Papel da Liderança na Motivação, Desempenho e Produtividade dos Funcionários do Serviço Distrital de Saúde, Mulher e Acção Social de Nicoadala, Província da Zambézia entre 2019 e 2020 / The Role of Leadership in the Motivation, Performance and Productivity of Employees of the Service of Nicoadala, Zambezia Province between 2019 and 2020. 2020

Actualmente as organizações passam por diversas mudanças que levam as instituições a terem uma liderança que renova suas estratégias de motivação em seu cotidiano. O estudo intitulado " papel da liderança na motivação, desempenho e produtividade dos funcionários do Serviço Distrital de Saúde, Mulher e Acção Social de Nicoadala- Provincia da Zambézia entre 2019 e 2020, com objectivo de analisar a contribuição da liderança no desempenho, motivação e produtividade dos funcionários, com a questão de partida: Até que ponto a liderança do Serviço Distrital de Saúde, Mulher e Acção Social de Nicoadala contribuiu para motivação, desempenho e produtividade dos funcionários entre 2019 e 2020? Através de uma pesquisa descritiva, numa simbiose de pesquisa quantitativa e qualitativa, associada ao uso de técnicas de recolha de dados como entrevista e questionário. Dos resultados do estudo, constatou ­ se que a liderança do SDSMASN optou durante o período em referência, conjunto de factores e estratégias para manter os colaboradores motivados no desempenho e produtividade, destacando: Crescimento profissional, relações laborais, condições de trabalho, estabilidade de emprego, que se refletem num modelo de liderança democrática, enerentes a organização. Contudo, a liderança do Serviço Distrital de Saúde, Mulher e Acção Social de Nicoadala deve continuar aprimorar por um modelo de liderança democrática, não obstante, deve também, continuar a incluir os colaboradores no processo de tomada de decisão, uma véz que a participação de colaboradores na vida da instituição pode contribuir para a motivação, desempenho e produtiviade dos funcionários.

Currently, organizations undergo several changes, which lead institutions to have a leadership that renews their motivation strategies in their daily lives. The study and entitled "The role of leadership in the motivation, performance and productivity of employees of the District Service of Health, Women and Social Action of Nicoadala- Province of Zambézia, between 2019, 2020, with the objective of analyzing the contribution of leadership in the performance, motivation and productivity of employees, with the starting question: To what extent the leadership of the District Health, Women and Social Action Service of Nicoadala contributed to the motivation, performance and productivity of employees among 2019 and 2020? Through a descriptive research in a symbiosis of quantitative and qualitative research, associated with the use of data collection techniques such as interview and questionnaire. From the results of the study, it was found that the leadership of SDMASN chose, during the period in question, a set of factors and strategies to keep employees motivated in performance and productivity, highlighting: Professional growth, labor relations, working conditions, job stability, which are reflected in a model of democratic leadership, inherent to the organization. However, the leadership of the Nicoadala District Health, Women and Social Action Service must continue to improve through a model of democratic leadership, however, it must also continue to include employees in the decision-making process, since the participation of employees in the life of the institution can contribute to employee motivation, performance and productivity.

Estilo de liderazgo situacional en el profesional de enfermería y su relación con factores laborales / Style of situational leadership in the nursing professional and its relationship with labor factors in a second level hospital, 2021 / Estilo de liderança situacional no profissional de enfermagem e sua relação com fatores de trabalho. hospital de segundo nível, 2021

RESUMEN Objetivo: Identificar el estilo de liderazgo situacional del profesional de enfermería y su relación con los factores laborales en un hospital de segundo nivel. Metodología: Se trata de un estudio descriptivo relacional de corte transversal. La población de estudio fueron 111 enfermeras, para la recolección de datos se utilizó el instrumento de Paul Hersey y Keneth Blanchard (1973), el cual consta de 12 situaciones. El instrumento del estudio se envió por correo electrónico y WhatsApp, y se utilizó el formato en papel para incrementar la tasa de respuesta. La información se procesó a través del programa SPSS V24. Resultados: Se obtuvo una tasa de respuesta del 56%. Los participantes tienen una edad media de 36 años y una DE 11,82. Hay un predominio del sexo femenino del 90,3%, el 36% tiene estudios a nivel de especialización y maestría. En cuanto a los años laborando, más del 40% tiene menos de 5 años. El estilo mayormente adoptado por el personal es el estilo participativo (E3) 42%, seguido del estilo persuasivo (E2) 37%, dirigir (E1) 13%, por último, el estilo delegar (E4) 8%. El estilo de liderazgo situacional no presentó asociación estadísticamente significativa con los años laborando y la preparación académica, ya que se obtuvo valores p> 0.05. Se evidencio una relación estadísticamente significativa entre los años de labor como profesional de enfermería y la preparación académica, con una p<0.05. Conclusión: El estilo de liderazgo predominante es el participativo y no se evidenció relación estadísticamente entre el estilo de liderazgo y los factores laborales.

