Darbo tikslas: Įvertinti X ligoninės medicinos darbuotojų nuomonę apie savo sveikatą ir darbo aplinkos sąlygas. Darbo uždaviniai: 1. Nustatyti medicinos darbuotojų nuomonę apie savo sveikatą. 2. Išanalizuoti medicinos darbuotojų darbo aplinkos sąlygų subjektyvų vertinimą. 3. Įvertinti medicinos darbuotojų nuomonę, apie darbo aplinkos sąlygojamą poveikį sveikatai, priklausomai nuo socialinių ir demografinių veiksnių Tyrimo metodika: Tyrimas atliktas 2012 sausio - vasario mėnesiais atsitiktinai atrinktoje vienoje Kauno ligoninėje. Tyrimo metu naudotas vienmomentis anoniminės apklausos metodas. Buvo apklausti visi Kauno miesto X ligoninėje atsitiktinai atrinktų 6 skyrių medicinos darbuotojai. Viso išdalinta 173, gražintos atgal 148, ir iš jų statistinėje analizėje buvo naudotos 140 teisingai užpildytos anketos. Atsako dažnis 80,9 proc. Statistinė duomenų analizė atlikta naudojant SPSS 15.0 ir MS Excel programą. Rezultatai ir išvados. Tik trečdalis tyrime dalyvavusių medicinos darbuotojų savo dabartinę savo sveikatos būklę įvertino kaip gerą. Geriau savo sveikatos būklę vertino daugiau slaugytojų nei gydytojų. Savo darbo sąlygomis buvo patenkinti tik penktadalis tiriamųjų. Respondentai dažniausiai nurodė jų darbo aplinkoje esančius žalingus sveikatai veiksnius: darbas susijęs su nepatogia kūno padėtimi, darbo aplinka užteršta biologinės kilmės medžiagomis, darbas lydimas emocinės įtampos. Tik 5,7 proc. respondentų nurodė kad po darbo jaučiasi psichologiškai nepavargę... [toliau žr. visą tekstą] / Aim of study: to asses the X hospital medical staff opinion about their health and working environment. Objectives: 1. To identify medical staff opinion about their health. 2. To analyze the medical staff subjective assessment about the environmental conditions. 3. To evaluate the medical staff opinion about the working environment effects on their health, depending on the socio-demographic factors. Methods: the study was performed randomly in one Kaunas hospital in January 2012 - February. The anonymous questionnaire was used in survey. All randomly selected staff were interviewed in 6 departments of Kaunas X hospital. Distributed 173, 148 returned, and for the statistical analysis were used 140 correctly completed questionnaires. The response rate was 80,9%. Statistical analysis was performed using SPSS 15.0 and Microsoft Excel. Results and conclusions. Only a third of the medical staff involved in the study their current health condition assessed as good. As better health rated more nurses than doctors. With working conditions were satisfied only one-fifth of respondents. The respondents` commonly indicated in their working environment harmful health factors: the work is associated with awkward postures, working environment is contaminated with substances of biological origin, the work is accompanied by emotional stress. Only 5,7% respondents indicated that after work do not feel psychologically tired. More than half (60.6 %) medical staff indicated that some of existing... [to full text]

Darbo tikslas. Ištirti gydytojų ir slaugytojų santykių etinius aspektus Uždaviniai. Atskleisti gydytojų požiūrį į gydytojų ir slaugytojų profesinių santykių etiką; atskleisti slaugytojų požiūrį į gydytojų ir slaugytojų profesinių santykių etiką; palyginti gydytojų ir slaugytojų požiūrius į jų tarpprofesinį bendradarbiavimą. Tyrimo metodika. Atlikta VšĮ Ukmergės ligoninėje dirbančiųjų gydytojų ir slaugytojų anoniminė apklausa. Anketos buvo išdalintos gydytojams (n = 98) ir slaugytojams (n = 225), grąžintos iš viso 246 anketos (atsako dažnis – 73,3 proc.), 82 gydytojų ir 164 slaugytojų. Gauti duomenys analizuoti SPSS 20.0 programiniu paketu. Ryšiai tarp požymių vertinti Chi kvadrato (χ2) bei z kriterijais. Rezultatų skirtumas laikytinas statistiškai reikšmingu, kai p<0,05. Rezultatai. Didžioji dauguma (93,5 proc.) apklausoje dalyvavusių gydytojų profesinius gydytojų ir slaugytojų santykius etiniu požiūriu vertino teigiamai/l.teigiamai. Absoliuti dauguma (98,7 proc.) gydytojų nurodė, jog jų pavestus darbus slaugytojai atlieka sąžiningai. Kad niekada nėra girdėję slaugytojų nepalankios nuomonės apie gydytojų darbą, nurodė tik maža dalis (16,5 proc.) gydytojų. Tik trečdalis (35,4 proc.) respondentų, mano kad pasikeitimas informacija profesiniais klausimais tarp gydytojų ir slaugytojų yra pakankamas. Tik trečdalis (31,3 proc.) gydytojų mano, kad slaugytojai nėra gydytojo nurodymų vykdytojai, jie turi savo funkcijas, kurias įgyvendina darbe gydytojų. 26,3 proc. gydytojų savo darbo... [toliau žr. visą tekstą] / Aim of the study. To investigate the ethical relationship aspects between doctors and nurses. Objectives. To reveal doctors’ attitude towards the professional relationship ethics between doctors and nurses; to discover nurses’ attitude towards the professional relationship ethics between doctors and nurses; and to compare both groups’ attitudes towards their professional collaboration. Methods. There was an anonymous survey carried out at the public institution Ukmergės hospital. Respondents were employees: doctors and nurses. Questionnaires were handed to 98 doctors and 225 nurses, 246 filled questionnaires were returned (response rate is 73,3 percentage), out of which 82 doctors and 164 nurses responded. Data received was analyzed by SPSS 20.0 program package. Relations between features were assessed by Chi square (χ2) and z criteria. Difference between results is considered statistically significant when p<0,05. Results. The majority of doctors, who participated in the survey (93,5 %) evaluated professional relationships between doctors and nurses from the ethical point of view positively or very positively. The majority of doctor respondents (98,7 %) claimed that nurses fulfilled their duties conscientiously. However, only a small part of doctors (16,5 %) stated that they had never heard unfavorable nurses’ opinion about doctors’ work. Only one third of respondents (35,4 %) thought that exchange of information between doctors and nurses on professional matters was... [to full text]

