Carmen Silvia Gabriel

Collective and decentralized management model in public hospitals: perspective of the nursing team

Esta pesquisa objetivou apresentar a implantacao do modelo de gestao colegiada e descentralizada, em unidades funcionais, em um hospital publico do municipio de Ribeirao Preto, SP, segundo a visao da equipe de enfermagem e da assistente tecnica de saude. Trata-se de estudo de caso historico-organizacional, na vertente qualitativa, que se utilizou da analise tematica de conteudo, proposta por Bardin, para a analise dos dados. A instituicao adotou a descentralizacao de sua estrutura administrativa a partir de 1999, mediante a aplicacao da gestao compartilhada, o que possibilitou algumas melhorias internas, com repercussao positiva na assistencia prestada ao usuario. A implantacao verticalizada do processo parece ter prejudicado a adesao dos trabalhadores, embora a gestao colegiada tenha intensificado a comunicacao, o compartilhamento do poder e da decisao. O estudo aponta, apesar dos avancos em relacao a qualificacao da assistencia, que muito ha que se fazer para se concretizar essa proposta gerencial inovadora.This research aims to present the implementation of the collective and decentralized management model in functional units of a public hospital in the city of Ribeirão Preto, state of São Paulo, according to the view of the nursing staff and the health technical assistant. This historical and organizational case study used qualitative thematic content analysis proposed by Bardin for data analysis. The institution started the decentralization of its administrative structure in 1999, through collective management, which permitted several internal improvements, with positive repercussion for the care delivered to users. The top-down implementation of the process seems to have jeopardized workers adherence, although collective management has intensified communication and the sharing of power and decision. The study shows that there is still much work to be done to concretize this innovative management proposal, despite the advances regarding the quality of care.

Utilização de indicadores de desempenho em serviço de enfermagem de hospital público

El estudio objetivo identificar indicadores de desempeno adoptados por el Servicio de Enfermeria de hospital publico y analizar la opinion de los enfermeros en relacion a la utilizacion de estos indicadores para evaluar la calidad de la asistencia de enfermeria. Se trata de estudio descriptivo exploratorio con abordaje cuantitativo, que utilizo datos de los informes de gestion de la institucion y aplico un cuestionario en una muestra de 25 enfermeros. Se verifico que la institucion trabaja con tres bancos de datos de indicadores, siendo dos generales y uno especifico de enfermeria que analiza 11 indicadores. Los indicadores de incidencia de ulcera por presion y de caidas fueron los unicos considerados muy pertinentes para calificar la asistencia de enfermeria por 100% de los enfermeros. Se concluye que la institucion utiliza indicadores para acompanamiento de resultados y existe una valorizacion de la utilizacion de indicadores de procesos por los enfermeros para evaluar desempeno de la enfermeria, siendo necesario ampliar el analisis para indicadores multidisciplinares.The study aimed to identify performance indicators adopted by the Nursing Service of a public hospital and to analyze the opinions of the nurses regarding the use of these indicators to evaluate the quality of the nursing care. This is descriptive exploratory study with a quantitative approach, which used data from the management reports of the institution and applied a questionnaire in a sample of 25 nurses. It was found that the institution works with three databases of indicators, two being general and one specific for Nursing, which analyze 11 indicators. The indicators of pressure ulcer incidence and incidence of falls were the only ones considered highly relevant to qualify the nursing care for 100% of the nurses. It was concluded that the institution uses indicators for monitoring outcomes and tends to valorize the use of process indicators by the nurses to evaluate the Nursing performance, with it being necessary to expand the analysis to include multi-disciplinary indicators.

Framing the difficulties resulting from implementing a Participatory Management Model in a public hospital

