This thesis covers research around the Medical Emergency Team (MET) system, describing its development, evaluation and other related research that evolved as a result of the MET concept. The basic problem that prompted development of the MET system was related to the inadequate care given to the seriously ill in acute hospitals. This thesis contains background research on some of the reasons why a MET system may be useful, including the limited skills and knowledge of medical training and the sort of acute problems encountered in a hospital at night. Research then describes how the MET system works, including published data on when and how often the team is called, the type of patient the team is called to, the interventions performed by the team, and the outcome of patients on whom a MET was called. At the same time research was being performed around outcome indicators used to measure the effectiveness of the MET system, resulting in the use of cardiac arrests, deaths and unanticipated admission to the Intensive Care Unit (ICU) as common end-points for research in this area. Further research demonstrated that potentially preventable antecedents were common before serious illness The thesis then concentrates on how effective the MET system was in reducing death and serious adverse events. The first study compared a hospital where a MET system had been implemented to two control hospitals and found there was a reduction in admissions to the ICU but after adjustment, not for deaths and cardiac arrests. The second study used a cluster randomised methodology, enrolling 23 hospitals across Australia, comparing the three end-points described above. The study found no difference between both groups. It did highlight some interesting areas around the importance of effective implementation in determining the effectiveness of systems in health. Other publications have described the importance of developing effective ways of caring for the seriously ill outside traditional areas such as ICUs. The MET system, or variations on it, is now implemented in many hospitals in Australia and around the world and there have been two international MET conferences held in North America and international guidelines on the MET concept established.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

Diss. Linköping : Linköpings universitet, 2005.

Source: Dissertation Abstracts International, Volume: 57-08, Section: B, page: 4985. Advisor: David Martin. Includes bibliographical references (leaves 128-131).

Made available in DSpace on 2014-06-11T19:31:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2003-06-16Bitstream added on 2014-06-13T18:42:51Z : No. of bitstreams: 1 flores_dg_dr_mar.pdf: 1556092 bytes, checksum: 33c06c8d03c5281137862815c03ace96 (MD5) / A escolha do tema do presente trabalho - Construindo uma gestão participativa - surgiu da necessidade de relatar minha experiência profissional como Diretor de uma das unidades do Centro Paula Souza - a Escola Técnica Estadual Amim Jundi - o local da construção. Minha vida profissional e, posso acrescentar, minha vida pessoal sempre estiveram pautadas por atitudes, hábitos e princípios democráticos. A busca de respostas, tanto para a solução de problemas no cotidiano escolar, bem como para a fundamentação teórica das experiências vividas, estão traduzidas, inicialmente, pela dissertação de Mestrado - Conselho de Escola: Possibilidades e Limitações; e, na atualidade, pelo desenvolvimento deste trabalho. É óbvio que a própria escolha do tema, tanto da dissertação quanto da tese, demonstra minha crença na democracia, apesar do contexto político e econômico, que, às vezes, dificultam a efetiva realização desse ideal de governo. Durante as leituras específicas sobre gestão participativa, as pesquisas e levantamento de documentos, na verdade, durante o desenvolvimento do presente trabalho, pude perceber o quanto há para caminhar no sentido de edificar a gestão participativa, não somente na Amim Jundi, mas nas escolas de modo geral. O objetivo central deste estudo é expor, analiticamente, as mudanças efetuadas na organização e gestão da Escola Técnica Estadual Amim Jundi, no período de 1996 a 2000. Situada no município de Osvaldo Cruz - SP, a Amim Jundi faz parte do complexo institucional denominado Centro Estadual de Educação Tecnológica Paula Souza - CEETEPS - instituição pública voltada para a educação profissional de nível básico, técnico e tecnológico. / The choice of the present work - Building a participative management - has risen from my need of reporting my professional experience as Director of one of Centro Paula Souza units - the Escola Técnica Estadual Amim Jundi - The building site. My professional life and, I should add that, my personal life have always been supported by democratic attitudes, habits and principles. The search for answers, as to the solution of problems in the school daily life as to the theoretical basis of the experience passed through, are translated, first, by the Masters Dissertation - School Council: possibilities and Limits; and, today, by the development of the present work. Obviously, the choice of the theme itself, as much of the Dissertation as the Thesis, demonstrates my belief in democracy, despite the political and economic context, which, sometimes, makes difficult the effective achievements of this government ideal. During the specific readings about participative management, research and document collection, actually, during the development of this work, I could tell how far it is to make progress in order to construct the participative management, not only at Amim Jundi School, but in schools in general. This work aims to show, analytically, the changes done in the organization and management of Amim Jundi School, from 1996 to 2000. located in the town of Osvaldo Cruz - SP, Amim Jundi School makes part of the institutional complex called Centro Estadual de Educação Tecnológica Paula Souza - CEETEPS (Paula Souza Technological Education State Center) - a public institution devoted to the professional education in basic, technical and technological levels.

