University of Macau / Faculty of Social Sciences. / Department of Government and Public Administration

Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-09-03T20:51:32Z No. of bitstreams: 2 dissertação_versão_entrega.pdf: 2146095 bytes, checksum: 66d0041030ddcbe24116d583661b809c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-09-03T20:51:32Z (GMT). No. of bitstreams: 2 dissertação_versão_entrega.pdf: 2146095 bytes, checksum: 66d0041030ddcbe24116d583661b809c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-07-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / In the State of Goiás, the outsourcing management of public hospitals existed for ten years, despite this, studies examining this process are still scarce. The aim of this study was to analyze how outsourcing management influences the work process and the repercussions for the workers. This study consists in the case of two public hospitals in the State of Goiás with outsourced management. The hospitals were selected based on the development of the outsourcing process management. Thus, a hospital has been selected as the process is developed and widely another hospital in which the process is being implemented. For data collection, semi-structured interviews were conducted with ten workers of different occupational categories of each hospital. The choice of the workers was random, and the inclusion criterion that the subject worked directly in health care by the user. The data obtained were categorized on the following categories: productivity / turnover of users, greater job autonomy, control of worker and illness. The Social Organizations (OS) operating in the logic of productivity, it is necessary to maintain a high turnover of users. The policy employed by OSs for management of public hospitals is the logic employed in the private sector and involves the increased job control, reduction of worker‘s autonomy, work intensification and culminate in illness of the workers. It is observed that the centrality of care of hospitals managed by OSs is on productivity and not on meeting the health needs of the user, who often leave the service without having their been met or after receiving an treatment of dubious quality . It is hoped that this research will contribute in analyzes of health work in hospitals outsourced management, increasing the resistance to this form of privatization and the breaking of the right to health. / No Estado de Goiás, a terceirização da gestão em hospitais públicos existe há mais dez anos, apesar disto, os estudos que analisam este processo ainda são escassos. O objetivo desta pesquisa foi analisar como a terceirização da gestão influencia no processo de trabalho e as repercussões para o trabalhador da saúde. Este estudo consiste no caso de dois hospitais públicos do Estado de Goiás com gestão terceirizada. Os hospitais foram selecionados com base no desenvolvimento do processo de terceirização da gestão. Deste modo, foi selecionado um hospital em que o processo está amplamente desenvolvido e o outro hospital em que o processo está em implantação. Para coleta de dados, foram realizadas entrevistas do tipo semiestruturada com dez trabalhadores das diversas categorias profissionais de cada um dos dois hospitais. A escolha dos trabalhadores foi forma aleatória, sendo critério de inclusão que o sujeito trabalhasse diretamente no cuidado em saúde junto ao usuário. Os dados obtidos na coleta de dados foram categorizados em torno das seguintes categorias: produtividade/ rotatividade, intensificação do trabalho, autonomia, controle do trabalhador, adoecimento. Observase que as Organizações Sociais (OS) operam na lógica da produtividade, sendo necessário manter uma elevada rotatividade dos usuários no serviço. A política empregada pelas OSs para gestão dos hospitais públicos é a lógica empregada no setor privado e envolve o aumento do controle sobre o trabalho, a redução da autonomia do trabalhador, a intensificação do trabalho e culminam no adoecimento do trabalhador. Observa-se que a centralidade do atendimento dos hospitais geridos por OSs está na produtividade e, não no atendimento às necessidades em saúde do usuário, que muitas vezes, saem do serviço sem que estas tenham sido atendidas ou após ter recebido um atendimento de qualidade duvidosa. Espera-se que esta pesquisa possa contribuir nas análises acerca do trabalho em saúde em hospitais de gestão terceirizada, potencializando a resistência a esta forma de privatização e quebra do direito à saúde.

This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.

This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.

Source: Dissertation Abstracts International, Volume: 56-12, Section: B, page: 6692. Supervisor: Lu Ann Aday. Includes bibliographical references (leaves 164-167).

