The effects in assistance indicators of changes on a nursing team / Impactos da alteração da equipe de enfermagem nos indicadores da assistência

INTRODUCTION: This article discusses the path of healthcare associated infections (HAI) indicators in the intensive care unit (ICU) of a public teaching hospital in Belo Horizonte, Minas Gerais, Brazil, after certain change in its nursing staff: pair of nursing caregivers. The model of a pair of caregivers consists in assigning one nurse and one nursing technician for every three patients. The indicators analyzed were infection related to central venous catheters (CVCs), the risk of HAI, turnover, and absenteeism. OBJECTIVE: The objective of this paper is to understand the impact of the restructuring of the nursing staff in Human Resources and on the rate of infection in the ICU. METHODS: As for methods, it is a qualitative and descriptive research carried out as a case study. RESULTS: The results have shown that the risk of HAIs significantly increased after the change in staffing, but the density of vascular access infection associated with CVCs was drastically reduced. The results of turnover of nursing technics decreased and the turnover of nurses increased while the absenteeism of the nursing team decreased after the change. The interviews revealed that there was a gain at the care due to the change. CONCLUSION: As a conclusion, the results of the study have shown that the proposed nursing model caused a care gain, once the interviews exposed that and indicator directly related to nursing team care (infection associated with CVCs) decreased.

INTRODUÇÃO: Esse artigo discute a evolução do indicador de infecção relacionada à assistência à saúde (IRAS) em uma Unidade de Tratamento Intensivo (UTI) em um hospital-escola público de Belo Horizonte, Brasil, após alteração na equipe de enfermagem: par de cuidadores. Esse modelo de par de cuidadores consistiu em determinar um enfermeiro e um técnico em enfermagem para cada três pacientes. Os indicadores analisados foram infecções de corrente sanguínea associadas ao Cateter Venoso Central (CVC), risco de IRAS, turnover e absenteísmo. OBJETIVO: Compreender o impacto da reestruturação do time de enfermagem na área de Recursos Humanos e a taxa de infecção na UTI. MÉTODOS: Como métodos, é uma pesquisa qualitativa e descritiva, obtida por meio do estudo de caso. RESULTADOS: Os resultados apontaram que o risco das IRAS aumentou significativamente após a mudança da equipe de enfermagem, mas a densidade do indicador de infecções de corrente sanguínea associadas ao CVC reduziu drasticamente. Os resultados de turnover entre os técnicos de enfermagem caiu e dos enfermeiros aumentou, enquanto o absenteísmo da equipe de enfermagem reduziu. As entrevistas revelaram que houve um ganho na qualidade do cuidado relacionado à mudança. CONCLUSÃO: Conclui-se que os resultados demonstraram um ganho assistencial obtido pela mudança na equipe de enfermagem, uma vez que isso foi relevado nas entrevistas e houve redução nos resultados do indicador diretamente relacionado ao trabalho do enfermeiro (infecções associadas ao CVC)

Pregnant-puerperal care in Network: the experience of nurses, doctors and administrators / Cuidado gravídico-puerperal en Red: el vivido de enfermeros, médicos y gestores / Cuidado gravídico-puerperal em Rede: o vivido de enfermeiros, médicos e gestores

ABSTRACT Objective: Understand the experience of nurses, doctors and administrators of pregnancy-puerperal cycle care to women in the Rede Mãe Paranaense (Freely translated as Paranaense Mother Network). Method: Qualitative research according to social phenomena with 44 professionals from 10 municipalities of the Regional of Health, in Paraná State, Brazil. The testimonies were recorded until converge and were analyzed following the steps established from the background. Results: It was understood a content of meaning experienced among different professional classes. The "motives why" in which the Network was a reasoned proposal to improve the mother care quality, although there is disarticulation in the planning and application. The expectation for "motives for" proved fragility and challenges to reach the goals and aims of the Network in the Primary Health Care practice. Final considerations: The Network reorganization was carried out, but there are gaps in the reference and counter-reference system, especially for the pregnancy and high risky childbirth and puerperal cycle.

RESUMEN Objetivo: Comprender la vivencia de enfermeros, médicos y gestores en el cuidado para la mujer en el ciclo gravídico-puerperal en la Red Madre del estado Paraná (Rede Mãe Paranaense). Método: Investigación cualitativa bajo la luz de la Fenomenología Social con 44 profesionales de 10 municipios de Regional de Salud, Paraná, Brasil. Los testimonios fueron grabados hasta alcanzar la convergencia y analizados cumpliendo los pasos establecidos del referencial. Resultados: Se captó un contexto de significados vivenciados entre las diferentes clases profesionales. Los "motivos por qué" en que la Red vino como una propuesta fundamentada para mejorar la calidad del cuidado materno, aunque haya desarticulación en la planificación e implementación. La expectativa de los "motivos para" evidenció fragilidades y desafíos para el logro de los objetivos y metas de la Red en el servicio de Atención Primaria en Salud. Consideraciones finales: La reestructuración de la red ocurrió, pero todavía hay lagunas en el sistema de referencia y contrarreferencia, en especial para la gestación y parto de alto riesgo y seguimiento puerperal.

