This study investigated the attitudes and perceptions of nurse managers regarding cost containment issues in selected public hospitals in the Port Elizabeth metropole of the Eastern Cape. Four hospitals participated in the study, and 211 nurse managers completed questionnaires. The results obtained from the participants’ responses indicated that: ✦ Nurse managers are ill-prepared for many responsibilities regarding cost containment, and need appropriate orientation and preparation both during their initial formal, and during their nurse management and in service training in order to fulfil their “financial” or cost containment role more effectively. ✦ Nurse managers perceived the relationship between the productivity of staff and cost containment positively, but were reportedly unable to • prevent nurses from leaving their points of duty • curb the rate of absenteeism among nurses • reduce the number of resignations ✦ Nurse managers suggested that more effective hospital cost containment efforts should ensure that • effective security checks are performed to curb losses of stock and equipment • more public telephones are installed in hospitals • stricter controls regarding wheelchairs are implemented The rationalisation of staff and services, as well as specialised equipment among the four public hospitals could enhance these hospitals’ cost containment results. However, this would necessitate reorganising these hospitals’ services at provincial level. The nurse managers required more knowledge about hospitals’ financial management and cost containment issues. Guidelines for such a course were developed addressing: analysis of monthly variance reports; budgeting for manpower; balance statement; calculations for the supplies and expenses budget; income statements; the hospital’s budgetary cycle; break-even analysis; analysis of cost-effectiveness and cost-benefit analysis. / ADVANCED NURSING SCIENCES / D.Litt. et Phil.

Submitted by Ângelo Alves da Silva (angelo@gestaoalpha.com.br) on 2017-08-07T17:35:45Z No. of bitstreams: 1 TESE ANGELO=versão final.pdf: 3452257 bytes, checksum: 2fe47bf124fc2751dc7c5cfb42a77048 (MD5) / Approved for entry into archive by Maria Tereza Fernandes Conselmo (maria.conselmo@fgv.br) on 2017-08-08T23:36:42Z (GMT) No. of bitstreams: 1 TESE ANGELO=versão final.pdf: 3452257 bytes, checksum: 2fe47bf124fc2751dc7c5cfb42a77048 (MD5) / Made available in DSpace on 2017-08-09T13:00:10Z (GMT). No. of bitstreams: 1 TESE ANGELO=versão final.pdf: 3452257 bytes, checksum: 2fe47bf124fc2751dc7c5cfb42a77048 (MD5) Previous issue date: 2017-06-09 / O principal objetivo deste trabalho foi analisar os impactos da Lei de Responsabilidade Fiscal (LRF) no aumento ou diminuição das variáveis observadas nas finanças dos municípios brasileiros, especificamente no elemento de despesa INVESTIMENTOS e nas funções de governo EDUCAÇÃO e SAÚDE no período de 2001 a 2005 (depois da LRF) em comparação ao período de 1996 a 2000 (antes da LRF). A motivação desta pesquisa advém da expectativa de que a LRF possa ter contribuído para alavancar o volume de recursos aplicados no elemento de despesa Investimentos e nas diversas funções de governo, com destaque para Educação e Saúde, objeto deste estudo, haja vista a limitação que a referida Lei trouxe para os gastos com pessoal e para o controle do endividamento dos municípios brasileiros. Os resultados obtidos com esta pesquisa revelam que, no âmbito dos 2.644 municípios pesquisados, de todos os portes e de todas as regiões do Brasil, os impactos da LRF não provocaram uma homogeneidade de comportamento no tocante ao crescimento ou decrescimento orçamentário, ou seja, após o advento da LRF, houve municípios em que as aplicações de recursos públicos no elemento de despesa Investimentos e nas funções de governo Educação e Saúde aumentaram significativamente; em outros, aumentaram moderada ou timidamente e ainda em outros, diminuíram significativa, moderada ou timidamente, não demonstrando, portanto, um padrão uniforme de realização das aludidas rubricas orçamentárias. Naturalmente, pode-se depreender desse fato a questão da heterogeneidade das finanças dos municípios brasileiros, dentre os quais alguns se apresentavam bem equilibrados e outros muito endividados antes do advento da referida Lei; nos primeiros, os impactos da LRF foram positivos no sentido de aumentar os Investimentos e os gastos em Educação e Saúde; nos últimos, os novos gestores, temendo a responsividade de seus atos, pisaram no freio, diminuindo Investimentos e freando também gastos com Educação e Saúde no intuito de equilibrar as contas públicas. / The impacts of the Brazilian Fiscal Accountability Law (FAL) are analyzed with regard to variables´ increase or decrease in the public accounts of Brazilian municipalities, particularly on the expenditure item INVESTMENTS and on government administration in EDUCATION and HEALTH, between 2001 and 2005 (after FAL) compared to the 1996-2000 period (prior to FAL). Current research was foregrounded on the expectation that FAL may have contributed to leverage resources applied in the expenditure item and on several governmental functions, with special reference to Education and Health, the aim of current investigation. This is due to the fact that FAL has restricted expenditure on personnel and limited the debt capacity of Brazilian municipalities. Results reveal that, within the context of 2,644 big or small municipalities under analysis throughout the country, FAL´s impacts failed to cause a behavioral homogeneity with regard to budget growth or decrease. In other words, after the promulgation of FAL, several municipalities significantly increased their public Investments on Education and Health administration functions; others increased moderately or timidly their expenditures; others still, significantly, moderately or timidly decreased their expenditures. There was no uniform pattern for the achievement of the above budget items. The above data reveal the heterogeneity of the municipalities´ accounts, or rather, some had a healthy equilibrium, while others were in great debts prior to FAL. Whereas FAL´s impact on the former municipalities were positive due to increase in Investments and in expenditure on Education and Health, in the later, the new administrations feared the impacts of accountability of their activities, stepped on the brakes, decreased Investments and expenditure in Education and Health to maintain an equilibrium in public accounts.

This study investigated the attitudes and perceptions of nurse managers regarding cost containment issues in selected public hospitals in the Port Elizabeth metropole of the Eastern Cape. Four hospitals participated in the study, and 211 nurse managers completed questionnaires. The results obtained from the participants’ responses indicated that: ✦ Nurse managers are ill-prepared for many responsibilities regarding cost containment, and need appropriate orientation and preparation both during their initial formal, and during their nurse management and in service training in order to fulfil their “financial” or cost containment role more effectively. ✦ Nurse managers perceived the relationship between the productivity of staff and cost containment positively, but were reportedly unable to • prevent nurses from leaving their points of duty • curb the rate of absenteeism among nurses • reduce the number of resignations ✦ Nurse managers suggested that more effective hospital cost containment efforts should ensure that • effective security checks are performed to curb losses of stock and equipment • more public telephones are installed in hospitals • stricter controls regarding wheelchairs are implemented The rationalisation of staff and services, as well as specialised equipment among the four public hospitals could enhance these hospitals’ cost containment results. However, this would necessitate reorganising these hospitals’ services at provincial level. The nurse managers required more knowledge about hospitals’ financial management and cost containment issues. Guidelines for such a course were developed addressing: analysis of monthly variance reports; budgeting for manpower; balance statement; calculations for the supplies and expenses budget; income statements; the hospital’s budgetary cycle; break-even analysis; analysis of cost-effectiveness and cost-benefit analysis. / ADVANCED NURSING SCIENCES / D.Litt. et Phil.