Das práticas espontâneas à receita de humanização: um estudo sobre a implementação da política nacional de humanização em um hospital do Rio de Janeiro

Este estudo contempla a implementação da Política Nacional de Humanização no Hospital da Lagoa, unidade hospitalar sob gestão do Governo Federal, situada no Município do Rio de Janeiro. A escolha do Hospital da Lagoa baseou-se na tradição dessa unidade em implantar ações e atividades inovadoras com vistas à melhoria da qualidade da assistência e, também, pela proximidade que a pesquisadora desenvolveu com a instituição ao longo de sua vida profissional. Foi privilegiada a perspectiva dos gestores da instituição quanto à experiência de Humanização, iniciada em 2003 e ainda em curso. De acordo com a política, entende-se por humanização a valorização dos diferentes sujeitos implicados no processo de produção de saúde: usuários, trabalhadores e gestores. Como estratégia de mudanças, a humanização orienta-se por três princípios: a transversalidade; a estreita vinculação entre a atenção e a gestão em saúde; e a autonomia e protagonismo dos sujeitos nos processos de trabalho. Em se tratando de um estudo de caso, a metodologia do trabalho observou a triangulação, combinando análise documental, observação participante e realização de entrevistas semi-estruturadas com 17 gestores, de diversas categorias profissionais e diferentes níveis de chefia. A análise dos dados revelou a existência de muitos obstáculos a serem transpostos para a institucionalização da política. Entre estes, foram apontados pelos entrevistados: a fragilidade da política de humanização e a própria cultura organizacional instituída. Nesta, segundo os entrevistados, se localizam os entraves à gestão do trabalho: dificuldade na formação de equipes multiprofissionais, desconsideração com a saúde do trabalhador e inoperância do Colegiado de Gestão Participativa local. Embora tenham sido indicados aspectos favoráveis ao processo, ao final do trabalho de campo ainda não tinham sido implantados todos os dispositivos preconizados pela Política Nacional de Humanização. Ademais, os esforços para sua implementação passaram a concorrer com o a implantação de um programa de acreditação hospitalar, pactuado com o Ministério da Saúde.

Effects of thiamine on treatment performance of textile wastewater

Textile wastewater is commonly treated with activated sludge process technology. However, its treatment performance has not been demonstrated to be very effective. In this study, the effects of micronutrient thiamine on removal efficiencies of dissolved organic carbon (DOC) and chemical oxygen demand (COD) of textile wastewater in a batch test, together with its effect on the oxygen uptake rate (OUR) of activated sludge, were evaluated. Significant improvements were observed in the removal rates of DOC, COD and OUR with 121%, 156% and 121% of those of the control, respectively, when 0.5-2.0 mg/L thiamine was added to the wastewater treatment system. Thiamine could be probably used to improve the treatment performance of textile wastewater.

Enhancing the Performance of the Organic Light-emitting Device (OLED) by Thermal Treatment

A comparative study on the annealing of the ITO substrates and the organic layers were conducted on Organic light-emitting device (OLED). We fabricated four devices with the structure of Al/Alq(3)/TPD: PVK/NiO/ITO/Glass, and investigated the effect of heat on device performance by selectively annealing. When the TPD: PVK layers were annealed at 90 degrees C with 30 min annealing time and the ITO substrates were annealed at 300 degrees C with a constant annealing time (100 min). We find the OLED shows obvious performance improvement in brightness and current efficiency, which is attributable to the fact that annealing reduces defects and improves the interface structures of the organics and the organic/ITO interfaces. On the other hand, an appropriate annealing would slow the transportation of the hole, thus finally leads to more balanced electron and hole.

Design of a salisbury screen absorber using frequency selective surfaces to improve bandwidth and angular stability performance

A new design method that greatly enhances the reflectivity bandwidth and angular stability beyond what is possible with a simple Salisbury screen is described. The performance improvement is obtained from a frequency selective surface (FSS) which is sandwiched between the outermost 377 Ω/square resistive sheet and the ground plane. This is designed to generate additional reflection nulls at two predetermined frequencies by selecting the size of the two unequal length printed dipoles in each unit cell. A multiband Salisbury screen is realised by adjusting the reflection phase of the FSS to position one null above and the other below the inherent absorption band of the structure. Alternatively by incorporating resistive elements midway on the dipoles, it is shown that the three absorption bands can be merged to create a structure with a −10 dB reflectivity bandwidth which is 52% larger and relatively insensitive to incident angle compared to a classical Salisbury screen having the same thickness. CST Microwave Studio was used to optimise the reflectivity performance and simulate the radar backscatter from the structure. The numerical results are shown to be in close agreement with bistatic measurements for incident angles up to 40° over the frequency range 5.4−18 GHz.

