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2.
Med Ref Serv Q ; 38(2): 187-196, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31173566

RESUMEN

Due to staffing changes, clinical librarians in a large pediatric health care system needed to streamline how user requests were received and how best to handle the shared workflow. This article describes how REDCap and SAS were implemented to improve the management of requests, capture comprehensive user statistics, and convey the value of the library services through enhanced reporting.


Asunto(s)
Bibliotecólogos , Bibliotecas Médicas , Mejoramiento de la Calidad , Programas Informáticos , Eficiencia Organizacional/normas , Georgia , Hospitales Pediátricos , Almacenamiento y Recuperación de la Información/métodos , Estudios de Casos Organizacionales , Interfaz Usuario-Computador
3.
Curr Urol Rep ; 20(6): 28, 2019 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-30989344

RESUMEN

PURPOSE OF REVIEW: Operating rooms are critical financial centers for hospital systems, with surgical care representing about a third of all health care spending. However, not all of the costs are appropriate or necessary, as there are sometimes significant inefficiencies in how operating rooms are utilized. RECENT FINDINGS: Recent innovations utilizing patient-centered data, systems principles from manufacturing industries, and enhanced communication processes have made significant improvements in improving operating room efficiency. By focusing on improving communication, standardizing processes, and embracing a learning health system with innovations, significant improvements in operating room efficiency can be seen to improve outcomes and costs for the health system and patient.


Asunto(s)
Eficiencia Organizacional/normas , Quirófanos/organización & administración , Quirófanos/normas , Mejoramiento de la Calidad/normas , Eficiencia Organizacional/economía , Humanos , Quirófanos/economía , Mejoramiento de la Calidad/economía
4.
Artículo en Inglés | MEDLINE | ID: mdl-30935120

RESUMEN

Environmental⁻economic efficiency assessment is an effective way to evaluate the degree of coordination between an economy and the environment. Previous studies on environmental⁻economic efficiency have primarily investigated the efficiency of economic production and have often overlooked the efficiency of pollution treatment in overall economic activities. We applied a network data envelopment analysis model to evaluate the environmental⁻economic efficiency of a multistage process with undesirable outputs in 30 Chinese provinces during 2001⁻2017. The multistage process consisted of two sequential stages: economic production and pollution treatment. The results show that the average environmental⁻economic efficiency across all provinces was generally low but demonstrated a gradual upward trend during the study period. The spatial pattern for the 30 provinces showed that provinces with medium or high environmental⁻economic efficiency are mainly located in the eastern regions in China. Finally, few provinces exhibited economic activities with high economic production and pollution treatment efficiency, with most provinces generally having low economic production and pollution treatment efficiency. Hence, provinces with different economic production and pollution treatment efficiency modes should implement targeted improvement strategies according to their characteristics.


Asunto(s)
Economía , Eficiencia Organizacional/normas , Monitoreo del Ambiente/métodos , Contaminación Ambiental , China , Eficiencia Organizacional/economía , Monitoreo del Ambiente/economía
5.
Rev. cuba. salud pública ; 45(1): e1359, ene.-mar. 2019. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-991128

RESUMEN

Introducción: El estudio de la eficiencia de la distribución mayorista de los medicamentos debe tener en cuenta, no solo el cumplimiento de los indicadores clásicos económicos, sino también, en qué medida se está garantizando el nivel de abastecimiento de los diferentes surtidos para cada unidad. Objetivo: Evaluar, desde una perspectiva integral, la eficiencia de la distribución mayorista de medicamentos y otros productos farmacéuticos realizada en Cuba durante el año 2016. Métodos: Se desarrolló una investigación descriptiva, longitudinal y por trimestres para el año 2016. Se evaluó la rentabilidad, productividad y eficiencia técnica de escala de las 16 droguerías con que cuenta el país, para lo cual se planteó la resolución del análisis envolvente de datos, que se basó en la utilización del software libre OSDEA. Resultados: Se cumplieron las ventas y los ciclos de distribución, pero no se logró la cobertura por producto. Los recursos humanos y los gastos por recursos para la transportación se comportaron en el margen de lo planificado, pero se incrementó el gasto de las operaciones. Todas las droguerías funcionaron en el nivel de eficiencia planificada en cuanto a los indicadores financieros, sin embargo, el 10 por ciento de las unidades resultaron ineficientes según el indicador eficiencia técnica de escala. Discusión: La distribución mayorista de los medicamentos se realizó en 2016 con altos niveles de eficiencia. El análisis integral permitió identificar droguerías ineficientes por lo que este continúa siendo un tema a desarrollar. Las droguerías ineficientes deben revisar tanto el nivel de resultados como el de recursos consumidos para alcanzar niveles de eficiencia similares al de sus pares de referencia(AU)


