Yes / Advancing Industry 4.0 concepts by mapping the product of the automotive industry on the spectrum of Cyber Physical Systems, we immediately recognise the convoluted processes involved in the design of new generation vehicles. New technologies developed around the communication core (IoT) enable novel interactions with data. Our framework employs previously untapped data from vehicles in the field for intelligent vehicle health management and knowledge integration into design. Firstly, the concept of an inter-disciplinary artefact is introduced to support the dynamic alignment of disparate functions, so that cyber variables change when physical variables change. Secondly, the axiomatic categorisation (AC) framework simulates functional transformations from artefact to artefact, to monitor and control automotive systems rather than components. Herein, an artefact is defined as a triad of the physical and engineered component, the information processing entity, and communication devices at their interface. Variable changes are modelled using AC, in conjunction with the artefacts, to aggregate functional transformations within the conceptual boundary of a physical system of systems. / Jaguar Land Rover funded research “Intelligent Personalised Powertrain Healthcare” 2016-2019

Communication and coordination in complex sociotechnical systems require continuous assessment on its artefacts and how they are utilized to improve system performance. Situation Awareness (SA) is considered as a fundamental concept in designing and understanding interactions between human and non-human agents (i.e., information systems) that impact system performance. The interaction efficiency is partly determined by quality of information or SA distributed across agents to ensure the accuracy of decision making and resource allocations. Disrupting SA distribution between agents can significantly affect operations of the system with financial and safety consequences. This research applied the Distributed Situation Awareness (DSA) theory to study and improve patient flow management. The main objective of this research was to advance methodology in the DSA literature for (1) deriving design implications from DSA models, and (2) developing quantitative DSA models to formally compare system designs. This DSA research was situated in the domain of patient flow management. Data were collected using the three-part method of data elicitation, extraction, and representation to investigate DSA at a patient flow command and control center at Carilion Clinic in Roanoke, VA. The data used were elicited from observations and interviews on workers daily activities and available historical database (i.e., TeleTracking). Then, data were represented into a combined network to highlight social, task and knowledge elements in patient flows for studying and assessing patient flow management. The influence of the DSA on complex systems was examined qualitatively and quantitatively. The DSA combined network qualitatively characterized patient flow management and identified deficiencies of the command-and-control center functions. The network characterized admission, clinical (inside-hospital) transportation, discharge, and environmental services functions managed by Carilion Transfer and Communications Center (CTaC). These characterizations led to the identification of design principles on job roles, tasks performed, and SA transactions and distribution adopted by the state-of-the-art patient flow management facility. In addition, the network representing the current operation of CTaC illustrated the connection between functional groups, arbitration of resources, and job roles that could become the bottlenecks in transmitting SA. The network also helped identify inefficient task loops, which resulted in delay due to missing/poor SA, and task orders that could be modified to improve the patient flow and thus reduce the likelihood of delay. The qualitative (i.e., combined network) model was partially translated into a quantitative model based on discrete event simulation (DES) and agent-based modeling (ABM) to simulate patient transportation inside the hospital. The simulation model consisted of 28 patient origins, 29 equipment origins, 12 destinations, and more than 200 entities (i.e., simulation objects). The model was validated by lack of significant difference on various outcome metrics between 100 simulation replications and historical data using one-way t-tests. The simulation model captured the distribution and transactions of knowledge elements between agents within the modeled processes. Further, the model successfully verified the deficiencies in the existing system (i.e., delay and cancelation), attributing various instances of deficiency to be either SA related or non-SA related. The simulation model tested two interventions for eliminating SA deficiencies revealed by the qualitative model: (1) updating the wards nurse before picking up patients from inpatient floor, and (2) updating the X-ray nurse/team before arriving with the patient. Both interventions involved updates from the transporters to nurses, transmitting SA on the estimated time of arrival and patient information for the nurse to become aware of the