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.

Doctor of Philosophy (PhD) / Understanding factors that enhance or diminish performance levels of individuals is instrumental for achieving individual (low level) and organisational (high level) goals. In this study, the effect of social network structure, position, ties and information and communication technologies (ICT) use on performance attitudes of knowledge intensive workers in dispersed occupational communities is investigated. Based on social network theories of strength of weak ties and structural holes, and the social influence model of technology use, a theoretical framework is developed. In conjunction with qualitative interviews conducted with subject matter experts, the framework is used to further develop and refine a valid and reliable survey instrument. Secondly, network measures of degree centrality, density, structural holes (constraint and efficiency), tie strength and tie diversity are applied for exploring the association with ICT use and performance from a sample of 110 rural general practitioners. Empirical results suggest that network structure, position and ties of knowledge workers play a crucial role in individual performance and ICT use. In particular, degree centrality and task-level ICT use was found to be positively associated with performance while ego-network constraint was found to be negatively correlated with performance. In terms of ICT use, functional diversity and degree centrality were positively associated with task-level ICT use whereas ego-network efficiency was found to be negatively correlated with ICT use at the communication-structure level. Among the variables that showed significance, degree centrality best explained overall variance for performance, and functional diversity best explained overall variance for task-level ICT use, although professional accreditations remains a potent indicator also. The results from this study resonate with findings from past literature and extend traditional theory of social networks and performance within the micro level to include geographically dispersed individuals involved in knowledge intensive work. For individuals in such non-competitive settings, traditional network theories such as structural holes theory still apply. However, a key finding is that network structure is a much more potent predictor of performance although network position is important. The second key finding addresses a major gap in the literature concerning understanding social processes that influence ICT use. As the technology acceptance and the social influence models lack empirical evidence from a social networks perspective, this research shows that rather than the strength of ties which functions as a conduit of novel ideas and information, it is the functional tie diversity within individual professionals networks that increase ICT use at the task-level. Methodologically, the study contributes towards a triangulation approach that utilises both qualitative and quantitative methods for operationalising the study. The quantitative method includes a non-traditional “networks” method of data collection and analysis to serve as a fine complement to traditional research methods in behavioural studies. The outcome is a valid and reliable survey instrument that allows collection of both individual attribute and social network data. The instrument is theoretically driven, practically feasible to implement, time-efficient and easily replicable for other similar studies. At the domain level, key findings from this study contradict previous literature which suggests that professionals in occupational communities such as general practitioners decline in performance as they age. In fact, findings from this study suggest that age and experience do not affect for performance; rather, there is a negative relationship between experience and task-level ICT use, and that task-level ICT use is positively associated with performance in terms of attitudes to interpersonal care. Furthermore, degree centrality is also positively associated with professional accreditations, such as fellowship of the Royal Australian College of General Practitioners, which is conducive to performance in terms of attitudes to interpersonal and technical care. The contextual implication from the quantitative and qualitative evidence of this study is that while contemplating strategies for optimising ICT use or for improving attitudes to quality of care at the technical and interpersonal level, the importance of social structure, position and relations in the practitioner’s professional network needs to be considered carefully as part of the overall individual and organisation-level goals.