RESUMO Objetivo: Compreender a vivência de enfermeiros, médicos e gestores no cuidado à mulher no ciclo gravídico-puerperal na Rede Mãe Paranaense. Método: Pesquisa qualitativa à luz da Fenomenologia Social com 44 profissionais de 10 municípios de Regional de Saúde, no Paraná, Brasil. Os depoimentos foram gravados até alcançar a convergência e analisados cumprindo os passos estabelecidos do referencial. Resultados: Apreendeu-se um contexto de significados vivenciados entre as diferentes classes profissionais. Os "motivos por que" em que a Rede veio como uma proposta fundamentada para melhorar a qualidade do cuidado materno, embora haja desarticulação no planejamento e implementação. A expectativa dos "motivos para" evidenciou fragilidades e desafios para o alcance dos objetivos e metas da Rede no serviço de Atenção Primária à Saúde. Considerações finais: A reestruturação da Rede ocorreu, mas ainda há lacunas no sistema de referência e contrarreferência, em especial para a gestação e o parto de alto risco e seguimento puerperal.

Health human resources in Southern Philippines Medical Center, a 1,200-bed-capacity, tertiary government hospital

@#In November 2009, through Republic Act 9792, Davao Medical Center was renamed Southern Philippines Medical Center (SPMC). This act also provided for the increase in the bed capacity of the hospital from 600 to 1,200 beds.1 The set of implementing rules and regulations for the legislation subsequently specified the increase in the number of health human resources in SPMC to cope up with the hospital's growing number of clients.2 Currently, SPMC has a total of 4,737 personnel, composed of 3,329 employees with plantilla positions and 1,408 employees with non-plantilla positions, deployed to the different divisions of the hospital. Roughly a third of the total personnel are administrative staff, and two thirds are medical and allied medical staff. The Medical Center Chief (MCC) oversees the operations of the whole hospital. Five administrators directly assist the MCC in hospital management: the Chief of Medical Professional Services, the Chief Nurse, the Chief Administrative Officer, the Financial and Management Officer, and the Chief of Allied Professional Services. Due to the increasing bed occupancy rates and the pressing need to increase health human resources in SPMC, an increase in the institution’s bed capacity from 1,200 to 1,500 is presently being proposed through House Bill 7061.3 Once the bill is passed into law, it is expected that additional plantilla items will be created in order to meet the greater operational demands of a bigger hospital.

Development of the Inpatient Dignity Scale Through Studies in Japan, Singapore, and the United Kingdom

PURPOSE: The importance of human dignity in care is well-recognized. Care recipients' experiences with undignified care have been reported in many countries. However, few studies have measured these situations quantitatively, especially as there are no tools applicable to inpatients receiving ordinary daily care. This study aimed to develop a valid and reliable Inpatient Dignity Scale (IPDS) that can measure inpatients' expectations of and satisfaction with dignity in daily care. METHODS: We conducted a three-phase research project: item generation and a preliminary survey with 47 items related to patients' dignity in Japan, a main survey with 36 items with deliberate translation into English in Singapore, and a confirmatory survey with 35 items in England, with 442, 430, and 500 inpatients as participants in questionnaire surveys, respectively. Data from each survey were processed using factor analysis. RESULTS: Authors obtained a scale with a four-factor structure with acceptable reliability: (F1) respect as a human being, (F2) respect for personal feelings and time, (F3) respect for privacy, and (F4) respect for autonomy. CONCLUSION: The Inpatient Dignity Scale can be periodically used by hospital administrators or nurses to preserve inpatients' dignity in daily care by monitoring inpatients' views regarding their expectations of and satisfaction with dignity.

Contribuições e desafios do gerenciamento de enfermagem hospitalar: evidências científicas / Contribuciones y desafíos de la gestión de enfermería hospitalaria: evidencias científicas / Contributions and challenges of hospital nursing management: scientific evidence

Resumo OBJETIVO Analisar as evidências científicas, nacionais e internacionais, sobre contribuições e desafios do gerenciamento de enfermagem na atenção hospitalar. MÉTODO Revisão integrativa da literatura, com questão norteadora: Quais evidências científicas sobre o gerenciamento de enfermagem na atenção hospitalar? Dados coletados nas bases de dados LILACS, PubMed, Scopus, CINAHL e EMBASE. A amostra final de 14 artigos resultou em duas categorias: "Contribuições" e "Desafios". RESULTADOS As contribuições referem-se a aspectos que facilitam o desenvolvimento e organização do trabalho na perspectiva técnico-política, ao qualificar os processos produtivos. Os desafios estão atrelados à formação profissional, à satisfação com o trabalho, à sobrecarga, à manutenção da qualidade dos serviços, resolução de conflitos e trabalho em equipe. CONCLUSÃO Processos gerenciais e assistenciais são indissociáveis, requerem conhecimento adequado e atualizado para oferecer melhor experiência de cuidado ao usuário e coordenar ações da equipe.

