Governing the Access to COVID-19 Tools Accelerator: towards greater participation, transparency, and accountability.

The Access to COVID-19 Tools Accelerator (ACT-A) is a multistakeholder initiative quickly constructed in the early months of the COVID-19 pandemic to respond to a catastrophic breakdown in global cooperation. ACT-A is now the largest international effort to achieve equitable access to COVID-19 health technologies, and its governance is a matter of broad public importance. We traced the evolution of ACT-A's governance through publicly available documents and analysed it against three principles embedded in the founding mission statement of ACT-A: participation, transparency, and accountability. We found three challenges to realising these principles. First, the roles of the various organisations in ACT-A decision making are unclear, obscuring who might be accountable to whom and for what. Second, the absence of a clearly defined decision making body; ACT-A instead has multiple centres of legally binding decision making and uneven arrangements for information transparency, inhibiting meaningful participation. Third, the nearly indiscernible role of governments in ACT-A, raising key questions about political legitimacy and channels for public accountability. With global public health and billions in public funding at stake, short-term improvements to governance arrangements can and should now be made. Efforts to strengthen pandemic preparedness for the future require attention to ethical, legitimate arrangements for governance.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes: An International Comparison.

OBJECTIVE: Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals. BACKGROUND: Nursing governance and effects on nurse-related outcomes are not well studied. METHODS: Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries). RESULTS: International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3). CONCLUSIONS: Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes.

Responsabilidad social corporativa en los centros de la red hospitalaria de utilización pública de Cataluña / Corporate social responsibility in the centers of the public hospital network of Catalonia (Spain)

La adopción de un enfoque de gestión que integra la responsabilidad social corporativa en las organizaciones es una tendencia en aumento que da respuesta a las demandas de la sociedad relacionadas con la sostenibilidad, la ética y la transparencia. Las organizaciones sanitarias están adoptando la responsabilidad social corporativa de forma asimétrica, lo que plantea el análisis de los modelos de implantación y las iniciativas desarrolladas. Mediante una investigación cualitativa, con el estudio en profundidad de cuatro casos del ámbito sanitario catalán, se analiza la necesidad de abordar este nuevo enfoque y se identifican buenas prácticas y los retos para su implementación

The adoption of a management approach that integrates corporate social responsibility in organizations is an increasing trend that responds to the demands of society related to sustainability, ethics and transparency. Health organizations are adopting corporate social responsibility asymmetrically, which raises the analysis of the implementation models and the developed initiatives. Through qualitative research, with four in-depth case studies of the Catalan health sector, this article analyzes the need to address this new approach and to identify good practices and the challenges for its implementation

Media briefing on COVID-19 - 13/08/2020

COVID-19: atenção hospitalar na urgência e emergência

O Debate Virtual do Conass desta sexta-feira (7/8), às 17 horas irá tratar da atenção à Covid-19 nas urgências e emergências dos estados e municípios brasileiros, enfatizando a importância da integração da atenção hospitalar à Rede de Atenção à Saúde (RAS), considerando a continuidade do cuidado dos pacientes curados pela Atenção Primária à Saúde (APS). A iniciativa faz parte da implantação do Guia Orientador do Enfrentamento da Covid-19 na Rede de Atenção à Saúde, elaborado em parceria com o Conselho Nacional de Secretarias Municipais de Saúde (Conasems). Participarão do debate o médico especialista em terapia intensiva e medicina de emergência do Hospital Sírio-Libanês, Welfane Cordeiro Júnior; o diretor geral do Hospital Regional de Nova Andradina/Mato Grosso do Sul, Norberto Fabri Junior; o diretor geral do Hospital Municipal de Teixeira de Freitas/Bahia, Allan Jacqueson Barbosa Lobo; e a coordenadora estadual do Apoio Rede Colaborativa do Espírito Santo, Marfiza Machado de Novaes. A mediação do debate será feita pela assessora técnica do Conass, Rita Catanelli. Perguntas poderão ser enviadas pelo www.conass.org.br/participe O debate será transmitido pelo Portal do Conass: www.conass.org.br e pelos canais do Conselho no YouTube: www.youtube.com/conassoficial; e no FaceBook: www.facebook.com/conassoficial. Participe!

