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Improving hospital efficiency is a critical concern for health care managers and policy makers. Hospital technical efficiency is measured as the ratio of what quantity and quality of care is produced to what could be produced given the level of resources available to the hospital (its budget). What a hospital should produce given the resources at its disposal is called the “production frontier”. In order to improve hospital performance, health policy makers need knowledge and information about how well the hospitals they fund are utilizing the resources they receive. Data Envelopment Analysis, a non-parametric technique, is applied to administrative data on hospitals in Canada to produce the “technical frontier” and get insight into the variation of technical efficiency of acute hospitals at the Pan-Canadian level (except for the province of Quebec, which does not report its data on hospitals in a way that would make them comparable to the rest of Canada). DEA is preferred to the alternative method of stochastic frontier for the following reasons: DEA does not require to impose a specification on the production function of hospitals (for which theory is clearly lacking), and it allows the analyst to estimate a multi-output frontier (a stochastic frontier would have to weight arbitrarily the value of quantity versus that of quality of care in hospitals, whereas the DEA approach generates these weights from the data). Efficiency scores are serially de-correlated using a bootstrap technique and then entered as the dependent variable in regressions to identify the main factors of efficiency or inefficiency. Specifically, this thesis aims to: 1) estimate the level of technical efficiency of acute inpatient care in 35 teaching hospitals, 54 large hospitals and 90 medium-size hospitals respectively in Canada and identify the potential factors that have influence on technical efficiency; 2) uncover and measure the existence of possible spatial spillovers of hospital efficiency in Canada and examine its potential determinants while taking into account the interaction between hospitals by means of spatial regression; and 3) examine the technical and scale efficiency of the 229 small and rural hospitals across Canada (outside Quebec), as well as estimate the impact of institutional and contextual variables on hospital technical and scale efficiency respectively. The major findings are: 1) hospital output (combination of number and quality of stays; quality being measured as the inverse of in-hospital mortality) in Canada could be increased by 24 percent with the same resources by eliminating inefficiency. Highly efficient teaching hospitals benefit from producing care under favourable environments. Higher efficiency could be achieved by increasing cooperation within the health system and making more post- acute care beds available to both large and medium hospitals; 2) There is a substantial and significantly positive spatial spillover effect on the efficiency of acute inpatient care (elasticity of 0.3): Canadian hospitals are clearly complements to each other and work in networks much more than in competition. The hospital size (the number of beds), the percent of transfers between acute hospitals, and the percent of patient transfers to home care are the main drivers of efficiency among acute hospitals in Canada while controlling of the dependence between hospitals; and 3) Among small hospitals, the average output orientation technical efficiency on all types of services is 54% at the current input-output mix. To improve their technical efficiency, small hospitals should provide with more home care facilities to discharge their patients to (so-called Alternative Level of Care patients) and strengthen their cooperation with larger, urban hospitals. Small hospitals are scale inefficient, specifically, rural hospitals could reduce their size by 34% on average (around 6 acute beds) to achieve the optimal size. The study also found that the spending on diagnosis tests and the nursing as the percentages of total hospital spending (cost shares) are positively and significantly related to the scale efficiency. / Thesis / Doctor of Philosophy (PhD) / A hospital is technically efficient if it uses its resources (its budget) to get the most in terms of quantity (number of stays) and quality of care it can. A hospital can be more or less technically efficient for reasons independent of its control (typically, because of the environment in which the hospital operates) and efficiency is a value-neutral measure. This thesis aims to: 1) estimate the technical efficiency of acute inpatient care in Canada and identify the potential factors that influence the level of efficiency achieved by a given hospital; 2) uncover the existence of possible geographic clusters of efficiency (hospitals that are close geographically are also close in the efficiency scale, something called spatial spillovers in the literature) in Canada.; and 3) examine the role that size plays in the variation of technical efficiency among small and rural hospitals across Canada. The major findings are: 1) hospital output could be increased by 24 percent with the same resources by eliminating technical inefficiency; 2) There is a substantial and significantly positive spatial spillover effect on the efficiency of acute inpatient care: being close to an efficient hospital increases the efficiency score of a hospital, everything else being the same; and 3) The level of technical efficiency of small and rural hospitals across Canada is low overall and, perhaps surprisingly, larger rural hospitals are among the least efficient: among small hospitals, scale does not yield economies of resources.

