Existe trade-off entre eficiência e qualidade nas organizações hospitalares?

A mudança do perfil demográfico e epidemiológico das populações, com progressivo envelhecimento populacional e aumento de portadores de doenças crônicas não transmissíveis, somado a necessidade da ampliação da oferta de serviços de saúde e crescentes custos em saúde, impõe enormes desafios aos sistemas e serviços de saúde. A eficiência organizacional dos serviços de saúde tem papel importante tanto na racionalização dos custos quanto na melhoria da qualidade e segurança assistencial. Tendo papel central nos sistemas de saúde como centros difusores de conhecimento, capacitação profissional, incorporação de tecnologias, prestação de serviços de maior complexidade aos pacientes e, consequentemente, elevados custos destes serviços, aos hospitais é fundamental a busca por essa eficiência. Este estudo buscou analisar se existe trade-off entre eficiência e qualidade em organizações hospitalares e identificar quais determinantes poderiam estar associados com maiores ou menores escores de eficiência. Utilizou-se dois modelos de análise de envelopamento de dados (data envelopment analysis, DEA), sem e com variáveis de qualidade, com retornos variáveis de escala e orientados para resultado. Foram estudados 47 hospitais gerais públicos do estado de São Paulo. No modelo sem variáveis de qualidade 14 deles foram considerados eficientes, enquanto que 33 no modelo com estas variáveis. O coeficiente de correlação de Spearman entre os dois modelos foi de 0,470 (correlação moderada). Não há evidências de que haja trade-off entre eficiência e qualidade nestas organizações hospitalares. Hospitais eficientes no modelo sem variáveis de qualidade, também o foram com variáveis de qualidade, assim como houve hospitais ineficientes no modelo sem variáveis de qualidade que foram eficientes com estas variáveis. Não foram encontradas associações estatisticamente significantes (p<0,05) entre eficiência e as características dos hospitais estudados, como acreditação, modelos de gestão, porte hospitalar e atividades de ensino, apesar de alguns achados de maior ou menor escore de eficiência para alguns determinantes. Desta maneira, concluiu-se que a utilização de variáveis de qualidade é um fator fundamental na determinação da eficiência de organizações de saúde, e não podem estar dissociadas. Gestões eficientes também estão relacionadas à obtenção de melhores resultados assistenciais sem a necessidade que se tenha de optar em alcançar melhores resultados econômico-financeiros ou melhores resultados assistenciais.

Trilogia da qualidade

Unidade 1

Gráficos de controle para atributos

Unidade 5

Gráficos de controle para variáveis

Unidade 6

A ouvidoria pública como instrumento de controle das ações da Secretaria de Saúde do Pará

The State and Public Administration have gone through several reforms in search of a quick operation and the provision of services with quality. With the democratization of the country and the issue of the Constitution in 1988, further reform of the State and Public Administration, joined the government agenda in 1995 and included among its objectives, the principles of participation and social control. In view of this, it raises the Public Ombudsman in order to be a channel for the participation of users in the management of public affairs, social control, transparency of administrative actions, improving the quality of service and meeting the needs of the community. The aim of this study is to assess whether the Ombudsman of the State Department of Public Health to contribute to the period 2006-2008, for the improvement of specialized consulting services. The research is characterized as descriptive, qualitative approach. The collection technique used was the interview, conducted with 37 service users and two servants of the Ombudsman. The analysis was developed based on the perception of users and servers in the opinion of the Ombudsman. The most relevant results of the research showed that 41% of users search the Ombudsman because they believed that solve the problem presented. However, even with this level of public acceptance, the Ombudsman reached average index of resolvability of 53% in the period. In his role has not developed mechanisms for quality control of services, which is mentioned by 67% of users. It turned out the same fact in relation to popular participation, which is confirmed by 84% of users. For 24% of users, the problems raised were resolved, and of these, 56% believe that the Ombudsman has contributed to the positive outcome. As a result of the search results, it appears that the Ombudsman's SESPA / PA, is not fulfilling its role to ensuring the democratization of articipation in management, social control and has limited contribution to solving the problems of users and to improve the quality of services

Determinação de parâmetros de qualidade para formas farmacêuticas homeopáticas

All medicine, whether allopathic or homeopathic, must go through strict quality control, which must ratify their characteristics throughout the period of validity. During the time of preparation and storage, solutions of the drugs are in permanent contact with packaging materials that can release undesirable substances to the solution. Several factors may influence the release of packing materials, and factorial design (FD) is a useful tool for analyzing the phenomenon. The aim of this study was the determination of quality parameters for Homeopathic solid (globules) and liquid (drops) dosage forms. It was carried out analysis in homeopathic globules for weight variation, mechanical strength, and moisture content uniformity. For liquid preparations, standard solutions were prepared from natural rubber bulbs, which were subjected to exhaustive extraction with two ethanol solutions (30 and 70%) in the ultrasonic bath for 20 minutes at 25°C and 50°C in three successive cycles. Studies of transfer have been made within five days, by spectrophotometric analysis in the UV region at 312 nm with λmáx and 323 nm for samples in 70% ethanol and 30% respectively. PH values were analyzed. We also conducted two FD studies, where the first, the three-level variables were solvent (chloroform, ethanol and nhexane), sample mass (30, 60 and 90mg), particle size (large disk, small disk and powder sample). In the second study, the solvent level variables were different ethanolic degrees (EtOH 30%, 70% and pure). The percentage of lending in the solutions was 5.5%, 12.4%, 24.2% and 41% of the total estimated in the reference solution. The values of rate constants of transfer were determined in the order of 0.0134 days-1 and 0.0232 days-1 in absorbance values, the solutions in ethanol at 30% and 70% respectively. These results suggest that the speed of transfer of materials from rubber is affected both by the nature of the vehicle as by the temperature

