Ce travail de recherche a été motivé par la volonté de comprendre en profondeur le changement dans les organisations, l’importance et l’impact des compétences sur le changement dans le secteur hospitalier, en particulier dans une institution de santé du Yucatán. L’intention de l’étude est de provoquer une transformation de la situation actuelle telle que je lai expérimentée comme auteur, que l’on trouve aussi dans bien d’autres organisations, par rapport à la façon de se confronter au changement et pour comprendre comment les compétences contribuent à la réalisation des objectifs d'une organisation donnée. Ce travail essaie également de montrer comment la transformation mentionnée affecte les organisations, notamment en ce qui concerne les facteurs de résistance au changement et les situations qui sont la cause de ces transformations. L’étude montre comment s’acquièrent les compétences dans une organisation de santé (étude de cas), et montre quelles sont les compétences qui encouragent le changement et l'innovation dans un établissement de santé au Mexique. Enfin, des recommandations et suggestions sont proposées pour améliorer la performance de l'organisation (cas étudié). Pour réaliser cette recherche, une investigation-action a été réalisée (méthodologie où l’auteur est impliqué directement), à partir de techniques comme l'observation participante, la triangulation d’information et l'étude de cas. Cette recherche et ses résultats ont comme finalité de devenir un socle pour de futures recherches qui vont permettre d’établir un modèle pour le développement des compétences destinées à promouvoir le changement et l'innovation dans une organisation hospitalière (étude de cas). / This investigation was motivated by the interest of understanding change processes in organizations and the way in which competencies affect the health sector, particularly a hospital in Yucatan. This work had the intention of modifying the actual situation that I have experimented as an author and that actually exist in organizations about how to better face change and how competencies contribute to the achievement of the organization goals. At the same time, this work seeks to demonstrate how change affects organizations regarding resistance to change factors and the situations that provoke change processes. We also show how competencies may be learnt in a health institution (case study) and we define the competencies that propitiate change and innovation in a concrete health institution in Yucatan. Last, recommendations and suggestions are proposed in order to improve the performance of the organization. For this research work, investigation-action was used, as well as techniques like participative observation, data triangulation and case study. This investigation work and its results should be used in future investigation works as a basis for designing a model for competencies development that promote change and innovation in a health institution (case study).

O presente trabalho teve como objetivo conhecer de que modo as instituições públicas de saúde possibilitam às mulheres fazerem escolhas relacionadas à gestação e, principalmente, aos procedimentos ligados ao parto. Para tanto, realizamos levantamento bibliográfico e de documentos governamentais sobre gravidez e parto; realizamos visitas em um hospital-escola-maternidade, no período de nove meses, onde pudemos observar a rotina, realizar entrevistas, coordenar grupos, conhecer o espaço físico e o funcionamento de regras específicas dessa instituição Para fundamentar nossa investigação buscamos suporte na Psicologia Social, postulada por Enrique Pichon-Rivière a partir da leitura de José Bleger, e no campo da Saúde Coletiva. Constatamos que parte significativa das reivindicações iniciadas a partir de 1980, para um olhar voltado à saúde integral da mulher e à humanização do parto, foram contempladas, principalmente no que se refere aos aspectos legislativos. Contudo, tendo em vista a dinâmica do processo histórico, as reivindicações, ao serem efetivadas na prática, fomentaram novas questões. Uma delas é a de uma aparente burocratização e redução do que se entendia do conceito de humanização, pois em muitas situações esse ficava restrito à forma e ao momento do nascimento, colocando como sinônimos: parto normal e parto humanizado. Além disso, as mulheres não participavam diretamente na escolha de tais procedimentos. Tais decisões eram institucionais e tomadas a partir do que o corpo dela manifestasse. Desse modo, se é a assistência quem define as ações, parece que o lugar da mulher nesta relação é deslocado para o de objeto, e aí sim, o termo humanização, no sentido de relações entre humanos, precisaria ser efetivado, evitando o reducionismo referido acima. Se