There is a tradition of experimentation in fiction. From Laurence Sterne’s <u>Tristram Shandy</u> to B.S. Johnson’s <u>The Unfortunates</u>, we see an exploration in content and delivery of story. In Sterne’s <u>Tristram Shandy</u>, he uses tactics such as drawings and deletion of pages. In Johnson’s <u>The Unfortunates</u>, he shifts control to the readers by giving them the opportunity to shuffle sections of the book. Here, as the reader, you have a choice. You can read <u>Treatment Plan</u> as it is arranged, or you can jumble the sections labeled with an image in any order within the dated sections. What must remain in order are the sections that begin with a date. The book is a medical-model case study fashioned in experimental fiction. The cropped images which indicate the shuffled sections were taken of two stained glass windows at Salisbury Cathedral in the United Kingdom. *Please note that <u>Treatment Plan</u> is meant to be read in its printed form which consists of twenty four sections, twelve of which may be shuffled within the dated sections.* / Master of Fine Arts

Submitted by Joana Azevedo (joanad@id.uff.br) on 2017-07-03T13:19:51Z No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1218138 bytes, checksum: 18e2ebc92bec79a4a4425ad12f50a8da (MD5) / Rejected by Biblioteca da Escola de Engenharia (bee@ndc.uff.br), reason: Item rejeitado, pois a ficha catalográfica está fora do padrão. Atenciosamente, Catarina Ribeiro Bibliotecária BEE - Ramal 5992/5993/5994 on 2017-07-04T16:02:19Z (GMT) / Submitted by Joana Azevedo (joanad@id.uff.br) on 2017-07-25T19:03:22Z No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1214965 bytes, checksum: 68e92d70d6abc1d14fa500812bf136d5 (MD5) / Rejected by Biblioteca da Escola de Engenharia (bee@ndc.uff.br), reason: Olá, Joana! Favor verificar a formatação da ficha catalográfica. Att, Catarina on 2017-07-28T15:23:36Z (GMT) / Submitted by Joana Azevedo (joanad@id.uff.br) on 2017-07-28T19:49:56Z No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1215785 bytes, checksum: 467b30ba7c93d1a2974329c5606468f5 (MD5) / Approved for entry into archive by Biblioteca da Escola de Engenharia (bee@ndc.uff.br) on 2017-08-03T12:50:52Z (GMT) No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1215785 bytes, checksum: 467b30ba7c93d1a2974329c5606468f5 (MD5) / Made available in DSpace on 2017-08-03T12:50:52Z (GMT). No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1215785 bytes, checksum: 467b30ba7c93d1a2974329c5606468f5 (MD5) / A complexidade da gestão hospitalar, em conjunto com um cenário de escasez de recursos financeiros, compromete as atividades desempenhadas em hospitais públicos universitários. O presente estudo tem o objetivo de analisar as práticas de gestão hospitalar no Hospital Universitário Antonio Pedro (HUAP), no sentido de identificar oportunidades de aprimoramento em seus processos administrativos, bem como os fatores críticos responsáveis, refletindo sobre a maneira como tais fatores estão inter-relacionados. Sob a perspectiva metodológica, o estudo apoia-se em uma vertente teórica, baseada na coleta de dados secundários através do levantamento bibliométrico do acervo técnico-científico referente à gestão hospitalar, relevantes para subsidiar a pesquisa empírica proposta para ser realizada junto a atores-chave do HUAP. Já em termos empíricos foram realizadas entrevistas semiestruturadas com as lideranças funcionais tanto administrativas, quanto de assistência. Os resultados obtidos evidenciam lacunas nas interfaces de trabalho, sobretudo na relação entre as equipes médica e a administrativa, o que impacta sobre o faturamento da organização. Além disso, observaram-se hiatos na definição de processos, o que compromete algumas atividades, tanto na esfera assistencial quanto administrativa, gerando conflitos entre profissionais e impactando no atendimento aos pacientes. Uma vez evidenciados os fatores críticos, elaborou-se um mapa conceitual, que apresenta o processo gerencial do HUAP como um sistema composto pelos referidos fatores, bem como a forma como estão