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1	A construção de um conjunto de indicadores como ferramenta de monitoramento em organizações de saúde: uma aplicação em um centro cirúrgico / The construction of a set of indicators as a monitoring tool in healthcare organizations: an application in a surgical center Marquez, Priscila Bertholo 03 June 2016 (has links) O processo de gestão de organizações de saúde necessita de ferramentas de monitoramento para auxiliar a tomada de decisão, contribuindo para a melhor qualidade dos serviços prestados. Objetivo: Explorar as formas de construção de um conjunto de indicadores de modo a possibilitar o estabelecimento de uma medida que permita o monitoramento de um centro cirúrgico. Procura-se, desse modo, elaborar um modelo que utilize uma abordagem baseada em consenso para a definição dos indicadores e para o levantamento dos pesos de ponderação. Metodologia: Considerando o objetivo proposto, foi realizada uma pesquisa de campo e exploratória, utilizando levantamento de dados primários e secundários. Foi utilizada a ferramenta de análise hierárquica de processos (AHP), proposta por Thomas L. Saaty (1991) com foco na definição dos pesos de importância relativa dos indicadores; para o cálculo do consenso, foi utilizada a medida proposta por Wierman e Tastle (2005). Resultados: Após a revisão da literatura e do processo de entrevistas com os especialistas foram propostos 37 indicadores para a composição do painel de monitoramento da unidade de centro cirúrgico. Constatou que a opinião dos especialistas sobre o peso de importância dos indicadores é muito equilibrada e harmoniosa. No cálculo do peso de importância dos indicadores propostos verificou-se que 15 indicadores são responsáveis por 73% do resultado final do painel. No que se refere ao consenso sobre as notas dos indicadores, observou-se uma redução do entendimento dos especialistas. Conclusões: o resultado final da análise das dimensões de estrutura, processo e resultado, a unidade de centro cirúrgico foi considerada satisfatória em uma escada de insatisfatório à excelente. Para que o painel proposto possa ser utilizado de forma dinâmica no processo de gestão sugere-se a redução do mesmo para os 15 indicadores com maior peso de importância. Através da análise dos dados e das medidas de consenso apuradas, verificou-se a necessidade de entendimento sobre as estratégias e metas da organização. A construção de um painel ponderado pelo consenso dos especialistas adiciona a ferramenta de monitoramento a possibilidade de verificar o alinhamento dos indicadores com as metas do planejamento estratégico da organização. / The health organizations management process requires monitoring tools to boost decisionmaking, contributing to a better quality of services. Objective: To explore ways to construct a set of indicators also allowing the establishment of a measure that permits monitoring of a surgical center. Thus, seeking to develop a model using an approach based on consensus on the definition of indicators and for acquiring weights ponderation. Methodology: Considering the proposed objective, a field research and exploration were conducted using survey of primary and secondary data. We used hierarchical analysis tool for process (AHP), proposed by Thomas L. Saaty (1991) focused on defining the relative importance of weights indicators; to calculate the consensus, we used the measure proposed by Wierman and tastle (2005). Results: After reviewing the literature and interviewing process with the experts were proposed 37 indicators for monitoring the composition of the panel of the surgical center unit. It found that the opinions of experts on the weight of importance of indicators is very balanced and harmonious. In calculating the weight of importance of the proposed indicators we found that 15 indicators are responsible for 73% of the final result of the panel. As regards the consensus on the scores of indicators, there was a reduction in the understanding of experts. Conclusions: The final result of the analysis of the structure dimensions, process and result, the surgical center unit was considered satisfactory in an excellent to unsatisfactory ladder. For the proposed panel it can be dynamically used in the management process suggested to reduce even to 15 indicators with greater weight of importance. By analyzing the calculated consensus measures, there is a need for understanding the strategies and goals of the organization. The construction of a panel weighted by consensus of the experts adds monitoring tool the possibility to check the alignment of indicators with the organization\'s strategic planning goals. Centro cirúrgico Consenso Consensus Gestão Indicadores Indicators Management Monitoramento Monitoring Surgery Center