Resumen OBJETIVO Analizar las evidencias científicas, nacionales e internacionales, sobre contribuciones y desafíos del manejo de enfermería en la atención hospitalaria. MÉTODO Revisión integrativa, con cuestión-guia: ¿Cuáles son las evidencias científicas sobre gestión de enfermería en la atención hospitalaria? Datos recogidos en las bases de datos LILACS, PubMed, Scopus, CINAHL y EMBASE. La muestra final de 14 artículos resultó en dos categorías: "Contribuciones" y "Desafíos". RESULTADOS Las contribuciones se refieren a aspectos que facilitan el desarrollo y organización del trabajo desde la perspectiva técnico-política, al calificar los procesos productivos. Los desafíos están vinculados a la formación profesional, satisfacción con el trabajo, sobrecarga, mantenimiento de calidad, resolución de conflictos y trabajo en equipo. CONCLUSIÓN Procesos gerenciales y asistenciales son indisociables, requieren conocimiento adecuado y actualizado para ofrecer la mejor experiencia de cuidado y coordinar acciones del equipo.

Abstract AIM Analyze the scientific evidence, national and international, about contributions and challenges of nursing management in hospital care. METHOD Integrative literature review, with guiding question: What are the scientific evidence about nursing management in hospital care? Data was collected in LILACS, PubMed, Scopus, CINAHL and EMBASE databases. The final sample of 14 articles resulted in two categories: "Contributions" and "Challenges." RESULTS Contributions refer to aspects that facilitate the development and organization of work from a technical-political perspective, by qualifying the productive processes. The challenges were related to professional development, work satisfaction, overload, quality of service, conflict resolution and teamwork. CONCLUSION Management and care processes are inseparable, requires adequate and up-to-date knowledge to provide a better care experience for the health services user and coordinate team actions.

Curriculum Analysis on Health Management Schools in Republic of Korea: Focusing on Relationship with Licence and Certification / 보건행정학회지

BACKGROUND: This study aims to conduct curriculum analysis on health management schools focusing on relationship with licence and certification in Republic of Korea. METHODS: Possible employment field, licence and certification as well as curriculum were collected from the home page of 30 health management schools. The subjects and credits of curriculum were analyzed using descriptive statistics. Main subjects by areas were drew using categorization and ranking within qualitative methods. Comparative analysis was conducted for checking relationship between main subject and possible employment field, licence and certification. RESULTS: First, major employment fields after graduation were public health officer, general hospital and clinic, and National Health Insurance Service. Possible licence and certificate were hospital administrator, medical recorder, health education specialist, and medical insurance specialist. Second, total graduate credits were 133.9 including 79.0 for major education, 30.5 for of general education, and 30.5 for elective courses. Third, main subjects were reviewed by areas including basic medicine, health management, hospital business & management, medical records & information, insurance billing & assessment, healthcare marketing & tourism, and health education. There were highest number of subjects on health education area among 8 categories. By subjects, many health management schools open health law, medical terminology, introduction to public health, and biostatistics. Relationship between main subjects and possible employment field, licence and certification in health management schools was strong. CONCLUSION: It is necessary to review curriculum and for improving educational quality in health management schools. Also, development of curriculum standards for courses in health administration and introduction of accreditation system can be considered.

O processo de conformação do perfil assistencial nos hospitais federais da cidade do Rio de Janeiro, Brasil / The process of defining the hospital care profile in federal hospitals in the city of Rio de Janeiro, Brazil

Resumo Este artigo analisa o processo de conformação do perfil assistencial nos hospitais federais no município do Rio de Janeiro. Trata-se de um estudo descritivo, de abordagem qualitativa e que utilizou entrevistas semiestruturadas realizadas junto a gestores hospitalares. A análise dos dados foi realizada a partir da formação do Discurso do Sujeito Coletivo. Na percepção dos gestores esse processo é decorrente de um conjunto de estratégias emergentes, as propostas e as necessidades de mudança se constituem de reações adaptativas que as unidades desenvolvem de forma desarticulada visando à resolução de problemas identificados pelos profissionais e gestores. O processo é considerado muito mais a partir de uma perspectiva política do que racional e sistêmica. Algumas experiências de trabalho com a missão hospitalar, como o enfoque da démarche stratégique, já apontam para uma construção mais colegiada na definição do perfil assistencial, que considera o hospital como componente de uma rede integrada de serviços e que adota um processo de decisão menos incremental e mais integrador.

Abstract This article analyzes the process of shaping the care profile of federal hospitals in the city of Rio de Janeiro. This is a qualitative, descriptive study that draws on semi-structured interviews with hospital administrators. Data analysis used the Collective Subject Discourse approach. Managers believe this process is the result of a set of emerging strategies, proposals and need for change, which result in adaptive reactions that hospitals develop with no coordination between them to resolve problems identified by professionals and managers. The process is analyzed much more from a political point of view than from a rational and systemic one. Some of the experience with the hospital mission, such as the focus on a strategic approach, already signals a more collegiate approach to defining the profile of care, where the hospital is one component of an integrated network of services, with a decision process that is less incremental and more integrating.

Management changes resulting from hospital accreditation / Cambios gerenciales resultantes de la Acreditación hospitalaria / Mudanças gerenciais resultantes da Acreditação hospitalar

ABSTRACT Objective: to analyze managers and professionals' perceptions on the changes in hospital management deriving from accreditation. Method: descriptive study with qualitative approach. The participants were five hospital quality managers and 91 other professionals from a wide range of professional categories, hierarchical levels and activity areas at four hospitals in the South of Brazil certified at different levels in the Brazilian accreditation system. They answered the question "Tell me about the management of this hospital before and after the Accreditation". The data were recorded, fully transcribed and transported to the software ATLAS.ti, version 7.1 for access and management. Then, thematic content analysis was applied within the reference framework of Avedis Donabedian's Evaluation in Health. Results: one large family was apprehended, called "Management Changes Resulting from the Accreditation: perspectives of managers and professionals" and five codes, related to the management changes in the operational, structural, financial and cost; top hospital management and quality management domains. Conclusion: the management changes in the hospital organizations resulting from the Accreditation were broad, multifaceted and in line with the improvements of the service quality.