Introduction: The study of the efficiency of the wholesale distribution of medicines must take into account not only the compliance with the classic economic indicators but also to what extent the supply level of the different assortments for each unit is being guaranteed. Objectives: To evaluate the efficiency from an integral perspective, of the wholesale distribution of medicines and other pharmaceutical products, in Cuba in 2016. Methods: A descriptive, longitudinal and quarterly research was developed for the year 2016. The profitability, productivity and technical efficiency of scale of the 16 drugstores in the country were evaluated. For what was propoused the resolve of the Data Envelopment Analysis (DEA), wich was based on the use of the free software OSDEA. Results: Sales and distribution cycles were met, but coverage by product was not achieved. The human resources and the expenses for basic resources for the transportation behaved in the margin of what was planned, but the expenses of the operations increased. All the drugstores worked at the level of efficiency planned in terms of financial indicators, however 10 percent of the units were inefficient based on the technical efficiency of scale. Conclusions: The wholesale distribution of medicines was carried out in 2016 with high levels of efficiency. The comprehensive analysis allowed identifying inefficient drugstores so this continues to be a topic to be developed. Inefficient drugstores should review both the level of results and that of resources consumed to achieve efficiency levels similar to those of their reference peers(AU)


Asunto(s)
Humanos , Eficiencia Organizacional/normas , Buenas Prácticas de Distribución , Comercialización de Medicamentos , Epidemiología Descriptiva , Estudios Longitudinales , Cuba
6.
Rev. cuba. salud pública ; 45(1)ene.-mar. 2019. tab, graf
Artículo en Español | CUMED | ID: cum-73447

RESUMEN

Introducción: El estudio de la eficiencia de la distribución mayorista de los medicamentos debe tener en cuenta, no solo el cumplimiento de los indicadores clásicos económicos, sino también, en qué medida se está garantizando el nivel de abastecimiento de los diferentes surtidos para cada unidad. Objetivo: Evaluar, desde una perspectiva integral, la eficiencia de la distribución mayorista de medicamentos y otros productos farmacéuticos realizada en Cuba durante el año 2016. Métodos: Se desarrolló una investigación descriptiva, longitudinal y por trimestres para el año 2016. Se evaluó la rentabilidad, productividad y eficiencia técnica de escala de las 16 droguerías con que cuenta el país, para lo cual se planteó la resolución del análisis envolvente de datos, que se basó en la utilización del software libre OSDEA. Resultados: Se cumplieron las ventas y los ciclos de distribución, pero no se logró la cobertura por producto. Los recursos humanos y los gastos por recursos para la transportación se comportaron en el margen de lo planificado, pero se incrementó el gasto de las operaciones. Todas las droguerías funcionaron en el nivel de eficiencia planificada en cuanto a los indicadores financieros, sin embargo, el 10 por ciento de las unidades resultaron ineficientes según el indicador eficiencia técnica de escala. Discusión: La distribución mayorista de los medicamentos se realizó en 2016 con altos niveles de eficiencia. El análisis integral permitió identificar droguerías ineficientes por lo que este continúa siendo un tema a desarrollar. Las droguerías ineficientes deben revisar tanto el nivel de resultados como el de recursos consumidos para alcanzar niveles de eficiencia similares al de sus pares de referencia(AU)


