Contexte : Les premières implantations PACS (Picture Archiving and Communication System) remontent aux années 80. Le rehaussement récent du PACS au sein d’un centre hospitalier universitaire a permis d’étudier l’introduction d’innovations dans une technologie mature. Objectif : Dans un premier temps, effectuer une revue de la littérature sur les études évaluant la perceptions des utilisateurs de l’implantation des PACS. Deuxièmement, évaluer dans une étude de cas si le niveau d’alignement entre les tâches et la technologie prédit l’utilisation et la perception des bénéfices. Méthodes : Il y a eu une revue systématique de la littérature afin d’identifier les études sur la perception des utilisateurs du PACS. Une adaptation du modèle TTF (Task-Technology-Fit) développé par Goodhue (1995) a servi de base théorique pour l’étude de cas effectuée par questionnaire auto-administré. Résultats : Les modèles recensés dans la revue systématique sont mieux adaptés à des nouvelles implantions PACS qu’à des systèmes matures en évolution. Il y a une corrélation significative entre le niveau de l’alignement, tel que perçu par les utilisateurs, et la perception des bénéfices nets, ainsi que l’utilisation de la technologie. L’étude a démontré un écart entre la perception des utilisateurs et celle des développeurs interviewés. Conclusions : Cette étude supporte la validité du concept alignement tâche-technologie dans l’analyse d’un rehaussement PACS. Il est important de maintenir une interaction soutenue entre développeurs et utilisateurs, qui va audelà de la phase initiale de développement. / Context: The first PACS deployments date to the early 1980’s. The recent upgrade of PACS in a university teaching hospital has offered the opportunity to study the introduction of innovations in a mature technology. Objective: First, to conduct a literature review of studies evaluating user perceptions following deployment of PACS. Second, to evaluate in a case study if task-technology fit predicts utilisation and perceived benefits. Methods: A systematic review of the literature was conducted to identify studies evaluating user perceptions. An adaptation of the Task-Technology-Fit model developed by Goodhue (1995) served as a theoretical basis for the case study conducted with an auto-administered survey. Results: The models used in the studies identified in the review are more suited for initial deployments of PACS, rather than mature systems in a state of continuous evolution. There is a significant correlation between the level of task-technology fit and the users’ perception of net benefits, as well as use. The study also revealed a divide between the perception of users and that of developers involved in product evolution. Conclusion: The findings validate the use of task-technology fit to study a PACS upgrade. It is important to maintain a continuous interaction between users and developers beyond the early phases of product development.

Web 2.0 概念的開放、即時、互動、同步、多元的資訊傳遞方式創造出更多的群體價值。社群網站讓組織與使用者的互動更加密切，公眾接觸的概念興起，本研究政府部門的臺北市立動物園與社會企業網路媒體社企流個案，均為良好的公眾接觸個案。越來越多組織應用社群網站的程度，依據在於長期來看，社群網站創造多少效果。因此本研究從資訊系統層面、使用者層面與組織管理層面的文獻檢閱，探討社群網站對於各部門組織的重要性、目標與效果。加入Web 2.0的特性所建立效能衡量架構，檢視社群網站對兩研究個案所帶來的效果與經營策略。 研究設計兼具量化與質化的混合方法，透過量化網路問卷蒐集使用者態度，從資訊系統層面的系統品質、資訊品質、服務品質，以及使用者層面的公眾接觸、社會影響等構面，以多元迴歸模型，探討資訊系統滿意度、使用者忠誠度與顧客關係目標等使用者態度。並以質化深度訪談組織內部，從交易成本與組織創新等理論，探討組織如何導入社群網站、管理的過程、分工、評估與策略等。 研究發現，資訊系統層面顯著提升資訊系統滿意度，但對於使用者忠誠度與顧客關係目標無顯著關係；資訊品質對使用者態度沒有顯著關係。在第三部門意指使用者認同其理念，社群網站的介面和管理相對不重要。在政府機關，系統品質對於資訊系統滿意度以及使用者忠誠度皆有顯著影響，顯示政府在Web 2.0時代，社群網站管理者已能掌握資訊傳播的系統品質。使用者層面的公眾接觸與社會影響均具有顯著關係，其中公眾接觸構面的涉入與共同創造為最良好的解釋變項。在社會影響構面，在描述性統計評價最低，但與使用者態度有顯著關係，其中公眾形象為良好的解釋變項。使用者態度的顧客關係目標，資訊傳播最容易達成，實際行動與深化關係相對較難。組織管理層面，發現社企流為有機式組織，可以快速應變環境變化，待改善者為組際間合作。而動物園優勢為機關長官支持與跨組室推動，待改善為上級機關仍不熟悉Web 2.0，難掌握民意溝通管道。 從研究發現可以歸納出各部門均可適用的社群網站經營核心，包括「社群」、「內容」、「管道」。實務建議包括鎖定粉絲專頁的目標族群、虛實整合、提升公眾接觸、加強人際網絡建立、深化關係等。經營策略包括精美圖片、回應使用者問題、提供穩定與精彩的資訊內容、配合時事話題、異業合作等。 / In recent years, Web 2.0 has been the buzz word for the field of e-governance due to its openness, immediacy, and interactivity, which facilitate a more collective and effective networking life of the population. In this thesis, author reviews the literature from information system design, civil engagement, and organizational management to research on the importance, objective, and effectiveness of social media usage and its impact on non-profit organizations. Author selects two cases, Taipei City Zoo (the first sector) and Social Enterprise Insights (the third sector), to investigate and compare them to answer questions concerning the objective and effectiveness of utilizing social media. In this research, a mixed-method approach is adopted to collect both quantitative and qualitative data. An on-line questionnaire was administrated to users of both Facebook Fan Pages and in-depth interviews with organizational staffs. According to literature reviews, the research framework contains two dimensions: information system (system, information and service quality) and civic engagement and social influence on users. Author uses multiple regression to analyze users’ subjective responses. Findings are as follows. First, information system dimension contributes to merely information system satisfaction and information quality is no significant. Second, users’ dimension is significant, but social influence is the worst in descriptive statistics. Third, compared to deeper engagement and take action, communication of information is easy to obtain. Forth, in the organizational management dimension, SEI is an organic organization to adapt the changing environment. Manager support and cross- unit execution cause good-use of social media in the zoo. From this research, practical advices to social media “page masters” contains three main parts. First, the keys to manage social media are community, contents, and channels of communication. Second, the managing goals are focusing on target group, integrating virtual with real world, promoting civic engagement and establishing interpersonal network. Finally, the strategies are utilizing eye-catching pictures, promptly responding to users’ questions, and stable provision of interesting contents.

二十一世紀是知識經濟的時代，「創新」成為個人、團隊及組織致勝的關鍵，組織競爭力與生產力均靠「組織創新」而提升。學校面對新時代的挑戰，必須積極加以回應，如何將創新帶入學校組織之中，激發學校組織的創新，以提高學校效能，是各級學校無法逃避的時代課題。基於此一時代需求及國民中學的發展需要，本研究以臺中市一所國民中學為例，進行「學校創新」的初探性研究。 本研究採單一個案質性研究，運用個案文件、實地觀察及深入訪談進行資料蒐集，探討、詮釋及思索一所國民中學創新之歷程、策略及促成因素。經研究後獲致以下結論： 一、個案創新歷程為：(一)校舍重建;(二)校園新風貌;(三)學校創新領導;(四)型塑學校創新主軸;(五)發展具體創新項目;(六)形成創新團隊;(七)引進教育創新實驗方案;(八)創新發表與接受評鑑;(九)創新歷程的自省與深化;(十)建構學校創新文化;(十一)學校文化的創新。 二、個案創新策略為：(一)研訂創新主軸;(二)結合課程發展;(三)利用社區資源;(四)突出特色發展;(五)配合專案實驗;(六)參加創新評鑑。 三、個案創新促成因素為：(一)九二一地震是個案學校創新的契機; (二)學校外在環境的九年一貫課程的推動、教育創新實驗案的推廣、強調學校本位課程特色因素。(三)學校組織的領導、文化、策略、人力素質因素。 個案創新受九二一地震影響，此一天然災害因素組織無法掌控，唯透過本研究分析探討個案創新歷程、策略及促成因素，能深入瞭解學校創新之相關議題，並提出學校創新建議，供學校創新參考。 關鍵詞： 組織創新 學校創新 學校創新策略 學校創新促成因素 / Such an era of knowledge economy as the 21st century is, “innovation”has become the key for the individuals, teams, and organizations to outdo others while organizational competitiveness and productivity are both boosted relying upon “innovation of organization”. To confront with the challenges of the new era, a school has the need to respond to them vigorously. It is an inevitable subject of the era to schools of all levels how to bring forth innovation to academic outfits to set off their organizational innovation for greater efficacy. Based upon the demands for the era as well as the development of junior high schools of which one is exemplified in Taichung City, Taiwan, to carry out the preliminary test study of “innovation of school”. This paper adopts the unitary case story study of quality and nature by applying the methods of documentary analysis, observation, and in-depth interview to carry on the research, probing, interpretation, and pondering of a junior high school in term of the course of school innovation, strategy, and elements of facilitation. The conducted study sums up the follows: In the course of innovation: 1) Reconstruction of school building; 2) New styles and features of campus; 3) Leadership of school innovation; 4) Formulation of prospects in innovation of school; 5) Development of items of concrete innovation; 6) Formation of innovation team; 7)Introduction of experimental scheme for educational innovation; 8) Announcement of innovation and acceptance of appraisement; 9) Introspection and deepening of innovative course; 10) Establishment