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RECIIS (Online) ; 13(3): 608-617, jul.-set. 2019. ilus
Artículo en Portugués | LILACS | ID: biblio-1021520


Há sinalizações acadêmicas para o desenvolvimento de modelos de gerenciamento do conhecimento pautados no paradigma holístico. Mutuwa e Maiga afirmam que não há um modelo unificador para o setor de saúde, o que permite inferir que o modelo desses autores se propõe ao atingimento desse feito. Assim, esta pesquisa se justifica pelo objetivo de analisar a aderência do modelo de Mutuwa e Maiga à Gestão do Conhecimento holística, de modo a identificar se esse modelo supre a lacuna de uma estrutura unificadora para este setor. Essa análise é realizada por meio de procedimentos metodológicos mistos, contemplando a abordagem qualitativa-quantitativa e a Análise de Conteúdo. Por resultado, há uma adesão de somente 15,4% do modelo de Mutuwa e Maiga à Gestão do Conhecimento holística, conforme caracterização apresentada nessa pesquisa, permitindo inferir que a Gestão do Conhecimento não tem demonstrado direcionamento para uma abordagem orientada ao paradigma holístico. Assim, esta pesquisa contribui por fomentar o desenvolvimento de novos modelos de gerenciamento do conhecimento alicerçados no paradigma holístico, considerando os delineamentos aqui expostos.

There are academic signals for the development of knowledge management models based on the holistic paradigm. Mutuwa and Maiga affirm that there is no unifying model for the health sector, which allows to infer that the model of these authors is proposed to reach this achievement. Thus, this research is justified by the objective of analyzing the adherence of the model of Mutuwa and Maiga to Holistic Knowledge Management, in order to identify if this model bridged the gap of a unifying structure for this sector. This analysis is performed by means of mixed methodological procedures, including qualitative-quantitative approach and Content Analysis. As a result, the model of Mutuwa and Maiga adheres in 15.4% to the Holistic Knowledge Management, according to the characterization presented in this research, allowing to infer that Knowledge Management has not presented a direction towards a holistic paradigm-oriented approach. Thus, this research contributes to foster the development of new models of knowledge management based on the holistic paradigm, considering the designs presented here.

Hay señales académicas para el desarrollo de modelos de gestión del conocimiento pautados en el paradigma holístico. Mutuwa y Maiga afirman que no hay un modelo unificador para el sector de salud, lo que permite inferir que el modelo de esos autores se propone al logro de ese hecho. Así, esta investigación se justifica por el objetivo de analizar la adherencia del modelo de Mutuwa y Maiga a la Gestión del Conocimiento holístico, para identificar si ese modelo suplía la laguna de una estructura unificadora para este sector. Este análisis se realiza a través de procedimientos metodológicos mixtos, contemplando el abordaje cualitativocuantitativo y el Análisis de Contenido. Por lo tanto, el modelo de Mutuwa y Maiga se adhiere en un 15,4% puntos porcentuales a la Gestión del Conocimiento holístico, conforme caracterización presentada en esa investigación, permitiendo inferir que la Gestión del Conocimiento no ha presentado direccionamiento para un enfoque orientado al paradigma holística. Así, esta investigación contribuye por fomentar el desarrollo de nuevos modelos de gestión del conocimiento fundamentados en el paradigma holístico, considerando los delineamientos aquí expuestos.

Humanos , Organización y Administración , Administración de Personal , Toma de Decisiones en la Organización , Investigación Cualitativa , Educación Continua , Gestión del Conocimiento para la Investigación en Salud , Gestión del Conocimiento , Pediatría , Análisis Cuantitativo , Estrategias , Conocimiento , Salud Holística , Liderazgo , Aprendizaje , Motivación
Rev Esp Quimioter ; 32(4): 400-409, 2019 Aug.
Artículo en Español | MEDLINE | ID: mdl-31345006


The consensus paper for the implementation and development of the sepsis code, finished in April 2017 is presented here. It was adopted by the Regional Office of Health as a working document for the implementation of the sepsis code in the Community of Madrid, both in the hospital setting (acute, middle and long-stay hospitals) and in Primary Care and Out-of-Hospital Emergency Services. It is now published without changes with respect to the original version, having only added the most significant bibliographical references. The document is divided into four parts: introduction, initial detection and assessment, early therapy and organizational recommendations. In the second to fourth sections, 25 statements or proposals have been included, agreed upon by the authors after several face-to-face meetings and an extensive "online" discussion. The annex includes nine tables that are intended as a practical guide to the activation of the sepsis code. Both the content of the recommendations and their formal writing have been made taking into account their applicability in all areas to which they are directed, which may have very different structural and functional characteristics and features, so that we have deliberately avoided a greater degree of concretion: the objective is not that the sepsis code is organized and applied identically in all of them, but that the health resources work in a coordinated manner aligned in the same direction.

