Análisis del perfil en el personal de conducción de los hospitales públicos / Management staff profile analysis in public hospitals

Introducción: El personal de conducción en las organizaciones sanitarias está a cargo del proceso de dirigir, organizar, diseñar, optimizar y evaluar las actividades de los miembros de un grupo interdisciplinario. La meta es forjar un grupo de acción comprometido con la calidad, dispuesto a lograr la visión y los objetivos de la organización. Los OBJETIVOS del presente trabajo fueron conocer las características del personal de conducción en los hospitales públicos de Ciudad Autónoma de Buenos Aires (CABA), analizar sus errores más frecuentes, evaluar la visión del grupo de trabajo con respecto a la persona que ocupa el cargo y determinar si el personal se percibe apto para ejercer dicho cargo. METODOS: estudio transversal, descriptivo, prospectivo, realizado en el período de julio a noviembre del año 2021, con un abordaje mixto no probabilístico mediante una encuesta semi estructurada orientada a contestar cada uno de los objetivos. La misma fue diseñada en un formato de Google form y enviada vía e-mail y por WhatsApp a el personal de salud de los hospitales públicos de CABA. RESULTADOS: de las 91 encuestas realizadas obtuvimos que: liderazgo, capacitación en el área en que se desempeña y responsabilidad fueron las cualidades destacadas por los encuestados. El 85.7 (78) respondió que el requisito indispensable para el personal de conducción fue confiabilidad, responsabilidad, dar el ejemplo y estar disponibles para los demás. En relación a los errores más frecuentes el 56% (51) mencionó la falta de comunicación y el 52.7% (48) eligió la opción de imponer condiciones sin escuchar. Solo el 18.7% (17) de los encuestados no se sintió valorado por la persona que desempeña el cargo de conducción en su trabajo y el 61.5% (56) refirió sentirse capacitado para asumir un cargo de conducción por haber realizado cursos, ser resolutivos y/o poseer la capacidad de liderazgo. DISCUSION: Esta investigación nos ayudó a establecer la percepción y las expectativas del personal de salud en relación a las jefaturas y establecer las principales características que debería poseer la persona que ejerce cargos de conducción en los Hospitales Públicos de CABA.

Introduction: In health organizations, management staff is in charge of leading, organizing, designing, optimizing and evaluating the activities of all members of an interdisciplinary group. The purpose is to shape a team committed with quality, willing to accomplish the organization vision and objectives. The goals of this research were: to obtain information about the profile of Ciudad Autónoma de Buenos Aires (CABA) public hospitals management staff, to analyse their most frequent mistakes, to evaluate personnel opinions regarding their leaders, and to determine if management staff feels fit for the position. METHOD: The study was cross-sectional, descriptive and prospective. It was carried out between July and November 2021 with a mixed, non-probabilistic approach, with a semi-structured questionnaire prepared in Google Forms and sent by e-mail and whatsapp to CABA public hospitals personnel. RESULTS: From 91 surveys made, leadership, training in their own expertise area, and responsibility were the most highlighted qualities. 85.7% (78) of the respondents answered that it was essential for management staff to be reliable, be responsible, to walk the talk and to be available for their group. 56%(51) mentioned the "lack of communication skills" option and 52.7%(48) chose the "impose conditions without listening" option as the most frequent mistakes in their working area. Only 18.7%(17) did not feel highly regarded by management staff and 61.5%(56) referred to be suitable for management positions, as they had attended courses, were able to solve problems at work and had leadership ability. DISCUSSION: This investigation helped us to establish the health personnel perceptions and expectatives in relation to the chiefs and/or main characterstics of CABA public hospitals management staff

Validación de un instrumento para la categorización de usuarios, según dependencia y riesgo de cuidados, adaptado para servicios de neonatología de hospitales públicos de Chile / Validation of an instrument for the categorization of users according to dependence and risk of care, adapted for neonatology services of public hospitals of Chile

La categorización de usuarios según dependencia y riesgo de cuidados a través del instrumento CUDYR, responde a la reforma de salud chilena, que enfoca la gestión de las instituciones asistenciales, los cuales deben mejorar su eficiencia, efectividad, calidad y seguridad, otorgando una herramienta para la gestión del cuidado en atención cerrada. El objetivo de este estudio fue adaptar y validar el instrumento CUDYR para servicios de Neonatología de hospitales públicos de Chile. La muestra no probabilística correspondió a los casos disponibles por intención según los criterios de inclusión de juicio de expertos y estuvo conformada por 152 pacientes de un hospital público de Chile. Se aplicó consentimiento informado, utilizando los principios éticos propuestos por Ezequiel Emanuel. Se realizó adaptación del instrumento vigente por expertos en el área, abarcando filosofía de cuidados neonatales, y validación por contenido por contraparte experta en el área obteniéndose una calificación entre un 97% y 100% sobre la pertinencia de los ítems propuestos. Se aplicó el instrumento CUDYR-NEO durante diciembre de 2017. El instrumento final quedó conformado por dos dimensiones con una fiabilidad estimada mediante alfa ordinal de 0,89 y una varianza extraída de aprox. 0,56 (sobre 0,5) lo cual determina una alta calidad de medición del instrumento. Además, el instrumento cumple tanto con la validez convergente, así como con la validez discriminante. La saturación de los ítems en los factores latentes presentó cargas factoriales por sobre los 0,47 con un máximo de 0,99 consideradas como altas. Se concluye que el instrumento CUDYR-NEO presenta propiedades psicométricas suficientes y altas de fiabilidad y validez, constituyendo una herramienta adecuada para la categorización de usuarios según dependencia-riesgo en servicios de Neonatología.

