The effect of national tertiary public hospital performance assessment on the functional orientation of provincial public hospitals / 中华医院管理杂志

Objective:To analyze the impact of the national tertiary public hospital performance assessment(hereinafter referred to as the national examination) on the functional orientation of the provincial public hospitals in Zhejiang province, for reference to improve the allocation of provincial medical resources and high-quality development of public hospitals.Methods:The data came from the hospital financial data of 17 provincial tertiary public hospitals in Zhejiang province from 2012 to 2021 and the DRG quality performance analysis report of the tertiary hospitals in Zhejiang province from 2020 to 2021. The information of the number of employees and actual number of beds at the end of the period, etc., were extracted to analyze the overall operation of the hospital. The ratio of outpatient times to discharged times and the proportion of discharged patients undergoing surgery, as well as the proportion of discharged patients′ day surgery and level-4 surgery in hospital and in province were took as evaluation indicators to analyze the functional positioning of tertiary public hospitals.Results:Compared with 2012 to 2018, the average number of employees at the end of the period and actual number of beds in 17 hospitals from 2019 to 2021 increased by 761 and 303 respectively, and the average number of hospitalization days decreased by 2.26 days. The average ratio of outpatient times to discharged times in the hospital decreased from 175.76 in 2012 to 67.51 in 2021. The average proportion of discharged patients undergoing surgery in general hospitals increased from 0.39 in 2012 to 0.46 in 2021, and that in non-general hospitals decreased from 0.67 to 0.43. The average proportion of discharged patients undergoing day surgery in hospital and in province increased from 0.20 and 0.03 in 2020 to 0.23 and 0.04 in 2021 respectively, and the average proportion of discharged patients undergoing level-4 surgery in province increased from 0.04 to 0.05.Conclusions:The national examination could be conducive to strengthening the functional orientation of public hospitals. After the national examination, the ratio of outpatient times to discharged times in the provincial tertiary public hospitals in Zhejiang province had declined as a whole, the proportion of discharged patients in general hospitals had increased, but the proportion of level-4 surgery in hospitals needs to be further improved. The author suggested that we should continue to strengthen the operation mechanism of functional positioning of provincial public hospitals, improve the service capacity of hospitals for difficult and critical diseases, and improve the performance evaluation system of tertiary public hospitals.

Top-level design and practice exploration of salary reform in public hospitals / 中华医院管理杂志

The salary reform of public hospitals has a positive incentive effect on enhancing the public welfare of public hospitals, stimulating the enthusiasm of medical staff, and promoting high-quality development. The authors introduced the practice and exploration of the sequential salary system reform in Union Hospital, Tongji Medical College of Huazhong University of Science and Technology since 2018. It included the reform of physician performance based on medical groups, the reform of nursing performance based on vertical nursing management, the reform of medical technology performance based on resource marginal utilization, and the reform of management performance based on job responsibilities and 360°evaluation. The practice has showed that the salary reform could promote the improvement of medical service ability, improve nurses′ satisfaction, shorten the waiting time for medical technical examination, and steadily improve the performance of " National Examination" and the comprehensive ranking of hospitals. When studying and implementing the policy requirements of salary system reform, hospitals in different regions should take measures in accordance with local conditions, with accurate and safe information systems as the support, and focus on the distribution mode, compensation structure and funding sources.

Practice of medical technology performance reform in a large public hospital based on resource-based relative value scale theory / 中华医院管理杂志

With the deepening of the comprehensive reform process of public hospitals and the further refinement of high-quality development requirements, the reform of compensation system of public hospitals has also begun. Taking a hospital as an example, the authors deeply analyzed the four-dimensional performance appraisal scheme of medical technology departments based on resource-based relative value scale concept, with workload assessment as the foundation, multi-dimensional cost assessment as the emphasis, work efficiency as the spur and work quality as the foundation, and introduced the process of implementing the distribution scheme guided by knowledge value to the secondary distribution of departments. The performance appraisal scheme could scientifically reflect the work value of medical staff in medical and technical departments, strengthen the department′s awareness of cost control, improve the efficiency and quality of the department′s work, significantly motivate the medical and technical staff, and deepen the modern management of hospitals.

Clinical skills assessment and feedback in pediatric residency / Avaliação de habilidades clínicas e feedback na residência médica em Pediatria

Abstract: Introduction: A medical residency is the specialization par excellence in medical training and the program is responsible for ensuring that the recently graduated doctor reaches the established level of competence. A well-prepared assessment system with feedback is an effective tool to enhance the performance of future specialists and guarantee their qualification. Objective: To analyze the assessment system for pediatric residents at a university hospital, aiming to promote teaching training in assessment methods. Methodology: educational action research (research-teaching), conducted with teachers and preceptors in the pediatric residency of a university hospital. The stages consisted of: a) the application of a questionnaire on participant profile and assessment methods used to evaluate the medical residents; b) intervention (workshop) on the assessment of clinical skills and feedback; c) immediate assessment after the workshop, by applying another questionnaire based on level 1 of the Kirkpatrick model. Simple statistical analysis was used for the objective data and the content analysis, according to recommendations by Malheiros (2011) and Bardin (2013), for the qualitative part. Result: Ten (48%) of the 21 participants declared not being formally trained in assessment and that they applied the more traditional methods learned from personal experience. Regarding the assessment methods, 81% (17/21) of the participants used more than one, aiming to obtain a more encompassing and reliable assessment. However, none of the teachers/preceptors used a systematized assessment of the clinical skills or provided feedback to the medical residents. After the workshop, with a focus on assessing performance in a simulated 'Objective Structured Clinical Examination' (OSCE) environment, all the participants were favorable to apply the OSCE in their teaching-learning practice with residents and undergraduate students, reaching Kirkpatrick level 3. Conclusion: The action research helped identify limitations in the assessment and feedback system of the pediatric resident physician. The methodology used revealed an aggregating effect and contributed to the development of the collaborative and integrative sense in the group. However, it was not enough to positively interfere with the pediatric medical residency assessment in the short term.