Os serviços de urgência/emergência apresentam-se como uma das portas de entrada do Sistema Único de Saúde (SUS), têm por objetivo atender de forma imediata indivíduos com risco iminente de vida. Nos últimos anos, a demanda por atendimento nestes serviços tem aumentado, dificultando a organização do trabalho e o acesso aos pacientes que realmente necessitam, comprometendo a qualidade do trabalho da equipe de saúde. As mudanças no perfil de morbi-mortalidade por doenças crônicas não transmissíveis trazem repercussão para o atendimento às urgências/emergências hospitalares. Este estudo teve por objetivo caracterizar os atendimentos clínicos de adultos segundo aspectos demográficos, organizacionais e de diagnóstico médico de alta em um Serviço de Urgência de um Hospital de Ensino do interior de São Paulo, no ano de 2007. Trata-se de uma pesquisa com desenho metodológico quantitativo, do tipo descritivo e transversal, utilizando dados secundários, obtidos através de um banco de dados do próprio hospital, os quais foram analisados segundo a estatística descritiva, apresentados na forma de freqüência e porcentagens, discutidos a partir de referencial teórico de reorganização do atendimento a urgências/emergências clínicas na perspectiva do SUS. No período ocorreram 5285 atendimentos clínicos que se caracterizaram em sua maior parte por usuários do sexo masculino (54,1%), com escolaridade de ensino fundamental (73,9%), na faixa etária de 18 à 59 anos (62,8%), procedentes do município de Ribeirão Preto (63,7%). No que se refere ao diagnóstico mais freqüente encontramos a hipertensão essencial (primária), correspondendo a 4,9% do total de atendimentos realizados. Quanto as variáveis organizacionais que o mês com maior número de atendimentos clínicos foi janeiro, 10%, enquanto o mês de novembro teve o menor número de atendimentos clínicos (7,3%), o dia da semana que apresentou maior demanda foi a segunda-feira (16%); quanto a variável horário de entrada do paciente no serviço, das 12 às 24h obtivemos um porcentual de 67,1% do total de atendimentos clínicos. O principal motivo de saída após atendimento foi a internação hospitalar e o tempo de permanência na unidade predominante foi inferior a seis horas. A caracterização dos atendimentos clínicos do serviço de urgência/emergência fornece subsídios para a organização do trabalho na unidade de estudo e no próprio hospital. / Emergency services are one of the entrances of the Unified Health System (SUS). They aim to delivery immediate care to people at eminent risk of death. The demand for care in these services has increased in the last years. This makes the organization of the work and the access of patients who really need care more difficult, compromising the quality of the health team work. Changes in the profile of morbimortality by nontransmissible chronic diseases reflect on the care provided in hospital emergency services. This quantitative, descriptive, cross-sectional study aimed to characterize the adult clinical care delivered in an Emergency Service in a Teaching Hospital in the interior of the state of São Paulo, in 2007. Secondary data, obtained in the hospital database, were used to characterize care according to demographic and organizational aspects and the discharge medical diagnosis. Data were analyzed using descriptive statistics and presented as frequency and percentage. Data are discussed through the theoretical framework of the reorganization of clinical emergency care in the perspective of SUS. During the analyzed period, 5285 clinical care sessions were delivered, most clients were men (54.1%), with primary educational level (73.9%), between 18 and 59 years of age (62.8%), and lived in the city of Ribeirão Preto (63.7%). The most frequent diagnosis observed was essential high blood pressure (primary), corresponding to 4.9% of the total care sessions delivered. Regarding the organizational variables, it was found that January was the month with the highest number of care sessions (10%), while November had the lowest (7.3%). Monday was the day of the week that presented highest demand (16%); the peak time of patient\'s entrance to emergency service was between 12 am and 12 pm, with 67.1% of the total clinical care sessions. The main reason of exit after the care session was hospitalization, and the prevailing length of stay at the service was less than six hours. The characterization of the clinical care delivered at the emergency service supports the organization of the work in the service under study and in the hospital itself.

