A problemática da imputação dos custos nos hospitais do Serviço Nacional de Saúde (SNS)

As reformas propostas pelo modelo da Nova Gestão Pública tiveram repercussões importantes ao nível do setor da saúde, levando a que atualmente os prestadores de cuidados de saúde procurem aplicar a melhor prática clínica a um custo socialmente aceitável. A despesa do Estado com a Saúde é cerca de um quinto do total da despesa pública e, mais particularmente, a despesa com hospitais representa pouco menos de metade da despesa com saúde (pública e privada). O elevado peso dos gastos em saúde conduziu a alterações na gestão das unidades de saúde e a uma preocupação crescente com a gestão e tratamento contabilístico dos custos hospitalares. Nasce, assim, a necessidade de uma contabilidade virada para o interior da organização, que forneça informação adequada e atempada, destacando-se neste âmbito a Contabilidade de Custos. Torna-se pois importante que as organizações hospitalares ajustem a sua contabilidade às necessidades atuais, proporcionando uma sofisticada compreensão dos custos, e façam uso de modernas técnicas de imputação e controlo desses mesmos custos. Face ao exposto, o principal objetivo do trabalho é analisar a forma como são imputados os custos nos hospitais pertencentes ao Serviço Nacional de Saúde (SNS) e se existe uniformização nos critérios de imputação. Para tal, efetuamos uma investigação qualitativa através da realização de um estudo exploratório com recurso à Base de Dados de Elementos Analíticos (BDEA) do Ministério da Saúde e dos relatórios divulgados pelo sítio oficial do Ministério da Saúde Português. Observamos que, regra geral, os hospitais portugueses pertencentes ao SNS estão a seguir os requisitos normativos previstos no Plano de Contabilidade Analítica dos Hospitais (PCAH).

O Impacto da Reorganização Administrativa do Território das Freguesias: o caso do Distrito de Braga

A presente dissertação, apresentada no âmbito do Mestrado em Gestão das Organizações, ramo Gestão Pública, aborda o tema da Reorganização Administrativa do Território das Freguesias. O Memorando de Entendimento com a Troika assinado em Maio de 2011 pelo XVIII Governo constitucional previa a redução do número das autarquias locais. Assim que iniciou funções, o sentido do Governo seguiu a necessidade de alterar um modelo considerado como gasto e inadequado às necessidades das populações. O Governo considerou que um mapa das freguesias com mais de cem anos não era apropriado. Nos últimos 40 anos, a gestão local e administrativa revelou-se mais diversificada e ampla, tornando-se assim imprescindível, neste novo âmbito, apostar numa eficiência acrescida, que não era exatamente uma inquietação no séc. XIX, data do anterior mapa territorial das freguesias. A reforma não foi realizada através de um ajuste crescente, mas seguiu-se um impacto reformista que adequou o poder local a um novo tempo histórico executando-se alterações estruturais que incluíram mudanças no sector empresarial local, na organização do território, na gestão municipal e intermunicipal e no financiamento e democracia local. Qualquer reforma administrativa tem objetivos concretos a alcançar e é necessário perceber se esses objetivos são ou não atingidos. Neste caso, interessa constatar se ocorreu uma maior proximidade entre os níveis de decisão e os cidadãos, se se valorizou a eficiência na gestão e afetação de recursos, estimulando a economia de escala, se sucedeu uma progressão na prestação do serviço público, se foram observadas as especificidades locais e se essencialmente se fortaleceu a coesão e a competitividade territorial. O objetivo da investigação realizada foi verificar o impacto da Reorganização Administrativa do Território das Freguesias (adiante, RATF). Iniciando com um enquadramento teórico que enfoque as freguesias, no contexto da Administração Pública portuguesa, com uma breve abordagem dos seus meios de financiamento e regime de contabilidade, abordar-se-á seguidamente a RATF e a forma como foi implementada. Finalizar-se-á analisando os resultados obtidos através de um questionário por inquérito enviado às 120 uniões de freguesias criadas no Distrito de Braga. Verificar-se-á quais as alterações mais importantes e se houve uma efetiva redução de custos como pretendido aquando da sua implementação.

