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ItemGestão estratégica de pessoas e inovação: estudos de caso no contexto hospitalar(Revista de Administração, 2013-12) Queiroz, Ana Carolina Spolidoro; Albuquerque, Lindolfo Galvão de; Malik, Ana MariaNeste trabalho, procurou-se analisar as relações entre variáveis do contexto organizacional e de gestão de pessoas e as inovações. Os principais objetivos foram analisar e comparar os aspectos organizacionais e de gestão de pessoas que têm contribuído para a implementação de inovações. Foram conduzidos três estudos de caso em instituições hospitalares, duas localizadas no Brasil e uma nos Estados Unidos. Os resultados da pesquisa indicaram que a adoção de determinadas variáveis do contexto organizacional e de gestão de pessoas poderá estimular a inovação. Além disso, foi possível concluir que essas mesmas variáveis, quando alinhadas aos objetivos organizacionais de inovação, poderão facilitar a superação de obstáculos inerentes ao setor da saúde e que impedem a implementação bem-sucedida de inovações. ItemO acesso aos serviços de saúde por emigrantes brasileiros nos Estados Unidos(Sistemas de saúde, 2013) Duarte, Norberto de Almeida; Escrivão Junior, Álvaro; Siqueira, SueliAnalysis of the current political and economical context in the U.S.A., which involves access to and utilization of health services by immigrants, concerns more than 20 million foreign individuals who live in the country and do not have health insurance. This population corresponds to 43.8% of the 46 million people that do not have private health coverage in the U.S.A.; of these, 10.5 million do not have the legal documentation required to live in the country. In order to explore the needs, access and utilization of American health services by emigrants from Governador Valadares (located in the state of Minas Gerais, Brazil), fourteen emigrants from this city were selected by means of the snowball technique and were interviewed for this study. Questions concerning interviewees’ documentation, place of residence, jobs, needs, access to and use of health services were created. Information collected from emigrants residing in the states of Massachusetts and Connecticut allows us to assert the viability of access and utilization of health services subsidized by the federal and state governments and nongovernmental organizations. ItemSatisfação no trabalho e rotatividade dos médicos do Programa de Saúde da Família(RAP - Revista de Administração Pública, 2008-04) Campos, Claudia Valentina de Arruda; Malik, Ana MariaOne of the greatest problems of the Family Health Program in Brazil is the high turnover of its physicians. Given that the program is based on the relationship between health professionals and citizens, these high rates affect the model’s effectiveness. A survey to identify the correlation between job satisfaction and physician turnover in the city of São Paulo, Brazil, confirmed the hypothesis that there is a negative correlation between these indicators. The prestige of the partner institutions is the most important factor in determining the program’s physician turnover in São Paulo. Other job satisfaction factors that showed correlation with physician turnover were: training, commuting time, and lack of adequate equipment and materials. ItemHospitais e programas de qualidade no estado de São Paulo(RAE - Revista de Administração de Empresas, 2001-09) Malik, Ana Maria; Teles, João Pedro da SilvaThe Health Administration field understands and deals with quality issues in a way that differs from what is seen in the industry. This article presents a survey done in a sample of 159 hospitals in São Paulo state during the second semester 1999 regarding the implementation of quality initiatives. The sample had public, philanthropic, non-philanthropic and university hospitals. Among 97 hospitals answering the survey, 23% said they had some quality initiatives. The other 77%, whose answer was negative, blamed high costs, delayed results and lack of need for that fact. Most of those that had the initiatives did not know much about their costs and their consequences. Almost all of those that answered positively said they monitored managerial indicators. ItemLifestyle factors, direct and indirect costs for a Brazilian airline company(Revista Saúde Pública, 2014) Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, AlexOBJECTIVE: To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS: In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS: Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS: Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. ItemDo registro ao indicador: gestão da produção da informação assistencial nos hospitais(Ciência e Saúde Coletiva, 2007) Schout, Denise; Novaes, Hillegonda Maria DutilhUtilization of health care indicators in the monitoring of health system performance has become increasingly important in the last decades. The expansion of the public National Health System, Sistema Único de Saúde/SUS, growth of the private health sector and implementation of specific types of health care regulation models stimulated the utilization of indicators in the evaluation of hospital care quality and performance and proposals of national indicator systems. This was not accompanied with a corresponding investment in the conditions in which the needed data and information are produced in health services. The objective of this article is to identify some of the necessary conditions for health care performance indicator quality in hospitals: a pervasive institutional culture favoring clinical, administrative and research information and adequate organization and administration of clinical registers, hospital statistics and hospital information systems. No ready made universal hospital information packages will be able to achieve this, and each institution has to develop the ability to incorporate and use, according to specific needs and contexts, capabilities and material and human resources that will turn information management into a dynamic process and part of hospital management in general. ItemThe influence of lifestyle and gender on sickness absence in Brazilian workers(BMC Public Health, 2014) Rabacow, Fabiana Maluf; Levy, Renata Bertazzi; Menezes, Paulo Rossi; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, AlexBackground: Despite an increasing body of knowledge concerning gender and lifestyle factors as determinants of sickness absence in well-developed countries, the relationship