assim fosse praticado, as mulheres poderiam entrar na relação como capazes de fazer escolhas. Disso, temos como aposta que, para trabalhar com humanização, é importante considerar: 1) a amplitude do processo gestacional, 2) a imprevisibilidade do sujeito e, 3) flexibilização dos protocolos; senão, além, da violência obstétrica, poderíamos pensar na violência pseudo humanizada, ou seja, a tentativa de cumprir de forma enrijecida o que está no papel, se distanciando das contextualizações e marginalizando quem não esta de acordo com o já esperado / The aim of this study was to understand the way in which public health institutions give the women the possibility to make choices related to the gestation and, mainly to the procedures related to the parturition. Therefore, it was realized a bibliographic and government documents survey about pregnancy and parturition; it was realized visits in a school maternity hospital, for a period of eight months, where we could observe the routine, realize interviews, coordinate groups, get to know the physical space and the specific rules operation of this institution. To support this investigation we took reference to Social Psychology postulated by Enrique Pichon-Rivière starting by the reading of José Bleger and in the field of Collective Health. We found that a significant part of the claims that started in 1980, which had a view to the woman integration health and the parturition humanization were contemplated, mainly to what refer to the legislative aspects. However, considering the dynamic of the historic process, the claims, to be effective in practice, fomented new questions. One of them is an apparent bureaucratization and reduction of what was understood as the humanization concept, because in many situations this was restricted to the way and the moment of the birth, having as synonymies: normal birth and humanized birth. In addition to this, the women did not directly participated in the choice of these procedures. That decisions was institutionally and taken from what their body manifested. In this way, if it is the assistance, which define the actions, it seems that the woman place in this relation is displaced to the object, and then, the term humanization, in the sense of relation among humans, should have been effected, avoiding the reductionism referred above. In being practiced like mentioned above, the women should take part in the relation as capable of doing choices. Considering this, we have as a bet that, to work with humanization is important to consider: 1) the amplitude of the gestational process, 2) the unpredictability of the subject and 3) flexibility of the protocols; or else, beyond the obstetric violence, we should think about the pseudo humanized violence, in other words, the attempt to accomplish in a hardened form what is in the paper, getting away from the contextualization and marginalizing who is not in agreement with what is expected\"

Nossa pesquisa visa problematizar o dispositivo de grupo a partir da psicanálise lacaniana. A questão da qual partimos foi: Se a psicanálise aponta para o singular do sujeito, como trabalhar com dispositivos de grupos sem dissolvê-las num universal? Num primeiro momento, mapeamos alguns elementos históricos do surgimento da noção de grupo. Extraímos daí que tal noção nasce concomitantemente à noção de indivíduo, ambos tomados como totalidades. A psicanálise, por sua vez, não parte do indivíduo, pois tem como fundamento e horizonte de intervenção o sujeito, de forma que o dispositivo de grupo também deve levá-lo em conta. Na sequência, o tema grupo é investigado nas obras de S. Freud, W. R. Bion, E. Pichon-Rivière, J. Lacan procurando extrair-lhes uma lógica coletiva. A partir de Freud, temos um esquema no qual a tendência do grupo é fazer massa, identificando-se ao mesmo tempo verticalmente sob uma insígnia do mestre colocado como Ideal do Eu, e horizontalmente entre os sujeitos a partir do Eu, tendendo a apagar suas singularidades através de um grupo imaginariamente completo. Com isso, vemos a questão da identificação se tornar um problema central na questão dos grupos. Assim procuramos elementos que pudessem nos auxiliar para que o grupo não ceda aos efeitos imaginários. Frente a isso, Bion trouxe uma primeira contribuição do grupo sem líder, para quem o analista não atua do lugar de líder, trazendo a importante ideia de descompletar o grupo; Pichon, por sua vez, traz a ideia de interdependência dos sujeitos afirmando uma lógica coletiva, uma vez que os sujeitos não são mônadas isoladas. Na sequência, foi importante o recurso ao dispositivo de cartel, órgão de base da Escola lacaniana, o qual aponta para um grupo não completo, dado que a função do +1 é justamente descompletar o grupo a fim