transport status. The simulation ran for 1500 replications for results on transport time and cancellation rate on these two interventions. One-way t-tests revealed that the intervention to update the wards nurse resulted in significant reductions in mean transport and cancellation rate time compared to historical data (i.e., TeleTracking), yielding 0.42 minutes to 1.24 minutes reduction in transport time and 2% to 5% less cancelations. However, the second intervention resulted in a significant increase in transport time and thus was ineffective. DES and ABM supplemented the qualitative modeling with quantitative evidence on DSA concepts and assessment of potential interventions for improving DSA in patient flow management. Specifically, the DES and ABM enabled comparison and prediction of performance outcome from recommended changes to communication protocols. These findings indicate that DSA is a promising framework for analyzing communication and coordination in complex systems and assessing improvement on SA design quantitatively. / Doctor of Philosophy / Hospitals aim to provide care and treatment to patients in a timely and effective manner but their operations can be hindered by delays and long treatment times, resulting in high operating cost. A potential cause of this problem is the complexity of patient treatment process and the number agents involved. The treatment is provided through nurses, doctors, and technicians who work together to deliver care to patients. They all rely on the information from various medical devices and communicate patient-related information continuously to streamline patient movement towards different locations for different retreatments in the hospital. Thus, studying and improving communication and coordination between the medical staff could improve patient flow that in turn reduce idling resources and patient time in hospital, thereby lowering the healthcare cost without sacrificing quality of care. This dissertation investigated patient movement in the hospital adopting Distributed Situation Awareness (DSA). DSA models communication and coordination by examining the distribution of situation awareness (SA) between human and machine agents for a given task. The primary objective of this dissertation was to investigate how to develop DSA models for studying and improving patient flow management. The dissertation showed how to build a network model that illustrated how SA were generated and distributed amongst hospital staff and information systems to manage admission, discharge, room cleaning, and patient transportation. The network model also helped identified the deficiencies associated with different activities. Further, simulation was used to study the processes and SA communicated quantitively. The simulation model was able to show how one recommended change to the communication protocol could reduce patient transport time and cancellation for one route but another. This dissertation enhanced the methodology DSA for real-world applications and demonstrated the method to quantify SA distribution and transaction in complex system.

Uma questão central no estudo da estratégia é a tomada de decisão estratégica ou TDE (Eisenhardt e Zbaracki,1992; Papadakis e Barwise, 2002; Furrer et al, 2008; Ribeiro et al, 2016). Estudos anteriores demonstraram que, em setores mais dinâmicos de atividade, é melhor tomar decisões estratégicas mais rapidamente - já que processos estratégicos tradicionais e demasiadamente estruturados podem fazer com que empresas inseridas em ambientes de alta velocidade se tornem menos competitivas (Eisenhardt e Bourgeois, 1988; Judge e Miller, 1991). Mas e quanto aos ambientes de velocidade moderada, como os hospitais? Será que estes ambientes requerem uma TDE tão veloz quanto a prescrita pela literatura para as empresas, por exemplo, de Tecnologia? A resposta para esta pergunta pode ser útil a decisores atuando em ambientes menos velozes. Com o propósito maior de contribuir para sua obtenção, a pesquisa aqui apresentada teve como objetivo a análise dos processos decisórios estratégicos de três hospitais, através de entrevistas retroativas e semi-estruturadas realizadas com os diretores destas organizações. Para isso, foi utilizada a abordagem metodológica do tipo estudo de caso exploratório de casos múltiplos (Martins, 2008; Zainal, 2007). Foram realizadas entrevistas semiestruturadas com 15 executivos de três hospitais, num intervalo de 6 meses. As entrevistas foram analisadas em seu conteúdo e trianguladas com dados provenientes da análise documental (Yin, 1999). Os casos foram então comparados com os da literatura pré-existente. Resultados: (a) os processos decisórios estratégicos avaliados nesta pesquisa se revelaram estruturados e seguiram um padrão de ordenação de fases (Mintzberg, 1976), tendo durado mais tempo do que o prescrito pela literatura de TDE para empresas em ambientes rápidos (Eisenhardt e Bourgeois, 1988). Seus tempos de duração, porém, se mostraram adequados às dinâmicas de mercado em que as organizações estudadas estão inseridas e ao caráter estratégico das decisões; (b) os estilos de TDE foram predominantemente racionais, embora tenham sido evidenciados comportamentos políticos. Através de informações