A Policy Analysis of Legally Required Supervision of Nurse Practitioners and Other Health Professionals.

The use of legally required supervision occurs across health professionals who provide similar services. Legally required supervision has the potential to disrupt the production of high-quality, cost-efficient, accessible health services across disciplines. This paper examines the effects of nurse practitioner collaborative practice agreements and similar models of health professional regulation, defined as legally required supervision, on the cost and delivery of health services. A policy analysis examines empirical, policy, and law literature between two health professionals providing a similar service. Analysis includes literature on dental hygienists, dentists, certified registered nurse anesthetists, midwives, nurse practitioners, physicians, and pharmacists. A framework for legally required supervision across health professionals is presented. Antecedents of legally required supervision include occupational licensure, reimbursement policy, and institutional policy. Legally required supervision inhibits provider entry to practice and the production of health services by supervised providers. The cost of care increases under legally required supervision. Costs are measured by wages for providers and the price of services for patients. This paper and proposed framework summarize the antecedents and consequences of legally required supervision. Discipline-specific antecedents and provider characteristics must be considered when calculating the full effect of legally required supervision on the delivery and cost of health services.

Anesthesia residents' global (departmental) evaluation of faculty anesthesiologists' supervision can be less than their average evaluations of individual anesthesiologists.

BACKGROUND: Faculty anesthesiologists' supervision of anesthesiology residents is required for both postgraduate medical education and billing compliance. Previously, using the de Oliveira Filho et al. supervision question set, De Oliveira et al. found that residents who reported mean department-wide supervision scores <3.0 ("frequent") reported a significantly more frequent occurrence of mistakes with negative consequences to patients, as well as medication errors. In our department, residents provide daily evaluations of the supervision received by individual faculty. Using a survey study, we compared relationships between residents' daily supervision scores for individual faculty anesthesiologists and residents' supervision scores for the entire department (comprised these faculty). METHODS: We studied all anesthesiology residents in clinical years 1, 2, and 3 (i.e., neither in the "base year" nor in fellowship). There were daily evaluations of individual faculty supervision of operative anesthesia for 36 weeks. Residents clicked a hyperlink on the invitation e-mail taking them to a secure Web page to provide their global (departmental) assessment of faculty supervision. We calculated the ratio of each resident's global (departmental) faculty supervision score (i.e., mean among 9 questions × 1 evaluation) to the same resident's daily evaluations of individual faculty (i.e., mean among 9 questions × many evaluations). RESULTS: All 39 of 39 residents chose to participate. The mean departmental supervision score was significantly less (P < 0.0001) than the mean of individual faculty scores. The median ratio of scores was 86% (95% confidence interval, 83%-89%). Kendall's rank correlation between global and (mean) individual faculty scores was τb = 0.34 ± 0.11 (P = 0.0032). The ratios were uniformly distributed (P = 0.64) between the observed minimums and maximums; were not correlated with the mean value of individual faculty scores previously provided by each resident (P = 0.64); were not correlated with the number of individual faculty evaluations previously provided by each resident (P = 0.49); and did not differ among the first, second, or third year residents (P = 0.37). CONCLUSIONS: Residents' perceptions of overall (departmental) faculty supervision were less than overall averages of their perceptions of individual faculty supervision. This should be considered when interpreting national survey results (e.g., of patient safety), residency program evaluations, and individual faculty anesthesiologist performance.

A process evaluation of performance-based incentives for village health workers in Kisoro district, Uganda.