de mitigar seus efeitos imaginários. Nosso próximo passo foi abordamos os efeitos de sujeito - em oposição aos efeitos imaginários - a partir do recurso de vinhetas clínicas de atendimentos de grupos em articulação à contribuição lacaniana da sua tríade Imaginário, Simbólico e Real. A consideração desses três registros apontou para outro modo de universalizar um grupo como prescindindo do significante, uma vez que o que Lacan denominou como objeto a escapa às suas determinações simbólicas e imaginárias em suas tendências identificatórias e homogeneizantes. Extraída tal lógica coletiva, apontamos que o analista num grupo tem sua função ancorada no objeto a. Além disso, o analista deve considerar os efeitos da fala que os sujeitos têm entre si, visto que a transferência circula entre os sujeitos. Uma vez que os sujeitos em grupo tendem a responder às demandas um do outro, concluímos que é importante ao psicanalista fazer circular a palavra, de modo a manter a significação aberta, para que ninguém venha a ocupar o lugar de Ideal do Eu. Por fim oferecemos um quadro de leitura das experiências ambivalentes de grupo: como experiências produtivas (de determinação e indeterminação), mas também improdutivas (de indeterminação e determinação). Finalmente, concluímos que o dispositivo de grupo pode ser um importante dispositivo de intervenção clínica, ética e política para o campo da Saúde / This research aims to problematize the device group from Lacanian psychoanalysis. The question with which we started was: If psychoanalysis points to the singular subject, how to work with groups devices without dissolving them in a universal? Initially, we mapped some historical elements of the emergence of the notion of group. We extracted from this that such notion is born simultaneously with the notion of the individual, both taken as totalities. Psychoanalysis, in turn, does not arise from the individual, because it is based and has as intervention goal the subject, so that the device group should also take it into account. Subsequently, the group theme is investigated in the works of S. Freud, Bion, E. Pichon-Rivière J. Lacan seeking to extract from them a collective logic. From Freud, we have a scheme in which the tendency of the group is to make dough, identifying both vertically under a master insignia placed as the Ideal Self, and horizontally among subjects starting from themselves, tending to erase their singularities through an imaginary whole group. Therewith, we see the issue of identification become a central point in the matter of groups. Thus we seek elements that could help us so that the group does not give in to imaginary effects. Faced with this, Bion brought a first contribution of the \"leaderless group\", to which the analyst does not act in the place of leader, bringing the important idea of not to complete the group; Pichon, in turn, brings the idea of interdependence of individuals stating a collective logic, since the subjects are not isolated monads. Thereafter, it was important to make use of the cartel device, organ base of Lacanian School, which points to a not complete group, since the function of the +1 is precisely not complete the group in order to mitigate its imaginary effects. Our next step was to approach the \"effects of subjects\" - as opposed to imaginary effects - from the use of clinical vignettes used on groups treatment in articulating their contribution to the Lacanian triad Imaginary, Symbolic and Real. The consideration of these three records, pointed to another way of universalizing a group as waiving significant, since what Lacan has termed as escape object to their symbolic and imaginary determinations in its identificatory and homogenizing trends. Extracted such collective logic, it is possible to indicate that, in a group, the analyst has his role anchored in the object. In addition, the analyst must consider the effects of speech that individuals have with each other, since the transfer circulates between subjects. Since the subjects in groups tend to respond to each other demands, we conclude that it\'s important the psychoanalyst to circulate the word, in a way to keep an open meaning, so no one will take the place of the Ideal I. Finally we provide a reading framework for the ambivalent group experiences: as productive experiences (determination and indeterminacy) but also unproductive (of indeterminacy and determination). Lastly, we conclude that the group device can be an important tool for clinical policy in the field of health care intervention and ethics

