The aim of the current study was to develop and test a methodology that could be applied to the evaluation of the complaints processes of regulatory bodies of health professionals in Australia including mental health regulatory bodies such as the board that the Council of Australian Governments (COAG) are planning to set up to regulate the psychology profession. The methodology was applied to the evaluation of the complaints process at the Office of the Health Services Commissioner of Victoria (HSC). There were four main research questions. The first research question related to the extent to which the methodology was able to determine how well the HSC was performing in their role of resolving health complaints. The second research question explored the implications of the findings of the evaluation of the HSC complaints process for the management of health complaints in general. The third research question related to the strengths and limitations of the methodology when applied in a practical setting and the final research question related to further improvement of the methodology for future applications. Questionnaires and telephone interviews were used to examine the experiences of 133 providers and 150 complainants whose complaints had been reviewed and closed in one year. The methodology proved successful in assessing the performance of the complaints process at the HSC. The findings of the evaluation indicated that complainants and providers were generally satisfied with the process by which their complaints were managed. However, they were in general less satisfied with the outcome. In particular the evaluation highlighted the unintended negative consequences that complaints processes can have on the complainants and respondents. It was concluded that these maladaptive behavioural responses to complaints most probably have their origins in the negative emotional overlay attached to health complaints which has the potential to lead to unrealistic expectations of the process and outcomes on the part of complainants, and maladaptive post-complaint practices for health service providers. The findings highlight the importance of providing advocacy and support for the parties involved in health complaints as a means of minimising these maladaptive responses. Finally, it is acknowledged that these findings are specific to Australian health regulatory systems.

No / Aim. To determine the adequacy of initial nurse independent prescribingeducation and identify continuing professional development and clinicalgovernance strategies in place for non-medical prescribing.Background. In 2006, new legislation in England enabled nurses with anindependent prescribing qualification to prescribe, within their competence. In 2006,non-medical prescribing policies released by the Department of Health outlinedthe recommendations for education, continuing professional development andgovernance of non-medical prescribing; however, there was no evidence on a nationalscale about the exte nt of implementation and effectiveness of these strategies.Design. National surveys of: (i) nurse independent prescribers; and (ii) non-medical prescribing leaders in England.Methods. Questionnaire surveys (August 2008–February 2009) coveringeducational preparation, prescribing practice (nurse independent prescribers) andstructures/processes for support and governance (non-medical prescribing leaders).Results. Response rates were 65% (976 prescribers) and 52% (87 leaders). Mostnurses felt their prescribing course met their learning needs and stated courseoutcomes and that they had adequate development and support for prescribing tomaintain patient safety. Some types of community nurse prescribers had less accessto support and development. The prescribing leaders reported lacking systems toensure continuity of non-medical prescribing and monitoring patient experience.Conclusion. Educational programmes of preparation for nurse prescribing werereported to be operating satisfactorily and providing fit-for-purpose preparationfor the expansion to the scope of nurse independent prescribing. Most clinicalgovernance and risk management strategies for prescribing were in place inprimary and secondary care. / Department of Health (UK)

Yes / Healthcare systems worldwide devote significant resources towards collecting data to support care quality assurance and improvement. In the United Kingdom, National Clinical Audits are intended to contribute to these objectives by providing public reports of data on healthcare treatment and outcomes, but their potential for quality improvement in particular is not realized fully among healthcare providers. Here, we aim to explore this outcome from the perspective of hospital boards and their quality committees: an under-studied area, given the emphasis in previous research on the audits' use by clinical teams. Methods: We carried out semi-structured, qualitative interviews with 54 staff in different clinical and management settings in five English National Health Service hospitals about their use of NCA data, and the circumstances that supported or constrained such use. We used Framework Analysis to identify themes within their responses. Results: We found that members and officers of hospitals' governing bodies perceived an imbalance between the benefits to their institutions from National Clinical Audits and the substantial resources consumed by participating in them. This led some to question the audits' legitimacy, which could limit scope for improvements based on audit data, proposed by clinical teams. Conclusions: Measures to enhance the audits' perceived legitimacy could help address these limitations. These include audit suppliers moving from an emphasis on cumulative, retrospective reports to real-time reporting, clearly presenting the “headline” outcomes important to institutional bodies and staff. Measures may also include further negotiation between hospitals, suppliers and their commissioners about the nature and volume of data the latter are expected to collect; wider use by hospitals of routine clinical data to populate audit data fields; and further development of interactive digital technologies to help staff explore and report audit data in meaningful ways. / Health Services and Delivery Research Programme, Grant/Award Number: 16/04/06