Resumo: Introdução: A residência médica é a especialização por excelência na formação do médico, e cabe ao programa assegurar que o residente egresso atinja o nível almejado de competência. Um sistema avaliativo bem elaborado e com feedback é ferramenta efetiva para aprimorar o desempenho do futuro especialista e garantir a qualificação dele. Objetivo: Este estudo teve como objetivo analisar o sistema de avaliação do médico residente em pediatria de um hospital universitário, com o intuito de promover a formação docente em métodos avaliativos. Método: Trata-se de uma pesquisa-ação educacional (pesquisa-ensino) realizada com docentes e preceptores da residência médica em pediatria de um hospital universitário. As etapas consistiram em: 1. aplicação de questionário sobre o perfil dos participantes e os métodos avaliativos utilizados com os residentes; 2. intervenção com a realização de um workshop sobre avaliação de habilidades clínicas e feedback; 3. avaliação imediata, após o workshop, com aplicação de outro questionário, elaborado com base no nível 1 do método Kirkpatrick. Utilizaram-se a análise estatística simples, para os dados objetivos, e a análise de conteúdo, segundo recomendações de Malheiros e Bardin, para a parte qualitativa. Resultado: Dos 21 participantes, dez (48%) informaram que não tinham capacitação formal em avaliação e que utilizavam métodos avaliativos mais tradicionais. Quanto aos métodos, 81% (17/21) dos participantes informaram que utilizavam mais de um, com finalidade somativa, para obter uma avaliação mais abrangente e fidedigna. No entanto, nenhum utilizava uma avaliação sistematizada de habilidades clínicas com fornecimento de feedback. Após o workshop com enfoque em avaliação de desempenho em ambiente simulado, em que se adotou o Objective Structured Clinical Examination (OSCE), os participantes utilizaram, com os internos, o método avaliativo do aprendizado na sua prática cotidiana, e, dessa forma, o treinamento atingiu o nível 3 de Kirkpatrick. Conclusão: A pesquisa-ação propiciou identificar limitações no sistema de avaliação e feedback do médico residente em pediatria. A metodologia utilizada revelou um efeito agregador e contribuiu para desenvolver o sentido colaborativo e integrativo no grupo. No entanto, não foi suficiente para interferir positivamente, em curto prazo, na avaliação da residência médica em pediatria.

The role of internal auditing in promoting accountability in Higher Education Institutions / El papel de la auditoría interna en la promoción de la accountability en las Instituciones de Educación Superior / O papel da auditoria interna na promoção da accountability nas Instituições de Ensino Superior

Abstract This paper discusses the link between accountability and internal auditing, particularly analyzing the extent to which the latter contributes to improve the former, in Higher Education Institutions (HEIs). This study applied a questionnaire to the management boards of a sample of HEIs, to empirical analyze the relationship between internal auditing and accountability. The main focus was on internal auditing carried out by the offices or departments in those institutions. The paper contributes to understand how management boards perceive internal auditing to foster transparency and accountability in HEIs, allowing to corroborate that auditing, and particularly internal auditing, favors the institutions' accountability. In effect, it promotes the principles underlying accountability practices. The information provided in the scope of internal audits is acknowledged as contributing to improve management effectiveness and helping in decision-making. HEIs wanting to create an internal auditing office or to enhance the role of an existing one, should develop this office's activities so that it becomes an instrument to support accountability and good governance of the organization. The sample consisted of Portuguese public HEIs, universities and polytechnics. Despite a certain international convergence regarding this type of public sector organizations, and regarding their purposes and governance, certain contextual specificities might limit the generalization of the findings for other jurisdictions.

Resumen Este artículo discute la asociación entre la accountability y la auditoría interna, en particular analizando hasta qué punto esta última contribuye a mejorar la primera, en las Instituciones de Educación Superior (IES). Para analizar empíricamente la relación entre la auditoría interna y la accountability, el estudio se basa en los resultados de una encuesta enviada a los consejos de administración de una muestra de IES, con el enfoque principal en la auditoría interna realizada por las oficinas o departamentos en esas instituciones. El artículo contribuye a comprender cómo los consejos de administración perciben la auditoría interna para fomentar la transparencia y accountability en las IES, lo que permite corroborar que la auditoría, y particularmente la auditoría interna, sirve a la accountability. De hecho, ella promueve los principios subyacentes a las prácticas de accountability. Se reconoce que la información proporcionada en el ámbito de las auditorías internas contribuye a mejorar la efectividad de la gestión y ayuda en la toma de decisiones. Las IES que desean crear una oficina de auditoría interna o mejorar el papel de una existente, deben desarrollar las actividades de esta oficina para que se convierta en un instrumento de apoyo a la accountability y al buen gobierno de la organización. La muestra consistió en IES públicas portuguesas, universidades y politécnicos. A pesar de una cierta convergencia internacional con respecto a este tipo de organizaciones, así como con respecto a sus propósitos y gobernanza, ciertas especificidades contextuales pueden limitar la generalización de los resultados a otras jurisdicciones.