The effect of relationship management on project performance in construction

Few studies to date have paid attention to relationship management when addressing performance problems. To bridge the knowledge gap, a questionnaire survey is conducted to analyze the impact of relationship management on project performance in construction. The analysis reveals that the deterioration of working relationships may increase the likelihood of poor performance. Poor performance can be effectively reduced by improving some aspects of working relationships. Collaborative working contributes to performance improvement, in which long-term collaboration is more effective than short-term collaboration. In addition to the questionnaire survey, a series of expert interviews provide a deeper insight into effective relationship management.

Incentive Mechanisms and Their Impact on Project Performance

Good performance characterizes project success and value for money. However, performance problems are not uncommon in project management. Incentivization is generally recognized as a strategy of addressing performance problems. This chapter aims to explore incentive mechanisms and their impact on project performance. It is mainly based on the use of incentives in construction and engineering projects. The same principles apply to project management in other industry sectors. Incentivization can be used in such performance areas as time, cost, quality, safety and environment. A client has different ways of incentivizing his contractor’s performance, e.g. (1) a single incentive or multiple incentives; and (2) incentives or disincentives or a combination of both. The establishment of incentive mechanisms proves to have a significant potential for relationship development, process enhancement and performance improvement. In order to ensure the success of incentive mechanisms, both contractors and clients need to make extra efforts. As a result, a link is developed among incentive mechanisms, project management system and project performance.

The application of early contractor involvement and its impact on project performance

Early contractor involvement is a topic that has attracted attention from construction practitioners and researchers in the UK since the 1990s. It has been adopted to introduce construction knowledge and experience to the design process, and to integrate design with construction. In contrast with the limited number of previous studies on early contractor involvement, which used case studies, a questionnaire survey was conducted in this study, to investigate the application of early contractor involvement in current practice and its impact on project performance in terms of time, cost and quality. From an analysis of the questionnaire results, early contractor involvement is found to be increasingly used in the construction industry, and to have a significant impact on cost and time performance. This research provides empirical evidence related to the practice of early contractor involvement. It demonstrates the major influence of early contractor involvement on management processes and working relationships during a project, which contribute to performance improvement and project success.

Les dimensions négligées de l'évaluation de la performance : les valeurs et la qualité de vie au travail