Consenso , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/terapia , Tratamiento de Urgencia , Puntuaciones en la Disfunción de Órganos , Sepsis/diagnóstico , Sepsis/terapia , Antibacterianos/uso terapéutico , Biomarcadores/análisis , Lista de Verificación , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/terapia , Toma de Decisiones en la Organización , Diagnóstico Precoz , Servicios Médicos de Urgencia/métodos , Medicina Basada en la Evidencia , Humanos , Norepinefrina/uso terapéutico , Grupo de Atención al Paciente/organización & administración , España , Vasoconstrictores/uso terapéutico
Work ; 63(4): 537-545, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282463


BACKGROUND: To establish whether an organization has a valid Physical Employment Standard (PES), it is important to determine those aspects of the job that are critical to operational success. OBJECTIVE: To determine the tasks of the Offshore Wind Industry (OWI) and whether the ability to undertake these tasks is adequately assessed. METHODS: The task analysis was completed through: observations; the research team undertaking tasks; reviewing operational manuals; and focus groups. In addition, a review of existing PES for the OWI was completed to determine whether standards matched with the results of the task analysis. RESULTS: Five critical tasks were identified: transfer from the vessel to the Transition Piece; ascent of the internal ladder; manoeuvre through hatches; torque and tensioning; and hauling a casualty up the tower. With the exception of aerobic capacity, the physical components required by Technicians are not assessed by the current medical standards, nor are these assessments standardized across companies. CONCLUSIONS: The Job Task Analysis undertaken can be used to inform decisions regarding the physical fitness requirements (selection), assessments and training of Technicians, with a view to ensuring that they are physically capable of undertaking the critical tasks without undue risk of injury to themselves or others.

Evaluación del Rendimiento de Empleados/normas , Empleo/normas , Selección de Personal/normas , Análisis y Desempeño de Tareas , Viento , Adulto , Toma de Decisiones en la Organización , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aptitud Física , Centrales Eléctricas , Navíos , Reino Unido , Lugar de Trabajo , Adulto Joven
Rev Panam Salud Publica ; 43, july 2019
Artículo en Inglés | PAHO-IRIS | ID: phr-51105


[ABSTRACT]. Objectives. To document the underlying science of how the Pan American Health Organization (PAHO) adapted the Hanlon method, which prioritizes disease control programs, to its wider range of program areas and used it to implement the PAHO Strategic Plan 2014 – 2019. Methods. In 2014, PAHO established a Strategic Plan Advisory Group (SPAG) with representatives from 12 Member States to work closely with the PAHO Technical Team to adapt the Hanlon method to disease and non-disease control programs. Three meetings were held in 2015 – 2016 during which SPAG reviewed existing priority-setting methods, assessed the original Hanlon method and subsequent revisions, and developed the adapted method. This project was initiated by Member States, facilitated by PAHO, and conducted jointly in transparent and horizontal technical cooperation. Results. From the original Hanlon equation, the PAHO-adapted method maintains components A (size of problem), B (seriousness of problem), and C (effectiveness of intervention), drops component D (PEARL – Propriety, Economics, Acceptability, Resources, and Legality), and adds component E (inequity) and F (institutional positioning). The PEARL score was dropped because it serves a purpose for pre-screening process, but not in the priority-setting process for PAHO. Conclusions. The PAHO-adapted Hanlon method provides a refined approach for prioritizing public health programs that include disease and non-disease control areas. The method may be useful for the World Health Organization and country governments with similar needs.

[RESUMEN]. Objetivos. Documentar los fundamentos científicos a través de los cuales la Organización Panamericana de la Salud (OPS) adaptó el método de Hanlon, que sirve para asignar prioridades a los programas de control de enfermedades, para aplicarlo al conjunto de áreas programáticas y ejecutar el Plan Estratégico de la OPS 2014-2019. Métodos. En el 2014, la OPS creó un Grupo Asesor sobre el Plan Estratégico integrado por representantes de 12 Estados Miembros cuya misión era colaborar estrechamente con el equipo técnico de la OPS para adaptar el método de Hanlon para su aplicación a los programas de control de enfermedades y otras áreas programáticas. Se celebraron tres reuniones entre el 2015 y el 2016, en las cuales el Grupo Asesor examinó los métodos existentes de establecimiento de prioridades, evaluó el método de Hanlon original y sus revisiones, y elaboró el método adaptado. Este proyecto fue iniciado por los Estados Miembros, facilitado por la OPS y llevado a cabo conjuntamente mediante una cooperación técnica transparente y horizontal. Resultados. El método adaptado por la OPS mantiene los componentes A (magnitud del problema), B (gravedad del problema) y C (eficacia de la intervención) de la ecuación de Hanlon original, prescinde del componente D (resumido en la sigla PEARL, en inglés: pertinencia, factibilidad económica, aceptabilidad, disponibilidad de recursos y legalidad), e incorpora los componentes E (inequidad) y F (posicionamiento institucional). La puntuación PEARL no fue incluida porque solo cumple una función en el proceso de preselección, no durante el proceso de establecimiento de prioridades en el que estaba trabajando la OPS. Conclusiones. El método de Hanlon adaptado por la OPS proporciona un enfoque más preciso para la asignación de prioridades a los programas de salud pública relativos al control de enfermedades y a otras áreas programáticas. El método podría resultar útil para la Organización Mundial de la Salud y para aquellos gobiernos nacionales con necesidades similares.

