Construction and empirical study on the performance appraisal model for full-time researchers: a case study of a specialized children′s hospital / 中华医院管理杂志

Objective:To build a performance appraisal system for full-time researchers in specialized children′s hospitals, so as to mobilize their enthusiasm and improve their efficiency of scientific and technological output.Methods:Based on structure-process-result model, the library of indexes was initialized by such means as literature review and talent performance appraisal management experiences. From November 2020 to March 2021, Delphi method was adopted to finalize the appraisal indexes and weight of each index, while the quantifiable standards of the indexes were formulated by brainstorming, hence establishing the performance appraisal model index system for these researchers. Using both the new model and the original performance appraisal system of the hospital respectively, five full-time research staffs of research-oriented children′s hospital were selected for an empirical research on performance appraisal.Results:Fifteen experts carried out two rounds of Delphi research, finalizing a performance appraisal model for these researchers. The model comprises 3 level-1 indexes, 8 level-2 indexes and 23 level-3 indexes. Among them, the weight of scientific research output, scientific research process and scientific research investment of level-1 indexes were 0.507, 0.267 and 0.226, respectively. Empirical research showed that compared with the original appraisal indexes, the results of the new performance appraisal model were more targeted, enabling the research team to identify setbacks.Conclusions:The indexes set in the model built in this study prove more scientific, objective, and more reasonable in weight assignment. Such indexes can positively motivate and encourage the researchers, promoting the clinical-basic research integration, as well as the disciplinary development and research talent cultivation of the hospital.

Research on the willingness of county-level hospital physicians to participate in county-township human resource integration for medical institutions / 中华医院管理杂志

Objective:To study the willingness of county-level hospital physicians within a county medical alliance(alliance)to participate in county-township human resource integration for medical institutions, for furthering the development of such integration.Methods:Based on a discrete selection experiment, a questionnaire was designed for the selection of the work attributes that affect the participation of county-level hospital physicians in such an integration. On-the-job physicians from four county-level hospitals in a prefecture level city were selected by multi-stage stratified random sampling method as the survey objects, and a field questionnaire survey was conducted from November to December 2021. The mixed logit model was used to analyze the preference of physicians in county-level hospitals for five types of work attributes(work unit, monthly income, seniority required for professional title promotion, training opportunities, serving as middle-level and above administrators), the relative importance of each work attribute, and marginal willingness to pay with regard to their participation in the integration.Results:A total of 172 valid questionnaires were collected. When county-level hospital physicians participate in county-township human resource integration for medical institutions, their statistically significant job attributes and level preferences included monthly income, working unit of county-level hospitals, 7 years for professional title promotion, and more training opportunities ( P<0.001). The relative importance of monthly income ranked the highest among the five categories of work attributes, up to 55.55%. Conclusions:When physicians in county-level hospitals participate in the integration of county-township human resources, the most important was their monthly income, and economic incentives could enhance their willingness to participate.

Exploration of human resource allocation management of multi-campus public hospitals / 中华医院管理杂志

The multi-campus hospital mode plays an important role in fully leveraging the advantages of public hospitals, and promoting both the expansion of high-quality medical resources and the balanced regional layout. The authors analyzed the current situation and existing problems of human resource allocation of the multi-campus mode of a provincial tertiary hospital, and summarized its practice of optimizing such allocation by improving the top-level organizational framework design, coordinating the construction of talent echelons, and effectively allocating human resources. These experiences can provide references for human resources management in such a mode.

Application of the in-basket test in head nurse competence evaluation / 中华医院管理杂志

Objective:To evaluate the competence of head nurses by using the in-basket test for establishing a hierarchical training system for these nurses.Methods:A set of in-basket test was independently designed to evaluate the head nurses of a tertiary hospital in September 2021.Fourteen competency indicators, including positive initiative, coordination and communication ability, and leadership, problem solving ability, motivation, empowerment, attention to quality and order, etc, were selected to analyze the answers of the in-basket test and score their competency level. The measures were described by Mean±SD and M(IQR), and the counts were described by rates and percentages. The rank sum test and multiple linear regression were used to analyze the influencing factors of competency scoring of head nurses. Results:A total of 133 head nurses were tested, with a total competency scoring of 30.0(5.5). The highest indicators were talent cultivation 3.0(2.0), positive initiative 3.0(1.0), coordination and communication ability 3.0(1.0), while those with lower scores were empowerment 1.0(1.0) and motivation 1.5(1.5). The rank sum test analysis showed that age, position, job position character and working seniority were the influencing factors of competency score( P<0.05). The multiple linear regression analysis showed that, working seniorities of 16-20 years( β=0.583, P=0.013), 21-25 years( β=0.732, P=0.008), 26-30 years( β=0.632, P=0.026) were the influencing factors of competency score of head nurses. Conclusions:The in-basket test is practical to evaluate the competence of head nurses as a basis for their targeted training in the future.

Trabalho em equipe na área da saúde / Teamwork in health care

Médicos, enfermeiros e outros profissionais de saúde passam boa parte do tempo se comunicando e coordenando atividades de cuidado. Apesar disso, o treinamento em habilidades de comunicação interpessoal e de trabalho em equipe tem sido historicamente pouco enfatizado. O principal objetivo do trabalho em equipe é melhorar os desfechos no cuidado ao paciente. A necessidade de trabalhar em equipe vem sendo cada vez mais frequente no cuidado à saúde. Assim, é relevante conhecer os elementos fundamentais para o seu bom funcionamento, assim como os principais fatores com potencial de prejudicá-lo. Neste artigo, os seguintes tópicos serão discutidos: classificação das equipes de cuidado à saúde; princípios determinantes para o sucesso das equipes; e as principais barreiras que podem comprometer seu funcionamento. Existe um reconhecimento crescente sobre a importância do trabalho em equipe (em oposição ao rígido gerenciamento hierárquico) no cuidado ao paciente. A resistência à mudança nos métodos de trabalho imposta pela tradição de décadas deve ser enfrentada por meio de um processo educacional, de forma que este artigo visa a contribuir para essa finalidade. (AU)

Physicians, nurses, and other health care professionals spend a great amount of time communicating and coordinating care activities. Nevertheless, interpersonal communication and teamwork skills have been historically underemphasized in professional training. The ultimate goal of teamwork efforts is to improve patient care outcomes. The need for interdisciplinary teamwork has been increasing in the health care setting. Thus, the main attributes needed in a good interdisciplinary team should be known, as well as the factors that could lead to a poor team performance. In this study, we discuss the definition and classification of teamwork in health care, the fundamental principles for successful teamwork, and the main barriers to effective teamwork. The importance of teamwork has been increasingly recognized in health care. However, decades of tradition have hindered changes in the way health care is provided, and educational processes should be used as an approach to deal with this situation. The present study intends to contribute to this purpose. (AU)

Evaluación de las actividades de control mediante la lógica difusa compensatoria en una entidad hospitalaria / Evaluation of control activities through diffuse Compensatory Logic in a hospital entity

RESUMEN Fundamento: el control es fundamental para que un hospital logre alcanzar sus objetivos y metas trazadas, de lo contrario sería imposible que se puedan definir las medidas que se deben adoptar para alcanzarlos. Objetivo: evaluar las actividades de control como componente interno en una entidad hospitalaria cubana, mostrando la mejor dirección a seguir a la hora de la toma de las decisiones, con un bajo nivel de incertidumbres en los resultados. Métodos: se diseñó un modelo a través de la lógica difusa compensatoria, compuesto por los elementos fundamentales de la norma actividades de control. Resultados: las actividades de control en el hospital se encuentran en una categoría deficiente de algo verdadero, al influir de manera negativa la rotación del personal y los indicadores de rendimiento en el desempeño. Conclusiones: se obtuvo el índice de la gestión del control, al evidenciar que existen deficiencias notables en la implementación del mismo. Lo que permite al hospital establecer una estrategia de mejora, basadas en un plan de acción.

