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1.
J Nurs Adm ; 50(2): 104-108, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929344

RESUMO

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.


Assuntos
Governança Clínica/organização & administração , Eficiência Organizacional , Conselho Diretor/organização & administração , Colaboração Intersetorial , Cuidados de Enfermagem/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
2.
RECIIS (Online) ; 13(4): 803-816, out.-dez. 2019. tab
Artigo em Português | LILACS | ID: biblio-1047569

RESUMO

A formação de Redes Sociais Virtuais (RSVs) em comunidades como o Facebook tornou-se um importante instrumento de busca por socialização e informação. Este artigo apresenta dados sobre fontes de informação utilizadas por responsáveis de crianças com Transtorno do Espectro Autista (TEA) e como essas interferem na percepção de suporte interpessoal e nos processos de governança em saúde. No estudo quantitativo, participaram 90 membros das três maiores RSVs sobre TEA. Para a coleta de dados foi utilizado questionário semiestruturado, cujas respostas foram quantificadas para melhor visualização. Os resultados demonstraram que a participação nessas redes é a principal fonte de informação para metade dos participantes, especialmente para a parcela da população com menor renda; 70/90 voluntários informaram se sentir amparados pelos parceiros de RSV e 63/90 se sentem desamparados pela sociedade em geral. Este fenômeno pode ser explicado pela formação de laços sociais marcados pela reciprocidade de situações vividas.


The formation of Virtual Social Networks (RSVs) in communities as Facebook has become an important tool for searching for socialization and information. This article presents data on the sources of information used by those responsible for children with Autism Spectrum Disorder (ASD), and how they interfere in the perception of interpersonal support and health governance processes. In the quantitative study, 90 members from the 3 largest RSVs on ASD participated. For the data collection, a semi-structured questionnaire was used. Responses were quantified to facilitate visualization of the data. The results showed that participation in these networks is the main source of information for half of the participants, especially for the portion of the population with lower income; 70/90 volunteers reported feeling supported by RSV partners and 63/90 reported feeling helpless by society in general. A phenomenon that can be explained by the formation of social bonds marked by the reciprocity of lived situations.


La formación de Redes Sociales Virtuales (RSVs) en comunidades como Facebook se ha convertido en un importante instrumento de búsqueda de socialización e información. Este artículo presenta datos sobre fuentes de información utilizadas por responsables de niños con trastorno del espectro autista (TEA), y cómo interfieren en la percepción de soporte interpersonal y en los procesos de gobernanza en salud. Se trató de estudio cuantitativo, participaron 90 miembros de las 3 mayores RSVs sobre TEA. Para la recolección de datos se utilizó un cuestionario semiestructurado. Las respuestas se cuantificaron para facilitar la visualización de los datos. Los resultados demostraron que la participación en esas redes es la principal fuente de información para la mitad de los participantes, especialmente para la parcela de la población con menores ingresos; 70/90 voluntarios informaron sentirse amparados por los socios de RSV y 63/90 informaron sentirse desamparados por la sociedad en general. Fenómeno que puede ser explicado por la formación de lazos sociales marcados por la reciprocidad de situaciones vividas.


Assuntos
Humanos , Apoio Social , Governança Clínica , Rede Social , Transtorno do Espectro Autista , Relações Interpessoais , Socialização , Comportamento , Criança , Inquéritos e Questionários , Adolescente , Pessoal de Saúde , Comunicação , Internet , Acesso à Informação , Mídias Sociais , Governança
3.
Br J Nurs ; 28(16): S24-S32, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31518526

RESUMO

This clinical study focuses on peristomal skin complications (PSCs). For many patients, the causative factor behind peristomal moisture-associated skin damage was contact dermatitis caused by effluent leakage, resulting in sore and excoriated skin. PSCs are costly to the patient in relation to pain, time and worry and also impact nursing activity levels and healthcare costs. The study identifies the number of patients presenting with PSC, the causative factors and their resolution using medical grade Manuka honey flanges.


