Sistemas gerenciais em estabelecimentos de saúde podem ser considerados sistemas complexos, tendo em vista interação entre diferentes tipos de agentes na tomada de decisão (médico, paciente, gestor, entre outros), observação de transições de fase em epidemiologia, emergência de padrões de comportamento auto-organizado entre profissionais de saúde e incertezas quanto ao desfecho em saúde pós-tratamento. Em geral, os sistemas de apoio à decisão médica buscam maximizar resultados positivos e minimizar riscos em saúde aos pacientes, assim como propor diretrizes terapêuticas padronizadas e controlar custos em saúde. Há evidências de diferenças nos custos e benefícios derivados de sistemas decisórios Bayesianos centralizados (única distribuição a priori) e descentralizados (uma distribuição a priori por médico) aplicados ao processo de decisão de reserva de leito de Unidades de Terapia Intensiva (UTI) para períodos pós-operatórios. A existência de interação entre médicos com diferentes papéis no sistema decisório de indicação de UTI requer técnicas sofisticadas de avaliação econômica para comparação de vantagens e desvantagens associadas sistemas decisórios Bayesianos centralizados e descentralizados; tendo em vista que a aplicação de técnicas simples, como árvores de decisão ou cadeias de Markov, podem apresentar resultados imprecisos. Os objetivos deste estudo foram analisar a relação custo-benefício de sistemas de apoio à decisão médica centralizados e descentralizados para indicação de reserva de leito de UTI pós-operatório da perspectiva do sistema de saúde. Foi utilizada modelagem baseada em agentes, a partir de simulação de agentes usando raciocínio e atualização de crenças Bayesianos implementada no software NetLogo com análise de sensibilidade em Behavior Space. O modelo de decisão descentralizada apresenta benefício três vezes superior ao modelo centralizado (R$600 contra R$200). O modelo decisório descentralizado apresenta melhor razão custo-benefício ao sistema de saúde, permitindo maior flexibilidade na decisão médica e adaptabilidade dos agentes a diferentes situações. / Management systems in health facilities may be considered complex systems, due to the interaction among different types of agents in the decision process (physician, patient, manager, among other), observation of phase transitions in epidemiology, emergence of patterns in self-organized behavior among health professionals, and uncertainty in relation to health outcomes after treatment. In general, the medical decision support systems seek to maximize positive results and minimize risks in health to patients, as well as to propose standard therapeutic guidelines and to control the treatment costs. There are evidences of differences in costs and benefits derived from centralized (unique distribution a priori) and decentralized (one distribution a priori for each physician) Bayesian decision systems applied to the process related to decision of post-operatory booking of hospital beds in Intensive Care Unit (ICU). The existence of interaction among physicians in different roles in the decision system for ICU indication requires sophisticated techniques in economic evaluation for comparison of advantages and disadvantages associated to centralized and decentralized Bayesian decision systems; since other techniques, as decision trees and Markov chains, may present imprecise results. The objective of this study was to analyze the cost-benefit ratio of centralized and decentralized medical decision support systems for indication of booking of ICU beds in post-operatory period using the perspective of the health system. One agent-based model was applied, using simulation of agents based on Bayesian reasoning and beliefs updating implemented in the software NetLogo with sensitivity analysis in Behavior Space. The decentralized decision model presents benefits three times higher than the centralized decision model (US$270.27 versus US$90.09). The decentralized decision model presents better cost-benefit ratio to the health system, allowing enhanced flexibility in the medical decision process and adaptability of the agents to different situations.

