Construção de procedimento operacional padrão como ferramenta facilitadora de gestão em saúde em uma faculdade de odontologia / Construction of standard operating procedure as a facilitating tool for health management in a school of dentistry / Construcción de procedimiento operativo estándar como herramienta facilitadora para la gestión en salud en una facultad de odontología

O Procedimento Operacional Padrão é uma relevante ferramenta de gestão para otimizar o processo de trabalho dentro da perspectiva da resolutividade definida nos princípios do Sistema Único de Saúde.Objetivo:elaborar um Procedimento Operacional Padrãopara estandardizar o funcionamento do fluxo de materiais do almoxarifado da Faculdade de Odontologia da Universidade Federal do Pará. Metodologia:Estudo descritivo que propôs a criação de uma ferramenta de tecnologia leve dividido em três etapas: aprofundamento teórico, elaboração e refinamento. Resultados:A equipe envolvida no processo de trabalho da unidade de saúde colaborou com a construção do instrumento, favorecendo o estabelecimento de vínculo e assertividade. O Procedimento Operacional Padrãoelaborado constitui subsídio para organização do fluxo com o objetivo de esclarecer, facilitar e padronizar o uso do almoxarifado, promovendo estratégias de uso adequado no manejo dos materiais e a racionalização dos mesmos, com a finalidade de tirar máximo proveito e reduzir custos. Conclusões:A elaboração da ferramenta promoveu aprimoramento do processo de trabalho no manejo dos materiais e equipamentos odontológicos. A participação dos sujeitos envolvidos gerou fortalecimento do vínculo e co-responsabilização (AU).

The Standard Operating Procedure is a relevant management tool to optimizethe work processwithin the perspective of resolution as defined in the Unified Health Systemprinciples.Objective:to elaborate a Standard Operating Procedureto standardize the flow use of materials in the storeroom of the College of Dentistry of the Federal University of Pará.Methodology:Descriptive study which proposed the creation of a soft technology tool divided into three stages: theoretical deepening, elaboration and refinement. Results:The team involved in the health center'swork process collaborated with the development of the instrument, promoting the establishment of bonding and assertiveness. The elaborated Standard Operating Procedureconstitutes subsidy for the organization of the flow with the goal of clarifying, facilitating and standardizing the use of the storeroom, promoting strategies of adequate use in the handling of materials and the rationalization of them, in order to take full advantage and reduce costs. Conclusions:The tool elaborationpromoted the improvement of the work process in the handling of dental materials and equipment. The participation of the health center's team strengthened the bond and co-responsibility (AU).

El Procedimiento Operativo Estándar es una herramienta de gestiónrelevante para optimizar el proceso de trabajo en la perspectiva de resolución definida en los principios del Sistema Único de Salud.Objetivo: desarrollar un Procedimiento Operativo Estándarpara estandarizar el flujo de materiales en el almacén de la Facultad de Odontología de la Universidad Federal de Pará. Metodología: Estudio descriptivo que propuso la creación de una herramienta de tecnología liviana dividida en tres etapas: profundización teórica, elaboración y refinamiento. Resultados: El equipo involucrado en el proceso de trabajo delaunidad de saludcolaboró con la construcción del instrumento, favoreciendo el establecimiento de un vínculoe asertividad. El Procedimiento Operativo Estándarelaboradoconstituyesubsidio para la organización del flujo con el objetivo de aclarar, facilitar y estandarizar el uso del almacén, promover estrategias de uso adecuado en el manejo de los materiales y la racionalización de los mismos, con el fin de aprovechar al máximo y reducir los costos.Conclusiones: La elaboración de la herramienta promovió la mejora del proceso de trabajo en el manejo de materiales y equipos odontológicos. La participación de los sujetos involucrados fortaleció el vínculo y la corresponsabilidad (AU).