ABSTRACT Objective: To identify the situational leadership style of the nursing professional and its relationship with work factors in a second-level hospital. Methodology: This is a descriptive, relational, cross-sectional study. The study population was 111 nurses; for data collection the instrument of Paul Hersey and Keneth Blanchard (1973), which consists of 12 situations, was used. The research instrument was sent by email and WhatsApp, and available in print to increase the response rate. The information was processed through the SPSS V24 program. Results: A response rate of 56% was obtained. The participants have a mean age of 36 years and a SD of 11.82. There is a female predominance of 90.3%, where 36% has studied at the specialization and master's level. Regarding the years working, more than 40% has worked less than 5 years. The style mostly adopted by the staff is the participative style (E3) 42%, followed by the persuasive style (E2) 37%, directing (E1) 13%, and finally, the delegative style (E4) 8%. The situational leadership style did not present a statistically significant association with the years of work and academic preparation, since p values> 0.05 were obtained. A statistically significant relationship was evidenced between the years of work as a nursing professional and academic preparation, with a p <0.05. Conclusion: The predominant leadership style is participative and there was no statistically evidenced relationship between leadership style and work factors.

RESUMO Objetivo: Identificar o estilo de liderança situacional do profissional de enfermagem e sua relação com fatores de trabalho em um hospital de segundo nível. Metodologia: Trata-se de um estudo descritivo relacional transversal. A população do estudo foi de 111 enfermeiros, para coleta de dados o instrumento de Paul Hersey e Keneth Blanchard (1973), que consiste em 12 situações. O instrumento de estudo foi enviado por email e WhatsApp, e o formato de papel foi utilizado para aumentar a taxa de resposta. As informações foram processadas através do programa SPSS V24. Resultados: Obteve-se uma taxa de resposta de 56%. Os participantes têm idade média de 36 anos de idade e DE de 11,82. Há predominância do sexo feminino de 90,3%, 36% têm estudos no nível de especialização e mestrado. Quanto aos anos de trabalho, mais de 40% têm menos de 5 anos. O estilo adotado principalmente pelos funcionários é o estilo participativo (E3) 42%, seguido pelo estilo persuasivo (E2) 37%, direto (E1) 13%, e por último, o estilo delegado (E4) 8%. O estilo de liderança situacional não apresentou associação estatisticamente significante com os anos de trabalho e preparação acadêmica, uma vez que foram obtidos valores p> 0,05.Foi evidenciada uma relação estatisticamente significativa entre os anos de trabalho como profissional de enfermagem e preparação acadêmica, com p<0,05. Conclusão: O estilo de liderança predominante é participativo e não houve relação estatística entre estilo de liderança e fatores de trabalho.

Avaliação de desempenho na organização de gestão do trabalho no município de São Tomé-RN / Performance assessment in the work management organization in the city of São Tomé-RN / Evaluación del desempeño en la organización de gestión del trabajo en el municipio de São Tomé-RN

Objetivo: refletir sobre a necessidade de implantação da avaliação de desempenho dos profissionais de saúde do município de São Tomé-RN. Método: Trata-se de um ensaio reflexivo, de caráter descritivo e de abordagem qualitativa. Resultados: Tem-se a necessidade de sensibilizar a gestão, na perspectiva de implantar uma avaliação de desempenho, a partir de instrumentos, tendo em vista várias necessidades tais como: perfil profissional, assiduidade, comportamento profissional, capacitações de educação continuada, viabilizar desempenho eficaz do profissional, melhorar condições de trabalho e qualidade de vida no trabalho. Conclusão: Para concretizar a implantação de avaliação de desempenho é preciso que haja um bom planejamento; realizar diagnósticos na gestão com bases nos problemas levantados, constatar problemas não é o suficiente para provocar mudanças necessárias. Faz-se imperativo, portanto, empenhar-se na construção de estratégias que possam promover mudanças no cotidiano dos serviços de saúde que possam vir a contribuir para melhoria da gestão.(AU)

Objective: to reflect on the need to implement the performance evaluation of health professionals in the municipality of São Tomé-RN. Method: This is a reflective essay, with a descriptive character and a qualitative approach. Results: There is a need to sensitize management, with a view to implementing a performance evaluation, based on instruments, in view of various needs such as: professional profile, attendance, professional behavior, continuing education skills, enabling effective performance professional, improve working conditions and quality of life at work. Conclusion: In order to implement the performance evaluation, there must be good planning; making diagnoses in management based on the problems raised, finding problems is not enough to cause necessary changes. It is imperative, therefore, to commit to the construction of strategies that can promote changes in the daily life of health services that may contribute to improve management.(AU)

Objetivo: reflexionar sobre la necesidad de implementar la evaluación del desempeño de los profesionales de la salud en el municipio de São Tomé-RN. Método: Se trata de un ensayo reflexivo, con carácter descriptivo y enfoque cualitativo. Resultados: Existe la necesidad de sensibilizar a la gestión, con miras a implementar una evaluación de desempeño, basada en instrumentos, ante diversas necesidades tales como: perfil profesional, asistencia, comportamiento profesional, capacidades de educación continua, posibilitando un desempeño efectivo profesional, mejorar las condiciones laborales y la calidad de vida en el trabajo. Conclusión: Para implementar la evaluación de desempeño, debe haber una buena planificación; haciendo diagnósticos en la gestión basados en los problemas planteados, encontrar problemas no es suficiente para provocar los cambios necesarios. Por tanto, es imperativo apostar por la construcción de estrategias que puedan promover cambios en la vida diaria de los servicios de salud que contribuyan a mejorar la gestión.(AU)

A Guide to Performance Evaluation for the Intensivist: Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation in the ICU.