Made available in DSpace on 2016-06-02T20:45:42Z (GMT). No. of bitstreams: 1 6366.pdf: 596097 bytes, checksum: ae7647509ec0ee1cf50f9d12343512af (MD5) Previous issue date: 2014-03-27 / The main goal in this study is to analyze the learning process of the Brazilian Unified Health System (SUS) staff when exposed to an interactionist educational initiative. Such initiative aims the transformation of health practices by focusing on clinical management and qualifying care for the users of SUS in 33 hospitals from the 5 Brazilian geographical regions. This study used a specialization course that was developed in 2009-10 that focused on the articulated development of management abilities, support and education in health. The study was based on the principles of qualitative research and the completion of course work drawn by the attendees of the specialization course on Clinical Management was also used as a source of data. The content was analyzed for data interpretation aiming to identify and explain the causes and interactions for the production of the phenomenon. The novelty of the proposal was not an obstacle for the learning process. Student focused learning and the appreciation of previous knowledge where related to the practical application of such content and the broaden of autonomy, especially on what concerns recently acquired information. It was also observed that the participants actions were related to the three areas: clinical management; health awareness and education. The interaction in small groups, communication, integration and open dialogue were valued as fundamental e facilitating elements of learning, group work development and qualification of care. Transformation on practices on health related to management, attention and education were observed and were part of the knowledge that define the profile of clinical management built and developed through the course. / Objetivou-se neste estudo analisar o processo de aprender de trabalhadores do SUS expostos a uma iniciativa educacional interacionista. Esta iniciativa, o Curso de Gestão da Clínica nos Hospitais do SUS, foi orientada à transformação de práticas em saúde, considerando a gestão da clínica como eixo ordenador do cuidado prestado aos usuários da rede pública de saúde. Participaram 33 hospitais das cinco regiões geográficas do Brasil. Realizada entre 2009-10, no formato de uma especialização, objetivou o desenvolvimento articulado de capacidades de gestão, de atenção e de educação na saúde. A investigação foi baseada nos princípios da pesquisa qualitativa e utilizou o Trabalho de Conclusão do Curso, elaborado pelos participantes da especialização em Gestão da Clínica, como fonte para a coleta de dados. Para a interpretação dos dados, foi aplicada a técnica de análise de conteúdo. Foram encontradas três temáticas: (i) Práticas Educacionais; (ii) Práticas em Saúde; e (iii) Transformação das práticas em saúde considerando os pressupostos da gestão da clínica. Na temática das práticas educacionais, os subtemas Aprendizagem Baseada em Problemas e Aprender dialogando no trabalho mostraram que o ineditismo da proposta não foi um obstáculo à aprendizagem. Foram considerados como fatores positivos: a convivência em pequenos grupos, a valorização dos conhecimentos prévios e o diálogo. Observou-se que as transformações nas práticas dos participantes foram relacionadas às três áreas do perfil de competência proposto pelo curso. As práticas de gestão e de atenção à saúde incorporaram os pressupostos da gestão da clínica, especialmente em relação à melhoria da qualidade e da integralidade do cuidado.