Eventos adversos e incidentes notificados em um centro de materiais e esterilização / Adverse events and incidents reported in a materials and sterilization center

Objetivo: Caracterizar as notificações dos incidentes e eventos adversos do Centro de Material e Esterilização (CME) de um hospital de ensino. Método: Estudo retrospectivo, documental, descritivo e quantitativo em um CME classe II, em que foram analisadas as notificações contidas no banco de dados do Núcleo do Sistema de Gestão da Qualidade e Segurança do paciente, entre 2016 e 2020. Como técnica de análise dos dados coletados, utilizou-se o diagrama de causa e efeito, e a descrição das notificações foram agrupadas conforme o diagrama de 6M: método; material; mão de obra; máquina; medida; e meio ambiente. Resultados: Entre as notificações realizadas, as variáveis matéria-prima e método foram as que mais geraram incidentes durante todo o período, representando 28,54 e 26,44%, respectivamente. Além disso, o Centro Cirúrgico foi o que mais notificou e foi notificado pelo CME. Conclusão: Foi possível conhecer os incidentes que mais predominam no CME da instuição, e as variáveis materiais e método, com o centro cirúrgico, foram as variáveis e setor que mais geraram notificações no período pesquisado (AU)

Key Characteristics of a Fragile Healthcare Supply Chain: Learning from a Pandemic.

The COVID-19 pandemic has highlighted the many challenges that provincial health systems have experienced while scaling health services to protect Canadians from viral transmission and support care for those who get infected. Supply chain capacity makes it possible for health systems to deliver care and implement public health initiatives safely. In this paper, we present emerging findings from a national research study that documents the key features of the fragility of the health supply chain evident across the seven Canadian provinces. Results suggest that the fragility of the health supply chain contributes to substantive challenges across health systems, thus limiting or precluding proactive and comprehensive responses to pandemic management. These findings inform strategies to strengthen supply chain capacity and performance in order to enable health systems to effectively respond to pandemic events.

Logistics of an advanced therapy medicinal product during COVID-19 pandemic in Italy: successful delivery of mesenchymal stromal cells in dry ice.

BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic, Italian hospitals faced the most daunting challenges of their recent history, and only essential therapeutic interventions were feasible. From March to April 2020, the Laboratory of Advanced Cellular Therapies (Vicenza, Italy) received requests to treat a patient with severe COVID-19 and a patient with acute graft-versus-host disease with umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Access to clinics was restricted due to the risk of contagion. Transport of UC-MSCs in liquid nitrogen was unmanageable, leaving shipment in dry ice as the only option. METHODS: We assessed effects of the transition from liquid nitrogen to dry ice on cell viability; apoptosis; phenotype; proliferation; immunomodulation; and clonogenesis; and validated dry ice-based transport of UC-MSCs to clinics. RESULTS: Our results showed no differences in cell functionality related to the two storage conditions, and demonstrated the preservation of immunomodulatory and clonogenic potentials in dry ice. UC-MSCs were successfully delivered to points-of-care, enabling favourable clinical outcomes. CONCLUSIONS: This experience underscores the flexibility of a public cell factory in its adaptation of the logistics of an advanced therapy medicinal product during a public health crisis. Alternative supply chains should be evaluated for other cell products to guarantee delivery during catastrophes.

[Medical Consumable Management System Research under the New Situation].

With the continuous improvement of the difficulty of surgery, we need to investigate and analyze the current situation, to understand the structure and related attributes of medical consumables. Rely on the information construction of medical consumables; Improve the supervision method and further improve the refined management effect; Establish multi-modal procurement management; Improve management methods; Maximize the benefits of transformation structure and study the trace management of medical consumables in the key areas of the hospital's full life process at the same time. Provide data decision-making services for hospitals through the early warning management of medical consumables based on clinical quality management, and use tools such as HB-HTA to further construct a reasonable evaluation system for medical consumables.

Resource husbandry in challenging times.

Coronavirus disease 2019 (COVID-19) pandemic has put a huge pressure on healthcare systems across the globe, more so in developing countries. Not only patients of acute febrile illness and respiratory problems but also patients with other acute and chronic diseases are facing challenges while seeking healthcare, getting laboratory investigations done and obtaining medications. Healthcare workers have their challenges including limited resources, lack of personal protective equipments, and fear of contracting COVID-19. Resource husbandry, which refers to the judicious use of available stocks, is a vital concept that needs to be promoted during such challenging times to combat the shortage of medical resources while simultaneously providing effective treatment to the patients. Some easily implementable concepts of resource husbandry can have a significant impact and result in minimising trouble for many patients during a challenging time.