Considerando que o comprometimento é fundamental para a inserção do trabalhador na organização, bem com para o desenvolvimento de suas atividades, este trabalho teve como propósito identificar, analisar e relacionar o comprometimento organizacional e o comprometimento profissional de trabalhadores que compõem uma equipe de saúde de uma unidade básica. Para isso foi utilizado o Modelo dos três componentes de Meyer e Allen que considera o comprometimento em três correntes teóricos, ou seja, comprometimento afetivo, comprometimento instrumental e comprometimento normativo. Os profissionais da saúde estudados correspondem a três odontólogos, três médicos, dois administrativos, uma obstetra, uma enfermeira, uma fisioterapeuta e uma bióloga, dos quais quatro são terceirizados e a maioria trabalha somente na unidade básica. Quanto à caracterização acadêmica são oriundos basicamente de universidades privadas e têm nível superior completo. Realizadas as entrevistas semi-estruturadas, foi observado que o comprometimento profissional de base afetiva foi predominante nos sujeitos estudados o que é evidenciado quando mencionam em relação a profissão, sentirem-se contentes, realizados e felizes. As organizações de saúde devem articular estratégias que motivem o comprometimento afetivo no meio profissional e organizacional e ao mesmo tempo procurar reduzir fatores instrumentais e normativos. / Considering that the commitment is fundamental to insert the worker in an organization, as well as to develop their activities, this study had a purpose to identify, analyze and relate the professional and organizational commitment of the workers who belongs to a health team in a health center. In order to this, it was used a Model with three components of Meyer and Allen which considers the commitment in three theoretical focus: affective commitment, instrumental commitment and normative commitment. Health professionals who were studied are: three dentists, three physicians, two administrators, an obstetrician, a nurse, a physiotherapist and a biologist, whom four provide service and the majority works only in the basic unit. Regarding the academic characterization, they graduated most in private universities and have academic degree. After realizing the semi-structured interviews, it was noted that the affective professional commitment was predominant in the subjects when they mentioned about the profession, they feel glad, satisfied and happy. Health organizations must articulate strategies which motivate the affective commitment in professional and organizational environments and, at the same time, try to reduce instrumental and normative factors.