Η αγορά των συνταγογραφούμενων φαρμάκων λειτουργεί σε ένα πολύπλοκο περιβάλλον που διαμορφώνεται από ισχυρές κυβερνητικές πιέσεις, ριζικές αλλαγές στην ιατρική περίθαλψη σε παγκόσμιο επίπεδο, αυξανόμενο συγκεντρωτισμό της αγοράς και μεγαλύτερο ανταγωνισμό από αντίγραφα φάρμακα. Δημιουργείται έτσι η πιεστική ανάγκη για τις φαρμακευτικές εταιρίες να συγκεκριμενοποιήσουν την εικόνα που έχουν οι μέτοχοί τους για αυτές (εταιρική εικόνα) και αν είναι εφικτό να προσπαθήσουν να την διαμορφώσουν. Η δημιουργία και διατήρηση μιας θετικής εταιρικής φήμης είναι μια πολύ δύσκολη και πολύπλοκη διαδικασία, που λίγες εταιρίες κατορθώνουν να πετύχουν. Περισσότερη μελέτη του αντικειμένου υποστηρίζει την άποψη ότι υπάρχουν πολλοί εσωτερικοί παράγοντες που πρέπει να ρυθμιστούν από μια εταιρία για να απολαμβάνει ευνοϊκή φήμη από τους ομάδες ενδιαφερομένων (stakeholders). Οι εσωτερικοί παράγοντες αφορούν πληροφορίες ή σήματα που εκπέμπουν οι εταιρίες, σχετικά με την οικονομική και λογιστική τους επίδοση, την ύπαρξη θεσμικών επενδυτών στο μετοχικό τους κεφάλαιο, και την στρατηγική τους τοποθέτηση. Στηριζόμενοι σε αυτές τις πληροφορίες οι stakeholders, αξιολογούν την εταιρική φήμη. Ο απώτερος σκοπός της παρούσας εργασίας είναι η αξιολόγηση των παραγόντων που προσδιορίζουν την εταιρική φήμη στο φαρμακευτικό κλάδο, καθώς και ο τρόπος που συσχετίζονται μεταξύ τους. / The market of prescribed medicines functions in a complicated environment that is shaped by powerful governmental pressures, radical changes in the medical care in world level, increasing centralism of market and bigger competition than generic medicines. It's thus created the pressing need for the pharmaceutical companies to particularise the picture that have their shareholders for them (corporate picture) and if it is feasible they try they shape it. The creation and maintenance of positive corporate reputation is a very difficult and complicated process that few companies are achieving. Further study of the object supports the opinion that there are a lot of internal factors that should be regulated from a company in order to achieve a favourable reputation from their stakeholders. The internal factors concerns information and data that companies are emitting, with regards to their financial and accounting record, the existence of institutional investors in their participial capital, and their strategic placement. Based on this information the stakeholders are evaluating the corporate reputation. The ultimate aim of present study is the evaluation of factors that determines the corporate reputation in the pharmaceutical industry, as well as the way they are related to each other.

