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1.
Recurso educacional aberto em Espanhol | CVSP - Argentina | ID: oer-3884

RESUMO

1º Jornada «Derecho a la Salud», organizada por el CVSP Nodo Argentina, la Sala de Derecho a la Salud del Colegio de Abogados de Córdoba y la Escuela de Salud Pública y Ambiente de la Facultad de Ciencias Médicas–UNC. La misma se llevó a cabo el día 4 de diciembre del corriente año en el Salón Rojo de la Secretaría de Graduados en Ciencias de la Salud FCM-UNC. La jornada contó con la presencia de Profesionales de la Salud, Profesionales del Derecho, alumnos de postgrado de las Carreras de Ciencias Médicas, Derecho y Ciencias Sociales y público en general. Conferencia dictada por el Prof. Dr. Rubén Torres. Ex Miembro de la OPS. Rector de ISALUD de Buenos Aires.


Assuntos
Qualidade da Assistência à Saúde/organização & administração , Estilo de Vida Saudável/ética , Argentina , Política Nacional de Ciência, Tecnologia e Inovação , Sistemas de Saúde/economia
4.
N C Med J ; 80(5): 301-305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471515

RESUMO

Federal managed care rules require that the services delivered through Medicaid prepaid health plans are available, accessible, and continually being evaluated for improvement. Working with stakeholders, NC Medicaid created a Quality Strategy that serves as a roadmap to measure and oversee performance. NC Medicaid will make a variety of quality reports available including network access, annual quality measures, and provider survey results.


Assuntos
Programas de Assistência Gerenciada/organização & administração , Medicaid/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Humanos , North Carolina , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Estados Unidos
5.
Bull World Health Organ ; 97(8): 563-569, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31384074

RESUMO

In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.


Assuntos
Satisfação do Paciente , Assistência Centrada no Paciente/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde/organização & administração , Projetos de Pesquisa , Humanos , Assistência Centrada no Paciente/normas , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Reprodutibilidade dos Testes
6.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421945

RESUMO

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Assuntos
Continuidade da Assistência ao Paciente , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Cuidadores/organização & administração , Cuidadores/normas , Barreiras de Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Arquitetura de Instituições de Saúde/normas , França , Conhecimentos, Atitudes e Prática em Saúde , Número de Leitos em Hospital , Unidades Hospitalares/normas , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Inquéritos e Questionários
7.
J Clin Nurs ; 28(23-24): 4496-4503, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31408560

RESUMO

AIMS AND OBJECTIVES: To assess the perceptions of clinical practitioners regarding the different dimensions of patient safety culture in their hospital and examine the work-related predictors of patient safety culture perceptions. BACKGROUND: Patient safety is seen as a progressively critical focus in healthcare areas worldwide. Saudi Arabia aims to improve healthcare quality by providing access to healthcare for its increasing population. Hence, constantly assessing the patient safety culture of healthcare facilities in the country is imperative. DESIGN: One-sample correlational survey design. METHODS: The Hospital Survey of Patients' Safety Culture was used to survey the total population sample of 181 healthcare practitioners in a Saudi hospital from December 2018-January 2019. Strengths and weaknesses on PS culture were identified as perceived by the clinical practitioners. Regression analysis was performed to identify the work-related predictors of patient safety culture perceptions. The study followed the STROBE guideline. RESULTS: Nine of the 12 dimensions measured were identified as patient safety culture weaknesses, including 'management support for patient safety' (49.2%), 'teamwork across unit' (44.2%), 'frequency of events reporting' (43.1%), 'communication openness' (41.3%), 'overall perception of patient safety' (38.7%), 'supervisor/manager expectations and actions promoting patient safety' (32.9%), 'staffing' (23.7%), 'hospital handoffs and transitions' (19.6%) and 'non-punitive response to errors' (15.8%). None of the dimensions were identified as strengths by the respondents. Working hours per week and staff position were identified as significant predictors. CONCLUSIONS: The study underscores the urgent need to improve the patient safety culture of the hospital. RELEVANCE TO CLINICAL PRACTICE: Hospital administrators should highlight initiatives on positive patient safety impact plan for clinical practitioners and patients, such as monitoring, reporting and strictly adhering to hospital activities that reduce the risks associated with exposure to medical care.