RESUMEN Objetivo: analizar las percepciones de gestores y trabajadores sobre los cambios en la gestión hospitalaria resultantes de la Acreditación. Método: estudio descriptivo con aproximación cualitativa. Participaron cinco gestores de calidad hospitalaria y otros 91 trabajadores de las más diversas categorías profesionales, niveles jerárquicos y áreas de actuación de cuatro hospitales del sur de Brasil certificados por la Acreditación nacional de diferentes niveles, que contestaron la pregunta "Cuéntame sobre la gestión de este hospital, antes y después de la Acreditación". Los datos fueron grabados, transcritos por completo y transportados para acceso y manoseo en el software ATLAS.ti, versión 7.1. A seguir, fue aplicado el análisis de contenido, modalidad temática, a la luz del referencial de la Evaluación en Salud de Avedis Donabedian. Resultados: fue aprendida una gran categoría temática (family), llamada "Cambios Gerenciales Resultantes de la Acreditación: perspectivas de gestores y trabajadores" y cinco subcategorías (codes), relacionadas a los cambios gerenciales en las esferas operacional; estructural; financiera y de costo; en la alta gestión hospitalaria; y en la gestión de calidad. Conclusión: los cambios gerenciales en las organizaciones hospitalarias, resultantes de la Acreditación, fueron amplias, polifacéticas y coherentes con las mejoras en la calidad de los servicios.

RESUMO Objetivos: analisar as percepções de gestores e trabalhadores sobre as mudanças no gerenciamento hospitalar advindas da Acreditação. Método: estudo descritivo com abordagem qualitativa. Participaram cinco gestores da qualidade hospitalar e outros 91 trabalhadores das mais diversas categorias profissionais, níveis hierárquicos e áreas de atuação de quatro hospitais do sul do Brasil certificados pela Acreditação nacional de diferentes níveis, que responderam à questão "Fale-me sobre o gerenciamento deste hospital, antes e depois da Acreditação". Os dados foram gravados, transcritos na íntegra e transportados para acesso e manejo no software ATLAS.ti, versão 7.1. Após isso, procedeu-se a análise de conteúdo, modalidade temática, sustentada à luz do referencial da Avaliação em Saúde de Avedis Donabedian. Resultados: apreendeu-se uma grande categoria temática (family), denominada "Mudanças Gerenciais Advindas da Acreditação: perspectivas de gestores e trabalhadores" e cinco subcategorias (codes), relacionadas às mudanças gerenciais no âmbito operacional; estrutural; financeiro e de custo; na alta gestão hospitalar; e na gestão da qualidade. Conclusão: as mudanças gerenciais nas organizações hospitalares, advindas da Acreditação, se mostraram amplas, multifacetadas e coadunam às melhorais da qualidade nos serviços.

Application of a Q Method Study to Understanding Nurses' Perspective of Adopting Evidence-Based Nursing

PURPOSE: This study applied the Q method to identify and describe the various types of nurse perceptions that are crucially associated with their engagement in evidence-based nursing (EBN). METHODS: The study participants were nurses at a medical center and a regional teaching hospital. A series of Q sorts was performed by nurses to subjectively rank the Q statements. Q statements were constructed based on the literature related to EBN adoption by nurses and face-to-face interviews. RESULTS: A total of 60 participants were invited to rank 44 Q statements related to EBN. Factor analysis was conducted on the rankings of the Q statements. The following are the five prominent shared perspectives: (1) emphasized the obstacles to evidence searching and reading ability; (2) emphasized the organizational promotive strategies; (3) emphasized the available supportive resources; (4) emphasized the significance of EBN; and (5) emphasized the evidence-searching ability and external incentives. The five identified groups of perspectives can enhance hospital administrators to acknowledge the barriers and incentives associated with EBN practices. CONCLUSION: The exploration of clustering nurses' perceptions may facilitate the development of customized strategies to enable more appropriate training.

Health transformation plan: goals achievement in Nemazee hospital

Introduction: The main purpose of this study was to assess fulfillment of goals about "Health Transformation Plan [HTP] of Ministry of Health, Treatment and Medical Education" from the perspective of managers, which is as one of the most important management challenges in the Health System Reform Plan. These goals included six packages determined by the Ministry of Health, Treatment and Medical Education, the fulfillment of each of which one was evaluated separately as sub-goals in the current study. Finally, the rank of each package in comparison to other packages was determined and presented, using means rank test [Friedman test]

Method: This study was conducted using a questionnaire in which comments of the senior and middle managers of Nemazee hospital were collected as the research data. Due to the fact that about one year has passed since the beginning of implementation of HTP and since there were no documented methods or questionnaires, the researcher designed a self-made questionnaire. The basis of designing the questionnaire was the set of guidelines developed for Health System Reform Plan. These guidelines include goals that a hospital should achieve during implementation of Health System Reform Plan. After sharing these goals with senior and middle managers of Nemazee hospital [as the place of research], they were converted to a questionnaire including 20 questions. The questionnaire included the goals that must be achieved in Nemazee hospital of Shiraz during the implementation of the plan. After designing the questionnaire, a preliminary test was taken to assess the reliability

