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Nurses experiencing bullying or witnessing other nurses bullied may choose to vacate their hospital positions. Nurse attrition negatively impacts a hospital's bottom line, which can lead to insolvency and a lack of access to healthcare by patients. The purpose of this phenomenological study was to understand the choices nurses made regarding their careers after experiencing or witnessing bullying and to calculate a hospital's cost of loss. Freire's oppressed group theory provided the conceptual framework for the study. The basis of the research questions was to understand how the nurse felt when bullied or observing a coworker bullied, the actions taken, and the financial impact to the hospital. The snowball technique secured 11 RN participants for this phenomenological study with data collection consisting of a demographic questionnaire and semistructured interviews. Data analysis followed Maxwell's plan of initial analysis, transcribing and coding, theme identification, a final coding review, and the final abstraction. The findings in this study demonstrated that based on the lived experiences of the participants, demographics did not influence who or how nurses were bullied; and after leaving the employer, bullied nurses and witnesses displayed various emotions that encompassed nonchalance, anger, tears, or relief. Over half said they would have stayed if they had not been bullied or witnessed it. An additional theme demonstrated that the results of bullying significantly affected a hospital's bottom line in revenue and reputation. Eleven suggestions have been recommended for future studies. Academics, hospital administrators, nurses, and the community at large can use the study findings to effect changes in the hospital environment through conversations, grass-roots efforts, and collaboration.

The importance of health care institutions’ management is accepted about 20 years ago. First in Lithuania the post of hospital administrator was established in Hospital of Kaunas University of Medicine in 1996. It is the first investigation of the expediency’s appreciation of hospital administrator’s post in Lithuania. Aim of the study: to evaluate the appreciation of the hospital administrator’s post. Objectives: 1) To analyse papers influencing on hospital administrator’s job. 2) To investigate and compare the opinion of hospital administrators and departments’ chiefs about the necessity of manager in hospital. Methods: The study consists of the responses of 34 chiefs and 54 administrators of departments of Kaunas Medical University Hospital. We asked questions of chiefs and administrators to determine the necessity of administrator’s role in health care organization, what functions hospital administrators should do. The administrators’ response rate was 65% (35 of 54), the chiefs’ rate was 79% (27 of 35). There were used T and Chi-square tests, hospital administrators were compare to chiefs of departments. In all instances statistical significance is set at 0.05 level. Results: There is done the analysis of health care institutions’ management and roles of hospital administrator. By investigation in Hospital of Kaunas University of Medicine all chiefs of departments (100%) and almost all hospital administrators (97%) predicate that the post of hospital administrator is... [to full text]

Orientador: Ettore Bresciani Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica / Made available in DSpace on 2018-08-10T20:11:51Z (GMT). No. of bitstreams: 1 Thimmig_RolandoAntonio_D.pdf: 1460008 bytes, checksum: 14b7a07d7a7e08b91c77d5d2d015dc9f (MD5) Previous issue date: 2008 / Resumo: Este trabalho se propõe a elaborar um novo método para a acreditação em instituições de saúde pelo estudo de sistemas complexos, utilizando a sistemografia como ferramenta de modelização de sistemas. A utilização da técnica da sistemografia permite o mapeamento e a racionalização dos processos, facilitando sua compreensão pelos diversos profissionais envolvidos. O objetivo geral deste trabalho é apresentar este método de forma a simplificar o processo de acreditação, identificando redundâncias e incompletudes eventualmente existentes neste processo. Conceitualmente, a acreditação é um método voluntário e educacional de estímulo, avaliação e certificação externa da qualidade de serviços de saúde, que introduz, nas instituições prestadoras de serviços de assistência à saúde, a cultura da qualidade. Após a realização de uma revisão bibliográfica a respeito de sistemas, sistemografia, processos, gestão do conhecimento e acreditação hospitalar, é feita uma análise geral da acreditação de uma instituição de saúde, que passa a ser estudada através de seu processo de acreditação inicial (ou incremental) e de seu processo de manutenção (ou de reavaliação) da acreditação. Esta análise inclui o detalhamento desses dois processos através de seus sistemógrafos operacional, informacional e decisional, sendo seus processadores analisados, avaliados, comparados e tabulados segundo sua categoria, tipo e nível. A elaboração dos sistemógrafos operacionais (apresentando as operações envolvidas no processo), dos sistemógrafos informacionais (em que o fluxo das informações é destacado) e dos sistemógrafos decisionais (em que são mostradas as tomadas de decisões) permite, durante a análise da atividade em questão, avaliá-la e melhorá-la. Estes sistemógrafos permitem observar e eliminar redundâncias e ciclos que são (ou não) importantes para o processo propriamente dito, proporcionando assim a sua visualização sistêmica, identificando pontos que permitam sua racionalização, seu aumento de flexibilidade e sua agilização. Em seguida, a análise teórica é complementada através de um estudo de caso, em que é apresentado o processo de acreditação de um hospital de grande porte. Finalmente, são apresentadas as conclusões, baseadas tanto no estudo teórico como no estudo prático / Abstract: This work proposes a new method for the healthcare institution¿s accreditation trough the study of complex systems, using the systemography as a systems modeling tool. The systemographic technique use allows the processes¿ mapping and rationalization, enabling the different involved professionals understanding. The general objective of this work is to present this method in a way that simplifies the accreditation process, identifying redundancies and incompletenesses that may eventually exist in this process. Conceptually, accreditation is a voluntary and educational method that incentives, evaluates and certifies the quality of healthcare services, which introduces in the healthcare institutions services the culture of quality. After the bibliographical revision regarding systems, systemography, processes, knowledge management and hospitals' accreditation, a general analysis of a health institution accreditation is performed, through the study of its initial (or incremental) accreditation process and trough its maintenance (or revaluation) accreditation process. This analysis includes the two processes specification through their operational, informational and decisional systemographs, having their processors analyzed, appraised, compared and tabulated by category, type and level. The operational systemographs (listing the operations involved in the process), the informational systemographs (highlighting the information flow) and the decisional systemographs (presenting the decisions) allow, during the activity analysis, to evaluate and to improve it. These systemographs allow the identification and elimination of redundancies and the separation of the main process cycles from the others, providing a systemic visualization and identification of points that enable its rationalization, flexibility increase and agility. The theoretical analysis is followed and complemented by a case study, where a large hospital¿s accreditation process is presented. At the end, the conclusions based in the theoretical and practical reviews are presented. / Doutorado / Materiais e Processos de Fabricação / Mestre em Engenharia Mecânica