conectados, facilitando a observação das relações de causalidade entre estes. / The complexity of hospital management, together with a scenario of scarcity of financial resources, compromises the activities performed in public university hospitals. This study aims to analyze the hospital management practices at the Hospital Universitário Antonio Pedro (HUAP), to identify opportunities for improvement in their administrative processes, as well as those responsible for critical factors, reflecting on how these factors are interrelated. Under the methodological perspective, the study relies on a theoretical, based on secondary data collection through the bibliometric survey of technical and scientific evidence related to hospital management, relevant to support the empirical proposed research to be conducted with key players of HUAP. In the empirical study were carried out semi-structured interviews with the managers of the institution. The results show flaws in the work interfaces, especially in the relationship between medical staff and administrative, which has a direct impact on revenues of the organization. In addition, there were shortcomings in the definition of processes, which undertakes some activities, both in care as administrative, generating differences between professionals and impacting on patient care. Once the critical factors were evidenced, a conceptual map was elaborated, presenting the HUAP management process as a system composed of these factors, as well as the way in which they are connected, facilitating the observation of the causal relationships between them.

Made available in DSpace on 2014-12-17T14:46:44Z (GMT). No. of bitstreams: 1 AlineCMM_DISSERT.pdf: 1984168 bytes, checksum: cdfabc6da5b0a2c127bfdcc6151e09a1 (MD5) Previous issue date: 2010-10-08 / The Hospital Epidemiology Nucleus (NHE) is a structure that has a specific organizational climate, which influence the level of job satisfaction among professionals working in it. This is a descriptive study with a quantitative approach, aimed to identify the relationship between organizational climate in the NHE regulated in the city of Natal / RN and the job satisfaction among its professionals from the perspective of theoretical issues about Organizational Development. The research was carried out in 13 hospitals with different kinds of sponsorship, 9 public, 3 philanthropic and 1 private. Data were collected using the instrument "organization in hospitals: issues relating to climate and job satisfaction , with 33 professionals appointed and active on NHE. This study obtained an appropriate consent of the Research Ethics Committee of the Hospital of Pediatrics Professor Heriberto Ferreira Bezerra, from the Riograndense Northern League Against Cancer and the Federal University of Rio Grande do Norte. Data collected were organized and treated with simple descriptive statistics. It was observed that from 33 of surveyed people, 93% was female, had an average of 40 years old age, with activity duration between 1 and 2 years (84.9%). Furthermore, 45.5% of industry professionals were nurses. It was identified that professionals working in NHE perceive and experience its work environment as an Organization Structure in construction. It was found that with the exception of the aspects "working life", "socio-cultural" and "organizational culture , the other internal and external factors to the NHE does not have strong expression in the forming of an organizational climate conducive to the development of the sector. It was found that 70% of interviewed perceive the organizational climate as favorable for the industry's progress. Regarding the job level of satisfaction, respondents feel fairly satisfied with the organizational structure. Therefore, the results of this study are suggestive that there is some factor that is greatly contributing to a healthy organizational climate that encourages the industry team members of the NHE present behaviors that identify them as actors committed and satisfied with the work, even face of all obstacles to implementation of