BACKGROUND: Designing effective incentive systems for village health workers (VHWs) represents a longstanding policy issue with substantial impact on the success and sustainability of VHW programs. Using performance-based incentives (PBI) for VHWs is an approach that has been proposed and implemented in some programs, but has not received adequate review and evaluation in the peer-reviewed literature. We conducted a process evaluation examining the use of PBI for VHWs in Kisoro, Uganda. In this system, VHWs are paid based on 20 indicators, divided among routine follow-up visits, health education activities, new patient identifications, sanitation coverage, and uptake of priority health services. METHODS: Surveys of VHWs (n = 30) and program supervisors (n = 7) were conducted to assess acceptability and feasibility. Interviews were conducted with all 8 program supervisors and with 6 purposively selected VHWs to gain a deeper understanding of their views on the PBI system. Program budget records were used to assess the costs of the program. Detailed payment records were used to assess the fairness of the PBI system with respect to VHWs' gender, education level, and village location. RESULTS: In surveys and interviews, supervisors expressed high satisfaction with the PBI system, though some supervisors expressed concerns about possible negative effects from the variation in payments between VHWs and the uncertainty of reward for effort. VHWs perceived the system as generally fair, and preferred it to the previous payment system, but expressed a desire to be paid more. The annual program cost was $516 per VHW, with each VHW covering an average of 115 households. VHWs covering more households tended to earn more. There was some evidence that female gender was associated with higher earnings. Education level and proximity to the district hospital did not appear to be associated with earnings under the PBI system. CONCLUSIONS: In a one-year pilot of PBI within a small VHW program, both VHWs and supervisors found the PBI system acceptable and motivating. VHWs with relatively limited formal education were able to master the PBI system. Further research is needed to determine the long-term effects and scalability of PBI, as well as the effects across varied contexts.

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes.

OBJECTIVE: To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts. DESIGN: This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts. RESULTS: This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme. CONCLUSION: Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts.

Hope and despair: community health assistants' experiences of working in a rural district in Zambia.

BACKGROUND: In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work. METHODS: A phenomenological approach was used to examine CHAs' experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach. RESULTS: Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs' ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs' ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA's self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs' ability to deliver services. CONCLUSIONS: Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

BACKGROUND: Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. METHODS: The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. RESULTS: In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. CONCLUSIONS: The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

More than a checklist: a realist evaluation of supervision of mid-level health workers in rural Guatemala.

BACKGROUND: Mid-level health workers (MLHWs) form the front-line of service delivery in many low- and middle-income countries. Supervision is a critical institutional intervention linking their work to the health system, and it consists of activities intended to support health workers' motivation and enable them to perform. However its impact depends not only on the frequency of these activities but also how they are carried out and received. This study aims to deepen understanding of the mechanisms through which supervision activities support the performance of auxiliary nurses, a cadre of MLHWs, in rural Guatemala. METHODS: A multiple case study was conducted to examine the operation of supervision of five health posts using a realist evaluation approach. A program theory was formulated describing local understanding of how supervision activities are intended to work. Data was collected through interviews and document review to test the theory. Analysis focused on comparison of activities, outcomes, mechanisms and the influence of context across cases, leading to revision of the program theory. RESULTS: The supervisor's orientation was identified as the main mechanism contributing to variation observed in activities and their outcomes. Managerial control was the dominant orientation, reflecting the influence of standardized performance criteria and institutional culture. Humanized support was present in one case where the auxiliary nurse was motivated by the sense that the full scope of her work was valued. This orientation reflected the supervisor's integration of her professional identity as a nurse. CONCLUSIONS: The nature of the support health workers received was shaped by supervisors' orientation, and in this study, nursing principles were central to humanized support. Efforts to strengthen the support that supervision provides to MLHWs should promote professional ethos as a means of developing shared performance goals and orient supervisors to a more holistic view of the health worker and their work.

Internship logistics: successfully navigating the internship process.

This article, the second in the series, is designed to help medical practices understand how the internship process works. This article helps practice managers perform a needs analysis in order to determine if a student intern is appropriate, provides tools to help structure the internships and forms to evaluate the process, and identifies ways for the practice to avoid legal pitfalls when "employing" interns.

Projeto rinepe: 15 anos de ações de extensão por meio de um diálogo interdisciplinar e intercultural / Rinepe project: 15 years of extension actions through interdisciplinary and intercultural dialogue

