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Objetivo: Analisar os resultados de indicadores de desempenho hospitalar de uma unidade de urgência/emergência, que implantou o projeto "Lean nas Emergências". Métodos: Estudo descritivo, retrospectivo, do tipo transversal de abordagem quantitativa, em duas fases (antes e depois), cuja população foi composta por documentos de 7.590 internações nas clínicas médica, cirúrgica e ortopédica, atendidos no pronto-socorro. Os dados foram submetidos ao teste de normalidade e posteriormente, ao teste não paramétrico de Wilcoxon, considerando-se o nível de significância de 5% (p = 0,05). Resultados: As variáveis que apresentaram diferença significativa antes e depois da implantação do Projeto "Lean nas Emergências" foram: Nº de internações (p=0,03); Nº de Saídas (altas + óbitos) (p = 0,03); Giro de leito (p = 0,03); Intervalo de substituição de leitos (p=0,03) e Leitos operacionais disponíveis (p = 0,04). O número de internações; de saídas e o giro de leitos aumentaram em 13,2%, 20,6% e 11,7%, respectivamente e o tempo para o intervalo de substituição dos leitos diminuiu em 61,1%. Conclusão: Os indicadores que apresentaram significância nos resultados refletem a eficácia do projeto em quesitos importantes para o gerenciamento do número de leitos no pronto socorro, otimizando o tempo de estadia do paciente no ambiente hospitalar. (AU)

Objective: To compare the results of hospital performance indicators of an urgency/emergency unit that has implemented the "Lean in Emergencies" project. Methods: A descriptive, retrospective, cross-sectional study with a quantitative approach, in two phases (before and after), whose population was composed of documents from 7,590 admissions in medical, surgical, and orthopedic clinics, seen in the emergency room. The data were submitted to the normality test and later to the Wilcoxon non-parametric test, considering a 5% significance level (p = 0.05). Results: The variables that showed significant difference before and after the implementation of the Project "Lean in Emergencies" were: Number of admissions (p = 0.03); Number of Exits (discharges + deaths) (p = 0.03); Bed Turnover (p = 0.03); Interval for bed replacement (p = 0.03) and Available operational beds (p = 0.04). The number of admissions; outputs and bed turnover increased by 13.2%, 20.6% and 11.7%, respectively, and the time to bed replacement interval decreased by 61.1%. Conclusion: The indicators that presented significant results demonstrate the project's effectiveness in important aspects for managing the number of beds in the emergency room, optimizing the patient's length of stay in the hospital environment. (AU)

Objetivo: Analizar los resultados de los indicadores de desempeño hospitalario de una unidad de urgencia/emergencia, que implementó el proyecto "Lean en Emergencias". Métodos: Estudio descriptivo, retrospectivo, transversal con abordaje cuantitativo, en dos etapas (antes y después), cuya poplación fue compuesta por documentos de 7.590 internaciones en los consultorios médico, quirúrgico y ortopédico, atendidos en la sala de emergencias. Los datos fueran sometidos a la prueba de normalidad y posteriormente, a la prueba no paramétrica de Wilcoxon, considerando un nivel de significación del 5% (p = 0,05). Resultados: Las variables que presentaron diferencia significativa antes y después de la implementación del Proyecto "Lean en Emergencias" fueron: Número de internaciones (p=0,03); Número de Salidas (altas + óbitos) (p = 0,03); Rotación de camas (p = 0,03); Intervalo de reemplazo de camas (p=0,03) y Camas operativas disponibles (p = 0,04). El número de internaciones; de salidas y rotación de camas aumentaron en 13,2%, 20,6% e 11,7%, respectivamente, y el tiempo para el intervalo de reemplazo de camas disminuyó en 61,1%. Conclusión: Los indicadores que presentaron significación en los resultados reflejan la efectividad del proyecto en aspectos que son importantes para gestionar el número de camas en urgencias, optimizando el tiempo de estancia del paciente en el ambiente hospitalario. (AU)

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BACKGROUND: The growing demand for more efficient, timely, and safer health services, together with insufficient resources, put unprecedented pressure on health systems worldwide. This challenge has motivated the application of principles and tools of operations management and lean systems to healthcare processes to maximize value while reducing waste. Consequently, there is an increasing need for professionals with the appropriate clinical experience and skills in systems and process engineering. Given their multidisciplinary education and training, biomedical engineering professionals are likely among the most suitable to assume this role. In this context, biomedical engineering education must prepare students for a transdisciplinary professional role by including concepts, methods, and tools that commonly belong to industrial engineering. This work aims to create relevant learning experiences for biomedical engineering education to expand transdisciplinary knowledge and skills in students to improve and optimize hospital and healthcare care processes. METHODS: Healthcare processes were translated into specific learning experiences using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. This model allowed us to systematically identify the context where learning experiences were expected to occur, the new concepts and skills to be developed through these experiences, the stages of the student's learning journey, the resources required to implement the learning experiences, and the assessment and evaluation methods. The learning journey was structured around Kolb's experiential learning cycle, which considers four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Data on the student's learning and experience were collected through formative and summative assessments and a student opinion survey. RESULTS: The proposed learning experiences were implemented in a 16-week elective course on hospital management for last-year biomedical engineering undergraduate students. Students engaged in analyzing and redesigning healthcare operations for improvement and optimization. Namely, students observed a relevant healthcare process, identified a problem, and defined an improvement and deployment plan. These activities were carried out using tools drawn from industrial engineering, which expanded their traditional professional role. The fieldwork occurred in two large hospitals and a university medical service in Mexico. A transdisciplinary teaching team designed and implemented these learning experiences. CONCLUSIONS: This teaching-learning experience benefited students and faculty concerning public participation, transdisciplinarity, and situated learning. However, the time devoted to the proposed learning experience represented a challenge.

