Qualidade e satisfação do sistema de seguimento à distância de cardioversores-desfibrilhadores implantáveis

RESUMO - Com o aumento da esperança de vida e das doenças crónicas, cada vez se tem implantado mais cardioversores-desfibrilhadores (CDI) para prevenção de morte súbita. O aumento exponencial no número de implantes aumenta o número de seguimentos dos dispositivos, sobrecarregando os profissionais de saúde e comprometendo a qualidade dos serviços prestados. Segundo as recomendações internacionais, um CDI deverá ser vigiado a cada 3 meses, o que perfaz 4 consultas por ano/doente no mínimo, se não existirem episódios de “choques” ou “descompensações” clínicas, e mensalmente quando é atingido o indicador de substituição electiva do gerador. A evolução da tecnologia, de algoritmos, visualização de episódios e terapias requer recursos técnicos e humanos diferenciados e um gasto de tempo considerável no seguimento. Em países como os Estados Unidos da América, em que os doentes têm de percorrer distâncias muito grandes para aceder aos cuidados de saúde, tornou-se preemente a necessidade de um sistema de vigilância alternativo. Nesse sentido, e usando o conceito da telemedicina, foi criado o seguimento/monitorização à distância de dispositivos cardíacos. Este reduz os custos em consultas, deslocações e recursos humanos, uma vez que contempla apenas uma consulta presencial por ano. Por outro lado, aumenta a segurança do doente com a monitorização periódica e a criação de alarmes, permitindo uma assistência de qualidade e intervenção adequada imediata. Aproveitando as vantagens que este tipo de sistema de transmissão remota oferece, procedeu-se no meu serviço, à distribuição inicial de 62 comunicadores a doentes portadores de CDI´s ou com Ressincronizadores Cardíacos (TRC´s1). Apesar de ser considerada uma melhoria na qualidade dos serviços prestados, é também uma mudança importante na metodologia da consulta feita até aqui. Segundo vários autores, a avaliação da qualidade dos cuidados em saúde está intrinsecamente ligada ao grau de satisfação dos doentes com esses serviços, ou seja, à relação entre as suas expectativas e os resultados percebidos por eles, sendo considerado um importante indicador de qualidade dos serviços. Com este trabalho, pretende-se avaliar a percepção dos doentes face ao novo seguimento em termos de aceitação, satisfação, validade, segurança e confiança no novo sistema. Se este mantém os mesmos padrões de qualidade que o seguimento presencial. Trata-se de um estudo transversal com uma componente retrospectiva de avaliação da nova metodologia de consulta à distância. Para tal, foi elaborado um questionário, que foi aplicado a 40 doentes (17,5% do género feminino e 82,5% do género masculino; média de idades de 65 anos) que constituíram a amostra do estudo. Verificou-se uma média de 5 anos de tempo de implante do CDI. Dos dados obtidos, é de realçar que 70% dos inquiridos estão satisfeitos e 30% estão muito satisfeitos com esta nova metodologia de consulta e cerca 67,4% prefere a consulta à distância. Quando solicitados para comparar a qualidade do serviço prestado entre as duas consultas, 65% respondeu igual e 27,5% melhor. Todos os inquiridos responderam ter confiança e segurança com o sistema de consulta à distância. Cerca de 87,5% dos inquiridos vê-se mesmo a continuar com este tipo de consulta. Os resultados obtidos são bastante satisfatórios no que diz respeito à transição do modo como a consulta de CDI´s é feita. Reflectem também que a tecnologia não é necessariamente uma barreira no acesso aos profissionais de saúde, desde que suportada por algum contacto directo (telefone e através de uma consulta presencial por ano). 1 TRC – Terapia de Ressincronização Cardíaca

José Mourinho, The special one: A pedagogical case

The purpose of this work is to create a case to reflect about the leadership role of José Mourinho in Real Madrid CF, considering his successful background experiences in FC Porto, Chelsea FC and FC Inter. The case is based on the failure of the Special One in Real Madrid CF. This paper is mainly focused in the leadership process, charismatic leadership and contingency theory of leadership. Moreover it is intended to introduce concepts about the influence of leaders in the organizational culture, the management of human resources, and the role of a leader adapting to a different context.