The categorization of users according to dependence and risk of care through the CUDYR instrument, responds to the Chilean health reform, which focuses on the management of healthcare institutions, which should improve their efficiency, effectiveness, quality and safety, providing a tool for the management of care in closed care. The objective of this study was to adapt and validate the CUDYR-NEO instrument based on the CUDYR for Neonatology services of public hospitals in Chile. The non-probabilistic sample corresponded to the cases available by intention according to the inclusion criteria of expert judgment and consisted of 152 patients from a public hospital in Chile, informed consent was applied, using the ethical principles proposed by Ezequiel Emanuel. The current instrument was adapted by experts in the area, covering the philosophy of neonatal care, and validation by content by expert counterparts in the area, obtaining a score between 97% and 100% on the relevance of the proposed items. The CUDYR-NEO instrument was applied during December 2017. The final instrument was made up of two dimensions with a reliability estimated by ordinal alpha of 0.89 and an extracted variance of approx. 0.56 (about 0.5) which determines a high measurement quality of the instrument. In addition, the instrument meets both the convergent validity as well as the discriminant validity. The saturation of the items in the latent factors presented factorial loads over the 0,478 with a maximum of 0.99 considered as high. It is concluded that the CUDYR-NEO instrument has sufficient psychometric properties and high reliability and validity, constituting an adequate tool for the categorization of users according to risk-dependency and care management in Neonatology services.

A Multicentre Study of Nursing Leadership in Andalusian Hospitals from a Gender-based Perspective

ABSTRACT Introduction: Leadership is the ability to guide subordinates in a direction or decision so that they can perform a task or achieve a goal that leaves them feeling empowered and accomplished. Leaders are capable of producing changes and at the same time, they inspire others to do the same. This research analysed gender-based differences and dimensions of nursing leadership styles in 18 hospitals in Andalusia, a region of southern Spain. Methods: The sample population of the study comprised 335 subjects, who were middle managers in 18 public regional hospitals in Andalusia. The instrument used to measure different leadership styles was the Multifactor Leadership Questionnaire (MLQ 5X-Short form), which is composed of 45 items. Results: The study showed that the most predominant leadership style was transactional leadership with a mean value of M = 4.22 (standard deviation [SD] = 0.42) followed by transformational leadership with a mean value of M = 3.97 (SD 0.45). Of the three styles analysed, transactional leadership had the highest statistical median for both male and female subjects. From a gender-based perspective, transformational leadership showed statistically significant differences (p < 0.01) between men and women. This was true for leadership styles as well as for the dimensions that define each style. Conclusion: The most frequent leadership style in middle nursing management in Andalusian hospitals was transactional leadership. In regard to the three leadership styles as well as their dimensions, the female subjects obtained the highest scores. This means that from a gender-based perspective, female nursing managers had better performance levels than their male counterparts in the regional hospital system in Andalusia.

Indicadores de gestión para evaluar el desempeño de hospitales públicos: un caso de estudio en Chile y Ecuador / Assessing the performance of public hospitals using key indicators: a case study in Chile and Ecuador

Background: Continuous improvement, quality of care, and patient satisfaction demand the implementation of coordinated actions from all the healthcare personnel. They also require collaboration, management skills and attention to different dimensions to improve problems due to the lack of resources such as specialists, medical technology and infrastructure. Aim: To design and implement a model of indicators to evaluate the performance of hospitals. Material and Methods: The methodology used in this research included a review of the literature, data collection, conducting interviews, defining objectives and indicators, proposing a model of indicators, validating the set of indicators, implementing the indicators in a hospital, and analyzing the results. Results: The proposed model of 95 indicators was implemented in a hospital in Ecuador. The results indicate that 37 indicators meet the standard, 19 need to be reviewed, 10 show non-compliance and need serious improvements, and the remaining 29 were not informed by the hospital under study. Conclusions: The defined indicators are aimed to improve the performance of a hospital, are easily interpreted, can be measured without spending large amounts of money, and do not need excessive efforts to collect data, mainly if they are supported by information systems.