Este trabalho tem por objeto examinar a atuação administrativa consensual, com enfoque na solução de conflitos sobre prestações materiais de saúde na esfera administrativa. A Constituição Federal de 1988 reconhece expressamente a saúde como direito fundamental de todos e determina ser dever do Estado garanti-lo, mediante políticas sociais e econômicas que visem à promoção, proteção e recuperação da saúde. Para alcançar os fins estatuídos pelo constituinte, diversas políticas públicas têm sido elaboradas e executadas. Porém, tendo em vista que grande parte da população não tem acesso às ações e serviços de saúde, o trabalho se propõe a indicar possíveis alternativas para enfrentar esta problemática brasileira. Para construir uma concepção dogmática adequada à compreensão do direito à saúde e de suas repercussões jurídicas, a dissertação analisa a teoria dos direitos fundamentais, explicitando as variadas funções que o direito à saúde pode exercer conforme o caso concreto. A função positiva do direito à saúde é destacada neste estudo, sobretudo, sua importância no Estado Social na promoção da igualdade material. Na sequência, o trabalho se dedica ao estudo do Sistema Único de Saúde (SUS), com base na estrutura delineada pela Constituição para conduzir a elaboração e a execução de políticas sanitárias. Em seguida, o tema da participação popular na Administração Pública é examinado como vetor do caráter Democrático do Estado, analisando seus pressupostos, instrumentos e, ainda, suas formas de expressão no âmbito do Sistema Único de Saúde (SUS). Por fim, o texto explora o modelo de Administração consensual no Brasil, especialmente no tocante à atividade de dirimir controvérsias na via administrativa, buscando identificar se, e em quais casos, esta atuação configura um autêntico módulo convencional. Feito o recorte temático proposto como linha de pesquisa, o trabalho examina instrumentos pró-consensuais institucionalizados para a solução de conflitos em matéria de saúde na via administrativa, apontando caminhos voltados à realização do direito fundamental à saúde e aos objetivos do Estado previstos na Constituição Federal. / This essay intends to examine the consensual administrative action, approaching to the conflict resolution regarding to medical supplies as well as healthcare services in the administrative process. The Federal Constitution of 1988 expressly recognizes health as a fundamental right and States guarantee duty, through social and economic policies, which has the propose of health promotion, protection and recovery. In order to realize the constitutional aims, a lot of public policies have been developed and implemented. However, considering that great amount of the population does not have access to healthcare actions and services, the study has the purpose of identifying possible alternatives to deal with this Brazilian issue. In order to develop an appropriate dogmatic understanding related to right to health and its legal repercussions, this essay analyzes the fundamental rights theory, explaining the various right to health functions that could be used according to the case. The right to healths positive function is highlighted in this essay, mainly, its importance to the Social State regarding to substantive equality promotion. Afterwards, this essay studies the Brazilian healthcare system (so-called Sistema Único de Saúde, or simply SUS), based on the structure outlined by the Constitution related to development and performance of public health policies. Then, the public participation theme in Public Administration is analyzed as a Democratic State conductor, going through its assumptions, instruments, and also its way of expression in the Brazilian healthcare system (SUS). Finally, the study explores the Brazilian consensual administrative model, especially in relation to conflict resolution activity in the administrative process, with the view to identify if, and in which cases, this action consist on a genuine conventional mechanism. In the conclusion, the analyze focuses on institutional mechanisms in favor of conflicts resolution by consensus regarding to heath in the administrative process, pointing out possible ways which conduces to right of heath effectiveness and achievements related to the objectives stated in the Federal Constitution.

Made available in DSpace on 2015-07-15T13:31:40Z (GMT). No. of bitstreams: 1 Leonor Bastos - Saude Coletival.pdf: 2524442 bytes, checksum: 51d2c5bc14eebe7a44cee874d7735dbc (MD5) Previous issue date: 2008-04-14 / Care has always been part of human life. It is associated to the practice of the women who have thereby, in the everyday life and surrounded by cultural connotations, promoted life in all its forms and taken care of death. Because life is complex and multi-faceted, this care, in order to fulfill its role of protecting and defending life, needs to be drawn from multiple perspectives and wisdoms, in an articulated manner and in multiple technological levels, including the lighter ones. As such, it depends on the enlivened work of an integrated health team. This team should perform careful and constant action involving workers, user, family and community, and be based on social bonds and accountability. Care, as a result of this collective action integrating distinct perspectives and wisdoms, is nowadays the axis of all actions in health service, particularly in Basic Healthcare Units, which are usually the door to the healthcare needs of the local population. This study adopts such a perspective, and examines the process of care of persons with diabetes mellitus (DM) in a Healthcare Center of Feira de Santana. Its objective is to analyze the process of care of persons with DM aiming for the integrality of healthcare attention, and to discuss its guiding devices: access, bond-accountability, team-formation (the construction of subjects, insertion and habilitation), in the everyday dynamics of the Healthcare Unit. The methodology is qualitative and used semi-structured interviews and systematic observations as data collection techniques. As subjects, the study took healthcare workers and users enrolled in the