Organização do trabalho, conflitos e agressões em uma emergência hospitalar na cidade de São Paulo, Brasil

As condições e processos de trabalho penosos dos pronto-socorros somados a elevada demanda frente à capacidade e gravidade dos casos, dificultam as decisões, impactam no atendimento e favorecem conflitos. Trata-se de um estudo de caso, exploratório e qualitativo, utilizou-se dados documentais, entrevistas semiestruturadas e observação do trabalho, especificamente dos porteiros. Objetivou-se verificar como características da organização do trabalho aumentam conflitos e agressões em um pronto-socorro comprometendo os atendimentos. Constatou-se que os porteiros estão na linha de frente e são expostos à pressão dos usuários por atendimento. Para solucionar conflitos, extrapolam regras e procedimentos, realizam tarefas além da sua competência, podendo alterar o fluxo e a qualidade do atendimento. Os arranjos organizacionais desconsideram os porteiros como parte da equipe de cuidados expondo-os a conflitos e agressões. Espera-se contribuir para mudanças, melhorar as relações, a segurança e o fluxo de atendimento.

Evaluation of the capability of decentralized management of epidemiological surveillance in the state of Bahia

Evaluative research into the capability of decentralized management of epidemiological vigilance (EV) was conducted in the operational, organizational and sustainable dimensions in the state of Bahia, Brazil. The quantitative approach was used in the construction of a baseline, with primary data obtained through an online questionnaire answered by thirty-eight municipal EV managers. In the qualitative approach to analyze the context and assess the management capability of municipalities in two case studies, techniques adapted to the analysis of discursive practices were used. This was done through semi-structured interviews with managers of regional and municipal government, health workers and representatives of the municipal health council. The case studies showed that the municipality with enhanced management capability is that in which the manager has the greatest potential of using the resources of his position, in addition to his ability to control, negotiate and coordinate with other actors. Due to decentralization of EV, considering the shared nature of management between the three spheres of government, there is a marked variation in the management capability of municipalities, determined by social, economic, political inequalities and management mechanisms adopted.

Organization Performance Evaluation Using System Thinking: A Study in Brazilian Chemical Organizations Models

System thinking allows companies to use subjective constructs indicators like recursiveness, cause-effect relationships and autonomy to performance evaluation. Thus, the question that motivates this paper is: Are Brazilian companies searching new performance measurement and evaluation models based on system thinking? The study investigates models looking for system thinking roots in their framework. It was both exploratory and descriptive based on a multiple four case studies strategy in chemical sector. The findings showed organizational models have some characteristics that can be related to system thinking as system control and communication. Complexity and autonomy are deficiently formalized by the companies. All data suggest, inside its context, that system thinking seems to be adequate to organizational performance evaluation but remains distant from the management proceedings.

The implementation of effective dual-language programs

[EN]This research investigates the ways of implementing dual-language programs and the schools’ internal procedures of evaluating them. Previous studies have examined the effectiveness of bilingual programs (Genovesee et al. 2005; Howard et al. 2005; Krashen 2004). However, there is little still known about schools’ procedures that systematize the organizational aspect of such programs. The Mixed Methods Research (MMR) approach was applied in this study to analyze data collected through questionnaires, interviews, and case studies.

Formazione, apprendimento e nuove prospettive e-learning. Lo sviluppo delle nuove tecnologie didattiche e la creazione di sistemi di apprendimento lungo l’intero arco della vita

