Background: The National Department of Health adopted decentralisation of hospital management as a key policy in pursuit of a more efficient, effective, responsive and accountable public sector hospital system. The proposed decentralisation of hospital management represented a fundamental policy shift in the decision making processes between National, Provincial health departments and Hospitals. Provincial health departments were to “delegate significant decision making powers to hospital managers, including the authority to make decisions relating to personnel, procurement, and financial management” Objective: To gain in-depth understanding of the decentralisation of hospital management processes between 1996 and 2007 as it relates to the Human Resource Management function in public hospitals. Methodology: The study design was a descriptive qualitative comparative case study design. Results: Decentralisation was promoted as a policy reform to improve efficiency, equity and effectiveness of hospitals in South Africa. There was no formal policy from the National Department of Health guiding the implementation of decentralisation of hospital management. There was a shift of power over the control of HRM function between 1996 and 2007. Regional hospital gained more space and had more wide range of choices allowed in almost all HRM activities. District Hospital has gained some space and now has moderate choice allowed. The experiences and understanding of health managers vary on what happened during the policy process. Conclusion: The study found conclusive evidence that there are changes to HRM function during the ongoing debate on decentralisation of hospital management. More HRM functions were delegated to Hospitals.

Thesis (M.H.A)--University of Michigan, 1967.

Thesis (M.H.A)--University of Michigan, 1967.

Thesis (M.H.S.A.)--University of Michigan, 1981.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1959.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.S.A.)--University of Michigan, 1981.

Thesis (M.H.A.)--University of Michigan, 1959.