As Diretrizes Curriculares Nacionais para o curso de graduação em Odontologia determinam que, dentro das competências e habilidades que o cirurgião-dentista precisa desenvolver, encontra-se a capacidade de administração e gerenciamento de sua carreira, devendo estar apto para ser empreendedor, gestor e empregador, bem como para exercer papel de liderança dentro das equipes de saúde bucal. Nesse contexto, o objetivo do presente estudo é verificar a percepção e os conhecimentos dos alunos do último ano da Faculdade de Odontologia da Universidade de São Paulo em relação às estratégias de gestão para o ingresso no mercado de trabalho. Para tanto, foi realizado um estudo transversal, aplicando-se um questionário aos alunos que já haviam cursado a disciplina de Gestão e Planejamento em Odontologia de 2014. Os resultados foram tabulados em planilha Excel e analisados no pacote estatístico STATA 13.0. Dos 109 alunos matriculados na disciplina, 107 (99%) participaram da pesquisa, sendo a amostra composta por média de idade de 25 anos e por 70% dos participantes do gênero feminino. A partir da análise dos resultados, foi possível observar que 35,51% dos alunos sabem descrever com clareza o objetivo da organização na qual pretendem trabalhar; 45,79% acreditam que estão diante de uma oportunidade real para obter sucesso profissional; 58,88% estão seguindo esse caminho pela satisfação profissional; 37,38% aceitam riscos; 34,64% acreditam ter conhecimentos para gerir um bom negócio; e 54,21% consideram ter capacidade para liderar pessoas. Foi possível concluir, com este estudo, que a disciplina em questão consegue desempenhar o seu papel de auxiliar e orientar os alunos nessa transição para o ingresso no mercado de trabalho, tendo sido efetiva no aprendizado dos conhecimentos referentes às estratégias de gestão e empreendedorismo para esse início de carreira. Nesse sentido, observa-se ser fundamental que, ao longo do curso de graduação, a matriz curricular englobe conteúdos de gestão para o melhor desenvolvimento dessa competência. / The National Curriculum Guidelines for the degree course in Dentistry determine that, within the skills and abilities that the surgeon dentist needs to develop, it is the ability of administration and management of his career, and he should be able to be an entrepreneur, manager and employer and to exercise leadership role within the oral health teams. In this context, the aim of this study is to verify the perception and knowledge of students in the last year of the Faculty of Dentistry of University of São Paulo in relation to management strategies for entering the labor market. Thus, a cross-sectional study was conducted by applying a questionnaire to students who already had studied Management and Dentistry Planning in 2014. The results were tabulated in an Excel spreadsheet and analyzed using the statistical package STATA 13.0. Among the 109 students enrolled in the course, 107 (99%) participated in the survey, the average age of the sample was 25 years old and 70% were female. From the analysis of the results, it was observed that 35.51% of students know clearly describe the organization\'s purpose in which they wish to work; 45.79% believe they are facing a real opportunity for professional success; 58.88% are following this path by job satisfaction; 37.38% take risks; 34.64% believe they have knowledge to manage a good deal; and 54.21% consider having the ability to lead people. It was possible to conclude from this study that the discipline in question manages its role to assist and guide students in the transition for entering the job market. It was effective in teaching entrepreneurship and management strategies for this early career. In this sense, it is observed it is essential that, throughout the course, the curricular matrix covers management contents for the best development of this competence.

Abstract The aim of this study was to analyse the content and related competences of the work of the manager of municipal social and health services. In the theoretical part of the research, management tasks and the context and theoretic tendencies of management are examined. The management of social and health services is examined from the point of view of competence. The competences were formed based on general models of management and the analysis of managerial tasks in social and health services. The competences of social and health services management consist of those of operation, human resources and financial management, network cooperation and communication. Empirical study was executed in two phases. In the first phase, data were collected by an online and postal survey questionnaire aimed at managers of social and health services (n = 169). The data were analysed using SPSS statistical analysis software. When selecting the methods for data analysis, measuring the level and distribution of variables in the data were taken into consideration. In the analysis of the variables, both parametric and non-parametric