Orientadores: Maria Cecília Marconi Pinheiro Lima, Maria de Fátima de Campos Françozo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T01:04:00Z (GMT). No. of bitstreams: 1 ArdinghiBrollo_MariaLuiza_M.pdf: 3510871 bytes, checksum: 5b33da3ad30af3f705aead6a6043024c (MD5) Previous issue date: 2014 / Resumo: Vários aspectos da estrutura social estão envolvidos com a construção das políticas de saúde. As tensões decorrentes de olhares distintos para problemas comuns, a organização das ações e a escolha das prioridades, o exercício continuado das relações de poder. Estudar as políticas de saúde e a organização dos serviços não é tarefa pouco complexa. No caso das políticas de saúde voltadas às pessoas com deficiência, uma diretriz importante é um maior grau de equidade no acesso desta população às ofertas de saúde para satisfazer suas necessidades na busca de bem estar físico e psíquico. Este trabalho se propôs a analisar a implantação da Câmara Técnica de Reabilitação da Secretaria Municipal de Saúde de Campinas, como um instrumento de gestão pública. Para tanto, foi realizado um estudo qualitativo, por meio de pesquisa de fontes documentais relacionadas com a atenção à pessoa com deficiência desta secretaria. Dentre os documentos estudados, encontravam-se prospectos, atas de reuniões, relatórios e manuais, buscando-se neles os fatos e acontecimentos relacionados com a implantação da Câmara Técnica. Além disso, foram analisados questionários aplicados pelo gestor da área de reabilitação aos trabalhadores do Centro de Referência em Reabilitação, cuja finalidade era, na época, avaliar o trabalho realizado pelo grupo e planejar futuras ações. Os resultados permitiram a elaboração de um breve histórico da reabilitação no município de Campinas, contextualizando a concepção da Câmara Técnica; evidenciaram a área de reabilitação se organizando e adquirindo visibilidade na estrutura da Secretaria Municipal de Saúde; destacaram o estudo de um manual que evidenciou a organização de uma rede de atenção pautada na colaboração entre seus serviços; permitiram, na leitura das atas das reuniões da Câmara Técnica, a correlação das propostas apresentadas com fatos descritos na época. A análise dos conteúdos dos questionários ressaltou três eixos principais: a percepção de uma rede de serviços voltada à reabilitação; a constatação de mudanças internas, subjetivas nos trabalhadores que participaram da Câmara Técnica e a compreensão da interdisciplinaridade e intersetorialidade pelos mesmos. Nas falas dos trabalhadores foi possível evidenciar a autonomia do grupo técnico e de seus usuários na medida em que conheceram seus pares e se organizaram numa rede de ações e saberes. Nas falas desses trabalhadores percebemos a figura do trabalhador-cidadão que se sente parte integrante do problema e da solução / Abstract: Various aspects of social structure are involved in the construction of health policies. Tensions arising from distinct looks for common problems, the organization of actions and the choice of priorities, the continued exercise of power relations. Studying health policies and the organization of services is not just a complex task. In the case of health policies for people with disabilities, an important guideline is a greater degree of equity of this population to access health offering in order to meet their needs in the search of physical and mental well-being. This work proposed to analyze the implantation of the Municipal Secretary Health of Campinas¿ Technical Chamber of Rehabilitation as an instrument of public management. Thus, it was done a qualitative study, based on the research of documentary sources relating to the care for people with disabilities inside this organization. Among the documents studied, there were leaflets, minutes of meetings, reports and manuals, seeking in them the facts and events related to the implantation of the Technical Chamber. In addition, questionnaires applied by the rehabilitation area manager to the workers of the Rehabilitation Reference Center, whose purpose was, at the time, to evaluate the work done by the group and to plan activities for the coming year. The results allowed, in principle, the survey of a brief history of rehabilitation in the borough of Campinas, contextualizing the conception of the Technical Chamber; showed the area of rehabilitation being organized and getting visibility inside the Municipal Secretary of Health's structure; emphasized the study of a manual that showed the organization of a care network based in the collaboration between its services; allowed, in the reading of the minutes of the Technical Chamber's meetings, the correlation of proposals with facts described at the time. The analyses of the content of the questionnaires highlighted three main axes: the perception of a network of services aimed at rehabilitation; the finding of internal and subjective changes of the Technical Chamber's workers and the understanding of interdisciplinarity and intersectoriality by them. In the speeches of workers was possible to point the autonomy of the technical group and its members as they knew their peers and have organized a network of actions and knowledge. In the speeches of these workers we realized the image of the worker-citizen who feels part of the problem as well of the solution / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