Introduction: The study of the efficiency of the wholesale distribution of medicines must take into account not only the compliance with the classic economic indicators but also to what extent the supply level of the different assortments for each unit is being guaranteed. Objectives: To evaluate the efficiency from an integral perspective, of the wholesale distribution of medicines and other pharmaceutical products, in Cuba in 2016. Methods: A descriptive, longitudinal and quarterly research was developed for the year 2016. The profitability, productivity and technical efficiency of scale of the 16 drugstores in the country were evaluated. For what was propoused the resolve of the Data Envelopment Analysis (DEA), wich was based on the use of the free software OSDEA. Results: Sales and distribution cycles were met, but coverage by product was not achieved. The human resources and the expenses for basic resources for the transportation behaved in the margin of what was planned, but the expenses of the operations increased. All the drugstores worked at the level of efficiency planned in terms of financial indicators, however 10 percent of the units were inefficient based on the technical efficiency of scale. Conclusions: The wholesale distribution of medicines was carried out in 2016 with high levels of efficiency. The comprehensive analysis allowed identifying inefficient drugstores so this continues to be a topic to be developed. Inefficient drugstores should review both the level of results and that of resources consumed to achieve efficiency levels similar to those of their reference peers(AU)


Asunto(s)
Humanos , Eficiencia Organizacional , Buenas Prácticas de Distribución , Comercialización de Medicamentos , Eficiencia Organizacional/normas , Cuba , Epidemiología Descriptiva , Estudios Longitudinales
7.
Nurs Clin North Am ; 54(1): 53-79, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30712545

RESUMEN

The purpose of the Toyota Production System (TPS) Lean 5S methodology project is to improve the efficiency and effectiveness in a process by eliminating identified process waste of (1) defects (errors), (2) overproduction, (3) waiting, (4) confusion, (5) motion/travel, (6) excess inventory, (7) overprocessing, and (8) human potential. The specific aim of this quality improvement project was to evaluate the impact of the TPS 5S tool process, a problem-solving, space-organizing tool, on distractions and interruptions in the neurosurgery operating room (OR) workflow with a goal to decrease neurosurgery craniotomy infection rates in a neurosurgery OR suite within a 3-month period.


Asunto(s)
Craneotomía/normas , Eficiencia Organizacional/normas , Control de Infecciones/normas , Procedimientos Neuroquirúrgicos/normas , Quirófanos/normas , Guías de Práctica Clínica como Asunto , Garantía de la Calidad de Atención de Salud/normas , Mejoramiento de la Calidad/normas , Humanos
8.
Ethics Hum Res ; 41(1): 22-31, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30744311

RESUMEN

New federal policies require single IRB review for multisite studies, but many questions remain about how these IRBs will use local knowledge. The findings from our study, the first to examine how single IRBs perceive needs for local knowledge, reveal several challenges. Study respondents identified four potentially relevant types of local knowledge: about culture and linguistics, about geography and socioeconomics, about the researchers, and about the institutions. Such knowledge can potentially be obtained through local sites, but single IRBs may be unaware of potentially relevant local information, and lack of informal relationships may impede single IRBs' reviews and interactions with researchers. While a recent, commonly used, standardized single-IRB form asks three basic questions about local information, our findings suggest potential needs for additional information and, thus, have important implications for practice, policy, and research.


Asunto(s)
Eficiencia Organizacional/normas , Comités de Ética en Investigación , Conocimiento , Humanos , Investigadores
9.
Ethics Hum Res ; 41(1): 15-21, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30744312

RESUMEN

We reviewed the public comments submitted in response to the Department of Health and Human Services' (DHHS's) original and revised proposal for mandated single-IRB review of federally funded multisite research to see who responded to the proposed mandate and to determine what they said and how the agency addressed the public comments in its revised proposal. Our analysis indicates that support for the single-IRB mandate was limited. The most common argument against the proposed mandate came from those concerned with the loss of site-specific institutional review board (IRB) review of the protocol for a multisite study to address issues relevant to local context. Concerns were also raised that the single-IRB approach would replace one inefficient system (that entails, for example, multiple reviews of a single study) with another potentially inefficient system (involving the negotiation and management of multiple interinstitutional agreements). Empirical research about the implementation of DHHS's final rule-and the separate rule of the National Institutes of Health-mandating single-IRB review is needed to determine whether the single-IRB model achieves the stated goals.


