Gestão da qualidade: avaliação do processo de acreditação do Hospital Divina Providência

A temática desta pesquisa surgiu da análise do projeto de acreditação hospitalar do Hospital Divina Providência (HDP) junto à Organização Nacional de Acreditação - ONA do Governo Federal do Brasil – no município de Marituba da Região Metropolitana de Belém, objetivando mensurar o grau de entendimento dos colaboradores, usuários e gestores sobre o processo de Acreditação desenvolvido na Instituição. A metodologia utilizada para realização da pesquisa caracteriza-se como exploratória descritiva com abordagem quantitativa e quantitativa, de amostra probabilística por acessibilidade, aplicada aos três tipos de elementos acima mencionados, com o intuito de verificar, qual o nível de conhecimentos sobre o assunto abordado, e como eles veem a empresa inserida nesse tema. No decorrer do estudo, foi analisado quão grande tem se tornado a abordagem no Brasil e mundo, e como os hospitais têm adotado as certificações de qualidade como um fator de competitividade no mercado e de reconhecimento. Conclui-se que, a entidade não mantém um sistema de aprimoramento de gestão da qualidade com vistas a uma certificação de acreditação juntos aos colaboradores e gestores, de forma a auxiliá-los no desenvolvimento e amadurecimento do referido processo. Percebe-se também, que não há conformidade e nem integração de ideias a respeito do tema abordado entre gestores e colaboradores do HDP.

O processo de gestão da qualidade com foco em resultado em um hospital privado da cidade de Macapá:estudo de caso

Indubitavelmente a gestão da qualidade tem como proposito tornar a instituição um núcleo, que aprimora permanentemente seus processos, fazendo com que os profissionais busquem incessantemente a aprendizagem, aplicando o conhecimento à luz da acreditação, para que os serviços sejam seguros e confiáveis. Desta forma, o presente estudo tem o objetivo de analisar o processo de certificação de um hospital privado da cidade de Macapá avaliando os resultados, antes e após a acreditação através de relatórios gerenciais e aplicação de questionário. Os indicadores registrados pelo escritório da qualidade mostram as melhorias obtidas nos serviços, tais como: registros seguros e confiáveis, veracidade das informações, elevação na identificação dos riscos assistenciais, satisfação dos usuários, redução considerável do absenteísmo e tour over, aprimoramento da gestão de suprimentos e satisfação do clima organizacional. Os resultados obtidos com a aplicação do questionário aos profissionais de saúde mostram que 89% estão comprometidos em atingir os objetivos estratégicos institucionais, 80% se sentem mais preparados para exercer suas atividades, e 80% afirmam que o hospital é seguro. Tais resultados foram obtidos com a mudança de cultura, conforme a metodologia da Organização Nacional de Acreditação - ONA1, que visa despertar nas instituições de saúde melhoria contínua, correlacionando evidências clínicas e de gestão com suas ações, mitigando seus métodos de trabalho, contribuindo para eficácia da qualidade na assistência.

