Maria do Carmo Gullaci Guimarães Caccia-Bava

Hospital organization culture, capacity to innovate and success in technology adoption.

PURPOSE Absorptive capacity has been defined as an organizations ability to recognize the value of new information, assimilate it, and apply it to productive ends. This study aims to examine the type of organization culture that influences the capacity of hospital organizations to innovate by absorbing new technology and the importance of this absorptive capacity in information technology (IT) implementation success. DESIGN/METHODOLOGY/APPROACH Based on previous research, this study proposes a measure of absorptive capacity that includes managerial IT knowledge and communication channels and tests its relationship to the level of success implementing new systems. A sample of 192 hospital administrators shared their opinions about their organizations culture, ability to absorb new technology, and the extent to which their latest IT implementation operational for at least one year has been a success. FINDINGS The results show the importance of organization culture as an important factor in developing absorptive capacity, and the latters influence in the implementation of new technologies. ORIGINALITY/VALUE The study provides insights into the types of activities that management should undertake in order to enhance absorptive hospital capacity.

As tecnologias leves como geradoras de satisfação em usuários de uma unidade de saúde da família

O objetivo desta investigacao foi avaliar a qualidade da assistencia prestada em um nucleo de saude da familia (NSF), enfocando a satisfacao dos usuarios, com base nas tecnologias leves, bem como analisar aspectos dessa assistencia, produtores de satisfacao e de insatisfacao, no que diz respeito ao vinculo, a responsabilizacao, a resolubilidade, as expectativas, aos relacionamentos, ao conforto e acesso, e identificar recomendacoes para intervencoes locais. Apos realizarmos uma caracterizacao geral da populacao atendida no servico em estudo, selecionamos os sujeitos participantes da pesquisa. A coleta de dados deu-se por meio da entrevista semi-estruturada. A abordagem foi de natureza qualitativa, e os dados foram ordenados pelo metodo do Discurso do Sujeito Coletivo (DSC). A analise revela a importância atribuida, pelos usuarios do servico, as tecnologias leves, mas tambem a necessidade de diminuir o tempo de espera para as consultas e os encaminhamentos e obter o acesso a medicamentos e a atencao odontologica no proprio servico, fatores que levam a grande insatisfacao por parte dos usuarios.This study had the purpose to evaluate the quality of the health service provided at a Family Health Unit (FHU), with emphasis on user satisfaction, bas ed on soft technologies. Furthermore, this study also aimed to analyze the aspects of health care th at generated user satisfaction or dissatisfaction regarding attachment, accountability, providing sol utions, expectations, relationship, comfort, and access, and to identify recommendations for local i nterventions. The authors made a general characterization of the population seen at the stud ied service, and then selected the subjects. The

Spatio-temporal patterns of tuberculosis incidence in Ribeirão Preto, State of São Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis

INTRODUCTION The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirão Preto, State of São Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. METHODS We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. RESULTS The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirão Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. CONCLUSIONS The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

Gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil: análise espacial

Teenage pregnancy is a common public health problem worldwide. The objective of this ecological study was to investigate the spatial association between teenage pregnancy rates and socioeconomic characteristics of municipalities in Sao Paulo State, Southeast Brazil. We used a Bayesian model with a spatial distribution following a conditional autoregressive (CAR) form based on Markov Chain Monte Carlo algorithm. We used data from the Live Birth Information System (SINASC) and the Brazilian Institute of Geography and Statistics (IBGE). Early pregnancy was more frequent in municipalities with lower per capital gross domestic product (GDP), higher poverty rate, smaller population, lower human development index (HDI), and a higher percentage of individuals with State social vulnerability index of 5 or 6 (more vulnerable). The study demonstrates a significant association between teenage pregnancy and socioeconomic indicators.