of school innovative culture; and 11) Innovation of school culture. For the strategy of case story innovation: 1) Study to set the axis of innovation; 2) Integration of curricular development; 3) Utilization of community area resources; 4) Highlighting development of special features;5) Coordination of special case experiment; and 6) Participation in appraisement of innovation. For the elements of facilitation of case story innovation:1) 921 Earthquake is a turning point of school innovation;2) The factors of leadership, culture, strategy, and manpower quality of internal organization of a school;3) Enforcement of 9-year consistent curricula, application of information technology, extension of experimental scheme of school innovation, and emphasis upon the elements of characteristics in departmental curricula involving off-campus environment. 921 Earthquake is a great influence on the case story innovation . It is a natural disaster that organization can not control.But through this study to discuss the course of school innovation,strategy, and elements of facilitation in case story can understand the issues about school innovation and provide some suggestions for school innovation. Key words: organizational innovation school innovation innovation strategy of school the facilitating elements of school innovation

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Esta tese se pautou nas interfaces entre a estrutura do Sistema Nacional de Inovação em Saúde e o Sistema Nacional de Saúde - componentes estratégicos para os setores econômico e social do país. Abordou-se o marco jurídico institucional que dá sustentação à Ciência e Tecnologia em Saúde, envolvendo o arcabouço político que ampara a inovação tecnológica no país e os sistemas de regulação voltados a garantir sua sustentabilidade. O propósito desta pesquisa foi o de investigar as relações e os padrões que possibilitam o estabelecimento de vínculos entre os atores e ainda favorecem a formação de redes de pesquisas, buscando identificar quais os elementos que necessitam de maior foco dos gestores de forma que as conexões estabelecidas sejam fortalecidas e facilitem o monitoramento e a avaliação das redes. Caracteriza-se por ser uma pesquisa qualitativa elaborada a partir da teoria crítica, de abordagem quantitativa, incluindo um estudo de caso exploratório e analítico sobre a Rede Nacional de Pesquisa Clínica em Hospitais de Ensino, envolvendo a triangulação de métodos, baseada na observação, na análise de conteúdo e na vertente bibliográfica. Apoiou-se nas bases da Teoria Ator-Rede, ao investigar as relações e os padrões, que acabam por se configurar como vínculos entre pesquisadores e instituições. Os resultados depreendidos do estudo acrescentam novas compreensões sobre a gestão de redes de pesquisas, cuja análise se encontra hoje permeada por uma literatura centrada em atributos individuais. Ao se perceber a pesquisa clínica multicêntrica como estratégica fomentadora de inovação para saúde, esta tese delineou alternativas de gestão para expandir as conexões relacionais passíveis de fomentar, ampliar e fortalecer o Sistema Nacional de Ciência, Tecnologia e Inovação em Saúde e suas associações com as necessidades do Sistema Único de Saúde / This thesis is based on the interfaces between the Brazilian National System for Innovation in Health\'s structure and the Brazilian National Health System - strategic components for the economic and social sectors in the country. The institutional legal framework that gives support to Science and Technology in Health was referred to, considering the policies that sustain technological innovation in the country and the regulatory systems aimed at guaranteeing its sustainability. The goal of this study was to investigate the relationships and the patterns that make it possible to establish ties between actors and that also favor the formation of research networks, seeking to identify which elements require a greater focus from managers in order to strengthen the established ties and to facilitate network monitoring and evaluation. This study is a qualitative one that is elaborated upon critical theory, upon a quantitative approach, and includes