OBJECTIVES: In 2008, The Joint Commission implemented a new standard mandating a detailed evaluation of a provider's performance. The Ongoing Professional Practice Evaluation was designed to provide ongoing performance evaluation as opposed to periodic evaluation. The Focused Professional Practice Evaluation was designed to evaluate the performance of providers new to the medical staff or providers who are requesting new privileges. To date, we are unable to find critical care specific literature on the implementation of Ongoing Professional Practice Evaluation/Focused Professional Practice Evaluation. The purpose of this concise definitive review is to familiarize the reader with The Joint Commission standards and their application to Ongoing Professional Practice Evaluation/Focused Professional Practice Evaluation design and implementation, literature review in the noncritical care setting, and future process optimization and automation. DATA SOURCES: Studies were identified through MEDLINE search using a variety of search phrases related to Ongoing Professional Practice Evaluation, Focused Professional Practice Evaluation, critical care medicine, healthcare quality, and The Joint Commission. Additional articles were identified through a review of the reference lists of identified articles. STUDY SELECTION: Original articles, review articles, and systematic reviews were considered. DATA EXTRACTION: Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. DATA SYNTHESIS: There is limited data for the process of Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation implementation in critical care medicine. Key recommendations exist from The Joint Commission but leave it up to healthcare institutions to realize these. The process and metrics can be tailored to specific institutions and departments. CONCLUSIONS: Currently, there is no standard process to develop Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation processes in critical care medicine. Departments and institutions can tailor metrics and processes but it might be useful to standardize some metrics to assure the overall quality of care. In the future utilization of newer technologies like applications might make this process less time-intensive.

Mindfulness and job control as moderators of the relationship between demands and innovative work behaviours / Mindfulness y autonomía en el puesto de trabajo como moderadores de la relación entre las demandas y los comportamientos innovadores

Innovation enables organizations to respond successfully to rapid changes in a business environment. This innovation capability largely relies on employees. Although workers are required to be innovative, their jobs frequently contain higher demands that might make it difficult for them to innovate at work. The Job Demands-Control model active hypothesis suggests that highly demanding jobs that allow individuals enough discretion enhance innovative performance. Improving an important attentional resource such as mindfulness at work might also play a similar role, although there is a need for more research at this level. The main aim of this study is to examine the relative contribution of job control and increases in mindfulness as moderators in the job demands-innovation work behaviours relationship. The results obtained with 221 workers indicated that in previous situations characterized by high job demands (T1), workers who increase their capacity for mindfulness are more innovative in the future (T2)

La innovación permite que las organizaciones respondan eficazmente a cambios rápidos en su entorno empresarial, residiendo en gran medida tal capacidad innovadora en sus trabajadores y trabajadoras. Mientras que estos deben ser innovadores, sus puestos con frecuencia suponen demandas elevadas que pueden hacerles difícil innovar en su trabajo. La hipótesis activa del modelo demandas-control sugiere que puestos muy exigentes pero con suficiente autonomía mejoran el desempeño innovador. La mejora de un importante recurso atencional en el trabajo como el mindfulness podría desempeñar un papel similar, precisándose más investigación a este nivel. El objetivo principal de este estudio es examinar la contribución relativa de la autonomía y el incremento en mindfulness como moderadores de la relación de las exigencias del puesto con el desempeño innovador. Los resultados obtenidos con 221 trabajadores indicaron que en situaciones previas de gran demanda de trabajo (T1) aquellos trabajadores que aumentan su capacidad de mindfulness serán más innovadores en el futuro (T2)

Scholarly Productivity and Occupational Stress Among Physician Assistant Educators.

PURPOSE: Academic scholarship continues to challenge physician assistant (PA) educators in the United States, who typically enter academia with little experience in research or publication. Consequently, difficulty with navigating the promotion process might be expected to impact both job satisfaction and retention of PA faculty. Providing reasonable benchmarks for scholarship is one focus of this project, along with exploration of relationships among publication success, gender, job stressors, program support, and intent to leave academia. METHODS: Deidentified data from the online 2017 Faculty & Directors Survey was obtained from the Physician Assistant Education Association (PAEA), including gender, academic rank, program role, degree, publication numbers, and variables measuring program support, stressors, and intent to leave the institution or academia. Individual response rate was 60.3%, N = 1009. SPSS-v25 was used for data analysis. RESULTS: Respondents were 65% female. The mean number of total publications was 2.7 (down from 4.2 in 2010); the median was zero with 50.6% reporting no publications during their career. Almost half (45.5%) of PA faculty were stressed by research or publishing demands; 53.6% were stressed by the promotion process. Physician assistant educators stressed by promotion were more likely to consider leaving their institution or academia as a whole (Fisher's exact, P < .001 for both). CONCLUSION: This study updates publication benchmarks for PA educators. Scholarship levels have dropped since 2010, likely related to the recent influx of junior faculty. Navigating the promotions process is a significant occupational stressor for PA educators and is associated with faculty intent to leave academia.