[RESUMO]. Objetivos. Documentar o processo de base científica empregado pela Organização Pan-Americana da Saúde (OPAS) para adaptar o método de Hanlon, que define a priorização de programas para controle de doenças, às diversas áreas programáticas da OPAS e descrever como esta metodologia foi usada para implementar o Plano Estratégico da OPAS 2014-2019. Métodos. Em 2014, a OPAS formou um grupo consultivo sobre o Plano Estratégico, composto por representantes de 12 Estados Membros, para colaborar estreitamente com a Equipe Técnica da OPAS na adaptação da metodologia de Hanlon aos programas para controle de doenças e não doenças. Foram realizadas três reuniões em 2015–2016 em que se examinaram os métodos existentes para definição de prioridades, avaliaram-se o método de Hanlon original e versões revisadas posteriores e elaborou-se uma metodologia adaptada. Este projeto foi de iniciativa dos Estados Membros, com o auxílio da OPAS, conduzido conjuntamente com cooperação técnica transparente e equiparada. Resultados. Partindo da equação original de Hanlon, a metodologia adaptado pela OPAS mantém os componentes A (magnitude do problema), B (gravidade do problema) e C (eficácia da intervenção), elimina o componente D (PEARL – pertinência, viabilidade econômica, aceitação, recursos e legalidade) e acrescenta os componentes E (iniquidade) e F (posicionamento institucional). A pontuação do componente PEARL foi excluída porque serve à finalidade de pré-seleção, não ao processo de definição de prioridades para a OPAS. Conclusões. O método de Hanlon adaptado pela OPAS oferece um enfoque aprimorado para definir as prioridades programáticas em saúde pública que abrangem áreas de controle de doenças e não doenças. A metodologia pode ser útil à Organização Mundial da Saúde e aos governos de países com necessidades semelhantes.

Prioridades en Salud , Toma de Decisiones , Ética Institucional , Planificación Estratégica , Organización Panamericana de la Salud , Prioridades en Salud , Toma de Decisiones en la Organización , Planificación Estratégica , Organización Panamericana de la Salud , Prioridades en Salud , Toma de Decisiones en la Organización , Planificación Estratégica , Organización Panamericana de la Salud
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(4): 1048-1052, jul.-set. 2019. tab
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería, Repositorio RHS | ID: biblio-1005611


Objetivo: Analisar a percepção de graduandos de enfermagem sobre as competências gerenciais do enfermeiro na Estratégia Saúde da Família. Métodos: Trata-se de pesquisa descritiva, participante com abordagem qualitativa, em que foram empregadas as técnicas de observação participante e entrevista. Os dados foram submetidos à análise temática de conteúdo. Resultados: O planejamento e a organização revelaram-se como as competências mais importantes para a prática gerencial do enfermeiro e o empreendedorismo como a competência menos importante. Conclusão: Os conhecimentos limitados dos estudantes de enfermagem sobre as competências gerenciais, indispensáveis à prática qualificada e autônoma do enfermeiro gerente da Estratégia Saúde da Família, revelaram a necessidade, no contexto formativo desse estudo, de ações pedagógicas interdisciplinares que visem um preparo maior do aluno para executar tais funções no cotidiano da vida no território

Objective: To analyze the perception of nursing undergraduates about the managerial competencies of nurses in the Family Health Strategy. Methods: descriptive research, participant with a qualitative approach, using participant observation and interview techniques. The data were submitted to content thematic analysis. Results: Planning and organization proved to be the most important competencies for managerial practice of nurses and entrepreneurship as the least important competence. Conclusion: The limited knowledge of nursing students about managerial competences, indispensable to the qualified and autonomous practice of the nurse manager of the Family Health Strategy, revealed the need, in the formative context of this study, for interdisciplinary pedagogical actions aimed at a better student preparation to perform such functions in the daily life of the territory

Objetivo: Analizar la percepción de los graduandos de enfermería sobre las competencias gerenciales del enfermero en la Estrategia Salud de la Familia. Métodos: investigación descriptiva, participante con abordaje cualitativo, en que se emplearon las técnicas de observación participante y entrevista. Los datos se sometieron al análisis temático de contenido. Resultados: La planificación y la organización se revelaron como las competencias más importantes para la práctica gerencial del enfermero y el emprendedorismo como la competencia menos importante. Conclusión: Los conocimientos limitados de los estudiantes de enfermería sobre las competencias gerenciales, indispensables a la práctica calificada y autónoma del enfermero gerente de la Estrategia Salud de la Familia, revelaron la necesidad, en el contexto formativo de este estudio, de acciones pedagógicas interdisciplinares que visen una preparación mayor del alumno para ejecutar tales funciones en el cotidiano de la vida en el territorio