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BACKGROUND: Medical knowledge is accumulated in scientific research papers along time. In order to exploit this knowledge by automated systems, there is a growing interest in developing text mining methodologies to extract, structure, and analyze in the shortest time possible the knowledge encoded in the large volume of medical literature. In this paper, we use the Latent Dirichlet Allocation approach to analyze the correlation between funding efforts and actually published research results in order to provide the policy makers with a systematic and rigorous tool to assess the efficiency of funding programs in the medical area. RESULTS: We have tested our methodology in the Revista Médica de Chile, years 2012-2015. 50 relevant semantic topics were identified within 643 medical scientific research papers. Relationships between the identified semantic topics were uncovered using visualization methods. We have also been able to analyze the funding patterns of scientific research underlying these publications. We found that only 29% of the publications declare funding sources, and we identified five topic clusters that concentrate 86% of the declared funds. CONCLUSIONS: Our methodology allows analyzing and interpreting the current state of medical research at a national level. The funding source analysis may be useful at the policy making level in order to assess the impact of actual funding policies, and to design new policies.

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RESUMO Objetivo: instrumentalizar, com fluxograma e Procedimento Operacional Padrão, os enfermeiros da Atenção Primária à Saúde, a fim de monitorar os casos de sífilis gestacional. Método: pesquisa de abordagem qualitativa, tipo pesquisa-ação, modalidade prático-educativa. Participantes: representantes da Vigilância Epidemiológica, Programa Saúde da Mulher, Atenção Primária à Saúde, enfermeiros da Estratégia Saúde da Família e do corpo clínico médico. Concretizado na prefeitura de São José-SC, no mês de outubro de 2017. Resultados: elaborou-se um instrumento para auxiliar no atendimento de gestantes com exame de teste rápido reagente para sífilis. Conclusão: os participantes atuantes na prática assistencial da atenção primária permitiram, através de um processo dinâmico, a legitimidade, buscando atender às demandas dos serviços e dos profissionais. A celeridade no diagnóstico, acompanhamento e tratamento da sífilis na gestação estão relacionados com o manejo adequado, associado a ações, estratégias e atualizações, proporcionando assistência qualificada durante o período gestacional, para efetivamente erradicar a sífilis congênita.

RESUMEN Objetivo: instrumentalizar, con flujograma y Procedimiento Operativo Estándar, a los enfermeros de la Atención Primaria de la Salud, con el objetivo de monitorear los casos de sífilis gestacional. Método: investigación de enfoque cualitativo, tipo investigación-acción, modalidad práctico-educativa. Participantes: representantes de la Vigilancia Epidemiológica, Programa Salud de la Mujer, Atención Primaria de la Salud, enfermeros de la Estrategia Salud de la Familia y del cuerpo de clínica médica. Estudio realizado en la municipalidad de San José-SC, durante el mes de octubre de 2017. Resultados: se elaboró un instrumento para auxiliar en la atención de gestantes con de test rápido reactivo para sífilis. Conclusión: los participantes actuantes en la práctica asistencial da atención primaria permitieron, por medio de un proceso dinámico, la legitimidad, intentando atender las demandas de los servicios y de los profesionales. La celeridad en el diagnóstico, seguimiento y tratamiento de la sífilis gestacional se relacionan con el manejo adecuado, asociado a acciones, estrategias y actualizaciones, brindando asistencia cualificada durante el período gestacional, para erradicar la sífilis congénita de manera efectiva.

ABSTRACT Objective: To instruct, with a flowchart and Standard Operating Procedure, nurses from Primary Health Care, in order to monitor cases of gestational syphilis. Method: Qualitative research, action-research type, practical-educational modality. Attendees: Representatives of the Epidemiological Surveillance, Women's Health Program, Primary Health Care, nurses from the Family Health Strategy and the medical staff. Made in the city of São José-SC, in October 2017. Results: An instrument was developed to assist pregnant women with a rapid reagent test for syphilis. Conclusion: The participants working in the primary care assistance practice, through a dynamic process, allowed legitimacy, seeking to meet the demands of the services and the professionals. The speed in the diagnosis, monitoring and treatment of syphilis in pregnancy are related to the proper management, associated with actions, strategies and updates, providing qualified assistance during the gestational period, to effectively eradicate congenital syphilis.

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ABSTRACT Objectives: to understand the practice of the nurse in healthcare management of children with chronic condition in the hospital setting. Methods: analytical study of qualitative approach with theoretical and methodological reference of institutional ethnography. Developed in the pediatric unit of a university hospital, in a municipality in Northeastern Brazil. Data collections techniques were: participant observation, documentary analysis and semi-structured interview. Participants of the study totaled twenty professionals, including nurses, social workers, psychologists, pharmacists, nutritionists, physiotherapists, and doctors. For data analysis, it was used the Bardin's Content Analysis with interface of the Atlas.ti software. Results: categories of analysis were "Nurse as mediator of healthcare management"; "Nursing process as a mechanism of healthcare management". Final considerations: the nurse proved to be essential for healthcare management of the child with chronic condition, acting as mediator of the relationship between the doctor, the members of the health team, the user and their family.