provenientes tanto de documentos quanto das entrevistas, foi possível observar variações no estilo de TDE nestas organizações, ao longo do tempo. Estes foram se tornando cada vez menos centralizados e menos políticos; (c) cinco das seis decisões estudadas estavam completamente alinhadas a objetivos estratégicos claros e bem comunicados, obtidos através de processos de planejamento estratégico abrangentes e estruturados, feitos com a ajuda de consultorias especializadas. Estas características parecem ter relação direta com o sucesso da implementação da decisão estratégica e (d) a análise dos resultados evidenciou, ainda, que a experiência e o perfil de liderança dos decisores foram determinantes da forma como os processos de TDE ocorreram e do sucesso de sua implementação. Em todos os casos estudados, os superintendentes gerais trouxeram para a organização atual executivos que fizeram parte de suas equipes em outros hospitais, tendo este fato por si só contribuído para o consenso nas decisões e para a presença de um certo nível de comportamento político. Limitações: A aparente estruturação dos processos decisórios pode ser fruto da racionalização a posteriori dos entrevistados ou da seleção de casos menos conflituosos pelos líderes dos hospitais estudados. Estudos futuros em que os pesquisadores presenciem as reuniões de TDE podem reduzir estas limitações. / A central issue in the study of Strategy is Strategic Decision Making or SDM (Eisenhardt and Zbaracki, 1992; Papadakis and Barwise, 2002; Furrer et al., 2008; Ribeiro et al., 2016). Previous studies have shown that, in more dynamic industries, it is better to make strategic decisions more quickly, since traditional strategic and structured processes can cause companies in highly accelerated environments to be less competitive (Eisenhardt and Bourgeois, 1988; Judge and Miller, 1991). But what about organizations operating in moderate velocity environments, such as hospitals? Do they require such fast-paced decision-making processes, as the ones prescribed by SDM authors for Technology companies? The answer to that question may be of interest for decisors in moderate paced environments. With the main purpose of trying to answer it, we have analized SDM processes in three hospitals, by means of semi-structured and retroactive interviews with top level executives at these organizations. A methodological multiple case study approach was used (Martins, 2008; Zainal, 2007). 15 executives in three hospitals have been interviewed for this study, in a six-month interval. The data was triangulated with document analysis (Yin, 1999), and compared to the existing literature. Results: (a) the strategic decision-making processes evaluated in this research have proved to be well structured, following a pattern of stage sequencing (Mintzberg, 1976), having lasted longer than what is prescribed for fast paced industries in the literature (Eisenhardt e Bourgeois, 1988). The duration of these processes, however, suits the dynamics of the industry and the strategic character of the decisions in the examined cases; (b) a predominantly rational decision-making approach was observed, even if a certain degree of political behavior has been observed. Document and interview content analysis have revealed changes in SDM style, over time. SDM seems to be less politic and centralized nowadays than it was 20 years ago; (c) five of the six decisions studied were completely aligned to clear and well communicated goals, which were obtained through comprehensive and structured strategic planning processes that were implemented with the help of specialized consultancies. This fact seems to have direct relation with the rationality of the decision and the success of its implementation and (d) the analysis of the results demonstrated that decision-makers\' characteristics, such as educational background, previous experience, and leadership skills were instrumental in the way the strategic decision-making processes occurred in the cases studied in this research. However, in all cases studied, the general managers have invited former team members with whom they had worked in other organizations, and that fact alone could have contributed to the level of consensus observed and to the presence of a certain degree of political behavior. Limitations: the apparently structured nature of these SDM processes may be due to some form of retrograde rationalization made by the interviewees and/or a biased selection of cases by the hospital general managers. Future studies where researchers can witness ongoing SDM processes may produce cleaner data.