Resumo Este artigo discute a associação entre accountability e auditoria interna, analisando particularmente até que ponto a última contribui para melhorias na primeira, nas Instituições de Ensino Superior (IES). Para analisar empiricamente a relação entre auditoria interna e accountability, o estudo baseia-se nos resultados de um questionário enviado aos órgãos de gestão de uma amostra de IES, com o foco principal na auditoria interna desenvolvida pelos gabinetes ou departamentos nessas instituições. O artigo contribui para entender como os órgãos de gestão percebem a auditoria interna para promover a transparência e a accountability nas IES, permitindo corroborar que a auditoria e, principalmente, a auditoria interna, serve a accountability. Com efeito, ela promove os princípios subjacentes às práticas de accountability. A informação proporcionada no âmbito das auditorias internas é reconhecida como contribuindo para melhorar a eficácia da gestão e ajudar na tomada de decisões. As IES que desejem criar um gabinete de auditoria interna ou aprimorar o papel de um gabinete já existente, devem desenvolver as atividades desse serviço de modo a que se torne um instrumento para apoiar a accountability e a boa governança da organização. A amostra foi constituída por IES públicas portuguesas, universidades e institutos politécnicos. Apesar de existir uma certa convergência internacional em relação a este tipo de organizações do setor público, bem como em relação aos seus propósitos e governança, certas especificidades contextuais podem limitar a generalização dos resultados desta pesquisa, para outras jurisdições.

Teacher Behavior Checklist content validity according to Brazilian teachers and undergraduates / Validade de conteúdo do Teacher Behavior Checklist segundo professores e universitários brasileiros / Validez de contenido del Teacher Behavior Checklist según profesores y universitarios brasileños

This research, divided into two studies, expanded the content validity examination of the Teacher Behavior Checklist (TBC). In Study 1, the objective was to identify the degree of relevance attributed by teachers and undergraduates to the 28 TBC items, based on what they consider to characterize an effective teacher. The participants of Study 1 were 85 teachers and 91 students from different Brazilian universities. They assessed the TBC items on a seven-point scale (ranging from "1 = totally irrelevant" to "7 = totally relevant"). Students (Mean = 5.7) and teachers (6.1) considered the TBC items to be relevant. Study 2 sought to identify the 10 most important TBC qualities based on student perceptions. The participants of Study 2 were 995 undergraduates whose choices of items corroborated results from previous TBC studies. These data encourage the use of TBC in teacher formative assessment and research on effective teaching. (AU)

Esta pesquisa, dividida em dois estudos, ampliou a investigação da validade de conteúdo do Teacher Behavior Checklist (TBC). No Estudo 1, o objetivo foi identificar o grau de relevância atribuído por professores e graduandos aos 28 itens do TBC, baseados no que consideram caracterizar um professor eficaz. Participaram 85 professores e 91 estudantes de diferentes universidades brasileiras. Eles avaliaram os itens do TBC segundo uma escala de setes pontos ("1 = totalmente irrelevante" a "7 = totalmente relevante"). Estudantes (Média = 5,7) e professores (6,1) consideraram os itens do TBC relevantes. O Estudo 2 buscou identificar quais são as 10 qualidades mais importantes do TBC segundo estudantes. Participaram 995 graduandos cujas escolhas de itens corroboraram resultados de estudos anteriores com o TBC. Esses dados incentivam o uso do TBC na avaliação formativa de professores e na pesquisa sobre ensino eficaz. (AU)

Esta encuesta, dividida en dos estudios, amplió la investigación de validez de contenido del Teacher Behavior Checklist (TBC). El estudio 1 tuvo por objetivo identificar el grado de relevancia atribuido por profesores y estudiantes a los 28 ítems del TBC, basados en lo que consideran caracterizar un profesor eficaz. Participaron 85 profesores y 91 estudiantes de diferentes universidades brasileñas. Ellos evaluaron los ítems del TBC según una escala de siete puntos ("1 = totalmente irrelevante" a "7 = totalmente relevante"). Estudiantes (Media = 5,7) y profesores (6,1) consideraron los ítems del TBC relevantes. El estudio 2 buscó identificar cuáles son las 10 cualidades más importantes del TBC según los estudiantes. Participaron 995 estudiantes cuyas elecciones de los ítems corroboraron resultados de estudios previos con el TBC. Estos datos incentivan el uso del TBC en la evaluación formativa de profesores y en la investigación sobre enseñanza eficaz. (AU)

Desempenhos na Área de Competência Educação em Saúde: Autoavaliação de Estudantes de Medicina / Performance in Health Education Competency: Self-Assessment of Medical Students

Resumo: Introdução: As Diretrizes Curriculares Nacionais (DCN) para o curso de Medicina, publicadas no ano de 2014, descrevem as competências esperadas para o egresso. O objetivo deste estudo foi investigar como os estudantes de Medicina se avaliam na área de competência educação em saúde. Método: Trata-se de um estudo transversal analítico com estudantes dos dois últimos anos de quatro escolas médicas de Minas Gerais, Brasil. Aplicou-se um questionário embasado nas DCN e fundamentado em três ações-chave: identificação de necessidades de aprendizagem individual e coletiva, promoção da construção e socialização do conhecimento e promoção do pensamento científico e crítico e apoio à produção de novos conhecimentos. Realizou-se a análise descritiva e bivariada pelo teste qui-quadrado de Pearson, com nível de significância 5%. O teste analisou desempenhos na área de educação em saúde conforme sexo, ano de graduação e autoavaliação da experiência na atenção primária à saúde (APS). Resultados: Participaram 524 estudantes, a maioria do sexo feminino (57,0%), com idade entre 21 e 25 anos (66,9%), matrícula no último ano da graduação (65,3%), com participação em liga acadêmica (55,6%) e experiência positiva no âmbito da APS (78,5%). A maioria dos estudantes considerou "ótimo" o próprio desempenho nos quesitos de aprendizado com as relações interprofissionais (69,0%), identificação das próprias necessidades de aprendizagem (63,5%) e promoção de ações de educação em saúde da mulher (66,5%). Os estudantes avaliaram que o desempenho deles é "ruim/regular" no uso de sistemas de informação (33,8%) e na adoção de metodologia científica na leitura crítica de artigos técnico-científicos (21,2%). Foram associados à "boa/ótima" experiência em APS os seguintes desempenhos: apoio à produção de novos conhecimentos, construção e socialização de conhecimentos para a comunidade e promoção de ações de educação em saúde da mulher (p < 0,05). Nesse último desempenho, destaca-se a diferença significante entre sexos: as estudantes do sexo feminino avaliaram-se melhor que os homens (p < 0,05). Conclusão: A experiência positiva na APS está associada com desempenhos de fundamental importância para atuação médica, tanto na abordagem individual como na coletiva.