O presente trabalho teve como objetivo conhecer de que modo as instituições públicas de saúde possibilitam às mulheres fazerem escolhas relacionadas à gestação e, principalmente, aos procedimentos ligados ao parto. Para tanto, realizamos levantamento bibliográfico e de documentos governamentais sobre gravidez e parto; realizamos visitas em um hospital-escola-maternidade, no período de nove meses, onde pudemos observar a rotina, realizar entrevistas, coordenar grupos, conhecer o espaço físico e o funcionamento de regras específicas dessa instituição Para fundamentar nossa investigação buscamos suporte na Psicologia Social, postulada por Enrique Pichon-Rivière a partir da leitura de José Bleger, e no campo da Saúde Coletiva. Constatamos que parte significativa das reivindicações iniciadas a partir de 1980, para um olhar voltado à saúde integral da mulher e à humanização do parto, foram contempladas, principalmente no que se refere aos aspectos legislativos. Contudo, tendo em vista a dinâmica do processo histórico, as reivindicações, ao serem efetivadas na prática, fomentaram novas questões. Uma delas é a de uma aparente burocratização e redução do que se entendia do conceito de humanização, pois em muitas situações esse ficava restrito à forma e ao momento do nascimento, colocando como sinônimos: parto normal e parto humanizado. Além disso, as mulheres não participavam diretamente na escolha de tais procedimentos. Tais decisões eram institucionais e tomadas a partir do que o corpo dela manifestasse. Desse modo, se é a assistência quem define as ações, parece que o lugar da mulher nesta relação é deslocado para o de objeto, e aí sim, o termo humanização, no sentido de relações entre humanos, precisaria ser efetivado, evitando o reducionismo referido acima. Se assim fosse praticado, as mulheres poderiam entrar na relação como capazes de fazer escolhas. Disso, temos como aposta que, para trabalhar com humanização, é importante considerar: 1) a amplitude do processo gestacional, 2) a imprevisibilidade do sujeito e, 3) flexibilização dos protocolos; senão, além, da violência obstétrica, poderíamos pensar na violência pseudo humanizada, ou seja, a tentativa de cumprir de forma enrijecida o que está no papel, se distanciando das contextualizações e marginalizando quem não esta de acordo com o já esperado / The aim of this study was to understand the way in which public health institutions give the women the possibility to make choices related to the gestation and, mainly to the procedures related to the parturition. Therefore, it was realized a bibliographic and government documents survey about pregnancy and parturition; it was realized visits in a school maternity hospital, for a period of eight months, where we could observe the routine, realize interviews, coordinate groups, get to know the physical space and the specific rules operation of this institution. To support this investigation we took reference to Social Psychology postulated by Enrique Pichon-Rivière starting by the reading of José Bleger and in the field of Collective Health. We found that a significant part of the claims that started in 1980, which had a view to the woman integration health and the parturition humanization were contemplated, mainly to what refer to the legislative aspects. However, considering the dynamic of the historic process, the claims, to be effective in practice, fomented new questions. One of them is an apparent bureaucratization and reduction of what was understood as the humanization concept, because in many situations this was restricted to the way and the moment of the birth, having as synonymies: normal birth and humanized birth. In addition to this, the women did not directly participated in the choice of these procedures. That decisions was institutionally and taken from what their body manifested. In this way, if it is the assistance, which define the actions, it seems that the woman place in this relation is displaced to the object, and then, the term humanization, in the sense of relation among humans, should have been effected, avoiding the reductionism referred above. In being practiced like mentioned above, the women should take part in the relation as capable of doing choices. Considering this, we have as a bet that, to work with humanization is important to consider: 1) the amplitude of the gestational process, 2) the unpredictability of the subject and 3) flexibility of the protocols; or else, beyond the obstetric violence, we should think about the pseudo humanized violence, in other words, the attempt to accomplish in a hardened form what is in the paper, getting away from the contextualization and marginalizing who is not in agreement with what is expected\"