epidemiological surveillance. Thus, it is suggested for futures studies to seek to determine how the organizational culture, while significant internal factor, influencing the organizational climate establishment of NHE and therefore the level of job satisfaction and well-being of each members of the team / O N?cleo Hospitalar de Epidemiologia (NHE) constitui em uma organiza??o que apresenta um clima organizacional espec?fico, o qual contribui para o n?vel de satisfa??o laboral dos profissionais que nele atuam. Este estudo consiste em um trabalho descritivo, com abordagem quantitativa, que teve por objetivo identificar a rela??o entre o clima organizacional nos NHE regulamentados na Cidade do Natal/RN e a satisfa??o laboral dos profissionais que neles trabalham, sob a perspectiva dos aportes te?ricos acerca do Desenvolvimento Organizacional. A pesquisa foi desenvolvida em 13 hospitais com caracter?sticas mantenedoras diversas, 9 p?blicos, 3 filantr?picos e 1 privado. Os dados foram coletados, atrav?s do instrumento Organiza??o hospitalar: aspectos inerentes ao clima e a satisfa??o laboral , junto a 33 profissionais nomeados e atuantes nos NHE. O estudo recebeu parecer favor?vel dos Comit?s de ?tica em Pesquisa do Hospital de Pediatria Professor Heriberto Ferreira Bezerra, da Liga Norte Riograndense Contra o C?ncer e da Universidade Federal do Rio Grande do Norte. Os dados obtidos foram organizados e tratados com estat?stica descritiva simples. Constatou-se que dos 33 pesquisados, 93,9% eram do sexo feminino, tinham uma m?dia de 40 anos de idade, com um tempo de atua??o entre 1 e 2 anos (84,9%). Al?m disso, 45,5% dos profissionais do setor eram enfermeiros. Identificou-se que os profissionais que atuam no NHE percebem e vivenciam o seu ambiente de trabalho como uma estrutura organizacional em desenvolvimento. Verificou-se que, com exce??o dos aspectos vida profissional , n?vel s?cio-cultural e cultura organizacional , os demais fatores internos e externos ao NHE n?o apresentam forte express?o na conforma??o de um clima organizacional favor?vel ao desenvolvimento do setor. Constatou-se que 70% dos participantes percebem o clima organizacional como favor?vel ao progresso do setor. Com rela??o ao n?vel de satisfa??o laboral, os respondentes sentem-se bastante satisfeitos com a estrutura organizacional. Portanto, os resultados desta pesquisa s?o sugestivos de que existe algum fator que esteja de sobremaneira contribuindo para que o clima organizacional saud?vel do setor estimule os membros das equipes do NHE a apresentarem comportamentos que os identificam como atores comprometidos e satisfeitos com o trabalho desenvolvido, mesmo diante de todos os entraves para realiza??o da Vigil?ncia Epidemiol?gica. Com isso, sugere-se a realiza??o de estudos que busquem verificar de que forma a cultura organizacional, enquanto fator interno expressivo, influencia o estabelecimento do clima organizacional do NHE e, por conseguinte, o n?vel de satisfa??o laboral e bem-estar individual dos membros de sua equipe

This study was conducted to evaluate the effect of communication and information on the potential adoption of optical scanners by hospital pharmacy directors. The study used a randomly selected national mail survey of 600 hospital pharmacy directors. A response rate of 64.17% was attained and the instrument was determined to have adequate reliability. Believability of optical scanner assessment information was compared between directors with high and low optical scanner familiarity. Directors with high familiarity rates the information's influence on their decision to adopt significantly higher than directors with low familiarity. Directors were also asked to rate the importance of the source of information and the optical scanner characteristics when making their decision to adopt. Directors with high familiarity rated management sources, administrative uses and time-savings higher and cost lower in importance. The survey revealed that 18.96% of the respondents were currently using optical scanners, primarily for inventory control.