Abstract: Introduction: The National Curriculum Guidelines (NCGs) for the medical course, published in 2014, describe the expected competencies for graduating medical students. Objective: To investigate how medical students evaluate themselves in the area of Health Education. Method: Cross-sectional analytical study among student interns from four medical schools in Minas Gerais, Brazil. The questionnaire was based on the NGCs and substantiated by three key actions: 'Individual and Collective Learning Needs Identification'; 'Knowledge Construction and Socialization Promotion'; and 'Scientific and Critical Thinking Promotion and Support for New Knowledge Production'. Descriptive and bivariate analysis was performed using Pearson's Chi-square Test, with a significance level of 5%. The test assesssed performance in Health Education according to sex, year of undergraduate training and self-evaluation of experience in Primary Health Care (PHC). Results: A total of 524 students participated in the study, mostly females (57.0%), aged between 21 and 25 years (66.9%), in their final year of undergraduate training (65.3%), belonging to an academic league (55.6%) and having reported a positive experience in PHC (78.5%). The majority evaluate themselves as 'very good' at 'learning with interprofessional relationships' (69.0%), 'identification of personal learning needs' (63.5 %), and 'promotion of education actions in Women's Health' (66.5%). Students evaluate themselves as 'poor/satisfactory' at 'using information systems' (33.8%), and 'adoption of scientific methodology in critical reading of technical-scientific articles' (21.2%). The following performances were associated to a 'good/very good' PHC experience: 'support for new knowledge production'; 'knowledge construction and socialization in the community' and 'promotion of education actions in Women's Health' (p < 0.05). For this last performance there is a significant difference in sex, where female students evaluated themselves better than male students (p < 0.05). Conclusion: A positive experience in PHC was associated with performances considered of fundamental importance to medical practice, both from an individual and collective perspective.

Association between Social Skills, Sociodemographic Factors and Self-Statements during Public Speaking by University Students / Associação entre Habilidades Sociais, Fatores Sociodemográficos e Autoavaliações ao Falar em Público de Estudantes Universitários / Asociación entre Habilidades Sociales, Factores Sociodemográficos y Autoevaluaciones al Hablar en Público de Estudiantes Universitarios

Abstract Possessing a good repertoire of interpersonal skills and a good performance when speaking in public can be considered indispensable for the social and academic adaptation of college students. The aim was to characterize and compare the social skills repertoire of college students from different fields of study (the human, exact and biological sciences) and from different higher education institutions (public and private), and to investigate the associations between these abilities and their self-assessment about speaking in public. A total of 818 college students took part, who answered the Social Skills Inventory (IHS-Del-Prette), Self-Statements During Public Speaking Scale and a Socio-demographic and Occupational Questionnaire. The groups did not differ significantly in relation to their social skills' repertoire, with most of the participants (n = 432) having a below-average repertoire of abilities when compared to the normative group of the instrument. It was found that male college students and those who had a partner, a job or their own income, and direct contact with the public gave more positive self-assessments about speaking in public. The skills' classes of self-exposure to strangers and new situations, self-confidence in expressing positive feelings, conversation and social resourcefulness, self-control of aggressivity, and coping and self-confidence with risk, and having a vocational course were the variables that predicted a more positive self-assessment by college students about speaking in public.

Resumo Possuir um bom repertório de habilidades interpessoais e de desempenho ao falar em público pode ser considerado indispensável para a adaptação social e acadêmica dos universitários. Objetivou-se caracterizar e comparar o repertório de habilidades sociais de universitários provindos de diferentes áreas do conhecimento (humanas, exatas e biológicas) e instituições de ensino superior (pública e privada), bem como investigar as associações entre estas habilidades e as autoavaliações ao falar em público. Participaram 818 universitários, que responderam ao Inventário de Habilidades Sociais (IHS-Del-Prette), Escala de Auto-Avaliação ao Falar em Público e um Questionário Sociodemográfico e Ocupacional. Os grupos não diferiram significativamente quanto ao repertório de habilidades sociais, com a maioria dos participantes (n = 432) apresentando um repertório de habilidades abaixo da média em relação ao grupo normativo do instrumento. Verificou-se que os universitários do gênero masculino e aqueles que possuíam um companheiro, trabalho ou renda própria e contato direto com o público apresentavam autoavaliações ao falar em público mais positivas. As classes de habilidades de autoexposição a desconhecidos, autoafirmação na expressão de sentimento positivo, conversação e desenvoltura social, autocontrole da agressividade e enfrentamento e autoafirmação com risco e possuir um curso profissionalizante foram as variáveis preditoras de uma autoavaliação mais positiva dos universitários ao falar em público.