Nossa pesquisa visa problematizar o dispositivo de grupo a partir da psicanálise lacaniana. A questão da qual partimos foi: Se a psicanálise aponta para o singular do sujeito, como trabalhar com dispositivos de grupos sem dissolvê-las num universal? Num primeiro momento, mapeamos alguns elementos históricos do surgimento da noção de grupo. Extraímos daí que tal noção nasce concomitantemente à noção de indivíduo, ambos tomados como totalidades. A psicanálise, por sua vez, não parte do indivíduo, pois tem como fundamento e horizonte de intervenção o sujeito, de forma que o dispositivo de grupo também deve levá-lo em conta. Na sequência, o tema grupo é investigado nas obras de S. Freud, W. R. Bion, E. Pichon-Rivière, J. Lacan procurando extrair-lhes uma lógica coletiva. A partir de Freud, temos um esquema no qual a tendência do grupo é fazer massa, identificando-se ao mesmo tempo verticalmente sob uma insígnia do mestre colocado como Ideal do Eu, e horizontalmente entre os sujeitos a partir do Eu, tendendo a apagar suas singularidades através de um grupo imaginariamente completo. Com isso, vemos a questão da identificação se tornar um problema central na questão dos grupos. Assim procuramos elementos que pudessem nos auxiliar para que o grupo não ceda aos efeitos imaginários. Frente a isso, Bion trouxe uma primeira contribuição do grupo sem líder, para quem o analista não atua do lugar de líder, trazendo a importante ideia de descompletar o grupo; Pichon, por sua vez, traz a ideia de interdependência dos sujeitos afirmando uma lógica coletiva, uma vez que os sujeitos não são mônadas isoladas. Na sequência, foi importante o recurso ao dispositivo de cartel, órgão de base da Escola lacaniana, o qual aponta para um grupo não completo, dado que a função do +1 é justamente descompletar o grupo a fim de mitigar seus efeitos imaginários. Nosso próximo passo foi abordamos os efeitos de sujeito - em oposição aos efeitos imaginários - a partir do recurso de vinhetas clínicas de atendimentos de grupos em articulação à contribuição lacaniana da sua tríade Imaginário, Simbólico e Real. A consideração desses três registros apontou para outro modo de universalizar um grupo como prescindindo do significante, uma vez que o que Lacan denominou como objeto a escapa às suas determinações simbólicas e imaginárias em suas tendências identificatórias e homogeneizantes. Extraída tal lógica coletiva, apontamos que o analista num grupo tem sua função ancorada no objeto a. Além disso, o analista deve considerar os efeitos da fala que os sujeitos têm entre si, visto que a transferência circula entre os sujeitos. Uma vez que os sujeitos em grupo tendem a responder às demandas um do outro, concluímos que é importante ao psicanalista fazer circular a palavra, de modo a manter a significação aberta, para que ninguém venha a ocupar o lugar de Ideal do Eu. Por fim oferecemos um quadro de leitura das experiências ambivalentes de grupo: como experiências produtivas (de determinação e indeterminação), mas também improdutivas (de indeterminação e determinação). Finalmente, concluímos que o dispositivo de grupo pode ser um importante dispositivo de intervenção clínica, ética e política para o campo da Saúde / This research aims to problematize the device group from Lacanian psychoanalysis. The question with which we started was: If psychoanalysis points to the singular subject, how to work with groups devices without dissolving them in a universal? Initially, we mapped some historical elements of the emergence of the notion of group. We extracted from this that such notion is born simultaneously with the notion of the individual, both taken as totalities. Psychoanalysis, in turn, does not arise from the individual, because it is based and has as intervention goal the subject, so that the device group should also take it into account. Subsequently, the group theme is investigated in the works of S. Freud, Bion, E. Pichon-Rivière J. Lacan seeking to extract from them a collective logic. From Freud, we have a scheme in which the tendency of the group is to make dough, identifying both vertically under a master insignia placed as the Ideal Self, and horizontally among subjects starting from themselves, tending to erase their singularities through an imaginary whole group. Therewith, we see the issue of identification become a central point in the matter of groups. Thus we seek elements that could help us so that the group does not give in to imaginary effects. Faced with this, Bion brought a first contribution of the \"leaderless group\", to which the analyst does not act in the place of leader, bringing the important idea of not to complete the group; Pichon, in turn, brings the idea of interdependence of individuals stating a collective logic, since the subjects are not isolated monads. Thereafter, it was important to make use of the cartel device, organ base of Lacanian School, which points to a not complete group, since the function of the +1 is precisely not