Thesis (M.H.A.)--University of Michigan, 1975.

Thesis (M.H.A.)--University of Michigan, 1964.

Thesis (M.H.S.A.)--University of Michigan, 1982.

Dissertation (D.P.H.)--University of Michigan.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 4 uppsatser.

O presente estudo objetivou compreender o significado que os graduandos de enfermagem de uma Universidade Estadual Pública atribuem à Gerência da Assistência de Enfermagem. Para essa finalidade optou-se por uma abordagem qualitativa, na vertente da fenomenologia. Esse desenho metodológico contribui para iluminar a ideia de Gerência da Assistência para estudantes de graduação e procura tornar visível o que está oculto. Busca-se a essência dos significados atribuídos pelos sujeitos sobre o fenômeno investigado e procura compreender o homem segundo a realidade vivenciada por ele. Essa metodologia também possibilita desvendar os valores, as percepções e emoções dos sujeitos envolvidos. É uma filosofia que repõe as essências na existência e não compreende o homem e o mundo de outra maneira senão a partir da sua facticidade. A fim de compreender o fenômeno que este trabalho pretendeu desvelar, foi escolhido para o cenário do estudo os cursos de Graduação em Enfermagem de uma Universidade Pública, situada no Estado de São Paulo. A instituição congrega dois cursos de graduação em enfermagem. Foi realizada entrevista fenomenológica com 26 estudantes. Para o desenvolvimento da pesquisa a seguinte questão norteadora foi adotada: Qual a sua compreensão sobre Gerência da Assistência? Após as transcrições, os depoimentos foram primeiramente analisados individualmente e após globalmente, resgatando os temas: Significado da Gerência da Assistência; Exercício da Gerência da Assistência;Gerência da Assistência no campo de estágio; Gerência da Assistência e o papel do enfermeiro; Exercício Burocrático. Avaliou-se nos discursos apresentados que em diversos momentos a definição de gerência da assistência foi trazida como um processo de coordenação da unidade de trabalho, sendo que as articulações com o cuidado direto ao paciente foram poucas vezes manifestadas. Em relação à supervisão, os discursos revelam como atividade de fiscalização e controle do processo de trabalho e pouco como artifício de educação. Os discursos também apontam como uma das principais atividades da gerência da assistência o controle e organização de recursos humanos.Uma ferramenta da gerência da assistência citada pelos graduandos foi a Sistematização da Assistência de Enfermagem (SAE), destacando-a como importante instrumento para um atendimento integral e qualificado. Elucidaram que há enfermeiros que desenvolvem a SAE com a finalidade de atender às normas das instituições. Foi mencionada a dicotomia entre a teoria e a prática durante a formação; salientaram a importância do estágio e da contribuição da disciplina de gerenciamento (bloco teórico) para o entendimento da gerência da assistência. Ainda com relação ao processo formativo, referiram que durante toda a graduação o foco na abordagem gerencial acontece principalmente no último semestre de graduação. Os estudantes de enfermagem também trouxeram o conceito de atividades burocráticas. Muitos enfermeiros estão apenas cumprindo tarefas estabelecidas pela instituição e exercem atividades burocráticas; outros são tecnicistas e não desenvolvem a gerência de enfermagem. A ideia de compreender o significado da gerência da assistência para o graduando de enfermagem é um ato de repensar a prática de ensino e aprendizado. Faz-se importante expandir a população de estudo, incluindo outras instituições de ensino, sejam públicas ou privadas / The present study aimed to understand the meaning that the nursing students from a State Public University assign to the Management of Nursing Care. For this purpose, it was chosen a qualitative approach, based on phenomenology. This methodological design has helped to brighten the idea of Management Assistance for graduation students and seeks to make visible what is hidden. It is searched the essence of the meanings attributed by the subjects about the investigated phenomena and it is sought to understand the man according to the reality experienced by him. This methodology enables to unveil values, perceptions and feelings of the subject involved. It\'s a philosophy which replaces essence in existence and does not understand the man and the world in other way but from their facticity. In order to comprehend the phenomena that this work intended to unveil, nursing graduate courses from a public university located in the state of São Paulo were chosen for the study setting. The institution gathers two nursing graduate courses. A phenomenological interview was carried out with 26 students. The following guiding question was adopted for the research development: What is your comprehension about the management assistance? After transcriptions, the testimonials were analyzed individually and then globally, rescuing the theme: Meaning of Management Assistance; Exercise of Management Assistance; Management Assistance in the internship field; Management Assistance and the rule of nurses; Bureaucratic Exercise. It was evaluated that at several moments in the presented speeches, the definition of Management Assistance was translated as coordination process in the work unit, whereas the articulations with the patient direct care were only a few times expressed. Regarding the supervision, the speeches reveal as inspection and control of the work process and a little as artifice of education. The speeches also points out the human resources control and organization as one of the main activities of the Management Assistance. A tool of the Management Assistance mentioned by undergraduates was the Nursing Care Systematization (SAE), standing out itself as an important instrument for a whole and qualified care. They have elucidated that there are nurses who develop the SAE in order to suit the rules of the institution. The dichotomy between the theory and the practice on learning was mentioned; they pointed out the importance of the internship and the contribution of the administration subject (theoretical block) for the understanding of Management Assistance. Still concerning the formative process, they referred that in the whole graduation the focus on management approach happens in the last semester of graduation. The nursing students have also brought the concept of the bureaucratic activities. Many nurses are just complying with tasks established by the institution and exert bureaucratic activities; others are technicists and do not develop the nursing management. The idea of understanding the management assistance for the nursing student is an act to rethink the practice of teaching and learning. It is important to expand the study population, including educational institutions, whether public or private