L’objet de cette thèse est l’élaboration d’un modèle logique de mesure du maintien des valeurs, ainsi que son opérationnalisation afin d’entreprendre l’évaluation de la performance des systèmes de santé. Le maintien des valeurs est l’une des quatre fonctions de la théorie de l’action sociale de T.Parsons permettant d’analyser les systèmes d’action. Les autres fonctions sont l’adaptation, la production et l’atteinte des buts. Cette théorie est la base du modèle EGIPSS (évaluation globale et intégrée de la performance des systèmes de santé), dans lequel cette thèse s’insère. La fonction étudiée correspond, dans l’oeuvre de T.Parsons, au sous-système culturel. Elle renvoie à l’intangible, soit à l’univers symbolique par lequel l’action prend son sens et les fonctions du système s’articulent. Le modèle logique de mesure du maintien des valeurs est structuré autour de deux concepts principaux, les valeurs individuelles et organisationnelles et la qualité de vie au travail. À travers les valeurs individuelles et organisationnelles, nous mesurons la hiérarchie et l’intensité des valeurs, ainsi que le niveau de concordance interindividuelle et le degré de congruence entre les valeurs individuelles et organisationnelles. La qualité de vie au travail est composée de plusieurs concepts permettant d’analyser et d’évaluer l’environnement de travail, le climat organisationnel, la satisfaction au travail, les réactions comportementales et l’état de santé des employés. La mesure de ces différents aspects a donné lieu à la conception de trois questionnaires et de trente indicateurs. Ma thèse présente, donc, chacun des concepts sélectionnés et leurs articulations, ainsi que les outils de mesure qui ont été construits afin d’évaluer la dimension du maintien des valeurs. Enfin, nous exposons un exemple d’opérationnalisation de ce modèle de mesure appliqué à deux hôpitaux dans la province du Mato Grosso du Sud au Brésil. Cette thèse se conclut par une réflexion sur l’utilisation de l’évaluation comme outil de gestion soutenant l’amélioration de la performance et l’imputabilité. Ce projet comportait un double enjeu. Tout d’abord, la conceptualisation de la dimension du maintien des valeurs à partir d’une littérature abondante, mais manquant d’intégration théorique, puis la création d’outils de mesure permettant de saisir autant les aspects objectifs que subjectifs des valeurs et de la qualité de vie au travail. En effet, on trouve dans la littérature de nombreuses disciplines et de multiples courants théoriques tels que la psychologie industrielle et organisationnelle, la sociologie, les sciences infirmières, les théories sur le comportement organisationnel, la théorie des organisations, qui ont conçu des modèles pour analyser et comprendre les perceptions, les attitudes et les comportements humains dans les organisations. Ainsi, l’intérêt scientifique de ce projet découle de la création d’un modèle dynamique et intégrateur offrant une synthèse des différents champs théoriques abordant la question de l’interaction entre les perceptions individuelles et collectives au travail, les conditions objectives de travail et leurs influences sur les attitudes et les comportements au travail. D’autre part, ce projet revêt un intérêt opérationnel puisqu’il vise à fournir aux décideurs du système de santé des connaissances et données concernant un aspect de la performance fortement négligé par la plupart des modèles internationaux d’évaluation de la performance.

Comparaison de la performance de deux hôpitaux psychiatriques situés l’un en Colombie et l’autre au Québec

Les problèmes de santé mentale représentent un pourcentage important du fardeau de morbidité mondiale. Cela, ajouté aux ressources limitées disponibles pour le fonctionnement des établissements, encourage l’intérêt pour l’évaluation de leur performance. Ce projet propose d’utiliser le modèle ÉGIPSS pour évaluer la performance de deux hôpitaux psychiatriques dans deux systèmes de santé différents, le « Hospital Psiquiátrico Universitario del Valle » (HPUV) situé en Colombie et l’Institut universitaire en santé mentale Douglas au Québec. Le modèle a été choisi en raison de la richesse des dimensions qu’il comprend et son caractère global. Les données ont été recueillies à travers des entrevues et de la documentation disponible dans les établissements. L’analyse des résultats montre que le Douglas a une meilleure performance générale, même tenant compte qu’il se trouve dans un pays à haut revenu avec des standards d’évaluation supérieures. De vingt-et-une sous-dimensions évaluées, l’HPUV a présente six avec un état préoccupante et le Douglas aucune. L’analyse des résultats a aussi servi pour identifier des facteurs de causalité critiques des problèmes de performance, soit l’organisation à l’intérieur des établissements, la communication interne, les plans de santé mentale et la disponibilité des professionnels. La comparaison a permis apprécier l’influence de ces éléments dans les deux contextes.

Comparative performance of UK PFI and non-PFI hospitals

Since the first PFI hospital was established in 1994, many debates centred on the value for money and risk transfer in PFIs. Little concern is shown with PFI hospitals’ performance in delivering healthcare. Exploratory research was carried out to compare PFI with non‐PFI hospital performance. Five performance indicators were analysed to compare differences between PFI and non‐PFI hospitals, namely the length of waiting, the length of stay, MRSA infection rate, C difficile infection rate and patient experience. Data was collected from various government bodies. The results show that only some indexes measuring patient experience emerge statistically significant. This leads to a conclusion that PFI hospitals may not perform better than non‐PFI hospitals but they are not worse than non‐PFI hospitals in the delivery of services. However, future research needs to pay attention to reliability and validity of data sets currently available to undertake comparison.

Construção de base organizacional e suas implicações para performance corporativa: evidências da área abastecimento do Petróleo brasileiro S.A.