The importance of succession planning in family-owned Small and Medium Enterprises in Portugal

This work project addresses the importance of succession planning in family-owned Small and Medium Enterprises (SMEs). This is directly related with Human Resources Management (HRM) given that there is an HRM long term vision in order for the succession to be planned on time and benefit the companies. This study focused on SMEs since these are the entities that have a minor focus on HRM practices. A total of 22 in-depth interviews were conducted and analyzed. Selected SMEs owners/managers and successors/antecessors were interviewed with the purpose of acquiring more insight on the level of succession planning, using a qualitative methodology from which the process of succession was derived. This study unveils that the first step in this process is related to the definition of criteria to be a good successor, followed by the choice of possible successors, being the children the natural successors, but also considering other potential ones, and finally some considerations on the future of these companies.

Measuring social impact: A guideline to implement a tableau de bord

Many impact-seeking organisations cannot measure and demonstrate their social impact because they either lack technical expertise or requisite financial and human resources. This report clarifies the process of social impact measurement to help these organisations engage in social impact measurement practices. It presents a simple guideline to create a measurement approach based on the Tableau de Board. The guideline has been developed through a theoretical revision of best practices in social impact measurement, academic research and the author's individual thoughts and ideas. While a first testing of the approach revealed positive feedback, only future broad-scale testing will demonstrate the approach’s validity and feasibility.

Implementation progress of mental health services in Rwanda: Bugesera district case

RESUMO: O Ministério da Saúde do Governo do Ruanda identifica a saúde mental como uma área de prioridade estratégica para a intervenção em resposta à alta carga dos transtornos mentais no Ruanda. Ao longo dos últimos 20 anos após o genocídio, o sector público reconstruiu sua Resposta Nacional de Saúde Mental com base no acesso equitativo aos cuidados, através do desenvolvimento de uma Política Nacional de Saúde Mental e novas estruturas de saúde mental. A política de Saúde Mental do Ruanda, revista em 2010, prima pela descentralização e integração dos serviços de saúde mental em todas as estruturas nacionais do sistema de saúde e ao nível da comunidade. O presente estudo de caso tem como objetivo avaliar a situação do sistema de saúde mental de um distrito típico de uma área rural no Ruanda, e sugerir melhorias, incluindo algumas estratégias para monitoras as mudanças. Os resultados do estudo permitirão ao Ruanda reforçar a sua capacidade para implementar o Plano Nacional de Saúde Mental ao nível dos distritos. O relatório também será útil para monitorar o progresso da implementação de serviços de saúde mental nos distritos, incluindo a prestação de serviços de base comunitária e a participação dos usuários, suas famílias e outros interessados na promoção, prevenção, assistência e reabilitação em saúde mental. Este estudo também procurou avaliar o progresso da implementação dos cuidados de saúde mental a nível descentralizado, com vista a compreender as implicações em termos de recursos desses processos. Foi realizada uma análise situacional num local do distrito, baseado em entrevistas com as principais partes interessadas responsáveis, usando o Instrumento de Avaliação de Sistemas de Saúde Mental da Organização Mundial da Saúde (WHO-AIMS). Os resultados sugerem que os recursos humanos para a saúde mental e serviços de base comunitária de saúde mental no distrito continuam a ser extremamente limitados. Os profissionais de saúde mental são adicionalmente limitados na sua capacidade para oferecer intervenções de emergência a pacientes psiquiátricos e garantir a continuidade do tratamento farmacológico a pacientes com condições crônicas. Para planejar efetivamente, de acordo com as necessidades da comunidade, sugerimos que o sistema de saúde mental deve envolver também os representantes das famílias e dos usuários no processo de planificação de modo a melhorar a sua contribuição no processo de implementação das atividades de saúde mental. Este estudo de caso do Distrito de Bugesera oferece a primeira análise de nível distrital dos serviços de saúde mental no Ruanda, e pode servir como uma mais-valia para a melhoria do sistema de saúde mental, incluindo a advocacia para a melhoria da qualidade dos cuidados de saúde mental a este nível, aumentando o financiamento para a implementação de serviços clínicos de saúde mental e os recursos humanos disponíveis para a prestação de cuidados de saúde mental, principalmente a nível dos cuidados primários.--------------------- ABSTRACT: To deal with the high burden of mental health disorders resulting from consequences of the 1994 genocide against Tutsis, the Rwanda Ministry of Health (MoH) considers mental health as a priority intervention. For the last 20 years, Ministry of Health focused on rebuilding a national and equity-oriented mental health program responding to the population needs in mental health. Mental health services are now decentralized and integrated in the national health system, from the community level up to the referral level. This study assessed the situation of mental health services in one rural district in Rwanda. It was aimed at assessing the progress of implementation of mental health care at the decentralized level, focusing on resource implications and processes. This study is based on interviews conducted with key stakeholders, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). Findings show that human resources for mental health care and community-based mental health services of the assessed district remain extremely limited. Mental health professionals face limitation regarding the ability to provide emergency management of psychiatric patients and to ensure continuity of psychopharmacological treatment of patients with chronic conditions. To improve the implementation process of mental health interventions and activities, a planning process based on community needs and the involvement of representatives of families and users in planning process should be considered. The Bugesera case study on the situation of mental health services can serve as a baseline for improvement of the mental health program in Rwanda, in terms of quality care services, infrastructure and equipment, human and financial resources.

