Hospital humano: etnografia da humaniza����o hospitalar na perspectiva de usu��rios

This ethnographic work studies the experiences of patients admitted in public (PUH) and private (PRH) hospitals in the Brazilian northeastern region. 28 adult patients of different clinics participated in the study. Data were analyzed by the patient path method, consisting in a combination of complemented and articulated techniques free observation, participating observation, ethnographic interview and patient testimonials collected prospectively during the patients admissions, from their arrival and until their discharge. The analysis was carried out according to the Thematic Categories Analysis Technique and the data were interpreted pursuant to medical anthropology, healthcare humanization and healthcare promotion theoretical references. The ethical principles of Resolution 196/96 were followed. The human hospital, as revealed by the patient, highlights the significance of subjectivity. 225 (54.7%) out of 411 mentioned concepts were collected in a public hospital (PUH) and 186 (45.3%) in a private institution (PRH). The results show that the patient at the PUH and PRH ethnoevaluates different aspects of the healthcare professionals�� human and technical competence, the hospital��s functioning structure, the access to and the ethics in the financial management, and develops overcoming strategies for his stay at the hospital. This ethnoevaluation is mediated by different factors, namely: social and economic status, personality, religiosity, ironic speech, somber diagnosis and satisfied needs, prior hospital experiences and the conditions under which the interview was carried out. A pedagogic proposal for the hospital humanization must include structural, managerial and organizational changes of the offered services and use active methodologies aimed to the political resolution of problematic situations at work and the inclusion of affective and subjective factors, and become as well a tool for the collective learning. This study shows the importance for the user��s ethnoevaluation to be incorporated into the hospital management and care as a guideline in the decision making and clinical action, thus promoting practices that shall lead to a decent and humanized care. The multidisciplinary nature of this study allowed a wide understanding of the user��s perspective as a socially critical ethnoevaluator

Gest��o de estoques: uma proposta de reposi����o cont��nua para material m��dico hospitalar e medicamentos em um hospital universit��rio federal do estado do Rio Grande do Norte

The inventory management in hospitals is of paramount importance, since the supply materials and drugs interruption can cause irreparable damage to human lives while excess inventories involves immobilization of capital. Hospitals should use techniques of inventory management to perform replenishment in shorter and shorter intervals, in order to reduce inventories and fixed assets and meet citizens requirements properly. The inventory management can be an even bigger problem for public hospitals, which have restrictions on the use of resources and decisionmaking structure more bureaucratized. Currently the University Hospital Onofre Lopes (HUOL) uses a periodic replacement policy for hospital medical supplies and medicines, which involves one moment surplus stock replenishment, the next out of stock items. This study aims to propose a system for continuous replenishment through order point for inventory of medical supplies and medicines to the hospital HUOL. Therefore, a literature review of Federal University Hospitals Management, Logistics, Inventory Management and Replenishment System in Hospitals was performed, emphasizing the demand forecast, classification or ABC curve and order point system. And also, policies of inventory management and the current proposal were described, dealing with profile of the mentioned institution, the current policy of inventory management and simulation for continuous replenishment order point. For the simulation, the sample consisted of 102 and 44 items of medical and hospital drugs, respectively, selected using the ABC classification of inventory, prioritizing items of Class A, which contains the most relevant items in added value, representing 80 % of the financial value in 2012 fiscal year. Considering that it is a public organization, subject to the laws, we performed two simulations: the first, following the signs for inventory management of Instruction No. 205 (IN 205 ), from Secretary of Public Administration of the Presidency ( SEDAP / PR ), and the second, based on the literature specializing in inventory management hospital. The results of two simulations were compared to the current policy of replenishment system. Among these results are: an indication that the system for continuous replenishment reorder point based on IN 205 provides lower levels of safety stock and maximum stock, enables a 17% reduction in the amount spent for the full replenishment of inventories, in other words, decreasing capital assets, as well as reduction in stock quantity, also the simulation made from the literature has indicated parameters that prevent the application of this technique to all items of the sample. Hence, a change in inventory management of HUOL, with the application of the continuous replenishment according to IN 205, provides a significant reduction in acquisition costs of medical and hospital medicine