O presente relato apresenta o Projeto Rinepe (Rede Internacional de Estudos e Pesquisas sobre Liderança e Empreendedorismo) a partir da sistematização de atividades desenvolvidas no âmbito do projeto ao longo de seus quinze anos de atuação no contexto acadêmico e social. Liderança, Empreendedorismo e outros temas relacionados à Psicologia do Trabalho e das Organizações, à Administração e à Gestão de Pessoas são abordados no escopo do nomeado projeto. Enquanto um projeto de ações acadêmicas tem um papel relevante na formação de estudantes de graduação em diversas áreas. A partir de pesquisa documental, este relato apresenta as atividades de extensão realizadas, as pesquisas desenvolvidas, as participações em eventos científicos e sua articulação com o ensino, além das parcerias acadêmicas nacionais e internacionais firmadas pelo projeto. Com base no levantamento de atividades desempenhadas desde o ano de fundação e de sua subsequente análise, conclui-se que o projeto Rinepe se consolida, ao longo do tempo, como um espaço para o desenvolvimento de estudos, pesquisas e práticas inéditos ou sua atualização à luz de novas experiências, o que resulta em uma contribuição para a Psicologia do Trabalho e das Organizações, bem como para a área da Gestão de Pessoas, a partir de uma perspectiva interdisciplinar e intercultural

This report presents the Rinepe Project (International Network of Studies and Research on Leadership and Entrepreneurship) based upon a systematization of activities that were developed within the scope of the project over its fifteen years of activity in the academic and social context. Leadership, Entrepreneurship and several other topics related to Work and Organizational Psychology, Administration and People Management are addressed within the scope of the named project. While a project of academic actions has a relevant role in the training of undergraduate students in several areas. Based on documentary research, this report presents the extension activities and researches carried out as well as the participation in scientific events and their articulation with teaching, in addition to the national and international academic partnerships signed by the project. Based on the survey of activities carried out since the year of its foundation and on its subsequent analysis, it is concluded that the Rinepe project has consolidated itself, over time, as a space for the development of studies, research and practices or their updating through new experiences, what contributed to the Psychology of Work and Organizations, as well as to the area of People Management, regarding an interdisciplinary and intercultural perspective.

The Complexity Of Billing And Paying For Physician Care.

The administrative costs of providing health insurance in the US are very high, but their determinants are poorly understood. We advance the nascent literature in this field by developing new measures of billing complexity for physician care across insurers and over time, and by estimating them using a large sample of detailed insurance "remittance data" for the period 2013-15. We found dramatic variation across different types of insurance. Fee-for-service Medicaid is the most challenging type of insurer to bill, with a claim denial rate that is 17.8 percentage points higher than that for fee-for-service Medicare. The denial rate for Medicaid managed care was 6 percentage points higher than that for fee-for-service Medicare, while the rate for private insurance appeared similar to that of Medicare Advantage. Based on conservative assumptions, we estimated that the health care sector deals with $11 billion in challenged revenue annually, but this number could be as high as $54 billion. These costs have significant implications for analyses of health insurance reforms.

The dimensioning of nursing staff according to nursing coordinators: concept, aim and use.

This study aimed to conceptualize the dimensioning of nursing staff, as it is understood by professionals who realize this task, and also to reveal their aim and use of estimation of nursing human resources. It is a descriptive and exploratory study with a qualitative approach analyzed through Content analysis. The definition obtained corresponds to those found in literature and, as to its aim, it serves to preview the number of professionals; to guarantee the operation of the nursing work; to attend clients' expectations regarding their needs; to provide personnel and to guarantee their allocation in the work scale. As to the use of this definition in personnel management, it provides a justification to increase staff through new contracts.

Systematization of Nursing Care: seeking defining and differentiating theoretical contours / Sistematización de la Asistencia de Enfermería (SAE): buscando contornos teóricos definitorios y distintos / Sistematização da Assistência de Enfermagem: buscando contornos teóricos definitórios e diferenciadores

ABSTRACT The objective of this study was to elaborate theoretical propositions to help understanding the Systematization of Nursing Care as a distinct phenomenon of the Nursing Process. It is a reflective, theoretical study that presented two categories: "Systematization of Nursing Care: seeking differentiating contours" and "Systematization of Nursing Care: seeking defining contours". It was identified that the systematization is not concerned with guiding the professional nursing care itself, since this issue, together with the guidelines regarding the elaboration of clinical documentation resulting from the implemented nursing care, is related to the process. Despite what the Systematization of Nursing Care is, the idea is that it is a field of knowledge that, through its three pillars and constituent elements, supports the structuring of nursing services and, consequently, the organization or reorganization of professional work in nursing. It is concluded that systematization, in the light of the theoretical propositions presented here, is an area of knowledge that represents a particular way of carrying out the management of nursing services when the three pillars that compose it are considered.