statistical tests were exploited, taking into account the size and the quality of the data. In the second phase, five social and health service managers were thematically interviewed. The data from the thematic interviews were analysed by content analysis. In the basic duty of social and health managers, the management of change, financial and human resource management, cooperation and networking were emphasized. In change-related development work, working group membership or securing resources for others were emphasized. Compared to other managers, managers of social and health care organisations and managers in the largest municipalities were more often in charge of developing new operations models and producing services jointly with the private and third sector. The challenges of human resource management were related to the management of competence and its development. Cooperative networking seems to be increasing in the future thanks to reform of the service structure and diversification of service production. At present, relating to the managerial competences, the managers of social services needed operational, financial and staff management skills once in a while or quite often, more so than the others. In the near future, the managers of social and health care organisation needed skills in different areas more than managers of social services. In the future, all managerial competences are needed more often than at present. The requirements of the qualifications for a manager were Master's degree, education and experience in management and skills in accordance with managerial competence. The changes in the operational environment of social and health services will change manager's duties and the competence needed. In this study, useful information about the development of managerial competence in social and health services was acquired, and it can also be used in the evaluation and planning of managerial education. / Tiivistelmä Tutkimuksen tarkoituksena on analysoida kunnallisen sosiaali- ja terveystoimen johtajan työn sisältöä ja työhön liittyviä kompetensseja. Tutkimuksen teoriaosassa tarkastellaan sosiaali- ja terveystoimen johtamisen kontekstia, johtamistehtäviä ja johtamisen teoreettisia suuntauksia. Sosiaali- ja terveystoimen johtamista tarkastellaan kompetenssinäkökulmasta. Johtamistehtävien kompetenssit muodostettiin yleisten johtamiskompetenssimallien ja sosiaali- ja terveystoimen johtamistyön sisällön analyysin perusteella Sosiaali- ja terveystoimen johtamisen kompetensseiksi muodostuivat virkakelpoisuuden lisäksi toiminnan, henkilöstön ja talouden johtamisen, verkostoyhteistyön ja viestinnän sekä projektitoiminnan kompetenssit. Empiirinen tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisessä vaiheessa aineisto kerättiin Internet- ja postikyselyllä kuntien sosiaali- ja terveystoimen johtajilta (n = 169) Aineisto analysoitiin SPSS-tilasto-ohjemistolla. Aineiston analyysimenetelmien valinnassa huomioitiin muuttujien mittaustaso ja jakauma havaintoaineistossa. Muuttujien analyysissä hyödynnettiin aineiston koko ja laatu huomioiden parametrisiä ja parametrittomia tilastollisia testejä. Toisessa vaiheessa suoritettiin teemahaastattelu viidelle sosiaali- ja terveystoimen johtajalle. Aineisto analysoitiin teorialähtöisellä sisällön analyysillä. Sosiaali- ja terveysjohtajan perustehtävän johtamisessa korostui muutosjohtajuus, talous- ja henkilöstöjohtaminen sekä yhteistyö ja verkostoituminen. Muutoksiin liittyvässä kehittämistyössä johtajien toiminta painottui useimmin työryhmän jäsenyyteen tai resurssien turvaamiseen muille. Yhdistetyn organisaation ja suurimpien kuntien johtajat toimivat useammin kuin muut vastuullisessa tehtävässä uusien toimintamallien kehittämisessä ja palvelujen tuottamisessa yksityisen ja kolmannen sektorin kanssa. Henkilöstöjohtamisen haasteet liittyvät osaamisen johtamiseen ja sen kehittämiseen. Verkostoyhteistyö näyttäisi lisääntyvän tulevaisuudessa palvelurakenneuudistuksen ja palvelutuotannon monipuolistumisen myötä. Johtamiskompetensseista sosiaalitoimen johtajat tarvitsivat nykytilanteessa tyypillisemmin kuin muut toiminnan johtamisen, talous- ja henkilöstöjohtamisen taitoja silloin tällöin tai melko usein. Yhdistetyn organisaation johtajista useampi kuin sosiaalitoimen johtajista tarvitsi lähitulevaisuudessa eri alueen taitoja jatkuvasti. Tulevaisuudessa kaikkia johtamiskompetensseja tarvitaan nykyistä useammin. Johtajan kelpoisuusvaatimuksena edellytettiin ylempää korkeakoulututkintoa, johtamiskoulutusta ja -kokemusta sekä johtamiskompetenssien mukaisia taitoja. Tuloksissa korostuivat myös johtajan vuorovaikutustaidot hyvän johtajan ominaisuutena ja valintakriteerinä. Sosiaali- ja terveystoimen toimintaympäristön muutokset muuttavat johtajan työnsisältöä ja työssä tarvittavaa osaamista. Tutkimuksessa saatiin hyödyllistä tietoa sosiaali- ja terveystoimen johtamisosaamisen kehittämiseen ja johtamiskoulutuksen arviointiin ja suunnitteluun.

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