Corrigendum: From a View of the Hospital as a System to a View of the Suffering Patient.

[This corrects the article DOI: 10.3389/fpubh.2021.800603.].

How does a Network Platform Work for Participating Actors Towards Integrated Care Governance? A Case Study of a Dutch Hospital Region.

Introduction: Network platforms are interesting for integrated care governance as they seek solutions for the problem of competition and tensions between networks. In this paper, we analyse how a network platform functions for the actors involved, and how it is used in their work. Methods: We employed a case study in a Dutch urbanised hospital region, and conducted 17 interviews with hospital physicians, directors, and supporting staff who are involved in a network platform called "BeterKeten" (BK). Results: Actors assign different functions and purposes to BK: facilitating and legitimising professional (learning) communities; adapting to a changing policy context; enlarging professionals' and the networks' circle of influence; and extending governing possibilities. Network platform' dynamics and frictions entail changing professional and managerial practices; embedding a BK network in a partner network; and alignment of (conflicting) network platforms. Discussion: Network platforms are a promising strategy to govern, facilitate, and nurture network-building actions to enhance integrated care, offering new ways of working to cope with its multi-level nature. Conclusion: BK is a dynamic actor with steering capacities that enables the co-existence of multiple purposes. Further research could pay attention to how network platforms are able to develop modalities of integrated care governance that suit healthcare system's networked character.

From a View of the Hospital as a System to a View of the Suffering Patient.

Purpose: Hospitals aspire to provide patient-centered care but are far from achieving it. This qualitative mixed methods study explored the capacity of hospital directors to shift from a hospital systemic-view to a suffering patient-view applying the Salutogenic theory. Methods: Following IRB, we conducted in-depth narrative interviews with six directors of the six Israeli academic tertiary public hospitals, focusing on their managerial role. In a second meeting we conducted vignette interviews in which we presented each director with a narrative of a suffering young patient who died at 33 due to medical misconduct, allowing self-introspection. Provisional coding was performed for data analysis to identify categories and themes by the three dimensions of the sense-of-coherence, an anchor of Salutogenics: comprehensibility, manageability, and meaningfulness. Results: While at the system level, directors reported high comprehensibility and manageability in coping with complexity, at the patient level, when confronted with the vignette, directors acknowledged their poor comprehensibility of patients' needs and patient's experience during hospitalizations. They acknowledged their poor capacity to provide patient-centered care. Meaningfulness in the narrative interview focused on the system while meaningfulness in the vignette interview focused on providing patient care. Conclusions: The evident gaps between the system level and the patient level create lack of coherence, hindering the ability to cope with complexity, and are barriers to providing patient-centered care. To improve the delivery of patient-centered care, we suggest ways to consolidate the views, enabling the shift from a systemic-view to a patient-view.

Caracterização da autoridade que enfermeiras gerentes exercem em instituições de saúde no méxico e em portugal / Characterization of the authority exercised by nurse-managers in health institutions in mexico and portugal / Característización de la autoridad ejercida por enfermeras gerentes de instituciones de salud en méxico-portugal

Foram objetivos do estudo analisar o significado da autoridade exercida pela enfermeira gerente em instituições de saúde e comparar o tipo de autoridade de dirigentes de enfermagem no México e em Portugal. Pesquisa qualitativa, descritiva e comparativa, da qual participaram 24 gerentes de enfermagem. O instrumento utilizado foi o de roteiro de entrevista, com base nas dimensões: significado e tipo de autoridade.Discutiu-se o significado de autoridade de acordo com a teoria do interacionismo simbólico. Os resultados possibilitaram refletir sobre o significado de autoridade, revelando-se que, para as gerentes mexicanas, é um valor moral do gestor e, para os portugueses, uma competência inerente à posição. No que concerne ao tipo de autoridade exercido, para as primeiras predominou justiça, compreensão e igualdade em relação aos demais. Para os segundos,esta deve ser democrática, participativa e de aceitação. Conclui-se que não há confluência sobre a autoridade entre gerentes de ambos os países e que sua divergência incide na perspectiva final de suas decisões (AU).

The study aimed to analyze the meaning of the authority exercised by the nurse-manager in health institutions and to compare the type of authority of nurse-managers in Mexico and in Portugal. This study is qualitative, descriptive and comparative. A total of 24 nurse-managers participated. The instrument used was an interview script, based in the following dimensions: meaning and type of authority. The meaning of authority was discussed in accordance with the theory of symbolic interactionism. The results made it possible to reflect on the meaning of authority, revealing that ­ for the Mexican managers ­ it is a moral value on the part of the manager; while for the Portuguese, it is a skill which is inherent to the position. Regarding the type of authority exercised, for the former, justice, comprehension and equality in relation to the other employees predominated. For the latter, the authority must be democratic, participative and based on acceptance. It is concluded that among the managers from both countries there is no confluence regarding authority, and that their divergence affects the final perspective of their decisions (AU).

Los objetivos son analizar el significado de autoridad que ejerce la enfermera gerente en instituciones de salud y comparar el tipo de autoridad ejecutada por dirigentes de enfermería en México y Portugal. Investigación cualitativa, descriptiva y comparativa, participaron 24 gerentes de enfermería, el instrumento fue una guía de entrevista, basada en las dimensiones: significado y tipo de autoridad, se discutió el significado de autoridad según teoría de interaccionismo simbólico. Los resultados permitieron reflejar el significado de autoridad; para las gerentes mexicanas es un valor moral del dirigente y para los portugueses una competencia en función de la posición designada; respecto al tipo de autoridad que ejercen, en las primeras predominó, justicia, comprensión e igualdad hacia los demás, para los segundos democrática participativa y aceptación. Concluyéndose que no existe la misma dimensión de autoridad entre gerentes de ambos países, su divergencia radica en la perspectiva final de sus decisiones (AU).

Tomada de decisão e alta administração: a implantação de projetos de mudanças de gestão da clínica em hospitais do SUS / Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals

Resumo O presente artigo analisa a tomada de decisão da alta administração de hospitais públicos do Sistema Único de Saúde (SUS) em relação a projetos que foram elaborados com a intencionalidade de mudar a gestão da clínica. O desenho metodológico é de natureza qualitativa, baseado na perspectiva hermenêutica-dialética. Em termos de resultados, destaca-se que os diretores dos hospitais perceberam que os projetos de gestão da clínica mudaram a realidade hospitalar, aprimorando sua organização, mobilizando seus servidores no sentido de ordenar e sistematizar as ações e os recursos disponíveis. A racionalidade técnica foi a principal fundamentação presente nas tomadas de decisão dos gestores, apesar de, por vezes, os contextos organizacionais fragmentados impedirem a utilização de outros aspectos relacionados com a racionalidade, como a análise econômico-financeira. O modelo incremental e o político também se manifestaram nos discursos. Conclui-se que a tomada de decisão é prática de enorme dimensão que contempla aspectos racionais, como uso de técnicas de gestão e da capacidade de análise, interpretação e síntese, e aspectos subjetivos, como seleção de valores e vivências pessoais, visto que os problemas gerenciais são mais amplos, ambíguos, complexos e menos estruturados na prática.

Abstract This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people’s working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice.

Significance and inspirations of the performance appraisal for directors of public hospitals / 中华医院管理杂志

Performance appraisal is an important means for keeping hospitals on correct tracks for their medical services and their public interest nature,in addition to its importance in enhancing internal performance management within public hospitals.Since 2006,Shanghai Shenkang Hospital Development conducted performance appraisal for directors of 23 public hospitals in Shanghai.This paper highlights the importance of performance appraisal for these directors,and its significance in keeping the correct director of hospital operation.