Introdução: A atual mudança do perfil etário da população brasileira tem afetado a dinâmica dos sistemas de saúde, sociais, econômicos e políticos existentes, indicando a necessidade da articulação entre esses setores e o fortalecimento de políticas que proporcionem situação de independência aos idosos. Assim, a atenção primária vem sendo considerada uma importante estratégia, devendo apresentar acessibilidade e adaptação às necessidades dos idosos. Objetivos: Compreender a percepção de idosos atendidos em uma Unidade de Estratégia de Saúde da Família, do Município de São Paulo, acerca do processo de envelhecimento e conhecer as necessidades de saúde autorreferidas por esse grupo social. Percurso metodológico: Estudo qualitativo de abordagem etnográfica, cujo cenário cultural foi uma Unidade de Estratégia de Saúde da Família (ESF). Os participantes foram dez idosos atendidos na referida ESF. Os dados foram coletados por meio de entrevistas e da observação participante, no período de junho de 2015 a janeiro de 2016. Os achados foram apresentados na forma de narrativa e analisados segundo Minayo e à luz do referencial teórico da Resiliência e do Envelhecimento Ativo. Resultados: Das narrativas emergiram cinco categorias culturais, a saber: a percepção do envelhecimento e da velhice; a violência ao idoso; o ostracismo social; o acesso aos serviços de saúde e social: fatores dificultadores; a avaliação da ESF. A percepção do envelhecimento esteve associada à diminuição da capacidade funcional e às limitações físicas e cognitivas. Esse processo remeteu aos idosos a consciência da finitude e do luto antecipado, que afetou a perspectiva de vida desestimulando a realização de ações que proporcionassem bem-estar. Os discursos apresentaram, ainda, a problemática da violência por meio de abuso financeiro e abandono de familiares e dos setores formais, favorecendo o sentimento de solidão e de improdutividade. Esses componentes destacaram os fatores de riscos que interferiram no processo de resiliência, como a falta de acesso aos recursos necessários para o suprimento das necessidades sociais e de saúde, impossibilitando a continuidade de cuidado e a piora do quadro clínico. Considerações finais: O estudo permitiu identificar a percepção e as necessidades sociais e de saúde dos idosos. A falta de acesso aos serviços afetou a dinâmica social e familiar, a saúde e o bem-estar dos participantes. Assim, os serviços de atenção aos idosos precisam atuar diretamente sobre os determinantes que favorecem o Envelhecimento Ativo, por meio de ações que potencializem o bem-estar físico, social e mental ao longo de toda a vida. / Introduction: The change of population age profile in Brazil influences the dynamics of existing systems such as health, social, economic and political, suggesting the need for articulation between services and strengthening of policies that provide independence of the elderly. The primary health care is an important resource and must present accessibility and adaptation to the elder`s needs. Objective: Understanding the perception of aging process, of elderly treated in Family Health Strategy Service of São Paulo city and to know the health needs self-reported by this social group. Methods: Qualitative study using an ethnographic approach, focusing on the cultural scenario of the Family Health Strategy Unit (FHS). The participants in this study were ten elders treated in FHS. The data collection were done from June 2015 to January 2016. Was taken from narratives and analyzed according to Minayo, resilience theory and Active Aging. Findings: The following five cultural categories emerged from the narratives: perception about aging and oldness; the health and social services accessibility: difficulty factors; the elder abuse; the social ostracism; health and social services accessibility; FHS assessment. The perception of aging was associated with decreased functional capacity and physical and cognitive limitations. This process referred the elderly to awareness of finitude and anticipated mourning, which affected the prospect of life discouraging the realization of actions that provided welfare. The narrative presented the problem of violence through financial abuse, family neglect and formal sectors, favoring the feeling of abandonment, of loneliness and lack of productivity. These components highlighted the risk factors that interfere with the resilience process, such as lack of accessibility to the resources needed for the supply of social and health needs, preventing the continuity of care and the worsening of clinical symptoms. Final considerations: This study provided the perception, the social and health needs of the elderly. Lack of accessibility to services affected the social and family dynamics, health and welfare of participants. Care services for the elderly needs to act directly on the determinants that promote Active Aging, through actions that enhance the physical, social and mental well-being throughout life.

The aim of this Master’s thesis is to create marketing plan for private eye office. The thesis is divided into two main parts, theretical and practical. The first part summarizes theoretical knowledge about marketing of services and specifics in healt care marketing. It was created marketing mix 4P and 4C of health care. Practical part begins of introducing of private eye office. Next step is to analyze environment of eye office using following methods: McKinsey 7S, Porter's five forces and SLEPT analysis. Conclusions of these analyses are summarized in SWOT analysis. Afterwards each question of questionnaire survey – focused on client´s comfort and ways how to improve it, is analyzed. Results and ideas come from survey how to improve our clients comfort during the examination are summarized in the proposed solutions and discussion.