RESUMEN Se propuso elaborar proposiciones teóricas que auxilien en la comprensión de la Sistematización de la Asistencia de Enfermería como un fenómeno distinto del Proceso de Enfermería. Estudio teórico reflexivo que presentó dos clases: "Sistematización de la Asistencia de Enfermería: buscando contornos diferenciadores" y "Sistematización de la Asistencia de Enfermería: buscando contornos definitorios". Se identificó que la sistematización no se ocupa en orientar la asistencia profesional de enfermería por si misma, una vez que esa cuestión, sumada a las orientaciones a respecto de la elaboración de la documentación clínica resultante de la asistencia de enfermería implementada, se refiere al proceso. A pesar de lo que es la Sistematización de la Asistencia de Enfermería, se conviene definir como un campo de conocimiento que, por medio de sus tres pilares y elementos que la constituyen, soporta la estructuración de servicios de enfermería y, por así decirlo, la organización o reorganización del trabajo profesional en enfermería. Se concluye que la sistematización, siguiendo las proposiciones teóricas presentadas, constituye área de conocimiento que representa una forma particular de realizar la gestión de servicios de enfermería cuando se consideran los tres pilares que la componen.

RESUMO Objetivou-se elaborar proposições teóricas que auxiliem na compreensão da Sistematização da Assistência de Enfermagem enquanto fenômeno distinto do Processo de Enfermagem. Estudo teórico reflexivo que apresentou duas categorias: "Sistematização da Assistência de Enfermagem: buscando contornos diferenciadores" e "Sistematização da Assistência de Enfermagem: buscando contornos definitórios". Identificou-se que a sistematização não se ocupa em orientar a assistência profissional de enfermagem em si, já que essa questão, aliada às orientações quanto à elaboração da documentação clínica resultante da assistência de enfermagem implementada, diz respeito ao processo. A despeito do que é a Sistematização da Assistência de Enfermagem, tem-se que se trata de um campo de conhecimento que, por meio de seus três pilares e elementos constituintes, suporta a estruturação de serviços de enfermagem e, por consequência, a organização ou reorganização do trabalho profissional em enfermagem. Conclui-se que a sistematização, à luz das proposições teóricas aqui apresentadas, constitui área de conhecimento que representa uma forma particular de realizar a gestão de serviços de enfermagem quando se consideram os três pilares que a compõem.

You can't blame the wreck on the train.

General surgical residency education is faced with a number of challenges today. Among those are resident duty hour limitations, the fact that residency is hospital-based despite the practice of general surgery being largely outpatient, changing diseases and conditions treated by the general surgeon and changing methods of treatment, development and maintenance of a user friendly curriculum and the support and provision for faculty development. The greatest single barrier, though, to education of the surgical resident is the lack of appropriate supervision. In this article, the author describes some of the factors that have conspired to remove appropriate supervision from general surgery residency programs as well as describing a number of steps which, if accomplished, would allow the return appropriate supervision to those programs.

Considerações estruturais sobre o exercício do cargo da presidência das Comissões de Ética do Sistema de Gestão da Ética do Poder Executivo Federal (SGEPEF) / Structural considerations on the exercise of the presidency of the Ethics Commissions of the Ethics Management System of the Federal Executive Branch (SGEPEF) / Consideraciones estructurales sobre el ejercicio de la presidencia de las Comisiones de Ética del Sistema de Gestión de Ética del Ejecutivo Federal (SGEPEF)

Este artigo busca sistematizar conhecimentos advindos do exercício da presidência de comissão de ética de instituição pública de ciência e tecnologia, pivô de articulação e integração de inúmeros vetores, ao reunir aprendizagens, princípios e diretrizes, com o objetivo de delinear novas linhas de ação aos ocupantes desse cargo. Partindo do pressuposto de que a atuação no campo ético é práxis política em constante dinamismo e problematização, da utilização de uma abordagem metodológica estruturalista, na qual cada elemento dá significado e é, por sua vez, significado pelos demais, e da definição de quatro grandes dimensões de atuação no Policy Cycle, buscamos apontar diferentes efeitos sistêmicos e de estrutura da operacionalização do Sistema de Gestão da Ética do Poder Executivo Federal (SGEPEF), com seu marco legal e temporal em crescente institucionalização e legitimação. Concluímos indicando novas possibilidades sistêmicas e estruturais no campo ético para avanços e inovação na gestão pública, gerando, assim, ambiente de trabalho mais humanizado e saudável, com amplo desenvolvimento organizacional