Projeto de intervenção JUCERN Digital

Displays intervention project that proposes changes in the organizational and operational structure of the Board of Trade of Rio Grande do Norte. Analyzes routine flow of activities of business registration and organizational structure. Compare the models, with the current proposed. The work is divided into six chapters which lists since the description of the institution, work object, until the proposed new organizational and operational model. Uses the methodology of literature review and observation of reality

O papel da violência interpessoal compreendida como a manifestação de uma endemia social: uma análise geográfica sobre o fenômeno no Brasil e Rio Grande do Norte

En Brasil, la violencia interpersonal (homicidios) se ha incrementado de forma significativa, convirtiéndose en una preocupación cada vez mayor en todos los ámbitos políticos de la sociedad. Hoy es uno de los más graves problemas sociales y de salud pública. Se refiere a los problemas sociales, ya que interfiere en la distribución de la oferta de bienes y servicios a los ciudadanos; sino también un problema de salud, porque la violencia es uno de los fenómenos que causan gran impacto en la morbilidad y mortalidad del país, y genera un alto costo para el Sistema Único de Saúde (SUS). Esta es una crisis social, que es el resultado de un mundo capitalista globalizado, que exige a todos sus instrumentos de dominación (dinero, poder y competitividad en estado puro), en virtud del cual la violencia y los conflictos interpersonales se materializan en el territorio. El Río Grande do Norte (RN) ha estado siguiendo esta realidad que es nacional, con el aumento de las tasas de mortalidad por homicidios. En este sentido, este estudio tuvo como objetivo analizar la violencia interpersonal (agresión / homicidio), en Brasil y en el estado del RN, para entender cómo esto afecta a su población, en la morbilidad y mortalidad durante los años 2001 a 2011. Para ambos hicimos uso de método descriptivo / cuantitativo para determinar la magnitud, el tamaño, el perfil de las víctimas y los costos del SUS generados por el problema. Como resultado, podemos diagnosticar que en Brasil, la violencia se ha presentado una nueva dinámica regional, promovida por un proceso de interiorización del fenómeno en todo el país, este proceso de internalización se ha reflejado en la última década, el crecimiento de la violencia en el estado del RN, que ha causado un gran impacto en las tasas de la mortalidad del estado. Acerca la victimización, se puede ver que hay un perfil vulnerable formado por, varón, baja instrucción joven, sola y negro. Con respecto a los datos de morbilidad hospitalaria, la demanda creciente del fenómeno genera costes para el sistema de salud, y las graves consecuencias humanas, como la escalada del miedo y la destrucción de una generación de jóvenes brasileños. Por lo tanto, la falta de una política pública para afrontamiento, prevención y mitigación del problema revela el fracaso de la gestión pública, con consecuencias sociales y de salud, tanto individual como colectivamente.

Avaliação do acesso aos serviços de reabilitação física para vítimas de acidentes de trânsito: caminhos para melhoria da qualidade do sistema de saúde

The Physical Rehabilitation services (PR) are of fundamental importance in combating the global epidemic of Traffic Accidents (TA). Considering the numerous physical and social consequences of the survivors, quality problems in access to PR are a hazard to recovery of victims. It is necessary to improve the management of quality of services, assessing priority dimensions and intervening in their causes, to ensure rehabilitation available in time and suitable conditions. This study aimed to identify barriers to access to rehabilitation considering the perception of TA victims and professionals. The aim is also to estimate the access to rehabilitation and their associated factors. This is a qualitative and quantitative study of exploratory nature developed in Natal / RN with semi-structured interviews with 19 health professionals and telephone survey to 155 victims of traffic accidents. To explore barriers to access the speeches were transcribed and analyzed using the Alceste software (version 4.9). During the interviews used the following guiding question: “What barriers hinder or prevent access to physical rehabilitation for victims of traffic accidents?”. The names of classes and axes resulting from Alceste was performed by ad hoc query to three external researchers with subsequent consensus of the most representative name of analysis. We conducted multivariate analysis of the influence of the variables of the accident, sociodemographic, clinical and assistance on access to rehabilitation. Associations with p <0.20 in the bivariate analysis were submitted to logistic regression, step by step, with p <0.05 and confidence interval (CI) of 95%. The main barriers identified were: “Bureaucratic regulation”, “Long time to start rehabilitation”, “No post-surgery referral” and “inefficiency of public services”. These barriers were divided into a theoretical model built from the cause-effect diagram, in which we observed that insufficient access to rehabilitation is the product of causes related to organizational structure, work processes, professional and patients. Was constructed two logistic regression models: “General access to rehabilitation” and “Access to rehabilitation to public service”. 51.6% of patients had access to rehabilitation, and 32.9% in public and 17.9% in the private sector. The regression model “General access to rehabilitation” included the variables Income (OR:3.7), Informal Employment (OR:0.11), Unemployment (OR:0.15), Perceived Need for PR (OR:10) and Referral (OR: 27.5). The model “Access to rehabilitation in the public service” was represented by the “Referral to Public Service” (OR: 23.0) and “Private Health Plan” (OR: 0.07). Despite the known influence of social determinants on access to health services, a situation difficult to control by the public administration, this study found that the organizational and bureaucratic procedures established in health care greatly determine access to rehabilitation. Access difficulties show the seriousness of the problem and the factors suggest the need for improvements in comprehensive care for TA survivors and avoid unnecessary prolongation of the suffering of the victims of this epidemic.