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-10-07T17:09:06Z No. of bitstreams: 1 Saulo Gomes Bornhorst_.pdf: 2249660 bytes, checksum: 0da3d18d9a17341671013eee66f9f39e (MD5) / Made available in DSpace on 2015-10-07T17:09:06Z (GMT). No. of bitstreams: 1 Saulo Gomes Bornhorst_.pdf: 2249660 bytes, checksum: 0da3d18d9a17341671013eee66f9f39e (MD5) Previous issue date: 2015-02-27 / Nenhuma / Este trabalho trata da temática da gestão com foco no planejamento de serviços médicos em hospitais brasileiros. A utilização das ferramentas da gestão no setor de saúde brasileiro e mundial tem ocorrido com frequência cada vez maior nas últimas décadas, premida pela necessidade crescente de ter-se uma melhor alocação dos recursos existentes. Os hospitais brasileiros, entretanto, ainda têm projetado novos serviços médicos sem o necessário planejamento, resultando em frequente desperdício de recursos públicos e privados. O presente estudo, através de uma abordagem qualitativa, utiliza-se da pesquisa-ação para propor um método e um modelo (SBModel) para o planejamento de serviços médicos em hospitais brasileiros. Parte-se da utilização do Business Model Generation, adaptando-o para o cenário local de saúde, após a constatação da inexistência de um modelo adequado à realidade da saúde brasileira. Após a elaboração de um método e modelo iniciais e sua aplicação na elaboração de dois serviços médicos em um hospital privado localizado na cidade de Porto Alegre, RS, ocorreu uma validação com gestores hospitalares para, na sequência, ser feita uma aplicação do método e modelo (SBModel) validados em um serviço médico de outro hospital privado localizado na mesma cidade. Conclui-se que a ferramenta proposta (SBModel) tem um importante papel na organização ou reorganização de serviços médicos, sendo replicável no cenário nacional de saúde. / This Master thesis addresses the management thematic focused on the planning of medical services in Brazilian hospitals. The use of management tools in the Brazilian and global health sector has been occurring with an increasing frequency in recent decades, influenced by the growing need to have a better allocation of existing resources. Brazilian hospitals, however, have still designed new medical services without the necessary planning, resulting in frequent waste of public and private resources. This study, through a qualitative approach, uses Action research to propose a method and a model (SBModel) for the planning of medical services in Brazilian hospitals. It starts with the application of the Business Model Generation, adapting it to the local health scenario, after finding the absence of an appropriate model to the Brazilian health reality. After the development of a method, initial models and their application in the implementation of two medical services in a private hospital in the city of Porto Alegre (RS), there was a validation by hospital managers. Subsequently, a new application of the validated method and model (SBModel) was made in a medical service of another private hospital in the same city. It is inferred that the proposed tool (SBModel) plays an important role in the organization or reorganization of medical services, being replicable in the national health scenario.

<div>As the manufacturing and healthcare systems becomes more complex, efficiently managing these systems requires cooperation and coordination between different parties. This dissertation examines the coordination issues in a supply chain problem and diagnostic decision making in the healthcare system. Below, we provide a brief description of the problem and results achieved. </div><div> </div><div>With supply chain becoming increasingly extended, the uncertainty in the upstream production process can greatly affect the material flow that aims toward meeting the uncertain demand at the downstream. In Chapter 2, we analyze a two-location system in which the upstream production facility experiences random capacities and the downstream store faces random demands. Instead of decomposing the profit function widely used to treat multi-echelon systems, our approach builds on the notions of stochastic functions, in particular, the stochastic linearity in midpoint and the directional concavity in midpoint, which establishes the concavity and submodularity of the profit functions. In general, it is optimal to follow a two-level state-dependent threshold policy such that an order is issued at a location if and only if the inventory position of that location is below the corresponding threshold. When the salvage values of the ending inventories are linear, the profit function becomes decomposable in the inventory positions at different locations and the optimal threshold policy reduces to the echelon base-stock policy. The effect of production and demand uncertainty on inventory levels depends critically on whether the production capacity is limited or ample in relation to the demand. Only when the capacity is about the demand, the upstream facility holds positive inventory; otherwise, all units produced are immediately shipped to the downstream. We further extend our analysis to situations with general stochastic production functions and with multiple locations.