OBJETIVO: O estudo objetiva abordar as dificuldades relatadas pela equipe de enfermagem durante o processo de mudanca do modelo de gestao em um hospital publico no Brasil. METODO: Este estudo qualitativo utilizou a analise tematica de conteudo proposta por Bardin, sendo os dados analisados usando o referencial teorico de Bolman e Deal. RESULTADOS: A implementacao vertical da Gestao Participativa contradiz sua filosofia, influenciando negativamente a aceitacao das mudancas por parte dos trabalhadores. A estrutura descentralizada foi implementada, porem a tomada de decisao compartilhada foi apenas parcialmente utilizada. Apesar de haver facilitacao da comunicacao intra-unidade, as dificuldades mais significativas surgiram da falta de comunicacao inter-unidades.Valores e principios precisam ser compartilhados por equipes, contudo, isso somente ocorrera se os gestores reestruturarem responsabilidades descrevendo os papeis de todos os membros da equipe. CONCLUSAO: Modelos de gestao inovadores que tenham como premissa a descentralizacao da tomada de decisao e intensificacao da comunicacao incentivam a motivacao, a responsabilizacao, o aumento da satisfacao do pessoal, alem de contribuir para melhorar a qualidade do atendimento. A contribuicao do estudo centra-se na descricao da complexidade da implementacao de um modelo de gestao inovador, na analise do dissenso e, intencionalmente, no reconhecimento das dificuldades enfrentadas pelos funcionarios da organizacao.OBJECTIVE This study aims to address difficulties reported by the nursing team during the process of changing the management model in a public hospital in Brazil. METHODS This qualitative study used thematic content analysis as proposed by Bardin, and data were analyzed using the theoretical framework of Bolman and Deal. RESULTS The vertical implementation of Participatory Management contradicted its underlying philosophy and thereby negatively influenced employee acceptance of the change. The decentralized structure of the Participatory Management Model was implemented but shared decision-making was only partially utilized. Despite facilitation of the communication process within the unit, more significant difficulties arose from lack of communication inter-unit. Values and principals need to be shared by teams, however, that will happens only if managers restructure accountabilities changing job descriptions of all team members. CONCLUSION Innovative management models that depart from the premise of decentralized decision-making and increased communication encourage accountability, increased motivation and satisfaction, and contribute to improving the quality of care. The contribution of the study is that it describes the complexity of implementing an innovative management model, examines dissent and intentionally acknowledges the difficulties faced by employees in the organization.Objetivo: El estudio tiene como objetivo tratar de las dificultades del equipo de enfermeria durante el cambio del modelo de gestion en un hospital publico en Brasil. Metodo: Este estudio cualitativo utilizo el analisis de contenido tematico propuesto por Bardin; los datos fueron analizados utilizando el marco teorico de Bolman y Deal. Resultados: La aplicacion vertical de la Gestion Participativa, en contradiccion con su filosofia, incide negativamente en la aceptacion del cambio por los empleados. La estructura descentralizada se llevo a cabo, pero la toma de decisiones compartida se utilizo solo en parte. Aunque existe facilitacion de la comunicacion dentro de la unidad, dificultades surgieron de la falta de comunicacion inter-unidades.Valores y principios deben ser compartidos por los equipos; esto solo ocurre si los gerentes reestructurar las responsabilidades y describir las funciones de todos. Conclusion: Modelos innovadores de gestion que tienen como premisa la descentralizacion de las decisiones y una mayor comunicacion fomentan la motivacion, la responsabilidad, aumento de la satisfaccion, y mejoran la calidad de la atencion. La contribucion de este estudio se centra en la complejidad de la implementacion de una gestion innovadora, el analisis de disenso e intencionadamente en el reconocimiento de dificultades que enfrentan los empleados de la organizacion.Descriptores: Grupo de Enfermeria; Organizacion y Administracion; Comunicacion; Gestion en Salud.

Modelo de gestão colegiada e descentralizada em hospital público: a ótica da equipe de enfermagem

Esta pesquisa objetivou apresentar a implantacao do modelo de gestao colegiada e descentralizada, em unidades funcionais, em um hospital publico do municipio de Ribeirao Preto, SP, segundo a visao da equipe de enfermagem e da assistente tecnica de saude. Trata-se de estudo de caso historico-organizacional, na vertente qualitativa, que se utilizou da analise tematica de conteudo, proposta por Bardin, para a analise dos dados. A instituicao adotou a descentralizacao de sua estrutura administrativa a partir de 1999, mediante a aplicacao da gestao compartilhada, o que possibilitou algumas melhorias internas, com repercussao positiva na assistencia prestada ao usuario. A implantacao verticalizada do processo parece ter prejudicado a adesao dos trabalhadores, embora a gestao colegiada tenha intensificado a comunicacao, o compartilhamento do poder e da decisao. O estudo aponta, apesar dos avancos em relacao a qualificacao da assistencia, que muito ha que se fazer para se concretizar essa proposta gerencial inovadora.This research aims to present the implementation of the collective and decentralized management model in functional units of a public hospital in the city of Ribeirão Preto, state of São Paulo, according to the view of the nursing staff and the health technical assistant. This historical and organizational case study used qualitative thematic content analysis proposed by Bardin for data analysis. The institution started the decentralization of its administrative structure in 1999, through collective management, which permitted several internal improvements, with positive repercussion for the care delivered to users. The top-down implementation of the process seems to have jeopardized workers adherence, although collective management has intensified communication and the sharing of power and decision. The study shows that there is still much work to be done to concretize this innovative management proposal, despite the advances regarding the quality of care.