2	"Aeromicrobiota do ambiente cirúrgico: princípios e peculiaridades da climatização artificial" / "Air microbiology of surgical environment: principles and singularities of artificial climate" Paula, Juliana Ferreira Lima de 18 December 2003 (has links) O presente estudo tem como meta primordial investigar a temática aeromicrobiota do ambiente hospitalar, especialmente, do centro cirúrgico com vistas a enfocar contaminação biológica por conseqüência da climatização artificial, bem como fornecer informações técnicas aos profissionais afins. Assim, estabeleceu-se como objetivos específicos: quantificar e categorizar a produção do conhecimento científico nacional e internacional relacionada a aeromicrobiota do ambiente hospitalar e testar um método de avaliação microbiológica do ar do ambiente cirúrgico considerando os parâmetros biológicos da legislação nacional, e o binômio custo/benefício. As autoras evidenciaram na literatura investigada que a avaliação microbiológica do ar é expressiva nos estudos, e, quanto ao tipo de microrganismo o Aspergillus sp e o Staphylococcus sp foram os mais mencionados. Em seguida, apontam a problemática da aerocontaminação biológica e discutem as alternativas de controle da qualidade do ar. Com relação a avaliação microbiólogica do ar por meio de placas Petrifilm AC Aerobic Count (3M, St Paul, MN, USA) em diferentes salas cirúrgicas ortopédicas observaram que o número de amostras positivas da entrada foi menor que na saída do ar: sala1, 0,0 na entrada e 55,6 na saída; sala 2, 40 e 83,3 e na 14 de 20,0 e 60,0%, respectivamente. Quanto ao nível de contaminação (ufc) foi expressiva apenas duas amostras da sala 2. No computo geral, os gêneros isolados foram Bacillus, Micrococcus, Actinomyces. Vale acrescentar que fungos não foram detectados. Esses resultados apontam para a eficiência do sistema de climatização. Alertam para a necessidade de uma pluralidade de ações estruturadas na multidisciplinaridade, bem como, na aplicação crítica das Resoluções e Portarias vigentes. / This study has as main goal to investigate about air microbiology of hospital environment, specially, surgical center, aiming to focus biological contamination due to artificial climate, as well as to provide technical information to professionals. So, the specific goals of this study are to quantify and classify national and international production of scientific knowledge related to air microbiology of hospital environment and test an evaluation method of air contamination, taking into account biological parameters of Brazilian legislation, and the relationship between cost and benefit. The authors have pointed out into scientific literature that air microbiological evaluation is expressive and the microorganisms Aspergillus and Staphylococcus were mentioned mostly. Next, they show the problems concerning biological contamination by air and discuss about alternative ways of controlling air quality. Regarding the microbiological air evaluation applying Petrifilm AC Aerobic Count plates (3M, St Paul, MN, USA) in different orthopedic surgical rooms, the results reveal a greater number of positive samples collected at the air exit compared to those at the air entry: room 1 got 0.0 at entry and 55.6 at exit; room 2, 40 and 83.3 and room 14, 20.0 and 60.0%, respectively. The contamination level (ufc) was expressive only on two samples of room number 2. The final analysis shows that the isolated genus were Bacillus, Micrococcus and Actinomyces and fungus were not detected. These results point out the efficiency of the air conditioning system and strengthen to the need of a plurality of structured actions in the multidisciplinary field, as well as in the appliance of Brazilian legislation. Aeromicrobiota Air microbiology biological risk Centro Cirúrgico hospital infection Infecção Hospitalar Risco biológico surgery center
3	"Aeromicrobiota do ambiente cirúrgico: princípios e peculiaridades da climatização artificial" / "Air microbiology of surgical environment: principles and singularities of artificial climate" Juliana Ferreira Lima de Paula 18 December 2003 (has links) O presente estudo tem como meta primordial investigar a temática aeromicrobiota do ambiente hospitalar, especialmente, do centro cirúrgico com vistas a enfocar contaminação biológica por conseqüência da climatização artificial, bem como fornecer informações técnicas aos profissionais afins. Assim, estabeleceu-se como objetivos específicos: quantificar e categorizar a produção do conhecimento científico nacional e internacional relacionada a aeromicrobiota do ambiente hospitalar e testar um método de avaliação microbiológica