Hospital district viability and Medicaid /market changes

Hospital districts (HD) that serve the uninsured and the needy face new challenges with the implementation of Medicaid managed. The potential loss of Medicaid patients and revenues may affect the ability to cost-shift and subsequently decrease the ability of the HD to meet its legal obligation of providing care for the uninsured. ^ To investigate HD viability in the current market, the aims of this study were to: (1) describe HD's environment, (2) document the HDs strategic response, (3) document changes in the HD's performance (patient volume) and financial status, and (4) determine whether relationships or trends exist between HD strategy, performance and financial status. ^ To achieve these aims, three Texas HDs (Fort Worth, Lubbock, and San Antonio) were selected to be evaluated. For each HD four types of strategic responses were documented and evaluated for change. In addition, the ability of each HD to sustain operations was evaluated by documenting performance and financial status changes (patient volume and financial ratios). A pre-post case study design method was used in which the Medicaid managed care ���rollout'��� date, at each site, was the central date. First, a descriptive analysis was performed which documented the environment, strategy, financial status, and patient volume of each hospital district. Second, to compare hospital districts, each hospital district was: (i) classified by a risk index, (ii) classified by its strategic response profile, and (iii) given a performance score based upon pre-post changes in patient volume and financial indicators. ^ Results indicated that all three HDs operate in a high risk environment compared to the rest of the nation. Two HDs chose the ���Status Quo��� response whereas one HD chose the ���Competitive Proactive��� response. Medicaid patient volume decreased in two of three HDs whereas indigent patient volume increased in two of the three (an indication of increasing financial risk). Total patient revenues for all HDs increased over the study period; however, the rate of increase slowed for all three after the Medicaid rollout date. All HDs experienced a decline in financial status between pre-post periods with the greatest decline observed in the HD that saw the greatest increase in indigent patient volume. ^ The pre-post case study format used and the lack of control study sites do not allow for assignment of causality. However, the results suggest possible adverse effects of Medicaid managed care and the need for a larger study, based on a stronger evaluation research design. ^

Financial Planning by Contract Food Service Management Companies

Drugs in the workplace is a growing problem that threatens a valuable human resource - the employee. Managers in the hospitality industry can take a proactive stance in meeting the problem head on. The authors discuss what managers can do.

Hospital Administrative Characteristics and Volunteer Resource Management Practices

Purpose ��� The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach ��� This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings ��� Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications ��� First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications ��� Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value ��� The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors��� knowledge, this is the first empirical categorization of VRM practices.

Key factors in working capital management in the Brazilian market

Many studies have been conducted in corporate finance regarding long-term investment and financing decisions. However, short-term asset investments play a significant role in the balance sheet of companies. Moreover, financial managers dedicate significant amounts of time and effort to the subject of working capital management, balancing current assets and liabilities. This paper provides insights regarding the key factors of working capital management by exploring the internal variables of a number of companies. This study used data from 2,976 Brazilian public companies from 2001 to 2008, and found that debt level, size and growth rate can affect the working capital management of companies.

O Planeamento estrat��gico nos hospitais portugueses num contexto de austeridade: o caso particular dos Hospitais E.P.E.

Disserta����o apresentada para obten����o do grau de Mestre em Contabilidade e Finan��as Orientador: Professor Doutor Jos�� Freitas Santos

Carateriza����o da tomada de decis��o em organiza����es hospitalares : impacto do estatuto jur��dico