Orientador: Aparecida Mari Iguti / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T07:25:13Z (GMT). No. of bitstreams: 1 Moraes_ErikaFernandaVianade_M.pdf: 2128370 bytes, checksum: 7885fe8b3c0941969b0f1edff437f6c1 (MD5) Previous issue date: 2014 / Resumo: O aumento da carga de doença relacionado às Doenças Crônicas Não Transmissíveis (DCNT), decorrente do envelhecimento e da exposição a fatores de risco relacionados ao estilo de vida da população, tem sido motivo de iniciativas de reorganização dos Sistemas de Saúde de vários países, visando tornar a Atenção Básica à Saúde mais resolutiva. Em 2009, o Ministério da Saúde, inspirado na experiência britânica, propôs o Projeto Territórios: Estratégia de qualificação da Atenção Primária para ampliação dos limites da resolubilidade na atenção das doenças crônicas não transmissíveis: um eixo de reestruturação da Atenção Especializada no seu papel complementar, introduzindo os conceitos e ferramentas da Gestão Clínica para microgestão dos processos de trabalho e a construção de Linhas de Cuidado como indutores da articulação de redes de Saúde. O Projeto Territórios foi implantado em três municípios brasileiros, entre os quais Campinas (SP), onde ficou conhecido como "Projeto de Gestão da Clínica". Esta pesquisa, de natureza qualitativa, tem como objetivo analisar como os trabalhadores de um Centro de Saúde do Distrito de Saúde Norte de Campinas, partícipe do Projeto Territórios, percebem o próprio trabalho, e como os dispositivos de Gestão Clínica aplicados ao cuidado às DCNT interferiram na organização do trabalho desta equipe. Para tanto, após uma discussão teórica sobre a questão das Redes de Atenção à Saúde e um estudo documental sobre as experiências britânica e brasileira, foi realizado um grupo focal com trabalhadores de uma unidade da Atenção Básica de Campinas ¿ SP. Uma narrativa foi produzida para expressar o resultado da discussão no grupo focal, à maneira como propõem Onocko-Campos e Furtado (2008) e Ricoeur (1997). Após ser apresentada e validada pelo grupo de trabalhadores, a narrativa foi analisada de forma a apresentar as percepções dos trabalhadores acerca de três pontos críticos no remodelamento proposto para os serviços de saúde: (1) a tensão entre programação das ações de saúde e a organização do trabalho para dar respostas à demanda espontânea; (2) a fragilidade das relações entre as pessoas e serviços constituintes das redes de saúde e; (3) a relação entre os trabalhadores da saúde e a gestão, marcada pela assimetria de poder. De modo geral, os trabalhadores percebem positivamente as ações do Projeto Territórios e as identificam com um modelo de trabalho em saúde assemelhado à lógica da Programação em Saúde, localizam que esta proposição não dialoga com a necessidade de estarem organizados para dar respostas à demanda espontânea, mantendo `porta aberta¿ às necessidade de saúde da população, observam que entre a Atenção Básica e outros serviços de saúde do município existe uma relação distante e percebem-se frágeis e pouco potentes diante da necessidade de mudanças no processo de trabalho. Uma conclusão possível é a de que o fortalecimento da Atenção Básica deve conter estratégias de empoderamento e organização do trabalho que legitimem este nível de Atenção para produção de saúde frente a maior parte dos problemas de saúde da população e a lógica da programação em saúde não é potente para a organização das mudanças necessárias / Abstract: The increased burden of disease related to Chronic Noncommunicable Diseases (DCNT), due to aging and exposure to risk factors related to the lifestyle of the population, has been the subject of reorganization initiatives of Health Systems in several countries, aiming to make Primary Health Care more resolute. In 2009, the Ministry of Health, inspired on British experience, proposed the Projeto Territórios: Qualifying Primary Care Strategy to expand the limits of solvability in the care of chronic noncommunicable diseases: a restructuring axis of Specialized Care in its complementary role, introducing the concepts and tools of Clinical Governance for micro-management of work processes and the construction of Care Lines as inducers of articulation of Health. The Projeto Territórios was implemented in three municipalities, including Campinas - SP, where was known as "Projeto de Gestão da Clínica". This research, of qualitative nature, aims to analyze how the workers of a Health Center of the North Health District of Campinas - SP, participant of the Projeto Territórios, realize their own work, and how the devices of Clinical Governance applied to the care of DCNT interfere in the work organization of this team. To that end, after a theoretical discussion on the issue of Health Care Networks and documentary study of the British and Brazilian experiences, a focus group with workers in a unit of Primary Health Care was conducted in Campinas ¿ SP. A narrative was produced to express the result of the discussion in the focus group, to the way proposed by Onocko-Campos and Furtado (2008) and Ricoeur (1997). After being presented and validated by the group of workers, the narrative was analyzed to present the perceptions of workers on three critical points in the remodeling proposed for health services: (1) the tension between programming of health activities and work organization to give answers to spontaneous demand; (2) the fragility of relations between people and constituent services of health networks and; (3) the relationship between health workers and management, marked by asymmetry of power. In general, workers realize positively the Projeto Territórios actions and identify with a working model in health likened the logic of the Health Program, localize that this proposition does not dialogue with the need to be organized to give answers to the spontaneous demand, keeping `open door¿ to the health needs of the population, observe that between Primary Care and other health services in the municipality there is a distant relationship and perceive themselves fragile and underpowered on the need for changes in the work process. One possible conclusion is that the strengthening of primary care must include empowerment strategies and work organization to legitimize this level of attention to Care for health production across most of the health problems of the population and health programming logic is not powerful for the organization of the necessary changes / Mestrado / Política, Planejamento e Gestão em Saúde / Mestra em Saúde Coletiva, Política e Gestão em Saúde