Results: Cronbach's alpha coefficient [0.88] showed a high rate of reliability in the above questionnaire. After the final data collection, the questionnaire was tested in a sample of 100 senior and middle managers; the results showed that about six packages were specified by the Ministry of Health, Treatment and Medical Education. The majority of respondents [about 57%] believed that the HTP has greatly achieved its goals, and about 43% of them believed that the success of this plan was average

Conclusion: In ranking among the six main packages which was considered as sub-goals of this plan, the results showed that the studied packages were ranked respectively as follows: Package number 1, Package number 2, Package number 6, Package number 3, Package number 5 and Package number 4

The Impact of Hospital Specialization on Length of Stay per Case and Hospital Charge per Case / 보건행정학회지

BACKGROUND: Over the last few decades, because hospitals in South Korea also have undergone dramatic changes, Korean hospitals traditionally have provided specialized health care services in the health care market. Inner Herfindahl-Hirschman Index (IHI) measures hospital caseloads based on patient proportions, independent of patient volumes. However, IHI that rely solely on patient proportions might be problematic for larger hospitals that provide a high number of diagnosis categories, as the patient proportions in each category are naturally relatively smaller in such hospitals. Therefore, recently developed novel measure, category medical specialization (CMS) is based on patient volumes as well as patient proportions. METHODS: we examine the distribution of hospital specialization score by hospital size and investigate association between each hospital specialization and length of stay per case and hospital cost per case using Korean National Health Insurance Service-cohort sample data from 2002 to 2013. RESULTS: Our results show that IHI show a decreasing trend according to the number of beds and hospital type but CMS show an increasing trend according to the number of beds and hospital type. Further, inpatients admitted at hospitals with higher IHI and CMS had a shorter length of stay per case (IHI: B=-0.104, p<0.0001; CMS: B=-0.044, p=0.001) and inpatients admitted at hospitals with higher IHI and CMS had a shorter hospital cost per case (IHI: B=-0.110, p=0.002; CMS: B=-0.118, p=<0.0001). CONCLUSION: this study may help hospital policymakers and hospital administrators to understand the effects of hospital specialization strategy on hospital performance under recent changes in the Korean health care environment.

A arte do improviso: o processo de trabalho dos gestores de um Hospital Universitário Federal / The art of improvisation: the working process of administrators at a Federal University Hospital

ResumoEste artigo tem por objetivo analisar o processo de trabalho dos gestores de um Hospital Universitário Federal. Trata-se de uma pesquisa de abordagem qualitativa realizada mediante entrevista com 12 gestores. Entende-se por processo de trabalho o objeto a ser trabalhado, as ferramentas de trabalho e a atividade humana em si. Reconhece o trabalho como categoria analisadora dos modos de gestão dos profissionais de saúde. O HUF é responsável por duas políticas sociais, a educação e a saúde. O objeto de trabalho dos gestores é a questão organizacional, e as ferramentas de gestão utilizadas são burocráticas e antiquadas para o atual contexto político da gestão hospitalar. A característica mais expressiva na gestão desse hospital é o improviso, que degrada a potência dos gestores de tal modo que, ao invés de realizarem mudanças inovadoras no seu processo de trabalho, preferem deixar a função. O improviso resultou em uma produção de empecilhos sequenciais no aspecto decisório na gestão deste hospital escola. Enfim, analisou-se a transferência da gestão do HUF, da administração pública direta pela Universidade, para a Empresa Brasileira de Serviços Hospitalares, sob a alegação de se instituir um "novo" modelo de gestão.

AbstractThe scope of this article is to analyze the working process of administrators at a Federal University Hospital (HUF). It includes research with a qualitative approach conducted through interviews with twelve administrators. The work process, the work tools and the human activity per se are understood to be under scrutiny. Work is acknowledged as a category that analyzes the management methods used by professional health workers. The HUFs are responsible for two social policies, namely education and health. The aim of the administrators’ work is an organizational issue, and the administration tools used are bureaucratic and out-of-date for the current political context of hospital management. The most significant feature of this hospital administration is improvisation, which reduces the potential of the administrators in such a way that, instead of introducing innovative changes into their work process, they prefer to leave their jobs. Improvisation is caused by the production of sequential obstacles in management decision-making at this teaching hospital. In short, the transfer of administration at the HUF, from direct government administration by the University to the Brazilian Company of Hospital Services (EBSERH), was analyzed on the grounds that this would establish a "new" management model.