Humanos , Masculino , Femenino , Adulto , Competencia Profesional , Estudiantes de Enfermería , Toma de Decisiones en la Organización , Estrategia de Salud Familiar , Administración de los Servicios de Salud
Genes (Basel) ; 10(6)2019 06 13.
Artículo en Inglés | MEDLINE | ID: mdl-31200546


Direct-to-consumer genetic testing companies aim to predict the risks of complex diseases using proprietary algorithms. Companies keep algorithms as trade secrets for competitive advantage, but a market that thrives on the premise that customers can make their own decisions about genetic testing should respect customer autonomy and informed decision making and maximize opportunities for transparency. The algorithm itself is only one piece of the information that is deemed essential for understanding how prediction algorithms are developed and evaluated. Companies should be encouraged to disclose everything else, including the expected risk distribution of the algorithm when applied in the population, using a benchmark DNA dataset. A standardized presentation of information and risk distributions allows customers to compare test offers and scientists to verify whether the undisclosed algorithms could be valid. A new model of oversight in which stakeholders collaboratively keep a check on the commercial market is needed.

Enfermedades Genéticas Congénitas/genética , Pruebas Genéticas , Herencia Multifactorial/genética , Algoritmos , Comercio , Comportamiento del Consumidor , Toma de Decisiones en la Organización , Revelación , Enfermedades Genéticas Congénitas/epidemiología , Humanos
BMC Public Health ; 19(1): 835, 2019 Jun 27.
Artículo en Inglés | MEDLINE | ID: mdl-31248396


BACKGROUND: Commissioning and monitoring of community-based interventions is a challenge due to the complex nature of the environment and the lack of any explicit cut-offs to guide decision making. At what point, for example, is participant enrolment to interventions, course completion or satisfaction deemed to be acceptable or sufficient for continued funding? We aimed to identify and quantify key progression criteria for fourteen early years interventions by (1) agreeing the top three criteria for monitoring of successful implementation and progress; and (2) agreeing boundaries to categorise interventions as 'meeting anticipated target' (green); 'falling short of targets' (amber) and 'targets not being met' (red). METHODS: We ran three workshops in partnership with the UK's Big Lottery Fund commissioned programme 'Better Start Bradford' (implementing more than 20 interventions to improve the health, wellbeing and development of children aged 0-3) to support decision making by agreeing progression criteria for the interventions being delivered. Workshops included 72 participants, representing a range of professional groups including intervention delivery teams, commissioners, intervention-monitoring teams, academics and community representatives. After discussion and activities, final decisions were submitted using electronic voting devices. All participants were invited to reconsider their responses via a post-workshop questionnaire. RESULTS: Three key progression criteria were assigned to each of the 14 interventions. Overall, criteria that participants most commonly voted for were recruitment, implementation and reach, but these differed according to each intervention. Cut-off values used to indicate when an intervention moved to 'red' varied by criteria; the lowest being for recruitment, where participants agreed that meeting less than 65% of the targeted recruitment would be deemed as 'red' (falling short of target). CONCLUSIONS: Our methodology for monitoring the progression of interventions has resulted in a clear pathway which will support commissioners and intervention teams in local decision making within the Better Start Bradford programme and beyond. This work can support others wishing to implement a formal system for monitoring the progression of public health interventions.

Salud del Niño , Toma de Decisiones en la Organización , Promoción de la Salud/organización & administración , Administración en Salud Pública , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Encuestas y Cuestionarios , Reino Unido
Aerosp Med Hum Perform ; 90(7): 606-612, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31227033


BACKGROUND: From a population-based perspective, reports in the peer-reviewed medical literature suggest an increase in the overall prevalence of asthma in recent decades. Applicants for military aviation training with a current or past history of asthma are generally excluded in the United Kingdom.METHODS: In order to assess the impact of the prevalence of asthma on the available pool of military service candidates, the authors collected data on annual live births between 1916 and 2016 as well as peer-reviewed publications that provided insight into asthma prevalence trends within the United Kingdom across the last century (covering birth-year population cohorts ranging from 1924 to 1995). Regression techniques were used to estimate the prevalence of individuals who could reasonably expect to be found unfit for military aviation service due to asthma-like conditions within the birth-year cohorts between 2001 and 2016.RESULTS: Between 1916 and 2016, the number of live births in the United Kingdom has averaged approximately 802,000 per year. The reported prevalence of asthma, based on the assimilated data points, ranged from 2.3 cases per 1000 individuals among the 1924 birth-year cohort, to 29.8 cases per 1000 individuals among the 1990 birth-year cohort.DISCUSSION: Based on the data and analysis presented above, asthma continues to constitute a significant public health issue in the United Kingdom. Military services must base risk mitigation decisions on accurate and precise diagnostic categorizations, and prudently balance the benefits of allowing affected individuals to participate in military service with the potential for mission degradation or compromise.Porter WD, Powell-Dunford N, Wilde GD, Bushby AJR. Asthma and rotary-wing military aircrew selection. Aerosp Med Hum Perform. 2019; 90(7):606-612.