Gestión de recursos materiales "Guía para la aproximación diagnóstica de una unidad hospitalaria" / Material resource management "Guide for the diagnostic approach of a hospital unit" / Gerenciamento de recursos materiais "Guia para a abordagem diagnóstica de uma unidade hospitalar"

La complejidad en la administración de las Organizaciones Sanitarias requiere de un profundo conocimiento de sus componentes políticos, sociodemográficos, económicos, de sus procesos, interrelaciones, determinantes ambientales, factores internos y externos que se relacionan entre sí para el logro de los objetivos, todos orientados al cuidado de la salud de la población. El escenario actual evidencia instituciones de salud cada vez más complejas, debido al aumento en la demanda de los servicios, las expectativas de los usuarios y los costos de los insumos para la atención, generando la necesidad de contar con personal de enfermería capacitado y entrenado en los sistemas que dan apoyo y sustentan el proceso asistencial. Profundizar en el conocimiento de la gestión de los recursos materiales como sistema o como proceso que transversaliza el proceso asistencial es un punto de partida para el logro con eficacia y eficiencia de los resultados sanitarios. El Departamento de Administración de la Facultad de Enfermería, en el marco del Programa de formación permanente, organizó el curso "Gestión de los recursos materiales para la mejora en la calidad de atención". La finalidad fue dar respuesta a una necesidad identificada por el departamento y sentida por el colectivo de Enfermería de capacitar a quienes se desempeñan en las distintas áreas de gestión de los recursos materiales, para contribuir en la calidad del cuidado a la población. En este sentido uno de los procesos claves abordados en el curso y que se quiere socializar en este artículo fue una "Guía para realizar la aproximación diagnóstica de una unidad de gestión de recursos materiales", aplicando la teoría de sistemas como metodología para su consolidación. A partir de la realidad diagnóstica obtenida, identificar fortalezas y debilidades del Servicio en que se aplique y poder desarrollar un proyecto de mejora de la calidad.

The complexity in the administration of the Health Organizations requires a deep knowledge of its political, sociodemographic, economic components, of its processes, interrelationships, environmental determinants, internal and external factors that are related to each other to achieve the objectives, all oriented to the health care of the population. The current scenario shows increasingly complex health institutions, due to the increase in the demand for services, the expectations of users and the costs of the inputs for care, generating the need for trained and trained nursing personnel systems that support and sustain the care process. Deepening knowledge of the management of material resources as a system or as a process that mainstreams the healthcare process is a starting point for the effective and efficient achievement of health outcomes. The Administration Department of the Nursing Faculty, within the framework of the Ongoing Training Program, organized the course "Management of material resources for the improvement of quality of care". The purpose was to respond to a need identified by the department and felt by the nursing collective to train those who work in the different areas of material resource management, to contribute to the quality of care for the population. In this sense, one of the key processes addressed in the course and that we want to socialize in this article was a "Guide to carry out the diagnostic approach of a material resource management unit", applying systems theory as a methodology for its consolidation. Based on the diagnostic reality obtained, identify strengths and weaknesses of the Service in which it is applied and be able to develop a quality improvement project.

A complexidade na administração das Organizações de Saúde exige um profundo conhecimento de seus componentes políticos, sociodemográficos, econômicos, de seus processos, inter-relações, determinantes ambientais, fatores internos e externos que se relacionam para alcançar os objetivos, todos orientados aos cuidados de saúde da população. O cenário atual mostra instituições de saúde cada vez mais complexas, devido ao aumento da demanda por serviços, das expectativas dos usuários e dos custos dos insumos para o atendimento, gerando a necessidade de pessoal de enfermagem treinado e treinado sistemas que apóiam e sustentam o processo de atendimento. Aprofundar o conhecimento do gerenciamento de recursos materiais como um sistema ou como um processo que integra o processo de assistência à saúde é um ponto de partida para a obtenção eficaz e eficiente dos resultados da saúde. O Departamento de Administração da Faculdade de Enfermagem, no âmbito do Programa de Treinamento Contínuo, organizou o curso "Gestão de recursos materiais para melhorar a qualidade da assistência". O objetivo foi responder a uma necessidade identificada pelo departamento e sentida pelo coletivo de enfermagem para capacitar quem trabalha nas diferentes áreas de gestão de recursos materiais, a fim de contribuir para a qualidade da assistência à população. Nesse sentido, um dos principais processos abordados no curso e que queremos socializar neste artigo foi um "Guia para realizar a abordagem diagnóstica de uma unidade de gerenciamento de recursos materiais", aplicando a teoria dos sistemas como metodologia para sua consolidação. Com base na realidade diagnóstica obtida, identificar os pontos fortes e fracos do Serviço em que é aplicado e ser capaz de desenvolver um projeto de melhoria da qualidade.