RESUMEN Objetivos: comprender la práctica del enfermero en la gestión del cuidado al niño con condición crónica en el contexto hospitalário. Métodos: estudio analítico de abordaje cualitativo, con referencial teórico y metodológico de la etnografía institucional. Desarrollado en la unidad pediátrica de un hospital universitario, en un municipio del Nordeste brasileño. Se utilizaron técnicas de recolección de datos, como observación participante, análisis documental y entrevista semiestructurada. Participaron del estudio un total de veinte profesionales, siendo ellos enfermeros, asistentes sociales, psicólogos, farmacéuticos, nutricionistas, fisioterapeutas y médicos. Para el análisis de los datos, se utilizó el Análisis de Contenido de Bardin con interfaz del software Atlas.ti Resultados: las categorías de análisis fueron "enfermero como mediador de la gestión del cuidado"; "Proceso de enfermería como mecanismo de gestión del cuidado". Consideraciones finales: el enfermero se reveló fundamental para la gestión del cuidado al niño con condición crónica, actuando como mediador de la relación entre el médico, los integrantes del equipo de salud, el usuario y su família.

RESUMO Objetivos: compreender a prática do enfermeiro na gestão do cuidado à criança com condição crônica no contexto hospitalar. Métodos: estudo analítico de abordagem qualitativa, com referencial teórico e metodológico da etnografia institucional. Desenvolvido na unidade pediátrica de um hospital universitário, em um município do Nordeste brasileiro. Foram utilizadas técnicas de coleta de dados, como observação participante, análise documental e entrevista semiestruturada. Participaram do estudo vinte profissionais, sendo eles enfermeiros, assistentes sociais, psicólogos, farmacêuticos, nutricionistas, fisioterapeutas e médicos. Para análise dos dados, utilizou-se a Análise de Conteúdo de Bardin com interface do software Atlas.ti. Resultados: categorias de análise, bem como "Enfermeiro como mediador da gestão do cuidado"; "Processo de enfermagem como mecanismo de gestão do cuidado". Considerações finais: o enfermeiro revelou-se fundamental para gestão do cuidado à criança com condição crônica, atuando como mediador da relação entre o médico, os integrantes da equipe de saúde, o usuário e sua família.

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BACKGROUND: Healthcare organizations have invested efforts on hospital-based health technology assessment (HB-HTA) and enterprise risk management (ERM) processes for novel systems to obtain more accurate data on which to base strategic decisions. This study proposes to analyze how HB-HTA and ERM processes can share personal resources and skills to achieve principles with value-oriented results. METHODS: Literature on ERM and HB-HTA and data from interviews with healthcare managers compose the research data sources, which were submitted to a qualitative data analysis. It was oriented to identify the association between ERM and HB-HTA application in hospitals and the common principles between both processes, in addition to proposing the capability to share personal resources between both teams in a matrix. RESULTS: The common principles and personal background suggested for HB-HTA and ERM teams allowed the build of a matrix identifying how both teams can work in an integrated manner being more effective and value-oriented. The shared resource matrix reports how each professional (with a specific background) may interact with each activity associated to HB-HTA or ERM implementation guidelines. CONCLUSIONS: The identification of common principles and capabilities between ERM and HB-HTA suggested advances with the literature from both research areas. The opportunity to share personal resources also contributes to the implementation of those processes in hospitals with less financial resources, approaching its own management to be more efficient with the care chain.

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Resumen: Las fracturas de cadera en el anciano representan un grave problema sanitario. En nuestro país se ha producido un incremento exponencial de las mismas, por lo que suponen, desde el punto de vista de la gestión hospitalaria, un reto cada vez mayor. El objetivo del estudio es evaluar los resultados al año de la implementación piloto de un proceso clínico multidisciplinar para la atención de los pacientes mayores de 65 años con diagnóstico de fractura de cadera. Material y métodos: Estudio observacional de cohortes, retrospectivo. Se incluyeron los pacientes con edad igual o mayor de 65 años con diagnóstico de fractura de cadera. Los períodos analizados fueron el año natural 2013 (anterior a la intervención, 84 pacientes) y el año natural 2015 (en el que se desarrolla la implementación piloto, 85 pacientes). Las variables analizadas fueron la tasa de pacientes intervenidos en las primeras 48 horas, la estancia preoperatoria, la estancia total y la tasa de mortalidad al año. Resultados: La tasa de intervención en las primeras 48 horas en 2013 fue de 24.3% y en 2015 de 64.6%. Las medianas de las estancias preoperatoria y total se redujeron en tres días. No se encontraron diferencias en la tasas de mortalidad al año entre ambos grupos. Conclusión: Nuestro estudio sugiere que tras implementar un proceso clínico multidisciplinar para la atención de la fractura de cadera se pueden observar mejoras en la eficiencia asistencial. No se ha podido demostrar una menor tasa de mortalidad al año.

Abstract: Hip fracture in the elderly is considered to be a serious sanitary problem. In our country, these fractures have experimented an exponential growth, becoming an important challenge for healthcare management. This study is aimed to evaluate the 1-year-follow-up results after the pilot implementation of a multidisciplinary clinical pathway for hip fractures in over-65-year-old patients. Material and methods: We performed an observational retrospective cohort study. All over-65-year-old patients diagnosed with hip fracture were included. The analysed periods were the year 2013 (previous to the implementation of the clinical pathway, 84 patients) and the year 2015 (after the pilot implantation of the clinical pathway, 85 patients). We studied the following variables: rate of patients that underwent surgery during the first 48 hours, preoperative length of stay, total length of stay and one year mortality rate. Results: The rate of surgery during the first 48 hours was 24.3% in 2013 and 64.6% in 2015. The median of the preoperative and total length of stay decreased three days. One year mortality rates of both groups were not found to be statistically different. Conclusion: Our study suggests that improvements of the care efficiency may be achieved after the implementation of a clinical pathway for the hip fracture in the elderly. It was not possible to demonstrate a lower one year mortality rate.