M.Cur. / Quality health service delivery is a necessity in any health care service and is the responsibility of the management, but it is often not accomplished due to a variety of reasons. The most important determinant is the personnel of the health care service and their level of motivation to provide quality service. The aim of this study was the describing of motivation guidelines for the delivery of quality health service. The study was qualitative and contextual. The research strategy was explorative and descriptive. The study is based on the Botes research model and the Nursing Theory of Wholeness. Several measurements were taken to increase credibility. It is regarded as a prerequisite to explore, describe and implement a quality improvement programme for the specific health service, before motivation guidelines could be described for quality health service delivery. The quality improvement programme was based on literature, with recognition of the context of the health service. The determinants of quality health service delivery were discussed as well as the aim, reasons, prerequisites, contents and principles of the quality improvement programme and the quality improvement process. The realisation of the quality improvement programme was also discussed. The exploring, description and implementation of the quality improvement programme in the health care service is followed by the exploring and describing of factors which motivate and/or demotivate personnel to deliver quality health care service, by means of naive sketches obtained from open questionnaires of two samples. It was verified for accuracy during a feedback interview. The results are used to describe motivation guidelines which is confirmed by literature.

No description available.

The complexity of issues in health care in the United States--specifically insurance coverage, access, affordability, quality of care, and financing--requires effective new models for governing, in which governmental and non-governmental organizations seek to solve problems collaboratively rather than independently. This research explores collaborative governance as a model to form new partnerships among for-profit, nonprofit, and public organizations in an effort to create community-based, locally governed health care entities in Oregon through coordinated care organizations (CCOs). A key question is whether collaboration, through CCOs, brings together government and non-governmental organizations to solve "intractable problems" by establishing new public-private partnerships in Medicaid. The research focuses on the formation of CCOs, including the influence of local, political, institutional, and historical contexts, planning processes, and governance structures. The hypothesis is that conditions, norms, governance structures and processes, and the presence or absence of a combination of these factors, facilitate or impede participation and decision-making, and over time, successful system integration by these new complex organizations. This study developed insights into similarities and differences among CCO governance structures by investigating three CCOs. Findings from the case study suggest that the following key factors influence the collaborative governance process among government and non-governmental organizations within CCOs: prior history of conflict or cooperation; open, transparent, and inclusive processes for stakeholders; face-to-face dialogue, trust building, and shared understanding; and high-functioning governing boards. Results also indicate that maintaining stakeholder participation can be challenging due to time and cost, power imbalances and competing interests among stakeholders, and mistrust and lack of facilitative leadership. The results suggest that collaborative governance is a strategic approach for the allocation of limited resources across public, private, and nonprofit organizations to deliver services to Oregon's Medicaid population. The significance of this study is that it identified starting conditions that facilitate and hinder the ability of CCOs to effectively solve problems through governance mechanisms. Oregon's CCOs offer an example of multiple layers of governing institutions--federal, state, and county--using formal authority to influence a specified set of outcomes, the Triple Aim, in a specific policy domain: provision of health care services for underserved Oregonians. Results of the study can help inform a larger, more fundamental question in public administration about contemporary governance: whether government through collaborative governance can create the "conditions for rule and collective action" through public-private partnerships to achieve policy goals (Stoker, 1998). Further research is needed to better understand whether local community-based organizations such as CCOs offer a sustainable model to address policy issues in other arenas by which there is "more government action and less government involvement" (Agranoff & McGuire, 2003). This study contributes to the theory of collaborative governance and may inform future policy decisions about CCOs in Oregon and, more broadly, ongoing national health care reform efforts.