Για πολλές δεκαετίες οι μελετητές ερεύνησαν τη στάση των γιατρών απέναντι στα διαθέσιμα μέσα πληροφόρησής τους για τα φάρμακα που κυκλοφορούν στην αγορά. Ο προβληματισμός πάντα ήταν ο ίδιος: ο γιατρός επιλέγει πάντα με βάση τις ανάγκες του ασθενή, ή υπάρχουν και άλλοι παράγοντες που τον επηρεάζουν στις επιλογές του; Ποιος είναι ο ρόλος των φαρμακευτικών εταιρειών και μέχρι ποιο βαθμό μπορούν να καθορίσουν την άποψη του ειδικού επιστήμονα; Οι ιατρικοί επισκέπτες αντιπροσωπεύουν τον κυριώτερο σύνδεσμο επικοινωνίας της φαρμακευτικής εταιρίας με τους θεράποντες ιατρούς. Ποια είναι όμως η γνώμη των ιατρών σχετικά με τη χρησιμότητα αυτής της επικοινωνίας; Σκοπός μας σε αυτή την εργασία είναι να προσεγγίσουμε και να κατανοήσουμε τα κριτήρια με τα οποία επιλέγει ο γιατρός τα μέσα ώστε να μπορέσει να ενημερωθεί για την αγορά των φαρμάκων. Η εργασία μας θα χωριστεί σε δύο μέρη, στο πρώτο μέρος (το θεωρητικό) θα γίνει η βιβλιογραφική προσέγγιση του θέματος και συγχρόνως θα επιλεγεί το τελικό μοντέλο στο οποίο θα βασιστεί το δεύτερο μέρος, το πρακτικό. Στο πρακτικό μέρος μέσω του μοντέλου, θα εστιάσουμε σε συγκεκριμένα ερευνητικά πεδία, διερευνώντας, μέσω ερωτηματολογίων, τα μέσα ενημέρωσης των γιατρών, αλλά και τη σχέση τους με τους ιατρικούς επισκέπτες. Τελικός στόχος της έρευνάς μας είναι να διερευνήσουμε τα παραπάνω ερωτήματα, με στόχο την εξαγωγή συμπερασμάτων για την βελτίωση της επικοινωνίας μεταξύ φαρμακευτικών εταιριών και του θεράποντος ιατρού. / For decades researchers investigated the attitudes of doctors toward their information resources available for drugs on the market. The problem was always the same: always choose the doctor based on the needs of the patient, or are there other factors that influence the choices? What is the role of pharmaceutical companies and to what extent can determine the specific terms of the scientist? Medical sales represent the highlight of communication link of the pharmaceutical company with their doctors,. What is the opinion of physicians regarding the usefulness of this communication? Our aim in this work is to approach and understand the criteria by which the doctor chooses the means that it can be updated for the purchase of medicines. Our work will be divided into two parts, the first part (theoretical) will be the bibliographic approach and while it will select the final model that will build the second part, practical. In practical through the model, we will focus on specific areas of research, exploring, through questionnaires, media doctors, and their relationship with the medical visitors. The ultimate goal of our research is to explore these questions in order to draw lessons for improving communication between pharmaceutical companies and physician.

Non-Governmental Organisations (NGOs) play an increasingly important role in the world and receive a growing amount of outsourced development work. Funding enables them to do the work necessary to provide aid. NGO work is influenced by the dependence on their donors and many NGOs increasingly take donations from private donors as a way to try to mitigate donor dependence and maintain neutrality in their work. However there is little research analysing this shift and the potential positive and negative effects. This study looks at dependence and efficiency in an NGO - private donor relationship. The objective is to contribute to the discussion about NGO dependency on donors by evaluating the positive and negative impacts of primarily private donorship on NGOs’ work efficiency. Little research has been done on the private donor relationship and this study is contributing to filling that gap. The study is a qualitative case study, with Médecins Sans Frontières (MSF) due to their private donor base’s recent increase. The data were obtained through interviews with MSF Sweden staff, other MSF primary source documents and secondary sources written by scholars on the topic of NGO dependency on their donors. The results of this study concluded that MSF works more efficiently with a primarily private donor base, due primarily to their increase in independence and control of their own operations. Since the shift from EU-funding, MSF can spend fewer resources on reporting and more on allocating the money to the field. A primarily private donor base has a positive impact on MSF and it is safe to say that other NGOs will likely follow suit. Further research should look into other NGOs to see whether a primarily private donor base benefits them too or if MSF is a one case exception.

Magister Chirurgiae Dentium - MChD (Oral Medicine and Periodontics) / Traumatic dental injuries (TDI's) are an important public health problem in children and adolescents worldwide. The emergency center (EC) serves as the spearhead to the hospital as it has to deal with a broad spectrum of patients with different ailments and injuries. The level of knowledge and doctors' practice at emergency centers (EC's) regarding TDI's has a direct impact on patient outcomes. The current literature reports that EC doctors have insufficient knowledge of the management of TDI's.