ABSTRACT Background: the control is essential for a hospital to achieve its objectives and goals, otherwise it would be impossible to define the measures to be taken to achieve them. Objective: to evaluate control activities as a component of internal control in a Cuban hospital entity, showing the best direction to follow when making decisions, with a low level of uncertainty in the results. Methods: a model was designed through Diffuse Compensatory Logic, composed of the fundamental elements of the control activities standard. Results: the control activities in the hospital are in a deficient category of something true, negatively influencing staff turnover and performance indicators. Conclusions: the control management index was obtained, showing that there are notable deficiencies in its implementation. Allowing the hospital to establish an improvement strategy based on an action plan.

Absenteeism and the Technical Safety Index of a tertiary hospital nursing team / Absentismo e ndice de seguridad tcnica del equipo de enfermera de un hospital terciario / Absentesmo e ndice de segurana tcnica da equipe de enfermagem de um hospital tercirio

Abstract Objective: To identify the nursing team absenteeism rate, calculate the Technical Safety Index and compare them to the percentage established by the Federal Nursing Council. Method: A descriptive, analytical, and retrospective study which included nursing professionals working in a public and tertiary hospital. The Human Resources Department database of the Institution was used for data collection. Absenteeism was considered as any unplanned absence. Results: Ninety-nine (99) professionals participated, of which 21 were nurses and 78 were nursing technicians. Weekly days off prevailed among the expected absences, with 17% for both categories. Maternity leave prevailed among nurses and medical leave among nursing technicians regarding absenteeism, with averages of 12% and 9%, respectively. The Technical Safety Index was 42% for nurses and 38% for nursing technicians. Conclusion: The nursing teams absenteeism rate was 21.5%, while the Technical Safety Index was 40%, thus constituting higher values than those established by the Federal Nursing Council.

Resumen Objetivo: Identificar el ndice de absentismo del equipo de enfermera, calcular el ndice de Seguridad Tcnica y compararlos al porcentual establecido por el Consejo Federal de Enfermera. Mtodo: Estudio descriptivo, analtico, retrospectivo, que incluye a profesionales enfermeros actuantes en un hospital pblico y terciario. Para la recoleccin de datos, se emple el banco de datos del Departamento de Recursos Humanos del Centro. Se consideraron como absentismo las ausencias no previstas. Resultados: Participaron 99 profesionales, siendo 21 enfermeros y 78 tcnicos. Los das libres semanales prevalecieron entre las ausencias previstas, siendo el 17% para ambas categoras. En cuanto al absentismo, prevaleci la licencia de maternidad entre enfermeros y la licencia mdica entre tcnicos de enfermera, cuyos promedios fueron del 12% y el 9%, respectivamente. El ndice de Seguridad Tcnica fue del 42% para enfermeros y del 38% para tcnicos de enfermera. Conclusin: El ndice de absentismo del equipo de enfermera fue del 21,5%, mientras que el ndice de Seguridad Tcnica fue del 40%, por lo tanto, superiores a las cifras establecidas por el Consejo Federal de Enfermera.

Resumo Objetivo: Identificar a taxa de absentesmo da equipe de enfermagem, calcular o ndice de Segurana Tcnica e compar-los ao percentual estabelecido pelo Conselho Federal de Enfermagem. Mtodo: Estudo descritivo, analtico, retrospectivo, que incluiu profissionais de enfermagem, atuantes em um hospital pblico e tercirio. Para a coleta de dados, foi utilizado o banco de dados do Departamento de Recursos Humanos da Instituio. Consideraram-se como absentesmo as ausncias no previstas. Resultados: Participaram 99 profissionais, sendo 21 enfermeiros e 78 tcnicos. As folgas semanais prevaleceram entre as ausncias previstas, sendo 17% para ambas as categorias. Quanto ao absentesmo, prevaleceu a licena maternidade entre enfermeiros e a licena mdica entre tcnicos de enfermagem, cujas mdias foram de 12% e 9%, respectivamente. O ndice de Segurana Tcnica foi de 42% para enfermeiros e 38% para tcnicos de enfermagem. Concluso: A taxa de absentesmo da equipe de enfermagem foi de 21,5%, enquanto o ndice de Segurana Tcnica foi de 40%, portanto, superiores aos valores estabelecidos pelo Conselho Federal de Enfermagem.

Elaboração e validação de instrumento para avaliação dos recursos humanos e materiais na perspectiva da prevenção de lesão por pressão: estudo metodológico / Elaboration and validation of an instrument for the evaluation of human and material resources from the perspective of pressure injury prevention: a methodological study / Elaboración y validación de instrumento para evaluación de los recursos humanos y materiales en la perspectiva de la prevención de lesión por presión: estudio metodológico

