Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.

Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

Saúde mental e modelo médico-orgânico: necessidade de mudanças administrativas organizacionais

o presente estudo objetiva realizar uma análise da estrutura organizacional de u~n hospital psiquiátrico no úmbito público, o Hospital Municipal Jurandyr Manti·edini. visando a discutir criticamente a preponderância do modelo médico-orgânico como forma de abordagem e tratamento das doenças mentais. A esquizofrenia serviu como referencial de doença mental por. em função de suas múltiplas manifestações, permitir de forma mais rica a análise do modelo vigente. Através da descrição de um caso clínico, levantou-se o problema: como a rigidez e a estrutura hierárquica de poder. em lugar de propiciarem formas de tratamento da doença compatíveis com os avanços tecnológicos e as retormas psiquiátricas que preconizam a desospitalização e a maior humanização na relação terapeutapaciente. tornam essa relação cada vez mais distante e resistente à mudanças. Por meio de pesquisa documental e de campo. em que o problema pôde ser transformado em hipótese de trabalho, os dados coletados sob a forma de questionários e entrevistas corroboraram a hipótese de que teoria e prática permanecem ainda distantes no que se refere à necessária inclusão abordagens complementares que permitam não só um tratamento mais eficaz, mas também Lima estrutura administrativa/organizacional mais tlexível e conseqüentemente mais eficiente. Longe de ser um trabalho conclusivo. pretende abrir caminho para novas discussões. desdobrando-se em pesquisas futuras.

Impactos da reforma administrativa do governo Collor na modelagem organizacional do DNER

O Governo do Presidente Fernando Collor de Mello promoveu uma reforma administrativa do aparelho público federal, tida por muitos como desastrada e inconseqüente. O Departamento Nacional de Estradas de Rodagem - DNER, uma Autarquia responsável pelas estradas federais, foi um dos órgãos da administração indireta afetado. A dissertação se propõe a identificar as conseqüências dessa intervenção na modelagem organizacional do DNER, tomando como referência os processos reformistas ocorridos na administração pública brasileira desde os anos de 1930. A viagem pela história do órgão mostra os momentos iniciais da sua criação e a sua trajetória do sucesso ao declínio, quando então sofreu a reforma Collor de Mello. Os estudos realizados permitem concluir que as mudanças organizacionais efetuadas fizeram surgir um DNER frágil e limitado na sua capacidade operacional.

Política de compras e contratações: trajetória e mudanças na administração pública federal brasileira

A tese analisa as mudanças da política de compras e contratações da administração pública federal brasileira descrevendo de forma sistemática os seis casos nos quais as regras e procedimentos sofrem alteração substancial, na forma de leis gerais ou estatutos: a centralização das compras no período Vargas, em dois momentos decisivos (1931 e 1940); a revisão das regras de licitação pelo Decreto-lei n. 200, no contexto da reforma administrativa do governo Castello Branco; a edição de um estatuto das licitações (o Decreto-lei n 2.300) no governo Sarney; a aprovação no Legislativo de uma lei de licitações voltada para o combate à corrupção e ao direcionamento dos contratos públicos (Lei 8.666); a tentativa frustrada de uma nova lei alinhada com a reforma gerencial do primeiro governo Fernando Henrique Cardoso e a criação do pregão como nova modalidade de licitação, em 2000. A pesquisa focaliza o processo político de formulação dos problemas, especificação de soluções e tomada de decisão, com base no modelo de John Kingdon, desdobrando a análise em fluxos do processo político, dos problemas emergentes e das soluções, em cada contexto histórico específico. Os seis casos são descritos por meio de narrativas estruturadas e comparados a partir das categorias do modelo teórico para elucidar como se desenvolveu o processo de mudança, quais os atores relevantes, idéias, modelos e eventos políticos que explicam suas circunstâncias e resultado.

Pro- and anti-market reforms in democratic Brazil

Instituto Brasileiro de Economia

New challenges for international economic law teaching and research in México: Mexico’s outstanding waves of reforms

This position paper argues that at this time of Mexico’s ongoing big transformation, legal educators and researchers in Mexico need to pay greater attention to international economic law, and that a renewal and perhaps some re-orientation of the approach to teaching international economic law, could provide significant contributions to and shape and support both the objectives and outcomes of reform in Mexico. International Economic Law courses and research can be made more useful, not only for students themselves, but also for their contribution towards the role that academics, lawyers, and other epistemic communities need to play in the political, economic and social evolution that is accelerating in Mexico.

Governança da internet no espaço regulatório global: o idiossincrático modelo de gestão da ICANN

O presente trabalho pretende descrever e analisar a evolução institucional da Internet Corporation for Assigned Names and Numbers (ICANN), organização responsável pela gestão dos nomes de domínio e protocolos de comunicação entre computadores em rede ao redor do mundo. Iniciando sua trajetória como instituição privada estadunidense e vinculada ao departamento de comércio do mesmo país, a ICANN passa por diversas modificações estruturais ao longo da última década, de forma a englobar representantes de diversos setores sociais em suas atividades. Algumas peculiaridades em sua estrutura que ainda a vinculam aos Estados Unidos, no entanto, são objeto de controvérsia entre aqueles que buscam uma democratização da internet em nível global.

Why has productivity growth stagnated in most Latin American countries since the neo-liberal reforms?

Latin America’s economic performance since the beginning of neo-liberal reforms has been poor; this not only contrasts with its own performance pre-1980, but also with what has happened in Asia since 1980. I shall argue that the weakness of the region’s new paradigm is rooted as much in its intrinsic flaws as in the particular way it has been implemented. Latin America’s economic reforms were undertaken primarily as a result of the perceived economic weaknesses of the region — i.e., there was an attitude of ‘throwing in the towel’ vis-à-vis the previous state-led import substituting industrialisation strategy, because most politicians and economists interpreted the 1982 debt crisis as conclusive evidence that it had led the region into a cul-de-sac. As Hirschman has argued, policymaking has a strong component of ‘path-dependency’; as a result, people often stick with policies after they have achieved their aims, and those policies have become counterproductive. This leads to such frustration and disappointment with existing policies and institutions that is not uncommon to experience a ‘rebound effect’. An extreme example of this phenomenon is post-1982 Latin America, where the core of the discourse of the economic reforms that followed ended up simply emphasising the need to reverse as many aspects of the previous development (and political) strategies as possible. This helps to explain the peculiar set of priorities, the rigidity and the messianic attitude with which the reforms were implemented in Latin America, as well as their poor outcome. Something very different happened in Asia, where economic reforms were often intended (rightly or wrongly) as a more targeted and pragmatic mechanism to overcome specific economic and financial constraints. Instead of implementing reforms as a mechanism to reverse existing industrialisation strategies, in Asia they were put into practice in order to continue and strengthen ambitious processes of industrialisation.

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

Delays in stabilization or in reforms? The debt crisis

Empirical analyses attributing the 1980s' debt crisis to inconsistent stabilization policies rest on an inappropriate long-run approach. Revising this long-run approach yields opposite results: terms of trade shocks and foreign indebtedness explain this crisis, regardless of domestic stabilization policies. This prompts us to consider a new hypothesis, of delays in trade-policy reforms, with a model in which terms-of-trade variation (under shocks) is endogenous to export structure and efficiency of resource allocation. Evidence from the structural equations model shows that allocation distortions negatively affect changes in terms of trade, which then explain this crisis. A political economy extension demonstrates that income inequality and regional trade policy determine the distortions, which in turn leads to this crisis.