Medicina Aeroespacial/organización & administración , Asma/epidemiología , Aviación/organización & administración , Solicitud de Empleo , Personal Militar , Adolescente , Adulto , Medicina Aeroespacial/normas , Aviación/normas , Niño , Toma de Decisiones en la Organización , Humanos , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Prevalencia , Reino Unido/epidemiología , Adulto Joven
Gac. sanit. (Barc., Ed. impr.) ; 33(3): 293-295, mayo-jun. 2019. mapas, graf
Artículo en Español | IBECS | ID: ibc-183752


El objetivo de este trabajo es analizar el desempeño de la salud pública por las comunidades autónomas en España a partir de la información accesible en sus documentos anuales de revisión de gestión. Se realizó una búsqueda de sus memorias anuales, que se localizaron en 9 de las 17 comunidades autónomas. De su análisis se desprenden algunas diferencias en las estructuras de salud pública, así como en los contenidos publicados y en la utilización de indicadores de gestión. No siempre se aprecia una explicitación de la cartera de servicios, de los objetivos ni de los recursos adscritos. Si la evaluación de los servicios públicos y su difusión son ejercicios básicos de transparencia y de calidad de gestión, su práctica tiene amplio margen de mejora. La realización de memorias anuales por los servicios de salud pública no es sistemática, y las publicadas aportan poca información para una comparación de su actividad, efectividad y eficiencia

The objective of this study is to analyze the performance of regional public health services in Spain using the information accessible in their annual reports. A search of these was conducted, and 9 were obtained from the 17 Autonomous Communities. Their analysis shows some variation in the structure of the organizations providing public health services, as well as in the published contents and in the indicators used for management. The service portfolio, annual objectives and resources allocated are not always detailed. If the evaluation of public services and its dissemination are basic for transparency and quality management, there is much room for improvement. The compilation of annual reports by public health services is not systematic, and those that exist provide insufficient information for a comparative analysis of their activity, effectiveness and efficiency

Humanos , Administración de los Servicios de Salud/tendencias , Informes Anuales como Asunto , Administración en Salud Pública/tendencias , Toma de Decisiones en la Organización , Sistemas de Información en Hospital/organización & administración
Health Policy Plan ; 34(4): 271-281, 2019 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-31074778


The Global Vaccine Action Plan proposes that every country establish or have access to a National Immunization Technical Advisory Group (NITAG) by 2020. The NITAG role is to produce evidence-informed recommendations that incorporate local context, to guide national immunization policies and practice. This study aimed to explore the value and effectiveness of NITAGs in low- and middle-income countries (LMICs), identifying areas in which NITAGs may require further support to improve their functionality and potential barriers to global investment. A multi-methods study design was used, comprising 134 semi-structured interviews and 82 literature review sources that included 38 countries. Interviews were conducted with 53 global/regional and 81 country-level participants able to provide insight into NITAG effectiveness, including NITAG members, national immunization programme staff, and global agency representatives (e.g. the World Health Organisation, the Bill and Melinda Gates Foundation, Gavi the Vaccine Alliance). The review, including published and unpublished sources on NITAGs in LMICs, was conducted to supplement and corroborate interview findings. Data were analysed thematically. NITAGs were described as valuable in promoting evidence-informed vaccination decision-making, with NITAG involvement enhancing national immunization programme strength and sustainability. Challenges to NITAG effectiveness included: (1) unreliable funding; (2) insufficient diversity of member expertise; (3) inadequate conflicts of interest management procedures; (4) insufficient capacity to access and use evidence; (5) lack of transparency; and (6) limited integration with national decision-making processes that reduced the recognition and incorporation of NITAG recommendations. LMIC NITAGs have developed significantly in the past decade. Well-functioning NITAGs were trusted national resources that enhanced country ownership of immunization provision. However, many LMIC NITAGs require additional technical and funding support to strengthen quality and effectiveness, while maintaining impartiality and ensuring sufficient integration with national decision-making processes. Barriers to sustainable global support need to be addressed for LMIC NITAGs to both continue and develop further.

Comités Consultivos/organización & administración , Programas de Inmunización/organización & administración , Toma de Decisiones en la Organización , Países en Desarrollo , Práctica Clínica Basada en la Evidencia , Política de Salud , Humanos , Programas de Inmunización/economía , Programas de Inmunización/normas , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Vacunación/legislación & jurisprudencia
Medicine (Baltimore) ; 98(20): e15728, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31096530