Turismo e patrimônio cultural: processo de tombamento e estratégias de utilização turística do Centro Histórico de Natal/RN

In a globalized society, the relations between heritage and tourism are reflected in an ambiguous reality, shaped between the interests of preservation and the aspirations for economic benefits. On the one hand, the cities as a main generating cultural offerings needs to contemplate its heritage as a development axis, finding in the cultural tourism promotion a strategy to support the high cost of recovery and maintenance of its historical center and its expressions cultural. On the other, adds to the new requirements of demand, causing the tourism projects to turn to the cultural factor in the formation of their products, which allows municipalities to attract the growing cultural tourism segment. In this perspective, this study develops into a focused cross-cut in the analysis of Natal’s Historical City Center, in order to understand how this cultural heritage fallen has been used by the municipal administration for tourism. By understanding the heritage as a reference to identity and memory, as well as a cultural symbol of Natal society, characterized as an element surrounded by complex and strictly private situations, it identified the need for a qualitative approach to his deep understanding. The in-depth case study developed in two stages, first the realization of bibliographical and documentary research; and thereafter the interpretation of data collected through semi-structured interviews with municipal administrators and local residents. The survey results show that the official representatives of heritage are concerned about the preservation of the material dimension of the architectural heritage of the city, however, still can not reach and sensitize the local population, which seems to be part of a process that should be democratic and strengthening the sense of belonging of these people. Finally, it indicates an absence of revitalization strategies by the current municipal public administration for Natal’s Historical City Center, revealing a speech covered by a positivist interpretation of tourism, which deals with the use of assets by the scope of the marketing empiricism.

Avaliação de qualidade da unidade de diálise no Hospital Universitário Onofre Lopes - HUOL

Over the years there has been a broader definition of the term health. At the same time it was found also an evolution of the concept of health care which in turn has led to changes in the approach to delivery of health services and hence in its management. In this regard, currently the nephrology services have been searching for quality technical and social need. In view of these innovations and the quest for quality, it elaborated the general objective: to develop a quality assessment protocol for dialysis service Onofre Lopes University Hospital. It is an intervention project effected through an action research, which consisted of 4 steps. Initially was identified through a literature search in scientific literature, which quality indicators would apply to a dialysis unit being selected as follows: infection rate in hemodialysis access site, microbiological control of water used for hemodialysis and Index User satisfaction. Through critical reflection on the theme researched in the previous step, it was drawn up three data collection instruments, interview form type, applied between the months of October and November 2015. In addition to the information obtained, also made up of the use of information retrieval technique. The results were organized in graphs and tables and analyzed using qualitative and exploratory technical approach. Then a reflective analysis of the data obtained and the diagnosis of reality studied was traced and confronted with the literature was performed. The data produced in this study revealed that the Dialysis Unit of HUOL is much to be desired, considering that some weaknesses have been identified in its structure. Faced with this finding have been proposed, as a contribution and aiming to guide the development of future actions, suggestions for improvement that should be implemented and monitored to be assured overcoming these difficulties, allowing an appropriate organizational restructuring, and resulting in improved service public offered. It was concluded that for hemodialysis treatment results are achieved and positive, it is necessary to have physical structure and adequate infrastructure, multidisciplinary team specialized, trained and in sufficient quantity, well designed processes for professionals to have standards to be followed decreasing the chance to err, and a risk management system to detect and control situations that endanger patient safety.