Measuring Council Health to Transform Shared Governance Processes and Practice.

OBJECTIVE: The aim of this study was to develop a valid, reliable instrument to measure the effectiveness of shared governance councils BACKGROUND: The work of shared governance, that is, the decisions, takes place in its structures, notably, the councils. A literature search yielded no formal instrument for evaluating how these councils function. METHODS: A 4-phase process was used to generate valid items to measure shared governance council effectiveness, including content validity by experts, a pilot for feasibility, a larger pilot for internal consistency, and an exploratory factor analysis to delineate a final instrument. RESULTS: More than a dozen experts and participants from nearly 30 healthcare organizations contributed to the final development of the 25-item Council Health Survey instrument. Items for measuring council effectiveness at either the unit or division level were grouped in areas of structure, activities, and membership. CONCLUSIONS: When evaluating shared governance, nurses should focus on councils themselves, in which much of the work of shared governance occurs.

El auge de la Enfermería / Nursing Rising

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UK trainee-led paediatric governance collaboratives: improving the lives of both trainees and children.

Research is vital to paediatrics; however, many trainees feel there is a deficit in their opportunities, experience and exposure in this area. Three training regions in the UK, the West Midlands, Wales and Peninsula, have recently started region-wide, trainee-led research and governance collaboratives aimed at improving trainee access and education in research, undertaking good quality, multicentre audit, quality improvement and pilot projects in collaboration across the regions and implementing change. We report on the experiences, benefits and challenges of these trainee collaboratives (Paediatric Research Across the Midlands, Wales Research and Education Network and Peninsula Trainee Research Audit and Innovation Network) including a trainee survey looking at how these initiatives have improved skills in conducting multicentre prospective studies, team working skills, leadership, understanding of statistics and manuscripts and presentation skills. We also describe how collaboration with colleagues and participation in projects can benefit trainees in a wider sense of purpose and help to encourage morale, as well as what can be learnt as paediatric training moves forward.

Review of 128 quality of care mechanisms: A framework and mapping for health system stewards.

Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.

Administrative challenges of clinical governance in military and university hospitals of Kerman/Iran.

BACKGROUND: Over the recent years, clinical governance model has been applied to improve the quality of university and private hospitals in Iran. In addition to university hospitals, military hospitals have an effective role in the preservation and promotion of public health. The challenges of clinical governance implementation have not been investigated in such settings. Hence, the present study objective is to identify the administrative challenges of clinical governance in military and university hospitals of Kerman/Iran METHODS: This qualitative study was carried out through phenomenology in 2017. A sample of managers and experts in the implementation and execution of clinical governance was purposefully selected from three university hospitals and three military hospitals in Kerman, Iran. A total of 39 managers and experts were interviewed, and data were gathered via semistructured interviews with open questions. For data analysis, conventional content analysis method was employed. RESULTS: In this study, five main codes and 17 subcodes were obtained. Main codes were structural challenges, educational challenges, limitations, evaluation, and human resource challenges. CONCLUSIONS: Clinical governance is being implemented hastily with no appropriate structural, financial, and training facilities, ensuing a waste of resources, more difficult work for staff and a negative view of personnel.

Do corporate governance mechanisms and internal control systems matter in reducing mortality rates?

Internal controls are critical to guarding an institution against fraud, error, and devastation. They are effective tools for preventing losses and achieving organizational goals. However, internal control mechanisms need to be relevant, because the organization cannot comprehend the effectiveness of the system if they are out-of-touch with the operation. Health care control practices are not exceptionally different from what pertains in other industries. The health care organizations require effective corporate governance mechanisms to uphold their operations and performances. These practices assist health care organizations to exhume cynical practices that generate unproductive results and also factors militating against the hospital's goals or objectives. This study revealed that practices such as enhanced Board diligence, Health Professionals on board, financial prudence, and effective communication have the tendency of reducing mortality, if well executed.