</div><div> </div><div> </div><div>In Chapter 3, we examine the two-stage supply chain problem (described in Chapter 2) under the decentralized control. We consider two scenarios. In the first scenario, the retail store does not have any supply information including the inventory level at the manufacturing facility. We show that the upstream and downstream can be dynamically coordinated with proper transfer payment defined on local inventories and their own value function in the dynamic recursion. In the second scenario, the demand distribution is unknown to the manufacturing facility as well as the retail store does not know the supply information. We characterize the optimal transfer contracts under which coordination can be achieved, and propose an iterative algorithm to compute the optimal transfer contracts in the decentralized setting. The total profit of the decentralized system under our algorithm is guaranteed to converge to the centralized optimal channel profit for any demand and supply distribution functions. </div><div> </div><div>In Chapter 4, we provide a case study for the framework developed in [1]. The authors study the evaluation and integration of new medical research considering the operational impacts. As a case study, we first describe their two-station queueing control model using the MDP framework. We then present the structural properties of the MDP model. Since multiple classes of patients are considered in the MDP model, it becomes challenging to solve when the the number of patient classes increases. We describe an efficient heuristic algorithm developed by [1] to overcome the curse of dimensionality. We also test the numerical performance of their heuristic algorithm, and find that the largest optimality gap is less than 1.50% among all the experiments. </div><div> </div>

Non-communicable diseases are on the increase worldwide, causing more than 36 million deaths each year. Evidence of the link between the role of nutrition and reducing non-communicable diseases is predominant in the literature. The factors influencing intervention strategies/policies and activities, however, need attention. AIM: The study aims to examine the factors that influence nutrition interventions within the United Arab Emirates’ healthcare system. METHOD: This research adapts an interdisciplinary approach where a triangulation mixed methodology is applied. Both qualitative and quantitative methods are used, through the analysis of ten interviews with policy makers, four case studies and 161 questionnaires. Furthermore, the research framework, which emerged from the literature search and qualitative analysis, is tested and validated by rigorous quantitative analysis using SPSS. The statistical analysis, using factor analysis, MANCOVA and ranking analysis aims to provide solid support for the resulting factors. MAIN FINDING: The study identifies five factors that influence nutrition interventions in a healthcare system, and could enhance the effectiveness of nutrition interventions. The factors are 1) quality and processes, 2) training and use of technology, 3) senior management involvement and responsibility, 4) patient diversity, and 5) multidisciplinary teams. CONCLUSION: This study contributes to the emerging literature on management in nutrition interventions and the theory and importance of preventative measures in relation to nutrition. This study provides a roadmap for policy makers to adopt in order to enhance the role of nutrition interventions in healthcare settings.

Este trabalho teve por objetivo compreender como as noções de gênero estão presentes no processo de elaboração e de implantação das políticas públicas de saúde no Brasil, com foco em uma rede de atenção à violência O trabalho está organizado em duas partes: na primeira, teórica, realizou-se uma revisão da literatura e de documentos de domínio público sobre as políticas públicas de Saúde, bem como sobre as políticas de gênero e de combate à violência contra a mulher e as interfaces desta com a Saúde. Na segunda parte foi realizado um estudo de caso tendo como foco o Programa Iluminar Campinas, uma rede criada pela Coordenadoria de Saúde da Mulher, em 2001, para atender os casos de violência doméstica contra crianças e adolescentes, de violência sexual em qualquer idade ou sexo e de exploração sexual comercial de crianças e adolescentes. Buscou-se entender se a transversalidade de gênero atravessa o programa de atendimento à violência nas diferentes práticas, bem como analisar o modelo de gestão de cuidado que o programa desenvolve no cotidiano das ações. A perspectiva teórica do estudo foi a Teoria Ator Rede (TAR) que apresenta ferramentas de pesquisa para acompanhar as diversas estratégias desenvolvidas; os atores envolvidos foram ouvidos e buscou-se identificar os papéis desempenhados pelas diversas materialidades envolvidas nestas ações. Assim, a metodologia envolveu a análise de documentos, entrevistas e observações de eventos do Programa Iluminar. A análise possibilitou identificar que a organização do cuidados em Campinas tem inovado no atendimento aos casos de violência sexual, articulando diferentes setores, como Educação, Assistência Social, Segurança Pública, Judiciário, Saúde e organizações não-governamentais para promover o acolhimento humanizado e diferenciado às pessoas em diversos pontos da rede de cuidados; reduzir o tempo de atendimento às urgências e emergências; possibilitar o transporte público gratuito e seguro e gerar políticas locais com os dados da notificação. O Programa agregou diversas materialidades na organização do cuidados e gerou um novo olhar para a questão da violência entre os profissionais e a população. Porém, a transversalidade da noção de gênero das diferentes ações de forma a contemplar casos como os de violência por parceiro íntimo - ainda é um desafio a ser superado pelo Programa Iluminar, para ampliar o acesso a