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Esse é um estudo transversal no campo da saúde coletiva e tem como tema a avaliação de serviços da Atenção Básica à Saúde, vinculados ou não ao ensino, em dois municípios do interior paulista. O objetivo geral foi avaliar e comparar o desempenho do processo de trabalho em equipe, segundo padrões de qualidade da Estratégia de Saúde da Família, baseando-se na Proposta AMQ-MS, em Unidades de Saúde da Família nos municípios de Ribeirão Preto e São José do Rio Pardo, e como específicos: descrever as características gerais das Unidades de Saúde da Família incluídas no estudo em Ribeirão Preto e São José do Rio Pardo; verificar os estágios de desenvolvimento alcançados pelos municípios considerando o componente de trabalho das equipes; descrever e analisar pontos fortes e fracos ao desenvolvimento da qualidade e avaliar comparativamente os resultados obtidos entre as equipes das unidades de Ribeirão Preto, onde há atividades de ensino de e São José do Rio Pardo, onde tais atividades não existem. No período de abril a junho de 2011, foram aplicados os instrumentos 04 e 05 do AMQ, ambos relacionados à Unidade de Análise: a Equipe. Foi realizada análise de concordância para fins comparativos, enquanto que para verificar associação, foi empregada a razão de prevalência (RP) e seu intervalo de confiança a 95% (IC 95%) como estimadora de magnitude entre variáveis. Para comparação de proporções foi empregado o teste de Z. Em todas as análises considerou-se um nível de significância de 5%. A concordância entre os resultados foi feita por meio da estatística Kappa. A pesquisa revelou que as USF pesquisadas em Ribeirão Preto não foram privilegiadas em qualidade quando comparadas as USF pesquisadas em São José do Rio Pardo, onde referente à Consolidação ao Modelo o município de Ribeirão Preto encontrou-se no estágio considerado satisfatório e São José do Rio Pardo no estágio considerado regular. Em relação à Atenção a Saúde e no Componente: Equipes, envolvendo os dois instrumentos, os dois municípios se enquadram no estágio satisfatório. O pior desempenho por subdimensão foi apresentado na Participação Comunitária e Controle Social considerado fraco. Observou-se não linearidade entre a complexidade de implementação dos processos de trabalho e a autoavaliacão das equipes de saúde da família dos municípios estudados. / This is a cross-sectional study in the public health field and has as its theme the service evaluation of Primary Health in two municipalities of São Paulo. The overall objective was to evaluate and compare the performance of the process of teamwork, according to the quality standards of the Family Health Strategy, based on the Proposal AMQ-MS in Family Health Units in the municipalities of Ribeirão Preto and São José Rio Pardo, and specific as to describe the general characteristics of the Family Health Units included in the study in Ribeirão Preto and São José do Rio Pardo, check the stages of development achieved by considering the component municipalities work teams; describe and analyze strengths and weaknesses to the development of quality and benchmark results between teams units Ribeirão Preto, where there are activities for teaching and Sao Jose do Rio Pardo, where such activities do not exist. In the period April to June 2011 were applied instruments 4 and 5 of AMQ, both related to the Unit of Analysis: Team. Statistical analyzes were performed, in the forms of agreement analysis for comparative purposes, while checking for association, we used the prevalence ratio and its confidence interval at 95% (95% IC) as an estimate of magnitude between variables. For comparison of proportions test was used to Z. In all analyzes it was considered a significance level of 5%. The agreement between the results was made by Kappa. The research revealed that the USF surveyed in Ribeirão Preto were not privileged in quality when compared to USF surveyed in São José do Rio Pardo, where on the Consolidation Model to the city of Ribeirão Preto found himself on stage as satisfactory and São José do Rio Pardo on stage considered regular. Regarding Health Care and Component: Teams, involving the two instruments, the two municipalities fall within the satisfactory stage. The worst performance by subdimension was featured on \"Community Participation and Social Control\" considered weak. Observed nonlinearity between the implementation complexity of work processes and selfassessment of family health teams in the cities studied.

