No presente estudo, objetivou-se a compreensão da forma como a participação social se desenvolve no Conselho Municipal de Saúde, do município de Rio Branco, assim como a identificação da sua influência nas ações de promoção à saúde. Para tal, foi utilizada uma abordagem qualitativa e a metodologia de estudo de caso. A investigação foi realizada em etapas, sendo elas: acompanhamento das reuniões do referido órgão, com a utilização da técnica conhecida como observação sistemática; a segunda consistiu na análise documental das atas das reuniões dos órgãos colegiados, relatórios de gestão, entre outros; e realização de entrevistas com todos os conselheiros. Apesar do órgão estudado já ter sido criado há mais de duas décadas, a participação social somente tem-se desenvolvido muito paulatinamente apenas nos últimos quatros anos. Este conselho apresenta como entraves a sua efetivação e real democratização da gestão das políticas públicas de saúde, os mesmos obstáculos identificados em outros conselhos estudados no país. São eles: relações assimétricas de poder; dificuldades de representação, principalmente no segmento dos usuários; capacitações insuficientes para o pleno exercício do mandato de conselheiro, entre outros. Mesmo diante de inúmeros aspectos que atravancam uma participação equânime, os conselheiros têm uma postura positiva quanto ao seu papel enquanto contribuinte para esse processo e quanto ao conselho enquanto espaço de democratização das tomadas de decisões. Há que se considerar o potencial de compartilhamento de poder e responsabilidades de espaços como estes, e os atores envolvidos devem ter o seu esforço de participar valorizado e incentivado, dando-lhes voz e escuta e tendo suas intervenções e, ou solicitações atendidas, tendo em vista que esse é o objetivo de se incluir constitucionalmente a participação da sociedade na gestão da coisa pública / The present study aimed at understanding how social participation develops the Municipal Health Council of the city of Rio Branco, and the identification of its influence on the actions of health promotion. To this end, we used a qualitative approach and case study methodology. The research was carried out in stages , namely: monitoring the meetings of that body , using the technique known as systematic observation , the second consisted of documentary analysis of the minutes of the meetings of the collegiate bodies , management reports , among others , and achievement interviews with all directors . Despite this organ studied , having been established for more than two decades , community involvement and has developed very slowly in just the past four years . This board features as barriers to its effectiveness and real democratization of the management of public health policies , the same as those identified in other studies in the country . They are: asymmetric power relations; difficulties of representation, especially in the segment of users ; capabilities insufficient for the full office of counselor, among others . Even with numerous aspects that clutter equitable participation, counselors have a positive attitude about their role as contributors to this process and the council as an area of democratization of decision making. We must consider the potential sharing of power and responsibilities of spaces like these , and the actors involved must have their efforts valued and encouraged to participate by giving them a voice and listening and taking their interventions and or requests answered , considering that this is the goal of including constitutionally society participation in the management of the \"thing \" public .