Program of Attention to persons with DM. The method of analysis for the interviews was guided by the Thematic Subject Analysis (MINAYO, 1996) and the Analyzer Flowchart of Merhy (1997), which also grounded the analysis of the observations. The results reveal that the process of caring of persons with DM has as its main intervention core the practice of nursing (in particular that of the nurse). In the everyday context of the healthcare services, that process has been fragmented, disconnected, and guided by the doctor-centered model. Access is limited, focused, and oriented towards low-complexity actions. Bond and user-embracement are still performed distanced from co-accountability (workers, users, service networks) in the definition of the therapeutic project of the persons with DM and who need the Healthcare Unit. In conclusion, the study points as necessary an expansion of the debate on integral care, considering the everyday praxis of those involved in the process. Key-words: Care has always been part of human life. It is associated to the practice of the women who have thereby, in the everyday life and surrounded by cultural connotations, promoted life in all its forms and taken care of death. Because life is complex and multi-faceted, this care, in order to fulfill its role of protecting and defending life, needs to be drawn from multiple perspectives and wisdoms, in an articulated manner and in multiple technological levels, including the lighter ones. As such, it depends on the enlivened work of an integrated health team. This team should perform careful and constant action involving workers, user, family and community, and be based on social bonds and accountability. Care, as a result of this collective action integrating distinct perspectives and wisdoms, is nowadays the axis of all actions in health service, particularly in Basic Healthcare Units, which are usually the door to the healthcare needs of the local population. This study adopts such a perspective, and examines the process of care of persons with diabetes mellitus (DM) in a Healthcare Center of Feira de Santana. Its objective is to analyze the process of care of persons with DM aiming for the integrality of healthcare attention, and to discuss its guiding devices: access, bond-accountability, team-formation (the construction of subjects, insertion and habilitation), in the everyday dynamics of the Healthcare Unit. The methodology is qualitative and used semi-structured interviews and systematic observations as data collection techniques. As subjects, the study took healthcare workers and users enrolled in the Program of Attention to persons with DM. The method of analysis for the interviews was guided by the Thematic Subject Analysis (MINAYO, 1996) and the Analyzer Flowchart of Merhy (1997), which also grounded the analysis of the observations. The results reveal that the process of caring of persons with DM has as its main intervention core the practice of nursing (in particular that of the nurse). In the everyday context of the healthcare services, that process has been fragmented, disconnected, and guided by the doctor-centered model. Access is limited, focused, and oriented towards low-complexity actions. Bond and user-embracement are still performed distanced from co-accountability (workers, users, service networks) in the definition of the therapeutic project of the persons with DM and who need the Healthcare Unit. In conclusion, the study points as necessary an expansion of the debate on integral care, considering the everyday praxis of those involved in the process. / O cuidado faz parte da vida humana desde os seus prim?rdios e est? associado ? pr?tica das mulheres que atrav?s dele, no cotidiano, envolto em conota??es culturais, promovem a vida em todas as suas manifesta??es e cuidam da morte. J? que a vida ? complexa e multifacetada, este cuidado, para que cumpra a sua fun??o de proteger e defender a vida precisa ser constru?do sob v?rios olhares e saberes, de forma articulada, nos diversos n?veis tecnol?gicos, dentre eles o enfoque nas tecnologias leves. Para tanto, depende do trabalho vivo de uma equipe de sa?de integrada, que desenvolva a??es cuidadosas, envolvendo trabalhadores, usu?rio, fam?lia e comunidade, de forma continuada, constru?da com base no v?nculo e na sponsabiliza??o social. O cuidado, fruto dessa a??o conjunta dos diversos olhares e saberes se constitui hoje no eixo das a??es em um servi?o de sa?de, particularmente das Unidades B?sicas de Sa?de que, em geral, s?o utilizadas como porta de entrada para as necessidades de sa?de da popula??o adscrita ? sua ?rea. Nessa perspectiva, este estudo tem como objeto o processo de cuidar de pessoas com DM em um Centro de Sa?de de Feira de Santana. Objetiva analisar o processo de cuidar de pessoas com DM com vistas ? integralidade da aten??o ? sa?de e discutir seus dispositivos orientadores: acesso, ?nculo-responsabiliza??o, forma??o da equipe (constru??o dos sujeitos, inser??o e capacita??o), na din?mica cotidiana da Unidade de Sa?de. A metodologia ? qualitativa. A entrevista semiestruturada e a observa??o sistem?tica utilizadas como t?cnicas de coleta de dados, tendo como sujeitos trabalhadores de sa?de e usu?rios cadastrados no Programa de Aten??o ?s pessoas com DM. O m?todo de an?lise das entrevistas foi orientado pela An?lise de Conte?do Tem?tica (MINAYO, 1996) e o Fluxograma Analisador de Merhy (1997) que fundamentou a an?lise das observa??es. Os resultados revelam que o processo de cuidar das pessoas com DM tem como n?cleo central de interven??o a pr?tica de enfermagem (em especial da enfermeira), ? constru?do no cotidiano dos servi?os de sa?de, de forma fragmentada e parcelar, orientado pelo modelo m?dico-centrado. O acesso ? restrito, focalizado e direcionado ? a??es de baixa complexidade. O acolhimento e v?nculo ainda s?o operados distantes da co-responsabiliza??o (trabalhadores, usu?rios e rede de servi?os) na defini??o do projeto terap?utico das pessoas com DM que demandam ? Unidade de Sa?de. Conclui-se que, ? necess?rio ampliar o debate sobre o cuidado integral, valorizando a pr?xis cotidiana dos sujeitos envolvidos no processo.