Submitted by Everaldo Coelho Soares (everaldo.soares@ucsal.br) on 2016-10-06T23:44:57Z No. of bitstreams: 1 TÔRRES ODS-2014.pdf: 4776938 bytes, checksum: bc4170c6f3a156b2854665618bf0d50d (MD5) / Approved for entry into archive by Maria Emília Carvalho Ribeiro (maria.ribeiro@ucsal.br) on 2016-12-27T21:18:06Z (GMT) No. of bitstreams: 1 TÔRRES ODS-2014.pdf: 4776938 bytes, checksum: bc4170c6f3a156b2854665618bf0d50d (MD5) / Made available in DSpace on 2016-12-27T21:18:06Z (GMT). No. of bitstreams: 1 TÔRRES ODS-2014.pdf: 4776938 bytes, checksum: bc4170c6f3a156b2854665618bf0d50d (MD5) Previous issue date: 2014-12-03 / Este estudo homenageia ao pai, médico dedicado durante 25 anos ao subúrbio de Periperi, região situada ao norte de Salvador, capital do Estado da Bahia, pertencente à macrorregião Leste, micro região de Salvador e 1ª Diretoria Regional de Saúde. Em Periperi viveu a pesquisadora (infância e parte da juventude), filha do primeiro médico a fixar residência no subúrbio ferroviário e atuar na profissão desde a sua graduação em 1942. Acresce a justificativa o fato de a pesquisadora, ter exercido a profissão médica durante 50 anos neste local, além de ter sido fundadora da primeira clínica privada com atendimentos médicos de urgência no subúrbio. Trata-se de pesquisa qualitativa, fundamentalmente descritiva, enquadrada como estudo de caso, mas utilizando diversas estratégicas metodológicas cujo instrumento principal de coleta de dados consistiu na aplicação de entrevista semiestruturada às famílias residentes ou que residiram em Periperi, divididas por décadas, de 1960 a 2010. Foram selecionadas 65 famílias com filhos que informaram sobre data de nascimento e sexo dos filhos, local do parto, local de vacinação, doenças imunopreviníveis ocorridas, atendimentos de saúde subsequentes e acrescentaram dados sobre a história local. Foram incluídas informações sobre prontuários disponíveis nos arquivos do consultório de Pediatria da autora em Periperi (42% de 1203 atendimentos) e da Clínica “Atendimentos Médicos de Urgência” (28% de 6.535 prontuários), também local de serviço da autora, ao lado de outros profissionais. Resultados referentes às 65 famílias: 203 trabalhos de parto, 207 crianças (duas adotadas, dois partos gemelares) indicam que, nas décadas de 1960 e 1970, a maioria dos partos foi em domicílio, assistidos por aparadeiras ou parteiras, sendo que as famílias possuíam muitos filhos nessas décadas, não havendo nenhuma com filho único, o que só veio a acontecer na de 1980 e que foi o modelo de 80% das famílias na década de 2000; a vacinação das crianças foi realizada, na maioria, no subúrbio de Periperi e as doenças imunopreviníveis tiveram incidência cada vez menor, ao longo do período considerado. Alguns planos de saúde foram utilizados, mas a partir da década de 2000 o SUS liderou os atendimentos. Quanto ao subúrbio, o marco de seu desenvolvimento sociocultural foi a construção da Avenida Afrânio Peixoto (Suburbana), depois do que surgiram as diversas clínicas privadas. O consultório de pediatria fez 52,08% dos atendimentos particulares, os demais por oito planos de saúde, tendo prevalecido UNIMED (24,26%). A Clinica AME funcionou com seis especialidades, oito médicos, a maior demanda foi para o serviço de ginecologia, seguida da Clínica Médica e Ultrassonografia; apoiou trabalhos de extensão e de pesquisa de alunos da UFBA, e da UCSal, e Feiras de Saúde e Educação para a Saúde do Lions Clube de Salvador-Periperi; cedeu espaço à FIOCRUZ para pesquisa internacional (esquistossomose mansônica). Foi possível observar a evolução da saúde, o êxito das ações do governo, dos planos nacionais de imunização, das campanhas vitoriosas de vacinação e de mudança no esquema vacinal do Brasil. Conclui ser o SUS um bom sistema de saúde, e que o médico já foi mais humanista. / This paper pays homage to a father and medical doctor who dedicated 25 years to Periperi, an area located on the northern surroundings of Salvador. Salvador is the capital of the state of Bahia, and is itself a micro-region, located in the macro-region East.The exact designation, as far as public health care is concerned, is First Regional Health Directory.The researcher lived in Periperi during childhood and part of her youth, being the daughter of the first physician to actually live in the aforementioned railway district. He started work as soon as she graduated from Medical School in 1942. The author has also worked in that area for 50 years. She has also started the first private clinic in the area, where office and emergency calls were available. The present work is a qualitative and basically descriptive piece of research -a case study-but utilizing various methodological strategies. The research instrument has been a semi-structured questionnaire, applied to families who now live in Periperi or who have lived there in the past. The sample was classified according to the decades from 1960 to 2010. Sixty five families with children were selected, with data on birth date, gender, birth and vaccination