Assuntos
Governança Clínica , Complicações Pós-Operatórias/prevenção & controle , Dermatopatias/prevenção & controle , Estomas Cirúrgicos/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Medição de Risco , Dermatopatias/etiologia , Reino Unido
4.
Stud Health Technol Inform ; 264: 739-743, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438022

RESUMO

Electronic Health Records (EHRs) are at the heart of reforms aiming for improving the efficiency and quality of citizens healthcare services. Although there is still some skepticism, open source (OS) EHR is a growing phenomenon in health informatics. Given the widespread adoption of OS software (OSS) in several domains, including operating systems, and enterprise systems, the repeated shortfalls faced by healthcare organizations with dominant proprietary EHRs create an opportunity for other alternatives, such as OSS to demonstrate their abilities in addressing these well-documented problems, including inflexibility, high costs, and low interoperability. However, scholars have expressed extensive concerns about the sustainability of OS EHR. Recognizing that OSS project sustainability relies on their governance arrangements, this case study reports on the evolution of the governance and sustainability of a Japanese OS EHR project and provides rich insights to other open source EHR initiative stakeholders, including physicians, developers, researchers, and policymakers.


Assuntos
Registros Eletrônicos de Saúde , Governança Clínica , Humanos , Japão , Informática Médica , Software
5.
Int J Health Policy Manag ; 8(4): 199-210, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31050965

RESUMO

BACKGROUND: The Government of Romania commissioned international technical assistance to help unpacking the causes of arrears in selected public hospitals. Emphases were placed on the governance-related determinants of the hospital performance in the context of the Romanian health system. METHODS: The assessment was structured around a public hospital governance framework examining 4 dimensions: institutional arrangements, financing arrangements, accountability arrangements and correspondence between responsibility and decision-making capacity. The framework was operationalized using a 2-pronged approach: (i) a policy review of broader health system governance arrangements influencing hospital performance; and (ii) a series of 10 casestudies of public hospitals experiencing financial hardship. Data were collected during 2016-2017 through key informant interviews with central authorities and hospital management teams, exhaustive semi-structured questionnaires filled in by hospitals, as well as the review of documentary sources where feasible. RESULTS: Overall, the governance landscape of Romanian public hospitals includes a large number of seemingly modern legislative provisions and management instruments. Over the past 30 years substantial efforts have been made to put in place standardised hospital classification, hospital governance structures, management and service purchasing contracts with key performance indicators, modern reimbursement mechanisms based on diagnosis-related groups (DRGs), and regulatory requirements for accountability, including internal and external audit. Nevertheless, their application appears to have been challenging for a range of reasons, pointing to the misalignment between the responsibility and decisionmaking capacity given to hospitals in a questionably conducive context. Incoherent policy design, outdated and often disjointed regulatory frameworks, and cumbersome administrative procedures limit managerial autonomy and obstruct efficiency gains. In a context of chronic insufficient funding, misaligned incentives, and overly rigid service procurement processes, hospitals seem to struggle to adjust service baskets to the population's health needs or to overcoming financial hardship. External challenges, combined with the limited strategic, operational, and financial management capacity within hospitals, make it difficult to exhibit good financial and general performance. CONCLUSION: Existing governance arrangements for Romanian public hospitals appear conducive to poor financial performance. The suggested framework for hospital governance assessment has proved a powerful tool for identifying system and hospital-specific challenges contributing to sub-optimal hospital performance.


Assuntos
Governança Clínica , Assistência à Saúde/organização & administração , Hospitais Públicos/organização & administração , Tomada de Decisões , Administração Hospitalar , Humanos , Romênia , Responsabilidade Social
6.
Int J Health Plann Manage ; 34(2): e1293-e1301, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924978

RESUMO

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.


Assuntos
Governança Clínica/organização & administração , Hospitais Militares/organização & administração , Hospitais Universitários/organização & administração , Administradores Hospitalares , Humanos , Entrevistas como Assunto , Irã (Geográfico) , Inovação Organizacional , Administração de Recursos Humanos em Hospitais , Melhoria de Qualidade/organização & administração
7.
BMC Health Serv Res ; 19(1): 114, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744633