Esta dissertação examina algumas implicações do processo de implementação de estratégias para a performance corporativa. Este relacionamento é examinado na Área de negócios Abastecimento, da empresa Petróleo Brasileiro S.A, durante o período de 1996 e 2003. A despeito da profusão de estudos sobre estratégia empresarial, ainda há escassez de trabalhos que examinem o processo de implementação de mudanças organizacionais e suas implicações para o aprimoramento de certos indicadores de performance corporativa. Adicionalmente, tendem a prevalecer na literatura gerencial, abordagens pontuais de caráter imediatista e prescritivo, que não captam o processo de mudança organizacional e suas implicações para performance ao longo do tempo. o exame da implementação de estratégias é realizado com base em seis variáveis organizacionais extraídas da literatura existente: "comportamento da liderança"; "interação e influência"; "inovação e aprendizado"; "gestão de pessoas"; "comunicação e fluxos de conhecimento" e "estrutura organizacional". As implicações das mudanças na base organizacional para performance corporativa são examinadas a partir de dezenove indicadores, agrupados em três categorias: (i) operacionais, (ii) econômico-financeiro e (iii) segurança, meio ambiente e saúde. Esta dissertação consiste num estudo de caso individual, o qual é baseado em evidências empíricas qualitativas e quantitativas, coletadas em trabalhos de campo. A coleta dos dados baseou-se em fontes e técnicas múltiplas. Os efeitos das variáveis organizacionais que comporiam o Abastecimento, antes da criação da Área de negócio, em 1996, foram pequenos. Esses efeitos foram moderados no período entre 1996 a 2000, só apresentando impactos relevantes sobre indicadores operacionais entre 2000 e 2003, com reflexos positivos sobre o desempenho econômico, pois muitos custos foram reduzidos. Isso sugere que estratégias tecnológicas de longo prazo são um rumo robusto e consistente. As evidências sugerem que a empresa optou pela construção de uma base organizacional visando melhoria de performance no longo prazo, alinhando-se com autores que defendem essa construção como forma de fortalecer a competitividade no longo prazo. Esta dissertação contribui para o entendimento de fatores organizacionais que favorecem a implementação de estratégias e dos mecanismos que alavancam aprendizado e inovação numa empresa nacional. Este estudo conclui que a utilização de estruturas organizacionais, com o suporte da liderança e prática de baixas barreiras interfuncionais, alavancaram o aprendizado e a inovação, favorecendo resultados econômicos. Isto contradiz a proposição de autores que afirmam que reestruturação organizacional possui baixo potencial de geração de resultados, ou que enfatizam soluções de curto prazo para obtenção imediata de resultados, em detrimento da competitividade da empresa nos médio e longo prazos.

Acumulação de competências tecnológicas e suas implicações para o aprimoramento de indicadores de performance operacional na Gradiente Eletrônica S.A. - Unidade Manaus

Esta dissertação enfoca as implicações práticas da trajetória de acumulação de competências tecnológicas para o aprimoramento de indicadores de performance operacional. Esse relacionamento é examinado na Gradiente Eletrônica S/A durante período de 1970 a 2000. Baseada em um estudo de caso individual, esta dissertação fundamenta-se em evidências empíricas, qualitativas e quantitativas, coletadas por meio de entrevistas, observação direta e documentos internos da empresa em estudo. O exame da acumulação de competências tecnológicas é feito através de uma estrutura descritiva existente na literatura, porém adaptada especificamente para a indústria de eletroeletrônicos de consumo. O exame do aprimoramento de performance é baseado num conjunto de indicadores operacionais, típicos da indústria de eletroeletrônicos. A aplicação de estruturas descritivas, para examinar as implicações da acumulação de competências tecnológicas sobre o aprimoramento de performance operacional, em empresas de eletro-eletrônicos, ainda é escassa, principalmente no nível intra firma e em economias de industrialização recente, como no Brasil. Em termos de evidência empírica, a dissertação mostra que a acumulação de competências tecnológicas evoluiu de maneira irregular, lenta, não linear e, alguns níveis, foram acumulados de forma incompleta. As evidências sugerem, ainda, que a acumulação de competências tecnológicas influenciou positivamente o aprimoramento de onze indicadores de desempenho. Contudo, os níveis desenvolvidos não foram suficientes para aprimorar, ou mesmo sustentar, outros dois indicadores de performance. Alinhando-se a recentes estudos na literatura de empresas de economias emergentes (ex.: Figueiredo, 2001), as evidências desta dissertação sugerem que a maneira e a velocidade com que a empresa acumula suas competências tecnológicas, joga um papel chave no aprimoramento de seus indicadores de performance técnica. Por conseguinte, isto pode gerar beneficios para a performance financeira, como por exemplo, a margem operacional líquida. Não obstante, a experiência da Gradiente sugere que, outros fatores, internos e externos à empresa, podem obscurecer ou mesmo minar as contribuições da acumulação de competências tecnológicas.