Esse é um estudo transversal no campo da saúde coletiva e tem como tema a avaliação de serviços da Atenção Básica à Saúde, vinculados ou não ao ensino, em dois municípios do interior paulista. O objetivo geral foi avaliar e comparar o desempenho do processo de trabalho em equipe, segundo padrões de qualidade da Estratégia de Saúde da Família, baseando-se na Proposta AMQ-MS, em Unidades de Saúde da Família nos municípios de Ribeirão Preto e São José do Rio Pardo, e como específicos: descrever as características gerais das Unidades de Saúde da Família incluídas no estudo em Ribeirão Preto e São José do Rio Pardo; verificar os estágios de desenvolvimento alcançados pelos municípios considerando o componente de trabalho das equipes; descrever e analisar pontos fortes e fracos ao desenvolvimento da qualidade e avaliar comparativamente os resultados obtidos entre as equipes das unidades de Ribeirão Preto, onde há atividades de ensino de e São José do Rio Pardo, onde tais atividades não existem. No período de abril a junho de 2011, foram aplicados os instrumentos 04 e 05 do AMQ, ambos relacionados à Unidade de Análise: a Equipe. Foi realizada análise de concordância para fins comparativos, enquanto que para verificar associação, foi empregada a razão de prevalência (RP) e seu intervalo de confiança a 95% (IC 95%) como estimadora de magnitude entre variáveis. Para comparação de proporções foi empregado o teste de Z. Em todas as análises considerou-se um nível de significância de 5%. A concordância entre os resultados foi feita por meio da estatística Kappa. A pesquisa revelou que as USF pesquisadas em Ribeirão Preto não foram privilegiadas em qualidade quando comparadas as USF pesquisadas em São José do Rio Pardo, onde referente à Consolidação ao Modelo o município de Ribeirão Preto encontrou-se no estágio considerado satisfatório e São José do Rio Pardo no estágio considerado regular. Em relação à Atenção a Saúde e no Componente: Equipes, envolvendo os dois instrumentos, os dois municípios se enquadram no estágio satisfatório. O pior desempenho por subdimensão foi apresentado na Participação Comunitária e Controle Social considerado fraco. Observou-se não linearidade entre a complexidade de implementação dos processos de trabalho e a autoavaliacão das equipes de saúde da família dos municípios estudados. / This is a cross-sectional study in the public health field and has as its theme the service evaluation of Primary Health in two municipalities of São Paulo. The overall objective was to evaluate and compare the performance of the process of teamwork, according to the quality standards of the Family Health Strategy, based on the Proposal AMQ-MS in Family Health Units in the municipalities of Ribeirão Preto and São José Rio Pardo, and specific as to describe the general characteristics of the Family Health Units included in the study in Ribeirão Preto and São José do Rio Pardo, check the stages of development achieved by considering the component municipalities work teams; describe and analyze strengths and weaknesses to the development of quality and benchmark results between teams units Ribeirão Preto, where there are activities for teaching and Sao Jose do Rio Pardo, where such activities do not exist. In the period April to June 2011 were applied instruments 4 and 5 of AMQ, both related to the Unit of Analysis: Team. Statistical analyzes were performed, in the forms of agreement analysis for comparative purposes, while checking for association, we used the prevalence ratio and its confidence interval at 95% (95% IC) as an estimate of magnitude between variables. For comparison of proportions test was used to Z. In all analyzes it was considered a significance level of 5%. The agreement between the results was made by Kappa. The research revealed that the USF surveyed in Ribeirão Preto were not privileged in quality when compared to USF surveyed in São José do Rio Pardo, where on the Consolidation Model to the city of Ribeirão Preto found himself on stage as satisfactory and São José do Rio Pardo on stage considered regular. Regarding Health Care and Component: Teams, involving the two instruments, the two municipalities fall within the satisfactory stage. The worst performance by subdimension was featured on \"Community Participation and Social Control\" considered weak. Observed nonlinearity between the implementation complexity of work processes and selfassessment of family health teams in the cities studied.