Este estudo teve por objetivo analisar os indicadores de tempo da carga de trabalho da equipe de enfermagem, em unidades de internação de Clínica Médica, Cirúrgica e de Terapia Intensiva Adulto. O método foi estudo de caso, observacional, transversal de natureza quantitativa, realizado no Hospital Universitário da Universidade de São Paulo. Os procedimentos metodológicos foram organizados em três etapas: adequação do instrumento classificação de atividades proposto por Mello (2002) à linguagem padronizada de intervenções de enfermagem NIC - Classificação das Intervenções de Enfermagem, por meio da técnica de mapeamento cruzado; validação do instrumento das intervenções/atividades de enfermagem, utilizando a técnica oficina de trabalho e mensuração da frequência e do tempo despendido nas intervenções/atividades de enfermagem, utilizando o método amostragem do trabalho. Foram identificadas 126 intervenções de enfermagem, 24 classes de intervenções e sete Domínios da NIC, 14 atividades associadas e nove atividades pessoais. A carga de trabalho das três unidades foi mensurada, por meio do método amostragem do trabalho. A amostra das observações foi realizada com intervalo de 10min, durante 7 dias, sendo obtidas 25.308 observações do trabalho dos profissionais de enfermagem nas unidades estudadas. Os enfermeiros das Clínicas Médica, Cirúrgica e Terapia Intensiva Adulto, despenderam o tempo, respectivamente, 34,7%, 35,7% e 37,9% em intervenções de cuidado direto; 43,8%, 43,5% e 40% em intervenções de cuidado indireto; 3,9%, 6,1% e 5,3% em atividades associadas e 17,6%, 14,7% e 16,8% em atividades pessoais. Os técnicos/auxiliares de enfermagem despenderam, respectivamente, 50,1%, 48,7% e 61,8% em intervenções de cuidado direto; 20%, 21,7% e 11,8% em intervenções de cuidado indireto; 4,7%, 5,3% e 4% em atividades associadas e 25,2%, 24,3% e 22,4% em atividades pessoais. O tempo médio estimado para cada intervenção/atividade foi de 10min. na Clínica Médica, 8,5min. na Cirúrgica e 8,6min. na Terapia Intensiva Adulto. O tempo médio de cuidado por leito, nas 24 horas foi de 4h Clínica Médica sem leitos de alta dependência 4,4h, na Clínica Médica com leitos de alta dependência e 6,2h para os leitos de alta dependência; de 4,6h na Clínica Cirúrgica e 11,6h na Terapia Intensiva Adulto. A produtividade dos enfermeiros atingiu nas Clínicas Médica 82%, Cirúrgica 85% e na Terapia Intensiva Adulto 83%. A produtividade dos técnicos/auxiliares de enfermagem atingiu nas Clínicas Médica, Cirúrgica e Terapia Intensiva Adulto, respectivamente, 75%, 76% e 78%. De acordo com a taxonomia adotada, o Domínio de maior representatividade à equipe de enfermagem e aos enfermeiros foi o Domínio Sistema de Saúde, com a intervenção Documentação, a mais frequente. Para os técnicos/auxiliares de enfermagem, o Domínio Fisiológico Complexo com a intervenção Administração de Medicamentos como a mais frequente. Ao se comparar o tempo obtido nas intervenções realizadas nas unidades com o tempo estimado na NIC verificou-se que 43,4% das intervenções de cuidado direto e 18% das intervenções de cuidado indireto estão dentro do intervalo do tempo estimado na NIC. Este estudo permitiu identificar indicadores de carga de trabalho nas dimensões quantitativa e qualitativa, nas unidades estudadas de um hospital geral, de ensino, de média complexidade, considerado referência nacional na assistência de enfermagem. / The aim of this study was to analyze time indicators of the nursing staff workload in hospitalization units of medical, surgical clinic and intensive adult care. It was a cross-sectional, observational, case-study with a quantitative approach carried out in the University Hospital of the São Paulo University. The methodology was organized into three steps: adjustment of the classification Instrument of activities proposed by Mello (2002) regarding standardized language of nursing interventions NIC - Nursing Interventions Classification, by means of a cross-mapping technique; validation of the intervention / nursing activities, using a workshop technique and measuring the amount of time and time spent on interventions / nursing activities by the work sampling method. We identified 126 nursing interventions, 24 intervention classes, seven NIC domains, 14 associated activities and nine personal activities. The workload of the three units was measured by the work sampling method. A sample of observations was performed with an interval of 10 minutes, during seven days and 25,308 observations were obtained from the nursing staff work in the analyzed units. Time spent by nurses of the medical, surgical clinic and from the adult intensive care were as follows: 34.7%, 35.7% and 37.9% in direct care interventions; 43.8%, 43.5% and 40% in indirect care; 3.9%, 6.1% and 5.3% in associated activities and 17.6%, 14.7% and 16.8% in personal activities. Time spent by the technicians / nursing assistants were, respectively, 50.1%, 48.7% and 61.8% in direct care interventions; 20%, 21.7% and 11.8% in indirect care; 4, 7%, 5.3% and 4% in associated activities and 25.2%, 24.3% and 22.4% in personal activities. The mean times estimated for each intervention / activity was 10min. in the medical clinic, 8.5 min. in the surgical and 8.6 min. in adult intensive care. The mean time of care per bed in 24- hour period was 4 h at the general medical clinic without high dependency beds, 4.4 h in the medical clinic with high dependency beds and 6.2 h for high-dependency beds; 4.6 h in the surgical clinic and 11.6 h in the adult intensive care. The nurse´s productivity in the clinic has reached 82%, 85% in the surgical clinic and 83% in the adult intensive care. The productivity of technicians / nursing assistants in the medical and surgical clinic and intensive care has reached, respectively, 75%, 76% and 78%. According to the adopted taxonomy, the domain of greater representation for the nursing staff and for nurses was the Health System Domain and the Documentation intervention was addressed as the most frequent. For technicians / nursing assistants the Complex Physiologic Domain with the Drug Administration intervention as of the greatest occurrence. When comparing the time obtained in interventions performed in the units with estimated time according to NIC, it was found that 43.4% of direct care interventions and 18% of indirect care interventions are within the range of the estimated time at the NIC. This study identified indicators of workload in quantitative and qualitative dimensions, the units studied in a general hospital, teaching, of medium complexity, considered a national reference in nursing care.