A lesão por pressão é caracterizada por um dano localizado na pele e/ou nos tecidos moles subjacentes geralmente sobre uma proeminência óssea ou relacionado a um dispositivo médico. Apesar da disponibilidade na literatura de escalas de avaliação de risco do cliente, as condições do cenário em que o cliente está inserido não são avaliadas, em termos de recursos humanos e materiais. Objetivos: Identificar os recursos humanos e materiais imprescindíveis para a prevenção de lesão por pressão; elaborar e validar um instrumento para avaliação dos recursos humanos e materiais na perspectiva da prevenção de lesão por pressão. Metodologia: Trata-se de um estudo metodológico, de abordagem qualitativa e medidas quantitativas. O percurso metodológico foi dividido em três fases. Na primeira fase foi realizada uma revisão integrativa de literatura, e após aplicação dos critérios de inclusão e exclusão, foram selecionados dois artigos, uma Resolução do Conselho Federal de Enfermagem nº 543/2017, um Protocolo prevenção de úlcera por pressão do Ministério da Saúde/2013, além de um nota Técnica da Anvisa nº3/2017 e um Guideline Prevent and Treatment of Pressure Ulcers: Quick Reference Guide/2014, que serviram como base para a segunda fase, elaboração do instrumento. A terceira fase foi a validação do instrumento por enfermeiros especialistas, mediante a técnica Delphi, no caso deste estudo, enfermeiros titulados pela Associação Brasileira de Enfermagem em Dermatologia (SOBENDE). Além da análise qualitativa, preconizada pela Técnica Delphi, optou-se por realizar também a análise quantitativa, utilizando Índice de Validade de Conteúdo com uma taxa não inferior a 0,70 e o coeficiente de concordância (AC1) de Gwet. Resultados: Foi evidenciado uma baixa taxa de concordância entre os especialistas advindas da primeira rodada pela técnica Delphi, foram necessárias duas rodadas de perguntas e respostas para que todos os itens do protocolo atingissem Índice de Validade de Conteúdo (IVC) superior a 0,70. Na primeira fase o IVC relacionado aos recursos humanos e materiais no cuidado intermediário foi de 0,77, no limiar do IVC considerado satisfatório e na segunda fase esse valor foi de 0,82. Concomitante, no cuidado de alta dependência o IVC foi de 0,73 na primeira fase e 0,81 na segunda fase. Além do IVC, foi utilizado o índice de concordância de Gwet (AC1) que considera mais de uma categoria pertinente a escala de Likert modificada, considerada como uma extensão otimizada do coeficiente Kappa. Percebeu-se que o AC1 conseguiu obter valores diferenciados da fase I para a fase II e consequentemente migrações na classificação Landis e Koch. As alterações sugeridas pelos especialistas na primeira e segunda fase trouxeram pouca modificação do instrumento em relação a versão inicial, o qual sua versão final totalizou 32 itens, 24 direcionados para os recursos humanos e 8 para os recursos materiais. Conclusão: O instrumento elaborado e validado, como produto da dissertação, contribuirá para a prática dos enfermeiros, permitindo um diagnóstico situacional das unidades de internação em relação aos recursos humanos e materiais na perspectiva da prevenção de lesão por pressão

The pressure lesion is characterized by a localized damage to the skin and / or soft tissues underlying generally a prominent bony or related to a medical device. Despite the availability in the literature of customer risk assessment scales, the conditions of the scenario in which the client is inserted are not evaluated in terms of human and material resources. Objectives: To identify the human resources and materials essential for the prevention of pressure injuries; develop and validate an instrument for the evaluation of human and material resources from the perspective of pressure injury prevention. Methodology: This is a methodological study, with a qualitative approach and quantitative measures. The methodological course was divided into three phases. In the first phase, an integrative review of the literature was performed, and after applying the inclusion and exclusion criteria, two articles were selected, a Resolution of the Federal Nursing Council No. 543/2017, a Protocol for the Prevention of Pressure Ulcer of the Ministry of Health / 2013, in addition to an Anvisa Technical Note nº3 / 2017 and a Guideline Prevent and Treatment of Pressure Ulcers: Quick Reference Guide / 2014, which served as the basis for the second phase, instrument elaboration. The third phase was the validation of the instrument by specialist nurses, using the Delphi technique, in the case of this study, nurses graduated by the Brazilian Association of Nursing in Dermatology (SOBENDE). In addition to the qualitative analysis, recommended by the Delphi Technique, we also performed the quantitative analysis, using Content Validity Index with a rate of not less than 0.70 and the coefficient of agreement (AC1) of Gwet. Results: It was evidenced a low agreement rate among the experts from the first round by the Delphi technique, two rounds of questions and answers were necessary so that all the items of the protocol reached Content Validity Index (CVI) of more than 0.70. In the first phase, the IVC related to human and material resources in intermediate care was 0.77, at the IVC threshold considered satisfactory and in the second phase this value was 0.82. Concomitant, in the high-dependency care IVC was 0.73 in the first phase and 0.81 in the second phase. In addition to IVC, the Gwet concordance index (AC1) was used, which considers the modified Likert scale, considered as an optimized extension of the Kappa coefficient, to be more than one relevant category. It was found that AC1 was able to obtain differentiated values from phase I to phase II and consequently migrations in the Landis and Koch classification. The changes suggested by the experts in the first and second phases brought little modification of the instrument in relation to the initial version, whose final version totaled 32 items, 24 for human resources and 8 for material resources. Conclusion: The instrument developed and validated, as a product of the dissertation, will contribute to the practice of nurses, allowing a situational diagnosis of hospitalization units in relation to human and material resources from the perspective of prevention of pressure injury

La lesión por presión se caracteriza por un daño localizado en la piel y / o en los tejidos blandos subyacentes generalmente sobre una prominencia ósea o relacionado con un dispositivo médico. A pesar de la disponibilidad en la literatura de escalas de evaluación de riesgos del cliente, las condiciones del escenario en que el cliente está insertado no son evaluadas, en términos de recursos humanos y materiales. Objetivos: Identificar los recursos humanos y materiales imprescindibles para la prevención de lesión por presión; elaborar y validar un instrumento para la evaluación de los recursos humanos y materiales en la perspectiva de la prevención de lesiones a presión. Metodología: Se trata de un estudio metodológico, de abordaje cualitativo y medidas cuantitativas. El recorrido metodológico se dividió en tres fases. En la primera fase se realizó una revisión integrativa de literatura, y tras la aplicación de los criterios de inclusión y exclusión, se seleccionaron dos artículos, una Resolución del Consejo Federal de Enfermería nº 543/2017, un Protocolo de prevención de úlcera por presión del Ministerio de Salud / Y una nota técnica de la Anvisa nº3 / 2017 y una guía de prevención y prevención de la presión arterial: Quick Reference Guide / 2014, que sirvieron como base para la segunda fase, elaboración del instrumento. La tercera fase fue la validación del instrumento por enfermeros especialistas, mediante la técnica Delphi, en el caso de este estudio, enfermeros titulados por la Asociación Brasileña de Enfermería en Dermatología (SOBENDE). Además del análisis cualitativo, preconizado por la Técnica Delphi, se optó por realizar también el análisis cuantitativo, utilizando Índice de Validez de Contenido con una tasa no inferior a 0,70 y el coeficiente de concordancia (AC1) de Gwet. Resultados: Se evidenció una baja tasa de concordancia entre los expertos provenientes de la primera ronda por la técnica Delphi, fueron necesarias dos rondas de preguntas y respuestas para que todos los ítems del protocolo alcanzase Índice de Validez de Contenido (IVC) superior a 0,70. En la primera fase el IVC relacionado a los recursos humanos y materiales en el cuidado intermedio fue de 0,77, en el umbral del IVC considerado satisfactorio y en la segunda fase ese valor fue de 0,82. Concomitante, en el cuidado de alta dependencia el IVC fue de 0,73 en la primera fase y 0,81 en la segunda fase. Además del IVC, se utilizó el índice de concordancia de Gwet (AC1) que considera más de una categoría pertinente a la escala de Likert modificada, considerada como una extensión optimizada del coeficiente Kappa. Se percibió que el AC1 logró obtener valores diferenciados de la fase I para la fase II y consecuentemente migraciones en la clasificación Landis y Koch. Las alteraciones sugeridas por los expertos en la primera y segunda fase trajeron poca modificación del instrumento en relación con la versión inicial, el cual su versión final totalizó 32 ítems, 24 dirigidos a los recursos humanos y 8 para los recursos materiales. Conclusión: El instrumento elaborado y validado, como producto de la disertación, contribuirá a la práctica de los enfermeros, permitiendo un diagnóstico situacional de las unidades de internación en relación con los recursos humanos y materiales en la perspectiva de la prevención de lesión por presión