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Este artigo visa descrever variáveis organizacionais de três Centros de Atenção Psicossocial Álcool e Droga (Caps AD) quanto às atividades, abrangência, recursos disponíveis, perfil dos usuários e profissionais, práticas e estratégias terapêuticas, bem como o quanto o cuidado está pautando nas diretrizes governamentais do modelo psicossocial. Este estudo, descritivo-exploratório, analisa normas, diretrizes governamentais e dados arquivísticos relativos a dois Caps AD do Distrito Federal e um de São Paulo. Os dados foram submetidos a análises qualitativas (planilhas categoriais) e quantitativas (estatísticas descritivas). Os resultados evidenciaram problemas de infraestrutura, abrangência territorial divergente da recomendada, dificuldades de acesso do usuário ao serviço, de articulação dos profissionais com a rede de atenção psicossocial, comprometendo o atendimento das demandas, a adesão dos usuários ao tratamento e o desempenho dos profissionais, o que indica frágil alinhamento do cuidado às diretrizes governamentais. A efetiva aplicação do modelo depende da solução desses problemas.

This study aims to describe organizational variables of three Psychosocial Alcohol and Drug Care Centers (Caps AD) in terms of their activities, coverage, available resources, client and employee profiles, practices, and therapeutic strategies, as well as how much care is based on the governmental guidelines of the psychosocial model. This descriptive exploratory study analyzes norms, governmental guidelines, and archival data for two of the Caps AD located in the Brazilian Federal District and one in São Paulo. The data were submitted to qualitative (categorical tables) and quantitative analysis (descriptive statistics). The results indicate problems with the infrastructure, territorial coverage different from the recommended one, difficulties clients have accessing services, communication between the staff and the network of psychosocial care centers, adversely affecting service provision, patients' adherence to treatment, and staff performance, which indicates fragile alignment between the services offered and governmental guidelines. The effective application of this model depends upon a solution to these problems.

Este estudio se caracteriza por describir variables organizativas tres Centros de Atención Psicosocial Alcohol y Droga (Caps AD) las necesidades, la comprensión, los recursos disponibles, el perfil de los usuarios y los profesionales, las prácticas y los recursos terapéuticos, así como cuánto el cuidado está pautando en las directrices gubernamentales del modelo psicosocial. Este estudio, descritivo-exploratorio, analiza normas, orientaciones gubernamentales y datos arquivísticos, se refiere a dos Caps AD del Distrito Federal y un de São Paulo. Los datos se someten a análisis cualitativas (planilhas categoriais) y cuantitativas (estatísticas descritivas). Los resultados evidenciaron problemas de infraestructura, alcance territorial divergente de la recomendada, dificultades de acceso del usuario al servicio, de articulación de los profesionales con la red de atención psicosocial, comprometiendo la atención de las demandas, la adhesión de los usuarios al tratamiento y el desempeño de los profesionales, lo que indica frágil alineación del cuidado a las directrices gubernamentales. Una aplicación efectiva del modelo depende de la solución de problemas.

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BACKGROUND: The first phase of an enterprise risk management (ERM) program is the identification of risks. Accurate identification is essential to a proactive and effective ERM function. The authors identified a lack of such risk identification in the literature and in practical cases when interviewing the chief risk officers from healthcare organizations. A risk inventory specific to healthcare organizations that includes detailed risk scenarios and risk impacts currently does not exist. Thus, the objective of this research is to develop an enterprise risk inventory for healthcare organizations to create a common understanding of how each type of risk impacts a healthcare organization. METHOD: ERM guidelines and data from 15 interviews with chief risk officers were analyzed to create the risk inventory. The identified risks were confirmed through a survey of risk managers from a range of global healthcare organizations during the ASHRM conference in 2017. Descriptive statistics were developed and cluster analysis was performed using the survey results. RESULTS: The risk inventory includes 28 risks and their specific risk scenarios. Cyberattack was ranked as the principal risk by the participants, followed by sentinel events and risks associated with human capital management (organizational culture, use of electronic medical records and physician wellness). The data analysis showed that the specific characteristics of the survey participants, such as the length of time working in risk management, the size of the organization, and the presence of a school of medicine, do not impact an individual's opinion of the importance of the risks identified. A personal background in risk management (clinical or enterprise) was a characteristic that showed a small difference in the perceived importance of the risks from the proposed risk inventory. CONCLUSIONS: In addition to defining specific risk scenarios, the enterprise risk inventory presented in this research can contribute to guiding the risk identification phase of an ERM program and thereby support the development of a risk culture. Patient data security in hospitals that operate with high levels of technology is fundamental to delivering high quality and safe care to patients. At the top of the risk ranking, the identification of cyberattacks reflects the importance that healthcare risk managers place on this risk by allocating time and other resources. Exploring opportunities to improve cyber risk management and evaluating the benefits of using the risk inventory at the beginning of the risk identification phase in an ERM program are suggestions for future studies.

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BACKGROUND: Fertility preservation (FP) is a major determinant of quality of life after cancer remission for women who may not have achieved their ideal family size. This article describes the FP services and strategy currently available, highlighting issues of oncofertility worldwide. For these patients in complex situations, health networks are essential to improve coordination of care, and the strengthening of this coordination is a major challenge to improve the performance of the health system. Two international networks have been created in order to foster scientific exchange between countries and to standardize the oncofertility healthcare circuit. However, the paucity of referral nationwide networks lead to a structural gap in health care policies. SHORT CONCLUSION: Management strategies of oncofertility in the world are still fragile and uneven. To structure the oncofertility sector, a multidisciplinary project allowing teams to collaborate is of utmost importance particularly in low and middle-income countries.