an exploratory and analytical case study on the Brazilian National Network of Clinical Research in Teaching Hospitals, comprising a triangulation of methods, based on observation, on content analysis and on bibliographic lines. Upon investigating relationships or patterns, this study relied upon the bases of Actor-Network Theory, which result in ties formed between researchers and institutions. The results gathered from the study added new insight into the management of research networks, whose analysis is currently permeated by literature centered on individual attributes. Upon perceiving multicenter clinical trials as a strategy that fortifies innovation in health, this thesis outlined management alternatives that may expand the relational connections believed to foment, increase and strengthen the Brazilian National Science, Technology and Innovation System and its associations with Brazilian Public Health System needs

INTRODUÇÃO: A curarização residual está associada a maior risco de morte após anestesia. Erros diagnósticos após o uso de bloqueador neuromuscular (BNM) estão relacionados com prevalência de 65-88% de curarização residual pré-extubação traqueal (CRPE). Esse estudo analisou a decisão clínica intuitiva de usar antagonista de BNM antes da extubação traqueal. MÉTODOS: Após aprovação do Comitê de Ética em Pesquisa, a decisão clínica dos anestesiologistas da nossa instituição foi auditada em 150 pacientes. A participação foi voluntária e anônima. As decisões, como se fossem resultados de um teste diagnóstico, foram comparadas à aceleromiografia, com TOF < 0,9 definido como CRPE. Uma árvore de decisão foi estruturada para comparar as diferentes estratégias e uma pesquisa sequencial (Delphi), realizada entre 108 anestesiologistas, extraiu as heurísticas (regras simplificadoras) mais usadas. RESULTADOS: A prevalência de CRPE foi de 77%. A intuição clínica apresentou sensibilidade de 0,35 (0,23-0,49) e especificidade de 0,80 (0,54- 0,94) para CRPE (P= 0,0001). Em uma escala de 0-10 a utilidade esperada da intuição foi menor do que sempre antagonizar (4,1 + 4,4 vs. 8,4 + 3,0, P< 0,05). As heurísticas mais proeminentes foram O intervalo desde a última dose de BNM foi curto e O padrão respiratório está inadequado, citadas por 73% e 71% dos anestesiologistas, respectivamente. Uma hora após dose única de atracúrio comparada ao rocurônio, 69,3% vs. 47,1% (P= 0,0035) dos anestesiologistas não usam antagonista antes da extubação traqueal. Os anestesiologistas têm a percepção de que a prevalência de curarização residual clinicamente significativa é maior na prática dos seus colegas do que na sua própria prática clínica (razão de chances 7,8 (3,8-16,2) P< 0,0001). CONCLUSÕES: A intuição clínica não deve ser usada para descartar a presença de curarização residual. Sempre usar o antagonista é uma estratégia melhor do que usar a intuição clínica para decidir. Os anestesiologistas tomam a decisão intuitiva baseados em uma previsão da duração dos efeitos do BNM e no julgamento qualitativo da adequação do padrão respiratório do paciente. Eles se consideram mais capacitados para evitar a curarização residual do que os colegas. Demonstram confiança excessiva na própria capacidade de prever a duração de ação do BNM e de descartar intuitivamente a presença de CRPE / BACKGROUND: Residual curarization is associated with a higher risk of death after anesthesia. Diagnostic errors after the use of neuromuscular blocking agents (NMBA) are related to 65-88% prevalence of preextubation residual curarization (PERC). This study analyzed the clinical intuitive decision of antagonizing NMBA before tracheal extubation. METHODS: After IRB approval, this clinical decision was audited in 150 patients. Participation in the study was voluntary and anonymous. Decisions, as if a diagnostic test, were compared to acceleromyography, with TOF<0.9 defined as PERC. A decision tree was structured to compare different decision strategies. A sequential survey (Delphi) was conducted among 108 anaesthesiologists to elicit the most frequently used heuristics (rules of thumb). RESULTS: PERC prevalence was 77%. Clinical intuition presented sensitivity of 0.35 (0.23-0.49) and specificity