Studier visar att en god och säker vård har ett nära samband med en hög grad av omvårdnadskompetens hos personalen. Trots att specialistsjuksköterskor har ansvar för att initiera och tillämpa evidensbaserad vård samt att driva utvecklingen inom vården saknas en tydlig beskrivning av vad detta faktiskt innebär samt hur kompetensen bäst kan komma till användning. Syftet är att belysa specialistsjuksköterskors kompetens och dess betydelse för vårdkvalitet och vårdutveckling. För att kunna besvara syftet utfördes en litteraturöversikt. Arton artiklar, varav tolv med kvalitativ metod och sex med kvantitativ metod inkluderades i resultatet. Samtliga artiklar kvalitetsbedömdes med modifierade granskningsmallar. Därefter gjordes en tematisk analys av artiklarnas resultat. Specialistsjuksköterskors avancerade kompetens visade sig ha en viktig betydelse för flera patientgrupper såväl som för andra vårdprofessioner. Den avancerade kompetensen gjorde skillnad i både vårdkvalitet och vårdutveckling. Ett flertal utmaningar i form av organisatoriskt motstånd och otydligheten i rollbeskrivningar kan leda till brist på utvecklingsmöjligheter och att kompetensen som specialistsjuksköterskor har inte används fullt ut. Att sjukvårdsorganisationer tar tillvara på specialistsjuksköterskors kompetens behöver ses som en förutsättning för vårdens förbättringsarbete och för utvecklingen av vårdkvaliteten. / Research has proven that a care of high quality is connected with a high degree of nursing competence. Although nurse specialists with advanced education have responsibilities to implement evidence-based research in practice, in addition to improve the quality of nursing care, there is a lack of a comprehensive and clear description of what this actually means and how their skills best should be applied. The purpose of this study is to examine the roles of nurse specialists and the impact their professional knowledge has on quality of care and health care development. A literature review was performed. Eighteen articles, of which twelve with qualitative method and six with quantitative method, were included in the result. A thematic analysis was made of the results of the articles. The skills of specialist nurses proved to be important for several patient groups as well as for other healthcare professions. The advanced competence made a difference for both quality of care and healthcare improvement. Thus, several challenges like organizational resistance and ambiguity in role descriptions can lead to a lack of development opportunities and that the competence of specialist nurses are not being fully utilized. The skills of nurse specialists need to be seen by healthcare organizations as a prerequisite for the improvement of care and for the development of care quality.

Bakgrund. Att få en allvarlig bristning i samband med förlossning kan ge kvinnor smärta, lidande, och låg livskvalitet under lång tid. Syfte. Syftet med förbättringsarbetet har varit att förbättra eftervården genom att införa strukturerad uppföljning, öka kvalitén i bedömning och diagnostik, förbättra informationen till patienten och utveckla former för patientdelaktighet i förbättringsarbetet. Syftet med studien har varit att ur ett verksamhetsperspektiv beskriva erfarenheterna av patientdelaktigheten i förbättringsarbetet. Metod. Förbättringsarbetet har designats med hjälp av Förbättringstrappan och utgått från ett patientprocessorienterat perspektiv. Metod för studien var kvalitativ i form av en fallstudie. Resultat. Genom förbättringsarbetet följs kvinnorna upp via bristningsregistret, uppföljningsbesök med 3D- ultraljud görs på en specialinrättad mottagning. Vidare får kvinnorna individuell fysioterapeutinformation innan hemgång, en vårdkedja har införts och former för patientdelaktighet har utformats och använts. Dessa är frågeformulär, intervjuer, workshops och patientföreträdare i förbättringsnätverket. Resultatet från studien visar att formerna för patientdelaktighet ger skilda förutsättningar för delaktigheten. Resultatet visar på betydelsen av organisatoriska förutsättningar, värdet av patientdelaktighet, utmaningar vid införande och vilket reellt inflytande som patientdelaktigheten haft under processen och för resultaten av förbättringsarbetet. Slutsatser. Patientdelaktighet skapar värde i flera dimensioner. Patientdelaktighet behöver designas, anpassas till kontexten och förbättringsarbetets mål och dess syfte behöver vara tydligt uttryckt. / Background. Perineal tears during childbirth can lead to after-delivery complications that leads to great suffering and low quality of life for a long time. Purpose. The purpose has been to improve after-delivery care by systematic follow-up, increasing the quality of diagnostics and management of these women, improving the information for the patient and developing new ways of improving including patients in the improvement work. The purpose of the study has been to study the effect of patient participation in the improvement work. Method. "The improvement ramp" and patient process-oriented perspective has been used to design the improvement work. The method of the study was qualitative in the form of a case study. Results. Follow-up using 3D-ultrasound is introduced. A care chain has been introduced and ways of patient participation have been designed and used. These are questionnaires, interviews, workshops and patient representatives in the improvement network. The results of the study show that the ways of patient participation provide different conditions for participation. The result shows the importance of organizational conditions, the value of patient participation, challenges in the introduction and the real influence that patient participation has had during the process and on the results of the improvement work. Conclusions. Patient-participation in QI creates values in several dimensions. Patient-participation needs to be carefully designed in compliance with context, goals and purpose.