complete the group in order to mitigate its imaginary effects. Our next step was to approach the \"effects of subjects\" - as opposed to imaginary effects - from the use of clinical vignettes used on groups treatment in articulating their contribution to the Lacanian triad Imaginary, Symbolic and Real. The consideration of these three records, pointed to another way of universalizing a group as waiving significant, since what Lacan has termed as escape object to their symbolic and imaginary determinations in its identificatory and homogenizing trends. Extracted such collective logic, it is possible to indicate that, in a group, the analyst has his role anchored in the object. In addition, the analyst must consider the effects of speech that individuals have with each other, since the transfer circulates between subjects. Since the subjects in groups tend to respond to each other demands, we conclude that it\'s important the psychoanalyst to circulate the word, in a way to keep an open meaning, so no one will take the place of the Ideal I. Finally we provide a reading framework for the ambivalent group experiences: as productive experiences (determination and indeterminacy) but also unproductive (of indeterminacy and determination). Lastly, we conclude that the group device can be an important tool for clinical policy in the field of health care intervention and ethics

Submitted by Valdinei Souza (neisouza@hotmail.com) on 2016-10-03T21:09:37Z No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / Approved for entry into archive by Urania Araujo (urania@ufba.br) on 2016-10-04T20:07:55Z (GMT) No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / Made available in DSpace on 2016-10-04T20:07:55Z (GMT). No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / A pesquisa apresentada nesta dissertação de mestrado teve como objetivo a investigação do uso e importância do prontuário do paciente em instituições de saúde, através da publicação de atos ou informações nos sítios eletrônicos oficiais destas. Esse trabalho foi desenvolvido metodologicamente utilizando uma abordagem qualitativa, tendo por base a pesquisa descritiva na forma documental, utilizando a técnica de observação direta para a coleta de dados. A pesquisa fez uma investigação da publicidade das ações relacionadas aos prontuários e arquivos, nos sítios eletrônicos de doze instituições de saúde previamente escolhidas, respondendo objetivamente a dezoito questões formuladas, conhecendo assim a realidade de cada uma, e do conjunto destas no que tange a relação prontuário e arquivo da instituição de saúde com os respectivos sítios eletrônicos. Essa investigação revelou que nenhuma instituição apresentou em seu sítio eletrônico a totalidade de respostas positivas. A instituição que chegou mais próximo do resultado alcançou doze das dezoito respostas, que representa 66,67%, revelando assim a necessidade dos sítios eletrônicos serem melhorados para a garantia do acesso a informação dos clientes ou pacientes. O trabalho apresentou ainda o panorama atual da legislação sobre prontuário, as correlações com a prática e a identificação de ações quanto a soluções para inserção dessa espécie documental como instrumento relevante de registro de informação para a eficácia de um atendimento de qualidade e com segurança jurídica ao paciente. / ABSTRACT The research presented in this Master’s thesis investigated the use and importance of patients’ medical records at health institutions, by publishing actions or information on their official websites. This study was developed methodologically using a qualitative approach, having descriptive research in documentary form as a base, and utilizing the technique of direct observation for data collection. The research analyzed the disclosure of actions related to medical records and archives on the websites of 12 previously selected health institutions, objectively responding to 18 formulated questions. The reality of each institution and the group as a whole with regards to the health institutions’ medical records and files’ relation with their websites was discovered in this way. The analysis revealed that none of the institutions presented totally positive replies on their websites. The institution which came closest to the outcome attained 12 of the 18 responses, representing 66.67%. Therefore, this revealed the need for improvements to the websites, in order to guarantee access to information on clients or patients. This study also presents an overview of legislation on medical records, correlations with practice and identifying actions for solutions to insert a patient’s medical records as a relevant instrument to record information for an effective, high quality service and legal certainty for patients.