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AbstractIntroduction: This paper aims to develop a data warehouse (AD-SISCOLO) in order to support the management of the cervical cancer screening program in the municipality of Rio de Janeiro/Brazil. As a part of the management process, the program managers of the municipality perform tedious manual work in order to calculate a series of performance indicators and then take decisions based on them. Methods AD-SISCOLO was implemented using the Pentaho BI Suite Business Intelligence Platform and the MySQL database management system. The indicators to be calculated and visualized in the tool were based on the municipal data of the cytopathology and histopathology tests from January 2012 until December 2014, which was obtained from the Information System of Cervical Cancer (SISCOLO) after a record linkage process. The follow-up indicators were based on a simplified version of the Brazilian guidelines for the cervical cancer screening. Results AD-SISCOLO allows the visualization of a set of test-based and follow-up indicators from different views and dimensions, which enable managers to monitor all the phases of the screening process and to identify the process' failures. Conclusions Compared with the current available environments in Brazil, AD-SISCOLO is unique in its visualization of the follow-up indicators of groups of women, according to their test results and age. Thereby it provides presentation flexibility to suit the program manager's needs.

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Hip fracture in the elderly is considered to be a serious sanitary problem. In our country, these fractures have experimented an exponential growth, becoming an important challenge for healthcare management. This study is aimed to evaluate the 1-year-follow-up results after the pilot implementation of a multidisciplinary clinical pathway for hip fractures in over-65-year-old patients. MATERIAL AND METHODS: We performed an observational retrospective cohort study. All over-65-year-old patients diagnosed with hip fracture were included. The analysed periods were the year 2013 (previous to the implementation of the clinical pathway, 84 patients) and the year 2015 (after the pilot implantation of the clinical pathway, 85 patients). We studied the following variables: rate of patients that underwent surgery during the first 48 hours, preoperative length of stay, total length of stay and one year mortality rate. RESULTS: The rate of surgery during the first 48 hours was 24.3% in 2013 and 64.6% in 2015. The median of the preoperative and total length of stay decreased three days. One year mortality rates of both groups were not found to be statistically different. CONCLUSION: Our study suggests that improvements of the care efficiency may be achieved after the implementation of a clinical pathway for the hip fracture in the elderly. It was not possible to demonstrate a lower one year mortality rate.

Las fracturas de cadera en el anciano representan un grave problema sanitario. En nuestro país se ha producido un incremento exponencial de las mismas, por lo que suponen, desde el punto de vista de la gestión hospitalaria, un reto cada vez mayor. El objetivo del estudio es evaluar los resultados al año de la implementación piloto de un proceso clínico multidisciplinar para la atención de los pacientes mayores de 65 años con diagnóstico de fractura de cadera. Material y métodos: Estudio observacional de cohortes, retrospectivo. Se incluyeron los pacientes con edad igual o mayor de 65 años con diagnóstico de fractura de cadera. Los períodos analizados fueron el año natural 2013 (anterior a la intervención, 84 pacientes) y el año natural 2015 (en el que se desarrolla la implementación piloto, 85 pacientes). Las variables analizadas fueron la tasa de pacientes intervenidos en las primeras 48 horas, la estancia preoperatoria, la estancia total y la tasa de mortalidad al año. Resultados: La tasa de intervención en las primeras 48 horas en 2013 fue de 24.3% y en 2015 de 64.6%. Las medianas de las estancias preoperatoria y total se redujeron en tres días. No se encontraron diferencias en la tasas de mortalidad al año entre ambos grupos. Conclusión: Nuestro estudio sugiere que tras implementar un proceso clínico multidisciplinar para la atención de la fractura de cadera se pueden observar mejoras en la eficiencia asistencial. No se ha podido demostrar una menor tasa de mortalidad al año.

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ABSTRACT Objective: To analyze the discourses of professionals that work on the reference service about the critical points that affects the essential attributes of the Primary Health Care (PHC) related to the control of tuberculosis in the city of João Pessoa. Method: The empirical material collected from August to October in 2014, through the interview technique was analyzed through the methodological-theoretical framework of French Discourse Analysis. Results: The discourses demonstrated the critical points on the control of the disease on PHC as being the lack of bond and welcoming from the professionals in relation to patients with tuberculosis. It was realized that the professionals have prejudice about the disease, that they have difficulties on the access to conducting exams, appointments and treatments, as well as there are fails on the reference and counter-referencing system. Final Considerations: Managers should be aware about the results that were found, so that facing actions can be planned and executed in order to minimize the existent of critical points.

RESUMEN Objetivo: Analizar los discursos de profesionales actuantes en el servicio de referencia sobre los puntos de estrangulamiento que afectan los atributos esenciales de la atención primaria de la salud (APS) relacionados con el control de la tuberculosis en el municipio de João Pessoa. Método: El material empírico se recolectó entre los meses de agosto y octubre de 2014 mediante técnica de entrevista y se analizó bajo el dispositivo teórico-analítico de Análisis del Discurso, en la línea francesa. Resultados: Los discursos categorizaron los puntos de estrangulamiento en el control de la enfermedad en la APS, en ausencia de vínculo y de acogida de los profesionales con relación al enfermo de tuberculosis. Se evidenciaron prejuicios de parte de los profesionales, dificultad de acceso a la realización de exámenes, consultas y tratamientos así como fallas en el sistema de referencia y contrarreferencia. Consideraciones finales: Es conveniente que los gestores tomen conciencia de los resultados encontrados, para poder planificar y ejecutar acciones con el fin de minimizar los puntos de estrangulamiento existentes.