serviços e programas que consigam intervir na violência de gênero / This study aims to understand how notions of gender are presented in the design and implementation of a public health policy in Brazil, with focus on a network on violence. The text is organized into two parts: the first part, theoretical, is a review of the literature and public domain documents on public health policies and policies on gender and violence against women, and its interface with the health sector. In the second part we conducted a case study that focused on the Programa Iluminar (Illuminating Program), a network created in Campinas, which was created by the Coordination of Women\'s Health in 2001, for dealing with cases of domestic violence against children and adolescents survivors of sexual violence at any age or sex, and commercial sexual exploitation of children and adolescents. We sought to understand whether gender mainstreaming through the assistance program to violence in their various practices and analyze the model of care management that the program develops in the daily actions. The theoretical perspective that guided the study was the Actor Network Theory (TAR), which provides tools for monitoring the various strategies developed, the stakeholders were heard and tried to identify the roles of various materiality involved in these actions. Thus, the methodology involved the analysis of institutional documents, interviews and observations of network meetings of the Iluminar Program.The analysis identified that the organization of the care network in Campinas has been an innovator in the care of patients with sexual violence, to articulate different sectors such as Education, Social Services, Public Safety, Judiciary, Health and nongovernmental organizations to promote the humane care and different people in different parts of the network of care, reduce the time to serve the emergency care, allow free public transport and insurance and generate local politics to the notification. The program has added a number of materiality in the organization of the care network and created a new look at the issue of violence among professionals and the public. However, the mainstreaming of gender concept of different actions such as including violence by intimate partners - is still a challenge to be overcome by the Programa Iluminar to expand access to services and programs that can intervene in gender violence

Medical records consist of a lot of data. Nevertheless, in today’s digitized society it is difficult for humans to convert data into information and recognize hidden patterns. Effective decision support tools can assist medical staff to reveal important information hidden in the vast amount of data and support their medical decisions. The objective of this thesis is to compare five machine learning algorithms for clinical diagnosis. The selected machine learning algorithms are C4.5, Random Forest, Support Vector Machine (SVM), k-Nearest Neighbor (kNN) and Naïve Bayes classifier. First, the machine learning algorithms are applied on three publicly available datasets. Next, the Analytic hierarchy process (AHP) is applied to evaluate which algorithms are more suitable than others for medical diagnosis. Evaluation criteria are chosen with respect to typical clinical criteria and were narrowed down to five; sensitivity, specificity, positive predicted value, negative predicted value and interpretability. Given the results, Naïve Bayes and SVM are given the highest AHP-scores indicating they are more suitable than the other tested algorithm as clinical decision support. In most cases kNN performed the worst and also received the lowest AHP-score which makes it the least suitable algorithm as support for medical diagnosis.

Uma questão central no estudo da estratégia é a tomada de decisão estratégica ou TDE (Eisenhardt e Zbaracki,1992; Papadakis e Barwise, 2002; Furrer et al, 2008; Ribeiro et al, 2016). Estudos anteriores demonstraram que, em setores mais dinâmicos de atividade, é melhor tomar decisões estratégicas mais rapidamente - já que processos estratégicos tradicionais e demasiadamente estruturados podem fazer com que empresas inseridas em ambientes de alta velocidade se tornem menos competitivas (Eisenhardt e Bourgeois, 1988; Judge e Miller, 1991). Mas e quanto aos ambientes de velocidade moderada, como os hospitais? Será que estes ambientes requerem uma TDE tão veloz quanto a prescrita pela literatura para as empresas, por exemplo, de Tecnologia? A resposta para esta pergunta pode ser útil a decisores atuando em ambientes menos velozes. Com o propósito maior de contribuir para sua obtenção, a pesquisa aqui apresentada teve como objetivo a análise dos processos decisórios estratégicos de três hospitais, através de entrevistas retroativas e semi-estruturadas realizadas com os diretores destas organizações. Para isso, foi utilizada a abordagem metodológica do tipo estudo de caso exploratório de casos múltiplos (Martins, 2008; Zainal, 2007). Foram realizadas entrevistas semiestruturadas com 15 executivos de três hospitais, num intervalo de 6 meses. As entrevistas foram analisadas em seu conteúdo e trianguladas com dados provenientes da análise documental (Yin, 1999). Os casos foram então comparados