Uso de indicadores de saúde na gestão de hospitais públicos da região metropolitana de São Paulo

O objetivo geral do presente estudo é conhecer os indicadores disponíveis bem como a utilização dos mesmos nas atividades de planejamento e gerenciamento dos hospitais públicos estaduais da Região Metropolitana da Grande São Paulo RMGSP. A partir de revisão bibliográfica e consulta a documentos técnicos sobre experiências no uso de indicadores para a gestão hospitalar, foram identificados os indicadores mais adequados às atividades da administração superior de Hospitais. Por meio de levantamento dos dados existentes na Secretaria de Estado da Saúde de São Paulo e de entrevistas semi-estruturadas com os gestores dos hospitais e com profissionais que atuam na área de informações, foram identificados os indicadores hospitalares disponíveis, e analisado o uso dos mesmos para a tomada de decisão, em nível gerencial. Os resultados do estudo demonstraram que os hospitais públicos estaduais produzem um considerável volume de informações, embora com lacunas importantes, e que muitos gestores desconhecem a existência de tais informações ou não as utilizem adequadamente para a formulação das diretrizes e a gestão dos hospitais.

Transparência, a resposta institucional à pressão social: o caso do Tribunal de Contas do Estado do Rio de Janeiro

The present work aims to identify emerging organizational changes in the Court of Accounts of the State of Rio de Janeiro - TCE/RJ that are happening in the contemporary scenery known as the Age of Information. The search for the comprehension of the institutional dynamics is oriented by concepts originated from the theory of complexity, which believe that the public services external control system can be understood in a political, technical and legal environment with growing levels of learning and innovation. While chasing the possible causes of these changes, we try to prove the hypothesis that the TCE/RJ is turning into a more transparent organization. For this purpose, we define the outlines and reaches of the principle of transparency, based in bibliographical and documental researches, and analyze the phenomenon perceived in a explanation research through semi-structured interviews performed with two groups: a sample representing the universe under jurisdiction entities top level directors and the other obtained in the universe of formal and informal leaderships existing in the educational body of the institution. The conclusion of the present work confirms the initial questions, indicating that the organization is really becoming more and more transparent. The social-technical changes that are happening today at the TCE/RJ are caused by the growing social pressure for more effective results in the control of public expenditures. Under the systemic point of view, we observe cracks in the protective bell-glass that evolves the institution - previously hermetic to the external contingencies and that works today as a SAC - Adaptive Complex System. Aspects such as organization structural changes, the introduction of strategic planning and the growing democratization of the decision process are producing a new organizational culture. The seniority of the Technical Headcount contributes to establish the pre-conditions for the development of a administration where the participation of the TCE/RJ technical employees adds importance to its development as an institution that generates republican effects in the society from its less hermetic decision process.

A Evolução e Consolidação das Práticas de Governança Corporativa no Banco do Brasil S.A. entre 1996 e 2006

The purpose of this dissertation is to identify the main historical and institutional facts that have led to the present corporate governance policy adopted by Banco do Brasil S.A. (BB). The good practices of corporate governance aim to increase corporate value and facilitate the funding of capital and contribute to company¿s duration over the time. Besides, ensure to the shareholders some governance principles such as disclosure", "compliance", "accountability", "fairness" and ¿corporate responsability¿ By the time BB has been shown its concern about disclosure especially for its close relationship with principal shareholder. ¿ the Brazilian Government, other equity partners and the Brazilian society. Banco do Brasil was founded in 1808 by the Portuguese emperor Dom João VI and today is the oldest bank operating in the local market. BB also was the first company listed on Brazilian stock exchange since 1906. In 1996, after some net losses, the Brazilian Government raised the bank¿s authorized capital in R$ 8 billion. This fact established the first attempts to develop bank¿s corporate governance through the years. Banco do Brasil currently has more than 24.4 million customers, served by a network of 15,113 points of service with R$ 296.4 billion in total assets2. The purpose of this work is to demonstrate the principal measures adopted by Banco do Brasil to reach the top level of corporate governance in the Brazilian stock exchange ¿ the New Market of Bovespa. This top position was reached in June 2006. Banco do Brasil was the first state owned company to reach this level of governance in Brazil. This dissertation was based on Yin's taxonomy methodology as a single case study. This research has used documents and file records as sources of evidence, including longitudinally research to demonstrate the evolution facts through time."

