Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-06-23T14:32:23Z No. of bitstreams: 1 Marcelo Antunes Marciano.pdf: 3212195 bytes, checksum: d0978d66fd9d22e11d99ba2207b6a553 (MD5) / Made available in DSpace on 2015-06-23T14:32:23Z (GMT). No. of bitstreams: 1 Marcelo Antunes Marciano.pdf: 3212195 bytes, checksum: d0978d66fd9d22e11d99ba2207b6a553 (MD5) Previous issue date: 2014 / Nenhuma / Este trabalho investiga como aumentar a qualidade dos serviços entregues à população pela gestão de operações em serviços de saúde, tanto no sistema público quanto na saúde suplementar, mais especificamente, em operadoras de plano de saúde e em hospitais do estado do Rio Grande do Sul (RS). O objetivo principal do presente trabalho consiste em analisar possibilidades de elevar a qualidade do sistema de saúde público e suplementar do estado do Rio Grande do Sul à luz do sistema dinâmico em que se inserem. Os objetivos específicos são: Mapear o sistema de saúde, por meio do pensamento sistêmico, e propor pontos de alavancagem à qualidade do sistema de saúde pública do RS; e Analisar a aderência aos critérios do Managed Care e de inovações em gestão de saúde, pelos atores “operadora de plano de saúde” e “hospital”. A dissertação é formada por dois artigos, cada um entregando um objetivo específico, e por capítulos adicionais que consolidam a entrega do objetivo geral. Quanto aos procedimentos metodológicos, a pesquisa parte de um paradigma positivista e orienta-se qualitativamente, fazendo uso de entrevistas, análise documental, coleta de dados secundários em bancos de dados de acesso público, análise por julgamento em dinâmica de grupo multidisciplinar e modelagem. Como resultados obteve-se a construção de um mapa que evidencia os atores e as relações desse sistema dinâmico, possibilitando a identificação de possíveis cenários, pontos de alavancagem e a sugestão de estratégias para auxiliar no aumento da qualidade do sistema de saúde pública do RS, bem como a construção de uma ferramenta, no caso, um questionário, por meio do qual foi possível verificar que os atores hospitalares contatados encontram-se mais aderentes do que as operadoras de plano de saúde contatadas com relação às boas práticas de gestão orientadoras do estudo. Argumenta-se que um sistema integrado de gestão, padronizado, empregado de forma sistêmica, com auxílio de estratégia organizacional, de inovações e com foco na cadeia de valor, contempla aspectos assistenciais, econômicos e competitivos, desses atores e, como consequência, pode contribuir para que as operadoras e hospitais possam aumentar a qualidade dos serviços prestados. / This work examines how to improve quality in health services, both in the public system and in supplementary health, more specifically, in health insurance companies and hospitals in the state of Rio Grande do Sul (RS). The main goal of the present work is to improve quality for the public and supplementary health systems in the state of Rio Grande do Sul under the dynamic system they are included into. Specific goals are: Mapping the health system through systemic thinking, proposing points of leverage regarding the quality of the public health system in RS; and analyzing the compliance with the Managed Care criteria and innovation in health management by the players, namely, “health insurance companies” and “hospitals”. The work is composed of two articles, each delivering a specific goal, and by additional chapters that consolidate the delivery of the general goal. As for the methodological procedures, the research develops from a positivist paradigm and it is based on a qualitative perspective, making use of interviews, document analysis, secondary data collection in public-access databases, analysis based on multidisciplinary group dynamics assessment and modeling. As a result, this led to the creation of a map that highlights players and relations of this dynamic system, allowing for the identification of possible scenarios, points of leverage, and the suggestion of strategies to help improve the quality of the public health system in RS, as well as the awareness that contacted hospital players were found to be more compliant than the contacted health insurance companies as far as good management practices that guided this study are concerned. We argue that a integrated and standardized management system, which is systematically used, with the help of organizational strategies, innovation, and a focus on the value chain, takes into account assistance-related, economic, and competitive aspects of these players and, as a consequence, it may contribute to improve quality to services provided.