No presente estudo, objetivou-se a compreensão da forma como a participação social se desenvolve no Conselho Municipal de Saúde, do município de Rio Branco, assim como a identificação da sua influência nas ações de promoção à saúde. Para tal, foi utilizada uma abordagem qualitativa e a metodologia de estudo de caso. A investigação foi realizada em etapas, sendo elas: acompanhamento das reuniões do referido órgão, com a utilização da técnica conhecida como observação sistemática; a segunda consistiu na análise documental das atas das reuniões dos órgãos colegiados, relatórios de gestão, entre outros; e realização de entrevistas com todos os conselheiros. Apesar do órgão estudado já ter sido criado há mais de duas décadas, a participação social somente tem-se desenvolvido muito paulatinamente apenas nos últimos quatros anos. Este conselho apresenta como entraves a sua efetivação e real democratização da gestão das políticas públicas de saúde, os mesmos obstáculos identificados em outros conselhos estudados no país. São eles: relações assimétricas de poder; dificuldades de representação, principalmente no segmento dos usuários; capacitações insuficientes para o pleno exercício do mandato de conselheiro, entre outros. Mesmo diante de inúmeros aspectos que atravancam uma participação equânime, os conselheiros têm uma postura positiva quanto ao seu papel enquanto contribuinte para esse processo e quanto ao conselho enquanto espaço de democratização das tomadas de decisões. Há que se considerar o potencial de compartilhamento de poder e responsabilidades de espaços como estes, e os atores envolvidos devem ter o seu esforço de participar valorizado e incentivado, dando-lhes voz e escuta e tendo suas intervenções e, ou solicitações atendidas, tendo em vista que esse é o objetivo de se incluir constitucionalmente a participação da sociedade na gestão da coisa pública / The present study aimed at understanding how social participation develops the Municipal Health Council of the city of Rio Branco, and the identification of its influence on the actions of health promotion. To this end, we used a qualitative approach and case study methodology. The research was carried out in stages , namely: monitoring the meetings of that body , using the technique known as systematic observation , the second consisted of documentary analysis of the minutes of the meetings of the collegiate bodies , management reports , among others , and achievement interviews with all directors . Despite this organ studied , having been established for more than two decades , community involvement and has developed very slowly in just the past four years . This board features as barriers to its effectiveness and real democratization of the management of public health policies , the same as those identified in other studies in the country . They are: asymmetric power relations; difficulties of representation, especially in the segment of users ; capabilities insufficient for the full office of counselor, among others . Even with numerous aspects that clutter equitable participation, counselors have a positive attitude about their role as contributors to this process and the council as an area of democratization of decision making. We must consider the potential sharing of power and responsibilities of spaces like these , and the actors involved must have their efforts valued and encouraged to participate by giving them a voice and listening and taking their interventions and or requests answered , considering that this is the goal of including constitutionally society participation in the management of the \"thing \" public .

Submitted by Jamile Barbosa da Cruz (jamile.cruz@ucsal.br) on 2017-01-17T16:47:41Z No. of bitstreams: 1 Dissertacao Karina.pdf: 1839170 bytes, checksum: 71a6e7183a10ca9a9d53fc20404a3f96 (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-01-17T17:04:35Z (GMT) No. of bitstreams: 1 Dissertacao Karina.pdf: 1839170 bytes, checksum: 71a6e7183a10ca9a9d53fc20404a3f96 (MD5) / Made available in DSpace on 2017-01-17T17:04:35Z (GMT). No. of bitstreams: 1 Dissertacao Karina.pdf: 1839170 bytes, checksum: 71a6e7183a10ca9a9d53fc20404a3f96 (MD5) Previous issue date: 2013-08-29 / Os conselhos gestores de políticas públicas são espaços de participação da sociedade, onde há possibilidade de sua atuação conjunta com o Estado. Sua existência é muito importante para fortalecer a democracia, especialmente por causa de características descendentes do período da democratização brasileira como a ênfase na deliberação. No entanto, a literatura aponta limites que ainda não foram transpostos para que os conselhos atinjam seu potencial democratizante. Esta pesquisa analisou como se articulam e como se manifestam a democracia, a participação e a deliberação no Conselho Municipal de Saúde da cidade de São Félix (CMS/SF), na Bahia. A investigação abrangeu o período compreendido entre abril de 2010 e março de 2012, para a qual realizou um estudo de caso de abordagem qualitativa. As análises partiram de dados coletados em documentos, observação e entrevistas aplicadas aos membros do conselho mencionado. Ao final, a pesquisa identificou um desenho institucional favorável o que não impediu a existência de fragilidade de deliberação, superficialidade do cumprimento da paridade, dúvidas sobre a efetividade deliberativa e uma associação com um tipo formal de democracia. A relevância desta pesquisa está na peculiaridade do campo empírico: contrariando a tendência, este estudo aconteceu em um município de pequeno porte do interior de um estado da região nordeste. / The management councils of public politics are spaces of social participation where there is the possibility of its joint actuation with the State. Its existence Is very important to strengthen democracy, especially because of features come from the democratization period in Brazil with an emphasis in deliberation. However the literature indicates to some limiting points that have not yet been overcome so that the councils fulfill its democratizing potential. This research analyzed how democracy, participation and deliberation articulate themselves and how they manifest in the City Council of Health in the municipality of Sao Felix in Bahia. Therefore a case study with a qualitative approach was made. The analysis came from the data collected in documents, observations and applied interviews to the members of the mentioned council. By the end of the research a favorable institutional frame was identified what did not prevent the existence of fragilities in deliberation, superficiality in fulfilling the parity, doubts about the deliberative effectiveness and association with a kind of formal democracy. The relevance of this study lays on particularity of the empiric field: contradicting the tendency the study was made in a small town in the countryside of a state in northern Brazil.