Missionary Medicine of Canadian Presbytery and Korean Doctors under Japanese Occupation: focusing Sung-jin and Ham-heung / 의사학

In East Asia during the second half of the 19th century, overseas mission work by Protestant churches thrived. Missionaries built schools and hospitals and effectively used them for evangelism. In the 20th century when Social Gospel Movement was expanding, medical work has been recognized as a significant mission service in and by itself. This article reviewed the construction and characteristics of missions work conducted by Canadian Presbytery; missionary doctors and Korean doctors who worked at the mission hospitals; why the missionary medical work had to stop; and career paths taken by Korean doctors upon liberation from Japanese occupation. The Canadian Presbytery missionaries, unlike other denomination missionaries, were rather critical of Imperial Japan, but supportive towards Koreans. This could have stemmed from the reflection of their own experience of once a colony of British Empire and also their value system that promotes egalitarian, democratic and progressive theology. The Sung-jin and Ham-heung Mission Bases were a community, interacting organically as a 'Triangle of Church, School and Hospital.' The missionaries mobilized the graduates from Christian schools and organized a Young Men's Christian Association (YMCA). Some of the graduates were trained to become medical doctors or assistants and worked at mission hospitals. Missionary doctors' approaches to balancing evangelism and medical practice varied. For example, Robert Grieson went through confusion and struggled to balance conflicting roles as a pastor for evangelism and also as a physician. Kate McMillan, on the other hand, had less burden for evangelism than Grieson, and focused on medical work by taking advantage of the opportunity that, as a woman, she can easily approach Korean women. Still another case was Florence Murray who practised evangelism within the hospital setting, and successfully carried out the role as a hospital administrator, going beyond 'women's work' as McMillan did. Korean doctors and assistants who worked at the mission hospitals had seen the spread of Protestantism in their youth; had received modern education; had experienced the fall of own country in 1910 and nationwide protest against Japan in 1919. The majority of them were graduates of Severance Medical College, the hub of missionary medicine at the time. After the resignation from the mission hospitals, 80 percent of them became self-employed general practitioners. The operations of the mission hospitals began to contract in 1930 due to tightened control by Imperial Japan. Shrine worship imposed on Christians caused internal conflict and division among missionaries and brought about changes in the form and contents of the mission organization. The incidence of the assault of Dr. Grieson brought about the dissolution of Sung-jin mission base and the interruption of the operation of Je-dong Hospital. As the Pacific War expanded, missionaries were driven out of Korea and returned home. In conclusion, the missions work by Canadian Presbytery missionaries had greatly impacted Protestantism in Korea. The characteristics of Canadian Presbytery were manifested in their support of Korean nationalism movement, openness for Social Gospel, and maintaining equal footing with Korean Christians. Specifically we note the influence of these characteristics in Chosun doctors who had worked in the mission hospitals. They operated their own hospitals or clinics in a manner similar to the mission hospitals by providing treatment for poor patients free of charge or for a nominal fee and treating the patients in a kind and humanistic way. After the 1945 Liberation, Korean doctors'career paths split into two directions. most of them defected to South Korea and chose the path to work as general practitioners. A few of them remained in North Korea and became educator of new doctors. It is meaningful that former doctors of Canadian missionary hosptal became dean of 2 medical colleges among 3 of all in early North Korea. This article does not cover the comparative analysis of the medical work by the missionaries of Canadian Presbytery and other denominations. It is desirable to include this analysis of the contents and the comparison in a future study of Korean doctors who participated in the mission hospitals, by denomination and by geographical region.

The Job Experience of Oncology Nurse Specialists

PURPOSE: The purpose of the study was to explore and describe the job experiences of oncology nurse specialists. METHODS: Nine oncology nurse specialists participated in the study. Data were collected through in-depth unstructured interviews with individual participants from February to June, 2014. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Corbin and Strauss's grounded theory method. RESULTS: From open coding, 98 concepts, 24 sub-categories, and 11 categories were identified. Analysis revealed that the core category of the job experiences of oncology nurse specialists was 'tightrope walking of professionalism without safeguards', consisting of four phases: Enthusiastic beginning, conflict, exertion, and internalization. To manage the 'tightrope walking of professionalism without safeguards', participants utilized various action/interactional strategies such as 'keeping the balance point' and 'taking a step forward.' As a result, participants experienced falling into a habitual routine and professional self-actualization. CONCLUSION: In-depth understanding of the job experiences of oncology nurse specialists will guide hospital administrators to promote effective interventions and policies to better support Korean oncology nurse specialists.

Public health emergency: social representations among managers of a university hospital / Emergência de saúde pública: representações sociais entre gestores de um hospital universitário / Emergencia de salud pública: representaciones sociales entre gestores de un hospital universitario

AIM: to comprehend the social representations of public health emergencies among managers who experienced the Influenza A (H1N1) Pandemic of 2009. METHOD: a qualitative case study, with its theoretical and methodological framework based on the Theory of Social Representations. The data was obtained through the techniques of free association and semi-structured interviews, applied individually to managers who worked in different positions of the hierarchical management structure of the institution during the pandemic emergency, a total of 30 participants. RESULTS: thematic content analysis resulted in the following categories: vulnerability, health protection, neglect - gray areas of the public sphere, and integrality. The social representations of public health emergencies attest to continuities that transit the overvalorization of negative discourses linked to the health/education public space, naturalization of the substantial character of the epidemic, and normative managerial action. However, the defense of ongoing education as a necessity associated with emergency management revealed possibilities for change in the technical-scientific perception of the management. CONCLUSIONS: to understand healthcare/nursing workers as political beings, assuming responsibilities in the areas of the macro and micro policies of the State, the university hospitals and the work teams, is a pathway that is emerging for the management of emergencies. .