places, immunopreventable diseases, subsequent doctor’s calls and further details about the local history. Details from available patient files at the authors office (42% out of 1203 consultations) an from files belonging to the office of "Atendimentos Médicos Especializados" (AME), where the author also worked (28 % of 6535 files). Concerning the alluded 65 families, 203 births were registered and a total of 207 infants were born, being two cases of twins.Two infants were adopted. Most births occurred at home in the 1960s and 1970s. Birthswere assisted mainly by midwives and most families had several children. The first case of a family having an only child happened in the 1980s. This became the model for 80% of the families in the 2000s. Vaccination was performed most frequently in Periperi. Immunopreventable diseases began to decrease in incidence. Private insurance was used to some extent but SUS (Unified Health System, a governmental initiative) took the leadership in the 2000s. The developmental and cultural mark of the 2000s was the building of a road, namely, Avenida Afrânio Peixoto or Avenida Suburbana, after the birth of many private medical offices. The pediatrics office was responsible for 52,8% of pediatric consultations, the remaining 24,26% being covered by UNIMED, a private insurance. Six specialties and eight doctors were responsible for the clinical work at Clínic AME. Gynecology, Internal Medicine and Ultrassonography were the leading specialties. AME also serve as a basis for research conducted by UFBA and UCSAL. Health Fairs and Educational Fairs promoted by Lions Club Salvador-Periperi received support from AME. Lions Club and Fiocruz used their space and international research about schistosomiasis was performed in their facilities. The evolution of health care and the success of governmental health plans was visible. The change in vaccination routine was successf and SUS has been recognized as a good health system. Doctors, however, appeared to be more humanistic in the past.

Hospitais são instituições complexas e fundamentais na vida do ser humano. Eles consomem quase a metade das despesas destinadas à saúde no Brasil. Devido à especificidade dessas instituições há a genuína dificuldade em adaptar a atividade médica a controles administrativos. No entanto, é possível encontrar hospitais que utilizam o processo orçamentário como ferramenta de gestão. Esse processo pode ser utilizado para alinhar os objetivos entre os gestores e a organização, para estruturação e alocação de esforços, mensuração de desempenho/performance do gestor, atrelando metas a incentivos. Ao deparar-se com um hospital público em que há a presença dessa ferramenta e que conta com ausência de incentivos financeiros para o alcance de metas orçamentárias, com a complexidade da gestão comum a estas instituições, incerteza da tarefa e do embate entre profissionais da área médica e da administração, há o interesse do entendimento de como é a utilização, pelos gestores clínicos, do processo orçamentário para a tomada de decisão. Portanto, este trabalho aplicou um estudo de caso, utilizando entrevistas semiestruturadas, no Hospital das Clínicas de Ribeirão Preto para esse entendimento. Os resultados demonstram que a interação dos gestores com o orçamento se dá predominantemente via planejamento de materiais e incorporação de novas tecnologias. Os instrumentos de gestão utilizados auxiliam nesse planejamento e acompanhamento das atividades que impactam em consumo de recursos. Também foi demonstrado que há a percepção, pelos gestores, de conflitos entre as lógicas administrativa e médica. / Hospitals are complex institutions and fundamental in human life. They consume almost half of the spending on health in Brazil. Because of the specificity of these institutions there is genuine difficulty in adapting to the medical activity management controls. However, it is possible to find hospitals that use the budget process as a management tool. This process can be used to align the goals of managers and the organization for structuring and allocation of effort, performance measurement manager tying goals to incentives. When faced with a public hospital where there is the presence of this tool and it has no financial incentives for achieving budget targets, the complexity of the joint management of these institutions, job uncertainty and the clash between medical professionals and administration, there is interest in understanding how to use the clinical management of the budgeting process for decision making. This study applied a case study using semi-structured interviews, the University Hospital of Ribeirão Preto to this understanding. The results demonstrate that the interaction of managers with budget occurs predominantly through materials planning and incorporation of new technologies. Management tools used to assist in planning the mapping of activities that impact on resource consumption. It was also shown that there is a perception by managers of conflict between administrative and medical logic.