A medical center specializing in ear, nose, and throat (ENT) services noted an increase in the number of postoperative ENT complications compared to the national average. The purpose of this mixed-methods project study was to examine ENT patients' preoperative patient education (PPE) needs regarding postoperative care. Grounded in Knowles's model of learning, core adult learning principles were applied as guidelines in facilitating patients' PPE learning. Data were collected from 58 ENT patients who were selected using a convenience sampling method and who responded to a PPE survey using a 5-point Likert scale and open-ended questions. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis for emergent themes. The quantitative findings included patients' perceived needs for preoperative and postoperative information regarding ENT care and surgery complications. The qualitative findings included patients' perceptions of PPE in ENT and recommendations for how to use PPE before and after surgery. Implications for positive social change include an awareness of patients' perceptions of PPE needs in ENT by hospital administrators, doctors, and nurses. A better understanding of PPE by patients could result in lower levels of postoperative complications in ENT.

The Centers for Medicare and Medicaid Services have been working with hospital networks across the United States to improve health care through education and training on clinical best practices and leadership frameworks. Some organizations have failed to reach the high-quality standards of care expected and have adverse patient care outcomes. The purpose of the study was to determine the relationship between leadership actions, funding type, and clinical care outcomes in participating Partners for Patients hospital programs in Iowa. The secondary variable data were provided from a Partnership for Patients contractor, through the Centers for Medicare and Medicaid Services Organizational Assessment Tool. Multiple linear regression analyses were used to determine the relationship between the leadership actions, funding type, and the clinical quality outcomes of catheter-associated urinary tract infections, central line associated bloodstream infections, falls with injury, and venous thromboembolism. The findings demonstrated no statistically significant relationships between leadership actions, such as completing a leadership checklist, incident dashboard, and board involvement in decision making, and the specified clinical care outcomes. There was a statistically significant relationship between leadership actions of completing a root cause analysis for incidents, federal funding type, and the clinical quality outcomes of falls with injury and venous thromboembolism. The results of this study will be shared with Partnership for Patients program leadership to positively impact patient care. The results may be useful as organizations continue to implement best practices to reduce medical errors, save cost, and increase patient safety.

The challenges of implementing the Common Core State Standards at the classroom level resulted in political pushback to the reform initiative after the local media covered poor implementation decisions. This study explored how elementary school teachers and instructional leaders described teachers' progress along the implementation continuum for the standards. The concerns-based adoption model served as the conceptual framework for this study. This multicase study design consisted of 16 interviews of teachers and instructional leaders from 4 schools. Data were analyzed through a process that began with open coding followed by axial coding to identify themes. Teacher collaboration driving implementation progress emerged as a theme. The following needs also emerged: (a) training to make the required instructional shifts, (b) common processes to monitor implementation progress, and (c) aligned resources. The results led to a semester-long professional development project pairing a quality improvement process popular in other fields with the existing professional learning community structure to address the problem. This project built on the implementation progress made through working collaboratively to meet the training needs of the teachers; the project also included mechanisms for monitoring teachers' progress in implementing the standards. The project study provides insight and specific steps for teachers and leaders working to implement the standards. Students will be the ultimate beneficiaries of this project study through improvements in their teachers' instructional practice.