This dissertation examines the organisational background to the modern British health education movement, largely by reference to the origins and forty years' history of the Central Council for Health Education (1927-1968), the first body attempting to impart leadership and national coherence to a diffuse and eclectic field of educational practice and health promotion which has found secure administrative foundations difficult to establish. The study begins with a review of nineteenth and early twentieth century influences contributing to the character and status of the movement in its pioneering years. The predominantly propagandist roots and voluntary sector affinities with which it emerged from half and century's precursory endeavours profoundly affected health education's opportunities to advance with other aspects of health care and education in the inter-war years. By then, health education had become a diffuse and unco-ordinated field of minor, local authority initiatives and separatist campaigning by specialist, national health charities, remaining largely outside the remit of health and education professions and neglected officially. How the challenge of countering developmental difficulties fell to a minor professional body rather than an officially promoted one, is a question critical to any interpretation of later developments, and the subject of further enquiry. Subsequent investigation focuses on the evolution of the central agency which resulted, the Central Council for Health Education, particularly its thirty years' quest for official recognition and stature, and the strategies and services devised in this cause. It is a story of persistent and widespread enterprise, significant in many of its ideas but constrained in their effective development by enduring failure to attract Government support and to progress beyond the limited subscription income and essentially propagandist aspirations of local public health services. Adjudged ineffective by the 'Cohen Enquiry' of 1960-64, Government intervation proved forty years late in seeking to redress the problems of inadequate central provision, when in 1968 an officially funded Health Education Council replaced its neglected predecessor. The investigation reveals the classical dilemma of a multi-disciplinary field failing to transcend the divisive character of its own interests, in search for developmental coherence, and failing, consequently, to command effective professional and political support.

The Health Sector at the state of Kuwait is facing many challenges. One of which is public expectations in health are high, and thus, the Ministry of Health (MOH) in Kuwait has amplified the health expenditure by 86% since 2007. And since the medicine budget represents half of the total MOH budget, it is proposed that the development in health policy might be a suitable tool to control the inflation within the health budget. This thesis examines the opportunities and challenges of introducing an EML in Kuwait and the factors influencing its effectiveness. A mixed-methodology approach has been used to enhance and validate the data, in the form of interviews, comparative studies and questionnaires. One major limitation to the research was the lack of previous data relating to this work, and the information should be gathered in person in the form of hard copies, and later, the data was analysed using qualitative and quantitative approaches. It has been attained that, the EML might be a valuable tool if adopted and implemented appropriately, EML adjustment to country health situation is crucial for successful utilisation and fulfilling the concept objectives. Standard Treatment Guidelines are fundamental part of EM selection process, in Kuwait there were lack in the uniformity of the local STG, but fortunately, there is an eagerness to innovate, and the medicine situation might benefit from a type of organisation, overall, if the EML implemented efficiently in Kuwait, it might help in improving the general health and control the inflation in MOH budget.