Submitted in fulfillment of the requirements for the Master’s Degree in Health Sciences in Radiography, Durban University of Technology, Durban, South Africa, 2017. / Introduction Work related stressors are identified as the main reason for the decline in patient care in Radiography in public hospitals. Radiographers opt to leave the public sector because of stressful experiences. Research has shown that the scarcity of qualitative studies on the phenomenon makes it difficult to understand work related stress in relation to radiography as a profession. Aim of the study The aim of the study was to explore and describe work related stressors in Radiography at a public hospital in Gauteng, South Africa. Methodology This study was a qualitative, exploratory, descriptive study. An interview guide was used to elicit information from 10 participants through semi-structured interviews. All the interviews were one-on-one and were audio-recorded. The data were analysed through Tesch’s eight steps of thematic analysis. Findings The following three themes emerged during data analysis, namely: personal well-being of Radiographers; decline in quality patient care and impaired radiography service; and, environmental enablers. The findings of the study revealed that the participants’ general health was compromised by various factors pertaining to work related stress. Conclusion Interventions necessary for dealing with work related stressors are highlighted as a way of enabling improvement of the working environment conditions. The participants in the study felt that hiring more staff could alleviate their work related stressors. The study has shown that it is also imperative that staff and management are constantly communicating well. / M

Made available in DSpace on 2016-06-02T19:58:06Z (GMT). No. of bitstreams: 1 5765.pdf: 8433563 bytes, checksum: bc40da772298b0f470eb5aabbd956292 (MD5) Previous issue date: 2012-06-29 / Financiadora de Estudos e Projetos / This work aims to present trip attraction models and rates to public hospitals located in mediumsized cities in the interior of the state of São Paulo Brazil. The hospitals cause significant impacts in the local traffic and because of that they can be characterized as Potential Trip Generation Centers. In this sense, this research presents rates and models that allow us to analyze the possible impacts related to trips attracted by new hospitals. In the development of the proposed models and rates, it was performed a research in seven Santas Casas de Misericórdia hospitals in seven medium-sized cities: São Carlos, Marília, Sertãozinho, Rio Claro, Jaú, Mogi- Guaçú and Araras. The data of the first five cases were used in the development of the trip attraction models and rates, while the last two ones were used to validate the developed models. In these hospitals were performed traffic counting of pedestrians, private vehicles, buses, motorcycles and bicycles, and also interviews with the users. Through the developed analysis were elaborated models of simple regression, multiple regressions, simple regression by trip objective and mode of transport and multiple regressions with dummy variables. Some of the models developed were validated by data collected and thus they were considered more reliable to be used in Brazilian hospitals than models of the Institute of Transportation Engineers-ITE. To complement this study, it was performed a doctoral internship in Madrid, Spain in 2011 where specific models were developed with data from four public hospitals of that city. Through the application of the elaborate models and the models of ITE, it was found that the models developed for Madrid are also more suitable to estimate the travels to Spanish hospitals than the models of the ITE. Thus, this study found that for Brazilian cities, where the second mode of transportation is the bus, and for the Spanish city where the second mode of transportation is the subway, the ITE models, that consider only travels by car, may not be sufficient to estimate the travels. / Este trabalho visa apresentar modelos e taxas de atração de viagens para hospitais localizados em cidades de porte médio do interior do estado de São Paulo - Brasil. Os hospitais causam impactos significativos no tráfego local, por isso, se caracterizam como potenciais Polos Geradores de Viagens PGVs. Nesse sentido, esta pesquisa apresenta taxas e modelos que permitem analisar os possíveis impactos em relação às viagens atraídas por novos empreendimentos hospitalares. Para o desenvolvimento das taxas e dos modelos foram realizados levantamentos de dados em sete hospitais com o padrão das Santas Casas de Misericórdia de sete cidades de porte médio: São Carlos, Marília, Sertãozinho, Rio