com os da literatura pré-existente. Resultados: (a) os processos decisórios estratégicos avaliados nesta pesquisa se revelaram estruturados e seguiram um padrão de ordenação de fases (Mintzberg, 1976), tendo durado mais tempo do que o prescrito pela literatura de TDE para empresas em ambientes rápidos (Eisenhardt e Bourgeois, 1988). Seus tempos de duração, porém, se mostraram adequados às dinâmicas de mercado em que as organizações estudadas estão inseridas e ao caráter estratégico das decisões; (b) os estilos de TDE foram predominantemente racionais, embora tenham sido evidenciados comportamentos políticos. Através de informações provenientes tanto de documentos quanto das entrevistas, foi possível observar variações no estilo de TDE nestas organizações, ao longo do tempo. Estes foram se tornando cada vez menos centralizados e menos políticos; (c) cinco das seis decisões estudadas estavam completamente alinhadas a objetivos estratégicos claros e bem comunicados, obtidos através de processos de planejamento estratégico abrangentes e estruturados, feitos com a ajuda de consultorias especializadas. Estas características parecem ter relação direta com o sucesso da implementação da decisão estratégica e (d) a análise dos resultados evidenciou, ainda, que a experiência e o perfil de liderança dos decisores foram determinantes da forma como os processos de TDE ocorreram e do sucesso de sua implementação. Em todos os casos estudados, os superintendentes gerais trouxeram para a organização atual executivos que fizeram parte de suas equipes em outros hospitais, tendo este fato por si só contribuído para o consenso nas decisões e para a presença de um certo nível de comportamento político. Limitações: A aparente estruturação dos processos decisórios pode ser fruto da racionalização a posteriori dos entrevistados ou da seleção de casos menos conflituosos pelos líderes dos hospitais estudados. Estudos futuros em que os pesquisadores presenciem as reuniões de TDE podem reduzir estas limitações. / A central issue in the study of Strategy is Strategic Decision Making or SDM (Eisenhardt and Zbaracki, 1992; Papadakis and Barwise, 2002; Furrer et al., 2008; Ribeiro et al., 2016). Previous studies have shown that, in more dynamic industries, it is better to make strategic decisions more quickly, since traditional strategic and structured processes can cause companies in highly accelerated environments to be less competitive (Eisenhardt and Bourgeois, 1988; Judge and Miller, 1991). But what about organizations operating in moderate velocity environments, such as hospitals? Do they require such fast-paced decision-making processes, as the ones prescribed by SDM authors for Technology companies? The answer to that question may be of interest for decisors in moderate paced environments. With the main purpose of trying to answer it, we have analized SDM processes in three hospitals, by means of semi-structured and retroactive interviews with top level executives at these organizations. A methodological multiple case study approach was used (Martins, 2008; Zainal, 2007). 15 executives in three hospitals have been interviewed for this study, in a six-month interval. The data was triangulated with document analysis (Yin, 1999), and compared to the existing literature. Results: (a) the strategic decision-making processes evaluated in this research have proved to be well structured, following a pattern of stage sequencing (Mintzberg, 1976), having lasted longer than what is prescribed for fast paced industries in the literature (Eisenhardt e Bourgeois, 1988). The duration of these processes, however, suits the dynamics of the industry and the strategic character of the decisions in the examined cases; (b) a predominantly rational decision-making approach was observed, even if a certain degree of political behavior has been observed. Document and interview content analysis have revealed changes in SDM style, over time. SDM seems to be less politic and centralized nowadays than it was 20 years ago; (c) five of the six decisions studied were completely aligned to clear and well communicated goals, which were obtained through comprehensive and structured strategic planning processes that were implemented with the help of specialized consultancies. This fact seems to have direct relation with the rationality of the decision and the success of its implementation and (d) the analysis of the results demonstrated that decision-makers\' characteristics, such as educational background, previous experience, and leadership skills were instrumental in the way the strategic decision-making processes occurred in the cases studied in this research. However, in all cases studied, the general managers have invited former team members with whom they had worked in other organizations, and that fact alone could have contributed to the level of consensus observed and to the presence of a certain degree of political behavior. Limitations: the apparently structured nature of these SDM processes may be due to some form of retrograde rationalization made by the interviewees and/or a biased selection of cases by the hospital general managers. Future studies where researchers can witness ongoing SDM processes may produce cleaner data.