?rea de concentra??o: Pol?tica, Cultura e Sociedade. / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-11-08T16:01:15Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) samuel_luiz_souza_pereira.pdf: 6573227 bytes, checksum: 5cb80c580c97be540c6a2c5b050eb1c5 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-11-10T12:00:53Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) samuel_luiz_souza_pereira.pdf: 6573227 bytes, checksum: 5cb80c580c97be540c6a2c5b050eb1c5 (MD5) / Made available in DSpace on 2018-11-10T12:00:53Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) samuel_luiz_souza_pereira.pdf: 6573227 bytes, checksum: 5cb80c580c97be540c6a2c5b050eb1c5 (MD5) Previous issue date: 2018 / A presente pesquisa insere-se nas atuais discuss?es da teoria pol?tica contempor?nea sobre democracia e participa??o. Parte-se do pressuposto que o sistema pol?tico democr?tico pode ganhar qualidade quando concilia a democracia representativa aos espa?os de democracia participativa, em suma, quando as institui??es pol?ticas formais conseguem, em algum grau, serem perme?veis ?s contribui??es da sociedade no controle e proposi??o de pol?ticas p?blicas. A assertiva que nos orienta, de alguma forma, tamb?m funcionou como base para cria??o dos Conselhos Gestores. N?o obstante a este fato, resta-nos saber se de fato tais Institui??es Participativas se fizeram exitosas em suas pretens?es. Da? o estudo das experi?ncias vividas no ?mbito dos Conselhos Municipais de Assist?ncia Social e Sa?de de Diamantina/MG. Com foco nestes espa?os, nos dirigimos a descortinar a din?mica da participa??o compreendendo-a a partir de vari?veis que acreditamos serem capazes de influenci?-la, inibindo ou impulsionando o protagonismo dos atores, s?o elas: o Desenho Institucional, portanto ?as regras do jogo?, os elementos sociais que se relacionam a ele - poder e interesses e as motiva??es para participa??o seja elas vinculadas a escolha racional e/ou derivadas do capital c?vico. O estudo emp?rico lan?a m?o de pesquisa documental e entrevista junto aos atores sociais envolvidos. Os resultados da pesquisa revelam limites das Institui??es Participativas analisadas principalmente no que se refere a representatividade dos atores sociais e na partilha de poderes entre Governo e Sociedade, mas, por outro lado, identifica potencialidade no que tange ao accountability tendo em vista a submiss?o de dados administrativos a aprecia??o dos conselhos. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Ci?ncias Humanas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2018. / This study is part of current discussions of contemporary political theory about democracy and participation. It is assumed that the democratic political system can be of a better quality if representative and participative democracy are conciliated, in short, when formal political institutions can, in any way, be opened to society contributions for controling and proposing public policies. The assertive that guide us has, some way, worked as basis to create administrative councils. Nonetheless, the question remains as to whether such participative institutions has succeded in their claims, then the need to study experiences lived in the full scope of City Councils of social assistance and health of Diamantina/MG. We worked in order to reveal the dinamic of participating, trying to comphreend it through some variables we believe are able to influence it in a way of inhibiting or giving a boost to its protagonists: institutional design (social elements ? power and interests) and motivation, even if it is linked to rational choice and/or came from civic capital. The empirical study let go off documental research and interview with social actors involved. Results show limits of participative institutions analysed, mainly relating to social actors representativity and power-sharing between government and society, but, on the other hand, it identify potentiality referring to accountability with a view of submitting administrative data to councils apreciation.

The Health Sector at the state of Kuwait is facing many challenges. One of which is public expectations in health are high, and thus, the Ministry of Health (MOH) in Kuwait has amplified the health expenditure by 86% since 2007. And since the medicine budget represents half of the total MOH budget, it is proposed that the development in health policy might be a suitable tool to control the inflation within the health budget. This thesis examines the opportunities and challenges of introducing an EML in Kuwait and the factors influencing its effectiveness. A mixed-methodology approach has been used to enhance and validate the data, in the form of interviews, comparative studies and questionnaires. One major limitation to the research was the lack of previous data relating to this work, and the information should be gathered in person in the form of hard copies, and later, the data was analysed using qualitative and quantitative approaches. It has been attained that, the EML might be a valuable tool if adopted and implemented appropriately, EML adjustment to country health situation is crucial for successful utilisation and fulfilling the concept objectives. Standard Treatment Guidelines are fundamental part of EM selection process, in Kuwait there were lack in the uniformity of the local STG, but fortunately, there is an eagerness to innovate, and the medicine situation might benefit from a type of organisation, overall, if the EML implemented efficiently in Kuwait, it might help in improving the general health and control the inflation in MOH budget.