The World Health Organisation (WHO) declared tuberculosis (TB) a global emergency, and this infectious disease remains a health threat by being the leading cause of death amongst adults (Naidoo, Dick & Cooper, 2008:55). In 2005, South Africa was ranked seventh in the world for having the highest TB rate and the lowest TB success rate in the world. As a professional nurse involved in the tuberculosis programme at a clinic in the Nelson Mandela Bay Municipality at local government level for approximately three years, the researcher observed that the morale of professional nurses who provide TB services appeared to be low. They also appeared to be frustrated because they feel that they are not winning the battle with regard to the TB epidemic in their communities irrespective of their efforts to try and curb the spread of the disease. The extent of the workload per person also appeared to add to the low morale and frustration of the professional nurses rendering TB health services because they feel that they are unable to manage everything. The objectives of the study were therefore to explore and describe how professional nurses experienced the management of health services being rendered to TB patients in Sub district B of the Nelson Mandela Bay Municipality (NMBM) in order to make recommendations that could be used by the district manager to address the research findings. The research study was based on a qualitative, explorative, descriptive and contextual research design. The research population consisted of all professional nurses who worked in the TB services of Sub district B. Non-probability, purposive sampling was used to select the participants for the study. Seven in-depth and three follow-up interviews were conducted before data saturation was achieved. The data gathered during the interview process by the researcher were transcribed and coded by an independent coder using Tech’s model for data analysis. Ethical considerations were adhered to throughout the research study. The aspect of trustworthiness according to Guba’s model was implemented in the research study and included credibility, applicability, consistency and neutrality. iii One theme, two sub themes and categories were identified relating to the diverse experiences expressed by the participants relating to the management of health services being rendered to TB patients. The experiences expressed by the professional nurses included both negative and positive experiences. The negative experiences expressed by the participants were for example, a lack of resources as hampering adequate service delivery, a concern regarding the number of staff contracting TB due to a lack of infection control measures, a difference in conditions of service between the two local authorities and the DOTS supporters as being a threat to patient confidentiality. The positive experiences expressed by the participants included experiences relating to job satisfaction in rendering TB health services, the DOTS supporters as being supportive to the staff, the TB meetings serving as an appropriate platform for problem solving and the audits conducted by managers as being remedial. The study concludes with recommendations made with regard to the areas of nursing practice, education and research.

The issues surrounding health care and health care policy are of great concern to politicians and the public alike. Government efforts in restructuring medicare, the "jewel" of Canada's social safety net, also affects the medical profession. It has been argued that this once powerful and dominant profession is experiencing a decline in its powers and authority. Is this decline inevitable or can the medical profession adapt to government reforms in such way as to maintain and even strengthen its power base? This dissertation examines the themes of professional autonomy and professional resistance. The changing composition, and possibly the decline, of the medical profession's clinical, economic, and political autonomy, is analyzed through an historical case study of the British Columbia Medical Association (BCMA). Minutes from the BCMA's Board of Directors and Executive, along with interviews with doctors active in BCMA politics, and a media review, are used to generate a portrait of the social forces influencing medical politics in British Columbia from 1964 to 1993 and of the BCMA's relations with the various provincial governments of that period. The negotiating strategies of the BCMA and the decisions behind these strategies are the focal point for an examination of professional resistance, an area neglected in sociology. The dissertation looks at the external and internal conflicts that impact on the resistance tactics of the BCMA and at the various successes and defeats the medical profession experiences in its bid to maintain professional autonomy. During the time period under study, government intervention becomes more frequent and invasive. The BCMA has the least success in protecting the political dimension of professional autonomy and most success in controlling aspects of clinical autonomy. The vast variety of resistance strategies at its disposal distinguishes it from labour groups and most other professions. Forced to accept measures it once fought against, the BCMA's efforts become focused on ensuring that reform measures are under the control of doctors (rather than government) to the greatest extent possible. Although the BCMA has lost aspects of professional autonomy, it remains one of the few professional organizations today that can force compromise from the state. / Arts, Faculty of / Sociology, Department of / Graduate

