A superlotação dos serviços de emergência hospitalar como evidência de baixo desempenho organizacional / The overcrowding of hospital emergency services as evidence of low organizational performance

O estudo teve como objetivo investigar a superlotação nos serviços de emergência hospitalar (SEH). Para tal, foram elaborados dois artigos, já publicados. O primeiro, elaborado durante a crise dos serviços de emergência hospitalar de 2005, discutiu as características estruturantes do Programa QUALISUS do Ministério da Saúde do Brasil, em curso de implantação, analisou as especificidades desses serviços e fez algumas considerações sobre o sistema de saúde do município do Rio de Janeiro, sede do início do programa QUALISUS. Com a complexidade do cenário onde o programa era implementado, exemplificado pela grave crise na assistência àqueles que demandavam cuidados nos serviços de emergência, assim como as características da matriz da qualidade sugerida pelo programa, cuja ênfase é na reorganização da rede dos serviços de emergência e na recepção dos serviços de emergência hospitalar, voltados para o acolhimento e a classificação de risco, optou-se pelo aprofundamento do estudo sobre os SEH. A partir de uma revisão sistemática, discutiu-se as intervenções voltadas para solucionar o problema da superlotação dos Serviços de Emergência Hospitalar, e identificou-se evidências de baixo desempenho organizacional. A revisão sistemática partiu de um universo de 2.992 títulos, onde foram selecionados 822 títulos para análise de resumos e textos integrais, entre o período de 2000 a junho de 2007. A superlotação foi caracterizada como um fenômeno mundial, com causas e conseqüências. As intervenções que interferiram positivamente no principal indicador da superlotação, o tempo de permanência no SEH, apontaram para a melhoria do fluxo de saída dos pacientes dos serviços de emergência hospitalar, através do aumento do desempenho organizacional. Os resultados dessa revisão desmistificaram as soluções que aumentam as barreiras de acesso ou melhoram a estrutura...

The study aimed to investigate the overcrowding in the public hospitals emergency rooms (ER). For such, two articles had been elaborated and are already published. The first one is related to the crisis of the public hospitals emergency rooms services which took place in the year of 2005 in Brazil. It presents the major characteristics of the Ministry of Health QUALISUS Program, analyzes the specificities of these services and made some considerations about the city of Rio de Janeiro health system, QUALISUS headquarter. Given the complexity of the broad picture where the program was implemented, leaded by the serious crisis in the emergency rooms medical care, as well as the characteristics of the quality matrix suggested by the program, whose emphasis is the reorganization of the emergency services network and in the reception of the services of hospital emergency driven toward the shelter and the classification of risk, it was decided to deepen the research on the emergency room aspects. From a thorough systematic review based on a universe of 2.992 titles, 882 full articles and abstracts from the period between 2.000 and 2.007 were analyzed. Overcrowding was characterized as a world-wide phenomenon, with causes and consequences. Among the main aspects, this literature raise up a range of interventions to solve the emergency room overcrowding. Low organizational performance is a scientific finding. Interventions that had modified positively the main indicator of overcrowding, the time of permanence in the emergency room, dealt with the improvement of the patients discharge from emergency rooms through the increase of the organizational performance. The results of this systematic revision had demystified the solutions that increase access barriers...

A Comparison of the Awareness of Medical Residents' Power Style, Communication Type and Organizational Effectiveness in Nurses and Technologists / 한국의학교육

PURPOSE: This study is a descriptive research comparing the awareness of medical residents' power style, communication type and organizational effectiveness in nurses and technologists. METHODS: A standardized survey questionnaire was sent to 288 nurses, 85 radiological technologists, and 107 medical technologists working at 4 university hospitals in a metropolitan area. Collected data were analyzed using statistical methods including 2-test, t-test, ANOVA, and Pearson correlation. RESULTS: There was a noticeable difference between the nurses and the technologists in their awareness of medical residents' power style and communication type. Power style and communication type correlates significantly with job satisfaction and organizational commitment. When residents exercised coercive power, downward communication took place between the residents and nurses and technologists. It also affected the overall amount of communication, job satisfaction and organizational commitment. CONCLUSION: To ensure active communication between medical residents and other allied health professionals and to promote mutually satisfying relationships, open and active communication channels should be provided. Communication skills training for every member of a hospital organization is needed to encourage effective horizontal communication.