A universidade e o seu contributo para o desenvolvimento da União Europeia

O trabalho presente é uma investigação sobre a Universidade sua génese e diversidade, caminhada e desenvolvimento, prosperidade em crescimento, papel cultural e fonte de conhecimento seus momentos de glória, seu de impasse e de crise e tentativas para devolver a glória e prestigio de outrora. Nasceu na Europa Meridional com o título de “Studium Generale”. Não nasceu nem “ex abrupto” nem “ex nihilo”, a sua génese remonta às escolas religiosas dos conventos e catedrais onde se conservavam os documentos da cultura greco – latina que mais tarde imperará na Europa sob o antropocentrismo, em oposição ao Teocentrismo. O “Studium General” nasce sobre o patrocínio da Igreja que mantinha como disciplinas principais nestes centros a Teologia e Filosofia, cuja leccionação é circunscrita a poucas Escolas e professores escolhidos. Acorriam à Universidade alunos de todos os cantos da Europa, evidentemente com meios e frades alunos pobres e para os frades criaram-se colégios que os acolhiam e protegiam. A reunião de estudantes devido a disturbios gerou ambiente controverso e obrigou as autoridades governamentais a medidas quer de contenção quer de protecção a residentes e forasteiros. O estudante era um estrangeiro que se deslocava no espaço europeu consoante a fama dos professores. A língua latina foi o veiculo de ligação e comunicação. Pouco a pouco os estados foram-se dando conta do valor da universidade e dos seus ensinamentos e disputavam com a Igreja o seu patrocínio. A Universidade contribui para o desenvolvimento dos Estados a nível administrativo, do direito, da criação de leis dando aos Estados uma maior e melhor organização no seu desenvolvimento. As Universidades concediam graus académicos, sendo o maior o de doutor. Todos esperavam o apoio do saber académico e científico para vencer a luta pela existência. O sistema escolático criticado pelo humanismo deu origem a novos modelos de universidade que surgiram com a supervisão dos Estados. Os modelos a partir do século XIX, são: ingês, alemão, americano, francês e russo. A universidade passa a ser o lugar do ensino superior, com o repúdio ao tradicinal e a investigação passa a fazer parte do papel da universidade. Em Portugal criou-se estruturas de apoio à formação de professores especialmente o sector de ciência e educação. Tardiamente a União Europeia dá atenção à educação criando programas como o Sócrates cujas acções são Comenios, Erasmus, Grundvig, Língua e Minerva. A mobilidade estudantil torna-se realidade na Europa e a flexibilidade na educação. A função da universidade actual ocupa-se do sector industrial e pós industrial da sociedade de informação, economia e empresa. Universidade como serviço público e mercado. Foi pena que a União Europeia, não reconhecesse ao Homem a centralidade de que tem direito, e esquecesse que sem o homem não há desenvolvimento nem criatividade. Estruturou-se a economia e a política obliterou a educação, a cultura, a formação, isto é um castelo construído sobre areia. Relembrando Antero cabe dizer: “Abrem-se as portas de ouro com fragor Mas dentro encontro só cheiro de dor Silêncio e escuridão nada mais”. Hoje a nossa Universidade é um problema. O seu caminho terá de ser o da cultura e a da educação. Tem de ser vista como poder em época de crise e o permanente primeiro que o transitório. Donde a necessidade de uma gestão de qualidade e de uma educação permanente.

Sensitivity analysis of a catchment-scale nitrogen model

There are now considerable expectations that semi-distributed models are useful tools for supporting catchment water quality management. However, insufficient attention has been given to evaluating the uncertainties inherent to this type of model, especially those associated with the spatial disaggregation of the catchment. The Integrated Nitrogen in Catchments model (INCA) is subjected to an extensive regionalised sensitivity analysis in application to the River Kennet, part of the groundwater-dominated upper Thames catchment, UK The main results are: (1) model output was generally insensitive to land-phase parameters, very sensitive to groundwater parameters, including initial conditions, and significantly sensitive to in-river parameters; (2) INCA was able to produce good fits simultaneously to the available flow, nitrate and ammonium in-river data sets; (3) representing parameters as heterogeneous over the catchment (206 calibrated parameters) rather than homogeneous (24 calibrated parameters) produced a significant improvement in fit to nitrate but no significant improvement to flow and caused a deterioration in ammonium performance; (4) the analysis indicated that calibrating the flow-related parameters first, then calibrating the remaining parameters (as opposed to calibrating all parameters together) was not a sensible strategy in this case; (5) even the parameters to which the model output was most sensitive suffered from high uncertainty due to spatial inconsistencies in the estimated optimum values, parameter equifinality and the sampling error associated with the calibration method; (6) soil and groundwater nutrient and flow data are needed to reduce. uncertainty in initial conditions, residence times and nitrogen transformation parameters, and long-term historic data are needed so that key responses to changes in land-use management can be assimilated. The results indicate the general, difficulty of reconciling the questions which catchment nutrient models are expected to answer with typically limited data sets and limited knowledge about suitable model structures. The results demonstrate the importance of analysing semi-distributed model uncertainties prior to model application, and illustrate the value and limitations of using Monte Carlo-based methods for doing so. (c) 2005 Elsevier B.V. All rights reserved.

The transformation of earth-system observations into information of socio-economic value in GEOSS

The Group on Earth Observations System of Systems, GEOSS, is a co-ordinated initiative by many nations to address the needs for earth-system information expressed by the 2002 World Summit on Sustainable Development. We discuss the role of earth-system modelling and data assimilation in transforming earth-system observations into the predictive and status-assessment products required by GEOSS, across many areas of socio-economic interest. First we review recent gains in the predictive skill of operational global earth-system models, on time-scales of days to several seasons. We then discuss recent work to develop from the global predictions a diverse set of end-user applications which can meet GEOSS requirements for information of socio-economic benefit; examples include forecasts of coastal storm surges, floods in large river basins, seasonal crop yield forecasts and seasonal lead-time alerts for malaria epidemics. We note ongoing efforts to extend operational earth-system modelling and assimilation capabilities to atmospheric composition, in support of improved services for air-quality forecasts and for treaty assessment. We next sketch likely GEOSS observational requirements in the coming decades. In concluding, we reflect on the cost of earth observations relative to the modest cost of transforming the observations into information of socio-economic value.