Cette thèse vise à comprendre comment et dans quelle mesure l’agrément des établissements de santé est-il efficace pour développer les capacités des acteurs, nécessaires pour améliorer la qualité des soins et des services. Au cours des dix dernières années, il y a eu une croissance rapide, à l'échelle mondiale de la mise en œuvre de programmes d'agrément en santé pour l’amélioration de la qualité. L'expérience de la dernière décennie prouve que l'agrément est une technique valable pour l'amélioration de la qualité dans beaucoup d’organismes de santé. Il est également utilisé pour soutenir les réformes en santé. Malgré cela, les outils de gestion comme l’agrément sont souvent critiqués, car elles sont adoptées avec enthousiasme négligeant fréquemment une implantation favorisant la mise en place de comportements durables et la démonstration de meilleurs résultats. Le développement des capacités (DC) est un processus délibéré, multidimensionnel, dynamique dont le but est d’améliorer la performance des individus, des équipes, de l’organisation et d’un système. Le DC constitue une des trois assises de l’implantation d’une démarche institutionnalisée de la qualité, au même niveau que la communication et la reconnaissance. Cette recherche c’est déroulée dans un organisme d’Arabie Saoudite dans le cadre de leur première démarche avec le Conseil canadien d’agrément (CCASS) des services de santé. Une étude de cas unique d’implantation de l’agrément a été menée utilisant une approche mixte. Quatre niveaux d’analyse ont été étudiés en détail (individu, équipe, organisation et système) afin de mesurer 28 effets escomptés du DC puisés dans la littérature. Des entretiens semi-structurés, des groupes de discussion, une revue de la documentation ont été réalisés. Dans le but de mesurer trois des effets escomptés, un questionnaire sur le niveau d’implantation de la qualité (NIQ) a été administré pour la première fois en Arabie Saoudite dans cinq organismes. La performance du cas a été évaluée en relation avec les autres et en fonction de son positionnement dans le cycle d’agrément. Des analyses qualitatives et quantitatives utilisant la technique de polissage par la médiane ont été exécutées. Au niveau des individus, l’agrément a motivé la participation à de nouvelles formations. L’auto-évaluation est l’étape qui encourage l’apprentissage par l’autocritique. Le sentiment de fierté est le changement affectif le plus souvent répertorié. Les équipes ont amélioré leur communication par l’implantation d’une « chaîne de commandement ». Elle a introduit des notions de respect et de clarté des rôles telles qu’exigées par les normes. Au moyen de la mesure du NIQ, nous avons constaté que la majorité des organismes saoudiens se positionnent au niveau minimal d’implantation (assurance qualité). Le plus expérimenté avec l’agrément démontre les meilleurs résultats tout près du second niveau. Enfin, plus les organismes progressent dans la démarche d’agrément, plus les écarts de perception entre les 8 domaines mesurés par le questionnaire du NIQ et entre les différentes catégories d’emploi s’amincissent. En conclusion, l’agrément a démontré de l’efficacité à développer de nouvelles capacités par l’intégration des transformations des individus et par l’impact de l’acquisition des nouvelles capacités sur le changement des pratiques, majoritairement au niveau des individus, des équipes et de l’organisation. Le processus d’agrément a également fait preuve d’importants pouvoirs de convergence au niveau de l’adoption des pratiques édictées par les normes d’agrément qui contribuent positivement à l’amélioration de la qualité. / The purpose of this thesis is to determine whether accreditation is effective for developing individual’s necessary capacities that improve quality. In the last decade, accreditation shows that is a valuable tool. Accreditation program implementation has also demonstrated a world wide increased. It is as well used to support health reform. Managerial practices of this type are often criticized. They are adopted with enthusiasm but their implementation is often neglected because there is some difficulties to demonstrate sustainable behaviour changes and better outcomes.. Capacity Building (CB) is a comprehensive process, multidimensional and dynamic that seeks to improve the performance of individuals, teams, the organization and a system. CB is one of the three foundational elements of institutionalise quality improvement practices a the same level of communication and recognition. This study happens in Saudi Arabia. The hospital had participated in his first initiative with the Canadian Council of Health Services Accreditation (CCHSA). A single case study to evaluate the implementation of accreditation has been carried using a mix methodology. For unit of analysis has been studded (individual, team, organization and system) to measure 28 anticipated