Sistemas gerenciais em estabelecimentos de saúde podem ser considerados sistemas complexos, tendo em vista interação entre diferentes tipos de agentes na tomada de decisão (médico, paciente, gestor, entre outros), observação de transições de fase em epidemiologia, emergência de padrões de comportamento auto-organizado entre profissionais de saúde e incertezas quanto ao desfecho em saúde pós-tratamento. Em geral, os sistemas de apoio à decisão médica buscam maximizar resultados positivos e minimizar riscos em saúde aos pacientes, assim como propor diretrizes terapêuticas padronizadas e controlar custos em saúde. Há evidências de diferenças nos custos e benefícios derivados de sistemas decisórios Bayesianos centralizados (única distribuição a priori) e descentralizados (uma distribuição a priori por médico) aplicados ao processo de decisão de reserva de leito de Unidades de Terapia Intensiva (UTI) para períodos pós-operatórios. A existência de interação entre médicos com diferentes papéis no sistema decisório de indicação de UTI requer técnicas sofisticadas de avaliação econômica para comparação de vantagens e desvantagens associadas sistemas decisórios Bayesianos centralizados e descentralizados; tendo em vista que a aplicação de técnicas simples, como árvores de decisão ou cadeias de Markov, podem apresentar resultados imprecisos. Os objetivos deste estudo foram analisar a relação custo-benefício de sistemas de apoio à decisão médica centralizados e descentralizados para indicação de reserva de leito de UTI pós-operatório da perspectiva do sistema de saúde. Foi utilizada modelagem baseada em agentes, a partir de simulação de agentes usando raciocínio e atualização de crenças Bayesianos implementada no software NetLogo com análise de sensibilidade em Behavior Space. O modelo de decisão descentralizada apresenta benefício três vezes superior ao modelo centralizado (R$600 contra R$200). O modelo decisório descentralizado apresenta melhor razão custo-benefício ao sistema de saúde, permitindo maior flexibilidade na decisão médica e adaptabilidade dos agentes a diferentes situações. / Management systems in health facilities may be considered complex systems, due to the interaction among different types of agents in the decision process (physician, patient, manager, among other), observation of phase transitions in epidemiology, emergence of patterns in self-organized behavior among health professionals, and uncertainty in relation to health outcomes after treatment. In general, the medical decision support systems seek to maximize positive results and minimize risks in health to patients, as well as to propose standard therapeutic guidelines and to control the treatment costs. There are evidences of differences in costs and benefits derived from centralized (unique distribution a priori) and decentralized (one distribution a priori for each physician) Bayesian decision systems applied to the process related to decision of post-operatory booking of hospital beds in Intensive Care Unit (ICU). The existence of interaction among physicians in different roles in the decision system for ICU indication requires sophisticated techniques in economic evaluation for comparison of advantages and disadvantages associated to centralized and decentralized Bayesian decision systems; since other techniques, as decision trees and Markov chains, may present imprecise results. The objective of this study was to analyze the cost-benefit ratio of centralized and decentralized medical decision support systems for indication of booking of ICU beds in post-operatory period using the perspective of the health system. One agent-based model was applied, using simulation of agents based on Bayesian reasoning and beliefs updating implemented in the software NetLogo with sensitivity analysis in Behavior Space. The decentralized decision model presents benefits three times higher than the centralized decision model (US$270.27 versus US$90.09). The decentralized decision model presents better cost-benefit ratio to the health system, allowing enhanced flexibility in the medical decision process and adaptability of the agents to different situations.

Introdução: São Paulo é uma megacidade com ocupação espacial heterogênea e desigualdades em saúde. Objetivos: Verificar se há aglomerados de nascidos vivos em hospitais SUS e não SUS e estudar as distâncias entre as residências das mães até os hospitais de parto. Métodos: Foi realizado um estudo com nascidos vivos (NV) de mães residentes e ocorridos em oito hospitais (4 SUS e 4 não-SUS) de alta complexidade do município de SP, em 2008. As informações foram obtidas da base de dados das declarações de nascido vivo unificada SEADE/SES e as bases cartográficas do Centro de Estudos da Metrópole. Foi empregado estimador de intensidade de Kernel para identificar aglomerados espaciais. A distância teórica entre residências maternas até o hospital do parto foi obtida em linha reta. Resultados: Os NV estudados representaram 27,8 por cento do total do MSP. Os NV dos hospitais SUS formaram 3 aglomerados, situados em distritos periféricos. A distância média percorrida entre a residência materna e o hospital do parto foi de 9,2 km para os NV de hospitais SUS e de 9,9 km para os não-SUS. Verificou-se uma proporção maior de mães de alta escolaridade (12,8 vezes), com mais de 35 anos de idade (3,2 vezes), nascimentos com 7 ou mais consultas de pré-natal (1,5 vezes) entre os NV de hospitais não-SUS que nos hospitais SUS. Os NV de hospitais SUS apresentaram proporções de mães adolescentes (17,9 vezes), grandes multíparas (21 vezes) e partos por via vaginal (5,2 vezes) maior que nos não-SUS. Não houve diferença estatisticamente significante da prevalência de baixo peso ao nascer e NV pré-termos. Discussão: Há uma associação entre a distribuição espacial dos nascimentos ocorridos em hospitais SUS e não-SUS. Os aglomerados de NV SUS situaram-se em distritos onde há condições de vida precárias e altas taxas de fecundidade. Os NV de hospitais não-SUS formaram um aglomerado na região central de alta renda e baixa fecundidade, seguindo padrão observado em outros estudos. As distâncias médias entre as residências maternas e hospitais de parto foram próximas nos dois tipos de rede. Os diferenciais das características maternas dos NV em hospitais SUS e não-SUS foram mais acentuados que aqueles encontrados em estudos realizados somente com técnicas de georrefenciamento, possivelmente devido aos hospitais não-SUS estudados atenderem a clientela de planos de saúde de alto poder aquisitivo. A ausência de diferença estatisticamente significante entre a prevalência de nascimentos pré-termo e de baixo peso ao nascer possivelmente se deve ao estudo ter sido realizado apenas em hospitais de alta complexidade. O diferencial encontrado na realização de consultas de pré-natal mostra o efeito positivo do SUS no acesso atenção pré-natal. Conclusão: Os aglomerados de nascimentos SUS e não-SUS mostram existir marcados diferenças quanto às características sociodemográficas. O SUS mostrou ter um efeito de positivo na promoção de maior equidade no acesso à atenção pré-natal e ao parto. / Sao Paulo is a megacity of heterogeneous spatial occupation and inequalities in health. Objectives: To determine whether there are clusters of live births (LBs) in hospitals of Unified Systems (SUS) and in others (non-SUS) and study the distances between the residences of the mothers concerned and the respective hospitals. Methods: A study was conducted a study of LBs of resident mothers which had occurred in eight hospitals (4 of the SUS and 4 others, not of the SUS) of hight complexity in the municipality of SP, in 2008. The information was obtained from the unified SEADE/SES database of the declarations of LBs and the cartographic bases from the Metropolitan Study Center (Centro de Estudos da Metrópole). Kernel\'s intensity estimator was employed to identify spatial clusters. The theorithical distance between the maternal residences and the respective maternity hospitals was taken as that given by a straight line between the two. Results: The LBs studied accounted for 27.8 per cent of the total of the municipality. The LBs of the SUS hospitals formed 3 clusters, all situated on the outlying districis. The average distance travelled from the maternal residence to the maternity hospital was 9.2 Km for the LBs of the SUS hospitals and 9.9 Km for the non-SUS ones. Higher proportions of mothers with a hight level of schooling (12.8 times), of more than 35 years of age (3.2times) and of births with 7 or more pre-natal medical visits (1.5 times) were found among the LBs of the non-SUS hospitals than among those of the SUS hospitals. The LBs of the SUS hospitals presented higher proportions of adolescent mothers (17.9 times), multiparous mothers (21 times) and vaginal deliveries (5.2 times) than those of the non-SUS ones. There was no statistically significant difference between the respective prevalences of low birth weight and pre-term LBs. Discussion: There is an association between the spatial distribution of the deliveries which occurred in the SUS and the non-SUS hospitals. The clusters of the SUS LBs where situated in districts characterized by precarious living conditions and high fertility rates. The LBs of the non-SUS hospitals formed a cluster in the central region, of high income and low fertility, in agreement with the pattern observed in other studies. The average distances between the maternal residences and the hospitals were near the two types of network. The differentials of the maternal characteristics of the LBs in SUS and non-SUS hospitals were more accentuated than those found in studies with georeferencing techniques alone, possibly as a result of the non-SUS hospitals studied attending to a clientele of high acquisitive power, with health insurance plans. The lack of any statistically significant difference between the prevalence of pre-term births and low birth weight is possibly due to this study\'s having been performed in hospitals of high complexity. The difference found in the frequency of pre-natal visits shows the positive effect of the SUS in terms of access to pre-natal attendance. Conclusion: The clusters of SUS and non-SUS showed there marked differences in sociodemographic characteristics. SUS has shown a positive effect in the promotion of greater equity in terms of access to pre-natal care and child birth

Opioid analgesics are commonly used to treat acute and chronic pain; in 2016 alone, more than 60 million patients had at least 1 prescription for opioid analgesics filled or refilled. Despite the ubiquitous use of these agents, the effectiveness of long-term use of opioids for chronic noncancer pain management is questionable, yet links among long-term use, addiction, and overdose deaths are well established. Because of overprescribing and misuse, an opioid epidemic has developed in the United States. The health and economic burdens of opioid abuse on individuals, their families, and society are substantial. Part 1 of this supplement will provide a background on the burden of pain and the impact of opioid abuse on individuals, their families, and society; the attempts to remedy this burden through prescription opioid use; and the eventual downward spiral into the current opioid epidemic, including an overview of opioid analgesics and opioid use disorder and the rise in opioid-related deaths

The mental health of healthcare workers during the Ebola outbreak in West Africa was a serious concern for healthcare professionals and the mental health field. One area in West Africa where healthcare workers played a significant role during the Ebola outbreak of 2014 and 2015 was Sierra Leone. This qualitative research study was designed to explore the perceptions of Sierra Leoneans healthcare workers' mental health, how they coped, and treatment they received while providing care for Ebola virus patients. This study, with a phenomenological research approach, used purposeful sampling to recruit 10 healthcare workers to participate in semi structured, open-ended interviews. The stress theory model and a hermeneutic phenomenology conceptual framework were used as a lens of analysis to understand the views of healthcare workers who worked directly with Ebola virus patients in Freetown, Sierra Leone. The results of the analysis of the collected data produced 9 major themes. The major themes suggest that healthcare workers experienced mental health symptoms such as depression and anxiety, personal thoughts and feelings such as insomnia, and suicidal ideation. Strategies for coping included using the Bible; and the detrimental impact included facing discrimination after the Ebola outbreak. Most of the healthcare workers blame the government for not providing adequate coping resources, which led to the personal consequence of hopelessness. This study may benefit mental health professionals working in an epidemic. Additionally, this study may contribute to social change by providing a deeper understanding of the mental health system and healthcare workers in Freetown, Sierra Leone.

<p><strong>Bakgrund:</strong> Den svenska hälso- och sjukvården står idag inför en mängd problem som kommer att förvärras i framtiden. Ökande kostnader, bristande tillgänglighet och växande förväntningar från medborgarna är några av problemen som måste lösas. För att möta dessa problem måste den svenska hälso- och sjukvården förändra sig, något som de historiskt har haft svårigheter med. I andra länder har man använt sig av designtänkande för att förändra sig, med goda resultat. </p><p><strong>Problem:</strong> Vilka faktorer är viktiga för att man ska kunna lösa upp det organisatoriska motståndet mot förändring inom den svenska hälso- och sjukvården? </p><p><strong>Syfte:</strong> Syftet med denna undersökning är att analysera och utvärdera designtänkande som hjälpmedel för förändring av hälso- och sjukvårdsorganisationen. </p><p><strong>Metod:</strong> Undersökningen är kvalitativ och består av en jämförelse mellan förändringsarbeten som genomförts med respektive utan designtänkande. </p><p><strong>Teorier:</strong> Professionsbyråkrati, dominerande idéer och företagets kultur, förändringsanalys, designtänkande och värdestjärnan. </p><p><strong>Empiri:</strong> 17 kvalitativa intervjuer med anställda vid tre sjukhus (Karolinska sjukhuset, S:t Görans sjukhus AB och Mälarsjukhuset) samt tre intervjuer med industridesigners som har genomfört förändringsarbete inom sjukvården. </p><p><strong>Analys:</strong> Analysen är uppdelad i två delar. Först analyserar författarna de förändringsarbeten som har genomförts utan designtänkande följt av en analys av de förändringsarbeten som genomförts med designtänkande. Variabler som är centrala för analysen är; motstånd vid förändring, förankring och involvering. </p><p><strong>Resultat:</strong> Denna undersökning visar att designtänkande är ett utmärkt hjälpmedel för förändring eftersom det är en användarfokuserad och involverande metod som baseras på goda faktaunderlag. Genom att ta in designkompetens utifrån kan hälso- och sjukvården få en bättre helhetssyn av sin egen verksamhet och få hjälp att lösa problem som de ännu inte lyckats lösa själva. </p><p><strong>Slutsats:</strong> De faktorer som är viktiga för att man ska kunna lösa upp det organisatoriska motståndet mot förändring inom den svenska hälso- och sjukvården är att beslutsfattarna närmar sig verksamheten, att man tillför resurser, att förändringar är bättre förankrade i verksamheten och involverar de anställda samt att man tar in kompetens utifrån som kan skapa en samverkan mellan de avdelningar och vårdinstanser som idag inte samarbetar.</p> / <p><strong>Background:</strong> Swedish healthcare is facing a number of problems that will only get worse in the future. Increasing costs, lack of accessibility and growing expactasions from citizens are just some of the problems. The Swedish healthcare system has to change, something that they, from a historical point of view, have had great difficulties with. In other countries design thinking has been a succesful method for change. </p><p><strong>Problem:</strong> Which factors are essential to disolve the organizational resistance to change in Swedish healthcare? </p><p><strong>Objective:</strong> The objective of this study is to analyse and evaluate the design thinking as a method for change in Swedish healthcare. </p><p><strong>Method:</strong> This study uses a cualitative method and compares organizational change processes performed with and without design thinking. </p><p><strong>Theories:</strong> Professional bureaucracy, dominating ideas and company culture, change analysis, design thinking and value star. </p><p><strong>Empiric:</strong> 17 qualitative interviews with employes at three different hospital (Karolinska hospital, S:t Görans hospital AB and Mälarsjukhuset) and three interviews with industrial designers who’ve worked with design thinking and service design within the Swedish healthcare system. </p><p><strong>Analysis:</strong> The analysis consists of two parts. First the authors analyse organizational change processes without design thinking as a method followed by an analysis of organizational change processes with design thinking as a method. Variables that are central for the analysis are; resistance to change, the anchoring of change in the organization and involvement. </p><p><strong>Result:</strong> This paper shows that design thinking is a good method for change in healthcare because it is a user oriented, involving and fact based method. By bringing in design skills from outside the organisation, Swedish healthcare can gain an improved holistic view of its operations and get the help they need to solve the problems that they have yet to solve on their own. </p><p><strong>Conclusion:</strong> Factors that are essential to disolve the organizational resistance to change in Swedish healthcare is that the decision makers must get closer to the organization floor, more resources, better anchored changes processes, involvement of the staff and seeking help outside of the organization to create collaboration between divisions.</p>

Bakgrund: Den svenska hälso- och sjukvården står idag inför en mängd problem som kommer att förvärras i framtiden. Ökande kostnader, bristande tillgänglighet och växande förväntningar från medborgarna är några av problemen som måste lösas. För att möta dessa problem måste den svenska hälso- och sjukvården förändra sig, något som de historiskt har haft svårigheter med. I andra länder har man använt sig av designtänkande för att förändra sig, med goda resultat.  Problem: Vilka faktorer är viktiga för att man ska kunna lösa upp det organisatoriska motståndet mot förändring inom den svenska hälso- och sjukvården?  Syfte: Syftet med denna undersökning är att analysera och utvärdera designtänkande som hjälpmedel för förändring av hälso- och sjukvårdsorganisationen.  Metod: Undersökningen är kvalitativ och består av en jämförelse mellan förändringsarbeten som genomförts med respektive utan designtänkande.  Teorier: Professionsbyråkrati, dominerande idéer och företagets kultur, förändringsanalys, designtänkande och värdestjärnan.  Empiri: 17 kvalitativa intervjuer med anställda vid tre sjukhus (Karolinska sjukhuset, S:t Görans sjukhus AB och Mälarsjukhuset) samt tre intervjuer med industridesigners som har genomfört förändringsarbete inom sjukvården.  Analys: Analysen är uppdelad i två delar. Först analyserar författarna de förändringsarbeten som har genomförts utan designtänkande följt av en analys av de förändringsarbeten som genomförts med designtänkande. Variabler som är centrala för analysen är; motstånd vid förändring, förankring och involvering.  Resultat: Denna undersökning visar att designtänkande är ett utmärkt hjälpmedel för förändring eftersom det är en användarfokuserad och involverande metod som baseras på goda faktaunderlag. Genom att ta in designkompetens utifrån kan hälso- och sjukvården få en bättre helhetssyn av sin egen verksamhet och få hjälp att lösa problem som de ännu inte lyckats lösa själva.  Slutsats: De faktorer som är viktiga för att man ska kunna lösa upp det organisatoriska motståndet mot förändring inom den svenska hälso- och sjukvården är att beslutsfattarna närmar sig verksamheten, att man tillför resurser, att förändringar är bättre förankrade i verksamheten och involverar de anställda samt att man tar in kompetens utifrån som kan skapa en samverkan mellan de avdelningar och vårdinstanser som idag inte samarbetar. / Background: Swedish healthcare is facing a number of problems that will only get worse in the future. Increasing costs, lack of accessibility and growing expactasions from citizens are just some of the problems. The Swedish healthcare system has to change, something that they, from a historical point of view, have had great difficulties with. In other countries design thinking has been a succesful method for change.  Problem: Which factors are essential to disolve the organizational resistance to change in Swedish healthcare?  Objective: The objective of this study is to analyse and evaluate the design thinking as a method for change in Swedish healthcare.  Method: This study uses a cualitative method and compares organizational change processes performed with and without design thinking.  Theories: Professional bureaucracy, dominating ideas and company culture, change analysis, design thinking and value star.  Empiric: 17 qualitative interviews with employes at three different hospital (Karolinska hospital, S:t Görans hospital AB and Mälarsjukhuset) and three interviews with industrial designers who’ve worked with design thinking and service design within the Swedish healthcare system.  Analysis: The analysis consists of two parts. First the authors analyse organizational change processes without design thinking as a method followed by an analysis of organizational change processes with design thinking as a method. Variables that are central for the analysis are; resistance to change, the anchoring of change in the organization and involvement.  Result: This paper shows that design thinking is a good method for change in healthcare because it is a user oriented, involving and fact based method. By bringing in design skills from outside the organisation, Swedish healthcare can gain an improved holistic view of its operations and get the help they need to solve the problems that they have yet to solve on their own.  Conclusion: Factors that are essential to disolve the organizational resistance to change in Swedish healthcare is that the decision makers must get closer to the organization floor, more resources, better anchored changes processes, involvement of the staff and seeking help outside of the organization to create collaboration between divisions.

The relationship between the Socialist Unity Party [SED] and the medical intelligentsia in the German Democratic Republic [GDR] has often been described as one of the most problem-atic for the Republic‟s political vanguard. This thesis discusses this relationship for the two dec-ades after the erection of the Berlin Wall in 1961. With the inability of East German workers to leave for West Germany after this event, the GDR was able to enforce their programme of so-cialist development in a new way. Doctors, despite being crucial for this socialist society and its legitimacy, were not excluded from the state‟s radical new policies. However, as files from the former state security apparatus, party and trade union make obvious, doctors were very success-ful in preventing both the ideological conditioning of their community and state interference in the composition of the medical elite. With the examination of the every-day life of the medical intelligentsia, especially in East German hospitals, this thesis contributes to the discussion about the difference between the claims of the socialist party and the realities faced in the healthcare sector. There were a variety of complex reasons for the increasing distance between the state‟s claim and reality, many of which will be analysed in the course of this work. This analysis is, em-bedded in a historical approach, outlined mainly by Mary Fulbrook, which sets the micro-level in the context of the macro-level, considering the correlation between the claim and ideology of the SED, their communication, mechanisms and policies reaching the boundaries of the social con-glomerate of doctors, as well as their reactions, career aspirations and pre-conditions. For the seventies, a whole section is dedicated to exploring the reasons that the medical intelligentsia was one of the main-clients of so-called „human trafficking gangs‟, enabling insight into their situa-tion and the attitude towards the socialist state, which led them to „vote with their feet‟. This the-sis demonstrates, especially for the sixties and seventies, that there is still much potential for fur-ther research, in to the case of the most ideologically unreliable social group in the GDR: the medical intelligentsia.