Asunto(s)
Eficiencia Organizacional/normas , Comités de Ética en Investigación , Ética en Investigación , Opinión Pública , Humanos , National Institutes of Health (U.S.) , Sujetos de Investigación , Estados Unidos , United States Dept. of Health and Human Services , Universidades
11.
Int J Health Plann Manage ; 34(2): e995-e1015, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30793372

RESUMEN

OBJECTIVES: The purpose of this evidence-based review is to identify and describe the interventions that have been implemented to reduce waiting times for major elective surgery. METHODS: Scoping review and presentation of the results according to the SUPPORT tools. We searched MEDLINE/PubMed, Embase, Cochrane Library, SciELO, DARE-HTA, and Google Scholar. The inclusion criteria for research design were comprehensive. RESULTS: We identified 5200 records. After eliminating duplicates and screening by title and abstract, 171 records remained for full-text assessment, of which 12 were ultimately included for this review because they reported specific interventions and 96 records were included for further reference. The included studies show significant variability regarding elective procedures, population, and type of provider, as well as in the characteristics of the interventions and the settings. All the studies had methodological limitations. We graded the certainty of the evidence as very low. CONCLUSIONS: According to the evidence found for this review, interventions most likely should be multidimensional, with prioritization strategies on the waiting lists to incorporate equity criteria, together with quality management improvements of the surgical pathways and the use of operating rooms, as well as improvements in the planning of the surgical schedule.


Asunto(s)
Procedimientos Quirúrgicos Electivos , Política Organizacional , Listas de Espera , Eficiencia Organizacional/normas , Humanos , Mejoramiento de la Calidad
12.
BMC Health Serv Res ; 19(1): 66, 2019 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-30678663

RESUMEN

BACKGROUND: The purpose of this paper is to explore a change strategy for lean success in hospitals based on a comprehensive review of the Chinese literature. METHODS: The methodology is a systematic review of the Chinese literature which identified 212 case study papers about lean implementation. We did a thematic content analysis of the 212 papers. RESULTS: Lean applications in Chinese hospitals show significant increases and are mainly used in the fields of outpatient services, operating rooms, pharmacy and logistics. Most hospitals applied lean as a single project but some were beginning to use lean as a systemic path for improvement with an emphasis on lean and strategy. The main goals were to increase the operating efficiency and reduce operating costs. Patients were not central to lean applications. Chinese hospitals appear to lack a full understanding of lean. Four factors appear to be critical for lean success - organizational leadership, adequate technology, stakeholder involvement and individual and organizational benefits. The relationship of these factors changes over time. CONCLUSIONS: This is the first paper to provide a comprehensive view of lean application in Chinese hospitals. The findings presented in this paper provide a systemic evidence to the application of lean in healthcare.


Asunto(s)
Eficiencia Organizacional/normas , Administración Hospitalaria , Gestión de la Calidad Total/normas , China , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Hospitales/normas , Humanos , Liderazgo , Calidad de la Atención de Salud/normas
13.
Physiother Res Int ; 24(1): e1756, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30403320

RESUMEN

OBJECTIVE: To identify and compare factors influencing the use of standardized outcome measures by neurological physical therapists working in representative developed (Canada) and developing (India) countries. METHODS: A self-administered web-based questionnaire on facilitators and barriers to using neurological outcome measures was sent by email to neurological physical therapists in Canada and India. Frequencies of responses to each question were computed. Differences between countries were assessed using two-proportion z test. RESULTS: Of 317 respondents, the use of standardized outcome measures was higher for Indian (96.7%) compared with Canadian physical therapists (89.2%). Among the most highly reported facilitators, three were common for both countries (known validity and reliability, outcome measures learned in professional training, and recommended in clinical practice guidelines). Three highly reported barriers were also common for India and Canada (lack of time, relying on judgement for clinical decisions, and unavailability of the assessment tools). Nevertheless, there were differences in the percentages of barriers and facilitators between countries. CONCLUSION: Understanding the factors influencing the uptake of outcome measures among neurological physical therapists working in a developed (Canada) and a developing country (India) can help identify whether strategies should or should not be modified to facilitate knowledge translation in different geographical, professional, or social contexts.