The thesis of this paper is based on the assumption that the socio-economic system in which we are living is characterised by three great trends: growing attention to the promotion of human capital; extremely rapid technological progress, based above all on the information and communication technologies (ICT); the establishment of new production and organizational set-ups. These transformation processes pose a concrete challenge to the training sector, which is called to satisfy the demand for new skills that need to be developed and disseminated. Hence the growing interest that the various training sub-systems devote to the issues of lifelong learning and distance learning. In such a context, the so-called e-learning acquires a central role. The first chapter proposes a reference theoretical framework for the transformations that are shaping post-industrial society. It analyzes some key issues such as: how work is changing, the evolution of organizational set-ups and the introduction of learning organization, the advent of the knowledge society and of knowledge companies, the innovation of training processes, and the key role of ICT in the new training and learning systems. The second chapter focuses on the topic of e-learning as an effective training model in response to the need for constant learning that is emerging in the knowledge society. This chapter starts with a reflection on the importance of lifelong learning and introduces the key arguments of this thesis, i.e. distance learning (DL) and the didactic methodology called e-learning. It goes on with an analysis of the various theoretic and technical aspects of e-learning. In particular, it delves into the theme of e-learning as an integrated and constant training environment, characterized by customized programmes and collaborative learning, didactic assistance and constant monitoring of the results. Thus, all the aspects of e-learning are taken into exam: the actors and the new professionals, the virtual communities as learning subjects, the organization of contents in learning objects, the conformity to international standards, the integrated platforms and so on. The third chapter, which concludes the theoretic-interpretative part, starts with a short presentation of the state-of-the-art e-learning international market that aims to understand its peculiarities and its current trends. Finally, we focus on some important regulation aspects related to the strong impulse given by the European Commission first, and by the Italian governments secondly, to the development and diffusion of e-learning. The second part of the thesis (chapters 4, 5 and 6) focus on field research, which aims to define the Italian scenario for e-learning. In particular, we have examined some key topics such as: the challenges of training and the instruments to face such challenges; the new didactic methods and technologies for lifelong learning; the level of diffusion of e-learning in Italy; the relation between classroom training and online training; the main factors of success as well as the most critical aspects of the introduction of e-learning in the various learning environments. As far as the methodological aspects are concerned, we have favoured a qualitative and quantitative analysis. A background analysis has been done to collect the statistical data available on this topic, as well as the research previously carried out in this area. The main source of data is constituted by the results of the Observatory on e-learning of Aitech-Assinform, which covers the 2000s and four areas of implementation (firms, public administration, universities, school): the thesis has reviewed the results of the last three available surveys, offering a comparative interpretation of them. We have then carried out an in-depth empirical examination of two case studies, which have been selected by virtue of the excellence they have achieved and can therefore be considered advanced and emblematic experiences (a large firm and a Graduate School).

Strategy as a matter of beliefs: the recorded music industry reinventing itself by rethinking itself

Managerial and organizational cognition studies the ways cognitions of managers in groups, organizations and industries shape their strategies and actions. Cognitions refer to simplified representations of managers’ internal and external environments, necessary to cope with the rich, ambiguous information requirements that characterize strategy making. Despite the important achievements in the field, many unresolved puzzles remain as to this process, particular as to the cognitive factors that condition actors in framing a response to a discontinuity, how actors can change their models in the face of a discontinuity, and the reciprocal relation between cognition and action. I leverage on the recent case of the recorded music industry in the face of the digital technology to study these issues, through a strategy-oriented study of the way early response to the discontinuity was constructed and of the subsequent evolution of this response. Through a longitudinal historical and cognitive analysis of actions and cognitions at both the industry and firm-level during the period in which the response took place (1999-2010), I gain important insights on the way historical beliefs in the industry shaped early response to the digital disruption, on the role of outsiders in promoting change through renewed vision about important issues, and on the reciprocal relationship between cognitive and strategic change.

Comparison between analytical and numerical methods for the assessment of masonry arch bridges: Case study of Clemente Bridge on Savio river

This research has focused on the study of the behavior and of the collapse of masonry arch bridges. The latest decades have seen an increasing interest in this structural type, that is still present and in use, despite the passage of time and the variation of the transport means. Several strategies have been developed during the time to simulate the response of this type of structures, although even today there is no generally accepted standard one for assessment of masonry arch bridges. The aim of this thesis is to compare the principal analytical and numerical methods existing in literature on case studies, trying to highlight values and weaknesses. The methods taken in exam are mainly three: i) the Thrust Line Analysis Method; ii) the Mechanism Method; iii) the Finite Element Methods. The Thrust Line Analysis Method and the Mechanism Method are analytical methods and derived from two of the fundamental theorems of the Plastic Analysis, while the Finite Element Method is a numerical method, that uses different strategies of discretization to analyze the structure. Every method is applied to the case study through computer-based representations, that allow a friendly-use application of the principles explained. A particular closed-form approach based on an elasto-plastic material model and developed by some Belgian researchers is also studied. To compare the three methods, two different case study have been analyzed: i) a generic masonry arch bridge with a single span; ii) a real masonry arch bridge, the Clemente Bridge, built on Savio River in Cesena. In the analyses performed, all the models are two-dimensional in order to have results comparable between the different methods taken in exam. The different methods have been compared with each other in terms of collapse load and of hinge positions.

L'utilizzo dei casi di studio per favorire l'apprendimento di metodologie e strumenti per lo sviluppo organizzativo o di percorsi di cura nelle aziende sanitarie

La formazione, in ambito sanitario, è considerata una grande leva di orientamento dei comportamenti, ma la metodologia tradizionale di formazione frontale non è la più efficace, in particolare nella formazione continua o “long-life education”. L’obiettivo primario della tesi è verificare se l’utilizzo della metodologia dello “studio di caso”, di norma utilizzata nella ricerca empirica, può favorire, nel personale sanitario, l’apprendimento di metodi e strumenti di tipo organizzativo-gestionale, partendo dalla descrizione di processi, decisioni, risultati conseguiti in contesti reali. Sono stati progettati e realizzati 4 studi di caso con metodologia descrittiva, tre nell’Azienda USL di Piacenza e uno nell’Azienda USL di Bologna, con oggetti di studio differenti: la continuità di cura in una coorte di pazienti con stroke e l’utilizzo di strumenti di monitoraggio delle condizioni di autonomia; l’adozione di un approccio “patient-centred” nella presa in carico domiciliare di una persona con BPCO e il suo caregiver; la percezione che caregiver e Medici di Medicina Generale o altri professionisti hanno della rete aziendale Demenze e Alzheimer; la ricaduta della formazione di Pediatri di Libera Scelta sull’attività clinica. I casi di studio sono stati corredati da note di indirizzo per i docenti e sono stati sottoposti a quattro referee per la valutazione dei contenuti e della metodologia. Il secondo caso è stato somministrato a 130 professionisti sanitari all’interno di percorso di valutazione delle competenze e dei potenziali realizzato nell’AUSL di Bologna. I referee hanno commentato i casi e gli strumenti di lettura organizzativa, sottolineando la fruibilità, approvando la metodologia utilizzata, la coniugazione tra ambiti clinico-assistenziali e organizzativi, e le teaching note. Alla fine di ogni caso è presente la valutazione di ogni referee.

Operational research applied to regional healthcare system

In this thesis we focus on optimization and simulation techniques applied to solve strategic, tactical and operational problems rising in the healthcare sector. At first we present three applications to Emilia-Romagna Public Health System (SSR) developed in collaboration with Agenzia Sanitaria e Sociale dell'Emilia-Romagna (ASSR), a regional center for innovation and improvement in health. Agenzia launched a strategic campaign aimed at introducing Operations Research techniques as decision making tools to support technological and organizational innovations. The three applications focus on forecast and fund allocation of medical specialty positions, breast screening program extension and operating theater planning. The case studies exploit the potential of combinatorial optimization, discrete event simulation and system dynamics techniques to solve resource constrained problem arising within Emilia-Romagna territory. We then present an application in collaboration with Dipartimento di Epidemiologia del Lazio that focuses on population demand of service allocation to regional emergency departments. Finally, a simulation-optimization approach, developed in collaboration with INESC TECH center of Porto, to evaluate matching policies for the kidney exchange problem is discussed.

Management control systems : subcomponents, optimal design and the role of time as a contingency

Management Control System (MCS) research is undergoing turbulent times. For a long time related to cybernetic instruments of management accounting only, MCS are increasingly seen as complex systems comprising not only formal accounting-driven instruments, but also informal mechanisms of control based on organizational culture. But not only have the means of MCS changed; researchers increasingly ap-ply MCS to organizational goals other than strategy implementation.rnrnTaking the question of "How do I design a well-performing MCS?" as a starting point, this dissertation aims at providing a comprehensive and integrated overview of the "current-state" of MCS research. Opting for a definition of MCS, broad in terms of means (all formal as well as informal MCS instruments), but focused in terms of objectives (behavioral control only), the dissertation contributes to MCS theory by, a) developing an integrated (contingency) model of MCS, describing its contingencies, as well as its subcomponents, b) refining the equifinality model of Gresov/Drazin (1997), c) synthesizing research findings from contingency and configuration research concerning MCS, taking into account case studies on research topics such as ambi-dexterity, equifinality and time as a contingency.

Reshaping Rural Extension: Learning for Sustainability (LforS): An Integrative and Learning-Based Advisory Approach for Rural Extension with Small-Scale Farmers

This publication offers concrete suggestions for implementing an integrative and learning-oriented approach to agricultural extension with the goal of fostering sustainable development. It targets governmental and non-governmental organisations, development agencies, and extension staff working in the field of rural development. The book looks into the conditions and trends that influence extension today, and outlines new challenges and necessary adaptations. It offers a basic reflection on the goals, the criteria for success and the form of a state-of-the-art approach to extension. The core of the book consists of a presentation of Learning for Sustainability (LforS), an example of an integrative, learning-oriented approach that is based on three crucial elements: stakeholder dialogue, knowledge management, and organizational development. Awareness raising and capacity building, social mobilization, and monitoring & evaluation are additional building blocks. The structure and organisation of the LforS approach as well as a selection of appropriate methods and tools are presented. The authors also address key aspects of developing and managing a learning-oriented extension approach. The book illustrates how LforS can be implemented by presenting two case studies, one from Madagascar and one from Mongolia. It addresses conceptual questions and at the same time it is practice-oriented. In contrast to other extension approaches, LforS does not limit its focus to production-related aspects and the development of value chains: it also addresses livelihood issues in a broad sense. With its focus on learning processes LforS seeks to create a better understanding of the links between different spheres and different levels of decision-making; it also seeks to foster integration of the different actors’ perspectives.