Use of performance indicators in the nursing service of a public hospital

El estudio objetivo identificar indicadores de desempeno adoptados por el Servicio de Enfermeria de hospital publico y analizar la opinion de los enfermeros en relacion a la utilizacion de estos indicadores para evaluar la calidad de la asistencia de enfermeria. Se trata de estudio descriptivo exploratorio con abordaje cuantitativo, que utilizo datos de los informes de gestion de la institucion y aplico un cuestionario en una muestra de 25 enfermeros. Se verifico que la institucion trabaja con tres bancos de datos de indicadores, siendo dos generales y uno especifico de enfermeria que analiza 11 indicadores. Los indicadores de incidencia de ulcera por presion y de caidas fueron los unicos considerados muy pertinentes para calificar la asistencia de enfermeria por 100% de los enfermeros. Se concluye que la institucion utiliza indicadores para acompanamiento de resultados y existe una valorizacion de la utilizacion de indicadores de procesos por los enfermeros para evaluar desempeno de la enfermeria, siendo necesario ampliar el analisis para indicadores multidisciplinares.The study aimed to identify performance indicators adopted by the Nursing Service of a public hospital and to analyze the opinions of the nurses regarding the use of these indicators to evaluate the quality of the nursing care. This is descriptive exploratory study with a quantitative approach, which used data from the management reports of the institution and applied a questionnaire in a sample of 25 nurses. It was found that the institution works with three databases of indicators, two being general and one specific for Nursing, which analyze 11 indicators. The indicators of pressure ulcer incidence and incidence of falls were the only ones considered highly relevant to qualify the nursing care for 100% of the nurses. It was concluded that the institution uses indicators for monitoring outcomes and tends to valorize the use of process indicators by the nurses to evaluate the Nursing performance, with it being necessary to expand the analysis to include multi-disciplinary indicators.

A competência técnica em informática de alunos de enfermagem

Nurses in the information age need to build their knowledge and abilities in order to be competent in this area. The objective of this study was to verify the knowledge of nursing freshmen (1st semester) and seniors (8th semester) registered in 2008 and 2007, respectively, regarding their ability to use informatics resources. This is a non-experimental, descriptive, exploratory survey. Data collection was performed using a questionnaire based on a set of competences in informatics. The results revealed a low rate of informatics knowledge among the freshmen. However, regarding the applications that students had the most difficulty to operate, between the two periods, seniors had the worst performance, which shows it is necessary to include computer classes in the preparation of these new professional, in order to prepare them for the work market.Nurses in the information age need to build their knowledge and abilities in order to be competent in this area. The objective of this study was to verify the knowledge of nursing freshmen (1st semester) and seniors (8th semester) registered in 2008 and 2007, respectively, regarding their ability to use informatics resources. This is a non-experimental, descriptive, exploratory survey. Data collection was performed using a questionnaire based on a set of competences in informatics. The results revealed a low rate of informatics knowledge among the freshmen. However, regarding the applications that students had the most difficulty to operate, between the two periods, seniors had the worst performance, which shows it is necessary to include computer classes in the preparation of these new professional, in order to prepare them for the work market.

Valores e práticas de trabalho que caracterizam a cultura organizacional de um hospital público

The study aimed to identify the values and practices which characterize the organizational culture of a public hospital in the view of the nurses. This is descriptive research structured based on Hofstedes framework and undertaken in a public hospital in the interior of the state of Sao Paulo. The sample was represented by 52 nurses. Data collection occurred in the period between December 2010 and February 2011, using the Brazilian Instrument for the Evaluation of Organizational Culture. The results showed that there is hierarchical rigidity and centralization of power (94%); there is competition and difficulty in working as a team (63%); the workers have little well-being and motivation (94%); there is little satisfaction in the work and promotion of interpersonal relationships (60%). In this regard, the hospitals culture is intimately related to the model of organization and management of the work, which further the fragmentation of the care and make it harder to work as a team and to develop interdisciplinarity, compromising the quality of the care. DESCRIPTORS: Nursing. Health Services. Organization and administration. Organizational culture.The study aimed to identify the values and practices which characterize the organizational culture of a public hospital in the view of the nurses. This is descriptive research structured based on Hofstedes framework and undertaken in a public hospital in the interior of the state of Sao Paulo. The sample was represented by 52 nurses. Data collection occurred in the period between December 2010 and February 2011, using the Brazilian Instrument for the Evaluation of Organizational Culture. The results showed that there is hierarchical rigidity and centralization of power (94%); there is competition and difficulty in working as a team (63%); the workers have little well-being and motivation (94%); there is little satisfaction in the work and promotion of interpersonal relationships (60%). In this regard, the hospitals culture is intimately related to the model of organization and management of the work, which further the fragmentation of the care and make it harder to work as a team and to develop interdisciplinarity, compromising the quality of the care. DESCRIPTORS: Nursing. Health services. Organization and administration. Organizational culture.