Sjuksköterskors praktiska kunskaper är avgörande för säker vård. Inom sjuksköterskeutbildningen kontrolleras färdigheter genom färdighetsexaminationer. Utifrån kartlagda brister i rättssäkerhet och arbetsmiljö vid färdighetsexaminationer initierades ett förbättringsarbete. Syftet med förbättringsarbetet var att förbättra processen för klinisk träning inom sjuksköterskeprogrammet genom att utveckla färdighetsexaminationer. En studie av förbättringsarbetet genomfördes i syfte att: Undersöka samsyn mellan lärare kring färdighetsexamination som pedagogisk aktivitet. Analysera och utveckla initial programteori utifrån intervjudata. Förbättringsarbete har utformats efter förbättringsmodellen, förbättringsrampen och programteoretisk ansats. Studie genomfördes med kvalitativa intervjuer och innehållsanalys utifrån en interaktiv och abduktiv ansats. Förbättringsarbetet resulterade i minskad variation mellan lärare i bedömningen av färdighetsexaminationer. Nya arbetssätt har lett till ökad samsyn mellan lärare och bättre arbetsmiljö. Programteorin reviderades utifrån intervjudata. Minskad variation visar på en ökad rättssäkerhet. Reviderad programteori har ökat möjligheten att dra lärdom av förbättringsarbetet såväl lokalt som generellt. Arbetet har bidragit till en utveckling av sjuksköterskeutbildningen och dess bidrag till en god och säker hälso- och sjukvård. / Nurses' practical knowledge is crucial for safe care. Within the nursing program skills are checked through clinical examinations. Based on identified deficiencies in terms of legal validity and working environment related to clinical examinations improvement work was initiated. The purpose of the improvement work was to improve the process of clinical training within the nursing program by developing the clinical examination. A study of the improvement work was conducted with the purpose of: Exploring teachers shared interpretations with clinical examinations as an educational activity. Analysing and developing initial program theory based on interview data. Improvement work was designed according to the model for improvement, improvement ramp, and a program theory approach. The study includes qualitative interviews with content analysis based on an interactive and abductive approach. The improvement work led to improved consensus between teachers and a better work environment. A reduction in variation between teachers’ assessments of clinical examinations was reached. The program theory was revised based on interview data. Reduced variation shows increased legal validity. Revised program theory has increased the possibility of learning from the improvement work both locally and in general. The work has developed the nursing education and its contribution to good and safe healthcare.

<p>Södersjukhuset i Stockholm är ett sjukhus som har påbörjat förändringsarbete för att kunna möta framtidens krav på högkvalitativ vård från patienter och samtidigt uppfylla ekonomiska krav från ägaren Stockholms Läns Landsting. Denna rapport är resultatet av en grundlig genomgång av dagens centrala provanalyssystem på Södersjukhuset med syfte att effektivisera systemet för att möta framtida krav.</p><p>I arbetet kartläggs flödet av patienter och prover som behandlas antingen på de provtagningsintensiva medicinska mottagningarna eller på avdelning 27. Eftersom omkring 85 % av volymen av analyser som beställs på dessa enheter är klinisk kemiska har det analyserande arbetet inriktats på just dessa flöden. För vissa klinisk kemiska analyser finns det ett alternativ till central laboratorieanalys, patientnära analys, som innebär att tiden från provtagning till provsvar finns tillgängligt förkortas markant. I rapporten tas för- och nackdelar med patientnära analys upp och dess applicerbarhet på Södersjukhuset diskuteras. Det framkommer att för Södersjukhusets del är det mer fördelaktigt att hålla fast vid ett centralt provanalyssystem då detta är mer flexibelt samtidigt som kostnaderna för detta är lägre än för patientnära analys. Samtidigt finns ett klart behov av att effektivisera dagens centrala provanalyssystem för att minska patienternas väntan och utnyttja Södersjukhusets resurser på ett bättre sätt.