of 0.80 (0.54-0.94) (P=0.0001). In a 0-10 rating scale, expected utility of intuition was lower than always antagonize all patients (4.1 + 4.4 vs. 8.4 + 3.0, P<0.05). The most salient heuristics were Short interval since the last NMBA dose and Breathing pattern is inadequate stated by 73% and 71% of the anesthesiologists, respectively. One hour after a single dose of atracurium compared with rocuronium, 69.3% vs. 47.1% (P= 0.0035) of the anesthesiologists do not use antagonist before tracheal extubation. They perceive that prevalence of clinically significant residual curarization is higher in their colleagues practice than in their own clinical practice (odds ratio 7.8 (3.8- 16.2), P< 0.0001). CONCLUSIONS: Clinical intuition should not be used to rule out residual curarization. Routine antagonism is a better strategy than the use of clinical intuition to make this decision. Clinicians make this intuitive decision based on a forecast of the duration of the effects of NMBA and on a qualitative judgement about the adequacy of the patients breathing pattern. They consider themselves more capable of avoiding residual curarization than their colleagues. They are overconfident in their own capacity to predict NMBA duration and intuitively rule PERC out

Submitted by Marcia Silva (marcia@latec.uff.br) on 2016-01-29T17:58:10Z No. of bitstreams: 1 dissert Carlo Bruzaferro Monti.pdf: 2502180 bytes, checksum: 678f8cd1b6f320299ab6fbb349aae510 (MD5) / Made available in DSpace on 2016-01-29T17:58:10Z (GMT). No. of bitstreams: 1 dissert Carlo Bruzaferro Monti.pdf: 2502180 bytes, checksum: 678f8cd1b6f320299ab6fbb349aae510 (MD5) Previous issue date: 2015-07-16 / O objetivo geral deste trabalho é analisar de que forma o desempenho da liderança e a importância dos seus papéis podem influenciar a promoção de atividades de inovação organizacionais. Para isso, esta pesquisa tem como objetivos específicos registrar qual a percepção dos gestores quanto à importância e o desempenho dos seus papéis, registrar quais tipos de atividades de inovação são promovidos pelos gestores sob a ótica de cada um dos seus papéis, analisar todas as variáveis de forma cruzada e criar um índice de coerência na promoção das atividades de inovação. A metodologia utilizada é um estudo de caso, com levantamento de informação feito por meio de questionário com perguntas fechadas. Foram feitas análises quanto aos tipos de atividades mais frequentes, aos tipos de atividades por cada papel do gestor, à importância de cada responsabilidade dos gestores, ao desempenho de cada responsabilidade dos gestores e ao desempenho em conjunto com a importância. Por fim, conclui-se que os gestores desta empresa não se comportam exatamente como esperado pela literatura. Este comportamento cria a oportunidade de se propor uma metodologia para que os gestores avaliem periodicamente suas responsabilidades e promovam as atividades de inovação necessárias de modo a maximizar sua coerência. / The aim of this study is to analyze how the performance of leadership and the importance of their roles can influence the promotion of organizational innovation activities. To do this, this research has the following specific objectives: registering the perception of managers on the importance and performance of their roles, record which types of innovation activities are promoted by managers from the perspective of each of their roles, analyze all the variables crosswise and create a consistency index in the promotion of innovation activities. The methodology used is a case study with information from survey through a questionnaire made of closed questions. Analyses were made for the most frequent types of activities, types of activities for each role of the manager, the importance of each one of manager’s responsibilities, the performance of each manager’s responsibilities and the performance together with the importance. Finally, it is concluded that managers of this company do not behave exactly as expected by literature. This behavior creates the opportunity to propose a methodology for managers periodically evaluate their responsibilities and promote the necessary innovation activities in order to maximize their coherence.