Efectividade e eficiência: médicos, gestores, informação e bom senso

RESUMO - Num contexto de escassez de recursos, agravado pelo aumento da procura de cuidados de saúde e pelo custo do imperativo tecnológico, muitas vezes erroneamente confundido com imperativo ético, a procura da eficiência é cada vez mais relevante. Para que esta se atinja e mantenha é preciso um conhecimento profundo dos efeitos das medidas eficazes, a verdadeira efectividade, numa perspectiva sistémica, o que implica uma partilha de saberes e acções concertadas entre médicos e gestores. A lógica económica não substitui o juízo clínico, mas reforça a necessidade de compatibilizar as intervenções úteis com o custo pessoal e social exigido. Precisa-se de boa informação que gere conhecimento e do insubstituível bom senso.

A indústria de defesa na cooperação Brasil-Portugal

The global dynamics of alliances are strongly determined by the level of cooperation among states. This cooperation can be embodied in various aspects, but the level of defense and security cooperation becomes usually more doctrinal and lasting. By the nature of sovereignty that instills in the bilateral relationship, cooperation at defense and security level can leverages other forms of cooperation. The circumstances and relational balance between Brazil and Portugal seem to evolve towards distancing opportunities, despite they are culturally and institutionally untainted. The economic dynamics, the strategic projection in global sustainability terms, the scale and ambition of Brazilian regional leadership, contrasts with the actual context of Portugal, distancing himself both on the stage where they operate. On the other hand, the historical and cultural roots, the language, the affinity of the peoples of CPLP and some opportunities for economic niches, trend to attract both countries. The condition of Portugal in NATO and Europe, coupled with the ability to export technical and human resources to value-added for Brazil, seems also to become approaching factors. On the balance of these dynamics, there is a set of exogenous factors (economic, external global relations matrix, regional stability, among others), which are not always controlled by any of both countries. These factors call for strong capacity for foresight analysis and decision making, with the inherent risk. There is cooperation vectors that are not apparently penalized by geographic distance, or by the difference of realities. Among these vectors we shall highlight synergies in technological niches, highly tradable goods and, mostly, using the domain of dual technologies. The thirteen niches herein identified are: Monitoring, Navigation, Command and Control, Electronics, Optoelectronics, Communication and remote sensing, Information Technologies, Flight Simulation, Specialized Training, Fiber Optic Sensors, Materials Engineering, Nanotechnology and Communications. Cumulating with identified opportunities in traditional relational framework, both countries are growing (in geography and economic terms) into the Atlantic, making it a central element in the bilateral approach. By being at the same time a growing stage of disputes and which stability tends to be threatened, it will be done an analysis of these synergistic vectors, superimposed on the impact on Atlantic securitization process.

A gestão do desempenho como prática de implementação participada de um plano estratégico: o caso do Banco de Moçambique

Dissertação de Mestrado em Políticas Desenvolvimento dos Recursos Humanos

Physiotherapy practice in the private sector: organizational characteristics and models.

BACKGROUND: Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models. METHODS: This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses. RESULTS: Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed. CONCLUSIONS: The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists' professional practices and patient outcomes are needed.

HR-asiantuntijapalveluiden käyttö PK-yrityksissä. Case: Virvo Oy palveluiden tarjoajana