O impacto das práticas ITIL na flexibilidade organizacional - evidências empíricas em uma empresa multinacional de TI

The present work has as main objective the identification and impact analysis for the practice ITIL in the organizational flexibility of a multinational IT company, being this study of quali-quantitative and exploratory nature. To achieve this objective, some theoretical studies on bureaucracy, organization flexibility, control, IT governance and ITIL were done, as a form to better understand the research problem. For analysis effect a set of eleven ITIL process was considered in this research ¿ service desk, incident management, problem management, change management, configuration management, release management, service level management, availability management, capacity management, continuity management and finally IT financial services management ¿ grouped in its two core areas ¿ service support and service delivery. Then a scale was constructed and validated, on the basis of theoretical models developed by Volberda (1997), Tenório (2002) and Golden and Powell (1999), to measure the flexibility related to each process comprising the ITIL core. The dimensions adopted to measure flexibility were: organization design task, managerial task, IT impact on work force, HR management, efficiency impact, sensitivity, versatility and robustness. The instrument used in research was a semi-structured interview, which was divided in two parts. The data collection was performed with ten interviewed people from an IT multinational company, based on convenience, some were managers and there were users, some were ITIL certified and others not. The statistic tests of t student and Wilcoxon non-parametric were adopted. The result of the research indicated that the ITIL service support area, for possessing greater operational focus, presents flexibility trend. The opposite was found for the service delivery area, which has greater tactical focus. The results also suggest that the change management discipline was the one that contributed for the most flexibility inside the company, followed by incident management discipline and the service desk function.

Capitalismo de estado e inovação: facetas da relação entre estado e iniciativa privada no desenvolvimento nacional

While countries managed to rapidly rise and recover economically, Brazilian social indicators have advanced at short pace in the last decades. Although millions of Brazilians have recently left poverty, Brazil still has a long way to go regarding its socioeconomic development. Circa one fifth of the population is still considered functionally illiterate, basic education has one of the poorest performances in the world, the country has no top-level universities nor produces technology or patents at relevant levels. This paper, at first, analyses how the interaction between government and private agents influenced Brazil’s industrial and economic development, identifying the existence of bonds based on the exchange of private interests that at great extension kept public policies from reaching goals of national interest – the so called crony capitalism. Secondly, the paper verifies how development policies based on the promotion of innovative companies and segments of the industry may positively impact broad socioeconomic development. The paper delves specifically into the cooperation between universities and industry as a development tool. Enterprises and universities, guided by their endogenous interests, may be combined for the structuring of a national innovation system. While universities are fundamentally interested in promoting knowledge accumulation, enterprises are willing to invest financial capital in universities in exchange for the economic exploitation of products developed within the academic environment and direct access to its human capital. Lastly, the paper identifies the legal and cultural barriers and advances of this mechanism in Brazil. It verifies that, notwithstanding the institutional advance promoted by the Law of Innovation to the university-enterprise cooperation in Brazil, the law wasn’t entirely capable of eliminating the legal uncertainty of this relationship and capturing in an efficient way the interests of the agents involved. Recently, federal law n. 12.863/2013 officially offered universities the option of bypassing problems related to public law by regulating support foundations, which conceives greater certainty and simplicity to the cooperation. There are, however, remaining uncertainties regarding the norms to be edited by the executive power, as well as conflicts of interest linked to the property rights over patents resulting from this kind of cooperation. The paper verifies, moreover, the existence of ideological resistance to this tool within universities, in such a way that it is unlikely that those relationships develop in a systematic way throughout the country without further engagement from the government and its executive and legislative bodies.