do ar do ambiente cirúrgico considerando os parâmetros biológicos da legislação nacional, e o binômio custo/benefício. As autoras evidenciaram na literatura investigada que a avaliação microbiológica do ar é expressiva nos estudos, e, quanto ao tipo de microrganismo o Aspergillus sp e o Staphylococcus sp foram os mais mencionados. Em seguida, apontam a problemática da aerocontaminação biológica e discutem as alternativas de controle da qualidade do ar. Com relação a avaliação microbiólogica do ar por meio de placas Petrifilm AC Aerobic Count (3M, St Paul, MN, USA) em diferentes salas cirúrgicas ortopédicas observaram que o número de amostras positivas da entrada foi menor que na saída do ar: sala1, 0,0 na entrada e 55,6 na saída; sala 2, 40 e 83,3 e na 14 de 20,0 e 60,0%, respectivamente. Quanto ao nível de contaminação (ufc) foi expressiva apenas duas amostras da sala 2. No computo geral, os gêneros isolados foram Bacillus, Micrococcus, Actinomyces. Vale acrescentar que fungos não foram detectados. Esses resultados apontam para a eficiência do sistema de climatização. Alertam para a necessidade de uma pluralidade de ações estruturadas na multidisciplinaridade, bem como, na aplicação crítica das Resoluções e Portarias vigentes. / This study has as main goal to investigate about air microbiology of hospital environment, specially, surgical center, aiming to focus biological contamination due to artificial climate, as well as to provide technical information to professionals. So, the specific goals of this study are to quantify and classify national and international production of scientific knowledge related to air microbiology of hospital environment and test an evaluation method of air contamination, taking into account biological parameters of Brazilian legislation, and the relationship between cost and benefit. The authors have pointed out into scientific literature that air microbiological evaluation is expressive and the microorganisms Aspergillus and Staphylococcus were mentioned mostly. Next, they show the problems concerning biological contamination by air and discuss about alternative ways of controlling air quality. Regarding the microbiological air evaluation applying Petrifilm AC Aerobic Count plates (3M, St Paul, MN, USA) in different orthopedic surgical rooms, the results reveal a greater number of positive samples collected at the air exit compared to those at the air entry: room 1 got 0.0 at entry and 55.6 at exit; room 2, 40 and 83.3 and room 14, 20.0 and 60.0%, respectively. The contamination level (ufc) was expressive only on two samples of room number 2. The final analysis shows that the isolated genus were Bacillus, Micrococcus and Actinomyces and fungus were not detected. These results point out the efficiency of the air conditioning system and strengthen to the need of a plurality of structured actions in the multidisciplinary field, as well as in the appliance of Brazilian legislation. Aeromicrobiota Centro Cirúrgico Infecção Hospitalar Risco biológico Air microbiology biological risk hospital infection surgery center
4	A construção de um conjunto de indicadores como ferramenta de monitoramento em organizações de saúde: uma aplicação em um centro cirúrgico / The construction of a set of indicators as a monitoring tool in healthcare organizations: an application in a surgical center Priscila Bertholo Marquez 03 June 2016 (has links) O processo de gestão de organizações de saúde necessita de ferramentas de monitoramento para auxiliar a tomada de decisão, contribuindo para a melhor qualidade dos serviços prestados. Objetivo: Explorar as formas de construção de um conjunto de indicadores de modo a possibilitar o estabelecimento de uma medida que permita o monitoramento de um centro cirúrgico. Procura-se, desse modo, elaborar um modelo que utilize uma abordagem baseada em consenso para a definição dos indicadores e para o levantamento dos pesos de ponderação. Metodologia: Considerando o objetivo proposto, foi realizada uma pesquisa de campo e exploratória, utilizando levantamento de dados primários e secundários. Foi utilizada a ferramenta de análise hierárquica de processos (AHP), proposta por Thomas L. Saaty (1991) com foco na definição dos pesos de importância relativa dos indicadores; para o cálculo do consenso, foi utilizada a medida proposta por Wierman e Tastle (2005). Resultados: Após a revisão da literatura e do processo de entrevistas com os especialistas foram propostos 37 indicadores para a composição do painel de monitoramento da unidade de centro cirúrgico. Constatou que a opinião dos especialistas sobre o peso de importância dos indicadores é muito equilibrada e harmoniosa. No cálculo do peso de importância dos