The inquiry concerned gaining insights into environmental elements needed within California public-sector organizations to increase employees’ willingness to share innovative ideas. Although research exists regarding the need for service innovation and employees as fruitful sources of innovative ideas, there have been limited studies concerning public-sector organizations and the best method to solicit employee ideas. The data collection for this qualitative research study consisted of a series of interviews with front-line, non-supervisory civil servants. The results provide insights and information on how public-sector organizations may foster a culture that promotes and encourages employee-led innovation. The themes that emerged were (a) transparency in the process of sharing ideas and what is needed to feel motivated to participate in a formal submission process; (b) recognition and follow up, including which types of follow up and recognition are needed to feel the idea submission was worth the effort; (c) safe space including what needs to be present within the process for employees to feel safe to participate; (d) organizational buy-in including the need for encouragement and demonstrated support from all levels of leadership. These themes contributed to form the following recommendations for organizations to create a process and culture for soliciting ideas from employees: (a) establishing a transparent and easy to use process; (b) utilizing trusted and unbiased evaluators to review ideas; (c) providing meaningful and specific follow-up on ideas submitted; (d) ensuring there is no public criticism of ideas, but having public praise for submitting ideas; creating an organizational culture to be promoting and supporting participation in these processes. The data analysis revealed several implications: a significant disconnect between what employees' need to be comfortable sharing ideas and the existing process; the insufficient efforts of current leaders to promote and execute innovation within their organizations; the need for a paradigm shift to embrace a culture and operations that support innovation at all levels of an organization.

Les maladies chroniques regroupent un ensemble de problèmes de santé tels que le diabète, l’hypertension, les maladies pulmonaires obstructives chroniques (MPOC) et le cancer. Elles requièrent une prise en charge continue, durant plusieurs années et évoluent généralement lentement. Ce projet de recherche vise à comprendre et à analyser les dynamiques associées à la mise en place d’un modèle organisationnel qui permet une meilleure prise en charge des patients atteints de maladies chroniques et à porter une attention particulière aux mécanismes professionnels et organisationnels qui favorisent la mise en place de ce modèle de soin dans un contexte pluraliste des organisations et du système de santé. Il vise aussi à explorer si le modèle mis en place permet d’atteindre les objectifs et les résultats de soins escomptés par le modèle. Le contexte de notre étude s’inscrit dans le réseau de l’écosystème des maladies chroniques et des relations inter-organisationnelles lors de l’implantation et de la mise en œuvre du Centre d’accompagnement interdisciplinaire en maladies chroniques CAIMC du CSSS du Haut-Richelieu-Rouville à Saint-Jean-sur-Richelieu. Les données récoltées proviennent d’entrevues individuelles représentatives de l’ensemble des acteurs professionnels du terrain, se fondent sur des documents et rapports, notamment ceux de divers comités de travail ainsi que de protocoles de soins. Notre recherche s’appuie sur le cadre conceptuel de l’analyse stratégique de Crozier et Friedberg (1977) ainsi que sur le système des professions d’Abbott (1988). Elle met en évidence une complexité organisationnelle et structurelle qui rend difficile la gestion du changement dans les