Influence of person-organization fit on turnover intention of medical staff: a case study of 9 public hospitals in the Pearl River Delta / 中华医院管理杂志

Objective To examine the impact of person-organization fit ( P-O fit) on turnover intention of medical staff and examine the mediating role of job involvement between P-O fit and turnover intention of medical staff.Methods The basic research hypothesis was obtained by combing the relationship among three variables of P-O fit, job involvement and turnover intention of medical staff. A questionnaire survey was conducted among 408 medical staff at 9 general public hospitals in the Pearl River Delta from July to August 2018. The contents of survey were as follows: the match between such factors as medical staff values, culture, personal ability and hospital, as well as turnover intention and job involvement of medical staff.The structural equation model was constructed by Amos 20.0, and the relationship between variables was analyzed.Results The path coefficients between the three variables were 0.436(P<0.001),-0.281 (P<0.05),-0.544(P<0.001), respectively.The total effect value and intermediate effect value were-0.470,- 0.082, respectively. P-O fit was positively related to job involvement. P-O fit and job involvement were negatively related to turnover intention of medical staff.Job involvement partially mediated the relationship between P-O fit and turnover intention. Conclusions In order to reduce the turnover intention of medical staff, hospitals must pay attention to the match of values, culture and personal ability between medical staff and hospitals, establish a match evaluation mechanism between medical staff and hospitals, create good working conditions and atmosphere for medical staff, and encourage medical staff to work harder.

Professionalism of clinicians at public hospitals in China / 中华医院管理杂志

Objective To investigate the present professionalism of clinicians at public hospitals in China and its relationship with practicing environment and hospital management system. Methods From April 2015 to March 2016, 659 clinicians of 11 public hospitals, from Guandong, Hubei and Guangxi provinces, were recruited into the study based on multi-stage sampling. The questionnaire included professional attitude(20 items)and professional behavior(10 items).Descriptive statistics and spearman rank correlation analysis were applied for analysis.Results For professional attitude, 15 items were agreed by over 80% of respondents.All the positive professional behaviours were agreed by over 80% of respondents and all the negative professional behaviours were denied by less than 30% of respondents. Professional attitude was positively correlated with professional behaviour(r=0.157, P<0.01), practicing environment (r= 0.269, P < 0.01 ) and management system ( r = 0.199, P < 0.01). Professional behaviour was uncorrelated with practicing environment or management system ( P >0.05 ). Conclusions Clinicians at public hospitals in China present positive professional attitude which is correlated with professional behaviour, but they are not in high accordance with each other. Clinicians have low satisfaction with the practicing environment and management system, which are important factors influencing professional attitude of clinicians.

Aproximações entre habilidades sociais, gerência do cuidado de enfermagem e o pensamento complexo / Approximations between social skills, nursing care management and complex thinking / Afinidades entre las habilidades sociales, la gestión de los cuidados de enfermería y el pensamiento complejo

Estudo com objetivo de refletir sobre as interfaces entre habilidades sociais e a gerência do cuidado de enfermagem na perspectiva da complexidade. Estudo descritivo do tipo ensaio reflexivo fundamentado na base teórico-filosófica do pensamento complexo e percepções das autoras. As habilidades sociais englobam classes de comportamentos sociais no repertório do indivíduo para lidar de maneira adequada com as demandas das situações interpessoais. Elas se entrelaçam ao cotidiano da gerência do cuidado de enfermagem, pois gerenciar implica relacionar-se com os outros e, para tal, o enfermeiro necessita de um comportamento socialmente hábil. Este é um processo multifacetado, hologramático, não linear e, assim sendo, o cartesianismo é insuficiente para a sua sustentação epistemológica. Portanto, optou-se por pautar as reflexões nos princípios do pensamento complexo e concluiu-se que as relações interpessoais desenvolvidas pelos enfermeiros a partir de competências galgadas em um comportamento socialmente hábil representam importante mola propulsora para que a gerência do cuidado se distancie de uma prática reducionista e mecanicista.

This study aims to reflect on the interfaces between social skills and nursing care management from the perspective of complexity. Descriptive study of the type reflective essay grounded on the theoretical-philosophical basis of complex thinking and perceptions of the authors. Social skills encompass classes of social behaviors in the repertoire of individuals to deal adequately with demands of interpersonal situations. They are intertwined with the daily routine of nursing care management, since taking on the position of manager implies relating to others. To accomplish this, nurses need a socially skillful behavior. This is a multifaceted, hologramatic, non-linear process and, therefore, Cartesianism is insufficient for its epistemological support. Therefore, we decided to list the reflections grounded on the principles of complex thinking and we concluded that interpersonal relations developed by nurses stemming from competences based on a socially skillful behavior represent an important propulsive spring so that management of care be far from a reductionist and mechanistic practice.

Study on the efficiency of nursing service and the allocation of human resources in blood collection center based on visiting volume / 中国实用护理杂志

Objective To provide scientific basis for evaluating the efficiency of nursing service and reasonable allocation of human resources in blood collection by analyzing the time variation of visiting time in blood collection center. Methods Through the retrospective analysis of 2016 in different seasons and different blood centers working day and different time visits, obtains the variation of visits time;using a queuing analysis to evaluate different visits under the condition of nursing service efficiency and puts forward the scheme of optimal allocation of human resources. Results The blood center visits within one year of the first quarter of the lowest, the second quarter increased significantly, reaching the peak at the third quarter, the fourth quarter is relatively reduced; the work on Monday, Thursday, two or three high, five less;morning visits in different time was significantly higher than that in the afternoon, the morning peak on the 8:00-9:00 and 14:00-15:00 concentration in the afternoon peak; the situation of human resource allocation at this stage of blood centers, visits the peak season of nurse service intensity and low efficiency, the patients waiting for a long time, visits the low peak season, the nurse service intensity was low, idle for a long time, resulting in a waste of resources, quantitative configuration after the nurse service reasonable intensity, high work efficiency, effective treatment time of patients increased. Conclusions According to the law of time variation, the nursing service efficiency can be scientifically analyzed and the nursing manpower should be quantified to provide a scientific basis for hospital management.