This article seeks to systematize knowledge arising from the exercise of the presidency of the ethics committee of a public institution of science and technology, pivot of articulation and integration of numerous vectors, bringing together learning, principles and guidelines, with the objective of outlining new lines of action for the occupants of this office. Assuming that acting in the ethical field is political praxis in constant dynamism and problematization, using a structuralist methodological approach where each element gives meaning and is, in turn, signified by the other elements, and defining four major dimensions of action in the Policy Cycle, we seek to point out different systemic and structural effects of the operationalization of the Ethics Management System of the Federal Executive Branch (SGEPEF), with its legal and temporal framework in increasing institutionalization and legitimation. We conclude by indicating new systemic and structural possibilities in the ethical field for advances and innovation in public management, generating a more humanized and healthy work environment, with broad organizational development.

Este artículo busca sistematizar los saberes surgidos del ejercicio de la presidencia del comité de ética de una institución pública de ciencia y tecnología, pivote de articulación e integración de numerosos vectores, reuniendo aprendizajes, principios y lineamientos, con el objetivo de trazar nuevas líneas de acción para los ocupantes de esta posición. Asumiendo que actuar en el campo ético es una praxis política en constante dinamización y problematización, desde un enfoque metodológico estructuralista donde cada elemento da sentido y es, a su vez, significado por los demás, y definiendo cuatro grandes dimensiones de acción en el Ciclo Político, buscamos señalar distintos efectos sistémicos y estructurales de la operativización del Sistema de Gestión de Ética del Poder Ejecutivo Federal (SGEPEF), con su marco legal y temporal en creciente institucionalización y legitimación. Concluimos señalando nuevas posibilidades sistémicas y estructurales en el campo ético para el avance y la innovación en la gestión pública, generando un ambiente de trabajo más humanizado y saludable, con amplio desarrollo organizacional.

Las normas técnicas para la formación en ingeniería biomédica, tecnología y administración en salud / Technical standards for the training in biomedical engineering, health technology and health management

Introducción: Los documentos normativos establecen el estado del arte relacionado con determinado campo del conocimiento. Existe una gran cantidad de normas relacionadas con los servicios de salud y su gestión, cuya aplicación es relevante en este sector. Objetivo: Exponer la importancia de las normas técnicas en la formación de los profesionales en ingeniería biomédica, tecnología y administración en salud. Desarrollo: Diferentes aspectos relacionados con el desempeño y las funciones de los profesionales en ingeniería biomédica, tecnología de la salud y administración en salud están recogidos en normas técnicas internacionales y en otras de carácter nacional, que resultan pertinentes y de gran utilidad para su formación en el nivel de grado y el posgrado. Conclusiones: Las profesiones abordadas requieren emplear los documentos normativos relacionados con sus funciones para contribuir con la calidad de los servicios de salud; de ahí la pertinencia de su incorporación en los planes de estudio de estas carreras(AU)

Introduction: Normative documents establish the state of the art related to a certain field of knowledge. There is a large number of standards related to health services and their management, whose application is relevant in this sector. Objective: To show the importance of technical standards in the training of professionals from the fields of biomedical engineering, health technology and health management. Development: Different aspects related to the performance and functions of professionals from the fields of biomedical engineering, health technology and health management are gathered in international and other national technical standards, relevant and useful for their training at the undergraduate and postgraduate levels. Conclusions: The addressed professions require the use of normative documents related to their functions in order to contribute to the quality of health services, hence the relevance of their incorporation into the curriculums of these major(AU)

Las normas técnicas para la formación en ingeniería biomédica, tecnología y administración en salud / Technical standards for the training in biomedical engineering, health technology and health management