Improving hospital pharmacy inventory management using data segmentation.

PURPOSE: This case study describes the development and empirical validation of an easy-to-implement practical framework for improving hospital pharmacy inventory management. SUMMARY: Research suggests various inventory optimization models, which can lead to cost reductions while maintaining adequate service levels; however, they are facing limited adoption in healthcare settings. The main barriers appear to be the high effort and complexity of implementation, the dependence on data that are not available or might not be in the right form, and the one-size-fits-all approach often followed without addressing healthcare sector-specific particularities. A research framework was developed by adapting relevant inventory models to the healthcare context using the concept of data segmentation on the basis of a three-dimensional classification of hospital pharmacy inventory items based on their relative importance, clinical criticality, and consumption pattern. Suitable replenishment policies were assigned to high-impact classes, and an integrated performance-measurement component assesses the framework's effectiveness. The suggested approach was implemented and empirically tested at the pharmacy of a large public hospital using longitudinal data. The results demonstrate substantial improvements with respect to all of the selected key performance indicators and translate into inventory cost savings due to reduced stockholding costs and better synchronization of inventories to demand. CONCLUSION: Use of standard software functionalities combined with targeted data segmentation efforts significantly improves hospital pharmacy inventory cost performance.

Associations Between Practices and Behaviors at the Health Facility Level and Supply Chain Management for Antiretrovirals: Evidence from Cameroon, Namibia, and Swaziland.

BACKGROUND: While measuring, monitoring, and improving supply chain management (SCM) for antiretrovirals (ARVs) is understood at many levels of health systems, a gap remains in the identification and measurement of facility-level practices and behaviors that affect SCM. This study identifies practices and behaviors that are associated with SCM of ARVs at the hospital level and proposes new indicators for measurement. METHODS: We performed an in-depth literature review to identify facility-level practices and behaviors and existing indicators that are associated with SCM. We used the United States Agency for International Development's 2013 National Supply Chain Assessment Toolkit to define 7 supply chain function areas to frame the study. Qualitative, semistructured key informant and focus group interviews were conducted in hospitals with health professionals from Cameroon, Namibia, and Swaziland to understand facility-level practices and behaviors. RESULTS: Using the results from 54 key informant and focus group interviews from 12 hospitals, we identified 30 practices and behaviors that may affect ARV SCM at the facility level. The following practice areas were particularly associated with SCM: order verification, actions taken when ARV stock is received, changes in prescription and dispensing due to ARV stock-out, actions to ensure patient adherence, and communication with other affiliated facilities and higher-level SCM. We subsequently developed measurable indicators for future research. CONCLUSION: This study characterizes facility-level practices and behaviors that can affect ARV SCM. It also identifies gaps in their measurement. While this study uses ARVs as a tracer medicine to understand gaps in practices at the facility level, many of the findings are more broadly applicable to other medicines in an integrated setting. This study provides real-world evidence and the groundwork for further research to characterize the link between 30 facility-level practices and behaviors and ARV SCM at the facility and central levels.

Implementation and Evaluation of a RFID Smart Cabinet to Improve Traceability and the Efficient Consumption of High Cost Medical Supplies in a Large Hospital.