Resumen Poseer un buen repertorio de habilidades interpersonales y de desempeño al hablar en público puede ser considerado indispensable para la adaptación social y académica de los universitarios. Se objetivó caracterizar y comparar el repertorio de habilidades sociales de universitarios provenientes de diferentes áreas del conocimiento (humanas, exactas y biológicas) e instituciones de enseñanza superior (pública y privada), así como investigar las asociaciones entre estas habilidades y las autoevaluaciones al hablar en publico. Participaron 818 universitarios, que respondieron al Inventario de Habilidades Sociales (IHS-Del-Prette), Self Statements During Public Speaking Scale y un Cuestionario Sociodemográfico y Ocupacional. Los grupos no diferían significativamente en cuanto al repertorio de habilidades sociales, con la mayoría de los participantes (n = 432) presentando un repertorio de habilidades por debajo de la media en relación al grupo normativo del instrumento. Se comprobó que los universitarios masculinos y aquellos que tenían un compañero, trabajo, ingresos propios y contacto directo con el público, presentaban autoevaluaciones más positivas al momento de hablar en público. Los tipos de habilidades de autoexposicion a desconocidos, el reconocimiento en la expresión del sentimiento positivo, el diálogo y el desenvolvimiento social, el autocontrol de la agresividad y haber hecho un curso profesional, fueron las variables clave al momento de una auto evaluación positiva de los universitarios al hablar en público.

Research on target management of 21 medical institutions in Anhui province / 中华医院管理杂志

Objective To understand the status quo of the target management assessment of medical institutions in Anhui province, and provide a basis for further improving the performance appraisal mechanism and strategy of medical institutions. Methods In June 2017, 21 medical institutions in Anhui province conducted a questionnaire survey on the setup and implementation of target management indicators. Results Among the 21 medical institutions, there were 2, 16 and 3 hospitals in the first, second and third grades respectively. The average number of available beds was 681.35, and the average time for conducting target assessment was 4.42 years. The coverage rates of the clinical departments, medical technology departments, efficiency and efficiency, scientific research teaching, and department management of 21 medical institutions were 80% (316/397), 84% (52/63), 71% ( 120/168), 38% (48/126 ) and 60% (61/102) respectively. There were significant differences in coverage rates between clinical departments, medical technology departments, efficiency and efficiency, and research and teaching in different levels of medical institutions( P <0.05 ). Judging from the effectiveness of the current target assessment, it was considered that 64% ( 37/78 ) of the overall assessment results of the departments were in line with expectations, and the ratio of target management to hospital development management, department quality management, and functional department execution was 75% (42/64). Conclusions The status quo of performance assessment of medical institutions in Anhui province is running well, but the target management indicators and models of different medical institutions are different. It is necessary for the health administrators to establish a unified, authoritative and standard target performance assessment system.

Establishment of nursing performance management system based on hospital development strategy / 中国中西医结合急救杂志

Objective To explore a multi-dimensional nursing post performance management system based on hospital development as the objective and workload account as the foundation. Methods A total of 1 321 nursing staff in the nursing post of Changzhou Second People's Hospital Affiliated to Nanjing Medical University was selected as the study object, to observe the effect of the nursing performance appraisal team formally established in our hospital since November 2015 on nursing performane, the nursing department, the management office, etc departments jointly developed the nursing performance allocation principle, program and allocation method, the hospital resource planning (HRP) system, hospital information system (HIS) and self-made questionnaire were used to collect data, and the changes of various indexes before implementation of performance reform (from December 2014 to November 2015) and after implementation of performance reform (from December 2015 to November 2016) were compared and analyzed; the indexes were as follows: average monthly business income, average monthly nursing income, annual clinical non-receivable consumables expenditure, nursing human resources flexible allocation rate, nurses' degree of satisfaction with performance (remuneration and paying score, performance assessment system score) and qualified rate of nursing care quality. Results After the implementation of performance reform, average monthly business income, the average monthly nursing income, nursing human resources flexible allocation rate, compensation, paying scores and performance appraisal system scores were significantly higher than those before the implementation of performance reform [average monthly business income (ten thousand yuan): 13 653.24±1 309.49 vs. 11 869.26±991.16, average monthly nursing income (ten thousand yuan): 264.2 (252.1, 269.7) vs. 88.5 (80.8, 95.2), the ratio of nursing human resources flexible allocation rate: (1.74±0.52)% vs. (0.43±0.23)%, compensation and payment score: 4.76 (4.62, 4.85) vs. 3.47 (3.12, 3.60), performance appraisal system score: 4.88 (4.78, 4.95) vs. 2.80 (2.70, 3.14)], the difference was statistically significant (all P < 0.05), the annual clinical non-receivable consumables expenditure was decreased significantly compared with those before implementation performance reform (million yuan: 1.88±0.21 vs. 2.62±0.14, P < 0.05), and the qualified rate of nursing quality after performance appraisal were significantly improved compared with those before performance appraisal [nursing grading: (97.83±1.90)% vs. (91.11±1.61)%, ward management: (96.64±2.90)% vs. (90.06±2.40)%, nursing writing: (97.30±2.51)% vs. (91.33±1.96)%, nursing safety: (97.40±2.67)% vs. (90.13±1.96)%, first aid items: (97.44±2.64)% vs. (92.27±2.56)%, perioperative period: (96.86±2.50)% vs. (90.83±3.06)%, blood transfusion quality: (97.51±2.21)% vs. (92.13±2.37)%, disinfection and isolation: (97.43±2.70) % vs. (88.50±2.57)%, basic operation: (93.48±2.22)% vs. (87.51±2.03)%, practical ability: (93.38±1.97)% vs. (85.85±2.58)%, all P < 0.05]. Conclusion The establishment and application of the new performance management system mobilizes the enthusiasm of the department to actively control costs and decrease the expenditure of non-chargeable consumables, the nursing management staff can more flexibly arrange human resources and exert the management potential of middle-level cadres, and the nurses' degree of satisfaction and the nursing quality are significantly higher than those before nursing performance reform.