Este estudo é resultado de uma pesquisa de campo de caráter descritivo, realizada com os gerentes e coordenadores de unidades funcionais do Hospital das Clínicas da Universidade Federal de Minas Gerais. Teve como objetivo analisar a utilização de sistemas de informação enquanto instrumento para a tomada de decisão no exercício da gerência de unidades funcionais. A abordagem qualitativa utilizada na coleta e análise dos dados, com base na análise de conteúdo de Bardin, propiciou discussões fundamentadas na teoria e reflexões sobre a prática da gerência de unidades funcionais e a utilização de sistemas de informação como instrumento da gerência. O desenvolvimento da pesquisa considerou no primeiro momento, a caracterização da função de gerência de unidade funcional e as ações de tomada de decisão realizadas no exercício desta função. Posteriormente, foi descrito o ambiente informacional por meio do levantamento das informações produzidas pelos profissionais que exercem função de gerência, dos usuários dos sistemas, das necessidades de informação, das fontes de informação utilizadas, da avaliação das fontes disponíveis e da identificação de fontes potenciais. Os resultados do estudo constatam que a fase em que se encontra o processo de implementação do modelo gerencial de unidades funcionais é diferente em cada unidade estudada. Algumas já formalizaram a criação da unidade funcional, por meio do contrato de gestão e, outras ainda permanecem reproduzindo o modelo de gestão organizado em coordenações de enfermagem, médica e administrativa. Esta situação faz com que o uso de sistemas de informação para apoio à decisão seja incorporado de forma diferenciada pelos profissionais. Alguns reconhecem o sistema como um instrumento de apoio à decisão, desde que seja garantido o acesso às informações de forma segura e confiável. Para outros, a dificuldade em identificar os usuários, as necessidades e as fontes de informação demonstra o pouco conhecimento das possibilidades de sistematização das informações para uso no processo de trabalho. A incorporação de tecnologias computacionais na organização da informação foi identificada como condição para viabilização e integração do sistema, reconhecendo a necessidade de definir critérios de segurança para a alimentação e a recuperação das informações de forma seletiva. Finalmente, subsídios foram sugeridos para o desenvolvimento de sistemas de informação que respondam às demandas e necessidades dos usuários, bem como, para sua automação. / This study is the result of descriptive field research carried out with the managers and coordinators of the operational units of the University Hospital of the Federal University of Minas Gerais. The objective was to analyze the use of information systems as an instrument for decision-making in the management of operational units. The qualitative approach used in collecting and analyzing data based on Bardin’s content analysis, provided fundamental discussions on theory and reflection on the practice of management of operational units and the use of information systems as instruments for management. The research initially described the management job of the unit and the decision-making actions carried out in this position. Later there was a description of the computing environment through a survey of information produced by health workers who are in management positions, system users, information needs, the sources of information used, the evaluation of available sources and the identification of potential sources. The study found that the phase of implementation of the management model is different in each unit studied. Some have already formally created the unit through a management contract and others still use the management model organized around nursing, medical and administrative coordinators. This means that the information systems for decision-making are used in a different way by the health workers. Some recognize the system as an instrument to support decision, as long as they are assured of access to information in a safe and reliable way. For others, the difficulty in identifying the users, the needs and the sources of information show the lack of knowledge of the potential of the systematic organization of information at work. The incorporation of computer technology in organizing information was seen as a condition for the feasibility and integration of the system, recognizing the need to define safety criteria for feeding in and recovering information in a selective way. Finally, inputs were suggested for the development of information systems that will meet the demands and needs of users, as well as to permit its automation.