between these variables has not been elucidated in emerging economic power countries, where the burden of non-communicable diseases is particularly high. This study aimed to analyze the relationships among lifestyle-related factors and sick leave and to examine whether gender differences in sickness absence can be explained by differences in socio-demographic, work and lifestyle-related factors among Brazilian workers. Methods: In this longitudinal study with a one year follow-up among 2.150 employees of a Brazilian airline company, sick leave was the primary outcome of interest. Independent variables collected by interview at enrolment in the study were gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity and smoking). In addition, the risk for coronary heart disease was determined based on measurement of blood pressure, total cholesterol and glucose levels. The total number of days on sick leave during 12 months follow-up was available from the company register. Logistic regression analysis was used to determine the influence of socio-demographic, type of work and lifestyle-related factors on sick leave. Results: Younger employees, those with lower educational level, those who worked as air crew members and those with higher levels of stress were more likely to have sick leave. Body mass index and level of physical activity were not associated with sick leave. After adjustment by socio-demographic variables, increased odds for 10 or more days of sick leave were found in smokers (OR = 1.51, CI = 1.05-2.17), and ex-smokers (OR = 1.45, CI = 1.01-2.10). Women were more likely to have 10 or more days of sick leave. Gender differences were reduced mainly when adjusted for type of work (15%) and educational level (7%). Conclusions: The higher occurrence of sick leave among women than among men was partly explained by type of work and educational level. Our results suggest that type of work, a stressful life, and smoking are important targets for health promotion in this study population ItemAvaliação externa de organizações hospitalares no Brasil: podemos fazer diferente?(Revista Ciência e Saúde Coletiva, 2014-10) Schiesari, Laura Maria CesarThis paper presents different aspects related to the use of external evaluation of health services in Brazil, especially hospital accreditation. It´s based upon the author´s experience in implementing quality models in hospitals, as well as on her master and PhD works. The author presents a few aspects concerning the impact of the use of these models and their specificities. The results are listed: management improvement, process standardization, training, team work, patient focused care, motivation, external recognition, culture change. The author also points out the bad and the good aspects concerning the way such models are used in Brazilian hospitals. ItemDeterminantes de uso de serviços de saúde: análise multinível da região metropolitana de São Paulo(Revista Saúde Pública, 2015) Chiavegatto Filho, Alexandre Dias Porto; Wang, Yuan-Pang; Malik, Ana Maria; Takaoka, Julia; Viana, Maria Carmen; Andrade, Laura HelenaOBJETIVO: Analisar os determinantes individuais e contextuais do uso de serviços de saúde na Região Metropolitana de São Paulo. MÉTODOS: Foram utilizados os dados do estudo São Paulo Megacity, a versão brasileira da pesquisa multicêntrica World Mental Health Survey. Foram analisados 3.588 indivíduos adultos residentes em 69 áreas da Região Metropolitana de São Paulo, SP (38 municípios adjacentes e 31 subprefeituras do município de São Paulo), selecionados por meio de amostragem multiestratificada da população não institucionalizada. Foram ajustados modelos multinível logísticos Bayesianos para identificar os determinantes individuais e contextuais do uso de serviços de saúde nos últimos 12 meses e a presença de médico de referência para cuidados de rotina. RESULTADOS: As características contextuais do local de residência (desigualdade de renda, violência e renda mediana) não apresentaram associação significativa (p > 0,05) com o uso de serviços ou com a presença de médico de referência para cuidados de rotina. A única exceção foi a associação negativa entre residir em uma área com alta desigualdade de renda e a presença de médico de referência (OR 0,77; IC95% 0,60;0,99) após controle das características individuais. O estudo apontou uma forte e consistente associação entre algumas características individuais (principalmente escolaridade e presença de plano de saúde) com o uso de serviços de saúde e ter médico de referência. A presença de doenças crônicas e mentais associou-se fortemente com o uso de serviços no último ano (independentemente de características individuais), mas não com a presença de médico de referência. CONCLUSÕES: Características individuais como maior escolaridade e ter plano de saúde foram determinantes importantes do uso de serviços de saúde na Região Metropolitana de São Paulo. A melhor compreensão desses determinantes é necessária para o desenvolvimento de políticas públicas que permitam o uso equitativo dos serviços de saúde. ItemAnálise dos fundamentos do modelo value-based health care delivery à luz das teorias de estratégia(Revista Alcance - Eletrônica, 2013-12) Veloso, Germany Gonçalves; Bandeira-de-Mello, Rodrigo; Malik, Ana MariaGlobally, the health sector presents problems related to cost, quality and access. Porter and Teisberg (2004, 2006) proposed a specific management model for strategic administration in this sector - Value-Based 496 Germany Gonçalves Veloso, Rodrigo Bandeira-de-Mello, Ana Maria Malik - análise dos fundamentos ... Health Care Delivery (VBHCD). This model has been adopted by many actors in the health care sector. However, it has been accepted without a proper analysis of its bases and consistency with strategic theory. This theoretical essay analyzes the proposed model in light of the general paradigms of business strategy, such as Porter’s model and the Resource Based View. Initially, the article summarizes the theoretical explanations of Port’s classic model and RBV. Next, the VBHCD is examined, comparing it with these explanations, and looking for any links and contradictions. We conclude that the VBHCD model is not fully aligned with any one specific theory. Although proposed by Porter, part of its rationale actually stems from other theoretical perspectives. This integrative approach of concurrent theories, although it is presented in the literature, still faces difficulties and barriers, an aspect that is not clear in the model.