The efficiency of a smart cabinet with RFID technology to improve the information about inventory management for cardiothoracic surgery as well as for time savings, was assessed in a large reference hospital. In a 6-month study, the implemented operational RFID process (StocKey® Smart Cabinet) consisted of: i) product reception, registration and labelling in the general warehouse; ii) product storage in the cabinet and registered as inputs by radiofrequency; iii) products registered as outputs as required for surgery; iv) product assignment to a patient in the operating room; and v) return of products not used to the cabinet. Stock-outs, stock mismatches, urgent restocking, assignment of high-value medical products to patients, and time allocated by the supervisory staff to the stock management, were assessed on a monthly basis. 0% stock-outs and 0% stock mismatches using RFID were observed during the study. Monthly percentages of products requiring urgent restocking ranged from 0% to 13.3%. No incorrect assignments to patients of surgery products or prostheses were detected. The percentage of correct assignments increased from 36.1%-86.1% to 100% in the first 4-5 months. The total average time allocated by the supervisory staff to the whole logistic chain was reduced by 58% (995 min with the traditional manual system vs. 428 min with RFID). The RFID system showed the ability to monitor both the traceability and consumption per patient of high-value surgery products as well as contributed to significant time savings.

Hospital Supply Expenses: An Important Ingredient in Health Services Research.

The purpose of this article is to shed light on hospital supply expenses, which form the second largest expense category after payroll and hold more promise for improving cost-efficiency compared to payroll. However, limited research has rigorously scrutinized this cost category, and it is rarely given specific consideration across cost-focused studies in health services publications. After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over 3,500 U.S. hospitals. We find supply expenses to make up 15% of total hospital expenses, on average, but as high as 30% or 40% in hospitals with a high case-mix index, such as surgery-intensive hospitals. Future research can use supply expense data to better understand hospital strategies that aim to manage costs, such as systemization, physician-hospital arrangements, and value-based purchasing.

Analysis of Factors Influencing Hospitals' Implementation of a Green E-Procurement System Using a Cloud Model.

Currently, the green procurement activities of private hospitals in Taiwan follow the self-built green electronic-procurement (e-procurement) system. This requires professional personnel to take the time to regularly update the green specification and software and hardware of the e-procurement system, and the information system maintenance cost is high. In the case of a green e-procurement system crash, the efficiency of green procurement activities for hospitals is affected. If the green e-procurement can be moved to a convenient and trusty cloud computing model, this will enhance the efficiency of procurement activities and reduce the information maintenance cost for private hospitals. However, implementing a cloud model is an issue of technology innovation application and the technology-organization-environment (TOE) framework has been widely applied as the theoretical framework in technology innovation application. In addition, finding the weight of factors is a multi-criteria decision-making (MCDM) issue. Therefore, the present study first collected factors influencing implementation of the cloud mode together with the TOE as the theoretical framework, by reviewing the literature. Therefore, an expert questionnaire was designed and distributed to top managers of 20 private hospitals in southern Taiwan. The fuzzy analysis hierarchical process (FAHP), which is a MCDM tool, finds the weights of the factors influencing private hospitals in southern Taiwan when they implement a cloud green e-procurement system. The research results can enable private hospitals to successfully implement a green e-procurement system through a cloud model by optimizing resource allocation according to the weight of each factor. In addition, the results of this research can help cloud service providers of green e-procurement understand users' needs and develop relevant cloud solutions and marketing strategies.

Implantação da padronização de fios de sutura em hospital militar / Implementation of suture standardization in a military hospital

No mercado brasileiro, há muitos fabricantes e inúmeros tipos diferentes de fios de sutura. O que corrobora com uma demanda crescente de procedimentos nos hospitais. Seus recursos limitados levaram a elaboração deste estudo de caso sobre a implantação da padronização dos fios de sutura em um hospital militar para simplificar os processos de aquisição e controle de estoque, mantendo a qualidade do material. Para a definição das suturas, foram coletados os dados de consumo extraído do programa de gestão do hospital, SGH, e a partir de entrevistas semiestruturadas com representantes dos profissionais que utilizam o produto na instituição. Foi feito análise do conteúdo das entrevistas e dividido entre as categorias: caracterização, questões sobre os procedimentos realizados, fios de sutura utilizados e análise técnica. Foram retirados da padronização três itens, padronizados 90 fios e 21 deles foram sugeridos para análise à inclusão e serão incluídos nos futuros processos licitatórios. O estudo gerou um manual para fios de suturas no hospital contendo: novas fichas padronizadas para auxílio na distribuição, uso e faturamento dos fios de sutura por cada clínica cirúrgica; relação dos procedimentos cirúrgicos divididos pela clínica que realiza, com seu respectivo código de faturamento; e estruturação do documento padrão para análise técnica das suturas, antes ou após a aquisição. O manual trouxe melhorias na gestão desses itens, facilitando e aumentando a qualidade dos processos licitatórios, reduzirá problemas relacionados ao desabastecimento de itens, problemas com sua identificação e cobrança pelos procedimentos cirúrgicos. Além disso, promoverá maior estruturação para ações de tecnovigilância no hospital, integrando o corpo clínico às avaliações técnicas da qualidade desses produtos