A simple, coherent framework for partitioning uncertainty in climate predictions

A simple and coherent framework for partitioning uncertainty in multi-model climate ensembles is presented. The analysis of variance (ANOVA) is used to decompose a measure of total variation additively into scenario uncertainty, model uncertainty and internal variability. This approach requires fewer assumptions than existing methods and can be easily used to quantify uncertainty related to model-scenario interaction - the contribution to model uncertainty arising from the variation across scenarios of model deviations from the ensemble mean. Uncertainty in global mean surface air temperature is quantified as a function of lead time for a subset of the Coupled Model Intercomparison Project phase 3 ensemble and results largely agree with those published by other authors: scenario uncertainty dominates beyond 2050 and internal variability remains approximately constant over the 21st century. Both elements of model uncertainty, due to scenario-independent and scenario-dependent deviations from the ensemble mean, are found to increase with time. Estimates of model deviations that arise as by-products of the framework reveal significant differences between models that could lead to a deeper understanding of the sources of uncertainty in multi-model ensembles. For example, three models are shown diverging pattern over the 21st century, while another model exhibits an unusually large variation among its scenario-dependent deviations.

Processes governing the predictability of the Atlantic meridional overturning circulation in a coupled GCM

The processes that govern the predictability of decadal variations in the North Atlantic meridional overturning circulation (MOC) are investigated in a long control simulation of the ECHO-G coupled atmosphere–ocean model. We elucidate the roles of local stochastic forcing by the atmosphere, and other potential ocean processes, and use our results to build a predictive regression model. The primary influence on MOC variability is found to come from air–sea heat fluxes over the Eastern Labrador Sea. The maximum correlation between such anomalies and the variations in the MOC occurs at a lead time of 2 years, but we demonstrate that the MOC integrates the heat flux variations over a period of 10 years. The corresponding univariate regression model accounts for 74.5% of the interannual variability in the MOC (after the Ekman component has been removed). Dense anomalies to the south of the Greenland-Scotland ridge are also shown to precede the overturning variations by 4–6 years, and provide a second predictor. With the inclusion of this second predictor the resulting regression model explains 82.8% of the total variance of the MOC. This final bivariate model is also tested during large rapid decadal overturning events. The sign of the rapid change is always well represented by the bivariate model, but the magnitude is usually underestimated, suggesting that other processes are also important for these large rapid decadal changes in the MOC.

Development-led archaeology in north-west Europe

Many countries in northern Europe have seen a huge expansion in development-led archaeology over the past few decades. Legislation, frameworks for heritage management and codes of practice have developed along similar but different lines. The Valetta Convention has had considerable impact on spatial planning and new legislation on archaeological heritage management within EC countries as well as on the funding, nature and distribution of archaeological fieldwork. For the first time these 12 papers bring together data on developer-led archaeology in Britain, Ireland, France, the Low Countries, Germany and Denmark in order to review and evaluate key common issues relating to organisation, practice, legal frameworks and quality management.

Towards global drought early warning capability: expanding international cooperation for the development of a framework for global drought monitoring and forecasting

Drought is a global problem that has far-reaching impacts and especially 47 on vulnerable populations in developing regions. This paper highlights the need for a Global Drought Early Warning System (GDEWS), the elements that constitute its underlying framework (GDEWF) and the recent progress made towards its development. Many countries lack drought monitoring systems, as well as the capacity to respond via appropriate political, institutional and technological frameworks, and these have inhibited the development of integrated drought management plans or early warning systems. The GDEWS will provide a source of drought tools and products via the GDEWF for countries and regions to develop tailored drought early warning systems for their own users. A key goal of a GDEWS is to maximize the lead time for early warning, allowing drought managers and disaster coordinators more time to put mitigation measures in place to reduce the vulnerability to drought. To address this, the GDEWF will take both a top-down approach to provide global real-time drought monitoring and seasonal forecasting, and a bottom-up approach that builds upon existing national and regional systems to provide continental to global coverage. A number of challenges must be overcome, however, before a GDEWS can become a reality, including the lack of in-situ measurement networks and modest seasonal forecast skill in many regions, and the lack of infrastructure to translate data into useable information. A set of international partners, through a series of recent workshops and evolving collaborations, has made progress towards meeting these challenges and developing a global system.