Qualidade microbiológica de leite UHT caprino: pesquisa de bactérias dos gêneros Staphylococcus, Bacillus e Clostridium

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A utilização do controle estatístico do processo para o monitoramento do sangue: estudo de caso no Memonorte-RN

The present work is grounded basically on the use of the Basic Tools for the Statistic Process Control SPC, with the intent to detect non-conformities on a given productive process. It consists on a case study accomplished at a Hemocenter in Natal (Rio Grande do Norte). In this study it is shown that, the Statistic Process Control Technique, which was used as a tool, is useful to identify on-conformities on the volume of hemocomponents. The gathering of the used data was performed by means of document analysis, direct observations and database queries. The results achieved from the study show that the analyzed products, even though when they have presented, in some cases, points out of control, they satisfied the ANVISA standards. Finally, suggestions for further improvement of the final product and guidance for future employment of CEP, also extended to other lines of production, are presented

Testes de vigor utilizados na avaliação da qualidade fisiológica de lotes de sementes de milho-doce (sh2)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influência da dureza e potencial hidrogeniônico da calda de pulverização sobre o controle do ácaro-da-leprose em frutos de laranja doce

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Controle sanitário e ambiental de um projeto de reúso em um complexo de prédios corporativos

The study that resulted in this dissertation was developed at OU RNCE PETROBRAS, in Natal, which implemented a project of rational use and reuse of water, including use of wastewater from a Sewage Treatment Plant (STP) already in place, diluted with water from own wells for irrigation of green area of the building complex corporate enterprise. Establish a methodology that can serve as guidelines for future projects controlled reuse of water like this was the objective of this research. Been proposed, implemented and evaluated three instruments of sanitary and environmental control: 1) adaptation of sewage treatment plant and quality control of the treated effluent 2) analysis of soil-nutrient interaction in the irrigated area, 3) knowledge of the local hydrogeology, especially with regard to the direction of flow of the aquifer and location of collection wells of Companhia de Águas e Esgotos do Rio Grande do Norte (CAERN) situated in the surroundings. These instruments have proven sufficient and appropriate to ensure the levels of sanitary and environmental control proposed and studied, which were: a) control of water quality off the STP and the output of the irrigation reservoir, b) control of water quality sub surface soil and assessment of progress on soil composition, c) assessment of water quality in the aquifer. For this, we must: 1) establishing the monitoring plan of the STP and its effluent quality sampling points and defining the parameters of analysis, improve the functioning of that identifying the adequacy of flow and screening as the main factors of operational control, and increase the efficiency of the station to a relatively low cost, using additional filters, 2) propose, implement and adapt simple collectors to assess the quality of water percolating into the soil of the irrigated area, 3) determine the direction of groundwater flow in the area study and select the wells for monitoring of the aquifer.

Gestão da qualidade total: introdução dos conceitos e a sua utilização em um curso para abordar o comportamento individual do aluno/profissional/cidadão

A introdução do assunto qualidade, segundo as necessidades de mercado abre espaço para a discussão da qualidade como necessidade pessoal, e também para a formação do cidadão/profissional, além de introduzir assuntos específicos de administração de empresas. Dessa forma, foi oferecida uma disciplina optativa para os alunos do Instituto de Química do Campus de Araraquara, abordando o tema Qualidade e foi denominada Gestão da Qualidade por três anos seguidos. da avaliação geral do curso extraiu-se que ele deveria ser realizado sempre, que o tema é atual e relevante e contribui para a formação profissional/pessoal. Com relação ao comprometimento com o curso de graduação, cerca de metade dos alunos assume o seu comprometimento com os estudos e os restantes dizem estarem somente envolvidos. Conclui-se, portanto que o curso atingiu os seus objetivos propostos, introduziu os principais conceitos de qualidade segundo as normas da qualidade da série ISO 9000 e suscitou a discussão da formação do aluno/profissional/cidadão.

Análises físico-químicas de polpas de frutas e avaliação dos seus padrões de identidade e qualidade

The pulps are products that add economic value enjoy the fruits of the surplus productions of the same. Have good market acceptance because of its practicality and diversity of flavors available year round. In order to assess the quality of the fruit pulp through the physical and chemical parameters and the characteristics of manufacturing industry, we analyzed 36 samples of frozen fruit pulp of three brands marketed in RIO Grande do Norte, 14 brand A, 12 of 10 brand B and brand C, which corresponded to 14 different flavors, of which 10 have identity Standards and Quality (ISQ S) established by the Ministério da Agricultura, Pecuária e Abastecimento (MAPA), totaling 27 samples with ISQ s. We conducted the following physicalchemical analyzes on samples of fruit pulp: Total solids, total soluble solids, pH, titratable acidity, total sugars and the determination of ascorbic acid. The percentage of failure for each parameter evaluated was 37, 04% in total soluble solids, 22,22% for total solids and titratable acidity, 7,40% in relation to pH. The total sugars were within the requirements demanded by the MAPA and ascorbic acid content, determined only in the pulp of acerola and cashew, presented a non compliance in the pulp of brand B. The percentage of failures of the pulps with ISQ S was 59% with brand A, B and C accounted for 3,70%, 33,33% and 22,22% respectively. The pulps which have no established atandards such as pineapple pulp, showed similar values between brands and literature data unlike the pulp of plum, jackfruit and tamarind which diverged greatly in parameters such as total solids and total soluble solids. The study demonstrates the need for greater quality control by the producers with respect to raw materials, processing, packing, stored and the importance of ISQ S to establish the flavors have not yet covered by existing legislation, but already highly commercialized