effects of capacity Building culled from the literature. Semi-structure interviews, focus groups and a documentation review were conducted. A questionnaire on the quality implementation scale (QIS) was administered in five organizations. The performance of the case was measured in relation to the others and based on its positioning in the cycle. Qualitative and quantitative analyses using median polish technique were conducted. At the individual level, the accreditation motivated participation in new training. Self-assessment is the stage that encourages learning through self-criticism. The feeling of pride is the emotional change that was reported the most. The teams improved their communication by establishing a chain of command, which introduced the concept of respect and of clearly defined roles as required by the standards. Through the QIS measurement, we noted that all those involved position themselves at the minimal level of implementation (Quality Assurance). The most experienced with accreditation produce the best results very close to the second level. Finally, the further organizations progress in the cycle, the more the differences in perception between the eight QI domains studied narrowed. The same phenomenon was observed among different job categories. In conclusion, accreditation has demonstrated effectiveness to develop new capacities most specifically at the individual, team and organizational level. The accreditation process has also demonstrated significant convergence power to pushes the adoption of new practices dictated by the accreditation standards. Those practices were successful to demonstrated positive quality improvement outcome.

Cette thèse vise à comprendre comment et dans quelle mesure l’agrément des établissements de santé est-il efficace pour développer les capacités des acteurs, nécessaires pour améliorer la qualité des soins et des services. Au cours des dix dernières années, il y a eu une croissance rapide, à l'échelle mondiale de la mise en œuvre de programmes d'agrément en santé pour l’amélioration de la qualité. L'expérience de la dernière décennie prouve que l'agrément est une technique valable pour l'amélioration de la qualité dans beaucoup d’organismes de santé. Il est également utilisé pour soutenir les réformes en santé. Malgré cela, les outils de gestion comme l’agrément sont souvent critiqués, car elles sont adoptées avec enthousiasme négligeant fréquemment une implantation favorisant la mise en place de comportements durables et la démonstration de meilleurs résultats. Le développement des capacités (DC) est un processus délibéré, multidimensionnel, dynamique dont le but est d’améliorer la performance des individus, des équipes, de l’organisation et d’un système. Le DC constitue une des trois assises de l’implantation d’une démarche institutionnalisée de la qualité, au même niveau que la communication et la reconnaissance. Cette recherche c’est déroulée dans un organisme d’Arabie Saoudite dans le cadre de leur première démarche avec le Conseil canadien d’agrément (CCASS) des services de santé. Une étude de cas unique d’implantation de l’agrément a été menée utilisant une approche mixte. Quatre niveaux d’analyse ont été étudiés en détail (individu, équipe, organisation et système) afin de mesurer 28 effets escomptés du DC puisés dans la littérature. Des entretiens semi-structurés, des groupes de discussion, une revue de la documentation ont été réalisés. Dans le but de mesurer trois des effets escomptés, un questionnaire sur le niveau d’implantation de la qualité (NIQ) a été administré pour la première fois en Arabie Saoudite dans cinq organismes. La performance du cas a été évaluée en relation avec les autres et en fonction de son positionnement dans le cycle d’agrément. Des analyses qualitatives et quantitatives utilisant la technique de polissage par la médiane ont été exécutées. Au niveau des individus, l’agrément a motivé la participation à de nouvelles formations. L’auto-évaluation est l’étape qui encourage l’apprentissage par l’autocritique. Le sentiment de fierté est le changement affectif le plus souvent répertorié. Les équipes ont amélioré leur communication par l’implantation d’une « chaîne de commandement ». Elle a introduit des notions de respect et de clarté des rôles telles qu’exigées par les normes. Au moyen de la mesure du NIQ, nous avons constaté que la majorité des organismes saoudiens se positionnent au niveau minimal d’implantation (assurance qualité). Le plus expérimenté avec l’agrément démontre les meilleurs résultats tout près du second niveau. Enfin, plus les organismes progressent dans la démarche d’agrément, plus les écarts de perception entre les 8 domaines mesurés par le questionnaire du NIQ et entre les différentes catégories d’emploi s’amincissent. En conclusion, l’agrément a démontré de l’efficacité à développer de nouvelles capacités par l’intégration des