Health information systems are the core support to decision-making in health organizations. Economic and clinical managements often function separately, while a governance system for quality and safety functions with quality checks and performance accountability, could improve efficiency. The aims of this study were, within a respiratory rehabilitation unit (RRU), to: develop a management-strategy dashboard based on key performance areas (KPAs), identify key performance indicators (KPIs) for each KPA which allow multidimensional assessment; estimate the expected results from the implementation of this dashboard using the balanced score card (BSC) method.In December 2017, a working group was set up at the RRU to develop the dashboard by selecting criteria for KPA and determining the KPIs with their rationale, weight, calculation method, measurements, supply system, target values, and working rules.After 3 meetings, 6 KPAs and 12 KPIs for the financial area, 3 KPAs and 15 KPIs for internal processes, 6 KPAs and 8 KPIs for innovation and growth, and 4 KPAs and 5 KPIs for the Clients' Perspective were approved. A strategic map showing the cause/effect relations between the different KPAs was drawn.A BSC-based quality measurement integrating economic and clinical management dimensions is possible also in an RRU. The proposed dashboard can improve communication, strategy, information dissemination, information communication technology management, budget negotiations, organizational quality, and accountability to stakeholders.

Sistemas de Información en Salud/normas , Centros de Rehabilitación/organización & administración , Unidades de Cuidados Respiratorios/normas , Benchmarking , Toma de Decisiones en la Organización , Humanos , Indicadores de Calidad de la Atención de Salud
Value Health ; 22(5): 545-548, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31104732


The "Reference Case" was developed to facilitate comparability among published cost-effectiveness analyses intended to contribute to decisions about the broad allocation of healthcare resources. Although the societal perspective is recommended for Reference Case analyses, empirical estimations rarely adequately represent the patient perspective, and more often, healthcare system or payer perspectives are used. In this commentary, we discuss the evolution of the Reference Case over the past 20 years and how it now needs to further evolve. This should begin with a patient-informed societal perspective. A realignment of the societal perspective to better include patient perspectives in CEA creates a conduit for patient inclusion. Engaging patients to both derive patient-informed value elements and prioritize value elements using stated preference methods will lead to patient inclusion in the societal perspective and a patient-informed Reference Case analysis.

Análisis Costo-Beneficio/métodos , Prestación de Atención de Salud , Participación del Paciente , Años de Vida Ajustados por Calidad de Vida , Asignación de Recursos , Toma de Decisiones en la Organización , Humanos , Valores Sociales
Int J Technol Assess Health Care ; 35(3): 204-211, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31017075


OBJECTIVES: Very few practical frameworks exist to guide the formulation of recommendations at hospital-based health technology assessment (HTA) units. The objectives of our study were: (i) to identify decision criteria specific to the context of hospital-based health technologies and interventions, (ii) to estimate the extent to which the expert community agrees on the importance of the identified criteria, (iii) to incorporate the identified criteria into a decision-aid tool, and (iv) to illustrate the application of a prototype decision-aid tool. METHODS: Relevant decision criteria were identified using existing frameworks for HTA recommendations, our past experience, a literature search, and feedback from a survey of diverse stakeholders. RESULTS: Based on the survey results, twenty-three decision criteria were incorporated into the final framework. We defined an approach that eschewed a scoring system, but instead relied on a visual means for arriving at a final recommendation, by juxtaposing the importance rating for each criterion against the results of the health technology assessment. For a technology to be approved, a majority of criteria considered important should also have received favorable findings. CONCLUSIONS: We created a simple and practical decision-aid tool that incorporates all decision criteria relevant to a hospital-based HTA unit. With its ease of use and accessibility, our tool renders the subjective decision-making process more structured and transparent.

Toma de Decisiones en la Organización , Técnicas de Apoyo para la Decisión , Práctica Clínica Basada en la Evidencia/organización & administración , Administración Hospitalaria , Evaluación de la Tecnología Biomédica/organización & administración , Conducta Cooperativa , Análisis Costo-Beneficio , Eficiencia Organizacional , Humanos , Políticas
Int J Med Inform ; 126: 176-186, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31029259


BACKGROUND: Medical data stream clustering has become an integral part of medical decision systems since it extracts highly-sensitive information from a tremendous flow of medical data. However, clustering and maintaining of medical data streams is still a challenging task. That is because the evolving of medical data streams imposes various challenges for clustering such as the ability to discover the arbitrary shape of a cluster, the ability to group data streams without a predefined number of clusters, and the ability to maintain the data clusters dynamically. OBJECTIVE: To support the online medical decisions, there is a need to address the clustering challenges. Therefore, in this paper, we propose an effective density-based clustering and dynamic maintenance framework for grouping the patients with similar symptoms into meaningful clusters and monitoring the patients' status frequently. METHODS: For clustering, we generate a set of initial medical data clusters based on the combination of Piece-wise Aggregate Approximation and the density-based spatial clustering of applications with noise called (PAA+DBSCAN) algorithm. For maintenance, when new medical data streams arrive, we maintain the initially generated medical data clusters dynamically. Since the incremental cluster maintenance is time-consuming, we further propose an Advanced Cluster Maintenance (ACM) approach to improve the performance of the dynamic cluster maintenance. RESULTS: The experimental results on real-world medical datasets demonstrate the effectiveness and efficiency of our proposed approaches. The PAA+DBSCAN algorithm is more efficient and effective than the exact DBSCAN algorithm. Moreover, the ACM approach requires less running time in comparison with the Baseline Cluster Maintenance (BCM) approach using different tuning parameter values in all datasets. That is because the BCM approach tracks all the data points in the cluster. CONCLUSION: The proposed framework is capable of clustering and maintaining the medical data streams effectively by means of grouping the patients who share similar symptoms and tracking the patients status that naturally tends to be changing over time.