Relationship between transformational leadership and creative work involvement among clinical medical workers / 中华医院管理杂志

Objective To examine the impact of transformational hospital leadership on clinical medical workers'creative work involvement.Methods From February to July 2016,826 clinical medical workers,including 359 doctors and 467 nurses, were randomly selected to complete a transformational leadership scale, a basic needs satisfaction scale and a creative work involvement scale.The data were analyzed using correlation analysis and structural equation model.Results Transformational leadership positively affected autonomy need satisfaction(β=0.40,P<0.001),competence need satisfaction(β=0.33, P<0.001),relatedness need satisfaction(β=0.81,P<0.001)and creative work involvement(β=0.64, P<0.001)respectively.All three needs satisfaction partially mediated the relationship between transformational leadership and creative work involvement.Conclusions Hospital personnel department should launch leaderships training programs to promote transformational leadership,which in turn will meet high level of psychological needs of medical workers,thus encouraging their creative work involvement.

Necessidade de remanejamento entre setores: percepção dos técnicos de enfermagem em um hospital / Necesidad de reubicación entre sectores: la percepción de los técnicos en enfermería en un hospital / The necessity of work reassignment between sectors: perception of nursing technicians in a hospital

Objetivo: analisar as percepções dos técnicos de enfermagem de um hospital de pequeno porte sobre o remanejamento entre setores. Método: Pesquisa descritiva, com abordagem qualitativa, em que os dados foram coletados por meio de entrevistas com trinta técnicos de enfermagem, utilizando-se o método de saturação. O material foi analisado a partir da análise de conteúdo proposta por Bardin. Resultados: Os resultados apontaram que o remanejamento é considerado, pelos colaboradores, uma situação eventual e necessária à rotina de trabalho. Entretanto, pode-se observar que causa desconforto à equipe e que deve ser realizado com critérios que não impactem no processo de trabalho dos envolvidos. Os pontos negativos elencados pelos colaboradores, neste processo, foram a sobrecarga de trabalho e a mudança de setor, entretanto os mesmos citaram a possibilidade de aprendizado e a perfeiçoamento profissional, como pontos positivos do remanejamento. Conclusão: O remanejamento é percebido como parte da rotina pelos profissionais, sendo necessário um investimento, por parte da gestão, para prevenir situações de desconforto e desarranjos que impactem na saúde ocupacional de seus colaboradores bem como na qualidade da assistência de seus pacientes.

Objective: to analyze the perceptions of nursing technicians in a small hospital in Belo Horizonte about work reassignmentbetween sectors. Method: This was an exploratory study with a qualitative approach in which the data were collected throughinterviews with thirty nursing technicians by applying the saturation method. The data were analyzed through the content analysisproposed by Bardin. Results: The results indicated that work reassignment is considered by employees as an eventual andnecessary event in their work routine. However, it is noticed that it causes discomfort to team members and must be carried outwith criteria in order to not impact the work process of those involved. The negative aspects mentioned in this process were workoverload and sector change. However, the participants mentioned the possibility of learning and professional development aspositive aspects. Conclusion: Work reassignment is perceived by professionals as part of the work routine, requiring an investmentby the management to prevent discomfort and disarray situations that impact the occupational health of employees and patients’quality care.

Objetivo: analizar las percepciones de los técnicos de enfermería de un hospital pequeño acerca de la reubicación de sectores.Método: Se trata de una investigación exploratoria, con enfoque cualitativo, en el que se recogieron los datos a través deentrevistas con treinta (30) técnicos de enfermería, y se utiliza el método de saturación. Todo el material fue analizado a partir delanálisis de contenido propuesto por Bardin. Resultados: Nuestros resultados mostraron que la reubicación es considerada por losempleados como sea posible y necesario en la situación de su rutina de trabajo. Sim embargo, se puede observar que esto causamolestias al equipo y debe llevarse a cabo con criterios que no impactan en el proceso de trabajo de los involucrados. Hay aspectosnegativos de este proceso como la carga de trabajo y el cambio de sector. Sin embargo, los participantes se refirieron a laposibilidad de aprendizaje y desarrollo profesional. Conclusión: La reubicación se percibe como parte de la rutina profesional, querequiere una inversión de la dirección para evitar situaciones de malestar y trastornos que afectan a la salud en el trabajo de susempleados y la calidad de atención a sus pacientes.

A qualidade da relação líder-membro e o empenhamento organizacional dos enfermeiros / La calidad de la relación líder-miembro y el empeño organizativo de los enfermeros / Quality of the leader-member relationship and the organizational commitment of nurses

RESUMO Objetivo: Conhecer a perceção da qualidade da relação de liderança e o empenhamento organizacional dos enfermeiros e analisar a influência da qualidade desta relação. Método: Abordagem quantitativa, transversal e correlacional. Amostra não probabilística por conveniência com 408 enfermeiros. Dados obtidos através de questionário no Centro Hospitalar de Lisboa Central, entre janeiro e março 2013. A análise estatística dos dados foi efetuada através do software estatístico IBM® SPSS® Statistics 19. Resultados: Consideraram-se válidos 342 questionários. A qualidade da relação de liderança é satisfatória e os enfermeiros encontram-se fracamente empenhados na organização. A qualidade de relação de liderança encontra-se estatisticamente correlacionada com o empenhamento organizacional: existe uma associação moderada com o empenhamento afetivo (rs=0,42, p<0,05), baixa com o empenhamento normativo (rs=0,37, p<0,05) e muito baixa com o empenhamento calculativo (rs=0,14, p<0,05). Conclusão: A liderança exerce influência no empenhamento organizacional. Existe oportunidade de melhoria da qualidade da relação de liderança entre enfermeiro e enfermeiro líder, com a consequente possibilidade de incrementar o empenhamento organizacional.

RESUMEN Objetivo: Conocer la percepción de la calidad de la relación de liderazgo y el empeño organizativo de los enfermeros y analizar la influencia de la calidad de esa relación. Método: Abordaje cuantitativo, transversal y correlacional. Muestra no probabilística por conveniencia con 408 enfermeros. Datos obtenidos mediante cuestionario en el Centro Hospitalario de Lisboa Central, entre enero y marzo de 2013. El análisis estadístico de los datos fue llevado a cabo mediante el software estadístico IBM® SPSS® Statistics 19. Resultados: Fueron considerados válidos 342 cuestionarios. La calidad de la relación de liderazgo es satisfactoria y los enfermeros se hallan débilmente empeñados en la organización. La calidad de relación de liderazgo se encuentra estadísticamente correlacionada con el empeño organizativo: existe una asociación moderada con el empeño afectivo (rs=0,42, p<0,05), baja con el empeño normativo (rs=0,37, p<0,05) y muy baja con el empeño calculativo (rs=0,14, p<0,05). Conclusión: El liderazgo ejerce influencia en el empeño organizativo. Existe oportunidad de mejoría de la calidad de la relación de liderazgo entre enfermero y enfermero líder, con la consecuente posibilidad de incrementar el empeño organizativo.