This thesis deals with the handling of waste and linen. It is divided into a theoretical and practical part.The theoretical part describes the history of Česky Krumlov hospital and is followed by an in-depth look at the history and development of the handling of waste and linen in a medical facility etc. In the practical part of the research qualitative-quantitative methods were used in the form of observation, interview, questionnaire and secondary data analysis. In Česky Krumlov Hospital I observed the ongoing activities and gathered data. The research sample for the interview consisted of 10 respondents. The questionnaires consisted of 21 questions. A secondary analysis of operating rules, guidelines and waste management legislation was used. The main objectives of the research were to compare the system of waste and linen handling in Česky Krumlov hospital with applicable legislation and rules of operation. In so doing, to determine whether there are shortcomings in the separation of waste and the handling of laundry and in which department(s). In addition, to compare the production of waste in amount and time with regards to the use of disposable devices and instruments. Finally, to monitor the way employees separate waste in the hospital and compare the approach to it between smokers and non-smokers.For the purpose of this research five research questions and four hypotheses were put forward: V1: Does the procedure for handling waste meet legislative requirements and the current operating system? V2: Does the system of separation and disposal of waste differ in individual departments and if so why? V3: Can a more effective system for waste management be found? V4: Does the procedure for handling linen meet legislative requirements and the current operating system? V5: Can a more effective way of handling laundry be found? H1: The attitude to the separation of waste is different in smokers and non-smokers. H2: The sorting method depends on education. H3: The sorting method depends on the job position. H4: The sorting method depends on the amount of work experience of employees. Interviews were transcribed using MS Word 2007, and then processed using XMind 6. The hypotheses were statistically analyzed.In addition, information from my observations, interviews and the operating rules and directives for hospital staff helped me to answer the research questions. On the basis of the statistical findings all the hypotheses, with exception to H1, were confirmed. Hypothesis H1 was refuted. During the work all the objectives were met with exception to the fifth objective where problems relating to the quality of services provided by the laundry in České Budějovice Hospital, a.s. were identified. A comparison of the waste management system in Česky Krumlov Hospital a.s. with its operating rules, guidelines and legislation shows that overall the procedures correspond. There were just a few exceptions in the form of unlocked containers for infectious waste and a lack of signatures on labels of some of the staff responsible. During my observation no errors occurred in the separation of waste. The hospital has established a uniform system, whereby the procedures only vary according to the type of waste. The established system of waste separation in Česky Krumlov Hospital a.s. is very good, fully compliant with legislative requirements and is efficient. When comparing the production of general waste over time, the amount is decreasing. However, the amount of hazardous waste being produced is increasing. It was found that the attitude to waste separation does not differ in smokers and non-smokers and that university-educated workers separate less waste at work than others due to the type of job within the organization. Nurses recycle more and more responsibly. The same can be observed for employees with more work experience. I found minor discrepancies in the handling of laundry and the current operating rules.

Les personnes morales sont pleinement assujetties à une responsabilité pénale du fait de l'activité médicale à laquelle elles participent. Dotées en effet d'une personnalité morale punissable, il faut également constater que le domaine de l'imputabilité s'étend aux infractions médicales ou apparentées. Toutefois, le mode d'imputation indirect de l'infraction prévu par l'article 121-2 du Code pénal est identifié comme la principale cause du confinement de la responsabilité dans ce domaine. Il apparaît en effet que les professionnels de santé, dont les médecins, ne peuvent commettre une infraction pour le compte de l'entité, ceux-là ne disposant pas de la qualité d'organe ou de représentant requise par le texte. Le mécanisme impose également de rapporter la preuve de l'implication de la figure décisionnelle, ce qui se révèle particulièrement délicat. Aussi, la responsabilité doit être considérée comme inadaptée à la matière médicale. Le déploiement de la responsabilité passera donc par l'application d'un nouveau modèle d'imputation de l'infraction. Le premier, fondé sur une présomption d'implication des organes ou représentants, devra finalement être écarté en raison des nombreuses faiblesses qu'il comporte. Un second modèle, fondé sur une imputation directe de l'infraction et sur l'identification d'une faute médicale fonctionnelle, donnant lieu à une responsabilité fonctionnelle, sera finalement retenu. Un tel choix nécessitera cependant de modifier les termes de l'actuel article 121-2 du Code pénal. / Legal persons are fully subject to criminal responsibility resulting from their activities related to medical matters. Having a punishable legal personality, the scope of imputation covers all crimes in the medical domain and its neighboring crimes. Nevertheless, the indirect mode of liability adopted in article 121-2 of the French Penal Code is considered the main reason of limiting the responsibility in this area. It seems that professionals working in the health domain, including doctors, could not commit a crime for the account of the institution as they are not enjoying the quality of being an organ or representative which is required by the text to engage responsibility of legal persons. This mechanism requires also the proof of the involvement of a figure on the level of decision-making in the institution, something that is particularly sensitive. The responsibility, as such, is to be considered not well adapted to medical matters. The maintenance of a meaningful criminal responsibility calls for the application of a new model of imputing criminal liability for crimes in the medical domain. First to be mentioned is that this new model shall exclude any presumption of involvement of organs or representatives of the health institution ; such a model could be attacked from different angles. Second, the model to be adopted shall depend on direct imputation based on the identification of a functional mistake that leads to functional responsibility. However, it is to be noted that adopting this model requires a modification of the wording of article 121-2 of the French penal code.