This study examined hospital governance in British Columbia. Considered to be one of the most important issues facing the health care industry today, hospital governance is nevertheless an ill-defined and poorly understood concept. Foundational and exploratory in nature, the study’s primary objectives were: a) to define hospital governance within the context of British Columbia; b) to examine the structural and functional relationships among key participants; c) to investigate decision-making responsibilities; d) to investigate what, if any, variations exist in the governance of acute care, long term care, and specialized care hospitals; and e) to explore the critical issues which face hospital governance today and in the future under New Directions policy initiatives. All hospitals (N=107) in the province were studied, with the exception of diagnostic treatment centers, private for-profit facilities, military, and federal institutions. Utilizing documentary examination, survey administration, and interview techniques, the study included hospital chief executive officers (N=106), hospital board members (N=735), hospital board chairs (N=106), and selected high ranking senior officials from the Ministry of Health who had direct responsibility for hospital activities (N=15). Results of the study provide for in-depth demographic board profiles, and show that hospital governance is similarly defined across all hospital categories as “a complex relationship of overlapping structures and activities which has the responsibility and the authority to oversee the organization’s operation and to ensure its commitment of providing optimum health care to its residents.” The study identifies the key participants of hospital governance and delineates sixteen activities considered to be under the hospital board’s domain. Seven issues are identified as being critical for hospital governance in the future. Although there was general agreement as to the individuals most often responsible for recommending and implementing activities brought before the board, there were considerable perceptual differences between participants as to who possesses final decision-making responsibility. Data results consistently demonstrated important differences in responses between the hospital and Ministry populations. The study shows that overall, the participants of hospital governance are generally satisfied with the traditional roles and structures of hospital boards and are overwhelmingly dissatisfied with New Directions policy initiatives. This study further suggests that due to the discrepancies in priorities, perceptions, and ideologies of the hospital and Ministry populations, hospital governance is in a highly volatile and transitive state. / Graduate and Postdoctoral Studies / Graduate

The dissertation discusses the provision and organization of mental health services through the operation of Community Mental Health Centres outside the Greater Vancouver area in the Province of B.C.. A derived organizational structure of a CMHC is presented permitting a generalizable discussion of inter- and intra-organizational features and their relationship to administration peculiar to this organization. A number of propositions are generated regarding CMHC organizational structure and process; these propositions are based on the dimensions identified in the areas of organizational technology, environment and goals. The propositions are applied to a model of management permitting an examination of general areas of management concern. Methods of optimizing these areas are discussed operationally with the intent of facilitating organizational effectiveness in a CMHC. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

M.Comm. / Chapter 2 Chapter 2 researches the literature with regard to the evolvement of health care delivery in the USA and specifically the effect that the development and implementation has had on managed care. Chapter 3 Chapter 3 briefly describes the process of management and the components of strategic management. It also mentions the evolvement of management style proposed by Hickman. Finally it sets out in a graphical format the categories and "levels" into which health care can be divided and delivered. It is suggested that these are the issues to consider when assessing a medical benefit fund. Chapter 4 Chapter 4 presents the results and the findings of the various components and factors that impacted upon the external and internal analysis of the fund. The framework used to analyse the fund for strategic management are those proposed by De Bruyn, Kruger and McKinsey. Comments are made about the extent to which each component of strategic management is being applied within Steelmed based upon the evidence assimilated from the study. Finally the financial statements and membership numbers are used to evaluate how successful Steelmed has been. Chapter 5 Chapter 5 highlights the changes to take place if fourth wave strategic management is to be implemented and makes recommendations about the need for an on-going study to measure the effect this will have.

The traditional model of leadership in medicine and health care generally centres around a hierarchical structure of power and influence, resting in the hands of a select few administrators, with limited input from employees. A newly developed Cancer treatment centre in the Province of British Columbia, Canada has attempted to institute a unique, team-based system of shared leadership and decision-making. In order to accomplish this task, the Senior Administrator of the centre hired professional group development experts to facilitate the formation of the newly established Leadership Team. A team of nine individuals participated in a group-process based model of team leadership development, consisting of a series of intensive weekend workshops. This study evaluates the impact of those intensive workshops on the members of the Cancer centre Leadership Team. Qualitative case-study methodology, combined with the use of indepth interviews, illuminated eight categories of shared experience among seven of the nine team members, as a result of having participated in the workshop series. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate