A qualidade dos cuidados de enfermagem e a Norma ISO 9001 : Aplicação empírica no Hospital CUF Infante Santo

A preocupação com a qualidade e normalização dos serviços de saúde é cada vez maior, verificando-se que, para responder às progressivas exigências dos utentes, aparecem entidades que criam normas universais, as quais pretendem a garantia da qualidade nos serviços de saúde. Contudo, a implementação de um sistema de gestão da qualidade, através da norma ISO 9001, nestas organizações, é um desafio pela dificuldade de avaliação da qualidade dos serviços prestados- cuidados de saúde. Estando presente num hospital profissional como médicos, enfermeiros e gestores, com características culturais que influenciam a forma de encarar a qualidade e a sua monitorização para a existência de uma mudança profunda, quando se implementa uma política de qualidade, é fundamental conhecer a definição da qualidade de cada profissional, membro de uma cultura e, deste modo, a sua postura perante o fenómeno. O presente trabalho tem como objectivos identificar a percepção dos enfermeiros do Hospital Cuf Infante-Santo, relativamente ao sistema de gestão da qualidade, segundo a norma ISO, e, consequentemente, investigar pontos fortes, pontos fracos, ameaças e oportunidades da implementação dessa norma nessa organização hospitalar. Para atingir os objectivos, foi desenvolvido um modelo de análise, onde se considera o relacionamento entre as características da qualidade em saúde, cultura organizacional hospitalar e do sistema da norma ISO, para o desenvolvimento da melhoria contínua na organização. Os dados, para a elaboração desta dissertação, foram recolhidos através de inquérito por questionários aos enfermeiros do Hospital Cuf Infante-Santo, que se encontravam a laborar na organização aquando da implementação da norma ISO, sendo utilizado o método quantitativo e técnicas do estudo qualitativo na análise de dados orientados para o significado das acções. Do trabalho desenvolvido, conclui-se que a percepção relativamente às alterações na qualidade dos cuidados está limitada pelo facto de a maioria dos respondentes não conhecer o sistema de qualidade (Norma ISO 9001), sendo este um dos pontos fracos para a implementação da norma ISO na organização. Deste modo, a situação diagnosticada constitui um alerta para as organizações de saúde, ao implementarem sistemas de gestão da qualidade, potencializarem os pontos fortes identificados, como a orientação dos enfermeiros para o cuidar e para o cliente e, por outro lado, evitar repetir pontos fracos, como o identificado anteriormente, através do envolvimento e formação dos seus colaboradores nas políticas da qualidade. Os enfermeiros preocupam-se com a qualidade, mas referem que não a monitorizam regularmente. Pelo que, esta necessidade com a implementação do sistema de gestão da qualidade, deverá ser corrigida, de modo a que a organização de saúde em estudo caminhe para a excelência. ABSTRACT: The concern with the quality and standardization of health services is increasing, verifying that to respond to the progressiva demands of the users, there appear entities wishing to create universal standards to ensure the quality in health services. However, implementing a quality management service, through ISO 9001 standard, in these organizations, it is a challenge by the difficulties of evaluation in the quality of the provided services - health care. Being present in a hospital professionals such as doctors, nurses and managers, with cultural characteristics that influence the way and method of facing the quality and its monitoring for the existence of a profound change, when a quality policy is implemented, it is fundamental to know the definition of the quality of each and ever professional, member of a culture, and in this way, their posture towards the phenomenon. This present study aims to identify the perceptions of nurses at the Infante-Santo CUF Hospital, relatively to the quality management system, according to the ISO standard, and consequently, investigating strengths, weaknesses, threats and opportunities of the implementation of this standard in that hospital organization. To achieve these aims or objectives, an analysis model was developed, which considers the relationship between the characteristics of the quality of health, hospital organizational culture and the ISO standard system, for the further development of the continuous improvement in the organization. The data for the elaboration of this dissertation was collected through questionnaire surveys done to the nurses at Infante-Santo CUF Hospital, who were working in the organization during the ISO standard implementation, being used the quantity method and techniques of the quality study in the analysis of data orientated to the meaning of actions. The developed research concluded that the perception related to the alterations in the quality of the care is limited by the majority of respondents not knowing the quality system (ISO 9001 standard), being this one of the weaknesses to the implementation of the ISO standard in the organization. Therefore, the diagnosed situation constituted a warning to the health organizations, to implement quality management systems, potentially the identified strengths, such as the orientation of the nurses to the care and to the client, and on the other hand, avoiding the repetition of weaknesses, as previously identified, through the involvement and training of its employees in the quality policies. The nurses are concerned about the quality but they refer that there is no regular monitoring. Thus, this necessity of the implementation of the quality and management system should be corrected, so that the health organization being studied should proceed to excellence.

Qualidade e comunicação nas organizações de saúde : Aplicação prática no Hospital CUF Infante Santo

A presente dissertação discute a cada vez maior exigência de qualidade nas organizações de saúde, que deve ser encarada como uma ferramenta de gestão e de mudança, e a necessidade intrínseca de uma melhor e mais abrangente rede de comunicação, que se impõe para a transmissão de informação e conhecimento, numa sociedade que a uma velocidade atroz se encontra em constante mutação e desenvolvimento. Neste sentido, a temática em estudo assume particular importância no contexto actual, pois apenas a qualidade representa o garante da subsistência da organização abrindo caminho à eficiência e à eficácia organizacional e de interesse para a instituição, pois parte do conhecimento da percepção dos enfermeiros, que na organização de saúde estão directa e proporcionalmente relacionados com a satisfação do cliente. Os enfermeiros asseguram a manutenção dos padrões de qualidade, que a organização pretende alcançar e comunicar, sendo fundamentais na imagem global transmitida e, consequentemente, na criação de valor da própria organização. Este estudo apresenta como objectivo principal averiguar o conhecimento, o envolvimento e quais as necessidades sentidas, na perspectiva dos enfermeiros, no âmbito da comunicação organizacional, de modo a melhorar a comunicação na organização de saúde, de forma a promover uma gestão de qualidade, garantindo uma subsequente imagem global de excelência. A investigação empírica analisou de forma sistemática informação relevante na área da qualidade, da comunicação organizacional e da inovação. Assim, aplicou-se um inquérito por questionário, fundamentado nos princípios de autores como Deming (1986); Chiavenato (2004); Druker (2000); Biscaia (2000) e Jeffries, (1992), junto dos enfermeiros do Hospital CUF Infante Santo. Com a realização de uma investigação exploratório-descritiva coloca-se a tónica na definição de conceitos e na descrição de factores, através de uma abordagem híbrida qualitativa e quantitativa, foi possível empreender-se o estudo e edificar-se os resultados, que permitem fazer uma caracterização de um conjunto de necessidades a colmatar no âmbito da comunicação interna e verificar a receptividade a inovações de forma a conseguir um maior envolvimento, formação e adesão dos enfermeiros nas políticas de qualidade. As conclusões apuradas levaram à apresentação da indispensabilidade de um envolvimento dos enfermeiros na gestão organizacional ao nível das políticas de qualidade e dos processos de melhoria contínua, observando a emergência de necessidades comunicacionais, nomeadamente a intranet, numa atitude afirmativa de imposição deste canal como um importante facilitador, desde que adaptado à realidade da organização. ABSTRACT: This dissertation discusses the increasing demand for quality in health organizations, which should be seen as a management and change tool, and the intrinsic need of a better and wider communication network, which is required for the transmission of information and knowledge, in a society that is at an atrocious speed constantly changing and developing. ln this sense, the theme in study assumes particular importance in the current context, thus only the quality represents the guarantee of the continuation and existence of the organization opening the way to organizational efficiency and effectiveness and of interest to the institution, as by part of the perception knowledge of the nurses, which in the health organization are directly and proportionately related to the client’s satisfaction. The nurses ensure the maintenance of the quality standards, that the organization aims to reach and communicate, being fundamental in the global image transmitted, and consequently, in the creation of value for the organization itself. The study presents as main objective the investigation of knowledge, the involvement and which necessities needed and felt, in the nurses' perspective, within the organizational communication, as to better the communication within the health organization, in such a way to promote the quality management, guaranteeing a subsequent global image of excellence. The empirical research analyzed in systematic way information relevant in the area of quality, of the organizational communication and innovation. Thus, a survey questionnaire was applied, based on the principles of authors such as Deming (1986); Chiavenato (2004); Druker (2000); Biscaia (2000) e Jeffries, (1992), among nurses of the Infante Santo CUF Hospital. With the completion of an exploratory-descriptive research, the emphasis was put on the concepts definition and the factors description, through a quality and quantity hybrid approach, it was possible to carry out the study and edify the results, which permit in the making of a characterization of a group or set of necessities to cover in the internal communication ambit and verify the acceptability to innovations so that a greater involvement be achieved, training and adherence of the nurses in the quality policies. The conclusions reached led to the presentation of the indispensability of an involvement of the nurses in the organizational management at the level of the quality policies and the processes for continuous improvement, observing the emergency of communication needs, namely the intranet, in an affirmative attitude of imposition of this channel such as an important facilitator, as long as ifs adapted to the reality of the organization.

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Background Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization’s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. Methods A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. Conclusions The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

Qualidade dos sistemas de informação no serviço de radiologia do Hospital de Curry Cabral

A preocupação com a qualidade dos serviços prestados pelas organizações de saúde é uma realidade. Em resultado de várias pressões e diferentes metodologias têm sido implementadas nas instituições Sistemas de Informação a fim de melhorar a qualidade e segurança dos procedimentos aí desenvolvidos. A qualidade dos Sistemas de Informação assume um destaque pela sua componente de mais-valia, neste trabalho procuramos avalia-la e verificar a sua correta implementação. A presente dissertação reporta-se ao estudo dos Sistemas de informação no Serviço de Radiologia do HCC, tendo como objetivo principal saber se os Sistemas de Informação, potenciaram a melhoria da qualidade de desempenho dos profissionais de saúde, assim como caracterizar a qualidade dos Sistemas de Informação. Como estratégia de pesquisa optamos por um estudo de natureza descritiva, utilizando um modelo de análise quantitativo. Aplicou-se um questionário elaborado pela investigadora, tendo sido aceites as respostas de 55 questionários realizados aos utilizadores dos SI. De uma forma geral os resultados demonstram que os Sistemas de Informação foram bem aceites por parte dos profissionais deste serviço, existindo porem algumas deficiências que não permite que se atinja níveis de qualidade elevados. Relativamente à formação depreendemos que existem algumas lacunas relativas ao processo de formação dos utilizadores, que podem ser colmatadas por uma intervenção adequada. ABSTRACT: The concern about the quality of the accounted services by the health organizations is a reality. Information Systems have been installed in many establishments as a result of many pressures and different methodologies in order to improve the quality and safety of the procedures developed in such places. The quality of the Information Systems gains relevance due to its “rise” character; on this essay we aimed to evaluate and verify its adequate execution. The present essay is about the study of the Information Systems on the Radiology Service of Hospital Curry Cabral (HCC) being its main objective to know if the Information Systems improved the performance of the health professionals, as well as to point out their quality. We decided to build a study of descriptive nature using a quantitative analysis method. We applied an inquiry elaborated by the researcher and accepted the answers of 55 inquiries made to the SI users. In general, the results revealed that the Information Systems were well accepted by the professionals of this service. However, some minor problems do not allow high standard of quality to be obtained. As regards training we understand that there are a few defaults concerning the process of formation of the users which can be surpassed if using an adequate intervention.

Equivalent Hearing Loss in Children

Early intervention is the key to spoken language for hearing impaired children. A severe hearing loss diagnosis in young children raises the urgent question on the optimal type of hearing aid device. As there is no recent data on comparing selection criteria for a specific hearing aid device, the goal of the Hearing Evaluation of Auditory Rehabilitation Devices (hEARd) project (Coninx & Vermeulen, 2012) evolved to collect and analyze interlingually comparable normative data on the speech perception performances of children with hearing aids and children with cochlear implants (CI). METHOD: In various institutions for hearing rehabilitation in Belgium, Germany and the Netherlands the Adaptive Auditory Speech Test AAST was used in the hEARd project, to determine speech perception abilities in kindergarten and school aged hearing impaired children. Results in the speech audiometric procedures were matched to the unaided hearing loss values of children using hearing aids and compared to results of children using CI. 277 data sets of hearing impaired children were analyzed. Results of children using hearing aids were summarized in groups as to their unaided hearing loss values. The grouping was related to the World Health Organization’s (WHO) grading of hearing impairment from mild (25–40 dB HL) to moderate (41–60 dB HL), severe (61-80 dB HL) and profound hearing impairment (80 dB HL and higher). RESULTS: AAST speech recognition results in quiet showed a significantly better performance for the CI group in comparison to the group of profoundly impaired hearing aid users as well as the group of severely impaired hearing aid users. However the CI users’ performances in speech perception in noise did not vary from the hearing aid users’ performances. Within the collected data analyses showed that children with a CI show an equivalent performance on speech perception in quiet as children using hearing aids with a “moderate” hearing impairment.

Factores de éxito en el programa de responsabilidad social empresarial (RSE) para el sector salud, aplicación de la norma ISO 26000 en la IPS Fundación Cardio Infantil

El presente estudio tiene como objetivo mostrar los factores de éxito del programa de Responsabilidad Social de la Fundación Cardioinfantil, teniendo en cuenta que esta institución se ha convertido en un referente de compromiso social y sostenibilidad en el sector salud y en las instituciones de cuarto nivel de complejidad. Para alcanzar este objetivo se realizaron visitas y se aplicó un instrumento en la Fundación Cardioinfantil y en cuatro instituciones más del mismo nivel de atención en las ciudades de Bogotá, Cali y Medellín, donde generosamente aportaron información acerca del desarrollo de sus programas de Responsabilidad Social y de la aplicación de los tópicos contenidos en la ISO 26000 dentro de sus instituciones. Así mismo dentro de la Fundación Cardioinfantil se realizó una entrevista con la persona encargada de desarrollar el programa, quien manifestó los detalles del funcionamiento de este y los esfuerzos realizados para lograr la diferenciación en el sector salud. A través de este recorrido por las diferentes instituciones de salud consultadas y de la investigación realizada en la fundación Cardioinfantil se realizó una matriz DOFA que nos reveló la falta de comunicación en las mejoras realizadas en las diferentes organizaciones de salud, una vez han detectado las fallas en inherentes a su actuación con los grupos de interés. La adopción de estándares internacionales para la gobernanza y aplicación de los programas de RSE aún es incipiente en el sector salud en general. También es posible resaltar el hecho de que programas de RSE desarrollados a nivel de la fundación Cardioinfantil evolucionan hacia la innovación en la calidad de la atención y la trasformación de sus organizaciones hacia la mejora continua.

Chronic disease prevention and health promotion. Public policies and social network analysis of the hospitals services and oyhers health and social organizations to support joint action for children with diabetes

Comunicação apresentada na 18th Conference International of Health Promotion Hospitals & Health Services "Tackling causes and consequences of inequalities in health: contributions of health services and the HPH network", em Manchester de 14-16 de april de 2010

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.