Claro, Jaú, Mogi-Guaçú e Araras. Os dados dos cinco primeiros hospitais foram utilizados na elaboração das taxas e dos modelos de atração de viagens, enquanto que, os dois últimos, foram utilizados no processo de validação dos modelos desenvolvidos. Nesses hospitais realizaram-se contagens volumétricas de pedestres, de automóveis, de ônibus, motos, bicicletas, além de entrevistas junto aos usuários. Por meio das análises desenvolvidas elaboraram-se modelos de regressão simples, de regressão múltipla, de regressão simples por objetivos de viagens e por modos de transportes e de regressão múltipla com variáveis dummy. Alguns dos modelos elaborados foram validados pelos dados de campo e, portanto, eles foram considerados mais confiáveis para serem aplicados em hospitais brasileiros do que os modelos norte-americanos (Institute of Transportation Engineers-ITE). Para complementar esta pesquisa foi realizado um estágio de doutorado em Madrid-Espanha no ano de 2011 em que foram elaborados modelos específicos com dados de quatro hospitais públicos daquela cidade. Por meio da aplicação dos modelos elaborados e dos modelos ITE, verificou-se que os modelos elaborados para Madri também foram mais indicados para estimar viagens dos hospitais espanhóis do que os modelos do ITE. Deste modo, nesta pesquisa constatou-se que tanto para as cidades brasileiras, em que o segundo modo de transporte é o ônibus, quanto para a cidade espanhola, onde o segundo modo de transporte é o metrô, os modelos do ITE que, consideram somente as viagens por automóveis, podem não ser suficientes para estimar suas viagens.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-06-18T15:16:38Z No. of bitstreams: 1 gustavodossantosleal.pdf: 1483994 bytes, checksum: 89f9f94dc5bad8bf99b5379884bcc912 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-09-03T16:07:37Z (GMT) No. of bitstreams: 1 gustavodossantosleal.pdf: 1483994 bytes, checksum: 89f9f94dc5bad8bf99b5379884bcc912 (MD5) / Made available in DSpace on 2018-09-03T16:07:37Z (GMT). No. of bitstreams: 1 gustavodossantosleal.pdf: 1483994 bytes, checksum: 89f9f94dc5bad8bf99b5379884bcc912 (MD5) Previous issue date: 2018-04-27 / O fato de não existir dinheiro público não exime o Estado de responsabilidades básicas com os cidadãos que habitam o território sob sua jurisdição. Entretanto, como em um serviço totalmente público não é guiado pelo sistema de preços, razão de ser de toda a organização, não se pode ter a certeza de que a oferta deste determinado tipo de serviço está sendo satisfatória. Assim, a análise de eficiência pode ser uma ferramenta para guiar os tomadores de decisão de organizações públicas. Neste contexto, este trabalho se propõe a avaliar a eficiência quanto à operacionalidade de hospitais conduzidos pelo setor público nas microrregiões do sudeste brasileiro definidas pelo Instituto Brasileiro de Geografia e Estatística. Foram coletados dados oriundos do DATASUS de 2016 a fim de se aplicar técnicas estocásticas e determinísticas de mensuração da eficiência. Neste sentido foram propostos três modelos entre Análise por Envoltória de Dados e Análise de Fronteira Estocástica, para, posteriormente, encontrar as variáveis não controláveis que interferem na eficiência das unidades de produção, permitindo, portanto, a indicação de quais microrregiões são eficientes no manejo mencionado e a comparação dos resultados dos modelos propostos. / The fact that there is no public money does not take away the responsibility of the Government of basic responsibilities with the citizens who live in the territory under their jurisdiction. However, as in a fully public service there is no objective targeting that indicates consumer satisfaction, reason for every organization to exist, one cannot be sure that this particular type of service is being satisfactory. Thus, efficiency analysis can be a tool to guide decision makers from public organizations. In this context, this work proposes to evaluate the efficiency of the operation of hospitals conducted by the public sector in the microregions of the Brazilian southeast instituted by the Brazilian Institute of Geography and Statistics. Data were collected from DATASUS Data Base in the year of 2016 were collected in order to apply stochastic and deterministic techniques for measuring the efficiency. In this sense, were proposed three models between analysis by Data Envelopment Analysis and Stochastic Frontier Analysis, to subsequently to determine the exogenous variables to the direct control of the manager that interfere in the efficiency of the production units. Thus allowing the indication of which microregions are efficient in the management mentioned and the comparison of the results of various models.