Contexte L'importance des stratégies nationales d'amélioration de la qualité est de plus en plus reconnue par les décideurs politiques des systèmes de santé et par les organisations internationales telles que l'OMS, l'OCDE et la Banque mondiale. À la suite de leur questionnement sur la manière de gérer l'amélioration systémique de la qualité, certains pays de l'OCDE, comme l'Allemagne, le Royaume-Uni, la France, le Canada, etc. ont stratégiquement adopté la stratégie systémique appelée « agence d'appui à l'amélioration de la qualité des soins et des services de santé ». Elle repose notamment sur des approches centrées sur le patient/usager et sur la collaboration des parties prenantes et encourage, entre autres, l'amélioration de la qualité à tous les niveaux de changement dans une juridiction : individuel, équipe, organisationnel et systémique, en assurant la cohérence de toutes les autres stratégies de la qualité. Cette thèse vise à examiner comment les stratégies nationales ont été façonnées dans certaines juridictions dans le monde et ensuite, en sélectionnant différentes juridictions ayant implanté une telle stratégie, elle en étudie deux cas en profondeur. Méthodes Dans un premier temps, une étude comparative en ligne des pratiques internationales de 13 juridictions de différentes régions du monde, sélectionnées selon un choix raisonné, a été réalisée. Cette étude s’est basée sur les sept principales fonctions de gestion de la qualité des soins et des services de santé dans une juridiction, proposées après avoir mobilisé plusieurs cadres dont le cadre d’action de l’OMS, et sur les indicateurs de qualité des soins, mis à disposition par l'OCDE sur son site Internet. Ensuite, deux agences de deux juridictions différentes, classées dans chacun des deux modèles proposés dans la première phase de la recherche, ont été sélectionnées afin de les étudier de manière approfondie en mobilisant un modèle d'analyse systémique. Il s'agit de la Haute autorité de santé (HAS) en France et de l'Institut national d'excellence en santé et services sociaux (INESSS) au Québec. Avec une approche déductive, dans le cadre d'une analyse d'implantation du type 2 et d’une approche inductive dans le cadre du type 3, plusieurs sources de données : une recherche documentaire approfondie, des entretiens semi-structurés, un groupe de discussion, et une observation ont été utilisées de manière itérative pour réaliser ce travail. Toutes les données ont été traitées et analysées de manière confidentielle à l'aide du logiciel QDA Miner 6.0.2 et validées par chaque agence étudiée. Résultats Les résultats du premier article ont révélé que les pays faisant partie du modèle 1 de notre taxonomie se classaient mieux pour la qualité des soins de santé avec, par exemple, 100 % (en Suède) à 21 % (en Allemagne) des principales fonctions de gestion de la qualité assurées par le "ministère de la Santé" et la plupart des fonctions modérément, voire pas du tout, concentrées dans une seule organisation. Parmi les deux agences contrastées étudiées, les résultats montrent que la HAS a un éventail d'activités plus large et que l'INESSS est plus concentré sur l’évaluation des médicaments, technologies et modes d’intervention en santé. Les résultats du second article ont, en effet, montré que ces deux agences d’appui à l’amélioration de la qualité disposent d'une autonomie relative et que chacune a eu un impact sur l'amélioration de la qualité des soins et des services dans les milieux de pratique de sa juridiction. Enfin, les résultats du troisième article ont fait ressortir deux grands groupes de facteurs contextuels : ceux liés au contexte interne des agences et ceux liés à leur environnement externe pouvant influencer les effets perçus de cette stratégie. Conclusion Cette recherche empirique internationale sur les stratégies systémiques d'amélioration de la qualité est l'une des premières. Elle vient enrichir la compréhension des différentes stratégies systémiques dans les juridictions et produit des connaissances aussi bien pour la pratique que pour la recherche. Nos conclusions peuvent être utilisées, non seulement, pour optimiser cette stratégie dans les juridictions que nous avons étudiées (France et Québec), mais aussi dans d'autres juridictions qui les ont également implantées. En outre, elles peuvent être utiles et inspirantes, à la fois, pour des pays développés, émergents et en développement qui n'ont pas encore implanté ce type de stratégie systémique. / Background The importance of national quality improvement strategies is increasingly recognized by policymakers in health systems and by international organizations such as the WHO, the OECD, and the World Bank. Following their questioning of how to manage the systemic quality improvement, some OECD countries, such as Germany, England, France, and Canada, etc. have strategically adopted the systemic strategy referred as the “Quality Improvement Support Agency for Health Care and Services (QISA)”. It is based on patient/user-centered approaches and stakeholder collaboration and promotes, among other things, quality improvement at all levels of change within a jurisdiction: individual, team, organizational and systemic by ensuring consistency across all quality strategies. This thesis aims to examine how national strategies have been shaped in some jurisdictions around the world and then, by selecting different jurisdictions that have implemented such a strategy, it studies two cases in depth. Methods First, an online comparative study of international practices in 13 jurisdictions in different regions of the world, selected according to a reasoned choice, was conducted. The study was based on the seven key health care and services quality management functions in a jurisdiction, proposed after mobilizing