Proposition of a Shared and Value-Oriented Work Structure for Hospital-Based Health Technology Assessment and Enterprise Risk Management Processes.

BACKGROUND: Healthcare organizations have invested efforts on hospital-based health technology assessment (HB-HTA) and enterprise risk management (ERM) processes for novel systems to obtain more accurate data on which to base strategic decisions. This study proposes to analyze how HB-HTA and ERM processes can share personal resources and skills to achieve principles with value-oriented results. METHODS: Literature on ERM and HB-HTA and data from interviews with healthcare managers compose the research data sources, which were submitted to a qualitative data analysis. It was oriented to identify the association between ERM and HB-HTA application in hospitals and the common principles between both processes, in addition to proposing the capability to share personal resources between both teams in a matrix. RESULTS: The common principles and personal background suggested for HB-HTA and ERM teams allowed the build of a matrix identifying how both teams can work in an integrated manner being more effective and value-oriented. The shared resource matrix reports how each professional (with a specific background) may interact with each activity associated to HB-HTA or ERM implementation guidelines. CONCLUSIONS: The identification of common principles and capabilities between ERM and HB-HTA suggested advances with the literature from both research areas. The opportunity to share personal resources also contributes to the implementation of those processes in hospitals with less financial resources, approaching its own management to be more efficient with the care chain.

Development of an enterprise risk inventory for healthcare.

BACKGROUND: The first phase of an enterprise risk management (ERM) program is the identification of risks. Accurate identification is essential to a proactive and effective ERM function. The authors identified a lack of such risk identification in the literature and in practical cases when interviewing the chief risk officers from healthcare organizations. A risk inventory specific to healthcare organizations that includes detailed risk scenarios and risk impacts currently does not exist. Thus, the objective of this research is to develop an enterprise risk inventory for healthcare organizations to create a common understanding of how each type of risk impacts a healthcare organization. METHOD: ERM guidelines and data from 15 interviews with chief risk officers were analyzed to create the risk inventory. The identified risks were confirmed through a survey of risk managers from a range of global healthcare organizations during the ASHRM conference in 2017. Descriptive statistics were developed and cluster analysis was performed using the survey results. RESULTS: The risk inventory includes 28 risks and their specific risk scenarios. Cyberattack was ranked as the principal risk by the participants, followed by sentinel events and risks associated with human capital management (organizational culture, use of electronic medical records and physician wellness). The data analysis showed that the specific characteristics of the survey participants, such as the length of time working in risk management, the size of the organization, and the presence of a school of medicine, do not impact an individual's opinion of the importance of the risks identified. A personal background in risk management (clinical or enterprise) was a characteristic that showed a small difference in the perceived importance of the risks from the proposed risk inventory. CONCLUSIONS: In addition to defining specific risk scenarios, the enterprise risk inventory presented in this research can contribute to guiding the risk identification phase of an ERM program and thereby support the development of a risk culture. Patient data security in hospitals that operate with high levels of technology is fundamental to delivering high quality and safe care to patients. At the top of the risk ranking, the identification of cyberattacks reflects the importance that healthcare risk managers place on this risk by allocating time and other resources. Exploring opportunities to improve cyber risk management and evaluating the benefits of using the risk inventory at the beginning of the risk identification phase in an ERM program are suggestions for future studies.

ERM for Health Care Organizations: An Economic Enterprise Risk Management Innovation Program (E2RMhealth care).

BACKGROUND: In recent years, health care organizations have looked to enterprise risk management (ERM) for novel systems to obtain more accurate data on which to base risk strategies. OBJECTIVE: This study proposes a conceptual ERM framework specifically designed for health care organizations. METHODS: We explore how hospitals in the United States and Brazil are structuring and implementing ERM processes within their management structure. This study incorporates interviews with 15 chief risk officers (8 from the United States and 7 from Brazil) with qualitative data analysis using NVivo (QSR International software). RESULTS: The interviews confirm that adopting ERM for health care organizations has gained momentum and become a priority, and that the demand for risk economic assessment orientation is common among health care risk managers. CONCLUSION: We propose an ERM model for health care (Economic Enterprise Risk Management in Health Care) divided into four maturity levels and complemented by an implementation timeline. The model is accompanied by guidelines to orient the gradual implementation of ERM, including orientation to perform risk economic assessment.

Tools for evaluating environmental performance at Brazilian public ports: Analysis and proposal.

The port sector critically needs improved management techniques to evaluate its environmental performance. In the present study, we conducted an exploratory research to understand the metrics used in the Brazilian public ports to assess their environmental performance. We considered two state agencies and two port authorities of southern Brazil. As preliminary results, we found that economic factors are excluded in the tools for measuring environmental performance. A system of indicators to address this shortcoming was then proposed, but it could not be applied because of data deficiencies. Thus, the system was divided into two parts: a simplified system with 7 indicators (measuring costs related to criteria were measured only technically) and an advanced system with 5 indicators (approaching costs were currently difficult to measure). Thus, the proposed indicators can be applied by port authorities to facilitate decision-making related to environmental management. As suggestions for further work, we propose research that includes more ports, both public and private, to provide an overview at the national level.