The purpose of this study is to provide a critical examination of the concept of hospital governance in a community hospital in British Columbia. The format of the thesis is to model the development of the Canadian health system in an extensive case analysis. The case analysis approach permits the expounding of theoretical concepts of hospital trustee roles and functions. Through the application of qualitative research, the fundamental issue addressed was the involvement of the Lions Gate Hospital trustees with policy issues during a ten year period of analysis from January 1969 through December 1978. The hypothesis was that the hospital trustees were not substantially involved in policy making but were primarily concerned with operational management issues and this suggested that the role of the trustee did not evolve in concert with the change in the Canadian health system under national health insurance. The hypothesis was tested through application of the research methods of content analysis and grounded theory in a review of the minutes of the Board of Management and the annual reports. In tracing the evolution of the Canadian health insurance program, it was shown that the enactment of the hospital insurance components which preceded medical care insurance produced an emphasis on hospital care and diagnostic services rather than ambulant care. Cost sharing provisions initially for capital funding and later for operational costs encouraged and stimulated the demand for hospital facilities across Canada. With the advent of these third party Insurance schemes, the role of the hospital trustee should have changed from one of fundraiser to one of policy maker; however, the trustees at Lions Gate Hospital were found to be predominantly concerned with operational management issues rather than policy issues. National health insurance established the legitimacy of hospital trustees as policy makers and the professionalization of hospital administration established the feasibility of the Chief Executive Officers being held accountable for operational management. The missing link is support from the provincial government of British Columbia and the lack of definitive legislation and requirements embodied in the Hospital Act (RS Chapter 176; 1979). The current legislation inhibits policy making and long range planning and reinforces the conception of a hospital board as an administrative body. The lack of policy development initiatives by the Lions Gate Hospital trustees resulted from the restrictive mandate of the Hospital Act, the inadequate funding system for hospitals, the process of trustee selection, the education process for hospital trustees, the role of the Chief Executive Officer and the interaction with the organized medical staff. Weak and ineffective boundary spanning roles allowed the hospital trustees to function as an administrative board rather than a policy making board. The outcome of the analysis of the governance process at Lions Gate Hospital was an unfulfilled expectation that the hospital trustees would perform three basic functions - mandate, maintain and monitor. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

During the past five (5) to seven (7) years, the American hospital literature has reflected a growing interest in the concept of Risk Management. Today, Risk Management, as an administrative control mechanism, is well established in many hospitals in the United States. Risk Management focuses on a system of identifying, monitoring and taking corrective action for potential or actual problems (the risks) that may result in unwarranted and unplanned personal injury, property damage, or other form of loss. Ultimately, Risk Management is concerned with the hospital's overall objectives of providing safe, quality patient care while using available resources efficiently. The expression, Risk Management, has not been defined with any regularity or consistency with respect to British Columbia Acute Care Hospitals. A generalized concept of protection against risks has been evident for many years, although in Canada (and specifically, British Columbia), it has been approached functionally. For example, hospital administrators have been accustomed to providing a safe and secure environment through such means as guidelines, accreditation standards and quality assurance. In addition, they are obligated to consider legal issues relating to hospital care and to obtain appropriate insurance coverage for the various types of losses the hospital might be exposed to. A new interest in Risk Management appears to represent a possibly defensive position taken by those who anticipate increasing amounts of risk and subsequent litigation. The question to be studied in this paper is whether there is any need for British Columbia Acute Care Hospital Administrators to move from their present rather pragmatic decision-making process for problem solving in selected areas to the more assertive and defensive approach of Risk Management. The answers were be sought by: 1. Reviewing the pertinent American literature on risk management. 2. Considering whether this presented an applicable approach to the British Columbia situation by: a. reviewing pertinent Canadian (and specifically British Columbian) literature on the same topic. b. reviewing Canadian (and specifically British Columbian) health services against their ideological background. 3. Discussing selected Risk Management considerations with: a. British Columbia legal experts in the health field. b. British Columbia insurance experts in the health field. 4. Discussing selected Risk Management considerations vis a vis present practices and procedures with hospital administrators (at senior and department head level) in two (2) British Columbia Community General Hospitals and covering three (3) hospital departments. The information collected from these interviews was presented in a case study format. The discussions focus on the major differences between the Canadian and American hospital industries. In addition, the variances between the findings in the literature review and the responses by the case study participants will be described. The analysis will draw conclusions about the need for British Columbia hospital administrators to change their present practices and move to a system of Risk Management. Recommendations for planning the introduction and evaluation of Risk Management in British Columbia Acute Care Hospitals are presented at the end of the study. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No / Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. STUDY OBJECTIVES: This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? METHOD: 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. RESULTS: 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. DISCUSSION: Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.