Gestão de perdas em sistemas de abastecimento de água: uma abordagem construtivista / Water loss management: a constructivist approach

RESUMO Com o aumento da demanda e a crise hídrica em muitos países, a gestão de perdas em sistemas de abastecimento de água mostra-se relevante em todos os serviços de água. Esta pesquisa propôs-se a construir um modelo de avaliação de desempenho para apoiar uma empresa de saneamento quanto à gestão de perdas nos sistemas de abastecimento de água que opera. Para tanto, baseou-se na Metodologia Multicritério de Apoio à Decisão - Construtivista (MCDA-C). A construção do modelo seguiu as três fases do MCDA-C: estruturação, avaliação e recomendações. Na fase de estruturação, foram construídos 64 descritores, distribuídos em quatro áreas de preocupação: perdas aparentes, perdas reais, apoio operacional e relacionamento externo. Ao final da fase de avaliação, o status quo do sistema de abastecimento de água estudado foi de 22,51, considerado, pelo decisor, no nível competitivo. Foram elaboradas recomendações de ações para melhorar o desempenho do status quo para aqueles descritores que apresentaram desempenho comprometedor e que foram julgados pelo decisor como merecedores de aperfeiçoamento. As recomendações simuladas em conjunto foram importantes para a melhora no desempenho em todas as áreas de preocupação, resultando no desempenho global de 60,82. Assim, a metodologia MCDA-C mostrou-se coerente para os temas abordados nesta pesquisa e confirmou suas premissas construtivistas em todas as suas fases aqui desenvolvidas: estruturação, avaliação e recomendações.

ABSTRACT Considering the increasing demand and the water crisis in many countries, loss management in water supply systems seems relevant to all water services. This research set out to build a performance evaluation model to support a sanitation company on the loss management in the water supply systems that it operates, based on the Constructivist Multicriteria Decision Aid Approach (MCDA-C). The model construction followed the three phases of MCDA-C: structuring, actions evaluation and recommendations. The structuring phase resulted in 64 descriptors in four families of fundamental points of view: apparent losses, real losses, operational support, and external relations. At the end of the evaluation phase, the status quo of the water supply system studied was 22.51, within the competitive level judged by the decision-maker. Actions recommendations were designed to improve the status quo performance of those descriptors with compromising performance, judged by the decision-maker as relevant to be improved. Recommendations were important for improving performance in all families of fundamental points of view, resulting in the overall performance of 60.82. This way, the MCDA-C methodology proved to be consistent for the topics covered in this research and confirmed its constructivist assumptions in all the stages developed here: structuring, evaluation and recommendations.

Performances evaluation of Sysmex XN-9000 hematology analyzer under body fluid mode for detecting peritoneal and pleural fluids / 医疗卫生装备

Object To verify and evaluate the performances of Sysmex XN-9000 hematology analyzer under body fluid mode when used for peritoneal and pleural fluids detection.Methods According to the guidance of ICSH, Sysmex XN-9000 hematology analyzer under body fluid mode had its performances verified on background counting, carryover, precision, linear range and etc of RBC-BF and TC-BF, and then was compared with microscopy on RBC-BF, TC-BF, PMN％, MN％, N％, L％, M％and E％.Results The RBC-BF and TC-BF had the background counting being 0.00, carryover being 0.00％and 0.07％ respectively, coefficients of variation (CV) of within-run precision being from 0.96％to 17.89％as well as from 2.19％to 10.33％respectively, CV of between-run precision being from 3.34％to 4.73％as well as from 8.33％to 10.75％resptctively, and the linear ranges being (0～5) ×1012/L and (0～20) ×109/L respectively. There was a high correlation between Sysmex XN-9000 hematology analyzer and microscopy when detecting RBC-BF, TC-BF, PMN％, MN％, N％, L％, M％and E％. The Spearman rank correlation coefficients (rs) were 0.977, 0.995, 0.863, 0.929, 0.926, 0.949, 0.965 and 0.816 (P<0.05), and there were statistical significances between the correlations. Bland-Altman bias analysis on the analyzer and microscopy showed that RBC-BF had the bias (4.6％) lower than that (5.6％) of TC-BF;MN％had the bias (-2.0％) lower than that (4.2％) of PMN％;L％, N％, M％and E％had the bias being-0.5％, 4.4％,-5.9％and-1.6％respectively, which were all met the requirements of the manufacturer.Conclusion Sysmex XN-9000 hematology analyzer under body fluid mode proves its performances for routine detection of peritoneal and pleural fluids.

Estudo experimental do falar em público com e sem plateia em universitários / Experimental study of public speaking with and without audience in undergraduates / Estudio experimental de hablar en público con y sin audiencia en estudiantes universitarios

Objetivou-se comparar a frequência dos marcadores comportamentais de ansiedade entre grupos com e sem plateia, frente à situação experimental do falar em público. Participaram ao todo 72 universitários, que responderam ao Teste de Simulação de Falar em Público (TSFP), Inventário de Habilidades Sociais (IHS-Del-Prette), Self Statements During Public Speaking Scale (SPSS) e Questionário Sociodemográfico e Ocupacional. Os grupos diferiram significativamente em relação à maioria dos marcadores comportamentais de ansiedade, avaliados por meio do Protocolo de Registro do Falar em Público (PRFP), com médias de frequências superiores para o grupo com plateia. Constatou-se, ainda, que quanto mais elaborado o repertório de habilidades sociais de um universitário, mais positivamente ele avaliará o seu próprio desempenho em situações de falar em público. Sugerem-se novas pesquisas com maior número de universitários, com diferentes níveis de ansiedade social, que permitam examinar as associações entre habilidades sociais, autoavaliações ao falar em público e ansiedade social. (AU)