Tutkielma on kvalitatiivinen haastattelututkimus, jonka tavoitteena on tarkastella HR-asiantuntijapalveluiden;konsultoinnin, ulkoistamisen ja vuokrajohtajuuden käyttöä sekä mahdollisuuksia PK-sektorilla. Tutkimuksessa perehdytään myös työn toimeksiantajan, case-yritys Virvon liiketoimintaan HR-asiantuntijapalveluiden markkinoilla ja siihen, miten Virvo pystyy vastaamaan näihin haasteisiin. HR-asiantuntijapalveluiden markkinoiden selvittämiseksi on haastateltu neljää HR-asiantuntijaa. Tämän pohjalta on tehty 15 PK-yrityksen toimitusjohtajan haastattelua HR-asiantuntijapalveluiden käytön selvittämiseksi. Tehdyt haastattelut ovat olleet puolistrukturoituja, jolloin on käytetty valmiita kysymyspohjia. Tutkimuksessa on selvinnyt, että HR-asiantuntijamarkkinat ovat vasta muotoutumassa ja että ala on varsin uusi. PK-yritysten HR-toimintojen haasteisiin pystytään parhaiten vastaamaan HR-asiantuntijapalveluilla, jotka ovat selkeitä kokonaisuuksia ja järkevästi hinnoiteltuja. Tärkeinä asioina on nähty esimerkiksi käytännön toteutus sekä lisäajan saaminen varsinaisen liiketoiminnan hoitamiseen. Palveluiden käyttö korostuu erityisesti erilaisissa muutostilanteissa kuten esimerkiksi yrityksen kasvuvaiheessa. Voidaan todeta myös, että liiketoiminnan tila vaikuttaa HR-asiantuntijapalveluiden käyttöön.

Manpower development and nation-building : Singapore's experience

Manpower is a basic resource. It is the indispensable means of converting other resources to mankind '.s use and benefit. As a process· of increasing the knowledge, skills, and dexterity of the people of a society, manpower development is the most fundamental means of enabling a nation to acquire the capacities to bring about its desired future state of affairs -- a more mighty and wealthier nation. Singapore's brief nation-building history justifies the emphasis accorded to the importance of good quality human resources and manpower development in economic and socio-political developments. As a tiny island-state with a poor natural resource base, Singapore's long-term survival and development depend ultimately upon the quality and the creative energy of her people. In line with the nation-building goals and strategies of the Republic, as conditioned by her objective setting, Singapore's basic manpower development premise has been one of "quality and not quantity". While implementing the "stop-at-two" family planning and population control programs and the relevant immigration measures to guard against the prospect of a "population explosion", the Government has energetically fostered various educational programs, including vocational training schemes, adult education programs, the youth movement, and the national service scheme to improve the quality of Singaporeans. There is no denying that some of the manpower development measures taken by the Government have imposed sacrifice and hardship on the Singapore citizens. Nevertheless, they are the basic conditions for the island-Republic's long-term survival and development. It is essential iii to note that Singapore's continuing existence and phenomenal-success are largely attributable to the will, capacities and efforts of her leaders and people. In the final analysis, the wealth and the strength of a nation are based upon its ability to conserve, develop and utilize effectively the innate capacities of its people. This is true not only of Singapore but necessarily of other developing nations. It can be safely presumed that since most developing states' concerns about the quality of their human resources and the progress of their nation-building work are inextricably bound to those about the quantity of their population, the "quality and not quantity" motto of Singapore's manpower development programs can also be their guiding principle.

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.

Addressing Adherence to Antiretroviral Therapy in Ouagadougou, Burkina Faso: Insights from hospital ethnography

L'épidémie de l'infection au virus de l'immunodéficience humaine (VIH) constitue une crise majeure en santé publique de nos jours. Les efforts de la communauté internationale visent à rendre les traitements antirétroviraux (TARV) plus accessibles aux personnes vivant avec le VIH, particulièrement dans les contextes à ressources limitées. Une observance quasi-parfaite aux TARV est requise pour tirer le maximum de bénéfices thérapeutiques à l'échelle individuelle et à l'échelle populationnelle. Cependant, l’accroissement de la disponibilité des TARV s'effectue dans des pays africains qui disposent de systèmes de santé fragiles et sous-financés. Ceux-ci souffrent également d'une pénurie de personnel de santé, lequel joue un rôle central dans la mise en oeuvre et la pérennité des interventions, notamment celle du soutien à l'observance thérapeutique. La présente étude ethnographique relate l'expérience de personnel de santé dans la fourniture des services de soutien à l'observance dans un contexte de ressources limitées et d'accroissement de l'accès aux TARV. L'étude a été menée dans deux centres hospitaliers de la capitale du Burkina Faso, Ouagadougou. Trois conclusions principales sont mises au jour. Tout d'abord, une bonne organisation – tant logistique que matérielle – dans la provision de services de soutien à l'observance est capitale. L’infrastructure d’observance doit aller au-delà des unités de prise en charge et s’intégrer au sein du système de santé pour assurer un impact durable. De plus, la provision des TARV dans le cadre d'une prise en charge médicale exhaustive est essentielle pour un soutien à l'observance efficace. Ceci implique la présence de professionnelles de santé en nombre suffisant et disposant d‘outils pour soutenir leur pratique clinique (tests de laboratoire, traitements pour infections opportunistes), ainsi que des mécanismes pour leur permettre d’aider les patients à gérer la vie quotidienne (gratuité des services, programmes d’alphabétisation et soutien psychosociale). Enfin, une amélioration de la coordination des programmes VIH au niveau national et international est nécessaire pour assurer une prise en charge cohérente au niveau local. La programmation conçue dans les pays étrangers qui est incomplète et de courte durée a un impact majeur sur la disponibilité de ressources humaines et matérielles à long terme, ainsi que sur les conditions de travail et de prestation de services dans les unités de soins.