RESUMO Objetivo: Analisar os discursos de profissionais atuantes no serviço de referência sobre pontos de estrangulamento que afetam os atributos essenciais da atenção primária à saúde (APS) relacionados ao controle da tuberculose no município de João Pessoa. Método: O material empírico coletado nos meses de agosto a outubro de 2014 mediante técnica de entrevista foi analisado por meio do dispositivo teórico-analítico de Análise de Discurso, na linha francesa. Resultados: Os discursos explicitaram os pontos de estrangulamento no controle da doença na APS como sendo a ausência de vínculo e de acolhimento dos profissionais em relação ao doente de tuberculose. Percebeu-se preconceito por parte dos profissionais, dificuldades de acesso à realização de exames, consultas e tratamento bem como falhas no sistema de referência e contrarreferência. Considerações finais: Convém tornar os gestores cientes dos resultados encontrados, para que ações de enfrentamento sejam planejadas e executadas a fim de minimizar os pontos de estrangulamento existentes.

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Este artigo discute os limites e as potencialidades da gestão do trabalho na Estratégia Saúde da Família, a partir do discurso dos gestores formais, ocupantes de cargos de autodireção na gestão municipal da saúde. Trata-se de um estudo do tipo descritivo, exploratório, com abordagem qualitativa. Foram entrevistados 72 gestores, por meio de entrevista semiestruturada com base em um roteiro guia, em 36 municípios. A análise dos dados foi fundamentada no método de análise do discurso. Os resultados apontam limites à constituição da gestão do trabalho nos municípios, com destaque para a interferência política, baixa provisão de profissionais médicos, inoperância das redes de atenção à saúde e o controle financeiro e orçamentário no bojo da macropolítica. Dentre as potencialidades, são citados o vínculo trabalhador-usuário, a gestão compartilhada, o controle de metas e resultados e o Programa Mais Médicos. Nesse sentido, o maior desafio na ativação da potência para a ação do trabalhador consiste na inovação por meio de novos modos de produzir a gestão do trabalho, com base na cogestão com espaços dialógicos de tomada de decisão que tenham a potência de disparar novas formas de vida no gestor e no trabalhador, através da democratização da tomada de decisão.(AU)

This article discusses the limits and potentialities in the management of labor in the Family Healthcare Strategy, starting on the discourse for the formal managers, officers in self-direction positions at the Municipal Healthcare Management. This is a descriptive, exploratory study with a qualitative approach. Seventy two managers, in 36 Municipalities, were interviewed using a semi-structured survey based on a guiding script. The data analysis was founded on the Discourse Analysis Method. The results pointed to the limits of the constitution of labor management in the municipalities, highlighting political interference, low provision of medical professionals, healthcare attention grids that are inoperative, and the financial and budgetary control in the center of macropolitics. Out of the potentialities mentioned, the bond between worker and client, the shared-management, the control of goals and results, and the More Physicians (Mais Médicos) Program were cited. In this sense, the greatest challenge in the activation of power to the worker's action is innovation through new ways of producing the management of the work, based on co-management with dialogical spaces of decision-making that have the power to trigger new forms of life in the manager and the employee, through the democratization of decision-making.(AU)

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Purpose - Without use the expected benefits from healthcare management systems (HMS) cannot be derived. Thus, while use alone may not guarantee success, one can safely assume that the more use the better. HMS has been instrumental in facilitating care providers' work. However, many hospitals have encountered usage problems and some user-related factors have been recognized in the literature as potentially important to make HMS more successful. The purpose of this paper is to test the importance of the factors proposed in the literature as important determinants of HMS usage measured by the number of hours used and the frequency of use. Design/methodology/approach - Several user-related variables such as user participation, user expertise, and user training previously studied separately by different authors are brought together into an integrated model to be tested empirically. Data from 213 nurses using their hospital HMS have been used to test proposed relationships between the independent variables and HMS usage results. Findings - The results confirm the importance of these factors and provide the basis for managerial recommendations. Hospital managers can use the resources validated by this study to improve their own operations and improve the likelihood of success implementing HMS. Future research projects may identify other possible factors important for HMS implementation success to improve the model proposed here. Originality/value - HMS is a very widely used and an important system for hospitals, but has been neglected in research. This is one of the first rigorous studies of HMS, and the results provide new practical insights for hospital administrators.

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RESUMO Objetivo: analisar a percepção dos enfermeiros gestores da atenção primária à saúde sobre o processo de enfermagem. Método: estudo qualitativo em que os dados foram coletados por meio de entrevistas e analisados a partir da Análise de Conteúdo proposta por Bardin. Resultados: os gestores reconhecem a importância do processo de enfermagem, embora sua implementação não seja prioridade no momento. Existe dificuldade conceitual e não compreensão de que a implementação da metodologia de assistência deva perpassar pela gestão municipal. Conclusão: necessita-se de ampliação da visão dos gestores quanto à importância do processo de enfermagem e qualificação dos profissionais. Acredita-se na participação ativa dos órgãos legisladores de enfermagem, gestão local de saúde e governo federal para que a implementação do processo de enfermagem seja viabilizada. .