Ongoing and Focused Provider Performance Evaluations in Emergency Medicine: Current Practices and Modified Delphi to Guide Future Practice.

The Joint Commission requires ongoing and focused provider performance evaluations (OPPEs/FPPEs). The authors aim to describe current approaches in emergency medicine (EM) and identify consensus-based best practice recommendations. An online survey was distributed to leaders in EM to gain insight into current practices. A modified Delphi approach was then used to develop consensus to recommend best practice. A variety of strategies are currently in use for OPPE/FPPE. "Peer reviewed cases with opportunity for improvement" was identified as a preferred metric for OPPE. Although the preference was for use of peer review in OPPE, a consistent and standard adoption of robust internal care review processes is needed to establish expected norms. National benchmarking is not available currently. This was a limited survey of self-identified leaders, and there is an opportunity for additional engagement of leaders in EM to identify a unified approach that appropriately relates to patient outcomes.

Information within residency monthly evaluation forms at two institutions.

Periodic review of resident performance is an important aspect of residency training. Amongst allopathic residency programs, it is expected that the performance of resident physicians which can be grouped based on the ACGME core competencies, be assessed so as to allow for effective feedback and continuous improvement. Review of monthly evaluation forms for residents in the core ACGME programs at Marshall University and the University of Toledo demonstrated a wide spread in the number of Likert questions that faculty were asked to complete. This number ranged from a low of 7 in Surgery to a high of 65 in Psychiatry (both Marshall Programs). Correlation and network analysis were performed on these data. High degrees of correlations were noted between answers to questions (controlled for each resident) on these forms at both institutions. In other words, although evaluation scores varied tremendously amongst the different residents in all the programs studied, scores addressing different competencies tended to be very similar for the same resident, especially in some of the programs which were studied. Network analysis suggested that there were clusters of questions that produced essentially the same answer for a given resident, and these clusters were bigger in some of the different residency program assessment forms. This seemed to be more the rule in the residency programs with large numbers of Likert questions. The authors suggest that reducing the number of monthly questions used to address the core competencies in some programs may be possible without substantial loss of information.

System-integrated technology-enabled model of care to improve the health of stroke patients in rural China: protocol for SINEMA-a cluster-randomized controlled trial.

BACKGROUND: Despite the significant burden of stroke in rural China, secondary prevention of stroke is suboptimal. This study aims to develop a SINEMA for the secondary prevention of stroke in rural China and to evaluate the effectiveness of the model compared with usual care. METHODS: The SINEMA model is being implemented and evaluated through a 1-year cluster-randomized controlled trial in Nanhe County, Hebei Province in China. Fifty villages from 5 townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual care) with a target to enroll 25 stroke survivors per village. Village doctors in the intervention arm (1) receive systematic cascade training by stroke specialists on clinical guidelines, essential medicines and behavior change; (2) conduct monthly follow-up visits with the support of a mobile phone application designed for this study; (3) participate in virtual group activities with other village doctors; 4) receive performance feedback and payment. Stroke survivors participate in a health education and project briefing session, receive monthly follow-up visits by village doctors and receive a voice message call daily as reminders for medication use and physical activities. Baseline and 1-year follow-up survey will be conducted in all villages by trained staff who are blinded of the randomized allocation of villages. The primary outcome will be systolic blood pressure and the secondary outcomes will include diastolic blood pressure, medication adherence, mobility, physical activity level and quality of life. Process and economic evaluation will also be conducted. DISCUSSION: This study is one of very few that aim to promote secondary prevention of stroke in resource-constrained settings and the first to incorporate mobile technologies for both healthcare providers and patients in China. The SINEMA model is innovative as it builds the capacity of primary healthcare workers in the rural area, uses mobile health technologies at the point of care, and addresses critical health needs for a vulnerable community-dwelling patient group. The findings of the study will provide translational evidence for other resource-constrained settings in developing strategies for the secondary prevention of stroke.

Evidence of validity of the Competence Scale of Actions of Nurses in Emergencies / Evidências de validade da Escala de Competências das Ações do Enfermeiro em Emergências / Evidencias de validez de la Escala de Competencias de las Acciones del Enfermero en emergencias

ABSTRACT Objective: to evaluate the validity of the Competence Scale of Actions of Nurses in Emergencies based on internal structure, internal consistency, and external criteria. Methods: methodological study to verify new evidence of validity of the Scale, with contents previously validated. The Scale has 81 measurable actions at five levels of competence and can be applied both for self- and/or hetero-evaluation. Results: one hundred and forty seven nursing assistants and 41 managers from the five regions of Brazil participated in the study. They were linked to mobile prehospital emergency service, fixed prehospital emergency service, or hospital emergencies. Dimensionality was evidenced by exploratory factorial analysis of the 81 items, pointing out seven factors that explained 66.5% of the total data variance. Cronbach's alpha ranged from 0.79 to 0.98. The Kaiser-Meyer-Olkin 0.988 indicated that the correlations between the items were significant. In the external criterion, Pearson's correlations between hetero-evaluation competence scores and the manager's subjective classification were significant (p < 0.001), as well as differences in the means of these competencies by criterion group. In addition, scores by characteristics were evaluated to detect statistically different means. Conclusion: through the adopted Statistical Procedures, with multi-methods and multi-informants, different psychometric properties were analyzed. A summary of evidence was generated showing that the Scale is valid and reliable.