Introducción: Los documentos normativos establecen el estado del arte relacionado con determinado campo del conocimiento. Existe una gran cantidad de normas relacionadas con los servicios de salud y su gestión, cuya aplicación es relevante en este sector. Objetivo: Exponer la importancia de las normas técnicas en la formación de los profesionales en ingeniería biomédica, tecnología y administración en salud. Desarrollo: Diferentes aspectos relacionados con el desempeño y las funciones de los profesionales en ingeniería biomédica, tecnología de la salud y administración en salud están recogidos en normas técnicas internacionales y en otras de carácter nacional, que resultan pertinentes y de gran utilidad para su formación en el nivel de grado y el posgrado. Conclusiones: Las profesiones abordadas requieren emplear los documentos normativos relacionados con sus funciones para contribuir con la calidad de los servicios de salud; de ahí la pertinencia de su incorporación en los planes de estudio de estas carreras(AU)

Introduction: Normative documents establish the state of the art related to a certain field of knowledge. There is a large number of standards related to health services and their management, whose application is relevant in this sector. Objective: To show the importance of technical standards in the training of professionals from the fields of biomedical engineering, health technology and health management. Development: Different aspects related to the performance and functions of professionals from the fields of biomedical engineering, health technology and health management are gathered in international and other national technical standards, relevant and useful for their training at the undergraduate and postgraduate levels. Conclusions: The addressed professions require the use of normative documents related to their functions in order to contribute to the quality of health services, hence the relevance of their incorporation into the curriculums of these major(AU)

Caminhos do apoio nstitucional no cotidiano das equipes de saúde / Paths of institutional support in the family health strategy / Caminos del apoyo institucional en la estrategia de salud de la familia

Este artigo é sobre o Apoio Institucional como ferramenta para consolidação das práticas no Sistema Único de Saúde (SUS). Com base na análise institucional, esta pesquisa mostra caminhos do trabalho do Apoio Institucional (AI) às equipes de Estratégia de Saúde da Família (ESF), a partir de uma experiência enquanto apoiadora. Refletindo sobre a função de apoio às equipes da ESF de um município do interior do Rio Grande do Sul, a serem avaliadas pela adesão ao Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ), objetivou-se principalmente apresentar a função do AI auxiliando as equipes e; especificamente, mapear as relações de cogestão e autonomia preconizadas pelo SUS, e explorar os discursos e práticas dessa construção. Constitui-se este em um aporte que prioriza saberes que, para além dos acadêmicos, abarca o saber cotidiano dos atores envolvidos, dando voz às experiências dos trabalhadores e gestores nos seus contextos sociais.

This article presents a report about Institutional Support (AI) as a tool for consolidating practices in the UnifiedHealth System (SUS). Based on the concepts of institutional analysis, the experience as a supporter shows ways of working in Institutional Support for Family Health Strategy (ESF) teams. Reflecting the role of support to the FHS teams of a municipality inthe interior of Rio Grande do Sul, to be evaluated by the adhesion to the Access and Quality Improvement Program of Primary Care, the objective was: to present the role of the AI helping the teams and, specifically, to map the co-management and autonomy relationships recommended by the SUS, exploring the practices of this construction. The tool democratized the relationship between workers and managers, promoting greater communication between them, constituting a contribution that prioritized, in addition to academic knowledge, the everyday knowledge of the actors involved, giving voice to their experiences in their social contexts. (AU)

Este artículo presenta un informe sobre el Apoyo Institucional (AI) como herramienta para la consolidación de prácticas en el Sistema Único de Salud (SUS). Con base en los conceptos del análisis institucional, la experiencia como acompañante muestra formas de trabajar en equipos de Apoyo Institucional a la Estrategia de Salud de la Familia (ESF). Reflejando el papel de apoyo a los equipos de la ESF de un municipio del interior de Rio Grande do Sul, a ser evaluado por la adhesión al Programa de Mejora del Acceso y la Calidad de la Atención Básica, el objetivo fue: presentar el papel de la AI ayudar a los equipos y, específicamente, mapear las relaciones de cogestión y autonomía recomendadas por el SUS, explorando las prácticas de esa construcción. La herramienta democratizó la relación entre trabajadores y directivos, promoviendo una mayor comunicación entre ellos, constituyendo un aporte que priorizó, además del conocimiento académico, el conocimiento cotidiano de los actores involucrados, dando voz a sus experiencias en sus contextos sociales. (AU)