Job Stress and Organizational Effectiveness of Dental Technicians / 대한산업의학회지

OBJECTIVES: To investigate the relationship between job stress and the variables associated with the organizational effectiveness of dental technicians. METHODS: The job stresses were divided into the following six components; somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and hostility. The organi-zational effectiveness variables in this study included job satisfaction, occupational commitment, organizational commitment and intent to leave. The sample used in this study consisted of 248 dental technicians working in hospitals and dental laboratories. The data were collected with self-administered questionnaires between March 16 and April 29 in 2002, and the results analyzed with ANOVA and multiple regression analysis. RESULTS: Firstly, job stress of dental technicians was found to be significantly different in relation to the number of workers at the workplace and the working hours. The level of job stress was the highest when the number of workers were more than 10, or when the daily working hours were over 12. Secondly, of the six variables of job stress, five variables of somatization, interpersonal sensitivity, depression, anxiety, and hostility were found to have significant negative correlations with job satisfaction. Thirdly, all six job stress variables were found to have significant negative correlations with the occupational and organizational commitments of the dental technicians. Finally, depression was the only job stress variable found to have a significant effect on the dental technicians' intent to leave. CONCLUSIONS: The results of this study indicate that personal and organizational efforts are very important to improve the organizational effectiveness in reducing work related stress. Organizational support, especially for managing the depression of dental technicians is recommended.

The Relationship of Organizational Culture and Organizational Effectiveness at the General Hospital / 예방의학회지

OBJECTIVES: Organizational culture has been important in field of organizational behavior research for the past decade. Although there has been a growing interest in the organizational culture and organizational effectiveness, there is few research in health care field. This study was carried out to investigate the relationship of organizational culture and organizational effectiveness at general hospital. METHODS: Data was collected by self-administrated questionares. Organizational cultures were measured by using Likert scale. A general hospital in Kyunggi-Do was selected and survey was conducted to 675 workers. Data was analyzed with computer package, PC- SPSS. RESULTS: There were four types of organizational culture in this hospital : consensual culture, developmental culture, hierarchical culture, rational culture. Many workers recognized their culture as rational culture and developmental culture. This finding showed that the hospital had both human related and task related climate. There were some differences in recognition of sub-organizational culture by occupational group, but perceived organizational culture was in accordance with sub-organizational culture in general. Multiple regression analysis and multiple logistic regression analysis were conducted to find the relationship of organizational culture and organizational effectiveness. As a result, developmental culture showed a strong relationship with organizational commitment and job-satisfaction. CONCLUSIONS: These results showed that types of organizational culture were significantly related to organizational effectiveness and understanding the existing culture is essential to develope their organizational effectiveness.

The Effect of Job Stress and Social Support on the Organizational Effectiveness of Hospital Employees / 예방의학회지

The purpose of this study is to investigate the effect of job stress and social support on the organizational effectiveness of hospital employees and to examine the role of social support in the experience of job stress among the employees. Previous studies have yielded mixed results regarding the role of social support. Some studies provide supporting evidence for the buffering effect of social support, while others do not. Still others report findings about reverse buffering effects. These inconsistent findings are, in part, accounted for by methodological problems such as poor measurement, small sample size, and the existence of high multicollinearity. To examine more rigorously the role of social support in relation to the negative effects of job stress, this study was carefully designed to overcome methodolgical shortcomings found in the past research. In addition, unlike the previous studies, which were concerned mostly with health-related variables as consequences of job stress, in this study, three work-related variables (job satisfaction, organizational commitment, and intent to stay) which had close relationships with organizational effectiveness were examined as output variables. The sample used in this study consisted of 353 employees from a university hospital in the suburbs of seoul. Data were collected with self-administered questionnaires and analyzed using canonical analysis and hierarchical regression analysis. The results of this study indicate that; (l) job stress has negative main effects on job satisfaction, organizational commitment, and intent to stay; (2) social support has positive main effects on the same three output variables, (3) social support does not moderate the harmful effects of job stress on the three outcome variables, and (4) the three-way interaction effects of (social support * job stress * gender) and of (social support * job stress * education) are not supported The implications of these findings for the management of human resources are discussed.