RESUMO

BACKGROUND: The purpose of this study was to contribute to knowledge about what is regarded as an appropriate governance model in welfare markets in healthcare, from the perspective of government. The study draws on a framework about governance in healthcare systems as a continuous process of priority setting, monitoring and accountability. It relates to various dimensions of management controls; a view on management controls as a package with interdependence between different controls, a use of management controls as coercive or enabling, and implications of involving providers in the design of control systems. METHODS: The empirical material is limited to experiences of governance models used in Swedish primary care. Data from the 21 county councils responsible for organizing and financing healthcare in Sweden was gathered during 2016-2017 through a survey, interviews and document review. Data was analyzed using conventional content analysis. RESULTS: According to the county councils, governance is a continuous process. Four controls are used in all county councils: contracts, reimbursement systems, dialogue and performance measurement systems (PMS). The appropriateness of different controls is associated with their interdependence, e.g. the more formalized the use of dialogue, the more enabling the use of PMS. An appropriate governance model should on the one hand support innovations and quality improvements and on the other hand ensure external accountability for the use of allocated resources and adherence to agreements. The interviewed representatives described the intended role as both coercive and enabling but in favor of enabling. Using management controls in a way that improves the providers' attitude towards and capacity to achieve the assigned task of delivering high-quality healthcare was described as central. CONCLUSIONS: An appropriate governance model in healthcare systems should enable governments to combine two roles: to force compliance with agreements to ensure external accountability for the use of allocated resources and to offer support to learning and quality improvement in the healthcare system. Governance can be regarded as a continuous process where several management controls operate as a package and the appropriateness of different controls is associated with their interdependence. An appropriate governance model should, from the perspective of government, encompass a high level of formalization of both coercive and enabling types of control but with greater emphasis on enabling types. Governments may pursue the objectives of support to providers and external accountability in healthcare systems by using management controls in enabling ways.


Assuntos
Assistência à Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde , Governança Clínica , Assistência à Saúde/normas , Humanos , Atenção Primária à Saúde/normas , Responsabilidade Social , Suécia
8.
BMC Med Ethics ; 20(1): 7, 2019 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-30678668

RESUMO

BACKGROUND: The red tape and delays around research ethics and governance approvals frequently frustrate researchers yet, as the lesser of two evils, are largely accepted as unavoidable. Here we quantify aspects of the research ethics and governance approvals for one interview- and questionnaire-based study conducted in England which used the National Health Service (NHS) procedures and the electronic Integrated Research Application System (IRAS). We demonstrate the enormous impact of existing approvals processes on costs of studies, including opportunity costs to focus on the substantive research, and suggest directions for radical system change. MAIN TEXT: We have recorded 491 exchanges with 89 individuals involved in research ethics and governance approvals, generating 193 pages of email text excluding attachments. These are conservative estimates (e.g. only records of the research associate were used). The exchanges were conducted outside IRAS, expected to be the platform where all necessary documents are provided and questions addressed. Importantly, the figures exclude the actual work of preparing the ethics documentation (such as the ethics application, information sheets and consent forms). We propose six areas of work to enable system change: 1. Support the development of a broad range of customised research ethics and governance templates to complement generic, typically clinical trials orientated, ones; 2. Develop more sophisticated and flexible frameworks for study classification; 3. Link with associated processes for assessment, feedback, monitoring and reporting, such as ones involving funders and patient and public involvement groups; 4. Invest in a new generation IT infrastructure; 5. Enhance system capacity through increasing online reviewer participation and training; and 6. Encourage researchers to quantify the approvals processes for their studies. CONCLUSION: Ethics and governance approvals are burdensome for historical reasons and not because of the nature of the task. There are many opportunities to improve their efficiency and analytic depth in an age of innovation, increased connectivity and distributed working. If we continue to work under current systems, we are perpetuating, paradoxically, an unethical system of research approvals by virtue of its wastefulness and impoverished ethical debate.


Assuntos
Governança Clínica/ética , Comitês de Ética em Pesquisa , Ética em Pesquisa , Órgãos Governamentais/ética , Pesquisadores/legislação & jurisprudência , Comportamento Cooperativo , Inglaterra , Revisão Ética , Comitês de Ética em Pesquisa/legislação & jurisprudência , Humanos , Entrevistas como Assunto , Pesquisadores/ética , Pesquisadores/organização & administração , Inquéritos e Questionários
9.
Int J Health Plann Manage ; 34(2): 744-760, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30657198

RESUMO

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.