Assuntos
Atitude do Pessoal de Saúde , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/organização & administração , Gestão da Segurança/organização & administração , Adulto , Hospitais Públicos/normas , Humanos , Arábia Saudita , Inquéritos e Questionários
8.
J Clin Nurs ; 28(23-24): 4264-4275, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31464017

RESUMO

AIMS AND OBJECTIVES: To systematically review and synthesise primary studies on the relationship between nurse staffing and hospital-acquired conditions. BACKGROUND: Research examining the association between nurse staffing and hospital-acquired conditions is varied owing to the use of different definitions and methods. DESIGN: This study was conducted based on a systematic review of related nursing literature. METHODS: The CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO and RISS databases were searched for either English or Korean language studies published between January 2000 and August 2018 that examined the association between nurse staffing and hospital-acquired conditions. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses check list. RESULTS: Totally, 19 published studies were included in the systematic review. Various measures were used to examine association between nurse staffing and hospital-acquired conditions. The majority of the reviewed studies revealed negative relationships between nurse staffing levels and hospital-acquired conditions. However, a substantial number of relationships were not significant. CONCLUSIONS: There is a need for future studies to examine the differences in the relationship between nurse staffing and hospital-acquired conditions and to use precise data collection on registered nurses' hours per patient day and total hours per patient day, as it is difficult to collect data on these measures. The findings of this study suggest that sufficient nurse staffing is a strong indicator of the provision of quality patient care. However, continuous efforts are recommended to find more conclusive relationships between nurse staffing and hospital-acquired conditions and to formulate guidelines regarding nurse staffing strategies. RELEVANCE TO CLINICAL PRACTICE: Nurse staffing is an important managerial strategy. Especially, given health policy changes, hospitals need to develop staffing strategies to prevent hospital-acquired conditions.


Assuntos
Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Acidentes por Quedas , Infecções Comunitárias Adquiridas/etiologia , Humanos , Complicações Pós-Operatórias/etiologia , Qualidade da Assistência à Saúde/organização & administração , Ferimentos e Lesões/etiologia
9.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 188-192, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183585

RESUMO

La mayor edad y creciente complejidad de los pacientes neuroquirúrgicos ingresados ha supuesto un incremento en las interconsultas con Medicina Interna. Esta colaboración presenta inconvenientes debido a la falta de continuidad asistencial y a la discrecionalidad de su uso. La adscripción de un internista al servicio de Neurocirugía a tiempo completo y con atribuciones asistenciales completas, salvo las estrictamente quirúrgicas, es una opción organizativa factible. Este sistema minimiza la necesidad de interconsultas, mejora la calidad asistencial percibida, permite que el cirujano se centre en tareas puramente quirúrgicas, aporta una visión global del paciente y de su enfermedad, enriquece al grupo con conocimientos especializados no neuroquirúrgicos y eleva el nivel científico del equipo. En nuestro servicio se dispone de una internista en plantilla desde hace 14 años. Describimos sus atribuciones de trabajo diarias, las ventajas asistenciales que proporciona al servicio y las implicaciones profesionales y laborales derivadas


The increasing age and complexity of in-hospital neurosurgery patients have raised the number of consultations with Internal Medicine. This type of collaboration is discretional and lacks temporal continuity. The full-time appointment of an internal medicine practitioner to a Neurosurgery Department, with complete care attributions except for strict surgical work, is a feasible organizational option. This method minimizes the need for medical consultation, improves the perceived quality of care, allows neurosurgeons to focus on purely surgical tasks, provides an integral vision of the patient's condition, enriches the group with specialized non-neurosurgical knowledge, and raises the scientific level of the team. In our Neurosurgery Department, an internal medicine practitioner has been working as part of the staff for 14 years. We describe her medical activity duties, the advantages our department gains from her daily work, and the professional and working implications derived


Assuntos
Humanos , Neurocirurgia/organização & administração , Encaminhamento e Consulta , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Cirurgiões , Medicina Interna
11.
Health Res Policy Syst ; 17(1): 71, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331334

RESUMO

As many developed health systems grapple with the reorientation of their systems to those that are commissioning led, consumer engagement has emerged as an important theme. Despite many governments asserting the importance of consumer engagement in commissioning, an evidence base is yet to be developed to support this approach. This paper identifies the challenges and gaps in the literature relating to consumer engagement and commissioning, before setting out five potential solutions to these challenges. Ultimately, consumer engagement needs clarity of purpose and any approach should be tailored to context. Effective client involvement needs time and investment. To embark on such a process without this effort can be counterproductive.


Assuntos
Participação da Comunidade/métodos , Assistência à Saúde/organização & administração , Prioridades em Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Participação do Paciente , Qualidade da Assistência à Saúde/organização & administração
12.
Med Care ; 57(8): 584-591, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31295188