transformations des individus et par l’impact de l’acquisition des nouvelles capacités sur le changement des pratiques, majoritairement au niveau des individus, des équipes et de l’organisation. Le processus d’agrément a également fait preuve d’importants pouvoirs de convergence au niveau de l’adoption des pratiques édictées par les normes d’agrément qui contribuent positivement à l’amélioration de la qualité. / The purpose of this thesis is to determine whether accreditation is effective for developing individual’s necessary capacities that improve quality. In the last decade, accreditation shows that is a valuable tool. Accreditation program implementation has also demonstrated a world wide increased. It is as well used to support health reform. Managerial practices of this type are often criticized. They are adopted with enthusiasm but their implementation is often neglected because there is some difficulties to demonstrate sustainable behaviour changes and better outcomes.. Capacity Building (CB) is a comprehensive process, multidimensional and dynamic that seeks to improve the performance of individuals, teams, the organization and a system. CB is one of the three foundational elements of institutionalise quality improvement practices a the same level of communication and recognition. This study happens in Saudi Arabia. The hospital had participated in his first initiative with the Canadian Council of Health Services Accreditation (CCHSA). A single case study to evaluate the implementation of accreditation has been carried using a mix methodology. For unit of analysis has been studded (individual, team, organization and system) to measure 28 anticipated effects of capacity Building culled from the literature. Semi-structure interviews, focus groups and a documentation review were conducted. A questionnaire on the quality implementation scale (QIS) was administered in five organizations. The performance of the case was measured in relation to the others and based on its positioning in the cycle. Qualitative and quantitative analyses using median polish technique were conducted. At the individual level, the accreditation motivated participation in new training. Self-assessment is the stage that encourages learning through self-criticism. The feeling of pride is the emotional change that was reported the most. The teams improved their communication by establishing a chain of command, which introduced the concept of respect and of clearly defined roles as required by the standards. Through the QIS measurement, we noted that all those involved position themselves at the minimal level of implementation (Quality Assurance). The most experienced with accreditation produce the best results very close to the second level. Finally, the further organizations progress in the cycle, the more the differences in perception between the eight QI domains studied narrowed. The same phenomenon was observed among different job categories. In conclusion, accreditation has demonstrated effectiveness to develop new capacities most specifically at the individual, team and organizational level. The accreditation process has also demonstrated significant convergence power to pushes the adoption of new practices dictated by the accreditation standards. Those practices were successful to demonstrated positive quality improvement outcome.

Made available in DSpace on 2011-05-04T12:36:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / No Estado do Mato Grosso, o Conselho Estadual de Saúde CES/MT considerou que, para atuar de acordo com o que lhe é preconizado pelas Leis 8080/90 e 8142/90, é necessário que seus conselheiros sejam qualificados e continuamente tenham seus conhecimentos aperfeiçoados. Neste contexto, o Conselho, no ano de 2004, entendeu ser importante estabelecer uma Política de Educação Permanente em Saúde - PEP capaz de propiciar o aprimoramento dos conselheiros e agentes sociais na gestão e construção do Sistema Único de Saúde. Assim, o CES/MT constituiu um Grupo de Trabalho Interinstitucional GTI com o objetivo de formular e coordenar a construção PEP. A política e o plano de ações que a colocaria em prática foram construídas em oficinas regionais e aprovadas em reunião ordinária do CES, porém, as atividades decorrentes dessas propostas não foram implementadas. E analisar o processo decisório da Política de Educação Permanente em Saúde para Conselheiros e Agentes Sociais no Estado de Mato Grosso (2004/2006) é o objetivo geral do estudo desta dissertação. O estudo do processo decisório em políticas publica poderá contribuir para evidenciar e compreender os problemas que levaram a não implementação de uma política e isto é fundamental para a gestão pública, sobretudo quando envolve as relações do poder executivo com o CES/MT. Justifica-se ainda a necessidade de construir, no campo especifico estudos que permitam suprir lacunas na área do conhecimento