RESUMO Objetivo: avaliar evidências de validade da Escala de Competências das Ações do Enfermeiro em Emergências com base na estrutura interna, na consistência interna e no critério externo. Métodos: estudo metodológico para verificação de novas evidências de validade da Escala, com conteúdos previamente validados. A Escala com 81 ações mensuráveis em cinco níveis de competências pode ser realizada tanto para o enfermeiro se autoavaliar como outros o avaliarem. Resultados: participaram 407 enfermeiros assistenciais e 41 gestores das cinco regiões do Brasil, atuantes em emergências pré-hospitalar móvel, fixa ou hospitalar. A dimensionalidade foi evidenciada mediante análise fatorial exploratória dos 81 itens, apontando sete fatores que explicaram 66,5% da variância total dos dados. O alfa de Cronbach variou de 0,79 a 0,98. O Kaiser- Meyer-Olkin 0,988 indicou que as correlações entre os itens foram significantes. No critério externo, correlações de Pearson entre escores de competências de heteroavaliação e classificação subjetiva do gestor foram significantes (p<0,001), bem como diferenças das médias dessas competências por grupo critério. Adicionalmente, avaliaram-se escores por características, verificando-se médias estatisticamente distintas. Conclusão: por meio dos Procedimentos Estatísticos adotados, com multimétodos e multi-informantes, analisaram-se diferentes propriedades psicométricas, gerando um sumário de evidências, demostrando que a Escala é válida e confiável.

RESUMEN Objetivo: evaluar evidencias de validez de la Escala de Competencias de las Acciones del Enfermero en Emergencias con base en la estructura interna, en la consistencia interna y en el criterio externo. Métodos: estudio metodológico para verificación de nuevas evidencias de validez de la Escala, con contenidos previamente validados. La Escala con 81 acciones mensurables en cinco niveles de competencias puede ser realizada tanto para que el enfermero se autoevalúe como otros lo evalúen. Resultados: participaron 407 enfermeros asistenciales y 41 gestores de las cinco regiones de Brasil, actuantes en emergencias pre-hospitalaria móvil, fija o hospitalaria. La dimensionalidad fue evidenciada mediante análisis factorial exploratoria de los 81 ítems, apuntando siete factores que explicaron 66,5% de la variancia total de los datos. El alfa de Cronbach varió de 0,79 a 0,98. El Kaiser- Meyer-Olkin 0,988 indicó que las correlaciones entre los ítems fueron significantes. En el criterio externo, correlaciones de Pearson entre puntajes de competencias de heteroevaluación y clasificación subjetiva del gestor fueron significantes (p<0,001), así como diferencias de las medias de esas competencias por grupo criterio. Adicionalmente, se evaluaron puntajes por características, verificándose medias estadísticamente distintas. Conclusión: por medio de los Procedimientos Estadísticos adoptados, con multimétodos y multiinformantes, se analizaron diferentes propiedades psicométricas, generando un sumario de evidencias, demostrando que la Escala es válida y confiable.

Evaluation of a Measurement System to Assess ICU Team Performance.

OBJECTIVE: Measuring teamwork is essential in critical care, but limited observational measurement systems exist for this environment. The objective of this study was to evaluate the reliability and validity of a behavioral marker system for measuring teamwork in ICUs. DESIGN: Instances of teamwork were observed by two raters for three tasks: multidisciplinary rounds, nurse-to-nurse handoffs, and retrospective videos of medical students and instructors performing simulated codes. Intraclass correlation coefficients were calculated to assess interrater reliability. Generalizability theory was applied to estimate systematic sources of variance for the three observed team tasks that were associated with instances of teamwork, rater effects, competency effects, and task effects. SETTING: A 15-bed surgical ICU at a large academic hospital. SUBJECTS: One hundred thirty-eight instances of teamwork were observed. Specifically, we observed 88 multidisciplinary rounds, 25 nurse-to-nurse handoffs, and 25 simulated code exercises. INTERVENTIONS: No intervention was conducted for this study. MEASUREMENTS AND MAIN RESULTS: Rater reliability for each overall task ranged from good to excellent correlation (intraclass correlation coefficient, 0.64-0.81), although there were seven cases where reliability was fair and one case where it was poor for specific competencies. Findings from generalizability studies provided evidence that the marker system dependably distinguished among teamwork competencies, providing evidence of construct validity. CONCLUSIONS: Teamwork in critical care is complex, thereby complicating the judgment of behaviors. The marker system exhibited great potential for differentiating competencies, but findings also revealed that more context specific guidance may be needed to improve rater reliability.