ABSTRACT Objective: To understand the perception of the quality of leadership relationships and the organizational commitment of nurses, and to analyze the influence of this relationship quality. Method: Cross-sectional and correlational study, with a quantitative approach, using a non-probability convenience sampling with 408 nurses. The data were collected through questionnaires at Central Hospital in Lisbon, between January and March 2013. The statistical analysis of the data was carried out using IBM® SPSS® Statistics 19 software. Results: Three hundred forty-two questionnaires were considered valid. The quality of the leadership relationship was satisfactory, and the nurses were poorly committed to the organization. The quality of the leadership relationship was statistically correlated with organizational commitment: there was found a moderate association to affective commitment (rs=0.42, p<0.05), a low association with the normative commitment (rs=0.37, p<0.05), and a very low association with the calculative commitment (rs=0.14, p<0.05). Conclusion: Leadership exerts influence on organizational commitment. An opportunity to improve the quality of the leadership relationship between nurses and their leaders was found, with the consequent possibility of developing organizational commitment.

Nursing workload for cancer patients under palliative care / Carga laboral de enfermería de pacientes oncológicos bajo cuidados paliativos / Carga de trabalho de enfermagem de pacientes oncológicos sob cuidados paliativos

Abstract OBJECTIVE To verify the nursing workload required by cancer patients undergoing palliative care and possible associations between the demographic and clinical characteristics of the patients and the nursing workload. METHOD This is a quantitative, cross-sectional, prospective study developed in the Connective Bone Tissue (TOC) clinics of Unit II of the Brazilian National Cancer Institute José Alencar Gomes da Silva with patients undergoing palliative care. RESULTS Analysis of 197 measures of the Nursing Activities Score (NAS) revealed a mean score of 43.09% and an association between the performance status of patients undergoing palliative care and the mean NAS scores. The results of the study point to the need to resize the team of the unit. CONCLUSION The NAS has proven to be a useful tool in oncologic clinical units for patients undergoing palliative care.

Resumen OBJETIVO Verificar la carga laboral de enfermería requerida por pacientes con cáncer bajo cuidados paliativos y posibles asociaciones entre las características demográficas y clínicas de los pacientes y la carga laboral de enfermería. MÉTODO Se trata de un estudio de abordaje cuantitativo, transversal, prospectivo, desarrollado en la clínica de Tejido Óseo Conectivo (TOC) de la Unidad II del Instituto Nacional de Cáncer José Alencar Gomes da Silva, con pacientes en cuidados paliativos. RESULTADOS El análisis de 197 medidas del Nursing Activities Score (NAS) reveló un puntaje medio del 43,09% y una asociación entre el performance status de pacientes en cuidados paliativos con los valores medios del NAS. Los resultados del estudio señalan la necesidad de redimensionamiento del equipo de la Unidad. CONCLUSIÓN El NAS se mostró un instrumento pasible de utilización en unidades clínicas oncológicas, con pacientes en cuidados paliativos.

Resumo OBJETIVO Verificar a carga de trabalho de enfermagem requerida por pacientes com câncer sob cuidados paliativos e possíveis associações entre as características demográficas e clínicas dos pacientes e a carga de trabalho de enfermagem. MÉTODO Trata-se de um estudo de abordagem quantitativa, transversal, prospectivo, desenvolvido na clínica de Tecido Ósseo Conectivo (TOC) da Unidade II do Instituto Nacional de Câncer José Alencar Gomes da Silva, com pacientes em cuidados paliativos. RESULTADOS A análise de 197 medidas do Nursing Activities Score (NAS) revelou um escore médio de 43,09% e uma associação entre a performance status de pacientes em cuidados paliativos com os valores médios do NAS. Os resultados do estudo apontam para a necessidade de redimensionamento da equipe da Unidade. CONCLUSÃO O NAS mostrou-se um instrumento passível de utilização em unidades clínicas oncológicas, com pacientes em cuidados paliativos.

Análise de indicadores gerenciais e assistenciais após adequação de pessoal de enfermagem / Análisis de indicadores gerenciales y de atención posteriores a adecuación de personal de enfermería / Analysis of managerial and healthcare indicators after nursing personnel upsizing

RESUMO Objetivo: analisar indicadores assistenciais e gerenciais após adequação do quadro de pessoal de enfermagem. Método: estudo descritivo, retrospectivo com dados obtidos dos sistemas de registros informatizados de um hospital universitário do Sul do Brasil. Foram analisados estatisticamente indicadores assistenciais e gerenciais, referentes aos primeiros semestres de 2013 e 2014. Resultados: o incremento de 40,0% no número de enfermeiros e 16,0% no número de técnicos de enfermagem resultou na redução de 12,0% no percentual de afastamentos por doença, 21,8% no total do banco de horas excedentes, 92,0% nas horas extras pagas. Houve redução de 75,0% nas taxas de úlcera por pressão, de 10,5% no número de quedas e 50,0% nas infecções por sonda vesical de demora. Conclusão: a adequação do quantitativo de pessoal repercutiu positivamente nos indicadores gerenciais e assistenciais, e contribuiu para qualificar o cuidado e melhorar as condições de trabalho da equipe de enfermagem.

RESUMEN Objetivo: analizar indicadores gerenciales y de atención luego de adecuación del plantel de personal de enfermería. Método: estudio descriptivo, retrospectivo, con datos obtenidos del sistema de registros informáticos de hospital universitario del sur de Brasil. Fueron analizados estadísticamente indicadores gerenciales y de atención correspondientes a los primeros semestres de 2013 y 2014. Resultados: el incremento del 40,0% en cantidad de enfermeros y 16,0% de técnicos de enfermería resultó en una reducción del 12,0% del porcentaje de licencias de salud, 21,8% del total del banco de horas excedentes, 92,0% de horas extra pagas. Hubo reducción del 75,0% en tasas de úlcera por presión, de 10,5% en número de caídas y de 50,0% en infecciones por sonda vesical de demora. Conclusión: la adecuación cuantitativa del personal repercutió positivamente en los indicadores gerenciales y de atención, y contribuyó a calificar el cuidado y mejorar las condiciones laborales del equipo de enfermería.

ABSTRACT Objective: analyze healthcare and managerial indicators after nursing personnel upsizing. Method: a retrospective, descriptive study was conducted using data from computer systems of a university hospital in southern Brazil. Healthcare and managerial indicators related to the first half of 2013 and 2014 were statistically analyzed. Results: increases of 40.0% in the number of nurses and 16.0% in the number of nursing technicians led to reductions of 12.0% in the number of sickness absences, 21.8% in positive balance for compensatory time off, 92.0% in paid overtime. Reductions of 75.0% in pressure ulcer rates, 10.5% in the number of falls and 50.0% in infections due to indwelling catheter use were also observed. Conclusion: nursing staff upsizing caused a positive impact on managerial and healthcare indicators and helped qualify care and improve work conditions for the nursing team.