RESUMO - O decisor hospitalar tem como fun����o decidir os recursos de uma organiza����o de sa��de, sejam estes financeiros, materiais ou humanos, sendo decisivo o conhecimento e informa����o que o apoiem na aplicabilidade nas tomadas de decis��o e na solu����o dos problemas. As tomadas de decis��o suportam-se em modelos reproduzidos pelos decisores, em processos, modelos, e em princ��pios, que podem ou n��o assumir intui����o, objetividade, racionalidade e ��tica, bem como de t��cnicas v��rias que podem ser limitativas ou condicionadas, por for��a de fatores v��rios, como: a falta de informa����o inerente de uma multidisciplinaridade do processo; de condicionalismos organizacionais, internos ou externos, associados �� envolvente e cultura organizacional e influ��ncias pol��ticas e macroecon��micas; ao fator tempo; a tecnologia; a estrutura e desenho organizacional; a autoridade/poder e a autonomia para decidir; a lideran��a, e do estatuto jur��dico que o hospital possui. Este ��ltimo ponto ser�� esmiu��ado, mais profundamente, neste estudo. Iremos, atrav��s do estudo, compreender se os elementos componentes das decis��es tomadas nos hospitais, s��o ou n��o adaptadas em conson��ncia com diferentes pol��ticas de governa����o hospitalar, em contextos e din��micas organizacionais diferenciadas, por diferentes Estatutos Jur��dicos Hospitalares - EPE, SPA, PPP e Privados. Foi realizado um estudo de car��ter explorat��rio, descritivo-correlacional e transversal, baseou-se num question��rio aplicado a decisores hospitalares, incidindo nos dois vetores centrais do estudo, na tomada de decis��o e no estatuto jur��dico hospitalar. A decis��o �� ent��o, um valios��ssimo ve��culo na persecu����o das estrat��gias e planos formulados pelo hospital, esperando-se destes produzir consequentes resultados eficientes, eficazes e efetivos na sua aplica����o.

The nurse in the management of materials in teaching hospitals

OBJECTIVETo present the nurse's integration within materials management of six teaching hospitals of Paran�� - Brazil, and to describe the activities performed by nurses within this process.METHODA study of a qualitative approach and descriptive nature, conducted in teaching hospitals in Paran��, between June and August of 2013. The data collection was conducted through semi-structured interviews with eight nurses who worked in materials management; data were analyzed using content analysis.RESULTSThese showed that nurses perform ten categories of activities, distributed into four of the five steps of the materials management process.CONCLUSIONThe nurse, in performing of these activities, in addition to favoring the development of participative management, contributes to the organization, planning, and the standardization of the hospital supply process, giving greater credibility to the work with professionals who use the materials, and to the suppliers.

Financial Power of Attorney

A financial power of attorney (FPOA) is a document authorizing someone else (an agent) to manage your finances on your behalf if you (the principal) become incapacitated and are unable to make financial management decisions for yourself. If you become unable to decide for yourself and you have not prepared a financial power of attorney, a court proceeding will likely be required before a loved one will be able to assume authority over at least some of your financial affairs. Your FPOA can be drafted to go into effect as soon as you sign it or it can become effective at a later date or only in the case that a physician certifies that you have become incapacitated.

The Cycle Times of Working Capital: Financial Value Chain Analysis Method

Interest towards working capital management increased among practitioners and researchers because the financial crisis of 2008 caused the deterioration of the general financial situation. The importance of managing working capital effectively increased dramatically during the financial crisis. On one hand, companies highlighted the importance of working capital management as part of short-term financial management to overcome funding difficulties. On the other hand, in academia, it has been highlighted the need to analyze working capital management from a wider perspective namely from the value chain perspective. Previously, academic articles mostly discussed working capital management from a company-centered perspective. The objective of this thesis was to put working capital management in a wider and more academic perspective and present case studies of the value chains of industries as instrumental in theoretical contributions and practical contributions as complementary to theoretical contributions and conclusions. The principal assumption of this thesis is that selffinancing of value chains can be established through effective working capital management. Thus, the thesis introduces the financial value chain analysis method which is employed in the empirical studies. The effectiveness of working capital management of the value chains is studied through the cycle time of working capital. The financial value chain analysis method employed in this study is designed for considering value chain level phenomena. This method provides a holistic picture of the value chain through financial figures. It extends the value chain analysis to the industry level. Working capital management is studied by the cash conversion cycle that measures the length (days) of time a company has funds tied up in working capital, starting from the payment of purchases to the supplier and ending when remittance of sales is received from the customers. The working capital management practices employed in the automotive, pulp and paper and information and communication technology industries have been studied in this research project. Additionally, the Finnish pharmaceutical industry is studied to obtain a deeper understanding of the working capital management of the value chain. The results indicate that the cycle time of working capital is constant in the value chain context over time. The cash conversion cycle of automotive, pulp and paper, and ICT industries are on average 70, 60 and 40 days, respectively. The difference is mainly a consequence of the different cycle time of inventories. The financial crisis of 2008 affected the working capital management of the industries similarly. Both the cycle time of accounts receivable and accounts payable increased between 2008 and 2009. The results suggest that the companies of the automotive, pulp and paper and ICT value chains were not able to self-finance. Results do not indicate the improvement of value chains position in regard to working capital management either. The findings suggest that companies operating in the Finnish pharmaceutical industry are interested in developing their own working capital management, but collaboration with the value chain partners is not considered interesting. Competition no longer occurs between individual companies, but between value chains. Therefore the financial value chain analysis method introduced in this thesis has the potential to support value chains in improving their competitiveness.