Impression management, myth creation and fabrication in private social and environmental reporting: insights from Erving Goffman

This paper explores the nature of private social and environmental reporting (SER). From interviews with UK institutional investors, we show that both investors and investees employ Goffmanesque, staged impression management as a means of creating and disseminating a dual myth of social and environmental accountability. The interviewees’ utterances unveil private meetings imbued with theatrical verbal and physical impression management. Most of the time, the investors’ shared awareness of reality belongs to a Goffmanesque frame whereby they accept no intentionality, misrepresentation or fabrication, believing instead that the ‘performers’ (investees) are not intending to deceive them. A shared perception that social and environmental considerations are subordinated to financial issues renders private SER an empty encounter characterised as a relationship-building exercise with seldom any impact on investment decision-making. Investors spoke of occasional instances of fabrication but these were insufficient to break the frame of dual myth creation. They only identified a handful of instances where intentional misrepresentation had been significant enough to alter their reality and behaviour. Only in the most extreme cases of fabrication and lying did the staged meeting break frame and become a genuine occasion of accountability, where investors demanded greater transparency, further meetings and at the extreme, divested shares. We conclude that the frontstage, ritualistic impression management in private SER is inconsistent with backstage activities within financial institutions where private financial reporting is prioritised. The investors appeared to be in a double bind whereby they devoted resources to private SER but were simultaneously aware that these efforts may be at best subordinated, at worst ignored, rendering private SER a predominantly cosmetic, theatrical and empty exercise.

Ensemble projections for wine production in the Douro Valley of Portugal

Wine production is largely governed by atmospheric conditions, such as air temperature and precipitation, together with soil management and viticultural/enological practices. Therefore, anthropogenic climate change is likely to have important impacts on the winemaking sector worldwide. An important winemaking region is the Portuguese Douro Valley, which is known by its world-famous Port Wine. The identification of robust relationships between atmospheric factors and wine parameters is of great relevance for the region. A multivariate linear regression analysis of a long wine production series (1932–2010) reveals that high rainfall and cool temperatures during budburst, shoot and inflorescence development (February-March) and warm temperatures during flowering and berry development (May) are generally favourable to high production. The probabilities of occurrence of three production categories (low, normal and high) are also modelled using multinomial logistic regression. Results show that both statistical models are valuable tools for predicting the production in a given year with a lead time of 3–4 months prior to harvest. These statistical models are applied to an ensemble of 16 regional climate model experiments following the SRES A1B scenario to estimate possible future changes. Wine production is projected to increase by about 10 % by the end of the 21st century, while the occurrence of high production years is expected to increase from 25 % to over 60 %. Nevertheless, further model development will be needed to include other aspects that may shape production in the future. In particular, the rising heat stress and/or changes in ripening conditions could limit the projected production increase in future decades.

Impression management, fabrication and myth creation in private social and environmental reporting: insights from Erving Goffman

This paper explores the nature of private social and environmental reporting (SER). From interviews with UK institutional investors, we show that both investors and investees employ Goffmanesque, staged impression management as a means of creating and disseminating a dual myth of social and environmental accountability. The interviewees’ utterances unveil private meetings imbued with theatrical verbal and physical impression management. Most of the time, the investors’ shared awareness of reality belongs to a Goffmanesque frame whereby they accept no intentionality, misrepresentation or fabrication, believing instead that the ‘performers’ (investees) are not intending to deceive them. A shared perception that social and environmental considerations are subordinated to financial issues renders private SER an empty encounter characterised as a relationship-building exercise with seldom any impact on investment decision-making. Investors spoke of occasional instances of fabrication but these were insufficient to break the frame of dual myth creation. They only identified a handful of instances where intentional misrepresentation had been significant enough to alter their reality and behaviour. Only in the most extreme cases of fabrication and lying did the staged meeting break frame and become a genuine occasion of accountability, where investors demanded greater transparency, further meetings and at the extreme, divested shares. We conclude that the frontstage, ritualistic impression management in private SER is inconsistent with backstage activities within financial institutions where private financial reporting is prioritised. The investors appeared to be in a double bind whereby they devoted resources to private SER but were simultaneously aware that these efforts may be at best subordinated, at worst ignored, rendering private SER a predominantly cosmetic, theatrical and empty exercise.

Ensemble forecasting using TIGGE for the July-September 2008 floods in the Upper Huai catchment: a case study.

We present a case study using the TIGGE database for flood warning in the Upper Huai catchment (ca. 30 672 km2). TIGGE ensemble forecasts from 6 meteorological centres with 10-day lead time were extracted and disaggregated to drive the Xinanjiang model to forecast discharges for flood events in July-September 2008. The results demonstrated satisfactory flood forecasting skills with clear signals of floods up to 10 days in advance. The forecasts occasionally show discrepancies both in time and space. Forecasting quality could potentially be improved by using temporal and spatial corrections of the forecasted precipitation.