Appraisal; the next steps?

Appraisal offers an opportunity for both the clinician and the employer to demonstrate commitment to their professional responsibilities in a tangible manner that can benefit patients, the individual clinician and the service. One unintentional consequence of revalidation may have been to foster a belief that it has undermined the educational and developmental aspects of appraisal. The objective of promoting transparency and accountability through revalidation may have led some clinicians to feel they work in a culture of greater scrutiny and assessment, leading to an erosion of their engagement with the process. Some appraisers previously comfortable with the educational and supportive ethos of appraisal may be less likely to continue in that role if they are viewed or see themselves as GMC assessors. Priorities include a need for research to evaluate the impact and outcomes of appraisal and revalidation, to evaluate how appraisal can meaningfully feed into improving patient care and the contribution that medical education can make to the process.

Los factores psicosociales como predictores pronósticos de difícil retorno laboral tras incapacidad / Psychosocial Factors as Predictors for Difficult Labor Return after Incapacity

Se está incapacitado laboralmente, por estar enfermo y presentar limitaciones funcionales que afectan a la capacidad laboral y que impiden trabajar. Los factores psicosociales son determinantes en la salud de la población y por tanto determinantes en la enfermedad y el enfermar de la población trabajadora. Los factores psicosociales son factores precipitantes en el inicio de la incapacidad, son factores de mantenimiento de la incapacidad ligados a la cronificación de los procesos de incapacidad, condicionan la mala respuesta y la adherencia terapéutica, suponen barreras al retorno laboral, y pueden ser causa de presentismo laboral (estar presente en el trabajo, en malas condiciones por temor a perder el empleo). Los factores psicosociales son predictores del retorno al trabajo. Puesto que se trata de factores previos a la declaración de la incapacidad conviene conocerlos para prevenir la aparición de la incapacidad y su mantenimiento que determina un no retorno laboral o su postergación, tanto en la incapacidad temporal como permanente. Los factores psicosociales no causan la incapacidad pero pueden precipitarla, mantenerla o modificarla, terminando por condicionar la capacidad/incapacidad laboral. En un estudio de seguimiento de procesos de baja que alcanzaron los 365 días, los factores psicosociales estaban presentes en un 23% de forma significativa. Material y método: se revisaron hasta mayo de 2017 las siguientes bases de datos bibliográficas: SciELO, PUBMED, así como estudio de factores psicosociales en presentes en procesos de baja que llegaron a 365 días. Conclusiones: Los factores psicosociales están en el inicio de la baja como detonante impeditivo laboral de situaciones basales previas. Están en la cronificación del proceso una vez que la incapacidad se ha producido, están en la percepción del paciente de persistencia sintomatológica y de escasa respuesta al tratamiento, conllevan una percepción de mala evolución de su proceso de incapacidad, potencian lo disfuncional discapacitante y dificultan el retorno laboral. Si permanecen no resueltos y se produce el retorno al trabajo serán causan de bajo rendimiento laboral, pudiendo ser determinante de "ineptitud sobrevenida" y despido. Por todo ello, es capital la identificación temprana y la prevención de estos factores psicosociales para aminorar el absentismo por incapacidad. Las siguientes medidas reducirán el impacto de los factores psicológicos en la incapacidad temporal: actuar sobre las respuestas emocionales inadecuadas mediante atención psicológica. Atención temprana de los procesos osteomusculares y psíquicos. Evitar listas de espera para pruebas diagnósticas y para tratamientos. Consideración preventiva de las decisiones de alta médica. Incorporación parcial al trabajo (altas parciales) tras incapacidad. Facilitar la adaptación laboral ante la "actitud sobrevenida" del trabajador reincorporado. Evitar controversias entre alta médica y no apto, con concordancia decisoria. Horarios flexibles o reducción horaria que favorezcan la conciliación familiar. Prestaciones sociales para la atención a familiares con dependencia o gravemente enfermos. Mayor detección y protección de los factores psicosociales en el trabajo. Mejoras en la organización, condiciones y clima laboral, que fomenten la satisfacción laboral