This study aimed to compare the frequency of behavioral markers of anxiety between groups with and without an audience, against an experimental situation of public speaking. A total of 72 undergraduates participated, who responded to the Public Speaking Simulation Test, (TSFP), the Social Skills Inventory (IHS-Del-Prette), the Self Statements During Public Speaking Scale (SPSS), and the Sociodemographic and Occupational Questionnaire. The groups differed significantly considering most of the behavioral markers of anxiety, evaluated by the Public Speaking Register Protocol (PRFP), with higher frequency rates in the group with an audience. It was also found that the more elaborate is the social skills repertoire of an undergraduate, the more positive was his self-evaluation of his own performance in public speaking situations. It is suggested further research with a larger number of undergraduates with different levels of social anxiety, in order to allow the analysis of association between social skills, self-assessments when speaking in public, and social anxiety. (AU)

Se trató de comparar la frecuencia de los indicadores comportamentales de ansiedad entre los grupos participantes con y sin platea, frente a una situación experimental de hablar en público. Participaron 72 universitarios que respondieron Test de Simulación de Hablar en Público (TSFP) Inventario de Habilidades Sociales (IHS-Del-Prette), Self Statements During Public Speaking Scale (SPSS), y Cuestionario Sociodemográfico y Ocupacional. Los grupos diferían significativamente en relación a la mayoría de los indicadores comportamentales de ansiedad, evaluados por medio del Protocolo de Registro de Hablar en Público (PRFP), con promedio de frecuencia superior para el grupo con platea. Fue constatado, también, que cuanto más elaborado es el repertorio de habilidades sociales de un universitario, éste evaluará de forma más positiva su propio desempeño en situaciones de hablar en público. Se sugiere realizar nuevas investigaciones con un número mayor de universitarios, con diferentes niveles de ansiedad social, que permitan examinar las asociaciones entre habilidades sociales, autoevaluación al hablar en público y ansiedad social. (AU)

Assessment of service performance in foreign national libraries and suggestions for improving service in do-mestic libraries / 中华医学图书情报杂志

After the literature resources, service efficiency, impact contribution and service performance of 4 foreign national libraries were comparatively analyzed by taking their geographic location,culture and impact power into consideration,the strategy for the development of domestic libraries and the improvement of assessment systems was studied with suggestions put forward for the development and improvement of literature service in domestic li-braries,namely supporting innovation in enterprises, providing information service for governments, collecting re-cords of special and emergency events, taking the satisfaction of users and staff as well as the influence of social media into consideration when the library performance was assessed.

Development and application of a surgical information acquisition system based on performance assessment / 中华医院管理杂志

Covered in the paper is the development of the hospital's surgical information acquisition system during the healthcare reform and upgrading of its performance assessment scheme.Such a system is designed to precisely collect surgery scheduling, daytime surgery, and outpatient surgery workload, conducive to developing a performance assessment scheme based on surgery workload, motivating medical workers, and improving quality of care.

Motives of domestic scientific research workers to publish their papers / 中华医学图书情报杂志

Objective To analyze the papers published by domestic scientific research workers in order to improve the academic level of their papers. Methods The papers published by over 3000 domestic scientific research workers were investigated with questionnaires. Their motives to publish papers and the relation between the number of pub-lished papers and the assessment of their performance were analyzed. Results The number of papers published by domestic scientific research workers was increased. However, their academic level was to be further improved. Over quantization of the assessment mechanisms for scientific research increased the external motives to publish papers, thus leading to the insufficient internal motives of them to engage in scientific research. Conclusion A loose and comfortable academic environment should be created for the scientific research workers in order to initiate their in-ternal motives to publish papers. Over quantization of the assessment mechanisms for scientific research should be changed in order to reduce the external motives of domestic scientific research workers to publish papers. Innovative and cultural environment should be created in order to improve the soft power of scientific research in our country.

Análisis de un test de desempeño en expresión escrita mediante el modelo de MFRM

Este trabajo muestra la utilidad de un modelo de Rasch (Many-Facet Rasch Measurement, MFRM) para medir la competencia de los examinados, la severidad de los calificadores, la dificultad de las tareas y de las variables puntuadas en las pruebas de respuesta construida que se suelen emplear para evaluar el desempeño. Inicialmente se describe el modelo y sus estadísticos básicos. Finalmente se presenta un ejemplo ilustrativo en el que se analizan, mediante el programa FACETS, las fuentes de la variabilidad de las calificaciones de los estudiantes en un test de expresión escrita. Los resultados muestran que el procedimiento es útil para detectar a los calificadores que presentan valores extremos en la variable severidad/ benignidad y para obtener calificaciones objetivas de los examinados (libres de la severidad del calificador).

This paper describes how a Rasch model (Many-Facet Rasch Measurement) can be applied to performance assessment focusing on analysis of examinee, raters, tasks and variables. The article provides an introduction to MFRM, a description of analysis procedures, and an illustrative example to examine the effects of various sources of variability on students' performance on a writing test by means of the FACETS program. Results highlight the usefulness of the MFRM to detect raters that have extreme values on the continuum of severity/leniency as well as providing objective measurement of examinee (scores free of rater severity).