Identification précoce des nouveau-nés qui auront des problèmes de développement à deux ans: utilité de l'Évaluation neurologique d'Amiel-Tison

Malgré les avancées médicales, la prédiction précoce du devenir développemental des enfants nés prématurément demeure un défi. Ces enfants sont à risque de séquelles plus ou moins sévères telles l'infirmité motrice d'origine cérébrale, les déficiences intellectuelles et sensorielles ainsi que les difficultés d'apprentissage. Afin de diminuer l’impact fonctionnel de ces séquelles, l’identification de marqueurs précoces devient un enjeu important. Dans le contexte actuel de ressources financières et humaines limitées, seuls les enfants nés avant 29 semaines de gestation ou avec un poids de naissance (PN) <1250g sont systématiquement suivis, laissant pour compte 95% des enfants prématurés. L’identification de marqueurs précoces permettrait de cibler les enfants nés après 28 semaines de gestation porteurs de séquelles. Le principal objectif des présents travaux visait à évaluer l’utilité de l’Évaluation neurologique d’Amiel-Tison (ENAT) dans l’identification et le suivi des enfants nés entre 29 et 37 semaines de gestation et qui présenteront des problèmes neurodéveloppementaux à l’âge corrigé (AC) de 24 mois. Plus précisément, la fidélité inter-examinateurs, la stabilité ainsi que la validité prédictive de l’ENAT ont été évaluées. La cohorte était composée initialement de 173 enfants nés entre 290/7 et 370/7 semaines de gestation, avec un PN<2500g et ayant passé au moins 24 heures à l’unité de soins néonatals du CHU Sainte-Justine. Les enfants étaient évalués avec l’ENAT à terme et aux AC de 4, 8, 12 et 24 mois. À l’AC de 24 mois, leur développement était évalué à l’aide du Bayley Scales of Infant Development–II. Les principaux résultats révèlent une excellente fidélité inter-examinateurs ainsi qu’une bonne stabilité au cours des deux premières années de vie du statut et des signes neurologiques. Des différences significatives à l’AC de deux ans ont été relevées aux performances développementales en fonction du statut neurologique à terme, qui constitue l’un des meilleurs facteurs prédictifs de ces performances. Les résultats encouragent l’intégration du statut neurologique tel que mesuré par l’ENAT comme marqueur précoce dans le cours d’une surveillance neurodéveloppementale des enfants les plus à risque.

Flexibilité des pratiques de gestion des ressources humaines et intention de quitter des salariés.

Cette recherche s’intéresse au concept de la GRH à la carte et à son influence sur l’intention de départ des salariés. Pour ce faire, nous avons dû définir les différentes composantes qui entourent notre concept principal, nous faisons référence aux espaces de choix relatifs à l’organisation et à l’aménagement du temps de travail, aux espaces de choix relatifs à la rémunération, à la formation, etc. Dans leur description, ces pratiques qu’on trouve au coeur du concept de la GRH à la carte nous permettent de prendre conscience que la gestion des ressources humaines connaît une nouvelle facette. Celle-ci s’explique principalement par le souci des entreprises d’aujourd’hui de se rapprocher des attentes de leurs salariés, en leur offrant un certain nombre d’espaces de choix dans leur emploi. Les gestionnaires des ressources humaines parlent alors de personnalisation des pratiques des RH, ce qui exige une certaine flexibilité de la part des organisations. Ainsi, l’élaboration de notre étude nous a permis de présenter un modèle théorique dont l’objectif est de tester l’influence de la flexibilité des différents espaces de choix de la GRH à la carte sur l’intention de départ souvent manifestée par les salariés. Les résultats obtenus à l’aide de l’analyse multivariée appliquée à des données d’une institution bancaire haïtienne mettent en évidence l’impact significatif de certaines pratiques et le rôle médiateur du sentiment d’autodétermination dans la décision des salariés. Mots clés : Intention de départ volontaire, flexibilité des pratiques de la GRH à la carte, sentiment d’auto-détermination