que possam contribuir com as correções de rota e de gestão, apoiando a resolução de problemas da gestão pública, além de disseminar experiências asseguradas cientificamente colaborando na implantação de um SUS resolutivo, dequalidade e com participação e controle social. Foram utilizadas fontes secundárias, como documentos que registraram as ações colocadas em prática e as relações travadas neste processo; atas das reuniões do CES/MT, e a política de Educação Permanente em Saúde para Conselheiros e Agentes Sociais. As atas foram organizadas e sistematizadas cronologicamente, no tocante ao assunto da construção da PEP com a intenção de reproduzir, com o máximo possível de clareza, o que ocorreu no processo decisório. Desta maneira, o corpus foi metodologicamente trabalhado em dois eixos: cronologia e relações (embates e alianças) travadas pelos atores políticos participantes do processo decisório da PEP, procedimentos típicos da análise documental utilizada em estudos qualitativos. Para melhorar o rendimento de tais procedimentos e reforçar as estratégias metodológicas que lidam com a assimetria de interesses, foram incorporados à dissertação determinados pressupostos da técnica de análise de discurso, em especial o que se refere à ênfase na compreensão do papel social desempenhado pelo ator político como determinante para a fala que este produz. Produziu-se então, um conjunto de informações e explicações cujo intuito primordial foi de contribuir para que, na nova tentativa de implementação da Política de Educação Permanente em Saúde para Conselheiros e Agentes Sociais, os problemas já ocorridos fossem superados e não fossem, novamente, óbices. / In the Mato Grosso State, the State Council of Health – CES/MT considered that, to actuate in accordance with what is professed to him by the Laws 8080/90 and 8142/90, it is necessary that theirs counselors be qualified and continually have their knowledge improved. In this context, the Council, in the year 2004, understands that it is important to establish Permanent Education Politics in Health - PEP capable of propitiating the counselors and social agents´ refinement in the management and construction of the Sistema Único de Saúde (Unique System of Health). Thus, the CES/MT constituted a Group of Inter institutional Work - GTI with the objective of formulating and coordinating the PEP construction. The politics and the actions plan that would put it in practice were constructed in regional workshops and approved in ordinary reunion of the CES, but, the activities derived from these proposals were not implemented. And analyze the decisive process of the Permanent Education Politics in Health for Counselors and Social Agents (2004/2006) in the Mato Grosso State is the general objective of this dissertation´ s study. The study of the decisive process in public politics can contribute to evidence and understand the problems that led to the not implantation of a politic and this is fundamental for the public management, especially when it involves the executive power´s relations with the CES/MT. It still justifies the need of constructing, in the specific field studies that make it possible to supply blanks in the knowledge area that could contribute with the route and of management corrections, supporting the resolution of the public management problems, beyond disseminate experiences secured scientifically collaborating in the implantation of a decisive SUS, of quality and with social participation and control. Secondary sources, like documents that registered the actions put into practice and the relations engaged in this process were utilized; registers of the CES/MT´ s meetings and the Permanent Education politics for Counselor and Social Agents. The minutes were chronologically organized and systematized, concerning the subject of the PEP construction with the aim at reproducing, with the greatest of clarity, what occurred in the decisive process. In this manner, the corpus was methodologically worked in two main points: chronology and relations (clashes and alliances) engaged by the political actors participants of the PEP decisive process, typical procedures of the documental analysis utilized in qualitative studies. To enhance the income of such procedures and reinforce the methodological strategies that deal with the interests’ asymmetry, some purposes of the discourse analysis technique were incorporated to the dissertation, specially the one that is referred to the emphasis in the social paper´ s comprehension performed by the political actor as determinant for the speech that it produces. Thus, it produced an information and explications body whose primordial purpose was to contribute so that, in the new attempt of establishment of the Permanent Education Politics in Health for Counselors and Social Agents, the problems just occurred could be overcome and could not be, obstacles again.