The main benefits associated with health and safety management systems certification in Portuguese small and medium enterprises post quality management system certification

The purpose of this study is to characterize how Portuguese Small and Medium Enterprises (SMEs) view the Occupational Health and Safety Management Systems (OHSMSs) certification process, after receiving the Quality Management System (QMS) certification. References were based on the ISO 9001 standard for a QMS and OHSAS 18001 for OHSMS. The method used to evaluate the implemented systems, was by form of questionnaire. Those questioned had to have a certified quality management system, an implemented OHSMS and be a SME. The questionnaire was sent to 300 SMEs; 46 responses were received and validated. Of them, only 12 SMEs had the OHSMS certificate according to OHSAS 18001. Within those 12 companies that participated: 7 SMEs are from the industrial sector; 3 belong to the electricity/telecommunications sector and 2 SMEs are from the trade/services activity sector. The size of the sample was small, but corresponds to Portuguese reality. Moreover, 34 SMEs did not have the OHSMS certificate. The questionnaire requested the main reasons for SMEs to opt for non-certification and it was related with high costs, while the main reasons to certificate were, among others, needed to eliminate or minimize risks to workers. The main benefits that Portuguese SMEs have gained from the referred certifications have been, improved working conditions, ensuring compliance with legislation and better internal communication about risks and hazards. Also presented are the main difficulties in achieving an OHSMS certification including high certification costs, difficulties motivating personnel, difficulties in changing the company’s culture and increased bureaucracy.

Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).

Establishment of a health and safety management system according to the OHSAS 18001 standard

The thesis develops guidelines for the implementation of the health and safety management system according to the OHSAS 18001 standard, as well as the feasible threat analysis, project proposal schedule, future system quality improvements and organizational change evaluation. The theoretical part clarifies determination of occupational health and safety, its management system, the OHSAS 18001 standard and integrated management system compounded of triple ISO 14001, ISO 9001 and OHSAS 18001 standards. The literature includes such important aspects as human factor, organizational policies, possible benefits, threats, organizational safety culture, Deming’s quality improvement cycle, system implementation, maintenance and cost matters. The empirical part demonstrates real-life situation by using Andritz Pulp & Paper Oy as a case study. Prior the thesis proposal, Andritz Group is analysed including separate business areas, acquisition and integration strategies, current status of the health and safety management and parallel experiences of the largest business area Andritz Hydro. The proposal is aimed at improving the current health and safety system for the permanent and sub-contracted employees at Andritz Pulp & Paper both in Finland and in various projects globally.

Dairy goat health management and milk production on organic and conventional system in Brazil

The aimed of this article is to measure risk factors on health and milk production on organic and conventional dairy goats in Brazil. Two experimental groups (organic and conventional) were evaluated simultaneously. The study design was completely randomized. The organic herd consisted of 25 goats and 15 kids. In the conventional production system, a dairy herd comprising 40 goats and 20 kids participated in the study. Data on milk production and health management were available from January 2007 to December 2009. The abortion rate in the conventional system was 5% (2/40) whereas in organic system no abortion was diagnosed (0/25). The mortality rate at weaning in the conventional system was 5% (2/40) and in the organic system was 8% (2/25). Milk production was lower (2.20 kg/day) in organic than conventional system (2.66 kg/day). Goats and kids in organic farm had a higher FEC (386±104 and 900±204, respectively) (p<0.05) than those in conventional farm (245±132 and 634±212, respectively). In addition, Saanen kids had higher FEC (p<0.001) than goats. Treatment with antiparasitic drugs was higher in conventional system (50%) than organic system (1.3%).