Acumulação de competências tecnológicas e suas implicações para performance operacional: análise comparativa de duas empresas do grupo Lupatec em Caxias do Sul - RS

This work focuses on the implications of accumulation of technological competences for improvement of operational performance indicators. This relationship is examined in two mechanical industry firms in Caxias do Sul-RS, in the period 1985-2000. Based on a comparative case study, this work finds its ground in both qualitative and quantitative empirical evidences, collected in different sources in the firms, which are being studied. The examination of accumulation of technological competences is done through a structure of analysis existing in literature, which is specifically adapted to the mechanical industry. The examination of performance improvement is based on a set of typical operational indicators pertaining to mechanical industry. Studies of this nature are already found, mainly in Latin American literature, since the eighties. But, the application of these analytic structures in industrializing firms in Brazil is found only in the nineties. This work shows that within a unique enterprise group there is a different accumulation of technological competences, and it demonstrates that this process is not automatic. Moreover, it contributes to explain not only the differences between both firms, in terms of operational performance at some points in time, but also, how both firms got to (or did not get to) improve their performance indicators along time. This conclusion is not different from that of previous studies, but it derives from a study made in a specific industry (mechanical), which has not yet been studied in the south of Brazil.

Implicações das competências técnico-organizacionais para a performance competitiva em empresas seguidoras de mercado: evidências do segmento de turismo de aventura no Rio de Janeiro

This work focuses on the implications of technological-organizational competences for improvement of performance indicators. This relationship is examined during 1984 to 2005 in three small companies that operate in Rio de Janeiro within adventure tourism, more specifically, within tandem flights on hang-gliding. Based on a comparative case study grounded in both qualitative and quantitative empirical evidences collected in a detailed field search, this study is supported by an existing metric available in literature and adapted to adventure tourism segment. The metric to measure competences is based on four techno-organizational function: (i) product; (ii) sales & marketing; (iii) infra-structure & operational process; (iv) managing systems. The examination of performance improvement is based on a set of typical indicators used by this segment to evaluate results. This dissertation contributes to deepening the understanding of how techno-organizational competences affect the competitive performance of companies in this sector of adventure tourism.

Acumulação de Competências Tecnológicas e suas Implicações para a Performance Corporativa: Um Estudo Comparativo entre Duas Empresas da Indústria Moveleira em Bento Gonçalves - RS

This dissertation focus the implication of differences in accumulation of technological competences among companies and its reflex on the improvement of indexes of operational, economical and financial performance. This connection has been investigated at D'Itália Móveis Industrial Ltda. and Pozza S.A Industrial Moveleira, both companies of the furniture market located in Bento Gonçalves - RS. Based on a comparative case study of these two companies, this dissertation is based on empiric evidences about how the company has accumulated its technological competences. Such evidences are qualitative and quantitative, and were collected from several sources in the studied companies. The examination of technological competences accumulation is done based on an analytical structure that exists in the literature, that has been adapted to the analysis of the furniture market. The examination of performance improvement is based on a set of indexes used in the furniture industry. Studies about this subject are found in the literature, but the application of these analytic structures in the furniture market is scarce, mainly in brazilian companies. It has been noticed that the company D'Itália has accumulated technological competences on all the three functions analysed, what suggests implications for the improvement of its performance. On the other side, the company Pozza has shown a paralysation on technological competences accumulation during a long time, what brought implications for the reduction of its corporative performance. In this way, the conclusion of this dissertation suggests that the accumulation of technological competences has contributed to explain the differences of performance between both companies. Besides, it explains how both companies have managed (or not) to accumulate their indexes of performance in the long run. Even though this conclusion is not different from other studies formerly done, this conclusion is derivated from a study applied to a kind of industry that still wasn¿t examined in the available literature.