Asunto(s)
Actitud del Personal de Salud , Países en Desarrollo , Fisioterapeutas/normas , Modalidades de Fisioterapia/normas , Fisioterapia/normas , Canadá , Competencia Clínica/normas , Países Desarrollados , Eficiencia Organizacional/normas , Humanos , India , /organización & administración , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Investigación en Medicina Traslacional
14.
J Clin Nurs ; 28(5-6): 745-761, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30376199

RESUMEN

AIMS AND OBJECTIVES: To identify key areas of competence for digitalisation in healthcare settings, describe healthcare professionals' competencies in these areas and identify factors related to their competence. BACKGROUND: Digitalisation requires changes in healthcare practices, policies and actions to revise job expectations and workflows. The aspects of patient safety and integration of digitalisation into the professional context necessitate an assessment of healthcare professionals' competencies in digitalisation. DESIGN: Systematic review. METHODS: A systematic review was conducted following Center of Reviews and Dissemination guidelines, including application of a PRISMA statement. Four databases-CINAHL (EBSCO), MEDLINE (Ovid), Web of Science and Academic Search Premiere (EBSCO)-were searched for relevant original peer-reviewed studies published between 2012-2017. Twelve were chosen for final analysis: five quantitative studies and seven qualitative studies, which were, respectively, subjected to narrative and thematic synthesis. RESULTS: Key competence areas regarding digitalisation from a healthcare perspective identified encompass knowledge of digital technology and the digital skills required to provide good patient care, including associated social and communication skills, and ethical considerations of digitalisation in patient care. Healthcare professionals need the motivation and willingness to acquire experience of digitalisation in their professional context. Collegial and organisational support appear to be essential factors for building positive experiences of digitalisation for healthcare professionals. CONCLUSION: Healthcare organisations should both pay attention to the social environment of a workplace and create a positive atmosphere if they want to improve the response to digitalisation. The successful implementation of new technology requires organisational and collegial support. RELEVANCE TO CLINICAL PRACTICE: Recommendations for clinical practice include the following: development of competence in digitalisation by healthcare professionals when using technological equipment to minimise errors; provision of sufficient resources, equipment and room for technology usage; and provision of regular education that considers the participants' competencies.


Asunto(s)
Eficiencia Organizacional/normas , Personal de Salud/educación , Tecnología de la Información , Sistemas de Registros Médicos Computarizados , Actitud del Personal de Salud , Humanos , Cultura Organizacional , Investigación Cualitativa
15.
J Nurs Care Qual ; 34(3): 242-249, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30211776

RESUMEN

BACKGROUND: Few studies have evaluated technical efficiency of nursing care, and no such studies have been conducted in intensive care units (ICUs). PURPOSE: To explore relative technical efficiency of US ICUs and identify organizational factors associated with efficiency in providing quality of nursing care. METHODS: A total of 404 adult ICUs from the 2014 National Database of Nursing Quality Indicators were included. Data envelopment analysis was used to estimate technical efficiency, and multilevel modeling was employed to determine effects of organizational factors on efficiency. RESULTS: Nurse-to-patient ratio showed the strongest positive correlation with technical efficiency. Units in non-Magnet and small-size hospitals had higher technical efficiency than those in Magnet and medium- or large-size hospitals. CONCLUSIONS: A higher nurse-to-patient ratio greatly improved technical efficiency of nursing care in ICUs and the effect differed between hospitals. Administrators and policy makers can translate the study findings into management strategies to provide efficient nursing care in ICUs.


Asunto(s)
Eficiencia Organizacional/normas , Unidades de Cuidados Intensivos/estadística & datos numéricos , Estudios Transversales , Humanos , Unidades de Cuidados Intensivos/organización & administración , Admisión y Programación de Personal/normas , Admisión y Programación de Personal/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Factores de Tiempo
16.
Emerg Med Australas ; 31(2): 253-261, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30043403

RESUMEN

OBJECTIVE: To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. METHODS: A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). RESULTS: Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short-stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re-attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). CONCLUSION: ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.


Asunto(s)
Servicio de Urgencia en Hospital/normas , Política de Salud , Garantía de la Calidad de Atención de Salud/métodos , Territorio de la Capital Australiana , Eficiencia Organizacional/normas , Accesibilidad a los Servicios de Salud , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Estudios Longitudinales , Nueva Gales del Sur , Queensland
17.
Br J Hosp Med (Lond) ; 79(12): 676-681, 2018 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-30526106

RESUMEN

Despite significant advances in orthopaedic surgery, variability still exists between providers and practice locations, and process inefficiencies are found throughout the health care continuum. Evolving technologies, namely artificial intelligence, challenge the status quo by improving patient care in four areas: diagnosis, management, research and systems analysis. Artificial intelligence shows promise in promoting practice efficiency, personalizing patient care, improving institutional research capacity, and expanding high quality orthopaedic care to lower resource settings. Physicians should be involved in the development of artificial intelligence algorithms to ensure that patients derive maximum benefit from new advances while considering the ethical challenges of implementation.