Heart failure (HF) is a clinical syndrome associated with high morbidity and mortality with a large economic burden, and is the leading cause of hospitalizations among Medicare beneficiaries in the United States. Healthcare reform has focused on strategies to reduce HF readmissions, including outpatient HF clinics. Purpose: The purpose of this DNP Project was to answer the following question: In adult patients diagnosed with HF, how does enrollment in the HF clinic, compared to non-enrollment affect hospital admission and readmission rates? Methods: A retrospective analysis of 767 unique patients and their 1,014 respective admissions and readmissions was conducted. Continuous and categorical data was analyzed and presented as a mean (M), standard deviation (SD), absolute number (N) and percentage (%). A Pearson Chi Square test was used for categorical variables and Analysis of Variance was used for age and ejection fraction (EF). Results: Study sample demographics (N=767); age (M=79.72, SD=7.48); gender (57.6 % male) and EF (M=0.43, SD=0.16) were evaluated. The No HF clinic (No HFC) and HF clinic (HFC) enrollment groups (N=573) were compared for age (M=79.49, SD=7.65) (M=80.39, SD=6.94), male gender (54.6%, 66.5%) and EF (M= 0.44, SD=0.17) (M=0.42, SD=0.15), respectively. Each sample patient had at least one admission for HF during 2015; of which 573 (46.2%) were in the No HFC group and 194 (8.4%) were in the HFC group (p<0.001). There was no difference in all-cause readmissions between the No HFC group [n=95(14.5%)] and the HFC group [n=37(16.2%)] (p=0.534) and no difference in HF-related readmissions between the No HFC group [n=72(11.0%)] and the HFC group [n=23(10.0%)] (p=0.700). Conclusions: This DNP project demonstrated a significant difference in HF admission rates in favor of the HFC group. While no differences were found in all-cause or HF-related readmission rates in No HFC and HFC groups, the rates are less than the national average. Unintended findings were that datasets can be very poorly constructed and populated, resulting in large amounts of unusable data. Recommendations are for more rigor in the organization of datasets to assure accurate comparisons between admission and readmission rates based on enrollment in HF clinics.

No description available.

The extent and quality of strategic planning by institutional pharmacy directors was assessed. Also examined was how the extent and quality of strategic planning, institutional characteristics, pharmacy characteristics, and pharmacy director characteristics might be associated with the pharmacy's overall level of performance in selected areas. The majority of institutional pharmacy directors reported utilizing strategic planning for their departments. The global quality of strategic planning reported by pharmacy directors was average. However, directors conducting strategic planning reported a high level of strategic planning. The directors' rated time available, knowledge, and importance of strategic planning were found to be significantly associated with pharmacy directors' rated quality of strategic planning. Additionally, pharmacy directors' rated quality of strategic planning was found to be significantly associated with pharmacy performance for clinical, distributive, and administrative services.

Unidad de Práctica Prolongada para optar al título de Químico Farmacéutico / Los medicamentos son esenciales para algunos tratamientos y también para la prevención de algunas enfermedades, por lo que es importante corroborar, mediante un sistema de Farmacovigilancia (FV), su seguridad, efectividad y calidad. La FV se define como la ciencia y conjunto de actividades relacionadas con la detección, evaluación, comprensión y prevención de efectos adversos o de cualquier otro problema relacionado con medicamentos (PRM). Se creó un programa de FV en la Unidad de Paciente Crítico (UPC) y en la Unidad de Farmacia del Hospital Padre Hurtado por medio de un estudio observacional prospectivo, de una duración de 6 meses en la Unidad de Farmacia (directa) y en UPC (indirecta). La práctica prolongada se dividió en 3 etapas: 1) recolección y familiarización de la información, 2) Diseño del modelo de FV a realizar (pasiva por reporte espontáneo y activa por alertas en el sistema de prescripción y dispensación), 3) envío de reporte al Instituto de Salud Pública (ISP), caracterización de los reportes realizados y retroalimentación a los profesionales de la salud. Se detectó una serie de errores de medicación en el proceso de prescripción, donde predominó la falta de información