Segurança e legitimidade no trabalho remoto: relato de experiência em um hospital público e universitário / Security and legitimacy in remote work: an experience report in a public teaching hospital

Este relato de experiência tem como objetivo apresentar os esforços necessários em uma das ações de enfrentamento à COVID-19 no Hospital de Clínicas de Porto Alegre: viabilizar teletrabalho. Na iminência de criar uma estrutura tecnológica de preservação da operacionalidade da força de trabalho, foi necessário adotar medidas que permitissem a atuação remota dos colaboradores em atividades administrativas de apoio à assistência. Com este desafio desenvolveu-se, em curto espaço de tempo, uma solução técnica segura que permitisse acesso externo aos sistemas corporativos e registro eletrônico de frequência em regime de trabalho remoto. Além de ferramentas de apoio como: plataforma em nuvem para reuniões não presenciais, para documentos eletrônicos, etc. Desta forma, foi possível disponibilizar aos colaboradores do hospital, que não atuam na linha de frente, a atuação remota de seu trabalho. (AU)

This experience report aims to present the necessary efforts in one of the actions to confront COVID-19 at Hospital de Clínicas de Porto Alegre: enabling teleworking. In order to create a technological structure that would preserve the workforce's operability, measures were adopted to allow remote performance of employees in administrative support activities. With this challenge, a secure technical solution was developed in a short period of time, allowing external access to corporate systems and electronic frequency records in a remote work regime. Also developed were support tools such as a cloud platform for non-face-to-face meetings, for electronic documents, etc. Thus, remote performance of activities was made available to hospital employees who do not work at the front line. (AU)

A Reforma da Saúde de Brasília, Brasil / The Health Reform of Brasília, Brazil

Resumo O objetivo deste artigo é apresentar um conjunto de estratégias, ações de gestão e de organização do cuidado, que vêm sendo empreendidas naquilo que se convencionou chamar da Reforma do Setor Saúde do Governo do Distrito Federal no período de 2015-2018, que teve por base o fortalecimento da atenção primária à saúde, a organização da atenção secundária, a criação do complexo regulador em saúde, a proposição de uma regionalização e descentralização, a sistematização das contratações e execuções contratuais, além da proposição e criação de um novo modelo de gestão para o principal hospital público de Brasília.

Abstract This paper aims to show a set of strategies and care management and organization actions that have been undertaken in what was conventionally called the Health Sector Reform of the Government of the Federal District in the period 2015-2018, which was based on the strengthening of primary health care, the organization of secondary care, the establishment of the health regulatory complex, the proposed regionalization and decentralization, the systematization of contracting and contractual implementation, and the proposal and establishment of a new management model for the main public hospital in Brasília.

A criação do serviço social autônomo do Instituto Hospitalar de Base como novo modelo de gestão hospitalar do Distrito Federal, Brasil / The creation of the autonomous social service Instituto Hospital de Base as a new model for public hospital management in the Federal District, Brazil

Resumo A rede de saúde pública do Distrito Federal, como de resto todo o Sistema Único de Saúde, padece de ineficiências relacionadas à dificuldade de contratação e gestão de profissionais, bem como de realização de contratos para abastecimento e manutenção. Em Brasília, implantou-se em 2018 um novo modelo de gestão em seu maior hospital. Com a criação do serviço social autônomo Instituto Hospital de Base, unidade de saúde em funcionamento desde 1960, abriu-se a possibilidade de conferir agilidade a essas contratações, além de se instalar uma gestão baseada em metas e indicadores de resultado, com expressivos ganhos de eficiência. Este artigo relata os passos para a implantação desse modelo descentralizado de gestão hospitalar, as alternativas cogitadas, as dificuldades enfrentadas e alguns dos primeiros resultados desse novo modelo. Já se pode verificar e afirmar o sucesso do modelo jurídico-administrativo do Instituto Hospital de Base, que pode servir de paradigma para outras unidades de saúde do Distrito Federal e do Brasil.

Abstract The public health network of the Federal District, as in the rest of the Brazilian Unified Health System, suffers from inefficiencies related to the difficulty in hiring and managing professionals, as well as the implementation of supply and maintenance contracts. In Brasilia, a new management model was implemented in 2018 in its largest hospital. With the creation of the autonomous social service "Instituto Hospital de Base", a health unit in operation since 1960, the possibility of providing agility to these contracts was opened, in addition to establishing a management based on goals and outcome indicators, with expressive efficiency gains. This article reports the steps for the implementation of this decentralized model of hospital management, the alternatives considered, the difficulties faced and some of the first results of this new model. One can already verify and affirm the success of the legal-administrative model of "Instituto Hospital de Base", which can serve as a paradigm for other health units in the Federal District and in Brazil.

Reforma da Atenção Hospitalar para modelo de saúde baseada em valor e especialidades multifocais / Remodeling hospital care - an account of experiences in the Federal District of Brazil

Resumo A saúde pública em Brasília sofreu diversas melhorias desde sua implementação devido à mudança do perfil econômico, social e de escolaridade da população. Foi realizada uma reforma na Atenção Hospitalar por gestão baseada em evidências, através de um conjunto normativo que estabeleceu o ordenamento dos Serviços Hospitalares de Emergência, Atenção Ambulatorial Secundária, Regulação de Serviços de Saúde e modelagem organizacional da Secretária de Saúde do Distrito Federal. Tais mudanças permitiram que os profissionais nos seus diferentes níveis de atenção estejam interligados. Ou seja, os profissionais passam a prestar um serviço de saúde de forma contínua para a população, proporcionando um cuidado de saúde integral ao paciente. Essa abordagem garante ganho de eficiência no tratamento do paciente, pois os profissionais multifocais e focais trabalham de maneira integrada. Com a implementação da gestão da organização por processos de trabalho e o planejamento adequado, foi possível redesenhar o modelo assistencial utilizado nos dias atuais, permitindo através da gestão do conhecimento a ampliação do acesso e da interatividade, proporcionado ao cidadão através do modelo de gestão em saúde que agregue valor.

Abstract Since its creation in 1988, major changes have been made to Brazil's public health system in response to the epidemiological transition and the country's changing economic context and demographics. This article describes the recent healthcare reform implemented in the federal district's public hospital system. Guided by evidence-based management and a series of regulatory instruments, the reform organized hospital emergency services and secondary outpatient care, regulated health services, and remodeled the organizational structure of the Department of Health. These changes were aimed at promoting integration between health professionals across different levels of care and ensuring the provision of continuing comprehensive care. This approach guarantees efficiency gains in patient treatment, since multifocal and focal professionals work in an integrated manner. By reorganizing work processes and ensuring adequate planning, it was possible to redesign the care model to promote knowledge management and improve access to information and interactivity, thus helping to ensure the provision of quality, value-added care.

Efectos de la Nueva Gestión Pública en el desempeño: análisis de los hospitales públicos chilenos / Effects of the New Public Management System on performance: An analysis of Chilean public hospitals

RESUMEN Objetivo Evaluar los efectos de la implementación de una reforma de Nueva Gestión Pública (NGP) que profesionaliza los cargos de dirección, sobre el desempeño de los hospitales públicos chilenos. Métodos Se construyó una base de datos para 181 hospitales públicos chilenos con información pública del año 2015. Se determinó el efecto generado por la permanencia en el cargo de dirección de un hospital público de quien fue seleccionado a través del Sistema de Alta Dirección Pública (SADP), mediante la estimación de cuatro modelos de regresión multivariada. Resultados La permanencia en el cargo de la persona seleccionada vía SADP se asocia positivamente con variables como el número de altas, la rotación de pacientes y la tasa de ocupación, denotando una mejora en la rentabilidad de los recursos disponibles. No se encuentra una relación significativa entre dicha variable y la disminución de la letalidad. Conclusiones Este trabajo proporciona evidencias acerca de los efectos sobre el desempeño de una reforma inspirada en la NGP, en particular, se muestra que la incorporación de profesionales con capacidad de gestión en cargos de alta dirección en hospitales públicos chilenos mejora su desempeño, relevándose la importancia del perfil profesional de quienes dirigen este tipo de organizaciones y recomendando ampliar el periodo de nombramiento de estos cargos.(AU)

ABSTRACT Objective To evaluate the effects of the implementation of a New Public Management system -which professionalizes management positions- on the performance of Chilean public hospitals. Materials and Methods A database was constructed for 181 Chilean public hospitals using public information issued in 2015. The effect generated by the tenure of a person selected through the Public Senior Management System (SADP by its acronym in Spanish) for a senior management position in a public hospital was determined by estimating four multivariate regression models. Results The tenure of a person selected via SADP is positively associated with variables such as the number of discharges, rotation of patients and occupation rate, thus demonstrating an improvement in the profitability of the available resources. No significant relationship was found between the tenure of a person selected via SADP and the decrease in case fatality. Conclusions This article provides evidence about the effects on the performance of a reform based on the New Public Management system. Specifically, it demonstrates that the incorporation of professionals with management skills in senior management positions in Chilean public hospitals improves hospital performance, revealing the importance of the profession of those who direct this type of organizations. Thus, the recommendation is to extend the period of appointment people in these positions.(AU)

Gestão dos Serviços de Enfermagem frente a terceirização em hospitais públicos: mediando conflitos / Nursing Services Management facing outsourcing in public hospitals: mediating conflicts

Objeto do estudo: terceirização dos serviços de enfermagem em hospitais públicos e as repercussões para o processo saúde-doença dos enfermeiros gestores que lideram equipes com múltiplos vínculos trabalhistas. Objetivos: Descrever a percepção dos enfermeiros gestores sobre a terceirização dos serviços de enfermagem em hospitais públicos; discutir as implicações da terceirização para o processo saúde-doença dos enfermeiros gestores; analisar os mecanismos de enfrentamento adotados pelos enfermeiros gestores, frente às implicações da terceirização para a saúde. Pesquisa qualitativa, descritiva e exploratória. O estudo foi desenvolvido em hospitais públicos, localizados na região metropolitana do Rio de Janeiro, cuja gestão é realizada por empresas terceirizadas. Os participantes foram 25 enfermeiros com cargo de chefia, responsáveis pela gestão dos serviços, selecionados através da técnica SnowBall. Na coleta de dados, trabalhou-se com a técnica de entrevista, mediante um roteiro com perguntas abertas sobre o objeto de estudo e na caracterização sociodemográfica, ocupacional e estado de saúde dos participantes, um instrumento estruturado. As entrevistas foram gravadas, transcritas e analisadas através da técnica de análise de conteúdo temática e os resultados analisados com o suporte da Psicodinâmica do Trabalho. Os resultados evidenciaram 3 categorias: a terceirização como estratégia de dimensionamento de pessoal e as respectivas repercussões para a prestação de serviços; trabalho terceirizado como fator de risco psicossocial para a saúde mental do enfermeiro gestor e as estratégias individuais e coletivas de defesa frente ao sofrimento psíquico no trabalho terceirizado. A terceirização em hospitais públicos foi instituída como estratégia de reposição de pessoal, frente ao déficit de recursos humanos devido a aposentadorias, desligamentos e afastamentos. Outro aspecto apontado, foi a contenção de gastos com pessoal, devido à necessidade de abertura de concursos e cumprimento de obrigações trabalhistas. Identificou-se aspectos positivos e negativos com a terceirização: no primeiro caso, houve melhoria da prestação de serviços, devido aos protocolos, normas e treinamento de pessoal, por outro lado, evidenciou-se problemas para a gestão dos serviços, em função dos vínculos distintos, instabilidade empregatícia, alta rotatividade de pessoal e descontinuidade dos processos de trabalho. Há repercussões negativas para a saúde dos gestores e demais trabalhadores, em função de conflitos no relacionamento interpessoal e do desgaste, devido às diferenças de vínculos e de tratamento. Diante deste contexto, observou-se o sofrimento psíquico dos gestores, por terem que administrar trabalhadores que, apesar de possuírem a mesma função, são tratados de forma diferenciada, devido aos vínculos, carga horária e demais direitos trabalhistas distintos. Para se manterem no trabalho e enfrentarem o sofrimento decorrente das inúmeras exigências de cunho técnico e relacional, os gestores elaboram estratégias individuais e coletivas de defesa. Conclui-se que, apesar de as estratégias de defesa elaboradas pelos gestores serem de grande relevância para a minimização do sofrimento e não desistência do trabalho, essas estratégias não promovem mudanças efetivas no contexto laboral, tendo em vista a baixa autonomia e relativo poder decisório dos gestores.

Object of the study: outsourcing of nursing services in public hospitals and the repercussions for the health-disease process of nurse managers who lead teams with multiple labor ties. Objectives: To describe the perception of nurse managers about the outsourcing of nursing services in public hospitals; discuss the implications of outsourcing for the health- disease process of nursing managers; to analyze the coping mechanisms adopted by nurse managers facing the implications of outsourcing for health. Qualitative, descriptive and exploratory research. The study was developed in public hospitals located in the metropolitan region of Rio de Janeiro whose management is performed by outsourced companies. The participants were 25 senior nurses responsible for service management, selected through the SnowBall technique. In data collection, the interview technique was worked through a script with open questions about the object of study; and in the sociodemographic, occupational and health status of the participants a structured instrument. The interviews were recorded, transcribed and analyzed using thematic content analysis technique and the results analyzed with the support of Work Psychodynamics. The results showed three categories: outsourcing as a staff sizing strategy and the respective repercussions for service delivery; outsourced work as a psychosocial risk factor for the mental health of nurse managers and individual and collective defense strategies against psychic suffering in outsourced work. Outsourcing in public hospitals was instituted as a strategy of staff replacement due to the deficit of human resources due to retirements, dismissals and resignations. Another aspect pointed out was the containment of personnel expenses due to the need to open civil service examination and to fulfill labor obligations. Positive and negative aspects were identified with outsourcing: in the first case, there was an improvement in service delivery due to protocols, norms and personnel training; on the other hand, it was evident that there are problems for the management of services due to different ties, employment instability, high staff turnover and discontinuity of work processes. There are negative repercussions for the health of managers and other workers due to conflicts in interpersonal relationships and burnout due to differences in ties and treatment. Given this context, it was observed the psychological distress of managers because they have to manage workers who despite having the same function, are treated differently due to the ties, workload and other labor rights. In order to stay at work and face the suffering resulting from the numerous demands of technical and relational nature, managers develop individual and collective defense strategies. It is concluded that although the defense strategies elaborated by the managers are of great relevance for the minimization of suffering and not giving up work, these strategies do not promote effective changes in the work context in view of the low autonomy and relative decision making power of managers.

A atuação da Odontologia em unidades de terapia intensiva no Brasil / The practice of dentistry in intensive care units in Brazil

RESUMO Objetivo: Avaliar a atuação odontológica em unidades de terapia intensiva. Métodos: Estudo observacional de enquete, por meio do envio de questionários via plataforma on-line de colaboração de pesquisa em terapia intensiva no Brasil (AMIBnet). A pesquisa foi realizada de junho a outubro de 2017. Os questionários, envolvendo 26 questões fechadas sobre os hospitais e a atuação odontológica nas unidades de terapia intensiva foram enviados para 4.569 profissionais de diversas especialidades atuantes nas unidades. Resultados: Obtivemos 203 questionários respondidos, resultando em uma taxa de resposta de 4,44%. A maior parte das respostas teve origem em unidades de terapia intensiva na Região Sudeste do país (46,8%). Hospitais públicos (37,9%) e privados (36,4%) tiveram participação semelhante nos resultados. Dos respondentes, 55% apontaram que um serviço de Odontologia à beira de leito estava presente, sendo prestado de maneiras diversas. Conclusão: Presença de Serviço de Odontologia e de treinamentos e protocolos de prestação de serviço em saúde bucal estiveram correlacionados. Os métodos de cuidados orais variaram sobremaneira entre as em unidades de terapia intensiva pesquisadas.

ABSTRACT Objective: To evaluate the practice of dentistry in intensive care units. Methods: An observational survey study was conducted in which questionnaires were sent via the online platform for collaboration in intensive care research in Brazil (AMIBnet). The study was carried out from June to October 2017. The questionnaires, which contained 26 closed questions about hospitals and dentistry practices in the intensive care units, were sent to 4,569 professionals from different specialties practicing in the units. Results: In total, 203 questionnaires were returned, resulting in a response rate of 4.44%. Most of the responses were from intensive care units in the Southeast region of the country (46.8%). Public hospitals (37.9%) and private hospitals (36.4%) had similar participation rates. Of the respondents, 55% indicated that a bedside dentistry service was present, and they were provided in different ways. Conclusion: The presence of dentistry services and oral health service delivery training and protocols were correlated. The oral care methods varied greatly among the intensive care units surveyed.

Competencias profesionales, gestión clínica y grupos relacionados de diagnósticos: el caso de hospitales públicos chilenos / Professional competences, clinical management and diagnostic related groups in Chilean public hospitals

RESUMEN Objetivo Definir un modelo competencias profesionales para el desarrollo de un sistema de información de apoyo a la Gestión Clínica basado en Grupos Relacionados de Diagnósticos-GRD en hospitales públicos chilenos. Método Mixta. Investigación cualitativa, descriptiva, basada en entrevistas focalizadas con un muestreo teórico o intencionado a cuatro líderes expertos en GRD en Chile, con análisis de contenido; Investigación cuantitativa, con uso de Método Delphi a 18 gestores encargados de la implementación de las unidades de GRD en Chile, con 3 rondas. El análisis de los datos cuantitativos se realizó por conglomerados. Resultados Luego de cinco iteraciones, se evaluaron 78 competencias de un total de 179 en nivel "alto", del tipo: Conocimientos del líder de los equipos, formación profesional preferentemente enfermeras, 15 actitudes y valores, 17 habilidades o destrezas y 12 competencias específicas relacionadas al sistema de codificación. Conclusión Existe tendencia en los profesionales, a requerir el máximo de competencias, se observó una conducta masificadora, con baja discriminación y priorización. Se propone analizar las causas que dificultan la toma de decisiones y priorizar las competencias requeridas; Determinar para cada competencia el nivel requerido, las brechas entre la oferta de competencias y su demanda, y finalmente diseñar un sistema de evaluación del impacto del modelo en el desarrollo de competencias de los equipos.(AU)

ABSTRACT Objective To define a professional skills model for the creation of an information system to support clinical management based on diagnosis related groups (DRG) in Chilean public hospitals. Methods Mixed methodology. Qualitative, descriptive research based on focused interviews, with a theoretical or intentional sample of four leading DRG experts from Chile, with content analysis. Quantitative research using the Delphi method on 18 managers in charge of the implementation of DRG units in Chile, with three rounds. The analysis of quantitative data was carried out by clusters. Results After five iterations, 78 skills were evaluated out of a total of 179 as "high", including knowledge of the team leader, professional training (preferably nurses), 15 attitudes and values, 17 skills and 12 specific skills related to the coding system. Conclusion There is a tendency among professionals to require the maximum skills; a massive behavior was observed, with low discrimination and prioritization. To analyze the causes that make decision-making difficult and to prioritize the required skills is proposed to determine the necessary level for each skill, the gaps between skill offer and demand, and to design a system for evaluating the impact of the model on the development of the skills among the teams.(AU)

Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão / Patient safety culture in three Brazilian hospitals with different types of management

Resumo O objetivo do estudo foi avaliar a cultura de segurança do paciente e fatores associados em hospitais brasileiros com diferentes tipos de gestão: federal, estadual e privado. O desenho foi observacional transversal. Enviaram-se 1576 questionários aos profissionais de três hospitais do estado do Rio Grande do Norte, utilizando o Hospital Survey on Patient Safety Culture, adaptado para o Brasil, que mede 12 dimensões da cultura de segurança. As percepções são descritas através de uma nota geral (0 a 10) e dos percentuais de respostas positivas para estimar fortalezas e fragilidades em cada dimensão. A taxa de resposta foi de13,6% (n = 215). A segurança do paciente teve nota entre 7 e 10, para 78,1% dos respondentes, sendo a maior média das notas apresentada pelo hospital privado (8,32). O tipo de gestão hospitalar, unidade de serviço, cargo e quantidade de notificação de eventos adversos estiveram associados à nota geral da segurança do paciente (p < 0,001). Apenas o hospital privado apresentou fortalezas nas dimensões analisadas, enquanto que as fragilidades apareceram em todos os hospitais.

Abstract The scope of the study was to evaluate patient safety culture and associated factors in Brazilian hospitals with different types of management, namely federal, state and private hospitals. The design was cross-sectional and observational. A survey of 1576 professionals at three hospitals of Rio Grande do Norte state was performed using the Hospital Survey on Patient Safety Culture adapted for Brazil, which measures 12 dimensions of safety culture. Perceptions are described by attributing a general result (Range 0-10) and the percentage of positive responses to estimate their strengths and weaknesses. The response rate was 13.6% (n= 215). The patient safety coefficient was between 7 and 10 for 78.1% of the respondents, whereby the highest average grade was attributed to the private hospital (8.32). It has been estimated that the type of hospital management, unit service, position and number of adverse event notifications are associated with the overall patient safety grade (p <0.001). Only the private hospital had strengths in the dimensions analyzed, while the weaknesses appeared in all the hospitals.

Autogestión hospitalaria y cambios en el modelo asistencial. los médicos en la implementación de la experiencia en Mendoza, Argentina / Hospital self-management and changes in the care model. physicians in the implementation of the policy in Mendoza, Argentina

PROPÓSITO: Comprender y analizar el papel de los médicos en la implementación del modelo asistencial delineado en la política de descentralización hospitalaria en Mendoza, Argentina, entre 1990 y 2015. METODOLOGÍA: Estudio cualitativo, orientado por constructivismo, realizándose 30 entrevistas semiestructuradas a una muestra intencional de médicos en posiciones estratégicas en el Ministerio de Salud y en seis hospitales descentralizados de alta y mediana complejidad. Los datos se analizaron en base al Framework Analysis. RESULTADOS: Los relatos reflejan que la fijación de prioridades asistenciales de los hospitales está más influenciada por la capacidad de negociación de jefes médicos y directivos que por criterios sanitarios delineados desde el gobierno central. El modelo de cuidados progresivos afecta dispositivos tradicionales de socialización médica, como las revistas de sala. El trabajo en redes asistenciales es visualizado como responsabilidad del hospital por entrevistados de los centros menos complejos. En contraste, desde los grandes centros se concibe que la coordinación con atención primaria es competencia ministerial. La estandarización clínica es legitimada cuando los procedimientos se construyen de manera participativa. Si bien convive con sistemas promovidos por la administración, la vigilancia de las buenas prácticas se dirime en espacios de la profesión. CONCLUSIONES: Las creencias compartidas, fruto de la socialización profesional, operan como filtros a partir de los cuales los médicos en posiciones relevantes adoptan y/o adaptan valores e instrumentos del modelo asistencial que subyace a la descentralización hospitalaria. Las herramientas gestionarias que le son inherentes conviven pero no eliminan formas de autogobierno arraigadas en los servicios.

PURPOSE: To understand and analyze the role of physicians in the implementation of the care model outlined in the hospital decentralization policy in Mendoza, Argentina, between 1990 and 2015. METHODOLOGY: A qualitative study, with a constructivist approach, was conducted. A total of 30 semi-structured interviews were carried out with an intentional sample of physicians in strategic positions in the Ministry of Health and from six decentralized high- and medium-complexity hospitals. Data were analyzed using Framework Analysis. RESULTS: Participants' account indicate that the setting of healthcare priorities for hospitals is more influenced by the negotiation capacity of medical and administrative directors than by sanitary criteria delineated by the central government. The coordination of healthcare networks is seen as a responsibility of the hospital by interviewees from less complex centers. In contrast, those interviewed from high complexity hospitals view the coordination effort with primary care as a ministerial responsibility. Clinical standardization is legitimized when it is constructed in a participatory manner. Best practices monitoring, while promoted by administrative systems, is ultimately resolved in clinical medical spaces. CONCLUSIONS: Shared beliefs, which are the result of professional socialization, operate as criteria by which physicians in relevant positions adopt and / or adapt values and instruments of the care model that underlies hospital decentralization. The management tools that are inherent to it coexist but do not eliminate forms of self-government rooted in services.

The First Two Years of Instituto Estadual do Cérebro Paulo Niemeyer: Initial Results of a Brazilian Public Hospital Dedicated to Neurosurgery

The dissemination of specialty hospitals throughout the urban centers has revolutionized the full spectrum of care for cardiology, oncology and orthopedics during the last decades. To centralize care, from translational and basic research to clinicians and surgeons, in the same dedicated institution leads to a decrease in complications rates, mortality and possible reductions in the length of hospital stays. Moreover, there has been a significant impact on hospital costs and on the quality of care. The Insituto Estadual do Cérebro Paulo Niemeyer (IECPN, in the Portuguese acronym) was opened in June 2013 in Rio de Janeiro, Brazil. It is the very first high-volume neurosurgical institution in the country. The core foundation of this institution is that the anesthesiologists, intensive care practitioners, nurses, pathologists, radiologists and rehabilitation staffs are trained and live the full management of neurosurgical lesions at the same facility on a daily basis. The present paper seeks to analyze the circumstances in which the institution was planned and opened as well as its complexity, infrastructure and initial results following its first 24 months of operation.

Children hospitalized due to maltreatment in the ICU of a Public Health Service / Niños hospitalizados por maltrato en UTI de servicio público de salud / Crianças hospitalizadas por maus-tratos em UTI de serviço público de saúde

ABSRACT Objective: to characterize children hospitalized due to violence in a pediatric ICU in 2011; to relate violence and the mechanisms of trauma with death; to know the contextualization of violence, from the records in the medical records. Method: retrospective cohort, performed in a first aid hospital, Porto Alegre city, in the records of 22 children hospitalized in the ICU due to violence. Quantitative analysis was performed by absolute and relative frequency rates, chi-square and relative risk. Results: 54.5% were boys, 81.8% were white and 50% were up to three years old. Physical violence 50% and neglect 36.4%, family of children (77.3%), highlighting the mother (35.3%). Mechanisms of aggression: fall (22.7%), burns (18.2%). Burns were at high risk for death. Discharge to go home after ICU admission (59.1%). Conclusion: It is considered that the characterization of the cases of violence reflects the complexity of the theme, mainly, in face of the life histories that surround each case of children hospitalized by this aggravation.

RESUMEN Objetivo: caracterizar a los niños hospitalizados por violencia, en una UTI pediátrica, en 2011; relacionar la violencia y los mecanismos de trauma con el óbito; conocer la contextualización de la violencia, a partir de los registros en los prontuarios. Método: el corte retrospectivo, realizado en un hospital de pronto socorro, ciudad de Porto Alegre/RS, en los registros de 22 niños internados en la UTI por violencia. Se realizó un análisis cuantitativo por índices frecuenciales absolutos y relativos, qui-cuadrado y riesgo relativo. Resultados: 54,5% eran niños; 81,8% raza/etnia blanca y 50% tenían hasta tres años. Violencia física 50% y la negligencia 36,4%; familiar del niño (77,3%), destaque para la madre (35,3%). Mecanismos de agresión: caída (22,7%), quemaduras (18,2%). Las quemaduras presentaron un alto riesgo de muerte. Alta para el hogar después de la internación en UTI (59,1%). Conclusión: Se considera que la caracterización de los casos de violencia refleja la complejidad del tema, principalmente ante las historias de vida que envuelve cada caso de los niños hospitalizados por este agravio.

RESUMO Objetivo: caracterizar as crianças hospitalizadas por violência, em uma UTI pediátrica, em 2011; relacionar violência e os mecanismos de trauma com o óbito; conhecer a contextualização da violência, a partir dos registros nos prontuários. Método: coorte retrospectivo, realizado em um hospital de pronto socorro, Porto Alegre/RS, nos registros de 22 crianças internadas na UTI, por violência. Realizou-se análise quantitativa por índices frequenciais absolutos e relativos, qui-quadrado e risco relativo. Resultados: 54,5% eram meninos, raça/etnia branca 81,8% e 50% tinham até três anos. Violência física 50% e a negligência 36,4%, familiar da criança (77,3%), destaque para a mãe (35,3%). Mecanismos de agressão: queda (22,7%), queimaduras (18,2%). As queimaduras apresentaram risco elevado para óbito. Alta para casa após internação em UTI (59,1%). Conclusão: Considera-se que a caracterização dos casos de violência reflete a complexidade do tema, principalmente, diante das histórias de vida que envolve cada caso de criança hospitalizada por este agravo.