: In both states, report cards were widely disseminated within hospitals. The mean quality rating was higher (P = 0.0074) in New York than in California; New York respondents appeared to be more knowledgeable about key methods. One or more hospital characteristics was associated with each outcome measure. Leaders at high-mortality hospitals were especially critical and did not find the report useful, despite limited understanding of its methods. CONCLUSIONS: Recent hospital report cards were rated better than pioneering federal efforts. A report based on clinical data was rated better, understood better, and disseminated more often to key staff than one that was based on administrative data. Barriers to constructive use of outcomes data persist, especially at high mortality hospitals.

Gerência em saúde e concepçöes sobre a natureza humana nas organizaçöes: a visäo dos diretores de hospitais gerais do município de Campinas / Management in health and conceptions about the human nature in organizations: the general hospitals directors views in Campinas city

Trata da gerência em saúde e concepçöes da natureza humana na organizaçäo. Aponta várias dimensöes reveladoras como envolvimento no trabalho, conceitos sobre a organizaçäo e poder. Caracteriza as principais atitudes inter-humanas