Assuntos
Assistência à Saúde/organização & administração , Mortalidade , Mortalidade da Criança , Pré-Escolar , Auditoria Clínica/organização & administração , Governança Clínica/organização & administração , Controle de Custos/organização & administração , Feminino , Gana/epidemiologia , Conselho Diretor/organização & administração , Alfabetização em Saúde , Administração Hospitalar , Humanos , Lactente , Mortalidade Infantil , Mortalidade Materna , Modelos Estatísticos , Objetivos Organizacionais
10.
Health Res Policy Syst ; 17(1): 3, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30626377

RESUMO

BACKGROUND: Policy- and decision-makers seek to improve the quality of care in the health sector and therefore aim to improve quality through appropriate policies. Higher quality of care will satisfy service providers and the public, reduce costs, increase productivity, and lead to better organisational performance. Clinical governance is a method through which management can be improved and made more accountable, and leads to the provision of better quality of care. In November 2009, the Iranian Ministry of Health and Medical Education implemented new clinical guidelines to standardise and improve clinical services as well as to increase efficiency and reduce costs. The purpose of this study was to assess the challenges of implementing clinical governance through a meta-synthesis of qualitative studies published in Iran. METHODS: Ten databases, including ISI/Web of Sciences, PubMed/MEDLINE, Embase, PsycINFO, the Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and the Scientific Information Database, were searched between January 2009 and May 2018. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Thematic synthesis was used to analyse the data. RESULTS: Ten studies were selected and included based on the inclusion/exclusion criteria. In the first stage, 75 items emerged and were coded, and, following comparison and combination of the codes, 32 codes and 8 themes were finally extracted. These themes included health system structure, management, person-power, cultural factors, information and data, resources, education and evaluation. CONCLUSION: The findings of the study showed that there exist a variety of challenges for the implementation of clinical governance in Iran. To successfully implement a health policy, its infrastructure needs to be created. Using the views and support of stakeholders can ensure that a policy is well implemented. TRIAL REGISTRATION: CRD42017079077 . Dated October 10, 2017.


Assuntos
Assistência à Saúde/normas , Política de Saúde , Melhoria de Qualidade , Governança Clínica , Assistência à Saúde/organização & administração , Humanos , Irã (Geográfico)
11.
Nurs Ethics ; 26(4): 1039-1049, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29137552

RESUMO

BACKGROUND: After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to 'blow the whistle'. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. OBJECTIVE: To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia. RESEARCH DESIGN: Critical case study methodology using Fay's Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. ETHICAL CONSIDERATIONS: Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. FINDINGS: Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a 'social crisis' in the organisation and to whistleblowing. CONCLUSION: Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers' awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.


Assuntos
Atitude do Pessoal de Saúde , Governança Clínica/normas , Denúncia de Irregularidades/ética , Denúncia de Irregularidades/psicologia , Austrália , Governança Clínica/tendências , Ética em Enfermagem , Humanos , Segurança do Paciente/normas
12.
Int J Health Plann Manage ; 34(1): 177-186, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30113709

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. However, COPD is still underdiagnosed, undertreated, and not sufficiently prevented. Health administrative databases provide a powerful way of studying COPD in the population. METHODS: This retrospective study used administrative data, collected during 2011 and 2012, retrieved from 3 Italian local health authorities (LHAs). RESULTS: The analysis through administrative databases allowed firstly to identify patients with COPD receiving services by the 3 LHAs: The estimated average is ~3% of the population aged ≥40 years. Furthermore, it was also possible to stratify patients by investigating the health consumption in hospitalization for COPD and use of respiratory drugs. In all 3 LHA patients with moderate COPD were the majority of the population with COPD. Finally, it was possible to distinguish patients who made an appropriate use of SABA (76% of the total), patients who had a potentially inappropriate use (20%), and those with an overuse of SABA (4%). CONCLUSION: The use of SABA consumption patterns can be a reliable proxy variable to detect subgroups who may necessitate therapy revision. Health administrative databases seem beneficial for planning health care interventions, including the COPD field. They are robust information systems subjected to regular data quality controls remaining the prevalent data source, reliable because of the amount of data and the population coverage, especially in countries with a National Health Service System.


Assuntos
Governança Clínica , Bases de Dados Factuais , Doença Pulmonar Obstrutiva Crônica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente , Saúde da População , Prevalência , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Pesquisa , Estudos Retrospectivos
13.
JAAPA ; 32(1): 41-43, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30589735

RESUMO

Regulatory and accrediting standards require hospitals to have a medical staff responsible for quality of care, patient safety, and clinician self-governance. PAs are on about 20% of hospital medical staffs in the United States and the number is growing.