One may be incapacitated for work for being ill and presenting functional limitations that affect the work capacity preventing him/her from work. Psychosocial factors are decisive in the health of the population and therefore decisive in both the disease itself and in the fact of working population getting sick. These psychosocial factors are precipitating factors at the onset of disability. They are factors that keep the incapacity active which linked to the chronification of the incapacity processes they condition the poor response and the therapeutic adherence. They imply barriers to return to work, and may cause presenteeism (being present at work in poor conditions for fear of losing employment). Psychosocial factors are predictors of returning to work. Since they are initial factors to the declaration of the incapacity it is necessary to know them well to prevent the appearance and maintenance that determine a non-return labor or its postponement, either in the temporary or permanent incapacity. Psychosocial factors do not cause disability but can precipitate it, maintain it or modify it, ending up by conditioning the capacity / incapacity for work. Psychosocial factors were present in a significant 23% in a follow-up study of medical leave processes that reached up to 365 days. Material and method: the following bibliographic databases were searched up to May 2017: SciELO, PUBMED, as well as the psychosocial factors study appeared in low processes up to 365 days. Conclusions: The psychosocial factors are at the beginning of the sick leave as a preventive labor trigger of previous baseline situations. They are in the chronification process once the disability has occurred; they are in the patient’s perception of symptom persistence and poor response to treatment; they imply a perception of poor evolution of their incapacitation process, enhance the dysfunctional disabling and hinder the return to work. Unresolved and still returning to work will be cause of low work performance, being able to be determinant of "ineptitude overdue" and dismissed. For theses reasons it is important to early identify and prevent these psychosocial factors in order to reduce absenteeism due to disability. The following measures will reduce the impact of psychological factors on temporary disability: acting on inadequate emotional responses through psychological care; taking an early attention to musculoskeletal and psychic processes; avoiding the waiting lists for the diagnostic tests and treatments; having a preventive consideration of return-to-work decisions; taking a partial incorporation to work (high partial fit note-certified sickness episodes) after incapacity; facilitating the work adaptation to the "overcoming attitude" of the returned worker; avoiding disputes reaching decisive agreements between medically discharged and unfit; providing flexible hours or reduced hours that favor family reconciliation; receiving social care benefits for the dependents or acutely ill family members' attention; having a greater detection and protection of psychosocial factors at work and improving the organization, conditions and working climate promoting the satisfaction labor

The development and implementation of a performance appraisal framework for radiation therapists in planning and simulation.

It is a challenge for radiation therapists (RTs) to keep pace with changing planning technology and techniques while maintaining appropriate skills levels. The ability of individual RTs to meet the demands of this constantly changing practice can only be assured through establishing clearly defined standards for practice and a systematic process for providing feedback on performance. Investigation into existing models for performance appraisal produced minimal results so a radiation therapy-specific framework was developed. The goal for this initiative was to establish a framework that would reflect the complexity of practice and provide a clear measure of performance against them. This paper outlines the implementation of this framework into practice and discusses some lessons learned in the process. The framework was developed and implemented in six stages: (1) project team, (2) scope, (3) dosimetry pilot, (4) staff consultation, (5) finalisation and implementation and (6) future development and evaluation. Both cultural and organisational obstacles needed to be addressed before this framework could be successfully introduced. Even though this slowed progress, addressing these obstacles during the development process was essential to the success of this framework. The incremental approach provided the opportunity for each aspect to be tested and the development of subsequent stages to be informed by lessons learned during the previous one. This approach may be beneficial when developing and implementing projects involving performance appraisal to promote consistency, fairness and quality.

Evaluación del equipo de complemento del Hospital Clínic de Barcelona / Evaluation of the additional equipment of Hospital Clinic of Barcelona

OBJETIVOS. Describir la opinión de las enfermeras del Hospital Clínic de Barcelona (HCB) acerca del equipo de complemento (EC), valorar la necesidad de formación específica y especialización para los profesionales que forman parte del EC, desde el punto de vista del resto los profesionales de enfermería del hospital, y determinar el nivel de satisfacción y conocimiento del enfermero del equipo de parada cardiaca (el enfermero del equipo de parada es un profesional del EC). METODOLOGÍA. Estudio descriptivo transversal de mayo de 2014 a febrero de 2015. Se obtuvieron datos mediante la distribución de una encuesta anónima a los profesionales de enfermería del hospital con más de 5 años de antigüedad que no forman parte del EC. RESULTADOS. El EC está considerado un servicio del HCB con identidad y organización propia en un 80 %. Un 94 % piensa que es un servicio necesario y un 96 % que está formado por profesionales capacitados y preparados para realizar las funciones de enfermería. Un 78 % opina que deberían recibir una formación continuada. Un 96 % sabe que la enfermera o enfermero del equipo de parada es un profesional del EC y lo valora con un alto grado de satisfacción CONCLUSIONES. El EC, a pesar del paso del tiempo y de los cambios sucedidos en nuestro Hospital, se valora como un modelo de cobertura necesario y con una identidad propia, formado por unos profesionales capacitados, preparados y reconocidos por el resto de profesionales de enfermería del hospital, que asumen de manera eficaz otras funciones como la del equipo de parada cardiaca del hospital (AU)

OBJECTIVES. To describe the opinion of nurses about a non-specialized in hospital support team called Equipo de Complemento (EC), evaluate the perception of other nurses about their need of additional formation -since those nurses are responsible for the cardiac arrest call-, and define the opinion of other staff about their knowledge and satisfaction about this duty. METHODOLOGY. This is a cross-sectional study performed from May of 2014 to February 2015. Data was collected through an anonymous poll, which was given to the hospital nursery professionals with more than 5 years of service. The respondents were not taking part in EC. RESULTS. The 80 % of the respondents think of EC as a hospital service of identity with self-organization. A 94 % believe that EC is really necessary, and 96 % of the respondents thinks that EC is composed of trained professionals ready to do nursery tasks. 78 % of the professionals believe that EC nurses should receive continuing education. Finally, 96 % of the respondents know that the cardiac arrest nurse is a member of EC, and they rate these nurses with a high degree of satisfaction. CONCLUSION. The EC is seen as a needed model with self-identity, composed of trained professionals. The hospital professionals of Nursery are really satisfied of their job. EC take part in other tasks as cardiac arrests and are highly rated for this duty (AU)