Large-scale and long-term planning imposes extensive requirements on governance efforts regardless of whether it involves public organisations, private organisations, or both. The proportions of such planning entangle many actors and stakeholders as system components within and around a complex system. These system components and conditions in a complex planning environment introduce a diverse variety of strategic objectives into the planning. This study investigates how strategic objectives can affect the governance of complex planning systems, particularly in the context of national critical infrastructure protection. For this purpose, this thesis concentrates on a national planning procedure, STYREL, which Sweden has recently implemented for the case of power shortages. This case involves various actors from the national, regional and local levels who act on behalf of both public and private organisations in a planning process with four-year intervals, and it thus constitutes a relevant subject for this study. The investigation entailed the collection of evidence from documents and interviews. First, publicly available Swedish documents regarding the case provided an understanding of the planning. Second, interviews with decision-makers who are entrusted with this planning at municipalities and county administrative boards as well as with a few planners from power grid providers offered a deeper comprehension of both the proceedings in practice and the strategic objectives involved in this complex system for planning of critical infrastructure protection. Particularly, the findings resulted in several conceptual models that demonstrate these understandings in more detail. A soft system model visualises the problem situation and contains several elements, such as the system components, interrelations and conditions. Moreover, a multi-level planning model specifies sources of uncertainty in the planning and decision-making process that are associated with an insufficient alignment of strategic objectives in the STYREL case. These decompositions of the Swedish planning environment – both horizontal and vertical – further enabled this study to identify significant parameters of the systemic conditions and strategic objectives involved in such complex planning environments that challenge their governance. The findings of this study suggest that the Swedish process is not yet fully developed. The investigation particularly indicates that a better alignment of strategic objectives is necessary to ensure a selection of adequate goals and means that advances the future usability of the produced plan, which in turn would legitimate and strengthen this complex planning process for critical infrastructure protection. / Storskalig och långvarig planering ställer höga krav på styrning. Detta gäller oavsett om offentliga eller privata organisationer, eller båda, är involverade. Omfattningen av en sådan planering engagerar många aktörer och intressenter som komponenter inom och omkring ett komplext system. Dessa komponenter samt deras villkor inbäddade i en komplex planeringsmiljö skapar en mångfald av strategiska målbilder som följer med in till planeringen. Denna studie undersöker därför hur strategiska målbilder kan påverka styrningen av komplexa planeringssystem, särskilt i kontexten av skyddet av kritisk infrastruktur i samhället. Undersökningen fokuserar på en nationell planeringsprocess, kallad STYREL, som avser beredskapsplanering för elbristsituationer och som implementerats i Sverige. Planeringsmiljön omkring STYREL är ett relevant studieobjekt eftersom den involverar många aktörer från nationell, regional och lokal nivå. Dessa aktörer representerar offentliga och privata organisationer i den planeringsprocess som genomförs med fyraårsintervaller. Under undersökningens gång har bevis samlats in från dokument och intervjustudier. Först har offentlig tillgängliga dokument om fallet skapat en förståelse om planeringen. Intervjuer med beslutsfattare som är ansvariga för STYREL-planeringen hos länsstyrelser, kommuner samt elnätsbolag har sedan genererat en ännu djupare förståelse. Detta gällande både förfaringssättet i praktiken och de strategiska målbilder som är involverade i detta komplexa system för planering av kritisk infrastruktur-skydd. Resultaten ledde i synnerhet till några konceptuella modeller vilka demonstrerar förståelserna på ett detaljerat sätt. En systemmodell visualiserar problemsituationen och innehåller flera element såsom systemkomponenter, relationer och villkor. En multinivå-planeringsmodell specificerar källor av osäkerhet i planerings- och beslutsprocessen vilka är associerade med en otillräcklig harmonisering av strategiska målbilder i STYREL fallet. Dekompositionerna av den svenska planeringsmiljön – både horisontellt och vertikalt – gjorde det möjligt att identifiera signifikanta parametrar av de systemiska villkor och strategiska målbilder som är involverade i dessa komplexa planeringsmiljöer och utmanar deras styrning. Resultaten av studien indikerar att den svenska processen inte är fullt utvecklat. Undersökningen visar att en bättre harmonisering av strategiska målbilder är nödvändig för att säkerställa ett urval av adekvata mål och medel som skulle utveckla den framtida användbarheten av den producerade planen. Denna skulle i sin tur legitimera och stärka den komplexa planeringsprocessen för skyddet av kritisk infrastruktur. Därtill kunde detta främja en målgruppsorienterad kommunikation om risker och relevanta åtgärder. / <p>Vid tidpunkten för framläggningen av avhandlingen var följande delarbeten opublicerade: delarbete 1 under granskning, delarbete 3 under granskning.</p><p>At the time of the defence the following papers were unpublished: paper 1 under review, paper 3 under review.</p>

Esta dissertação é o compartilhar dos caminhos criados e trilhados por mim durante o processo de feitura do experimento cênico Entre o brilho do relâmpago e o canto do trovão, na linguagem da meia máscara expressiva. Ao longo de todo o percurso, inspirada pelo pensamento sistêmico, pela pedagogia de Jacques Lecoq e pela ideia de currículo em espiral de Jerome Bruner, desenvolvo a ideia de \"Cena-Mundo\" e amadureço a proposta de \"processo de criação em espiral\". / This master\'s thesis shares the paths that I\'ve created and walked through during the development process of the scenic experiment Between the lightning\'s glaring and the thunder\'s song through the usage of the expressive half mask. Throughout the journey, which was inspired by the systemic thinking, the pedagogy of Jacques Lecoq and the idea of spiral curriculum of Jerome Bruner, I\'ve developed the idea of \"scene-world\" and I\'ve grown in maturity over the proposal of \"spiral creation process\".