Assuntos
Governança Clínica , Corpo Clínico Hospitalar , Assistentes Médicos , Humanos , Corpo Clínico Hospitalar/estatística & dados numéricos , Segurança do Paciente , Assistentes Médicos/estatística & dados numéricos , Comitê de Profissionais , Qualidade da Assistência à Saúde
14.
São José dos Campos; s.n; 2019. 88 p. il., tab., graf..
Tese em Português | BBO - Odontologia | ID: biblio-1024218

RESUMO

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)


Assuntos
Humanos , Organização e Administração , Indicadores Econômicos , Marketing de Serviços de Saúde/métodos , Governança Clínica/organização & administração
15.
BMC Health Serv Res ; 18(1): 942, 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514304

RESUMO

BACKGROUND: Hospitals are increasingly parts of larger care collaborations, rather than individual entities. Organizing and operating these collaborations is challenging; a significant number do not succeed, as it is difficult to align the goals of the partners. However, little research has focused on stakeholders' views regarding hospital collaboration models or on whether these views are aligned with those of hospital management. This study explores Belgian hospital stakeholders' views on the factors affecting hospital collaborations and their perspectives on different models for Belgian interhospital collaboration. METHODS: Qualitative focus group study on the viewpoints, barriers, and facilitators associated with hospital collaboration models (health system, network, joint venture). RESULTS: A total of 55 hospital stakeholders (hospital managers, chairs of medical councils, chair of hospital boards and special interest groups) participated in seven focus group sessions. Collaboration in health care is challenging, as the goals of the different stakeholder groups are partly parallel but also sometimes conflicting. Hospital managers and special interest groups favored health systems as the most integrated form. Hospital board members also opted for this model, but believed a coordinated network to be the most pragmatic and feasible model at the moment. Members of physicians' organizations preferred the joint venture, as it creates more flexibility for physicians. Successful collaboration requires trust and commitment. Legislation must provide a supporting framework and governance models. CONCLUSIONS: Involvement of all stakeholder groups in the process of decision-making within the collaboration is perceived as a necessity, which confirms the importance of the stakeholders' theory. The health system is the collaboration structure best suited to enhancing task distribution and improving patient quality. However, the existence of networks and joint ventures is considered necessary in the process of transformation towards more solid hospital collaborations such as health systems.


Assuntos
Atitude do Pessoal de Saúde , Relações Interinstitucionais , Bélgica , Governança Clínica , Comunicação , Tomada de Decisões , Assistência à Saúde/organização & administração , Grupos Focais , Pessoal de Saúde/psicologia , Hospitais/estatística & dados numéricos , Humanos , Colaboração Intersetorial , Masculino , Pesquisa Qualitativa
16.
Rev. Rol enferm ; 41(11/12,supl): 99-102, nov.-dic. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-179948

RESUMO

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


Resumen en ingles


Assuntos
Humanos , Governança Clínica/organização & administração , Condições de Trabalho , Satisfação no Emprego , Equipe de Enfermagem/organização & administração , Atenção Primária à Saúde/organização & administração
17.
J Healthc Qual Res ; 33(5): 298-304, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30401424

RESUMO

AIM: To analyse a complete cycle of self-assessment using the European Foundation for Quality Management (EFQM) Model in the hospitals of the Madrid Health Service as regards the fundamental concepts of excellence (FCE). METHOD: Descriptive study of the EFQM self-assessments of the entire public hospital sector identifying the methodology and the information on strengths, weaknesses, evidence, RADAR matrix (Results, Approach, Deployment, Assessment and Review), and the related FCEs in the enabling criteria and in the prioritised action plans. RESULTS: The self-assessment was carried out in 85% of the hospitals (29/34), 86% of them required specific training (25/29), with a total of 329 teaching hours and 833 people in training. Multidisciplinary working groups were required in 83% of the hospitals (24/29), with 123 groups and 857 people involved. There were 3,686 strengths and 3,197 weaknesses identified: strengths and weaknesses were 78% (2,869) and 74% (2,355), respectively, for the enabling criteria and 22% (817) and 26% (842), respectively, for the results criteria. The mean score was 404 points with a median of 399. The main FCEs were managing with agility, developing organisational capability, sustaining outstanding results, creating a sustainable future, succeeding through the talent of people, and adding value for customers, with harnessing creativity/innovation and leading with vision, inspiration and integrity being placed in lower positions. A total of 113 action plans were identified for all the hospitals. CONCLUSION: A complete EFQM self-assessment cycle of the entire public hospital sector of a Regional Health Service is provided, linking the analysis and action plans with the FCE of the EFQM Model.


