[Productivity of teaching hospitals in the state of São Paulo,Brazil]. / Produtividade em hospitais de ensino no estado de São Paulo, Brasil.

Teaching hospitals can be defined as hospitals whose mission is both to provide health care to the population and to train qualified professionals. This represents high costs that need to be balanced by higher productivity and quality. The aim of the present study was to identify the level of productivity in five teaching hospitals in the state of São Paulo, Brazil. For that, we measured indicators such as patient length of stay, patient turnover rate, substitution interval, and number of employees per hospital bed. For a better understanding of the reality of these teaching hospitals, data regarding morbidity and geographic range of influence were also analyzed. Results were compared with the results from a previous study which analyzed private tertiary and secondary hospitals and public secondary hospitals. Productivity was defined as inversely proportional to length of stay, patient turnover rate, substitution interval, and number of employees per hospital bed. We observed that private hospitals have a higher productivity in terms of most indicators, which suggests that these hospitals make a more efficient use of their human, material, and financial resources. Teaching hospitals have a higher length of stay than the other hospitals (median = 7 days); lower turnover rate than private hospitals and similar to public hospitals (median = 3.70 days); higher employee per bed ratio than the private hospitals, and smaller than public hospitals (median = 7 employee/hospital bed). Substitution interval was different for each type of hospital; only public hospitals had a lower substitution interval than teaching hospitals (median = 1.70 days).

[Distribution of human resources in 8 general hospitals in São Paulo]. / Distribuição dos recursos humanos em oito hospitais gerals de São Paulo.

Technological development and the appearance of new medical specialties have led to increased division of labor in hospitals, with the resultant creation of subareas. Therefore, the redistribution of human resources in hospitals has become an important aim in order to achieve efficiency. On the basis of interviews conducted between May and October 1993 with the directors and superintendents of eight hospitals in São Paulo, Brazil, this study describes and analyzes the distribution of human resources in four broad areas: infrastructure, clinico-surgical inpatient care, the complementary area of diagnostics and therapeutics, and emergency and outpatient care. The study also analyzed the ratio of employees per bed, besides outlining a comparison of public and private hospitals. The results revealed that, on average, the ratio of employees to beds was 6.8. The proportional distribution of employees by broad areas was found to be 46.9% in infrastructure, 10.7% in diagnostics and therapeutics, 32.0% in inpatient care, and 10.3% in outpatient/emergency care.

[Hospital productivity in the light of hospital indicators]. / Produtividade em hospitais de acordo com alguns indicadores hospitalares.

Of all the facilities that are utilized by the health area in order to provide care, hospitals are certainly the most favorite whether of the population or of health professionals. This is due to the amenities and security offered by the concentration of human and technological resources. However, this means high costs that should be diluted by increases in productivity and quality. Thus quality of management, productivity, staffing, even though scrutinised by other researchers, deserve further analysis. This research project aims at bringing to light the productivity of hospitals by using hospital indicators such as length of stay, bed turnover bed turnover and replacement interval as well as the employees per bed ratio.

Estrutura organizacional em hospitais / Hospital organizational structure

O ponto básico para o funcionamento de qualquer instituiçäo é a existência de uma estrutura organizacional definida, que permita agrupar áreas afins, possibilitando, assim as tomadas de decisäo e a conseqüente operacionalizaçäo das diferentes tarefas. Procurou-se conhecer e analisar as estruturas dos hospitais públicos e privados, além de um levantamento bibliográfico a respeito do assunto. Segue-se também a sugestäo de elaboraçäo de estruturas menores ea utilizaçäo de estruturas matriciais para cumprir determinados objetivos

[Hospital organizational structure]. / Estrutura organizacional em hospitais.

The basic point for an Institution to work is the existence of a definite organizational structure that puts together similar areas allowing decisions and the operationalization of different tasks. Knowledge and analysis of structures of private and public hospitals and a bibliography review about the issue is the purpose of this paper. Suggestions are given about the elaboration of small structures and the utilization of matrix management in order to accomplish the hospitals objectives.

[Return to work after myocardial revascularization]. / Retorno ao trabalho após revascularização do miocárdio.

Six hundred and seventy-two patients classified in four strata with one hundred sixty-eight in each were evaluated during the fourth month after myocardial revascularization, with coronary artery bypass graft and/or internal mammary artery and coronary angioplasty, in order to verify the return or not to work as well as the conditions under which this was done. The four strata constituted by occupational profile were the following: I--entrepreneurs and managers; II--professionals with university degree; III--technicians; IV--unskilled and semi-skilled professionals. The aim of this research project was to discover how variables like demographics, education, procedure and support after procedure, were related to the return to work. Return to work did not occur in 20.8% of all cases. The non-return contingent in each of the four strata was the following: I = 11.9%; II = 15.5%; III = 26.2% and IV = 29.8%. Among those submitted to angioplasty the proportion of non-return was lower than that of those submitted to surgery.