Análise do desempenho das equipes de saúde bucal na estratégia saúde da família no Brasil: um estudo misto / Evaluating primary dental care in Brazil: a mixed methods study

A Estratégia Saúde da Família (ESF) constitui o principal modelo de organização da Atenção Primária (APS) no Brasil. A Saúde Bucal foi inserida na ESF em 2001 com a criação das equipes de saúde bucal (ESB) como área prioritária diante da necessidade de melhorar as condições de saúde bucal da população. Na última década, observou-se uma expressiva expansão da ESF com o alcance de serviços chegando a cerca de 63% da população brasileira em 2016. Com o objetivo de avaliar a qualidade dos serviços da ESF, o Ministério da Saúde lançou em 2011 o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). O principal desafio do PMAQ é instituir uma cultura de avaliação entre os profissionais e gestores da ESF que monitore e avalie processos e resultados das equipes. O objetivo desse estudo foi descrever as ações de APS realizadas pelas ESB no Brasil e compreender aspectos que levam ao diferente desempenho das ESB. Para isso, foi desenvolvido um estudo misto explanatório sequencial. Na fase quantitativa, análise descritiva e de cluster foram aplicadas em dados do PMAQ-AB para descrever a produção de 12.403 ESB. Também foi utilizada a Teoria de Resposta ao Item (TRI) para avaliar as qualidades psicométricas de 20 questões de saúde bucal do PMAQ-AB. Resultados da TRI foram usados para selecionar ESB com desempenhos extremos para a próxima fase. Na fase qualitativa foi realizado um estudo descritivo em dez ESB da região metropolitana de Belo Horizonte com desempenhos extremos classificados pela TRI na fase anterior. Os resultados quantitativos demonstraram que as ESB realizam procedimentos clínicos da odontologia básica, mas fazem menos reabilitação com próteses e coordenação do cuidado de câncer bucal. A análise da TRI demonstrou que os itens do questionário foram insuficientes para discriminar ESB de alto e baixo desempenho. No entanto, foi observado que ESB de alto desempenho tendem a realizar ações de prevenção e acompanhamento de câncer e confecção de prótese na APS. Os resultados da fase qualitativa confirmaram que ESB de alto desempenho tendem a trabalhar mais ações de promoção e prevenção de câncer de boca, inclusive utilizando contatos pessoais para encaminhar pacientes para serviço especializado. Já em relação à questão da prótese na APS, os dados qualitativos confirmaram os achados quantitativos e demonstraram que ESB de alto desempenho fazem prótese na APS, garantindo a reabilitação do usuário

The Family Health Strategy is the main organizational model of primary health care in Brazil. Dental care was included in the FHS in 2001 as a priority area due to the need to improve the oral health status of the population, and the oral health teams were created. In the last decade, there was a significant expansion of the ESF with the range of services reaching about 63% of the population in 2016. In 2011, the Brazilian Ministry of Health launched a program to assess the quality of FHS Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica ­ PMAQ-AB. The main challenge of PMAQ-AB was to stimulate a culture of evaluation among FHS professionals and managers who evaluate processes and outcomes of the teams. This study aimed to describe the actions performed at primary health care by oral health teams in Brazil and to understand factors that contribute to different performance of each team. For this, a mixed sequential explanatory study was developed. In the quantitative phase, we undertook descriptive statistics and cluster analysis to describe the production of 12,403 OHTs, and applied Item Response Theory (IRT) to assess survey's 20 dental care questions psychometric properties. IRT results were used to sample OHTs with extreme scores performance to the next phase. In the qualitative phase, we used descriptive approach applying thematic analysis in 10 dentists from extreme performance OHTs. Quantitative results showed OHTs provided basic dentistry clinical care, but underprovided rehabilitation with dentures and oral cancer care coordination. IRT analysis showed survey limitation to discriminate OHTs performance, except for rehabilitation with dentures and oral cancer-related items that tend to discriminate high-performance OHTs. Qualitative data showed barriers to access oral health services and failures for integrating oral cancer delivery services. Dentists' empathy and altruism determine the quality of oral cancer care coordination by means of their own network to refer patients suspect of oral cancer. OHTs that deliver dentures know better the population rehabilitation needs. Mixed method results showed the improvements in oral health services in Brazil, but pointed that in low performance OHT, patients face multiples barriers to access services. Also, low performance OHT failed to following oral câncer patients, and provided dentures

Misdiagnosing New Hires Is Costly.

Winning the war for talent will propel profitable practices ahead of the competitive flow. Today there are psychometric tools that can support busy leaders who are tired of a range of disappointments, from mis-hires to underperforming employees. This article discusses several of these assessment tools, addressing when and where they should be used. Additionally, it shows how by adopting the three Ds--Diagnosis, Determine, and Decide--you can stop losing money, stop the employee aggravation, and reduce your stress.