Assuntos
Governança Clínica/normas , Administração Hospitalar/normas , Hospitais Públicos/normas , Inovação Organizacional , Administração Hospitalar/métodos , Hospitais Públicos/estatística & dados numéricos , Humanos , Padrões de Referência , Espanha
18.
BMC Health Serv Res ; 18(1): 858, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30428881

RESUMO

BACKGROUND: Social accountability interventions such as CARE's Community Score Card© show promise for improving sexual, reproductive, and maternal health outcomes. A key component of the intervention is creation of spaces where community members, healthcare workers, and district officials can safely interact and collaborate to improve health-related outcomes. Here, we evaluate the intervention's effect on governance constructs such as power sharing and equity that are central to our theory of change. METHODS: We randomly assigned ten matched pairs of communities to intervention and control arms, administering endline surveys to women in each arm who had given birth in the last 12 months. Forty-six governance items were reduced by factor analysis into eight underlying scales. We evaluated the intervention's impact on these constructs using local average treatment effect estimates. RESULTS: Among intervention-area women who reported a community meeting, we further evaluated the influence of the governance constructs on health-related outcomes: home visit from a community health worker, modern family planning, and satisfaction with health services. A significantly greater proportion of intervention-area women compared to control reported the existence of community groups that provide and facilitate negotiated space between community members and healthcare workers (p = .003). Several governance constructs were positively associated with the health-related outcomes. Further, active participation in the intervention was also positively associated with several governance constructs. CONCLUSIONS: CARE's Community Score Card© facilitated the creation and claiming of effective and inclusive negotiated spaces in which community members and healthcare workers could vocalize service delivery issues and prioritize actions for improvement. We argue that reliable measurement of governance concepts such as power sharing, equity and quality of negotiated space, collective efficacy, and mutual responsibility will enhance our ability to evaluate social accountability interventions and understand the processes by which they affect change.


Assuntos
Governança Clínica , Serviços de Saúde Materna/normas , Serviços de Saúde Reprodutiva/normas , Adolescente , Adulto , Análise por Conglomerados , Agentes Comunitários de Saúde , Assistência à Saúde/organização & administração , Serviços de Planejamento Familiar/normas , Feminino , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Responsabilidade Social , Adulto Jovem
19.
BMJ Open ; 8(11): e022921, 2018 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-30478113

RESUMO

OBJECTIVE: To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services. SETTING: Four acute National Health Service hospitals in England. PARTICIPANTS: 111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff. RESULTS: There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff. CONCLUSIONS: The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.


Assuntos
Administração Hospitalar , Gestão de Riscos/métodos , Governança Clínica/organização & administração , Inglaterra , Conselho Diretor/organização & administração , Administração Hospitalar/métodos , Sistemas de Informação Hospitalar/organização & administração , Humanos , Gestão de Riscos/organização & administração , Medicina Estatal/organização & administração
20.
BMC Health Serv Res ; 18(1): 798, 2018 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-30342516

RESUMO

BACKGROUND: Audits are increasingly used for patient safety governance purposes. However, there is little insight into the factors that hinder or stimulate effective governance based on auditing. The aim of this study is to quantify the factors that influence effective auditing for hospital boards and executives. METHODS: A questionnaire of 32 factors was developed using influencing factors found in a qualitative study on effective auditing. Factors were divided into four categories. The questionnaire was sent to the board of directors, chief of medical staff, nursing officer, medical department head and director of the quality and safety department of 89 acute care hospitals in the Netherlands. RESULTS: We approached 522 people, of whom 211 responded. Of the 32 factors in the questionnaire, 30 factors had an agreement percentage higher than 50%. Important factors per category were 'audit as an improvement tool as well as a control tool', 'department is aware of audit purpose', 'quality of auditors' and 'learning culture at department'. We found 14 factors with a significant difference in agreement between stakeholders of at least 20%. Amongst these were 'medical specialist on the audit team', 'soft signals in the audit report', 'patients as auditors' and 'post-audit support'. CONCLUSION: We found 30 factors for effective auditing, which we synthesised into eight recommendations to optimise audits. Hospitals can use these recommendations as a framework for audits that enable boards to become more in control of patient safety in their hospital.


Assuntos
Governança Clínica/normas , Segurança do Paciente/normas , Feminino , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Países Baixos , Fatores Socioeconômicos , Inquéritos e Questionários
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