Avaliação de qualidade da unidade de diálise no Hospital Universitário Onofre Lopes - HUOL

Over the years there has been a broader definition of the term health. At the same time it was found also an evolution of the concept of health care which in turn has led to changes in the approach to delivery of health services and hence in its management. In this regard, currently the nephrology services have been searching for quality technical and social need. In view of these innovations and the quest for quality, it elaborated the general objective: to develop a quality assessment protocol for dialysis service Onofre Lopes University Hospital. It is an intervention project effected through an action research, which consisted of 4 steps. Initially was identified through a literature search in scientific literature, which quality indicators would apply to a dialysis unit being selected as follows: infection rate in hemodialysis access site, microbiological control of water used for hemodialysis and Index User satisfaction. Through critical reflection on the theme researched in the previous step, it was drawn up three data collection instruments, interview form type, applied between the months of October and November 2015. In addition to the information obtained, also made up of the use of information retrieval technique. The results were organized in graphs and tables and analyzed using qualitative and exploratory technical approach. Then a reflective analysis of the data obtained and the diagnosis of reality studied was traced and confronted with the literature was performed. The data produced in this study revealed that the Dialysis Unit of HUOL is much to be desired, considering that some weaknesses have been identified in its structure. Faced with this finding have been proposed, as a contribution and aiming to guide the development of future actions, suggestions for improvement that should be implemented and monitored to be assured overcoming these difficulties, allowing an appropriate organizational restructuring, and resulting in improved service public offered. It was concluded that for hemodialysis treatment results are achieved and positive, it is necessary to have physical structure and adequate infrastructure, multidisciplinary team specialized, trained and in sufficient quantity, well designed processes for professionals to have standards to be followed decreasing the chance to err, and a risk management system to detect and control situations that endanger patient safety.

Proposta de um sistema de avaliação de desempenho para o Restaurante Universitário da UFRN

The aim of this study was to propose a Performance Evaluation System for outsourced employees of the University Restaurant of the Federal University of Rio Grande do Norte to supply the lack of evaluative instruments. According to Provision of Services Contract nº050/2010 and nº055/2011 of FURN with SAFE LOCAÇÃO DE MÃO DE OBRA LTDA ME, it is the hired company to promote periodic functional performance evaluation of the outsourced employees, but this is not done. The performance evaluation process serves to evaluate if the employees are making their tasks according to the organizations’ objectives and goals, besides that helps to find service failures and capacity of employees demands, thus contributing to improve work conditions and the global performance of the organizations. To elaborate the proposal of evaluation, it was chosen an action research with the participation of all stakeholders, employees and managers from UR. On data collect, first, outsourced employees and management servers were interviewed, in order to raise existing perceptions about performance evaluation aspects. From these data and the work routine observation, a proposal of performance evaluation was elaborated, that was appreciated, criticized and adjusted by the actors involved (employees and managers) to the final formulation of the instrument. This study also presents the necessary steps to the implementation of the Performance Evaluation System. The proposed Performance Evaluation System can be applied to the FURN assuming this process, after modification of contract terms and the approval by the ADCON. It also can serve as an example to others units that works with the provision of outsourced services, enabling so the performance evaluation to be part of the management policy of all people working in FURN.

Função compras no setor público: fatores preponderantes para o alcance da celeridade dos pregões eletrônicos da Base Aérea de Natal

This study discusses the issue of deadlines in the purchasing process within the Federal Public Administration. Your main goal is to analyze the main factors that influenced, mainly in the implementation of sub-phases of electronic trading in BANT, in 2014, as service to the principle of celerity. The research is descriptive since they were identified and analyzed the factors that influenced in terms of purchases, through direct observation and interviews. Based on the theoretical framework, the purchasing function, four dimensions of analysis were established: "Legislation and procurement processes", "Structure and Organization of the purchasing department", "purchasing systems" and "Human Resources of the purchasing department." Analysis showed that, unlike what happens in the private sector, the public procurement sector has not reached a strategic status within organizations, which brings harmful consequences to the speed of the purchases. It was found that there is a need for greater involvement of the purchasing department staff and criers in the formulation of the organization's purchasing strategies and that these purchases elements present, about their attitudes, a hybrid profile, proactive regarding specifications of the items, but reactive in relation to the need to urgently purchase, due to the lack of a better plan, which overloads the work of the sector. The observation of these strategic aspects of the procurement function in BANT influenced the finding that the lack of staff and expertise in investments plus the lack of rigor and formality of legislation, among other factors, contributed mainly to the lack of speed of processes.