Board of directors and top management team: a study on CEO relative power and financial return

Best corporate governance practices published in the primers of Brazilian Securities and Exchange Commission and the Brazilian Corporate Governance Institute promote board independence as much as possible, as a way to increase the effectiveness of governance mechanism (Sanzovo, 2010). Therefore, this paper aims at understanding if what the managerial literature portraits as being self-evident - stricter governance, better performance - can be observed in actual evidence. The question answered is: do companies with a stricter control and monitoring system perform better than others? The method applied in this paper consists on comparing 116 companies in respect to the their independence level between top management team and board directors– being that measured by four parameters, namely, the percentage of independent outsiders in the board, the separation of CEO and chairman, the adoption of contingent compensation and the percentage of institutional investors in the ownership structure – and their financial return measured in terms return on assets (ROA) from the latest Quarterly Earnings release of 2012. From the 534 companies listed in the Stock Exchange of Sao Paulo – Bovespa – 116 were selected due to their level of corporate governance. The title “Novo Mercado” refers to the superior level of governance level within companies listed in Bovespa, as they have to follow specific criteria to assure shareholders ´protection (BM&F, 2011). Regression analyses were conducted in order to reveal the correlation level between two selected variables. The results from the regression analysis were the following: the correlation between each parameter and ROA was 10.26%; the second regression analysis conducted measured the correlation between the independence level of top management team vis-à-vis board directors – namely, CEO relative power - and ROA, leading to a multiple R of 5.45%. Understanding that the scale is a simplification of the reality, the second part of the analysis transforms all the four parameters into dummy variables, excluding what could be called as an arbitrary scale. The ultimate result from this paper led to a multiple R of 28.44%, which implies that the combination of the variables are still not enough to translate the complex reality of organizations. Nonetheless, an important finding can be taken from this paper: two variables (percentage of outside directors and percentage of institutional investor ownership) are significant in the regression, with p-value lower than 10% and with negative coefficients. In other words, counter affirming what the literature very often portraits as being self-evident – stricter governance leads to higher performance – this paper has provided evidences to believe that the increase in the formal governance structure trough outside directors in the board and ownership by institutional investor might actually lead to worse performance. The section limitations and suggestions for future researches presents some reasons explaining why, although supported by strong theoretical background, this paper faced some challenging methodological assumptions, precluding categorical statements about the level of governance – measured by four selected parameters – and the financial return in terms of financial on assets.

Cooperação e multi-level governance: o caso do Grande Recife Consórcio de Transporte Metropolitano

As primeiras regiões metropolitanas brasileiras foram instituídas de maneira vertical e autoritária como parte da estratégia de desenvolvimento nacional promovida pelo governo militar. Percebidas como instituições não-democráticas e rejeitadas como possível quarto ente federativo, as regiões metropolitanas, desde a Constituição de 1988, foram gradualmente esvaziadas dos seus propósitos originais. Em sua orfandade, os problemas socioeconômicos proliferaram e foram acentuados, e passaram a predominar relações intergovernamentais competitivas em vez de cooperativas. Um dos principais desafios enfrentados pelo modelo federalista brasileiro, em especial quando se trata destas regiões, está relacionado à necessidade de estabelecer maior cooperação e coordenação, tidas como imprescindíveis para garantir um relacionamento mais equilibrado entre os entes federativos, assim como para a efetiva implementação de políticas de enfrentamento das desigualdades e exclusão social nas aglomerações urbanas. Este trabalho analisa o Grande Recife Consórcio Metropolitano de Transportes (CMT), empresa pública multifederativa estabelecida em 2008 entre os governos municipais e estadual da Região Metropolitana de Recife (RMR). Responsável pelo planejamento, gestão e implementação compartilhada da política de transporte público coletivo na RMR, o Grande Recife se tornou realidade com a aprovação e regulamentação da Lei Federal nº 11.107 de 2005, conhecida como a Lei de Consórcios Públicos. O Grande Recife é uma experiência pioneira e inovadora, demonstrando que é possível encontrar uma maneira de superar conflitos e desafios comuns e, ao mesmo tempo, garantir a preservação da autonomia de cada ente, bem como os direitos cidadãos. Neste trabalho consideramos essa experiência de cooperação intergovernamental como um exemplo de multi-level governance (MLG), uma vez que é ilustrativa de um novo arranjo institucional democrático entre distintas esferas governamentais para a gestão compartilhada de um serviço público.