The Role of Science in Controlling Invasive Species: A Case Study on Wild Pigs

Presentation by Dr. Stephen Ditchkoff.

The FORA Framework - A Fuzzy Grassroots Ontology for Online Reputation Management

Online reputation management deals with monitoring and influencing the online record of a person, an organization or a product. The Social Web offers increasingly simple ways to publish and disseminate personal or opinionated information, which can rapidly have a disastrous influence on the online reputation of some of the entities. This dissertation can be split into three parts: In the first part, possible fuzzy clustering applications for the Social Semantic Web are investigated. The second part explores promising Social Semantic Web elements for organizational applications,while in the third part the former two parts are brought together and a fuzzy online reputation analysis framework is introduced and evaluated. Theentire PhD thesis is based on literature reviews as well as on argumentative-deductive analyses.The possible applications of Social Semantic Web elements within organizations have been researched using a scenario and an additional case study together with two ancillary case studies—based on qualitative interviews. For the conception and implementation of the online reputation analysis application, a conceptual framework was developed. Employing test installations and prototyping, the essential parts of the framework have been implemented.By following a design sciences research approach, this PhD has created two artifacts: a frameworkand a prototype as proof of concept. Bothartifactshinge on twocoreelements: a (cluster analysis-based) translation of tags used in the Social Web to a computer-understandable fuzzy grassroots ontology for the Semantic Web, and a (Topic Maps-based) knowledge representation system, which facilitates a natural interaction with the fuzzy grassroots ontology. This is beneficial to the identification of unknown but essential Web data that could not be realized through conventional online reputation analysis. Theinherent structure of natural language supports humans not only in communication but also in the perception of the world. Fuzziness is a promising tool for transforming those human perceptions intocomputer artifacts. Through fuzzy grassroots ontologies, the Social Semantic Web becomes more naturally and thus can streamline online reputation management.

Academic medical centers: A framework for strategic repositioning

This study sought to understand the elements affecting the success or failure of strategic repositioning efforts by academic medical centers (AMC). The research question was: What specific elements in the process appear to be most important in determining the success or failure of an AMC.s strategic repositioning? Where success is based on the longterm sustainability of the new position.^ "An organization's strategic position is its perceptual location relative to others" (Gershon, 2003). Hence, strategic repositioning represents a shift from one strategic position within an environment to another (H. Mintzberg, 1987a). A deteriorating value proposition coupled with an unsustainable national health care financing system is forcing AMCs to change their strategic position. Where the value proposition is defined as the health outcome per dollar spent. ^ AMCs are of foundational importance to our health care system. They educate our new physicians, generate significant scientific breakthroughs, and care for our most difficult patients. Yet, their strategic, financial and business acumen leaves them particularly vulnerable in a changing environment. ^ After a literature review revealed limited writing on this subject, the research question was addressed using three separate but parallel exploratory case study inquiries of AMCs that recently underwent a strategic repositioning. Participating in the case studies were the Baylor College of Medicine, the University of Texas M. D. Anderson Cancer Center, and the University of Texas Medical Branch.^ Each case study consisted of two major research segments; a thorough documentation review followed by semi-structured interviews of selected members of their governance board, executive and faculty leadership teams. While each case study.s circumstances varied, their response to the research question, as extracted through thematic coding and analysis of the interviews, had a high degree of commonality.^ The results identified managing the strategic risk surrounding the repositioning and leadership accountability as the two foundational elements of success or failure. Metrics and communication were important process elements. They both play a major role in managing the strategic repositioning risk communication loop. Sustainability, the final element, was the outcome sought.^ Factors leading to strategic repositioning included both internal and external pressures and were primarily financial or mission based. Timing was an important consideration as was the selection of the strategic repositioning endpoint.^ In conclusion, a framework for the strategic repositioning of AMCs was offered that integrates the findings of this study; the elements of success, the factors leading to strategic repositioning, and the risk communication loop. ^

Value Chain Dynamics and Growth of Local Firms:The Case of Motorcycle Industry in Vietnam

Vietnam’s burgeoning market for motorcycles has attracted global industry eaders,players from developing countries, and local firms. This has led to a dynamic evolution of value chains. This paper presents an explanation of the varieties of the growth patterns xperienced by the local suppliers, focusing on the roles of customer and local supplier strategies. Case studies showed that while the role of customers may be important, strategies of suppliers to improve the ompetitive edge in the production of otorcycle components and to diversify into other products account for important ariations of growth trajectories among local suppliers. Findings presented in this paper suggest the need to direct more attention to strategy that local firms use to boost their competitive edge in business.