Desenvolvimento e implementação de um modelo de data warehouse para integração de sistemas electrónicos de seguimento de pacientes hiv+: um estudo de caso da província da zambézia, moçambique / Development and implementation of a data warehouse model for integration of electronic monitoring systems hiv+ patients: a case study from the province of zambézia, mozambique

Desde 2007, o Sector de Saúde em Moçambique, incluindo a Província da Zambézia, está a implementar diferentes Sistemas Electrónicos para Seguimento de Pacientes (SESP) HIV+ em diversas Unidades Sanitárias (US). Estes sistemas estão sendo implementados de forma isolada em cada Distrito/US, sem, contudo, nenhuma comunicação em tempo real, nem intercâmbio electrónico de informações. Por outro lado, não existe um repositório provincial que agrega os dados dos sistemas em implementação, tornando complexos os processos de análise centralizada de dados e extracção dos mesmos para pesquisas em saúde. Para superar os problemas ora mencionados, neste estudo criamos e implementamos um modelo de Data Warehousing (DWH), utilizando como referência o SESP Open Medical Record System (OpenMRS) em uso na Província da Zambézia e realizamos um estudo exploratório com abordagem mista, a qualitativa e a quantitativa, visando o desenvolvimento e aperfeiçoamento efectivo do mesmo. Através das entrevistas semi-estruturadas e observação directa foi possível documentar os desafios e perspectivas para a implementação de SESP e a centralização de dados no contexto da Província da Zambézia. A centralização das bases de dados do Centro de Saúde (CS) 4 de Dezembro, em Quelimane, e CS de Gilé permitiu a validação da funcionalidade do modelo criado (DWH), razão pela qual propõe-se a sua implementação efectiva envolvendo todos interessados, desde os decisores até os utilizadores finais. Apesar de se revelar eficaz e eficiente, a implementação de SESP e DWH na província da Zambézia enfrenta barreiras de várias ordens tais como: falta de capacidade técnica dos profissionais afectos ao Sector de Saúde, a diversidade dos sistemas no início de implementação e escassez de recursos financeiros.

Since 2007, the health sector in Mozambique, in particular the province of Zambézia, is implementing different Electronic Patient Tracking System (EPTS) for HIV+ patients in various health units. These systems are being implemented in isolation in each district / health unit without real-time communication or electronic exchange of information. There is no provincial repository that aggregates the data of the systems in implementation, making complex the processes of centralized data analysis and data extraction for health research. To support the centralized data analysis, in this study we created and implemented a data warehousing (DWH) model, using as reference the EPTS Open Medical Record System (OpenMRS) in use in Zambézia Province. For the effective development of the model, we carried out an exploratory study with a mixed approach, being qualitative and quantitative. Through semi-structured interviews and direct observation, it was possible to document the challenges and perspectives of the implementation of EPTS and data centralization in the Zambézia Province context and for the validation of the model created, the databases of the 4 Dezembro Health Facility (HF) and Gilé HF were successfully centralized. The lack of technical capacity of Zambézia health sector, the diversity of the systems at the beginning of implementation and the difficulties associated with financial order constitute barriers to the implementation of EPTS and DWH. The proposed DWH model proved its functionality since it was possible to centralize the databases 4 de Dezembro HF and Gilé HF. For successful implementation of a EPTS and DWH it should be a process with initial involvement of all stakeholders from decision makers to end users.