Service users’ participation in mental health community-based organizations

Une grande proportion de personnes aux prises avec des problèmes de santé mentale vit dans l’isolement social. Les infirmières en santé communautaire sont interpellées au premier rang pour accompagner ces personnes dans leur processus de rétablissement et pour atténuer leur isolement social. La participation au sein d’organismes communautaires optimise l’expérience de rétablissement, diminue l’isolement social et renforce les réseaux sociaux de personnes ayant des problèmes de santé mentale. Toutefois, la participation des personnes utilisatrices de services dans la structure d’organisation des organismes communautaires est encore peu documentée. Afin de pallier cette lacune, cette étude avait pour objectifs de documenter, décrire la nature de la participation des personnes utilisatrices de services en santé mentale et d’explorer des facteurs facilitatants et des barrières à cette participation. Un devis de méthodes mixtes, qualitatif et quantitatif, a été utilisé. Dans le premier de deux volets, une enquête impliquant la réalisation d’entretiens semi-dirigés a été menée auprès de douze directeurs d’organismes communautaires œuvrant dans le domaine des services en santé mentale. Une version française du questionnaire « Adapted User Involvement » (Diamond, Parkin, Morris, Bettinis, & Bettesworth, 2003) a été administrée afin de documenter l’étendue de la participation des personnes utilisatrices de services dans les organismes visés. Pour le deuxième volet, deux organismes communautaires ont été sélectionnés à partir des résultats du questionnaire et de l’analyse documentaire de documents publics de ces organismes. Les scores obtenus au questionnaire ont ainsi permis de sélectionner des organismes présentant des résultats contrastés en matière de participation des personnes utilisatrices de services. Les entretiens semi-dirigés ont été menés avec différents groupes de répondants (membres de conseil d’administration, personnes utilisatrices de services, employés, directeurs) afin de recueillir de l’information sur les thèmes suivants: la nature de la participation des personnes utilisatrices de services, ainsi que les facteurs facilitants et les défis qui y sont associés. Les résultats de l’analyse montrent que: (1) les facteurs qui favorisent la participation des personnes utilisatrices sont: l’accès à un espace de participation pour les personnes utilisatrices et l’accompagnement de celles-ci par les intervenants de diverses disciplines pendant leur participation au sein des organismes communautaires, (2) les barrières de la participation des personnes utilisatrices au sein des organismes communautaires sont la stigmatisation sociale et les caractéristiques personnelles reliées aux problèmes de santé mentale chez les personnes utilisatrices, et (3) les avantages principaux de la participation des personnes utilisatrices de services se déclinent en services mieux adaptés à leurs besoins et leurs demandes, en leur appropriation du pouvoir (dans leur participation dans l’organisme communautaire) et en leur sentiment d’appartenance à l’organisme. À la lumière des ces constats, l’accompagnement des personnes utilisatrices de services dans leur participation apparaît une avenue prometteuse pour les infirmières en santé mentale communautaire afin de faciliter leur appropriation du pouvoir et d’améliorer leur bien-être.

The Role of Non-Governmental Organizations in International Cooperation in Public Health

This article discusses the possibility of the NGOs acting on international health cooperation and how this acting is regulated. Firstly, the international cooperation and its relation with public health is presented. After that, data on Brazilian bilateral health cooperation are brought in, in which it is possible to find the formal recognition of NGOs as partners of States. This allows the consideration of the role of NGOs in health cooperation. Although the action of NGOs is legitimated by international law, their regulation is just beginning. This suggests important issues to be improved in the legal relation between NGOs and States in the field of public health.

Corporate decision-making: A case study of decision support systems and financial performance in health care organizations

The purpose of this study was twofold: (1) To describe the relation of the intensity of DSS implementation to financial performance as an empirical exploration of improved performance at the organizational level. (2) To describe the relation of the intensity of DSS implementation to the type of organizational decision culture. A multiple case study design was utilized to compare three groups of paired cases. A pattern matching strategy was applied in this study. Four predictions were specified and compared to the empirical data. A progressively upward trend in the scores was predicted for the following theoretical relationships. (1) The greater the number of DSSs, the higher the sophistication index. (2) The greater the number of DSSs, the higher the financial ratios. (3) The greater the number of DSSs, the higher the culture score. (4) The higher the culture score, the higher the financial ratios. The data did not support any of the predicted trends except the relation between the number of DSSs and the financial ratios. The Income/Revenue ratio indicates the efficiency of a company's operations. One would expect that this ratio would be most affected by the operational and financial decision support systems. The majority of the systems measured in the study supported decisions tangential to the patient service areas. The evidence suggested that the type and number of decision support systems affects the bottom line. ^

Connecting the Nation : classrooms, libraries, and health care organizations in the Information age : update 1995 /

Mode of access: Internet.

Interagency coordination in drug research and regulation. Hearings before the Subcommittee on Reorganization and International Organizations of the Committee on Government Operations, United States Senate, Eighty-eighth Congress, first session. Agency coordination study, pursuant to S. Res. 27, 88th Cong. Review of cooperation on drug policies among Food and Drug Administration, National Institutes of Health, Veterans' Administration, and other agencies. Mar. 20-June 26, 1963.

Mode of access: Internet.

Drug abuse information, education, and rehabilitation programs supported by State health agencies and voluntary organizations.

Mode of access: Internet.