Testing some major determinants for hospital innovation success

PURPOSE Hospitals have adopted new policies, methods and technologies to change their processes, improve services, and support other organizational changes necessary for better performance. The literature regarding the four major areas of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the organizations change process propose their importance in successfully implementing organization innovation. While these factors may indeed be important to enhance hospital performance, the existing literature contains limited empirical evidence supporting their relationship to successfully implementing innovation in hospitals. This study aims to empirically test these relationships proposed in the literature by researchers in separate knowledge areas. DESIGN/METHODOLOGY/APPROACH A survey of 223 hospitals has been used to test an integrated model of these relationships. The response rate and the representativeness of the sample in terms of hospital size and geographical location were found satisfactory. The quality assurance/compliance managers for each hospital were the target respondents to questions, which require a corporate perspective while reducing the chance of bias for questions regarding top management leadership abilities. FINDINGS The results provide clear evidence about the importance of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the hospitals change process to the hospitals success in implementing innovation. PRACTICAL IMPLICATIONS Given the importance of hospitals to change their processes, improve services, and support other organizational changes necessary for better performance, a great benefit is that the main factors for successful innovation have been brought together from scattered literature and tested among hospitals. Further, the items used for measuring the main constructs provide further insights into how hospital administrators should go about developing these areas within their organizations. ORIGINALITY/VALUE This study is a first attempt at empirically testing the importance of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the hospitals change process for the success of innovation efforts.

Resolubilidade da estratégia saúde da família e unidades básicas de saúde tradicionais: contribuições do Pet-Saúde

O Programa de Educacao pelo Trabalho para a Saude (PET-Saude) materializa uma politica indutora de novas relacoes entre instituicoes de ensino de nivel superior e a rede assistencial a saude. A Universidade de Sao Paulo - Campus de Ribeirao Preto e a Secretaria de Saude do municipio, selecionadas pelo PET-Saude/2009, avaliaram a resolubilidade das Unidades Basicas de Saude (UBS) e das Unidades de Estrategia Saude da Familia (ESF), como forma de contribuir para a qualificacao da Atencao Basica. Foi realizado um estudo transversal em 13 Unidades de Saude (oito ESF e cinco UBS), com a participacao de 216 alunos dos cursos da area da saude, 30 preceptores (profissionais) da rede publica de saude e cinco tutores (docentes). Foram coletados dados de 12.494 atendimentos, sendo 7.129 (58,9%) em ESF e 4.963 (41,1%) em UBS, compostos por 4.059 (33,6%) pessoas do sexo masculino e 8.035 (66,4%) do feminino.As UBS referenciaram mais pacientes do que as Unidades de ESF (OR = 1,67; IC 95% 1,46 - 1,90; [p < 0,05]). As especialidades com maior demanda por encaminhamentos foram oftalmologia, cardiologia e ortopedia. A ESF apresenta-se como modelo assistencial com maior resolubilidade, e o PET-Saude e uma iniciativa importante, considerando-se que estimula a ampliacao desse modelo.

Pesquisa-aprendizagem no ensino da política e gestão de saúde: relato de uma experiência com e-Learning

Sao apresentados os resultados da experiencia de transformacao de uma disciplina tradicional do ensino medico voltada ao ensino da politica e gestao de saude com uso de tecnologias de informacao e comunicacao - e-Learning. Baseado em correntes construtivistas da educacao, o curso dedica especial atencao a motivacao do corpo discente, ao trabalho colaborativo e a procura e elaboracao de informacoes de fontes oficiais de saude. Sao caracteristicas do curso: motivar os alunos por meio da proposta de caracterizar o sistema de saude de um municipio de livre escolha dos mesmos; promover atividades de estudo e pesquisa em saude utilizando roteiros orientados a analise e gestao da assistencia; dar a conhecer e utilizar portais oficiais de informacoes em saude e criar um ambiente virtual de pesquisa-aprendizagem disponivel todo o tempo. Apos quatro anos de experiencia e em vista da boa aceitacao entre os alunos, o modelo de curso foi expandido a outros cursos da area da saude: Fisioterapia, Terapia Ocupacional, Nutricao e Metabolismo, Fonoaudiologia e Informatica Biomedica.