RESUMEN Objetivo: analizar las percepciones de los gerentes de enfermería de atención primaria de salud en el proceso de enfermería. Métodos: estudio cualitativo; los datos fueron recolectados a través de entrevistas y analizados desde el Análisis de Contenido propuesta por Bardin referencial teórico. Resultados: los gerentes reconocen la importancia del proceso de enfermería, aunque su aplicación no es la prioridad en este momento. No hay ninguna dificultad conceptual y la comprensión de que la ejecución de la ayuda metodología debe impregnar la gestión municipal. Conclusión: es necesario ampliar la visión de los administradores en cuanto a la importancia del proceso y la calificación de enfermería. Cree en la participación activa de los órganos legislativos de enfermería, administración de salud local y el gobierno federal para la aplicación del proceso de enfermería es factible. .

ABSTRACT Objective: this qualitative study aimed to analyze the perceptions of primary health care management nurses on the nursing process. Method: data were collected through interviews and analyzed by the Content Analysis proposed by Bardin’s theoretical framework. Results: managers recognize the importance of the nursing process, although its implementation was not a priority at the time of the interviews. A conceptual diffi culty and a lack of understanding that the implementation of the care methodology should be a cross-departmental action in the local healthcare management were clearly observed. Conclusion: managers should have their perspectives broadened concerning the relevance of the nursing process and the professional training. The active participation of legislative nursing bodies, local healthcare management and the federal government may open the way for the effective implementation of the nursing process. .

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Este estudo objetivou compreender a formulação do apoio institucional pelo Ministério da Saúde (MS) e como essa estratégia do método da roda vem sendo incorporada ao discurso oficial da gestão federal do SUS. O estudo se situa na categoria de pesquisa qualitativa. Analisamos documentos oficiais, diretrizes nacionais, cadernos de formação e políticas do MS. Identificamos dilemas, dificuldades e limites que os gestores do SUS vivenciam, cotidianamente, ao buscarem estratégias de mudança da lógica tradicional de governo (racionalidade gerencial hegemônica), seja na gestão democrática e participativa, ou na relação entre entes federados. A partir dos documentos analisados, pode-se supor um desejo de mudança por parte desses gestores, visto a consistência teórico-política adequada a isso. Entretanto, apresentam contradições, mostrando dificuldade de integração entre as áreas do MS e deste com os gestores descentralizados (estados e municípios)...

This study aimed to understand how institutional support was formulated by the Ministry of Health and how this strategy of a round-table method has been incorporated into the official discourse of the federal management of SUS. This study is categorized as qualitative research. We analyzed official documents, national guidelines, training booklets and policies of the Ministry of Health. We identified dilemmas, difficulties and limits that SUS managers experience daily while seeking strategies to change the traditional logic of government (hegemonic managerial rationality), either through democratic and participative management or in the relationship between federal entities. From the documents analyzed, it may be supposed that these managers have a desire for change, given that the political-theoretical consistency is appropriate for this. However, the documents present contradictions and show the difficulty of integration between areas of the Ministry of Health and between this ministry and the decentralized managers (states and municipalities)...

El objetivo de este estudio fue comprender la formulación de apoyo institucional por parte del Ministerio de Salud (MS) y de como esa estrategia del método de la rueda se ha incorporado en el discurso oficial de la gestión federal del SUS. El estudio se sitúa en la categoría de investigación cualitativa. Analizamos los documentos oficiales, las directrices nacionales, los cuadernos de formación y políticas del MS. Identificamos dilemas, dificultades y límites vividos cotidianamente por los gestores del SUS, al buscar estrategias de cambio de la lógica tradicional de gobierno (racionalidad gerencial hegemónica), tanto en la gestión democrática y participativa como en la relación entre los entes de la federación. A partir de los documentos analizados es posible suponer un deseo de cambio por parte de esos gestores, considerando la consistencia teórico-política adecuada a ello. No obstante, presentan contradicciones, mostrando la dificultad de integración entre las áreas del MS y de él con los gestores descentralizados (estados y municipios)...

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Este relato é um registro cartográfico do apoio institucional junto a uma Secretaria Estadual de Saúde na articulação da rede regional de Saúde Mental. O apoio institucional é uma estratégia da Política Nacional de Humanização nas redes de atenção à saúde e dispositivo de fomento de espaços de cogestão. O relato está pautado em três eixos: a produção de coletivos e os afetamentos dos encontros entre gestores e trabalhadores; a ação articuladora do apoio institucional, as ofertas na análise e a implicação colegiada; e os desejos e a construção coletiva dos objetos de investimento. Com a vivência da função apoio como caminho da articulação e extraindo os sentidos desse fazer pelos desejos que mobilizam o agir, elaborou-se um olhar crítico para as fortalezas e fragilidades dos sujeitos institucionais e dos seus papéis na produção colegiada do cuidado em saúde mental...

This report is a cartographic record of institutional support at a state health department, in organizing a regional mental health network. Institutional support is a strategy of the National Humanization Policy in healthcare networks and a device for fostering comanagement spaces. This report is guided by three strands: collective production and affection in meetings between managers and workers; action linking institutional support, offers under analysis and collegiate implications; and desires for and collective construction of investment objects. With the experience of the support function as a pathway for linking and extracting the meanings of this action through the desires that mobilize it, we take a critical look at the strengths and weaknesses of institutional subjects and their roles in the collegiate production of mental health care...

Este relato es un registro cartográfico del apoyo institucional en una Secretaría Estadual de Salud para la articulación de la red regional de Salud Mental. El apoyo institucional es una estrategia de la Política Nacional de Humanización en las redes de atención a la salud y un dispositivo de fomento de espacios de gestión conjunta. El relato sigue tres ejes: la producción de colectivos y las consecuencias de las reuniones entre gestores y trabajadores; la acción articuladora del apoyo institucional, las ofertas en el análisis y la implicación colegiada; y los deseos y la construcción colectiva de los objetos de inversión. Con la experiencia de la función de apoyo como camino de articulación y extrayendo los sentidos de ese quehacer por los deseos que movilizan la actuación, se elaboró una mirada crítica hacia los puntos fuertes y débiles de los sujetos institucionales y de los papeles que desempeñan en la producción colegiada del cuidado de la salud mental...