Este trabalho teve por objetivo compreender como as noções de gênero estão presentes no processo de elaboração e de implantação das políticas públicas de saúde no Brasil, com foco em uma rede de atenção à violência O trabalho está organizado em duas partes: na primeira, teórica, realizou-se uma revisão da literatura e de documentos de domínio público sobre as políticas públicas de Saúde, bem como sobre as políticas de gênero e de combate à violência contra a mulher e as interfaces desta com a Saúde. Na segunda parte foi realizado um estudo de caso tendo como foco o Programa Iluminar Campinas, uma rede criada pela Coordenadoria de Saúde da Mulher, em 2001, para atender os casos de violência doméstica contra crianças e adolescentes, de violência sexual em qualquer idade ou sexo e de exploração sexual comercial de crianças e adolescentes. Buscou-se entender se a transversalidade de gênero atravessa o programa de atendimento à violência nas diferentes práticas, bem como analisar o modelo de gestão de cuidado que o programa desenvolve no cotidiano das ações. A perspectiva teórica do estudo foi a Teoria Ator Rede (TAR) que apresenta ferramentas de pesquisa para acompanhar as diversas estratégias desenvolvidas; os atores envolvidos foram ouvidos e buscou-se identificar os papéis desempenhados pelas diversas materialidades envolvidas nestas ações. Assim, a metodologia envolveu a análise de documentos, entrevistas e observações de eventos do Programa Iluminar. A análise possibilitou identificar que a organização do cuidados em Campinas tem inovado no atendimento aos casos de violência sexual, articulando diferentes setores, como Educação, Assistência Social, Segurança Pública, Judiciário, Saúde e organizações não-governamentais para promover o acolhimento humanizado e diferenciado às pessoas em diversos pontos da rede de cuidados; reduzir o tempo de atendimento às urgências e emergências; possibilitar o transporte público gratuito e seguro e gerar políticas locais com os dados da notificação. O Programa agregou diversas materialidades na organização do cuidados e gerou um novo olhar para a questão da violência entre os profissionais e a população. Porém, a transversalidade da noção de gênero das diferentes ações de forma a contemplar casos como os de violência por parceiro íntimo - ainda é um desafio a ser superado pelo Programa Iluminar, para ampliar o acesso a serviços e programas que consigam intervir na violência de gênero / This study aims to understand how notions of gender are presented in the design and implementation of a public health policy in Brazil, with focus on a network on violence. The text is organized into two parts: the first part, theoretical, is a review of the literature and public domain documents on public health policies and policies on gender and violence against women, and its interface with the health sector. In the second part we conducted a case study that focused on the Programa Iluminar (Illuminating Program), a network created in Campinas, which was created by the Coordination of Women\'s Health in 2001, for dealing with cases of domestic violence against children and adolescents survivors of sexual violence at any age or sex, and commercial sexual exploitation of children and adolescents. We sought to understand whether gender mainstreaming through the assistance program to violence in their various practices and analyze the model of care management that the program develops in the daily actions. The theoretical perspective that guided the study was the Actor Network Theory (TAR), which provides tools for monitoring the various strategies developed, the stakeholders were heard and tried to identify the roles of various materiality involved in these actions. Thus, the methodology involved the analysis of institutional documents, interviews and observations of network meetings of the Iluminar Program.The analysis identified that the organization of the care network in Campinas has been an innovator in the care of patients with sexual violence, to articulate different sectors such as Education, Social Services, Public Safety, Judiciary, Health and nongovernmental organizations to promote the humane care and different people in different parts of the network of care, reduce the time to serve the emergency care, allow free public transport and insurance and generate local politics to the notification. The program has added a number of materiality in the organization of the care network and created a new look at the issue of violence among professionals and the public. However, the mainstreaming of gender concept of different actions such as including violence by intimate partners - is still a challenge to be overcome by the Programa Iluminar to expand access to services and programs that can intervene in gender violence