Clinical and corporate governance have been an area of ongoing concerns in the NHS. Since the Bristol Royal Infirmary scandal of the 1990s and the events concerning Sir Jimmy Savile there has been a dilemma of its true nature and relationship. Clinical and corporate governance are closely related as the two of them share similar processes such as openness, performance review, striving for effective end results, and accountability in the use of resources and power within healthcare management.

Background: Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The aim of the research study was to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice. Methods: A descriptive cross-sectional study design in the form of an online survey were conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies. Results: A total of 87 participants agreed to participate. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n=27, 35.5%) and the Western Cape (n=25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. An overwhelming number of participants (n=69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available, however, our results found that introducer stylets and/or bougies and EtCO2 devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks. Conclusion: The practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, rely on comprehensive implementation and adherence to all the 51 components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, there are areas that may benefit from further research to improve current practice.

There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented.

The purpose of the study was to investigate the assumptions that underpin contemporary hospital infection control programs from the perspective of the influence of clinical culture on the integration and ownership of the infection control program. The results of numerous studies have linked low levels of adherence with infection control principles amongst health care providers as the most significant factor contributing to nosocomial infection. Despite early successes in reducing nosocomial infection rates, results derived from current research demonstrate that nosocomial infection has remained a challenge to healthcare providers and patients alike and outbreaks are regularly reported in the infection control literature. Serious economic and social impact has resulted from the increasing levels of antibiotic resistance that have been reported amongst pathogens associated with nosocomial infection. This interpretive study takes an ethnographic approach, using multiple data sources to provide insight into the culture and context of infection control practice drawing upon clinicians' work and the clinician's perspective. There were three approaches to data collection. A postal survey of surgeons was conducted, a group of nurses participated in a quality activity, and a clinical ethnography was conducted in an intensive care unit and an operating theatre complex. Data were analysed in accordance with the qualitative and quantitative approaches to data management. Findings indicate that the clinical culture exerts significant influence over the degree to which the infection control program activities change practice and that rather than imposing the infection control program on the clinical practice setting from outside, sustained practice change is more likely to be achieved if the motivation and impetus for change is culturally based. Moreover surveillance, if it is to influence clinicians and their practice, must provide confidence in its accuracy. It must be meaningful to them and linked to patient care outcomes. Contemporary hospital infection control programs, based on assumptions about a combination of surveillance and control activities have resulted in decreased nosocomial infection rates. However, sustained infection control practice change has not been achieved despite the application of a range of surveillance and control strategies. This research project has utilized an ethnographic approach to provide an emic perspective of infection control practice within a range of practice contexts. The findings from this study are significant within the context of spiraling health costs and increasing antibiotic resistance associated with nosocomial infection.