There are many producers and countless diferent kinds of sutures. The increasing demand of health procedures and the resource-limited conditions led to elaboration of this case study about the deploiment of suture selection at this military hospital. The aim was making easier the purchasing process and inventory control, in the same time to keep the device quality. The suture setting, it was collected data of the expentidure from the hospital management software and through semistructured interviews with representatives of the prescriptors who used to make surgicals and similar procedures, it is, doctors and dentists. The data gathered was setted up in categories ­ profiling, questions about the surgical procedures, sutures used and technical analysis. The study generated a manual for sutures in hospital containing: new standardized tokens for distribution aid, reassessed standardization, removing three types of sutures and including 21 new sutures for the upcoming bids; use and billing of the sutures for each surgical clinic; relation of the surgical procedures divided by the clinic that performs, with its respective billing code; and structuring of the standard document for technical analysis of the sutures before or after acquisition. The research about the current status of sutures lead suture management improvement. It eased and increased quality of public bids, supply schedule, safety stock lever, billing and reduced shortage risks

Optimizing Endoscope Reprocessing Resources Via Process Flow Queuing Analysis.

The Massachusetts General Hospital (MGH) is merging its older endoscope processing facilities into a single new facility that will enable high-level disinfection of endoscopes for both the ORs and Endoscopy Suite, leveraging economies of scale for improved patient care and optimal use of resources. Finalized resource planning was necessary for the merging of facilities to optimize staffing and make final equipment selections to support the nearly 33,000 annual endoscopy cases. To accomplish this, we employed operations management methodologies, analyzing the physical process flow of scopes throughout the existing Endoscopy Suite and ORs and mapping the future state capacity of the new reprocessing facility. Further, our analysis required the incorporation of historical case and reprocessing volumes in a multi-server queuing model to identify any potential wait times as a result of the new reprocessing cycle. We also performed sensitivity analysis to understand the impact of future case volume growth. We found that our future-state reprocessing facility, given planned capital expenditures for automated endoscope reprocessors (AERs) and pre-processing sinks, could easily accommodate current scope volume well within the necessary pre-cleaning-to-sink reprocessing time limit recommended by manufacturers. Further, in its current planned state, our model suggested that the future endoscope reprocessing suite at MGH could support an increase in volume of at least 90% over the next several years. Our work suggests that with simple mathematical analysis of historic case data, significant changes to a complex perioperative environment can be made with ease while keeping patient safety as the top priority.

Clinically Integrated Supply Chain Infrastructure in Health Systems: The Opportunity to Improve Quality and Safety.

Health systems worldwide are challenged by the growing costs and demands of delivering high-quality healthcare services that are safe and cost-effective to support health and wellness for populations. This paper proposes a system-level transformation of clinical environment infrastructure to advance quality and strengthen patient safety at sustainable costs. Evidence of the impact and value of the clinically integrated supply chain strategy is emerging in three global health systems: Alberta Health Services (Canada), Mercy (US) and the National Health Service (UK) to inform a strategic roadmap for health system leaders to leverage supply chain infrastructure in clinical environments as a strategic asset to strengthen quality, safety and cost.

Case Study: Supply Chain Transformation in the UK National Health Service.

This case study provides evidence of the impact of the Scan4Safety program demonstrated in six National Health Service (NHS) Trusts, funded to achieve supply chain transformation to improve safety, quality and performance in the NHS in England. All 154 Trusts were mandated to adopt GS1 global standards for supply chain processes and Pan-European Public Procurement On-Line standards in 2014 to enable digital transactions across the NHS. The outcomes of this case reflect the early implementation of the program infrastructure in surgical theatre and cardiac programs. Outcomes include a 4:1 return on investment and projected savings of £1 billion pounds when scaled across the NHS.