RESUMO

BACKGROUND: The effects of Medicare payment reforms aiming to improve the efficiency and quality of care by establishing greater financial accountability for providers may vary based on the extent and types of other coverage for their patient populations. Providers who are more resource constrained due to a less favorable payer mix face greater financial risks under such reforms. The impact of the expanded Medicare dialysis prospective payment system (PPS) on quality of care in independent dialysis facilities may vary based on the extent of higher payments from private insurers available for managing increased risks. OBJECTIVES: To evaluate whether anemia outcomes for dialysis patients in independent facilities differ under the Medicare PPS based on facility payer mix. DESIGN: We examined changes in anemia outcomes for 122,641 Medicare dialysis patients in 921 independent facilities during 2009-2014 among facilities with differing levels of employer insurance (EI). We performed similar analyses of facilities affiliated with large dialysis organizations, whose practices were not expected to change based on facility-specific payer mix. RESULTS: Among independent facilities, similar modeled trends in low hemoglobin for all 3 facility EI groups in 2009-2010 were followed by increased low hemoglobin during 2012-2014 for facilities with lower EI (P<0.01). Post-PPS standardized blood transfusion ratios were 9% higher for lower EI versus higher EI independent facilities (P<0.01). Among large dialysis organizations facilities, there was no divergence in low hemoglobin by payer mix under the PPS. CONCLUSIONS: There is evidence of poorer quality of care for anemia under the PPS in independent facilities with lower versus higher EI. Provider responses to payment reform may vary based on attributes such as payer mix that could have implications for health disparities.


Assuntos
Anemia/terapia , Reforma dos Serviços de Saúde/organização & administração , Medicare/organização & administração , Sistema de Pagamento Prospectivo/organização & administração , Diálise Renal/economia , Adolescente , Adulto , Idoso , Anemia/economia , Anemia/etiologia , Eritropoetina/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Hemoglobinas/análise , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Masculino , Medicare/economia , Pessoa de Meia-Idade , Sistema de Pagamento Prospectivo/economia , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Diálise Renal/normas , Estados Unidos , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-31311072

RESUMO

Background: Village doctors, as gatekeepers for the health of rural residents in China, are confronted with adversity in providing the basic public health services (BPHS), which has significantly impeded them from providing high quality BPHS. This study aimed to explore the obstacles and difficulties faced by village doctors in order to improve the quality and efficiency of BPHS provision and increase the health level of the population. Methods: In-depth interviews were employed to conduct this qualitative study. A total of 51 village doctors in four cities of Shandong Province were interviewed. The interviews were transcribed, anonymized, and imported into NVivo11.0 to facilitate management. Thematic framework analysis employing the constant comparison method was applied to the data analysis. Results: The main challenges faced by village doctors comprised the shortage, gender imbalance, and poor education of village doctors; older village doctors in some villages; low income; lack of social security; inappropriate performance assessment; inadequate professional BPHS training; heavy workload; and insufficient cooperation from rural residents, which have exacerbated the quality, efficiency, and accessibility of BPHS to some extent. Conclusions: Village doctors, as the important BPHS providers in rural Shandong, are facing a wide range of challenges. It is urgent for government officials and policy makers to consider these challenges and concentrate on improving the quality of BPHS provision by developing relevant and practical strategies.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde/organização & administração , Médicos de Atenção Primária , Administração em Saúde Pública , Qualidade da Assistência à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , China , Feminino , Humanos , Masculino , Saúde Pública , Pesquisa Qualitativa , Saúde da População Rural
14.
Med Care ; 57(8): 654-658, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31259785

RESUMO

BACKGROUND/OBJECTIVE: Offering depression collaborative care services in primary care (PC) settings can reduce use of nonintegrated mental health care resources and improve mental health care access, particularly for vulnerable PC patients. Tests of effects on depression care quality, however, are needed. We examined overall quality of depression care and tested whether increasing clinic engagement in Veterans Affairs (VA)'s Primary Care-Mental Health Integration (PC-MHI) services was associated with differences in depression care quality over time. METHODS: We conducted a retrospective longitudinal cohort study of 80,136 Veterans seen in 26 Southern California VA PC clinics (October 1, 2008-September 30, 2013). Using multilevel regression models adjusting for year, clinic, and patient characteristics, we predicted effects of clinic PC-MHI engagement (ie, percent of PC patients receiving PC-MHI services) on 3 VA-developed longitudinal electronic population-based depression quality measures among Veterans newly diagnosed with depression (n=12,533). RESULTS: Clinic PC-MHI engagement rates were not associated with significant depression care quality differences. Across all clinics, average rates of follow-up within 84 or 180 days were, 66.4% and 74.5%, respectively. Receipt of minimally appropriate treatment was 80.5%. Treatment probabilities were significantly higher for vulnerable PC patients (homeless: 4.5%, P=0.03; serious mental illness: 15.2%, P<0.001), than for otherwise similar patients without these characteristics. CONCLUSIONS/POLICY IMPLICATIONS: Study patients treated in PC clinics with greater PC-MHI engagement received similarly high quality depression care, and even higher quality for vulnerable patients. Findings support increasing use of PC-MHI models to the extent that they confer some advantage over existing services (eg, access, patient satisfaction) other than quality of care.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Depressão/terapia , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , United States Department of Veterans Affairs/organização & administração , Feminino , Humanos , Estudos Longitudinais , Masculino , Serviços de Saúde Mental/organização & administração , Estudos Retrospectivos , Estados Unidos
15.
Med Care ; 57(8): 641-647, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31259786