indicadores propostos verificou-se que 15 indicadores são responsáveis por 73% do resultado final do painel. No que se refere ao consenso sobre as notas dos indicadores, observou-se uma redução do entendimento dos especialistas. Conclusões: o resultado final da análise das dimensões de estrutura, processo e resultado, a unidade de centro cirúrgico foi considerada satisfatória em uma escada de insatisfatório à excelente. Para que o painel proposto possa ser utilizado de forma dinâmica no processo de gestão sugere-se a redução do mesmo para os 15 indicadores com maior peso de importância. Através da análise dos dados e das medidas de consenso apuradas, verificou-se a necessidade de entendimento sobre as estratégias e metas da organização. A construção de um painel ponderado pelo consenso dos especialistas adiciona a ferramenta de monitoramento a possibilidade de verificar o alinhamento dos indicadores com as metas do planejamento estratégico da organização. / The health organizations management process requires monitoring tools to boost decisionmaking, contributing to a better quality of services. Objective: To explore ways to construct a set of indicators also allowing the establishment of a measure that permits monitoring of a surgical center. Thus, seeking to develop a model using an approach based on consensus on the definition of indicators and for acquiring weights ponderation. Methodology: Considering the proposed objective, a field research and exploration were conducted using survey of primary and secondary data. We used hierarchical analysis tool for process (AHP), proposed by Thomas L. Saaty (1991) focused on defining the relative importance of weights indicators; to calculate the consensus, we used the measure proposed by Wierman and tastle (2005). Results: After reviewing the literature and interviewing process with the experts were proposed 37 indicators for monitoring the composition of the panel of the surgical center unit. It found that the opinions of experts on the weight of importance of indicators is very balanced and harmonious. In calculating the weight of importance of the proposed indicators we found that 15 indicators are responsible for 73% of the final result of the panel. As regards the consensus on the scores of indicators, there was a reduction in the understanding of experts. Conclusions: The final result of the analysis of the structure dimensions, process and result, the surgical center unit was considered satisfactory in an excellent to unsatisfactory ladder. For the proposed panel it can be dynamically used in the management process suggested to reduce even to 15 indicators with greater weight of importance. By analyzing the calculated consensus measures, there is a need for understanding the strategies and goals of the organization. The construction of a panel weighted by consensus of the experts adds monitoring tool the possibility to check the alignment of indicators with the organization\'s strategic planning goals. Centro cirúrgico Consenso Gestão Indicadores Monitoramento Consensus Indicators Management Monitoring Surgery Center
5	Adverse Anesthesia Outcomes: A Retrospective Study of an Ambulatory Surgical Center versus a Dental Office Setting Agarwal, Gaurav 01 January 2007 (has links) Purpose: The purpose of this study was to compare the adverse events that occur with general anesthesia for dental rehabilitation between a hospital setting and dental clinic setting. Methods: A retrospective chart review was performed examining patients who had received dental rehabilitation with general anesthesia at the Virginia Commonwealth University Department of Pediatric Dentistry. Subjects were either treated in the Pediatric Dental Clinic or the Hospital Ambulatory Surgery Center (ASC) from July 2005 to December 2006. Anesthesia records of induction, intubation, maintenance, emergence and recovery were compared between the two settings.Results: There were a total of 422 charts reviewed with n=193 cases in the dental clinic and n=229 cases in the ASC. Patients in the dental clinic setting were slightly older (t = 2.63, df = 420, p-value = 0.0089), and healthier (chi-square = 45.9, df = 2, p-value Conclusion: Overall, the prevalence of adverse events occurring with dental rehabilitation under general anesthesia in the dental clinic setting was lower compared to adverse events in the hospital-based ambulatory surgical setting. adverse anesthesia event ambulatory surgery center dental office dental rehabilitation pediatric dental anesthesia Dentistry Medicine and Health Sciences Pediatric Dentistry and Pedodontics
6	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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