Conhecimentos dos usuários da Estratégia Saúde da Família sobre a fisioterapia

INTRODUCAO: Muitas experiencias exitosas de incorporacao do fisioterapeuta no Programa Saude da Familia ja foram publicadas na literatura. No entanto, alguns autores destacam que o desconhecimento da populacao sobre a fisioterapia e um dos fatores que limitam a atuacao desse profissional na atencao basica. OBJETIVO: Essa pesquisa objetivou investigar o conhecimento dos usuarios do Programa Saude da Familia sobre a Fisioterapia. MATERIAIS E METODO: Trata-se de um estudo transversal, descritivo e quantitativo. Aplicou-se um questionario a 275 usuarios de uma Unidade Saude da Familia em Ribeirao Preto/SP. RESULTADOS: Foi constatado que a maioria dos entrevistados ja tinha ouvido falar sobre a fisioterapia e a considerava importante. Entretanto, o conhecimento dos entrevistados voltou-se aos aspectos de reabilitacao e/ou tratamento, ao se referirem: ao conceito de fisioterapia; indicarem que as pessoas que precisam de Fisioterapia sao os deficientes fisicos, portadores de lesao e/ou algias musculo-esqueletico; que o fisioterapeuta trabalha principalmente no hospital e que nao realiza acoes educativas. CONCLUSAO: Esses dados demonstram um conhecimento restrito do campo de atuacao da fisioterapia. Dessa forma, evidencia-se a necessidade de execucao de estrategias que visem maior divulgacao do campo de atuacao da fisioterapia.

Soft technologies as generating satisfaction in users of a family health unit

O objetivo desta investigacao foi avaliar a qualidade da assistencia prestada em um nucleo de saude da familia (NSF), enfocando a satisfacao dos usuarios, com base nas tecnologias leves, bem como analisar aspectos dessa assistencia, produtores de satisfacao e de insatisfacao, no que diz respeito ao vinculo, a responsabilizacao, a resolubilidade, as expectativas, aos relacionamentos, ao conforto e acesso, e identificar recomendacoes para intervencoes locais. Apos realizarmos uma caracterizacao geral da populacao atendida no servico em estudo, selecionamos os sujeitos participantes da pesquisa. A coleta de dados deu-se por meio da entrevista semi-estruturada. A abordagem foi de natureza qualitativa, e os dados foram ordenados pelo metodo do Discurso do Sujeito Coletivo (DSC). A analise revela a importância atribuida, pelos usuarios do servico, as tecnologias leves, mas tambem a necessidade de diminuir o tempo de espera para as consultas e os encaminhamentos e obter o acesso a medicamentos e a atencao odontologica no proprio servico, fatores que levam a grande insatisfacao por parte dos usuarios.This study had the purpose to evaluate the quality of the health service provided at a Family Health Unit (FHU), with emphasis on user satisfaction, bas ed on soft technologies. Furthermore, this study also aimed to analyze the aspects of health care th at generated user satisfaction or dissatisfaction regarding attachment, accountability, providing sol utions, expectations, relationship, comfort, and access, and to identify recommendations for local i nterventions. The authors made a general characterization of the population seen at the stud ied service, and then selected the subjects. The

Atenção à saúde mental na Estratégia Saúde da Família: recursos não reconhecidos

Family Health Strategy (FHS) is one of the foundations of Primary Health Care. FHS offers a decentralized assistance in its referred territories, and attends different types of demands, including issues of mental health. This research aimed to make meanings with FHS professionals about their resources for mental health care. Thus, groups of discussion were conducted with these professionals in a town located in the state of Sao Paulo. Qualitative procedures of thematic analysis were conducted with the material, based on social constructionist contributions. This analysis highlights important technical and relational resources of the team regarding their practices with mental health, even though these resources were apparently little legitimized in their daily work. The need to create contexts for reflection among healthcare professionals where they can make new meanings about their actions is discussed. This may contribute to enhance the quality of mental health assistance in Primary Health Care.