Depuis la loi de l’hôpital, patient, santé et territoire (HSPT), les établissements de santé français ont montré de plus en plus d’intérêt à une meilleure offre de soin. L’utilisation des philosophies et des techniques d’amélioration de processus inspirée par le nouveau management public a été considérée comme un moyen d’augmenter la qualité des soins et de diminuer la durée d’hospitalisation. La télémédecine est une forme de pratique médicale à distance utilisant les technologies de l’information et de la communication et pouvant être considérée comme une innovation de processus dans le but d’améliorer le système de prestation de soins. Malgré l’intérêt apporté par les hôpitaux publics français à la mise en œuvre de la télémédecine, les facteurs de réussite et les obstacles influençant son implantation restent à développer. À travers cette thèse, nous tentons d’apporter les réponses à cette problématique par une recherche qualitative dans le secteur public de la santé. / Since the French law of the hospital, patients, health and territory (HSPT), the healthcare institutions have shown their interest for a better healthcare provision. The use of philosophies and process improvement techniques inspired by the new public management was seen as a way to increase the quality of care and reduce the length of hospital stays. Telemedicine is a kind of remote medical practice based on information technology and communication which can be considered as an innovation process in order to improve the healthcare delivery system. Despite the interest shown by the French public hospitals in implementing the telemedicine, success factors as well as barriers influencing its implementation need to be developed. By this work, we try to provide some answers to this problem by a qualitative research in the public healthcare sector.

The primary purpose of CTG is to detect early signs of intrapartum hypoxia and improve foetal outcomes. Intrapartum hypoxia remains the major cause of perinatal deaths mainly in monitored labours. This is attributed to the midwives’ lack of skills in the foetal implementation and interpretation of CTG. Midwives interpret foetal heart rate patterns erroneously hence they fail to detect early signs of severe foetal compromise. Accurate interpretation of CTG is the cornerstone for clinical decision during intra-partum foetal surveillance. Therefore, it is mandatory that midwives are competent in CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The objectives of this study were: -to explore and describe the perceptions of the midwives regarding their level of competence relating to cardiotocography. -to establish the levels of competence of midwives in relation to CTG. -to develop clinical guidelines that could be utilised by midwives in the implementation and interpretation of the cardiotocograph. The study utilised a quantitative non-experimental comparative descriptive research design. A self-developed and self-administered questionnaire was developed under the supervision of a statistician and was to collect data from a purposively selected sample of midwives who work in labour wards in Kwa-Zulu Natal public hospitals. A sample of 226 practicing midwives working in labour wards of the nine KZN public hospitals was selected using a non-probability convenience sampling method; only 125 responded. Data were collected on an excel spread sheet and analysed under the supervision of the statistician and research supervisor. The researcher assured of validity and reliability of the data collection method and data as well as of the data collection instrument. The findings revealed that the midwives in KZN public hospitals perceived themselves as being competent regarding CTG tasks; however they lack knowledge and skills in the implementation and interpretation of CTG. It was also evident that the midwives’ years of midwifery clinical experience, labour ward experience, possession of additional post basic midwifery qualification and the perceived level of competence related to CTG tasks number of years of the midwives did not influence their level of competence in the implementation and interpretation of CTG. Literature control supported these findings and there was consistency with that literature. Recommendations were made and clinical guidelines were developed to assist midwives with the assessment of foetal heart rate and the interpretation of the cardiotocograph results.