organisations pluralistes, surtout lors de l’implantation d’un modèle de soin dans un long horizon temporel. Cette implantation résulte de la gestion d’un processus d’apprentissage continu au sein de l’organisation. Le modèle que nous proposons constitue un cadre d’analyse qui permet une synthèse de diverses approches qui favorisent la compréhension de phénomènes complexes et leur gestion. Il contribue ainsi à raffiner et approfondir la compréhension des dynamiques organisationnelles et professionnelles associées à la mise en place d’un modèle organisationnel. Il peut valablement être utilisé pour l’étude de divers modèles de soins, outre celui des maladies chroniques. Il serait d’ailleurs judicieux de considérer un tel cadre d’analyse avant toute expérimentation ou implantation de modèles de soins dans des organisations pluralistes de santé. Cette étude permet de formuler des recommandations à l’attention des décideurs publics. Elle soutient, notamment, que la mobilisation d’un intrapreneur, ayant l’étoffe d’un leader transformationnel dans un cadre organisationnel agile, favoriserait la création et l’acquisition de connaissances permettant d’accélérer les processus et d’améliorer l’autogestion des patients. / Chronic diseases include a range of health problems such as diabetes, hypertension, chronic obstructive pulmonary disease (COPD) and cancer. They require continuous management over several years and generally evolve slowly. On the one hand, this research project aims to understand and analyze the dynamics associated with the implementation of an organizational model that allows for better management of patients with chronic diseases. On the other hand, it sheds light on the professional and organizational mechanisms that promote this chronic care model's implementation in a pluralistic context of organizations and the health system. Finally, it explores whether the model implemented makes it possible to achieve the model's objectives and results of care. The context of our study is part of the network of the chronic disease ecosystem and inter-organizational relations during the implementation and operation of the Centre d'accompagnement interdisciplinaire en maladies chroniques CAIMC of the CSSS du Haut-Richelieu-Rouville in Saint-Jean-sur-Richelieu. The data collected came from individual interviews representative of all professional actors in the field, documents and reports, particularly those of various working committees and care protocols. Our research is based on the conceptual framework of Crozier and Friedberg's (1977) strategic analysis and Abbott's (1988) system of professions. It highlights an organizational and structural complexity that makes it difficult to manage change in pluralistic organizations, especially when implementing a chronic care model over a long period of time. Implementation results from the management of a continuous learning process within the organization. The model we propose constitutes an analytical framework that allows a synthesis of various approaches that contribute to the understanding of complex phenomena and their management. It thus helps to refine and deepen the understanding of the organizational and professional dynamics associated with the implementation of an organizational model. It could be used for the study of other care models, in addition to chronic diseases. It would be appropriate to consider the use of such an analytical framework before experimentation or implementation of care models in pluralistic health organizations. This study makes several recommendations to public decision-makers. In particular, it argues that the mobilization of an intrapreneur, with the makings of a transformational leader in an agile organizational framework, would promote the creation and acquisition of knowledge to accelerate processes and improve patient self-management.