Utilização do instrumento de identificação de conhecimentos para administração segura de medicamentos com o uso de infusão automática / Use of an instrument to identify knowledge for safe administration of medications using automatic infusion

INTRODUÇÃO: Entre os riscos intrínsecos na assistência à saúde, a infusão de medicamentos é uma preocupação constante. Essa pesquisa analisou os tipos de notificações de eventos adversos, com a possibilidade dos profissionais envolvidos no uso incorreto de operação de Bombas de Infusão (BI). Os autores realizaram uma pesquisa dos problemas decorrentes de eventos adversos gerados da utilização de BI e desenvolveram um instrumento de identificação de conhecimentos de habilidades e usabilidades de BI. MÉTODOS: A metodologia utilizada no estudo foi desenvolvida em quatro fases. Na primeira e segunda fase, realizou-se uma pesquisa no banco de dados de relatos sobre notificações na unidade de Tecnovigilância da Agência Nacional de Vigilância Sanitária (ANVISA) com o levantamento de dados, classificação de equipamentos, tipificação de problemas e análise de causas comuns. Na terceira fase realizou-se a análise do banco de dados de notificações de um fabricante de BI. Na última fase foi feita a análise de causas comuns para desenvolver as ações preventivas e o desenvolvimento do instrumento proposto. RESULTADOS: Foram analisados os anos de 2006 a 2011 onde existiam 1.971 relatos sobre notificações de equipamentos médicos hospitalares, sendo 251 desses relatos sobre BI (12,6%). Essa porcentagem foi a maior encontrada entre todos os equipamentos notificados. CONCLUSÃO: O estudo permitiu afirmar que os profissionais que operam as BI, muitas vezes possuem carência de conhecimento e/ou falta de compromisso com a atividade. Pode-se afirmar que um aspecto importante e inquestionável sobre o uso de BI é a relação com a segurança.

INTRODUCTION: Among the inherent risks in health care, the infusion of drugs is a constant concern. This research examined the types of notification of adverse events, with the possibility of the health professionals involved in the incorrect use of Infusion Pumps (IP) operation. The authors conducted a research of the problems arising from adverse events generated using IP and developed an instrument to identify the skills and knowledge of BI usability. METHODS: The methodology used in the study was developed in four phases. In the first and second phases, we carried out a search in the database of reports on notification in technovigilance unit of the Brazilian Health Surveillance Agency (ANVISA) with data collection, equipment classification, classification and analysis of problems of common causes. In the third phase took place the analysis of the database of notification from an IP manufacturer. In the last phase an analysis was made of the common causes for developing preventive actions and the development of the proposed instrument. RESULTS: We analyzed the years 2006 to 2011 where there were 1.971 reports of medical equipment notification, and 251 of these reports on IP (12.6%). This percentage was the highest among all equipment reported. CONCLUSION: The study allowed us to say that the professionals who operate the IP often denote lack of knowledge and / or lack of commitment to the activity. It can be argued that an important and unquestionable aspect about the use of IP is related to safety.

Gestão Hospitalar: identificação das práticas de aprendizagem existentes em hospitais / Hospital Management: identifying learning practices in hospitals

A profissionalização da gestão em hospitais, a partir de diferentes práticas da administração, tem sido amplamente discutida, à luz de conceitos como gestão baseada em evidência, gestão do conhecimento e aprendizagem organizacional. Entretanto, são poucos os artigos identificando e discutindo essas práticas nas organizações de saúde. Este é o objetivo do presente artigo. Buscou-se realizar uma análise histórica da gestão em saúde no Brasil, considerando uma mudança a partir do processo de descentralização. Foi realizado o mapeamento das práticas de gestão enfatizando-se as metodologias de aprendizagem existentes no setor, a partir de pesquisas documentais. Pôde-se perceber uma mudança de modelo mental na área, passando de um enfoque linear para um enfoque sistêmico. Da mesma forma, identificou-se o processo de construção do conhecimento nessas organizações, especialmente a partir da prática médica. Constatou-se ainda que o processo de aprendizagem enfatiza a aprendizagem individual e não a aprendizagem organizacional.

The continuous improvement in management process of hospitals, has been widely related to concepts as evidence-based management, knowledge management and organizational learning. However, there are few articles identifying and presenting these practices in the health organizations. This is the objective of the present article. First, a historical analysis of health management in Brazil was conducted, considering the decentralization process. In this context, we perform a research to identify learning methodologies in the sector, from documentary research. A change of mental model in the area, looking for a systemic approach can be perceived. In the same way, the process of knowledge construction in these organizations generally started from the medical practice. One evidenced despite the learning process emphasizes the individual learning and not it organizational learning.