Análisis por Conglomerados , Toma de Decisiones en la Organización , Algoritmos , Estado de Salud , Humanos , Internet
Int J Technol Assess Health Care ; 35(3): 195-203, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31023393


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.

Toma de Decisiones en la Organización , Administración Hospitalaria , Gestión de Riesgos/organización & administración , Evaluación de la Tecnología Biomédica/organización & administración , Conducta Cooperativa , Humanos , Capacitación en Servicio , Gestión de Riesgos/normas , Evaluación de la Tecnología Biomédica/normas
Int J Technol Assess Health Care ; 35(3): 189-194, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31006390


OBJECTIVES: As healthcare decision makers continue to face challenges in health services delivery to their patients, disinvestment programs are being established for a sustainable healthcare system. This study aimed to collect data and information by means of a survey of disinvestment candidates and ongoing disinvestment projects in the health technology assessment (HTA) community. METHODS: An online survey was conducted to collect information on disinvestment candidates and activities from members of the Health Technology Assessment International Disinvestment & Early Awareness Interest Group, the EuroScan International Network and International Network of Agencies for Health Technology Assessment. RESULTS: Among the 362 invitees, twenty-four unique responses were received, and almost 70 percent were involved in disinvestment initiatives. The disinvestment candidates identified represented a range of health technologies. Evidence or signaling of clinical ineffectiveness or inappropriate use typically led to the nomination of disinvestment candidates. Health technology assessments and reassessments were usually conducted to evaluate the technology in question, and decisions usually led to the limited use of the technology. Barriers to disinvestment decisions included the strength of interest and advocacy groups, insufficient data for assessments, a systematic decision process and political challenges, while obstacles to their implementation were clinicians' reluctance and insufficient funding and incentives. CONCLUSIONS: The survey results suggested that disinvestment activities are occurring in the HTA community, especially in the public sector. Future research can further investigate the processes and methods used to reach and implement disinvestment decisions from our survey respondents and explore to form closer ties between the HTA and clinical communities.

Toma de Decisiones en la Organización , Asignación de Recursos/organización & administración , Evaluación de la Tecnología Biomédica/organización & administración , Humanos , Política , Asignación de Recursos/economía , Asignación de Recursos/normas , Evaluación de la Tecnología Biomédica/economía , Evaluación de la Tecnología Biomédica/normas
Nursing (Säo Paulo) ; 22(251): 2829-2833, abr.2019.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-996339


Pesquisa descritivo-exploratória, de abordagem quantitativa, que objetivou identificar a autopercepção de enfermeiros hospitalares sobre sua habilidade decisória. A coleta de dados ocorreu nos meses de junho e julho de 2017, por meio de um questionário prévio contendo 18 questões com respostas em formato Likert dispostas em 05 domínios do processo de tomada de decisão, além de formulário para caracterização da amostra. Participaram 20 Enfermeiros de hospital universitário público do Paraná, Brasil. Os dados foram analisados por meio de estatística descritiva, em medidas de proporção, incluindo classificação da habilidade decisória segundo o questionário empregado. A maioria dos participantes era do sexo feminino (75%), com idade entre 36 a 45 anos (65%). A habilidade decisória foi classificada como razoável (70%) e excelente (30%). Conclui-se que, apesar de os profissionais se perceberem aptos às decisões, existem espaços para melhorias, especialmente no que se refere à implantação de planos pós-decisões e identificação de fatores de apoio à decisão.(AU)

Descriptive-exploratory research, with a quantitative approach, aimed at identifying the self-perception of hospital nurses about their decision-making ability. Data collection took place in June and July 2017, through a previous questionnaire containing 18 questions with Likert format answers arranged in 05 domains of the decision making process, as well as a form for characterization of the sample. Twenty nurses from a public university hospital in Paraná, Brazil participated. The data were analyzed by means of descriptive statistics, in measures of proportion, including classification of the decision ability according to the questionnaire used. The majority of participants were female (75%), aged 36-45 years (65%). Decision-making ability was classified as reasonable (70%) and excellent (30%). It is concluded that, although the professionals feel apt to the decisions, there are spaces for improvements, especially with regard to the implantation of post-decision plans and identification of decision support factors.(AU)