OBJETIVO: compreender as representações sociais de emergências de saúde pública entre gestores que experienciaram a Pandemia de Influenza A (H1N1), de 2009. MÉTODO: pesquisa qualitativa, do tipo estudo de caso, encontrando na Teoria das Representações Sociais sua fundamentação teórico-metodológica. As informações foram obtidas pelas técnicas de associação livre e de entrevistas semiestruturadas, aplicadas individualmente a gestores que atuavam em diferentes instâncias da estrutura gerencial hierárquica da instituição, durante a emergência pandêmica, num total de 30 participantes. RESULTADOS E DISCUSSÃO: a análise de conteúdo temática resultou nas categorias: vulnerabilidade, proteção da saúde, descaso - zonas nebulosas da esfera pública e integralidade. As representações sociais de emergências de saúde pública atestam permanências que transitam pela sobrevalorização de discursos negativos ligados ao espaço público da saúde/ensino, naturalização do caráter substancial de epidemia e normativo da ação gerencial. Entretanto, a defesa da educação permanente como necessidade, associada à gestão das emergências, acena possibilidades de mudança na percepção técnico-científica da gestão. CONCLUSÕES: o entendimento do trabalhador da saúde/enfermagem, enquanto ser político, assumindo responsabilidades nos espaços das macro e micropolíticas do Estado, dos hospitais universitários e das equipes de trabalho são caminhos que se desenham para a gestão das emergências. .

OBJETIVO: comprender las representaciones sociales de emergencias de salud pública entre gestores que experimentaron la Pandemia de Influenza A (H1N1) de 2009. MÉTODO: investigación cualitativa, del tipo estudio de caso, que encuentra su fundamentación teórica metodológica en la Teoría de las Representaciones Sociales. Las informaciones fueron obtenidas por medio de las técnicas de asociación libre y de entrevistas semiestructuradas, aplicadas individualmente a gestores que actuaban en diferentes instancias de la estructura administrativa jerárquica de la institución, durante la emergencia pandémica, en un total de 30 participantes. RESULTADOS: el análisis de contenido temático resultó en las categorías: vulnerabilidad, protección de la salud, negligencia - zonas nebulosas de la esfera pública e integralidad. Las representaciones sociales de emergencias de salud pública comprueban permanencias que transitan por la sobrevalorización de discursos negativos ligados al espacio público de la salud/enseñanza, naturalización del carácter substancial de epidemia y normatividad de la acción administrativa. Entretanto, la defesa de la educación permanente como necesidad asociada a la gestión de las emergencias señala posibilidades de realizar cambios en la percepción técnica científica de la gestión. CONCLUSIONES: el entendimiento de los trabajadores de la salud/enfermería, como ser político, que asume responsabilidades en los espacios de las macro y micro políticas del Estado, de los hospitales universitarios y de los equipos de trabajo, son caminos que se diseñan para la gestión de las emergencias. .

A Study of Relationships Hardiness, Coping Behaviors and Organizational Commitment of General Hospital Employees / 간호행정학회지

PURPOSE: This descriptive correlation study was done to identify the hardiness, coping behavior, and organizational commitment of general hospital employees and show how these variables affect increases in role performance and problem solving ability to have a positive influence on organizational harmony. METHODS: A quantitative, descriptive research design was used with a sample of 368 employees working in general hospitals in M and C cities. A survey was used to collect the data. RESULTS: The score for perception of hardiness of general hospital employees was 2.85, and coping behavior was 2.40, both out of a possible 4 points, and organizational commitment, 3.03 out of a possible 5 points. There were statistically significant positive correlations between hardiness and coping behavior (r=.33, p<.001), also between hardiness and organizational commitment (r=.51, p<.001), and also between coping behavior and organizational commitment (r=.22, p<.001). CONCLUSION: The results of the study indicate that hardiness, coping behavior, and organizational commitment in general hospital employees have positive correlations, and thus hospital administrators should explore ways of increase individual employee hardiness and coping behavior, and make efforts to harmonize their organizations by enhancing organizational commitment.

Effects of Hospital Nurses' Perceived Organizational Support on Job Involvement and Organizational Citizenship Behavior / 간호행정학회지

PURPOSE: This descriptive study was done to identify effects of perceived organizational support (POS) on job involvement and organizational citizenship behavior (OCB) in hospital nurses. METHODS: Data were collected from Oct. 1 to Nov. 15, 2011. Participants in this study were 324 nurses working in 6 general hospitals in S, K, and C cities. Data were analyzed using descriptive statistics, t-test, ANOVA, Scheffe test, Pearson correlation coefficients, and multiple regression. RESULTS: POS was positively correlated with job involvement, and OCB (altruism, conscientiousness, courtesy, sportsmanship and civic virtue). Factors influencing job involvement were POS and marital status, which accounted for 15.7% of the variance, marital status influenced altruism, which accounted for 4% of the variance, POS influenced conscientiousness, which accounted for 10% of the variance, religion and marital status influenced courtesy, which accounted for 6.5% of the variance, age influenced sportsmanship, which accounted for 7.9% of the variance, and POS and clinical career influenced civic virtue, which accounted for 23.1% of the variance. Job involvement mediated on the relation between perceived organizational support and organizational citizenship behavior. CONCLUSION: The results of the study indicate that hospital administrators should explore ways of improve POS for better job involvement, conscientiousness, and civic virtue.