The interaction between the implementation of an occupational health and safety management system and safety culture:a case study in the rubber industry

A prominent theme emerging in Occupational Health and Safety (OSH) is the development of management systems. A range of interventions, according to a prescribed route detailed by one of the management systems, can be introduced into an organisation with some expectation of improved OSH performance. This thesis attempts to identify the key influencing factors that may impact upon the process of introducing interventions, (according to B88800: 1996, Guide to Implementing Occupational Health and Safety Management Systems) into an organisation. To help identify these influencing factors a review of possible models from the sphere of Total Quality Management (TQM) was undertaken and the most suitable TQM model selected for development and use in aSH. By anchoring the aSH model's development in the reviewed literature a range ofeare, medium and low level influencing factors were identified. This model was developed in conjunction with the research data generated within the case study organisation (rubber manufacturer) and applied to the organisation. The key finding was that the implementation of an OSH intervention was dependant upon three broad vectors of influence. These are the Incentive to introduce change within an organisation which refers to the drivers or motivators for OSH. Secondly the Ability within the management team to actually implement the changes refers to aspects, amongst others, such as leadership, commitment and perceptions of OSH. Ability is in turn itself influenced by the environment within which change is being introduced. TItis aspect of Receptivity refers to the history of the plant and characteristics of the workforce. Aspects within Receptivity include workforce profile and organisational policies amongst others. It was found that the TQM model selected and developed for an OSH management system intervention did explain the core influencing factors and their impact upon OSH performance. It was found that within the organisation the results that may have been expected from implementation of BS8800:1996 were not realised. The OSH model highlighted that given the organisation's starting point, a poor appreciation of the human factors of OSH, gave little reward for implementation of an OSH management system. In addition it was found that general organisational culture can effectively suffocate any attempts to generate a proactive safety culture.

Protocolo de la historia clínica de baja visión dentro del marco de la implementación del sistema health information management system (HIMS) en la clínica de optometría de La Universidad de La Salle

Tesis (Optometra). -- Universidad de La Salle, Facultad de Ciencias de La Salud. Programa de Optometria, 2014

AMBIVALENT IMPLICATIONS OF HEALTH CARE INFORMATION SYSTEMS: A STUDY IN THE BRAZILIAN PUBLIC HEALTH CARE SYSTEM

This article evaluates social implications of the ""SIGA"" Health Care Information System (HIS) in a public health care organization in the city of Sao Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

Health care marketing: the theory of planned behavior applied to patients' choise between private and public providers in the portuguese health care system.

Dissertation submitted in partial fulfillment of the requirements for degree of Master in Statistics and Information Management.

Prognostics health management: perspectives in engineering systems reliability prognostics

The Prognostic Health Management (PHM) has been asserting itself as the most promising methodology to enhance the effective reliability and availability of a product or system during its life-cycle conditions by detecting current and approaching failures, thus, providing mitigation of the system risks with reduced logistics and support costs. However, PHM is at an early stage of development, it also expresses some concerns about possible shortcomings of its methods, tools, metrics and standardization. These factors have been severely restricting the applicability of PHM and its adoption by the industry. This paper presents a comprehensive literature review about the PHM main general weaknesses. Exploring the research opportunities present in some recent publications, are discussed and outlined the general guide-lines for finding the answer to these issues.

Development and implementation of an integrated technical management system

Quality Management, Integrated Technical Management Systems, ITMS, Technical Elements, Environment, Occupational Health and safety, OH&S, Standards, ISO, General Regulations, Integration, Management Functions, Computer Centre, Suc-cess Concepts, Documentation, PCT, QMS, EMS, OH&S-MS, Portioning, Evaluation, Technical Cycle, Technical Compliance, Framework

Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system.