The certification role of venture capitalists, top underwriters and big-n auditors in ipos

Esta tese avalia o impacto dos principais atores recorrentes durante o processo de IPO, em particular, o venture capitalist, o underwriter, e o auditor, sobre as condições de comercialização das ações da empresa, capturado pelo bid-ask spread, a fração de investidores institucionais que investem na empresa, a dispersão de capital, entre outros. Além disso, este estudo também analisa alguns benefícios que os fundos de Venture Capital (VCs) fornecem às empresas que eles investem. Ele investiga o papel dos VCs em dificultar o gerenciamento de resultados em IPOs e quantifica o papel desempenhado por eles no desempenho operacional das empresas após sua oferta inicial de ações. No primeiro capítulo, os resultados indicam que as empresas inflam seus resultados principalmente nos períodos pré-IPO e do IPO. Quando nós controlamos para os quatro períodos diferentes do IPO, observamos que IPOs de empresas investidas por VCs apresentam significativamente menos gerenciamento de resultados no IPO e em períodos seguintes à orfeta inicial das ações, exatamente quando as empresas tendem a inflar mais seus lucros. Este resultado é robusto a diferentes métodos estatísticos e diferentes metodologias usadas para avaliar o gerenciamento de resultados. Além disso, ao dividir a amostra entre IPOs de empresas investidas e não investidas por VCs, observa-se que ambos os grupos apresentam gerenciamento de resultados. Ambas as subamostras apresentam níveis de gerenciamento de resultados de forma mais intensa em diferentes fases ao redor do IPO. Finalmente, observamos também que top underwriters apresentam menores níveis de gerenciamento de resultados na subamostra das empresas investidas por VCs. No segundo capítulo, verificou-se que a escolha do auditor, dos VCs, e underwriter pode indicar escolhas de longo prazo da empresa. Nós apresentamos evidências que as características do underwriter, auditor, e VC têm um impacto sobre as características das empresas e seu desempenho no mercado. Além disso, estes efeitos são persistentes por quase uma década. As empresas que têm um top underwriter e um auditor big-N no momento do IPO têm características de mercado que permanecem ao longo dos próximos 8 anos. Essas características são representadas por um número maior de analistas seguindo a empresa, uma grande dispersão da propriedade através de investidores institucionais, e maior liquidez através um bid-ask spread menor. Elas também são menos propensas a saírem do mercado, bem como mais propensas à emissão de uma orferta secundária. Finalmente, empresas investidas por VCs são positivamente afetadas, quando consideramos todas as medidas de liquidez de mercado, desde a abertura de capital até quase uma década depois. Tais efeitos não são devido ao viés de sobrevivência. Estes resultados não dependem da bolha dot-com, ou seja, os nossos resultados são qualitativamente similares, uma vez que excluímos o período da bolha de 1999-2000. No último capítulo foi evidenciado que empresas investidas por VCs incorrem em um nível mais elevado de saldo em tesouraria do que as empresas não investidas. Este efeito é persistente por pelo menos 8 anos após o IPO. Mostramos também que empresas investidas por VCs estão associadas a um nível menor de alavancagem e cobertura de juros ao longo dos primeiros oito anos após o IPO. Finalmente, não temos evidências estatisticamente significantes entre VCs e a razão dividendo lucro. Estes resultados também são robustos a diversos métodos estatísticos e diferentes metodologias.