Análisis de diferencias de género en el estilo de conducción de médicos pediatras de un hospital publico / Analysis of gender differences in management style of pediatricians in a public hospital

Los especialistas describen características de género en los estilos de conducción laboral que se transforman en barreras o facilitadores para acceder a puestos de responsabilidad. Sin embargo, las organizaciones actuales muestran una tendencia a ser menos jerárquicas con mayor acento en la formación profesional, el trabajo en equipo y la creación de redes. El objetivo fue describir la representación de género en el Hospital de Pediatría Juan P. Garrahan, analizando de modo asistemático el acceso de las mujeres a los cargos laborales de conducción y la presencia de diferencias de género en el estilo de conducción. Se realizó un análisis del marco histórico-social, se recolectaron datos de distribución por género de cargos médicos entre septiembre y octubre de 2010, aportados por el Departamento de Estadística del hospital y veinticuatro encuestas fueron repartidas en diferentes Servicios entre los que estuvieron representados: Internación de Cuidados Intermedios, especialidades clínicas y quirúrgicas. En el momento del análisis, las mujeres constituían el 63% del total de médicos en el hospital: Ocupaban cargos de conducción un 17.6% de las mismas vs un 27.8% de los varones empleados. Varones y mujeres coincidieron al autodefinirse como personas, apareciendo diferencias al definirse como jefes. A pesar de esto, las expectativas para con sus trabajos, se alternaron sin mayores diferencias por género. Las principales diferencias se encontraron en el modo de tomar decisiones, las características vinculares y los roles en el hogar. No se encontraron diferencias de género en el estilo de comunicación. Al comparar nuestro hospital con otras instituciones científicas o médicas, las diferencias resultaron importantes, confirmándose la hipótesis de que sus características, su metodología de trabajo, su reciente historia y su especialidad, permiten un desarrollo integral de las mujeres con una representación más real en todos los niveles de trabajo.

Strategic alliances: an analysis of Catalan hospitals / Alianzas estratégicas: un análisis de los hospitales catalanes

OBJECTIVE: To analyze the strategic alliances that Catalan hospitals form with other health care entities and other types of institutions to foster technological and organizational innovation. METHODS: Qualitative case studies were conducted at a sample of 16 public hospitals in Catalonia, Spain. The sample was limited to three (Level 1-3) of Catalonia's four levels of hospitals (classified according to the complexity of the diagnoses and treatments they provide), but Level 4 hospitals were considered as part of the network in the analysis of the alliances. At each hospital, interviews were conducted with the manager, the medical director, and the service director, using a questionnaire that gathered information on strategic alliances with a focus on telemedicine. Qualitative data processing was applied to identify patterns of alliances between hospitals and other institutions. RESULTS: Catalan hospitals interact with other health care agents through three main types of associations: alliances with other hospitals (the most frequent type); alliances with primary care centers (reported mostly by Level 2 hospitals); and alliances with other institutions (e.g., local government, medical companies, and universities). Human resource-sharing (staff mobility) and training were reported most frequently as reasons for creating the alliances. CONCLUSIONS: Strategic alliances are formed between hospitals and other health care agents to help improve performance, competitiveness, and services provided to users. These results may help health care system managers promote strategic alliances as a means of optimizing system efficiency without reducing user satisfaction-a key challenge within the context of the current economic situation.

OBJETIVO: Analizar las alianzas estratégicas que los hospitales catalanes forjan con otras entidades de atención de la salud y otros tipos de instituciones para fomentar la innovación tecnológica y de las organizaciones. MÉTODOS: Se condujeron estudios cualitativos de casos en una muestra de 16 hospitales públicos de Cataluña, España. La muestra se limitó a tres (Niveles 1 a 3) de los cuatro niveles de los hospitales catalanes (clasificados según la complejidad de los diagnósticos y los tratamientos que proporcionan), pero los hospitales de Nivel 4 se consideraron parte de la red en el análisis de las alianzas. En cada hospital se efectuaron entrevistas con el gerente, el director médico y el director de servicio, mediante un cuestionario que recopilaba información sobre las alianzas estratégicas con hincapié en la telemedicina. Se aplicó el procesamiento cualitativo de datos para identificar los modelos de alianzas entre los hospitales y otras instituciones. RESULTADOS: Los hospitales catalanes interactúan con otros agentes de atención de la salud a través de tres tipos principales de asociaciones: alianzas con otros hospitales (el tipo más frecuente); alianzas con centros de atención primaria (según lo informado principalmente por los hospitales de Nivel 2); y alianzas con otras instituciones (por ejemplo, el gobierno local, las empresas médicas y las universidades). El intercambio de recursos humanos (movilidad del personal) y la capacitación fueron mencionados como los motivos más frecuentes para crear las alianzas. CONCLUSIONES: Se forman alianzas estratégicas entre los hospitales y otros agentes de atención de la salud con el objeto de mejorar el desempeño, la competitividad y los servicios prestados a los usuarios. Estos resultados pueden ayudar a los gerentes de los sistemas de atención de la salud a promover alianzas estratégicas como medio para optimizar la eficiencia del sistema sin reducir la satisfacción de los usuarios -un reto clave en el contexto de la situación económica actual.