Asunto(s)
Inteligencia Artificial , Procedimientos Ortopédicos/métodos , Algoritmos , Toma de Decisiones Clínicas/métodos , Eficiencia Organizacional/economía , Eficiencia Organizacional/normas , Humanos , Procedimientos Ortopédicos/economía , Procedimientos Ortopédicos/normas , Atención Dirigida al Paciente/organización & administración , Calidad de la Atención de Salud/organización & administración , Investigación/organización & administración , Automanejo/métodos , Análisis de Sistemas
18.
Rev Bras Enferm ; 71(6): 2945-2952, 2018.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30517397

RESUMEN

OBJECTIVE: To analyze the diffusion of e-SUS Primary Care innovation in Family Health Teams. METHOD: A qualitative approach case study, based on Innovation Diffusion Theory and Technology Acceptance Model. We conducted 62 interviews and observation of professionals from Family Health Teams in six municipalities of Minas Gerais State, between March 2016 and January 2017. The data were treated through Categorical Thematic Content Analysis and, systematized, with Atlas.ti software . RESULTS: It was verified that although the e-SUS Primary Care strategy is recognized as a technological innovation, situations predominate that weaken its acceptance as: incompatibilities with the work process; sudden deployment, poor training; work overload; resistance; and negative impacts on health care. CONCLUSION: The diffusion of the e-SUS Primary Care strategy as a technological innovation has presented potential situations of its rejection, conforming as challenges to be overcome.


Asunto(s)
Eficiencia Organizacional/normas , Innovación Organizacional , Grupo de Atención al Paciente/tendencias , Atención Primaria de Salud/normas , Brasil , Eficiencia Organizacional/tendencias , Salud de la Familia/normas , Sistemas de Información en Salud/tendencias , Humanos , Atención Primaria de Salud/métodos , Investigación Cualitativa
19.
Einstein (Sao Paulo) ; 16(4): eGS4200, 2018 Nov 08.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30427480

RESUMEN

OBJECTIVE: To verify the impact of the Lean Six Sigma methodology in reducing incorrect entries of non-appropriated revenues and expenses. METHODS: Process for the review and application of the Lean Six Sigma methodology between December 2015 and September 2016, in a high-complexity general hospital in the city of São Paulo (SP). RESULTS: A total of 3,756,814 (100%) entries were audited between December 2015 and September 2016. The Sigma level evolved over the course of the process and increased from 3.44 Sigma in December 2015 to 5.92 Sigma in September 2016. Entries classified as non-appropriated revenues and expenses were brought down to 0% at the end of the study. CONCLUSION: The use of the Lean Six Sigma methodology was efficient in reducing incorrect entries, calculating costs, ensuring compliance in rendering of accounts and accurately determining cost-outcome ratios.


Asunto(s)
Eficiencia Organizacional/normas , Hospitales Públicos/organización & administración , Mejoramiento de la Calidad/organización & administración , Gestión de la Calidad Total/métodos , Hospitales Públicos/normas , Humanos , Mejoramiento de la Calidad/normas
20.
J Nurs Adm ; 48(12): 594-596, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30431510

RESUMEN

Technology is frequently viewed as a barrier to workflow and efficiency rather than as a tool that can be used to improve the quality of our care, increase efficiency, or enhance patient outcomes. However, when technology is applied effectively, nurse leaders can leverage tools such as clinical decision support to avoid errors, inform decision making, and boost provider and patient satisfaction. These topics were discussed at the AONE annual meeting in a preconference session. In this article, AONE session leaders detail ways to ensure that information technology is a valuable tool-and not an obstacle-for effective nursing practice.


Asunto(s)
Congresos como Asunto , Eficiencia Organizacional/normas , Liderazgo , Seguridad del Paciente/normas , Humanos , Enfermeras Administradoras , Sociedades de Enfermería , Flujo de Trabajo
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