Daniel Paulino Teixeira Lopes

Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil

BackgroundUnequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges.MethodsThe present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals.ResultsThe analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people.ConclusionsThere is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.

Management innovation and social innovation: convergences and divergences

The purpose of this paper is to discuss recent developments in the fields of management innovation and social innovation, in order to discover any possible convergences and divergences between them.,By examining the state of the art of the literature in both fields of study, this paper proposes a framework of theoretical approaches, conceptual dimensions, goals and objectives, processes, agents, outcomes, methods, and literature gaps.,There are substantial differences between management and social innovation in terms of theoretical and conceptual foundations. Although both share similarities given the relevance of technology and their focus on social relations, their generation and diffusion processes, among their other characteristics, are distinct.,As this is a theoretical paper concerning innovations that involve social elements at their core, the challenge is to incorporate technological innovation into the theoretical framework. This would help empirically oriented research on more types of innovation.,The agenda of practitioners, scholars, government, and civil society should take different types of innovation into account, particularly those that go beyond technology.,This paper contributes to a better understanding of innovations that go beyond technology, by analysing innovations (i.e. management and social innovation) that involve social aspects at their core. Few researchers have analysed these types of innovations jointly.,O objetivo deste artigo consiste em discutir os avancos mais recentes nos campos da inovacao gerencial e da inovacao social, na busca de possiveis aspectos convergentes e divergentes entre essas tematicas.,Ao examinar o estado da arte da literatura em ambas as tematicas, propoe-se um framework de abordagens teoricas, dimensoes conceituais, metas e objetivos, processos, agentes, resultados, metodos e lacunas da literatura.,Ha diferencas substanciais entre inovacao gerencial e social em termos de fundamentos teoricos e conceituais. Embora ambas compartilhem semelhancas, dado o seu foco nas relacoes sociais e a relevância da tecnologia, seus processos de geracao e difusao, entre outras caracteristicas, sao distintos.,Como se trata de um artigo teorico sobre inovacoes que envolvem elementos sociais em sua essencia, o desafio e incorporar a inovacao tecnologica no framework teorico. Isso ajudaria pesquisas empiricamente orientadas sobre mais tipos de inovacao.,A agenda de profissionais, academicos, governo e sociedade civil deve levar em conta diferentes tipos de inovacao, particularmente aquelas que vao alem da tecnologia.,Este artigo contribui para uma melhor compreensao das inovacoes que vao alem da tecnologia, ao analisar inovacoes (no caso, as gerenciais e sociais) que possuem aspectos sociais como elementos centrais. Poucos pesquisadores analisaram conjuntamente esses tipos de inovacoes.