RESUMO

BACKGROUND: The safety and quality of care provided to nursing home residents is a significant concern. Little is known whether fostering patient safety culture helps improve the safety and quality of nursing home care. METHODS: This study determined the associations of nursing home patient safety culture performance, as reported by administrators, directors of nursing, and unit leaders in a large national sample of free-standing nursing homes, with several "Nursing Home Compare" performance indicators. We conducted the survey in 2017 using the Agency for Healthcare Research and Quality Survey on Patient Safety Culture for nursing homes to collect data on 12 core domains of safety culture scores. Survey data were linked to other nursing home files for multivariable regression analyses. RESULTS: Overall, 818 of the 2254 sampled nursing homes had at least 1 completed survey returned for a response rate of 36%. After adjustment for nursing home, market, and state covariates, every 10 percentage points increase in overall positive response rate for safety culture was associated with 0.56 fewer health care deficiencies (P=0.001), 0.74 fewer substantiated complaints (P=0.004), reduced fines by $2285.20 (P=0.059), and 20% increased odds of being designated as 4-star or 5-star (vs. 1 to 3 star) facilities (odds ratio roughly=1.20, P<0.05). CONCLUSIONS: Efforts to improve nursing home performance in patient safety culture have the potential to improve broad safety and quality of care measures encapsulated in the Nursing Home Compare publication.


Assuntos
Casas de Saúde/organização & administração , Cultura Organizacional , Segurança do Paciente , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Humanos , Casas de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas
17.
BMC Health Serv Res ; 19(1): 433, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253140

RESUMO

BACKGROUND: Business cases are used to provide a structured justification in favour of investing in new projects, services or interventions. Despite the use of business cases in determining how limited resources will be allocated within England's National Health Service (NHS), guidance concerning how to develop and evaluate business cases in the context of healthcare is inconstant and of varying relevance. This study aimed to develop a new framework of quality indicators for healthcare-related business cases by analysing the content of expert guidance documents and a sample of NHS business cases. METHODS: Qualitative document analysis was conducted on guidance documents (n = 7) and existing NHS business case documents (n = 18). Documents were purposefully sampled using criteria to ensure the framework reflected a diverse spread of expert opinion, and a varied sample of example business cases from current practice. Data were analysed using thematic and content analysis, and are presented in a visualised framework. RESULTS: Seven themes were identified within the qualitative document analysis (purpose, strategic priorities, options, benefits, costs, risks and evaluation). These themes were described and presented with a framework of quality indicators for healthcare-related business cases. CONCLUSION: To ou`r knowledge, this is the first framework of business case quality indicators designed specifically for use in a healthcare context. The framework presented in this study has implications for how business cases are developed and evaluated by decision makers. In the future it would be beneficial to investigate how the framework could be used in practice as a tool for critical appraisal.


Assuntos
Assistência à Saúde/organização & administração , Padrões de Prática Médica/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Inglaterra , Estudos de Avaliação como Assunto , Humanos , Modelos Organizacionais , Desenvolvimento de Programas
18.
R I Med J (2013) ; 102(5): 26-29, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167524

RESUMO

As the Patient Centered Medical Home (PCMH) model has evolved nationally and in Rhode Island, there has been increased recognition that PCMH has not been sufficient to achieve desired cost and quality goals. In this article, we describe the evolving concept of "comprehensive primary care" in Rhode Island, which includes addressing the behavioral health and social determinants of health (SDOH) needs of patients. These needs are identified through systematic screening and dedicated care management and care coordination for patients who present with complex needs.


Assuntos
Assistência Integral à Saúde/economia , Reforma dos Serviços de Saúde , Assistência Centrada no Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Rhode Island , Determinantes Sociais da Saúde
20.
Ig Sanita Pubbl ; 75(1): 29-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31185489

RESUMO

AIM: The aim of this study was to review experiences of use of the Lean methodology in the hospital setting and assess the impact of the interventions in terms of time of processes, productivity, effects on staff and patientd satisfaction. METHODS: PubMed, Scopus and CINAHL databases were searched to identify studies evaluating the lean methodology. Two reviewers screened the citations identified and extracted data according to the PRISMA methodology. RESULTS: In total, 635 citations were identified, of which 27 were included in the present review. Most studies showed a positive outcome related to the implementation of the Lean methodology and tools.


Assuntos
Assistência à Saúde , Hospitais , Qualidade da Assistência à Saúde , Humanos , Satisfação Pessoal , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas
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