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O presente trabalho objetivou refletir sobre a experiência do apoio institucional no Distrito de Saúde da Secretaria Executiva Regional VI de Fortaleza-CE, Brasil, a partir da instituição de nova forma de gestão para transformar a atuação fragmentada das equipes de assessoria e da Estratégia de Saúde da Família. O processo de implantação do apoio institucional ocorreu por meio da qualificação da equipe apoiadora, do planejamento, da leitura da realidade, da reorganização do processo de trabalho das equipes da Estratégia de Saúde da Família e do monitoramento e avaliação. A ampliação do acesso aos serviços, instituição de colegiados gestores e melhoria do trabalho em equipe foram alguns resultados alcançados. Reconhecemos os inúmeros desafios a enfrentar, como a participação do controle social. Ademais, o apoio institucional favorece a transformação consciente do contexto da atuação em saúde...

The objective of this paper was to reflect on the experience of institutional support in the healthcare district of the Sixth Regional Executive Department of Fortaleza, Ceará, Brazil, starting from the establishment of a new management method that aimed to transform the fragmented actions of the advisory teams and the Family Healthcare Strategy. The process of implementing institutional support took place through qualification of the supporting team, planning, reading of the realities, reorganization of the work process of the Family Healthcare Strategy teams and monitoring and evaluation. Expansion of access to services, institution of a management board and improvement of teamwork were some of the results achieved. We recognize the countless challenges to be faced, such as participation of social control. Furthermore, institutional support favors conscious transformation of the context of healthcare actions...

El objetivo de este trabajo es reflexionar sobre la experiencia del apoyo institucional en el Distrito de Salud de Salud de la Secretaría Ejecutiva Regional VI de Fortaleza-Estado de Ceará, Brasil, a partir de la institución de una nueva forma de gestión para trasformar la actuación fragmentada de los equipos de asesoría y de Estrategia de Salud de la Familia. El proceso de implementación del apoyo institucional se realizó por medio de la calificación del equipo de apoyo, del planeamiento, de la lectura de la realidad, de la reorganización del proceso de trabajo de los equipos de Estrategia de Salud de la Familia y del monitoreo y evaluación. La ampliación del acceso a los servicios, la creación de grupos colegiados gestores y la mejora del trabajo en equipo fueron algunos resultados alcanzados. Reconocemos los innumerables desafíos que hay que enfrentar, tales como la participación del control social. Además, el apoyo institucional favorece la trasformación consciente del contexto de la actuación en salud...

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O objetivo deste estudo foi analisar as mudanças nos modos de gestão geradas pelo processo de intervenção dos apoiadores institucionais formados no Curso de Apoiadores Institucionais para a Humanização da Atenção e Gestão do Sistema Único de Saúde (SUS) em 2009, em Santa Catarina, Brasil. Trata-se de uma pesquisa do tipo qualitativa, com design exploratório-descritivo. Os sujeitos de pesquisa foram sete apoiadores institucionais que trabalharam a diretriz “cogestão” em seus planos de intervenção. A coleta de dados se deu por meio de pesquisa documental e entrevistas, sendo analisados por meio do método hermenêutico dialético. Eles foram categorizados e reagrupados em categorias temáticas: “Motivações para trabalhar cogestão”, “Experimentando a cogestão” e “Efeitos da intervenção”. Os resultados indicam que os movimentos disparados pelas intervenções dos apoiadores nos serviços com relação à cogestão foram importantes para promover mudanças em processos anteriormente cristalizados, entretanto inúmeros desafios ainda permanecem...

The aim of this study was to analyze the changes in management methods generated through the intervention process by institutional supporters who underwent training through the institutional supporters’ course for Humanization of Brazilian Health System (SUS) Care and Management, in Santa Catarina, Brazil, in 2009. This was a qualitative study with a descriptive and exploratory design. The research subjects comprised seven institutional supporters who worked on the “comanagement” guideline in their intervention plans. The data-gathering consisted of document research and interviews. The data analysis used the hermeneutic dialectic method, with classification and grouping into thematic categories: “Motivation for comanagement work”, “Experimenting with comanagement” and “Effects of Intervention.” The results showed that the movements triggered by interventions from supporters in services, with regard to comanagement, were important for promoting changes in processes that previously had been set in stone, although many challenges still remain...

El objetivo del estudio fue analizar los cambios en el modo de gestión generados por el proceso de intervención de los apoyadores institucionales formados en el Curso de Apoyadores Institucionales para la Humanización de la Atención y Gestión del del Sistema Brasileño de Salud (SUS), realizado en 2009 en Santa Catarina, Brasil. Se trata de un estudio cualitativo con diseño exploratorio descriptivo. Los sujetos de la investigación fueron 7 apoyadores institucionales que trabajaron la directriz “cogestión” en sus planes de intervención. La recolección de datos fue por medio de investigación documental y entrevistas y los datos se analizaron utilizando el método dialéctico hermenéutico. Los referidos datos fueron clasificados y agrupados en categorías temáticas: “Motivaciones para trabajar la cogestión”, “Cómo experimentar la cogestión” y “Efectos de la intervención.” Los resultados mostraron que los movimientos causados por las intervenciones de los apoyadores en los servicios en lo que se refiere a la cogestión fueron importantes para promover cambios en procesos anteriormente cristalizados, aunque todavía son muchos los desafíos...

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