Projeto de intervenção adaptando o Balanced Scorecard ao sistema de compras da Base Aérea de Natal

The present proposal for intervention examines the issue of public procurements carried out by a military organization on a Federal Public Administration. The main objective of this paper is to propose a model of strategic planning based on the Balanced Scorecard for the public procurement system, which contributes to increased efficiency, efficacy and effectiveness of acquisitions made in the Air Base of Natal city. Therefore, Structured interviews were used in order to make a diagnosis of the current reality of the procurement system along with the main requirement sectors of BANT, as well as the adaptation of the prospects of the BSC based on literature review. The technique used for the analysis of the interviews was the analysis of content whose results contributed to the preparation of the conceptual Strategic Map which was submitted to validation through a Focal Group. It was concluded through the analysis of the interviews, that the system of purchases of BANT is in a tactical profile because of low interaction between the system of purchases and the requirement sectors, aiming only at the “economicity” of acquisition in opposition of the effectiveness of material acquired, the lack of training of the elements which build the system and the absence of a proper planning. It is intended with thecreation of this proposal to contribute to the improvement of management with a focus on results in public administration as well as increasing efficiency, efficacy and effectiveness of public procurements. Whereas for the particular case the measurement of the results can only be performed after at least a year of its implementation, the present research constitutes a proposal of intervention.

Health reforms in Latin America: processes and results

Two types of health reforms in Latin America are analysed: one based on insurance and service commodification and the one referred to the unified public systems of progressive governments. Health insurance with explicit service packages has not fulfilled their purposes of universal coverage, equal access to necessary health services and improvement of health conditions but has opened health as a field of profit making for insurance companies and private health providers. The national health services as a state obligation have developed territorialized health services and widened substantially timely access to the majority of the population. The adoption of an integrated and wide social policy has an impact on population well fare. It faces some problems derived from the old health systems and the power of the insurance and medical complex.

A descentralização das políticas de desenvolvimento rural: uma análise da experiência do Rio Grande do Norte

MATOS FILHO, João. A descentralização das Políticas de desenvolvimento rural - uma análise da experiência do Rio Grande do Norte. 2002. 259f. Tese (Doutorado em Ciências Econômicas)– Instituto de Economia da Universidade Estadual de Campinas, Campinas, 2002.

O city marketing em Natal/RN e a construção da imagem da cidade

The growing importance of tourism in overall economic activity worldwide has favored the intensification of competition among cities that seek to create environments attractive to tourists and potential investors. It has been common practice to import characteristics of the business environment in the public management of cities. The city marketing is a key tool used by public leaders to promote a linkage between the tourism image and urban image and involves, in addition to promoting the image of the city, the planning of interventions in urban space, trying to formulate a positive image of the city able to facilitate the deployment of capital. This research seeks to understand the nature of city marketing as part of contemporary urban management and analyzes how is its application in decisions concerning the promotion of tourism in Natal/RN. The approach of this research is qualitative, exploratory and descriptive, in which respondents were the main leaders of two of the official tourism site, the Empresa Potiguar de Promoção Turística and the Secretaria Municipal de Turismo e Desenvolvimento Econômico. It was found that there is a strong articulation of public power with private enterprise in the design and conduct of the actions of urban marketing, that from the survey data show that the behavior of target markets provide guidelines for taking strategic decisions relating to tourism. Sun and sea are some key elements explored to form the image of Natal and to authorize the sale of the city as a tropical paradise. However, there is an increase in the diversification of tourism products, seeking to increase flow to the segments of ecotourism, adventure, business and culture. It s also growing the use of local culture as a tourism product, however, the cultural representation focuses on superficial values and does not bring to light the social and historical richness that the city has. Public authorities use the city marketing strategies as a means able to maximize the attractiveness of Natal urban space to investors, business groups and tourists. It can be observed that urban managers seek solutions that can continuously increase the tours, which often manifests in interventions that focus the tourist areas of the city, in oposition of those who do not contribute to a positive reading of the city, which ultimately generate the worsening of spacial and social inequalities