A estrutura organizacional de serviços de enfermagem em hospitais de ensino / The organizational structure of nursing services in teaching hospitals

Resumo: Para atender aos objetivos de descrever a configuração da estrutura dos serviços de enfermagem; explorar as dimensões estruturais, formalização e descentralização destes serviços; e identificar as estratégias utilizadas pelos enfermeiros gerentes para organizar o cuidado em hospitais de ensino do Paraná-Brasil e Groningen-Holanda, foi realizada uma pesquisa de abordagem qualitativa, que se caracteriza como estudo de casos múltiplos. A pesquisa consistiu de 15 casos - 12 realizados no Paraná e 03 em Groningen. Foram realizadas entrevistas com 15 enfermeiros gerentes que ocupavam posição de destaque na estrutura organizacional destes hospitais, conduzidas por uma matriz elaborada com questões relacionadas à dimensão da divisão e coordenação do trabalho e outras para identificação de serviços de alta complexidade, trianguladas com a análise documental. Os dados foram coletados no Paraná de março a maio de 2014 e em Groningen, de abril a setembro de 2015. A teoria organizacional elaborada por Mintzberg foi utilizada para examinar as características e as relações entre os elementos da organização da estrutura de Enfermagem. O processo de análise e o cruzamento dos casos forneceu base para generalizações, e as estruturas dos serviços de enfermagem foram separadas em grupos. Posteriormente, foram exploradas as dimensões estruturais formalização e descentralização e suas variações. Para a identificação das estratégias utilizadas pelos enfermeiros gerentes para organizar o trabalho nos hospitais de ensino dos dois cenários, foi utilizada a análise temática de conteúdo e os seguintes temas emergiram: Definição da estrutura organizacional; Características dos trabalhadores; e As forças que influenciam o ambiente de trabalho. Baseando-se na abordagem metodológica e no modelo teórico, os resultados apontaram que os serviços de enfermagem apresentaram formas estruturais híbridas, com prevalência de estruturas profissionais e mecanicistas. Na estrutura dos serviços de Enfermagem pesquisados, foi encontrada a coexistência de alto grau de formalização e alto grau de descentralização; e alto grau de formalização e baixo grau de descentralização. Embora existam diferenças entre os dois países relacionadas à economia, população, sistema de saúde, entre outras, não houve diferença significativa entre o tipo de estratégia adotada pelos gerentes de enfermagem para organizar o seu trabalho. Concluiu-se que a melhor estrutura é a que melhor se adapta à situação do serviço, aos objetivos da organização, ao tipo de atividades desenvolvidas e ao ambiente externo. Outro aspecto é que as diferentes partes da estrutura podem exigir a diferenciação das funções e responsabilidades e diferentes níveis de descentralização e formalização do processo do trabalho para serem eficaz. Entende-se que os gerentes de enfermagem exercem papel fundamental na escolha e definição de elementos estruturais que irão determinar o tipo de estrutura organizacional do serviço e, consequentemente, a sua eficiência. Neste sentido, a principal contribuição desta pesquisa está relacionada à importância do gerente de enfermagem em encontrar um ponto de equilíbrio e coerência entre a estrutura adotada e as constantes mudanças nas demandas institucionais e dos sistemas de saúde para garantir um processo de trabalho alinhado aos objetivos organizacionais e às necessidades de saúde dos pacientes.

Abstract: The aim of the research was to describe the structure configuration of nursing services; explore the structural dimensions of formalization and decentralization of these services; and identify the strategies used by managers to organize nursing care in teaching hospitals of Paraná-Brazil and Groningen-Holland. It was held a qualitative approach research, which is characterized as a multiple case study. The survey consisted of 15 cases - 12 performed in Paraná and 03 in Groningen. 15 nurse-managers, who assumed a prominent position in the organizational structure of these hospitals, were interviewed. The survey was conducted by a matrix composed of questions about the dimension of division and coordination of work, and others, for identification of high complexity services, triangulated with document analysis. Data was collected in Paraná from March to May 2014, and in Groningen, from April to September 2015. The organizational theory developed by Mintzberg was used to examine the characteristics and relations among the elements of the organization of nursing structure. The process of analysis and cross cases provided the basis for generalizations, and the structures of nursing services were separated into groups. It was later explored the structural dimensions of formalization and decentralization and its variations. To identify the strategies used by managers to organize the nurses' work in teaching hospitals of the two scenarios, it was used the thematic analysis of content and the following themes emerged: Definition of the organizational structure; Characteristics of workers; and forces that influence the work environment. Based on the methodological approach and the theoretical model, the results showed that the nursing services presented hybrid structural forms, with prevalence of professional and mechanistic structures. In the structure of the surveyed nursing services, it has been found that there are high coexistence degree of formalization and high degree of decentralization; and high degree of formalization and low degree of decentralization. Although there are differences between the two countries, such as economy, population, health care, among others, there was no significant difference between the type of strategy adopted by nursing managers to organize their work. It was concluded that the best structure is the one that best fits the service situation, the organization's objectives, the type of activities developed, and the external environment. Another aspect is that different parts of the structure may require the differentiation of roles and responsibilities of the nurses, and different levels of decentralization and formalization of the labor process to be effective. It is understood that nursing managers play a fundamental role in the selection and definition of structural elements that will determine the type of organizational structure of the service and, therefore, its efficiency. In this sense, the main contribution of this research is related to the importance of nursing manager to find a balance point and between of the adopted structure and the constant changes in the institutional demands and health systems to ensure a working process aligned with organizational goals, and, consequently, the health needs of patients. Keywords: Organisational structure, Decentralization, Formalization, Nursing service, Management, Teaching hospital, Nursing; Strategies; Personnel Administration; Teaching hospitals. The aim of the research was to describe the structure configuration of nursing services; explore the structural dimensions of formalization and decentralization of these services; and identify the strategies used by managers to organize nursing care in teaching hospitals of Paraná-Brazil and Groningen-Holland. It was held a qualitative approach research, which is characterized as a multiple case study. The survey consisted of 15 cases - 12 performed in Paraná and 03 in Groningen. 15 nurse-managers, who assumed a prominent position in the organizational structure of these hospitals, were interviewed. The survey was conducted by a matrix composed of questions about the dimension of division and coordination of work, and others, for identification of high complexity services, triangulated with document analysis. Data was collected in Paraná from March to May 2014, and in Groningen, from April to September 2015. The organizational theory developed by Mintzberg was used to examine the characteristics and relations among the elements of the organization of nursing structure. The process of analysis and cross cases provided the basis for generalizations, and the structures of nursing services were separated into groups. It was later explored the structural dimensions of formalization and decentralization and its variations. To identify the strategies used by managers to organize the nurses' work in teaching hospitals of the two scenarios, it was used the thematic analysis of content and the following themes emerged: Definition of the organizational structure; Characteristics of workers; and forces that influence the work environment. Based on the methodological approach and the theoretical model, the results showed that the nursing services presented hybrid structural forms, with prevalence of professional and mechanistic structures. In the structure of the surveyed nursing services, it has been found that there are high coexistence degree of formalization and high degree of decentralization; and high degree of formalization and low degree of decentralization. Although there are differences between the two countries, such as economy, population, health care, among others, there was no significant difference between the type of strategy adopted by nursing managers to organize their work. It was concluded that the best structure is the one that best fits the service situation, the organization's objectives, the type of activities developed, and the external environment. Another aspect is that different parts of the structure may require the differentiation of roles and responsibilities of the nurses, and different levels of decentralization and formalization of the labor process to be effective. It is understood that nursing managers play a fundamental role in the selection and definition of structural elements that will determine the type of organizational structure of the service and, therefore, its efficiency. In this sense, the main contribution of this research is related to the importance of nursing manager to find a balance point and between of the adopted structure and the constant changes in the institutional demands and health systems to ensure a working process aligned with organizational goals, and, consequently, the health needs of patients.