Submitted by pedro lacava (pedrolacava81@gmail.com) on 2018-08-21T23:41:12Z No. of bitstreams: 2 Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) / Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-08-22T17:06:00Z (GMT) No. of bitstreams: 2 Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) / Approved for entry into archive by Suzane Guimarães (suzane.guimaraes@fgv.br) on 2018-08-22T17:34:35Z (GMT) No. of bitstreams: 2 Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) / Made available in DSpace on 2018-08-22T17:34:35Z (GMT). No. of bitstreams: 2 Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) Tese mestrado revisada pra biblioteca pdf.pdf: 963157 bytes, checksum: 42bbb08bd8e02686a34793f4a8a38d37 (MD5) Previous issue date: 2018-08-01 / O estudo de caso com desenho transversal descritivo e enfoque qualitativo teve por objetivos avaliar a qualidade da Governança Corporativa em instituição hospitalar filantrópica localizada no Município de São Paulo e analisar as práticas implementadas mediante diretrizes do Instituto Brasileiro de Governança Corporativa e da Healthcare Governance and Tranparency Association. As boas práticas de governança corporativa podem contribuir significativamente para que as instituições filantrópicas hospitalares de excelência, associadas ao PROADI, sejam mais competitivas e autossustentáveis, a fim de que não necessitem de substanciais capitais de investidores, os quais podem, pelo seu interesse intrínseco de ganho, modificar a estrutura de capital, resultando em perda da filantropia, descaracterizando a missão da organização e sua finalidade social. Antecedeu à coleta de dados, a elaboração de instrumento constituído por 220 questões fechadas, com opções de respostas pré-codificadas (sim ou não) referentes às práticas recomendadas de governança corporativa compreendidas em nove dimensões de análise. A coleta foi realizada por meio de entrevistas com os principais gestores da instituição, e para cada questão com resposta afirmativa realizou-se análise documental com o intuito de evidenciar as informações referidas pelos entrevistados. Os principais resultados foram: O índice geral de qualidade da governança corporativa alcançou adequação de 75%; As Dimensões Associações e Conduta, Conflito de Interesses e Divulgação de informações apresentaram-se totalmente adequadas às diretrizes preconizadas; As dimensões Auditoria Independente e Associação Marca/Imagem apresentaram níveis de adequação inferiores a 50%. Os resultados atenderam plenamente aos objetivos da pesquisa, assim como foi possível apontar desdobramentos para futuros estudos, tais como: a inclusão de novas dimensões específicas ao setor de saúde, avaliação e análise crítica pelas organizações no que diz respeito aos resultados decorrentes das práticas de governança corporativa e o aprofundamento da questão referente à atribuição ou não de pesos diferenciados para as dimensões. / This case study with a descriptive and qualitative focus aims at evaluating Corporate Governance in a philanthropic hospital located in the city of São Paulo and analyzes the practices implemented through the guidelines of the Brazilian Institute of Corporate Governance and the Healthcare Governance and Transparency Association. Good governance practices can be important to make philanthropic hospitals of excellence more competitive and self-sustaining, so that they do not need capital from third parties, who can, for their interest in profit-making, modify their social patrimony, causing a lack of philanthropy , misleading the organization's mission and its social purpose. Before the data collection, an instrument was created consisting of 220 closed questions, with the option of pre-coded answers (yes or no) referring to recommended governance practices comprised in nine dimensions of the analysis. The data was collected by interviewing the main managers of the institution, and each affirmative answer led us to carry out the document analysis in order to evidence the information mentioned by the interviewees. The main results were as follows: The overall report on the quality of corporate governance was 75%; The Dimensions Associations and Conduct, Conflict of Interests and Disclosure of Complementary Information seemed to be suitable to recommended guidelines; independent auditing dimensions and brand/image association showed adequacy index below 50%. The results met thoroughly the research objective, but we were also able to find other areas for future studies, such as: the inclusion of new actions in the health sector, evaluation and critical analysis by organizations that are relevant to governance practices results.