Percepções e Sentimentos de Professores de Medicina frente à Avaliação dos Estudantes – um Processo Solitário / Medical Teachers’ Perceptions and Feelings about Student Assessment – a Lonely Process

Introdução O processo de avaliação formativa nas escolas médicas envolve o professor na observação direta do desempenho do estudante. Esta avaliação gera desconforto e angústia para alguns professores, na tentativa de serem justos e imparciais. Este trabalho tem por objetivos identificar as dificuldades na avaliação dos estudantes de Medicina, conhecer os sentimentos, conceitos e crenças dos professores frente ao processo e identificar os fatores que dificultam e facilitam esta avaliação. Método Foram conduzidos três Grupos Focais com professores do Departamento de Pediatria da Faculdade de Medicina da Universidade Federal de Minas Gerais estratificados por tempo de docência e classificados quanto a gênero, titulação e categoria funcional. As reuniões tiveram uma moderadora auxiliada pelo pesquisador, duraram entre 90 e 120 minutos e terminaram quando ocorreu a saturação do tema. Toda a discussão foi transcrita e rendeu 118 páginas, que foram submetidas à análise de conteúdo. Resultados O discurso foi categorizado em cinco grandes temas: dificuldade da avaliação de habilidade clínica e atitudes; relação professor-aluno; sentimentos vivenciados pelos docentes durante a avaliação; fatores facilitadores; necessidade de mudanças. Conclusões Os docentes sentem falta de objetivos bem definidos e instrumentos avaliativos específicos. Reconhecem a necessidade de melhores conhecimentos pedagógicos e considera a avaliação formativa uma situação solitária, com pouco respaldo da instituição. .

Introduction The student assessment process in medical schools involves the teacher’s direct observation of student performance. This evaluation causes distress and discomfort to some teachers in their attempt to be fair and impartial during feedback. This study aims to understand the feelings, concepts, and teachers’ beliefs regarding the process of subjective assessment of students and to identify the factors that both hinder and facilitate this evaluation. Method Three focus groups were formed with teachers from the Federal University of Minas Gerais School of Medicine, Department of Pediatrics, stratified by years of teaching and classified by gender, title, and functional category. The meetings had a moderator helped by the researcher, lasted between 90 and 120 minutes and finished when themes were exhausted. All discussions were transcribed, yielding 118 pages that were subjected to content analysis. Results Discourse was categorized into five major themes: the difficulty of assessing clinical skills and attitudes, the teacher/student relationship, feelings experienced by teachers during assessment, facilitating factors and need for change. Conclusions Teachers lack well-defined objectives and specific assessment tools. They recognize the need for better pedagogical knowledge and consider the act of evaluating an isolated task with very little support from the institution. .

Avaliação do comportamento tático no futebol: princípios táticos fundamentais nas categorias sub-14 e sub-15 / Tactical behavior assessment in soccer: fundamental tactical principles between U-14 and U-15 players

O processo de ensino-aprendizagem-treinamento do Futebol deve adequar as atividades de treino à demanda dos atletas e equipes. Neste âmbito, pouca investigação centra-se nas diferenças no comportamento tático dos jogadores de Futebol masculino em função da categoria, informação que apresenta-se importante à correta distribuição dos conteúdos de treino às idades dos praticantes. Este trabalho comparou o comportamento tático de jogadores de Futebol das categorias sub-14 (dez atletas) e sub-15 (10 atletas) por meio do Sistema de Avaliação Tática no Futebol (FUT-SAT). Procedimentos de confiabilidade inter e intra-observador foram contemplados e considerados satisfatórios, e recorreu-se ao teste de qui-quadrado para comparação da frequência de aparecimento dos princípios táticas entre as categorias e da distribuição das ações táticas no campo de jogo. Observou-se que jogadores sub-15 realizaram menos ações dos princípios "Espaço sem Bola" e "Concentração", e mais ações de "Unidade Ofensiva" em comparação aos atletas sub-14. Na defesa, os atletas sub-15 realizaram mais ações no meio campo defensivo e menos ações no meio-campo ofensivo em comparação à categoria sub-14, indicando que os jogadores da categoria sub-15 apresentaram-se mais capazes de proteger as zonas mais perigosas do campo de jogo, nomeadamente aquelas mais próximas da baliza a defender. Estes achados indicam especificidades nas características de jogo em relação à categoria dos atletas. Conclui-se que os comportamentos táticos dos jogadores de Futebol variam em função da categoria. Deste estudo emerge a importância de se adequar o processo de ensino-aprendizagem-treinamento do Futebol às demandas específicas cada categoria de prática.(AU)

The teaching-learning-training process of soccer players must be tailored to the athletes and teams' demands. In this scope, little attention has been paid to the tactical behavior of male soccer player related to the age, which is important to the training contents adjustment to the players' characteristics. This paper aimed to compare the tactical behavior of U-14 (ten athletes) and U-15 (10 athletes) soccer players through the System of Tactical Assessment in Soccer (FUT-SAT). Inter and intra expert reliability was performed and considered satisfactory, and chi-square test was used to compare the occurrence of tactical principles and the place of action on the game field between the ages. Results showed that U-15 players performed less "Width and Length" and "Concentration", but more "Offensive Unity" principles than U-14 players. During the defensive phase, U-15 players also performed more actions on the defensive midfield and less actions on the offensive midfield than U-14 players, what indicates that U-15 players were better able to protect the most dangerous zones on the game field, namely the closer than the own goal. These results indicated specificities in the playing characteristics related with the athletes' age. It is concluded that the tactical behavior of soccer players vary depending on the age. From this study emerges the importance of adjust the teaching-learning-training process of soccer players to the specific demands of each practice age.(AU)

Enlightenment of ISO11620:2014 for construction of military academic libraries / 中华医学图书情报杂志

After a description of ISO11620:2014 , the international criteria for library performance assessment , how to enforce the construction of military academic libraries was systematically elaborated in terms of improving the quality and use of their resources and infrastructures, and reducing their construction cost.