</p><p>I en kvantitativ analys av över 17 000 observationer tagna från kliniskt kemiskt laboratoriums datasystem konstateras att det inte är någon större skillnad i systemets flödestid för medicinska mottagningarna och avdelning 27. På medicinska mot-tagningarna använder man sig av en mycket lång säkerhetsledtid då man anger när provsvaren finns tillgängliga för patient, medan avdelning 27 räknar med att ha de flesta provsvaren färdiga till läkarronden 1,5 timmar efter avslutad provtagning.</p><p>Det står klart att dagens informationssystem, framför allt i processerna som sker innan själva analysen av proverna, är mycket bristfälligt. Detta ger upphov till ett flertal icke-värdeskapande aktiviteter som förlänger provernas flödestid och är kostsamt då det kräver mänskliga resurser för att utföra. Dessutom generar informationssystemet en datamängd som innehåller relativt lite information som kan användas för uppföljning av hur provanalyssystemet presterar. Genom att införa ett bättre anpassat informationssystem som stödjer de processer som är absolut nödvändiga för provanalyssystemet kan flödestiden för prover förkortas samtidigt som de löpande kostnaderna kommer att minska. Personalens kompetens kan också utnyttjas på ett bättre sätt då icke-värdeskapande aktiviteter elimineras. Tillsammans med ändrade rutiner vid beställning av analyser kan patienters väntan reduceras avsevärt. För en stor del av dagens patienter skulle det vara teoretiskt möjligt att genomföra provtagning och läkarbesök på en och samma dag, med någon timmes mellanrum, vilket skulle innebära en avsevärd samhällsekonomisk besparing.</p> / <p>As a consequence of the transition from public to private management, Söder-sjukhuset Hospital in Stockholm has been forced to a greater focus on economical aspects in addition to health care issues. In turn, this focus has initiated numerous improvement projects. This report is the result of a thorough analysis of the hospital’s patient testing system with the intention of meeting future demands on increased efficiency. The analysis is based on the mapping of two of the hospital’s most test intensive units - the medical clinic and ward no. 27 - and their subsequent flows.</p><p>An initial analysis concludes that a vast majority of all tests are analyzed at the laboratory for clinical chemistry. Since approximately 85 % of the total number of analyses is conducted at this particular institution, the latter part of this work is focused solely on the flows of tests that regard this specific laboratory.</p><p>For some analyses conducted at the laboratory for clinical chemistry there exists an alternative to central laboratory analysis, namely near-patient-testing. This method results in a drastic reduction of the time span from taking the test to attaining a result. In this report the strengths and weaknesses of near-patient-testing are discussed, as well as its applicability on Södersjukhuset in particular. It is proposed that it is advantageous for Södersjukhuset to continue using a central analysis system, as it is much more flexible and at the same time more cost efficient than near-patient-testing. At the same time there is an obvious need for a more efficient patient testing system in order to reduce waiting time for patients and utilize the hospital’s resources more wisely.</p><p>The mapping of the two units reveals a number of interesting similarities and differences. One of them being that while the medical clinic uses a substantial safety lead time, ward no. 27 presumes to have most test results available in time for doctor rounds, approximately 1.5 h after tests have been taken. An analysis of over 17 000 observations taken from laboratory’s data system confirmed that there is no considerable difference in system flow time between the two units.</p><p>It is evident that today’s information system is of substandard quality. This results in a number of non-value adding activities that not only prolong each tests flow time, but cause unnecessary use of human resources. Furthermore the information system generates a data mass of little use in reassessing the systems performance. By introducing a better adjusted information system, shorter flow time can be attained as well as lower running costs. With changed ordering routines for analyses, waiting time for patients can be reduced substantially. For a large part of today’s patients it would be theoretically possible to conduct both the test taking and the doctor’s appointment on the same day, just hours apart. This would result in extensive socioeconomic savings.</p>