Gestão de clínica odontológica: a capacitação para a utilização de tecnologias e ferramentas de gestão aplicadas à clínica odontológica / Dental clinic management: the training for the use of technologies and management tools applied to the odontological clinic

As mudanças radicais no cenário político-sócio-econômico brasileiro, exigem que os administradores adotem as melhores práticas e técnicas de gestão que possibilitem atingir os resultados planejados a despeito do segmento em que atuam. O objetivo desta pesquisa foi identificar o perfil gestor dos dentistas do município de São José dos Campos, e elencar as principais carências e necessidades de capacitação destes profissionais para a melhor organização e administração de suas clínicas. Os métodos e recursos utilizados para o desenvolvimento deste trabalho foram as pesquisas bibliográficas e a avaliação quantitativa por meio de questionário elaborado com perguntas estruturadas para respostas de múltipla escolha, formatado em três seções: I - Perfil do Entrevistado, II ­ Perfil Empreendedor, III ­ Rotina Operacional, para mapear e diagnosticar as práticas adotadas na gestão clínica. Os recursos utilizados para a submissão do questionário aos dentistas foram: Criação de QR Code para captura por meio de tecnologia móvel, criação de URL para acesso via internet e material impresso para resposta presencial. O estudo avaliou 219 dentistas e o indicador de estabilidade da pesquisa é de 95%. Os resultados confirmaram estatisticamente que os dentistas durante a formação, recebem pouca ou nenhuma informação de como realizar a gestão adequada de um consultório odontológico. Ficou evidenciado que os dentistas majoritariamente não utilizam as ferramentas e as técnicas administrativas fundamentais para o gerenciamento empresarial. Outro aspecto deficitário é o desconhecimento das técnicas de precificação, porquanto dificulta a comercialização acurada dos serviços gerando resultados financeiros na maioria das vezes insatisfatórios. Finalmente, a ausência de assessorias e consultorias especializadas é preponderante, comprometendo os indicadores econômicos em um mercado de acirrada concorrência principalmente para os dentistas recém-formados(AU)

The radical changes in Brazilian socio-economic political scenario require managers to adopt the best practices and management techniques that allow them to achieve the planned results regardless of the segment in which they operate. The objective of this research was to identify the management profile of dentists in São José dos Campos city and to highlight the main needs and qualification needs of these professionals for the best organization and administration of their clinics. The methods and resources used for the development of this work were the bibliographical researches and the quantitative evaluation through a questionnaire elaborated with structured questions for multiple choice answers, compounded in three sections: I ­ Interviewee Profile, II - Entrepreneur Profile, III - Routine Operational, to map and diagnose the practices adopted in clinical management. The resources used to submit the questionnaire to the dentists were: Creation of QR Code for capture through mobile technology, creation of URL for access by internet and printed material for personaly response. The study evaluated 219 dentists and the indicator of stability of the research is 95%. The results confirmed statistically that dentists during training receive little or no information on how to properly manage a dental practice. It was evidenced that mostly dentists do not use the tools and administrative techniques that are vital to business management. Another deficit aspect is the lack of knowledge in pricing techniques, as it makes it difficult to commercialize the services, generating financial results that are often unsatisfactory. Finally, the absence of advisory and specialized consultants is preponderant, compromising the economic indicators in a market of fierce competition mainly for the newly graduated dentists(AU)

Safe staffing: conceptions of primary health care nurses

Aim: To know the conceptions that nurses, from Primary Health Care clinical prac-tice, have of Safe Nurse Staffing. Safe Staffing is related to safe, high quality, high complexity care, in a variety of contexts. It is well established that safe nurse staffing and the quality of the practice environment are directly associated with client satisfaction, quality and safety of care, and nursing care-sensitive outcomes2. Methods: A descriptive exploratory study of a qualitative nature was carried out, using a questionnaire with open-ended questions. An intentional sample consisting of twenty five nurses was selected. The technique of content analysis7 was used for data analysis and treatment. Results: Seven categories were identified (and respective subcategories): Safety of Care; Workload; Training and Professional Development; Quality of Care; Client Characteristics; Organizational Environment; Outcomes. These results allow stating that the nurses interviewed conceive the concept of Safe Staffing, on their work context, in accordance with the dimensions described by Aiken and collaborators1,2,3. Conclusion: Nurses' conceptions of Safe Staffing integrate fundamental aspects as-sociated with this concept, and may influence the strategies developed within the scope of clinical governance

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