Building governance in the international financial system: Context and challenges

ABSTRACTThe international financial system has undergone deep changes since the 1970s and its stability cannot be reached in spite of actor's interests or the existence of countless coordination fora. Analyzing the system's incentive structure, one can note that its stability depends on the control of imbalances, which are not always harmful for States, creating, thus, a disturbing component in the quest for international financial management. Furthermore, non-state actors have acquired a disproportional share of power following financial globalization, escaping the control of States and of the international community.

DONATION DECISIONS: THE ROLES OF FINANCIAL AND EMOTIONAL INFORMATION

This paper investigates the impact of personal affinity toward a charity and information regarding financial management of potential recipient charitable organizations on decisions to donate. Using an experiment, the study examines how personal donation decisions differ from corporate donation decisions made by managers and how the emotional intelligence of donors affects donation decisions. The results indicate that threshold and financial information on charities assembled by the Better Business Bureau, a charity rating agency, made a significant impact on corporate donation decisions. The study also shows that emotional intelligence plays an important role that aids both individual donors and managers to regulate their donation decisions.

Analyse des nouvelles formes organisationnelles hospitali��res en ��mergence au Mali

Au Mali, une loi hospitali��re a ��t�� adopt��e en 2002 pour d��finir le cadre institutionnel d���une r��forme majeure. Cette loi a d��cr��t�� des transformations substantielles de la structure interne, tant administrative que clinique des ��tablissements publics hospitaliers notamment l���implication des populations locales dans la prise de d��cision de l�����tablissement, l���autonomie administrative et financi��re �� travers la d��l��gation budg��taire et l���implication des professionnels de sant�� �� la gestion, l���int��gration des services de sp��cialit�� et la participation du secteur priv�� au service public hospitalier. Cependant, la capacit�� des h��pitaux �� r��ussir les transformations pr��vues a ��t�� remise en question par la majorit�� des acteurs internes et externes. L���objectif de cette th��se a ��t�� d�����tudier de quelle mani��re l���h��pital malien se transforme sous la pression de la d��centralisation des pouvoirs de l�����tat et d�����tudier comment les groupes d���acteurs r��agissent face �� ces changements �� partir de deux cadres d���analyse. Le premier cadre int��gre les caract��ristiques essentielles des transformations hospitali��res en termes de diff��rents types de d��centralisation et le second cadre inspir�� des travaux de Crozier et coll. (1977) analyse les jeux de pouvoir entre les groupes d���acteurs hospitaliers selon deux niveaux �� savoir un niveau strat��gique et syst��mique. Pour cela, nous avons conduit une ��tude multiple de deux cas et utilis�� trois modes de collecte des donn��es �� savoir les entrevues semi-structur��es aupr��s des informateurs cl��s, l���analyse documentaire, et l���observation lors de r��unions. Dans un premier temps, les analyses ont r��v��l�� pour les changements intervenus dans la structure, selon l���importance des responsabilit��s attribu��es �� l���h��pital public, (1) plusieurs variantes de la d��centralisation. Globalement, l���intention politique ��tait focalis��e sur une d��l��gation puis une d��concentration et une d��volution; les m��canismes mis en place ont pench�� plus vers une d��concentration puis une d��l��gation et une d��volution tandis que les transformations r��ellement effectu��es dans les ��tablissements publics hospitaliers ont plut��t confirm�� une d��concentration en plus d���une d��l��gation particuli��rement dans le cas de l���implication des populations locales dans la gestion hospitali��re. Tandis que l���h��pital public pouvait faire des recettes �� partir du recouvrement partiel des co��ts des soins aupr��s des usagers, l�����tat gardait une main forte sur la gestion financi��re et la gestion du personnel, et d��finissait les directives et les objectifs �� poursuivre. (2) Les analyses apportent une compr��hension des liens existant entre les diff��rents ��l��ments du