Cost of nursing turnover in a Teaching Hospital / Costo de la rotatividad del equipo de enfermería en Hospital de Enseñanza / Custo da rotatividade da equipe de enfermagem em hospital de ensino

Abstract OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.

Resumen OBJETIVO Mapear los subprocesos relacionados con la rotatividad del equipo de enfermería y medir el costo de la rotatividad del equipo de enfermería. MÉTODO Estudio exploratorio-descriptivo, en la modalidad de estudio de caso, llevado a cabo en hospital de enseñanza del sudeste de Brasil, en el período de mayo a noviembre de 2013. La población estuvo compuesta del equipo de enfermería, utilizándose la metodología para el cálculo de costo de la rotatividad. RESULTADOS El costo total de la rotatividad fue de R$314.605,62 y, por colaborador, varió de R$2.221,42 a R$3.073,23. Los costos consecuentes de la pre contratación totalizaron R$101.004,60 (32,1%), siendo que el proceso plazas consumió R$92.743,60 (91,8%). Los costos referentes a la post contratación totalizaron R$213.601,02 (67,9%) y, para el subproceso de disminución de la productividad, R$199.982,40 (93,6%). CONCLUSIÓN El estudio permitió identificar la importancia de la gestión del costo de la rotatividad de personal y el impacto financiero del costo del colaborador alejado, que representó tres veces el sueldo medio del equipo de enfermería.

Resumo OBJETIVO Mapear os subprocessos relacionados à rotatividade da equipe de enfermagem e mensurar o custo da rotatividade da equipe de enfermagem. MÉTODO Estudo exploratório-descritivo, na modalidade de estudo de caso, realizado em hospital de ensino do sudeste do Brasil, no período de maio a novembro de 2013. A população foi composta pela equipe de enfermagem, utilizando-se a metodologia para o cálculo de custo da rotatividade. RESULTADOS O custo total da rotatividade foi de R$314.605,62, e por colaborador variou de R$2.221,42 a R$3.073,23. Os custos decorrentes da pré-contratação totalizaram R$101.004,60 (32,1%), sendo que o processo vagas consumiu R$92.743,60 (91,8%). Os custos referentes à pós-contratação totalizaram R$213.601,02 (67,9%), e para o subprocesso de diminuição da produtividade, R$199.982,40 (93,6%). CONCLUSÃO O estudo permitiu identificar a importância do gerenciamento do custo da rotatividade de pessoal e o impacto financeiro do custo do colaborador desligado, que representou três vezes o salário médio da equipe de enfermagem.

Estratégia do trabalho gerencial para alcance da acreditação hospitalar / Management strategies for hospital accreditation / Estrategia de trabajo de gestión para alcanzar la acreditación del hospital

OBJETIVO: analisar as estratégias do trabalho gerencial com vistas ao alcance da acreditação com excelência. MÉTODOS: trata-se de um estudo de caso com abordagem qualitativa, realizado em um hospital privado localizado em Belo Horizonte, MG, acreditado em nível de excelência pela Organização Nacional de Acreditação. Participaram do estudo 12 gerentes. A coleta foi realizada em 2011 por meio de entrevistas, com roteiro semiestruturado e analisadas por meio da análise de conteúdo. RESULTADOS: três categorias temáticas foram construídas - a) gestão de pessoas, pilar da estratégia gerencial para obter a acreditação com excelência; b) formando e treinando pessoas; c) comunicação: favorecendo um serviço de qualidade. CONCLUSÃO: a maior estratégia do trabalho gerencial identificada foi a gestão de pessoas, trazendo benefícios como: mais autonomia no trabalho da equipe, envolvimento de todos nos processo de melhorias propostas; valorização, reconhecimento e recompensa; investimento na capacitação de todos os envolvidos no cuidado; além de comunicação clara e processo de feedback, com reuniões semanais e mais participação da equipe nas decisões organizacionais e nos resultados. Para a instituição alcançar a acreditação hospitalar foi necessário que as pessoas conhecessem os princípios e valores da acreditação e descentralização das informações.

This study aims to analyze management strategies in order to be awarded a Certificate of Excellence. This is a qualitative case study carried out at a private hospital in Belo Horizonte accredited as Centre of Excellence by the National Accreditation Body. The study included 12 managers. Data was collected in 2011 through semi-structured interviews and analyzed using content analysis. The study results identified three thematic categories: a) people management as the main principle for Accreditation with Excellence certification; b) education and training; c) communication: promoting quality services. People management was the most important strategy identified since it promotes autonomy within the team; widespread commitment to proposed improvements; appreciation, recognition and reward; investment in the training of all professionals involved in the care process; clear communication in the workplace and feedback during the weekly meetings; and more staff participation in organizational decisions and results. For the institution to get the accreditation award the staff had to be aware of the principles and values of accreditation and of the importance of decentralization of information.

El objetivo de este estudio fue analizar las estrategias del trabajo de gestión a fin de lograr la acreditación de excelencia. Se trata de un estudio de caso con enfoque cualitativo realizado en un hospital privado de Belo Horizonte, MG, acreditado en el nivel de excelencia por la Organización Nacional de Acreditación. Participaron 12 gerentes. La recogida de datos se realizó en 2011 a través de entrevistas con guión semiestructurado que se analizaron según su contenido. Se construyeron tres temas: a) gestión de personas, pilar de la estrategia de gestión para la acreditación con excelencia; b) formación y capacitación de las personas; c) comunicación: promoción del servicio de calidad. La principal estrategia identificada fue la gestión de las personas, que aporta beneficios como mayor autonomía en el trabajo en equipo, la participación de todos en los procesos de las mejoras propuestas; valorización, reconocimiento y recompensa; inversión en la capacitación de todos los involucrados en los cuidados; además de la comunicación clara y del proceso de retroalimentación con reuniones semanales y mayor participación del personal en las decisiones organizativas y en los resultados. Para que la institución logre la mencionada acreditación el personal debe conocer los principios y valores de la acreditación y la descentralización de la información.