acerca del paciente y el medicamento (56 % y 27 %, respectivamente). También se detectó errores en la dispensación, donde se evidenció con mayor importancia el factor humano como causa de los distintos tipos de errores de medicación. Además, se realizaron 21 reportes, los cuales fueron enviados al Sistema Nacional de FV del ISP, 15 provenientes de la UPC y 6 de otras Unidades clínicas. Respecto a los provenientes de la UPC, 12 fueron catalogados como sospechas de reacciones adversas a medicamentos (RAM) y 3 como otros PRM. De las sospechas de RAM de la UPC, se observó que los medicamentos mayormente involucrados en sospechas de RAM fueron los antiinfecciosos con un 82 % y el sistema más afectado fue el de la piel con un 59 % del total. Respecto a la causalidad de los medicamentos sospechosos se obtuvo que 8 fueron catalogados como posible y 4 probables, no habiendo certeza en ningún caso (criterio Organización Mundial de la Salud (OMS) – Uppsala Monitoring Centre (UMC)). De la gravedad que implicaron las sospechas de RAM de la UPC se obtuvo que 6 fueron moderadas, 5 fueron graves y sólo 1 leve (criterio OMS-UMC). El tipo de mecanismo de producción de las sospechas de RAM predominante fueron las de tipo B, que fueron 7 y las de tipo A fueron 5 (criterio OMS-UMC). En promedio se prolongó en 19 días la hospitalización para los pacientes con sospechas de RAM e implicó una estadía de 18 días para los otros pacientes con PRM. Finalmente, se creó un sistema de FV en el hospital, pero sin duda es necesario hacer énfasis en los profesionales de la salud que este sistema no busca castigar los errores reportados con acciones punitivas, sino que más bien corregirlos y prevenirlos a futuro para así cooperar positivamente con el tratamiento del paciente y con su pronta mejoría. Esto es sumamente importante debido a que la UPC posee altas tasas de mortalidad y la acción del profesional Químico Farmacéutico es fundamental / Medications are essential for some treatments and also for the prevention of some diseases, so it’s important to corroborate, through a Pharmacovigilance (PhV) system, safety, effectiveness and quality, which are defined as science and the whole of activities related to detection, evaluation, understanding and prevention of adverse effects of any other drug related problem (DRP). A program of PhV was created in the Critical Patient Unit (CPU) and in the Pharmacy Unit of the Hospital Padre Hurtado by a prospective observational study, with a 6-month stay in the Pharmacy Unit (direct) and CPU (indirect). The project was divided into 3 stages: 1) Collection and familiarization of information; 2) Design of the VF model to be carried out; 3) submission of report to the Public Health Institute (PSI); characterization of reports and feedback to healthcare professionals. A series of medication errors were detected in the prescription process, where the lack of information about the patient and the medication predominated. Errors were also detected in the dispensation where the human factor was more important as a cause of the different types of medication errors. In addition, 21 reports were sent to the National PhV System of the Public Health Institute, 15 from the CPU and 6 from other clinical Units. Regarding those coming from the Critical Care Unit, 12 were classified as adverse drug reactions (ADRs) and 3 as other DRPs. It was observed that the drugs most involved in suspected ADR were anti-infectives with 82 %, the most affected system was the skin with 59 % of the total. Regarding the causality of the suspected drugs, it was obtained that 8 were classified as possible and 4 probable, with no certainty in any case (World Health Organization (WHO) - Uppsala Monitoring Center (UMC)). From the severity of UPC suspicions, 6 were moderate, 5 were severe and only 1 mild (WHO-UMC criteria). The type of mechanism of production of suspected ADRs was type B, which were 7 and type A were 5 (WHO-UMC criteria). On average, hospitalization for patients with suspected ADR was prolonged by 19 days and involved an 18-day stay for other MRP patients. Finally, it was possible to implement a system of VF in the hospital, but it is undoubtedly necessary to emphasize the health professionals, that this system does not seek to punish the errors reported with punitive actions but rather to correct them and to prevent them in the future in order to cooperate positively with the treatment of the patient and with their improvement, this becomes extremely important because the CPU has the high mortality rates and the action of the Pharmacist is fundamental