several frameworks, including the WHO's framework for action, and on the quality-of-care indicators made available by the OECD on its website. Next, two QISAs from different jurisdictions, classified in each of the two models proposed in the first phase of the research, were selected for in depth study with the mobilization of a systemic analysis model. These were the Haute autorité de santé (HAS) in France and the Institut national d'excellence en santé et services sociaux (INESSS) in Québec. Using a deductive approach in a type 2 implementation analysis and an inductive approach in the context of type 3, several sources of data: an extensive documentary research, semi-structured interviews, a focus group, and an observation were used in an iterative manner to complete this work. All data were processed and confidentially analyzed using QDA Miner 6.0.2 software. Finally, in a historical approach, a narrative was produced for each of the QISAs studied and validated by each studied. Results The results of the first article revealed that countries that are part of model 1 of our taxonomy ranked better for quality of care with, for example, 100% (in Sweden) to 21% (in Germany) of the key health care and services quality management functions performed by the "Ministry of Health" and most of the functions moderately, or not at all, concentrated in a single organization. Of the two contrasting QISAs studied, the results showed that the HAS has a broader range of activities and the INESSS is more focused on the assessment of drugs, technologies, and health interventions. The results of the second article showed that both have relative autonomy, and that each had an impact on improving the quality of care and services in the practice settings in its jurisdiction. Finally, the results of the third article highlight two main groups of contextual factors: those related to the internal context of the QISAs and those related to their external environment that can influence the perceived effects of this systemic strategy. Conclusion This international empirical research on systemic quality improvement strategies is one of the first. It adds to the understanding of different systemic strategies across jurisdictions and generates knowledge for both practice and research. Our conclusions can be used to optimize this strategy in the jurisdictions we studied (France and Québec), but also in other jurisdictions that have implemented them. Moreover, they can be useful and inspiring for developed, emerging, and developing countries that have not yet implemented this type of systemic strategy.

Les iniquités de santé vécues par les communautés autochtones sont des conséquences visibles des déterminants structurels de la santé, tels que le racisme systémique et le colonialisme. En 2021, une enquête auprès des Inuit du Nunavik, a révélé un manque de confiance envers les professionnels de la santé et des services non culturellement sécuritaires. Les infirmières en première ligne sont les piliers du système de soins nordiques. Cette étude avait pour but d’explorer la perspective d’infirmières de première ligne sur la prestation de soins et services promouvant l’équité exerçant auprès des communautés Inuit du Nunavik. Une perspective critique postcoloniale ainsi qu’un devis descriptif interprétatif (Thorne, 2016) ont été utilisés. Le cadre théorique développé par Browne et al. (2018) s’intitulant Key Dimensions of Equity-Oriented Health Care and Strategies to Guide Implementation a guidé cette étude. Au total, 10 infirmières et infirmiers de première ligne exerçant au Nunavik ont participé à des entrevues individuelles semi-structurées. Une analyse thématique des données (Braun et Clarke, 2006) a été effectuée. Les résultats ont permis d’identifier une conception fluide des soins et services promouvant l'équité, passant d’une perspective égalitaire à critique. Cette conception façonne de manière significative la perception du contexte nordique colonial, du système de santé et de l’approche de soins infirmiers. L'un des principaux défis exprimés par les infirmières concerne l'indifférence des systèmes de santé aux priorités des communautés. Des actions locales sont priorisées pour surmonter ce défi. Des pistes d’améliorations, telles que le développement d’une conscience critique sont décrites. / Health inequities experienced by Indigenous communities are visible consequences of structural determinants of health, such as systemic racism and colonialism. In 2021, a survey of Inuit in Nunavik revealed a lack of trust in health care professionals and culturally unsafe services. Primary care nurses (RNs) are the backbone of the northern health care system. The purpose of this study was to explore equity-oriented care and services from the perspectives of primary care RNs working in Nunavik Inuit communities. A critical postcolonial perspective (Anderson et al., 2009) and an interpretive descriptive design (Thorne, 2016) were used. The Key Dimensions of Equity-Oriented Health Care and Strategies to Guide Implementation (Browne et al., 2018) theoretical framework guided the study. Semi-structured interviews were conducted with ten primary care RNs working in Nunavik. The data was analyzed thematically (Braun & Clarke, 2006). The findings identified a fluid conceptualization of equity-oriented care and services, ranging from egalitarian to critical perspectives. This conception significantly shapes nurses' perceptions of the northern colonial context, the health system, and the nursing care approach. One of the main challenges expressed by nurses is the indifference of health systems to community priorities. Local actions are prioritized to overcome this challenge. Pathways of change, such as the development of critical consciousness, are described.