Made available in DSpace on 2011-05-04T12:36:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Inserido nesse universo de constantes mudanças e inovações de toda ordem que afetam as organizações contemporâneas públicas ou privadas, este trabalho pretendeu identificar e analisar os processos de trabalho da Diretoria de Administração do Campus da Fundação Oswaldo Cruz - DIRAC/Fiocruz centrado em um de seus processos-chave o DPO (Departamento de Projetos e Obras), trazendo uma reflexão que poderá subsidiar uma intervenção relacionada com a gestão da infra-estrutura física de saúde, permitindo um intercâmbio mais favorável com essa realidade. Para proceder às análises foram utilizados construtos do campo da Gestão de Processos de Negócio, cujo olhar está direcionado para a informação sobre infra-estrutura física de Unidades Operacionais de Saúde (UOS). Este olhar sobre a informação permeia toda a estrutura do trabalho de modo que a infra-estrutura em saúde possa ser compreendida e considerada relevante e de estratégia como apoio à inovação neste setor. Para compreender o funcionamento do DPO foram modelados os seus processos de trabalho no qual a importância da modelagem vem ao encontro da idéia de que uma organização só funciona de maneira eficaz quando é capaz de identificar e gerir suas numerosas e variadas atividades inter-relacionadas. Nesse sentido, a gestão organizacional é vista e entendida como um todo, completo e integral, tal como um sistema. Dessa forma, ao identificar o DPO como um processo-chave da DIRAC procurou-se determinar a sequência e interação dos seus processos intrínsecos permitindo uma análise crítica para melhoria desse processo, tanto quanto, identificar as principais formas de documentação e informações produzidas e fundamentais para o trabalho e gerenciamento de projetos e obras para a Fiocruz conforme abordagens contemporâneas de sistemas de gestão e garantia da qualidade. Além disso, procurou-se utilizar para a modelagem e análise dos processos a notação BPMN ou Business Process Modeling Notation e a metodologia BPM ou Business Process Management, como abordagens que combinam processos de negócio e organização para criar uma visão única e integrada de negócios representando a culminação das experiências coletivas, pensamentos e desenvolvimento profissional em gerenciamento de negócios das últimas décadas . Dentro do contexto que alia a TI e o gerenciamento de negócio corporativo à importância do alinhamento do negócio com sistemas de informação, a intenção por trás de todo este trabalho é que ele possa ser o marco inicial da arquitetura de processos de negócio que é a base superior das demais arquiteturas da TI. E sendo assim, que todos os outros setores da DIRAC possam incorporar este método de análise, tanto para possibilitar a geração de melhorias em seus processos quanto para que as outras arquiteturas da TI possam ser construídas fornecendo os subsídios iniciais para o futuro desenvolvimento de um sistema de informação corporativo e integrado como apoio à gestão da infra-estrutura física e da inovação em saúde na Fiocruz. / Immersed in the universe of constant changing and innovations of all kinds that affect the contemporary organizations, private and public, this academic paper was intended to identify and analyze the working processes of the DIRAC - Diretoria de Administração do Campus da Fundação Oswaldo Cruz/Fiocruz (Oswaldo Cruz Foundation Campus/Fiocruz), based on one of its key processes – the DPO – Departamento de Projetos e Obras (Department of Projects and Works), providing a reflection which could serve as an aid to an intervention related to the health facilities management, that is physical infrastructure, thus allowing a better interchange with this reality. In order to proceed to the analysis, constructions from the field of Business Process Management were used, with an approach headed towards the information about the physical infrastructure of UOS – Unidades Operacionais de Saúde (Operational Health Units). This approach pervades all the paper structure in order that the health facilities can be understood and recognized as a strategy to support innovations in this area. In order to understand the mechanism of DPO, its working processes were modeled in a way to support the idea that one organization only works efficiently when it is able to identify and manage its several and interrelated activities. In this way, the organization management is seen and understood as a whole, complete and integral, like a system. So by identifying the DPO as a key process of DIRAC, the purpose was to establish the sequence and interaction of its inherent processes, allowing a critical analysis to improve it, as well as identifying the main forms of documentation and information produced, fundamental to the functioning and management of projects and works for Fiocruz – in accordance with the contemporary approaches of management systems and quality assurance. Besides that, for the modeling and analysis of the processes it was used the notation BPMN, or Business Process Modeling Notation, and the methodology BPM, or Business Process Management, as approaches that combine business processes and organization to create a unique and seamless vision of business “representing the utmost step of collective experiences, thoughts and professional development in business management of the last decades”. Inside the context that unites IT and enterprise business management to the business alignment with the information systems, the aim of this paper is to be the initial milestone of the business processes architecture which is the basis of the other IT architectures. So, if all the other areas of DIRAC can integrate this analysis method, they will not only allow improvements in its processes but also support the building of other IT architectures. In this way, this paper will provide the initial input for the future development of a corporate and seamless information system as a means of support to the physical infrastructure and innovation management in health at Fiocruz.