OBJECTIVES: The objectives were to identify the social and medical factors associated with emergency department (ED) frequent use and to determine if frequent users were more likely to have a combination of these factors in a universal health insurance system. METHODS: This was a retrospective chart review case-control study comparing randomized samples of frequent users and nonfrequent users at the Lausanne University Hospital, Switzerland. The authors defined frequent users as patients with four or more ED visits within the previous 12 months. Adult patients who visited the ED between April 2008 and March 2009 (study period) were included, and patients leaving the ED without medical discharge were excluded. For each patient, the first ED electronic record within the study period was considered for data extraction. Along with basic demographics, variables of interest included social (employment or housing status) and medical (ED primary diagnosis) characteristics. Significant social and medical factors were used to construct a logistic regression model, to determine factors associated with frequent ED use. In addition, comparison of the combination of social and medical factors was examined. RESULTS: A total of 359 of 1,591 frequent and 360 of 34,263 nonfrequent users were selected. Frequent users accounted for less than a 20th of all ED patients (4.4%), but for 12.1% of all visits (5,813 of 48,117), with a maximum of 73 ED visits. No difference in terms of age or sex occurred, but more frequent users had a nationality other than Swiss or European (n = 117 [32.6%] vs. n = 83 [23.1%], p = 0.003). Adjusted multivariate analysis showed that social and specific medical vulnerability factors most increased the risk of frequent ED use: being under guardianship (adjusted odds ratio [OR] = 15.8; 95% confidence interval [CI] = 1.7 to 147.3), living closer to the ED (adjusted OR = 4.6; 95% CI = 2.8 to 7.6), being uninsured (adjusted OR = 2.5; 95% CI = 1.1 to 5.8), being unemployed or dependent on government welfare (adjusted OR = 2.1; 95% CI = 1.3 to 3.4), the number of psychiatric hospitalizations (adjusted OR = 4.6; 95% CI = 1.5 to 14.1), and the use of five or more clinical departments over 12 months (adjusted OR = 4.5; 95% CI = 2.5 to 8.1). Having two of four social factors increased the odds of frequent ED use (adjusted = OR 5.4; 95% CI = 2.9 to 9.9), and similar results were found for medical factors (adjusted OR = 7.9; 95% CI = 4.6 to 13.4). A combination of social and medical factors was markedly associated with ED frequent use, as frequent users were 10 times more likely to have three of them (on a total of eight factors; 95% CI = 5.1 to 19.6). CONCLUSIONS: Frequent users accounted for a moderate proportion of visits at the Lausanne ED. Social and medical vulnerability factors were associated with frequent ED use. In addition, frequent users were more likely to have both social and medical vulnerabilities than were other patients. Case management strategies might address the vulnerability factors of frequent users to prevent inequities in health care and related costs.

Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system

Objectifs - Identifier les facteurs de vulnérabilité sociaux et médicaux associés au recours multiple aux consultations des urgences. - Déterminer si les patients à recours multiple sont plus à même de combiner ces facteurs dans un système d'assurance universelle. Méthode Il s'agit d'une étude cas-contrôle rétrospective basée sur l'étude de dossiers médico-administratifs comparant des échantillons randomisés de patients à recours multiple à des patients n'appartenant pas à cette catégorie, au sein des urgences du Centre Hospitalier Universitaire Vaudois et de la Policlinique Médicale Universitaire de Lausanne. Les auteurs ont défini les patients à recours multiple comme comptabilisant au moins quatre consultations aux urgences durant les douze mois précédents. Les patients adultes (>18 ans) ayant consulté les urgences entre avril 2008 et mars 2009 (période d'étude) étaient inclus ; ceux quittant les urgences sans décharge médicale étaient exclus. Pour chaque patient, le premier dossier d'urgence informatisé inclus dans la période d'étude était sélectionné pour l'extraction des données. Outre les variables démographiques de base, les variables d'intérêt comprennent des caractéristiques sociales (emploi, type de résidence) et médicales (diagnostic principal aux urgences). Les facteurs sociaux et médicaux significatifs ont été utilisés dans la construction d'un modèle de régression logistique, afin de déterminer les facteurs associés avec le recours multiple aux urgences. De plus, la combinaison des facteurs sociaux et médicaux a été étudiée. Résultats Au total, 359/Γ591 patients à recours multiple et 360/34'263 contrôles ont été sélectionnés. Les patients à recours multiple représentaient moins d'un vingtième de tous les patients des urgences (4.4%), mais engendraient 12.1% de toutes les consultations (5'813/48'117), avec un record de 73 consultations. Aucune différence en termes d'âge ou de genre n'est apparue, mais davantage de patients à recours multiples étaient d'une nationalité autre que suisse ou européenne (n=117 [32.6%] vs n=83 [23.1%], p=0.003). L'analyse multivariée a montré que les facteurs de vulnérabilité sociaux et médicaux les plus fortement associés au recours multiple aux urgences étaient : être sous tutelle (Odds ratio [OR] ajusté = 15.8; intervalle de confiance [IC] à 95% = 1.7 à 147.3), habiter plus proche des urgences (OR ajusté = 4.6; IC95% = 2.8 à 7.6), être non assuré (OR ajusté = 2.5; IC95% = 1.1 à 5.8), être sans emploi ou dépendant de l'aide sociale (OR ajusté = 2.1; IC95% = 1.3 à 3.4), le nombre d'hospitalisations psychiatriques (OR ajusté = 4.6; IC95% = 1.5 à 14.1), ainsi que le recours à au moins cinq départements cliniques différents durant une période de douze mois (OR ajusté = 4.5; IC95% = 2.5 à 8.1). Le fait de comptabiliser deux sur quatre facteurs sociaux augmente la vraisemblance du recours multiple aux urgences (OR ajusté = 5.4; IC95% = 2.9 à 9.9) ; des résultats similaires ont été trouvés pour les facteurs médicaux (OR ajusté = 7.9; IC95% = 4.6 à 13.4). La combinaison de facteurs sociaux et médicaux est fortement associée au recours multiple aux urgences, puisque les patients à recours multiple étaient dix fois plus à même d'en comptabiliser trois d'entre eux (sur un total de huit facteurs, IC95% = 5.1 à 19.6). Conclusion Les patients à recours multiple aux urgences représentent une proportion modérée des consultations aux urgences du Centre Hospitalier Universitaire Vaudois et de la Policlinique Médicale Universitaire de Lausanne. Les facteurs de vulnérabilité sociaux et médicaux sont associés au recours multiple aux urgences. En outre, les patients à recours multiple sont plus à même de combiner les vulnérabilités sociale et médicale que les autres. Des stratégies basées sur le case management pourraient améliorer la prise en charge des patients à recours multiple avec leurs vulnérabilités afin de prévenir les inégalités dans le système de soins ainsi que les coûts relatifs.