Nursing undergraduates' technical competence in informatics

Nurses in the information age need to build their knowledge and abilities in order to be competent in this area. The objective of this study was to verify the knowledge of nursing freshmen (1st semester) and seniors (8th semester) registered in 2008 and 2007, respectively, regarding their ability to use informatics resources. This is a non-experimental, descriptive, exploratory survey. Data collection was performed using a questionnaire based on a set of competences in informatics. The results revealed a low rate of informatics knowledge among the freshmen. However, regarding the applications that students had the most difficulty to operate, between the two periods, seniors had the worst performance, which shows it is necessary to include computer classes in the preparation of these new professional, in order to prepare them for the work market.Nurses in the information age need to build their knowledge and abilities in order to be competent in this area. The objective of this study was to verify the knowledge of nursing freshmen (1st semester) and seniors (8th semester) registered in 2008 and 2007, respectively, regarding their ability to use informatics resources. This is a non-experimental, descriptive, exploratory survey. Data collection was performed using a questionnaire based on a set of competences in informatics. The results revealed a low rate of informatics knowledge among the freshmen. However, regarding the applications that students had the most difficulty to operate, between the two periods, seniors had the worst performance, which shows it is necessary to include computer classes in the preparation of these new professional, in order to prepare them for the work market.

Nursing informatics: unveiling the computer use by nurses

Estudio realizado con el objetivo de comprender la percepcion de enfermeros asistenciales, de una institucion filantropica, acerca del uso del computador en el trabajo. La recoleccion de datos ocurrio en enero de 2013, a partir de entrevistas con 12 enfermeros que respondieron a la pregunta: hableme sobre el uso del computador en su trabajo. Los datos fueron tratados utilizando la tecnica analisis de contenido, por medio del cual emergieron las siguientes categorias tematicas y subtemas: Percibiendo aspectos positivos en el uso del computador (nueve subtemas); Percibiendo aspectos negativos en el uso del computador (cuatro subtemas); Sugiriendo acciones para mejorar el uso del computador (seis subtemas); y Evaluando la informatizacion en el trabajo (tres subtemas). Fue posible concluir que los enfermeros tienen la percepcion de que el uso del computador se relaciona con la facilidad, la agilidad y la practicidad en el desarrollo de las actividades profesionales; pero aun existen aspectos tecnicos y operacionales que necesitan ser mejorados.

Decision-making of the nursing team after the revitalization of a decentralized management model

This studys objective was to identify changes in decision-making arising from the revitalization of the participatory management model and how these changes impacted the daily work of the nursing staff, as well as to identify potential difficulties. This qualitative case study was conducted in a public hospital in the State of Sao Paulo, Brazil. Participant observation and semi- structured interviews were conducted with 23 nursing workers and the Health Technical Assistant. We used thematic content analysis for data analysis. The revitalization of the management model was not comprehensive because many professionals were oblivious to the process. Shared actions did not occur and adherence to the model was hampered because the workers were not fully informed of the assumptions concerning this management model. For the implementation of this model to be effective, teamwork and the inclusionObjetivou-se identificar alteracoes ocorridas na tomada de decisao decorrentes da revitalizacao do modelo de gestao compartilhada e a interferencia delas no cotidiano de trabalho da enfermagem, bem como identificar as dificuldades encontradas. Trata-se de estudo de caso com abordagem qualitativa, desenvolvido em hospital publico do estado de Sao Paulo. Observacao participante e entrevistas semiestruturadas foram realizadas com 23 trabalhadores da enfermagem e a Assistente Tecnica de Saude. Para a analise dos dados optou-se pela analise tematica de conteudo. A revitalizacao do modelo de gestao nao ocorreu de forma expressiva, pois muitos profissionais desconheciam esse processo. O agir compartilhado nao se efetivou e a adesao ao modelo foi prejudicada, pois foi incipiente a estrategia de orientacao acerca dos pressupostos do modelo gerencial. Para que seja possivel a efetivacao deste modelo, deve ser revisto o trabalho em equipe e a insercao de todos os envolvidos buscando um trabalho mais articulado e qualificado.