Investigación descriptiva-exploratoria, de abordaje cuantitativo, que objetivó identificar la autopercepción de enfermeros hospitalarios sobre su habilidad decisoria. La recolección de datos ocurrió en los meses de junio y julio de 2017, por medio de un cuestionario previo que contenía 18 preguntas con respuestas en formato Likert dispuestas en 05 dominios del proceso de toma de decisión, además de formulario para caracterización de la muestra. Participaron 20 enfermeros de hospital universitario público de Paraná, Brasil. Los datos fueron analizados por medio de estadística descriptiva, en medidas de proporción, incluyendo clasificación de la habilidad decisoria según el cuestionario empleado. La mayoría de los participantes eran del sexo femenino (75%), con edad entre 36 a 45 años (65%). La habilidad decisoria fue clasificada como razonable (70%) y excelente (30%). Se concluye que, a pesar de que los profesionales se perciben aptos a las decisiones, existen espacios para mejoras, especialmente en lo que se refiere a la implantación de planes post-decisiones e identificación de factores de apoyo a la decisión.(AU)

Humanos , Organización y Administración , Toma de Decisiones en la Organización , Toma de Decisiones , Servicio de Enfermería en Hospital , Personal de Enfermería en Hospital
Invest Ophthalmol Vis Sci ; 60(3): M161-M183, 2019 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-30817831


Purpose: To discuss guidelines and ethical considerations associated with the development and prescription of treatments intended for myopia control (MC). Methods: Critical review of published papers and guidance documents was undertaken, with a view to carefully considering the ethical standards associated with the investigation, development, registration, marketing, prescription, and use of MC treatments. Results: The roles and responsibilities of regulatory bodies, manufacturers, academics, eye care practitioners, and patients in the use of MC treatments are explored. Particular attention is given to the ethical considerations for deciding whether to implement a MC strategy and how to implement this within a clinical trial or practice setting. Finally, the responsibilities in marketing, support, and education required to transfer required knowledge and skills to eye care practitioners and academics are discussed. Conclusions: Undertaking MC treatment in minors creates an ethical challenge for a wide variety of stakeholders. Regulatory bodies, manufacturers, academics, and clinicians all share an ethical responsibility to ensure that the products used for MC are safe and efficacious and that patients understand the benefits and potential risks of such products. This International Myopia Institute report highlights these ethical challenges and provides stakeholders with recommendations and guidelines in the development, financial support, prescribing, and advertising of such treatments.

Ética Médica , Miopía/prevención & control , Oftalmólogos/normas , Guías de Práctica Clínica como Asunto/normas , Toma de Decisiones en la Organización , Humanos , Internacionalidad
Sangyo Eiseigaku Zasshi ; 61(5): 141-158, 2019 Sep 25.
Artículo en Japonés | MEDLINE | ID: mdl-30905919


OBJECTIVE: The topic of occupational health physicians' specific interventions for deciding on corporate health measures has not been researched. Such interventions are necessary in corporate decision-making and for considering the needs of the company and its employees. We examined the aspects and methods of occupational health services that facilitate corporate decision-making regarding health measures. METHODS: We conducted semi-structured interviews with 11 certified occupational health physicians involved in the planning of health measures at 10 companies. Data were analyzed qualitatively and inductively using Berelson's content analysis method. RESULTS: We divided 144 items corresponding to the research theme into three categories: organizational decision-making process in health measures, occupational health physician interventions, and complementary factors concerning interventions. The interventions were further categorized as follows: building relationships, promoting mutual understanding; consensus-building process, coordination; visualization company needs based on hypotheses; and integrated planning and proposals. The study identified specific intervention methods of each category. DISCUSSIONS: Aspects and methods that facilitate decision-making in occupational health services were as follows: 1) understanding the scope of consensus formation and its impact based on the characteristics of corporate decision-making regarding health measures and premises of decision maker; 2) improving awareness about occupational health by consistently presenting information on occupational health, translating it to be necessary for corporate management. Occupational health professionals, mainly occupational health physicians, are expected to contribute to health policy decisions while utilizing the method clarified in this study.

Toma de Decisiones en la Organización , Empleo , Política de Salud , Necesidades y Demandas de Servicios de Salud , Evaluación de Necesidades , Médicos Laborales , Servicios de Salud del Trabajador/organización & administración , Salud Laboral , Rol del Médico , Humanos , Entrevistas como Asunto
Nurs Adm Q ; 43(2): 186-192, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30839455


As key members of the executive team, nurse executives play an integral role in the planning process and operationalization of strategic imperatives to ensure the overall success of the organization. Nurse executives are leading organizations through transition periods that require transformational leadership. Leaders must design a shared vision and set strategic priorities; empower others to lead; ensure access to resources needed for safe care delivery; and inspire people to meet the demands of the future. Paramount to effective strategic planning and achievement of positive outcomes is a leadership team that engages key stakeholders in the strategic planning process. This article provides an overview of a recently integrated health system's strategic planning process that included the engagement of patients and caregivers. This can serve as a blueprint for others in their efforts to implement a systematic approach for enhancing collaborative academic practice in their organizations.

Toma de Decisiones en la Organización , Prestación Integrada de Atención de Salud , Enfermeras Administradoras , Rol de la Enfermera , Cuidadores , Humanos , Ontario , Pacientes