La PMU au carrefour des nouveaux chemins du système de santé [Redesigning Swiss ambulatory health care system].

Primary care medicine is first in line to meet the necessary changes in our health care system. Innovations in this field pursue three types of objectives: accessibility, quality and continuity of care. The Department of ambulatory care and community medicine of the University of Lausanne (Policlinique médicale universitaire) is committed to this path, emphasizing interprofessional collaboration. The doctor, nurse and medical assistant coordinate their activities to contribute efficiently to meet the needs of patients today and tomorrow. This paper also addresses how our department, as a public and academic institution, might play a major role as a health care network actor. A master degree dissertation in health management has started to identify the critical success factors and the strategic core competencies needed to achieve this development.

Team Effectiveness in Patient Health Management: An Overview of Reviews

Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for perform- ance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effective- ness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness.

An evaluation of Primary health care system in Kerala

The thesis entitled An Evaluation of Primary Health Care System in Kerala. The present study is intended to examine the working of primary health care system and its impact on the health status of people. The hypothesis tested in the thesis includes, a. The changes in the health profile require reallocation of resources of primary health care system, b. Rate of utilization depends on the quality of services provided by primary health centers, and c. There is a significant decline in the operational efficiency of the primary health care system. The major elements of primary health care stated in the report of AlmaAta International Conference on Primary Health Care (WHO, 1994)” is studied on the basis of the classification of the elements in to three: Preventive, Promotive, and Curative measures. Preventive measures include Maternal and Child Health Care including family Planning. Provision of water and sanitation is reviewed under promotive measures. Curative measures are studied using the disease profile of the study area. Collection of primary data was done through a sample survey, using pre-tested interview schedule of households of the study area. Multi stage random sampling design was used for selecting the sample. The design of the present study is both descriptive and analytical in nature. As far as the analytical tools are concerned, growth index, percentages, ratios, rates, time series analysis, analysis of variance, chi square test, Z test were used for analyzing the data. Present study revealed that no one in these areas was covered under any type of health insurance. Conclusion states that considering the present changes in the health profile, traditional pattern of resource allocation should be altered to meet the urgent health care needs of the people. Preventive and promotive measures like health education for giving awareness among people to change health habits, diet pattern, life style etc. are to be developed. Proper diagnosis and treatment of the disease at the beginning of the stage itself may help to cure majority of disease. For that, Public health policy must ensure the primary health care as enunciated at Alma- Ata international Conference. At the same time Public health is not to be treated as the sole responsibility of the government. Active community participation is an essential means to attain the goals.