processus de r��forme, le type de m��canisme mis en place dans le cadre de la r��forme semble d��terminer le type de transformation effectu�� selon les fonctions que peut assurer l���h��pital public. La logique traduit le passage de la d��l��gation vers une d��concentration qui est jug��e comme ��tant la forme la moins pouss��e d���une d��centralisation. Dans un deuxi��me temps, les r��sultats confirment la pr��sence de conflit entre les normes professionnelles ��tablies et reconnues par les professionnels de sant�� et les normes organisationnelles et institutionnelles mises en avant par la r��forme. Elles sont d��fendues par la majorit�� des gestionnaires qui sont imputables face aux autorit��s alors que les normes professionnelles dominent dans les services cliniques. Les deux cas ont mis en ��vidence le soutien de leur direction g��n��rale, il existait une tension dans les r��actions des m��decins, qui a ��t�� variable selon le type de changement structurel vis��, tandis que les infirmiers se sont montr��s plut��t accessibles face aux nouvelles mesures introduites par la r��forme. L���une des originalit��s de cette th��se tient au fait que tr��s peu de travaux sur les pays en d��veloppement ont tent�� d���op��rationnaliser de fa��on multidimensionnelle les concepts de d��centralisation avant d���analyser les variantes susceptibles d���exister entre eux et les strat��gies d��velopp��es par les groupes d���acteurs de l���h��pital. En outre, alors que la pertinence de la prise en compte des caract��ristiques du contexte organisationnel dans la mise en place des r��formes des syst��mes de soins est au c��ur des pr��occupations, ce travail est l���un des premiers �� analyser l���influence de l���interaction entre le processus de r��forme hospitali��re et les prises de position des acteurs. Les r��sultats de cette th��se fournissent des recommandations aux d��cideurs politiques et aux gestionnaires quant aux modes de changement structurel �� privil��gier ou en ��viter dans la planification, l���ex��cution et la mise en ��uvre du processus de r��forme hospitali��re en fonction des caract��ristiques du contexte organisationnel sanitaire. La planification de la r��forme est essentielle : ��laborer un projet d�����tablissement discut�� et valid�� par l���ensemble des acteurs de l���h��pital. Ce projet doit ��tre compatible avec les objectifs du sch��ma d���organisation sanitaire nationale et d��terminer les moyens en personnel et en ��quipements, dont l���h��pital doit disposer pour r��aliser ses objectifs. Concevoir un cadre budg��taire et financier hospitalier flexible (qui va all��ger la chaine de prise de d��cision), sur lequel reposera le nouveau syst��me de gestion des h��pitaux. La capacit�� de mobilisation et d���ex��cution des ressources hospitali��res devrait renforcer l���autonomie de gestion. Enfin, promouvoir une culture de l�����valuation et faciliter les ��valuations p��riodiques de la mise en ��uvre de la r��forme hospitali��re par des organismes d�����valuation externes et ind��pendants.

Dise��o de una propuesta de mejoramiento de la gesti��n administrativa del hospital el tunal, mediante la aplicaci��n de la filosof��a de teor��a de restricciones (TOC)

El objetivo de este trabajo es presentar el dise��o de un proyecto de mejora a trav��s de la filosof��a TOC para la gesti��n Administrativa del Hospital El Tunal del Nivel III de Bogot�� DC, durante el per��odo 2013. Para lograr el objetivo de la propuesta de mejoramiento basada en la filosof��a TOC (Ingl��s siglas Theory of Constraints), se centra en crear un proceso de mejora continua en la gesti��n administrativa del Hospital El Tunal. Esta entidad es una Empresa Social del Estado y tiene por objeto la prestaci��n de servicios de salud a usuarios que presentan alg��n tipo de enfermedad o trastorno org��nico que afecta su salud; se centra en mejorar, corregir y proporcionar una mejor calidad de vida al usuario que viene a cubrir sus necesidades de salud. Este producto de investigaci��n terminar�� con una propuesta centrada en la mejora de la gesti��n administrativa, basada en la filosof��a TOC aplicado a la cartera morosa, tratando de ofrecer una serie de soluciones a los problemas actuales que impactan estas organizaciones centr��ndose en la mejora continua, la velocidad de flujo de los recursos administrativos, verificando si es eficaz en beneficio de los usuarios y los profesionales de la salud.