There are an increasing number of health care organizations seeking quality certification of thei... more There are an increasing number of health care organizations seeking quality certification of their processes through accreditation and a new law is under approval to make the quality certification compulsory for all institutions in Brazil. However, the research on accreditation demonstrate that there are still gaps on its actual benefits and that there is no general approach to the adoption of this program in the world. The aim of this study was to evaluate the impact of accreditation programs in Brazilian healthcare institutions, focusing on hospitals. The research project was developed in two stages: a literature review and an empirical research with the adoption of a quantitative approach, applying survey method. The questionnaire was developed from the literature review, other empirical researches and experts' opinion. The project was approved by the Research Ethics Committee of the Faculty of Medicine from the University of São Paulo (Process number 1,416,014). The survey was conducted over the internet using the SurveyMonkey software, from February to May 2016. From the 161 responses received, 141 were considered valid, 74.47% (105/141) were from hospitals and 23.53 % (36/141) came from other institutions in the healthcare sector, such as ambulatories, laboratories, among others. The sample was non-probabilistic and can be classified as a "convenience sample". The respondents are from 18 Brazilian states and the Federal District. Regarding the profile of the participants, the average age was 40 years old, 88% were postgraduates, 81% held managerial positions and 75% presented more than 10 years of professional experience. To evaluate the results, it was performed the Spearman correlation and logistic regression analysis. The results showed that, in the sample, there is evidence of a significant (α = 5%) and moderate correlation between the status of accreditation and patient safety activities (correlation coefficient = 0.537), quality management (correlation coefficient = 0.590), planning-policies and strategies (correlation coefficient = 0.629) and involvement of professionals in the quality programs (correlation coefficient = 0.430). The correlation between the status of accreditation and the patients' involvement was significant (α = 5%), but weak (correlation coefficient = 0.252) suggesting that this issue should be treated with an exclusive policy. It was identified 13 organizational impacts of accreditation related mainly to internal processes, culture, training, reputation of the institution and competitive aspects. The accreditation impact on the results has not been confirmed as relevant in the financial dimension, however, related to financial issues, it has been validated the need for investment in infrastructure, technological innovation and information technology in the earlier stage. It was also analyzed the reliability and validity of the survey instrument, showing that the structure of the questionnaire was adequate. In addition to the assessment of accreditation impact, this research identified some issues that may support institutions that intend to implement accreditation, in the planning phase.
Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vi... more Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vinicius e à toda a minha família que sempre me apoiaram incondicionalmente e incentivaram na realização dos meus sonhos.
To cite: Saut AM, Berssaneti FT, Ho LL, et al. How do hospitals engage patients and family member... more To cite: Saut AM, Berssaneti FT, Ho LL, et al. How do hospitals engage patients and family members in quality management? A grounded theory study of hospitals in Brazil. BMJ Open 2022;12:e055926.
Springer proceedings in mathematics & statistics, 2019
Quality management studies over time grow in importance both in the academic and the enterprise w... more Quality management studies over time grow in importance both in the academic and the enterprise world. What was previously treated in isolation, these days are essential to the survival of an organization. Thus, the parts that make up the quality processes of the institutions must be studied in a continuous way aiming at optimizing the whole process. In this context, risk management, which despite having a range of guidelines and frameworks, is little applied in the context of quality management, and does not play a relevant role in the implementation of processes. However, the latest version of ISO 9001:2015 presents requirements focused on risk management. Therefore, the present article aims to outline a profile on the insertion of risk management into the scientific productions focused on the study of the ISO 9001:2015 Quality Management standard. In order to reach the objective, a descriptive and a content analysis was carried out, with samples of documents belonging to the Web of Science Core Collection and the Scopus database, from 2015 to 2018. After the analyzes, it was possible to identify the consistent evolution of the publications, diversity of journals interested in the subject, interdisciplinarity between quality management and risk management and finally the relevance of the risk-based thinking, the influence of ISO 31000:2009 and the integrated management system.
Conflitos de interesse: não há conflitos de interesse a declarar. Resumo Objetivo: Identificar o ... more Conflitos de interesse: não há conflitos de interesse a declarar. Resumo Objetivo: Identificar o estágio de envolvimento dos pacientes nas Instituições de saúde brasileiras, nos programas de melhoria da qualidade e segurança. Métodos: Abordagem quantitativa, através de uma pesquisa de avaliação com 141 Instituições, localizadas em 18 estados e no Distrito Federal, no período de fevereiro a maio de 2016. Para coleta dos dados foi aplicado um questionário pela web, utilizando o software de questionários e pesquisas SurveyMonkeyÒ. No questionário, além das perguntas para caracterização das Instituições e dos respondentes, sete perguntas foram relacionadas às atividades de participação dos pacientes nos processos de gerenciamento da qualidade. Resultados: As atividades realizadas pela maior parte das Instituições foram "pesquisa de satisfação dos pacientes" e "processo formal para comunicação com os pacientes em relação às suas dúvidas, sugestões e reclamações". A média de atividades realizadas foi de 3,84 de um total de 7 atividades avaliadas. Conclusão: Considerando uma escala de 0 a 3, aproximadamente 70% das Instituições foram classificadas entre os estágios 0 (paciente não é envolvido) e 1 (participação na avaliação das metas de qualidade).
Objectives Although different forms of patient feedback are available, their use in hospital mana... more Objectives Although different forms of patient feedback are available, their use in hospital management is still limited. The objective of this study is to explore how patient feedback is currently used in hospitals to improve quality. Design This is a qualitative exploratory multiple case study. Data collection included nine interviews, of an average duration of 50 min, conducted between March and June 2019. Additionally, a document and secondary data analysis were performed. Setting This study was conducted in three Brazilian hospitals selected for their solid patient feedback practises. Participants Managers from the customer service, quality, nursing, operations, projects and patient experience departments of the three hospitals. Results Despite literature suggesting that organisational objectives regarding patient feedback are not clear, data show that there is managerial concern regarding the promotion of an environment capable of changing according to patient feedback. In these instances, organisational processes were structured to focus on patients' feedback and its receipt by the staff, including a non-punitive culture. Several patient feedback forms are available: voluntary events, patient surveys and informal feedback. Instruments to measure patient feedback focused on specific aspects of healthcare, to identify and clarify the problems for addressal by the management. The net promoter score was the main strategic indicator of patient feedback, used to assess the impact of improvement action. Conclusions The hospitals had established objectives that valued the patient's perspective. Involvement of the health team, availability of different channels for feedback and the use of quality tools are considered a good basis for using patient feedback to drive quality improvement.
The importance of reverse logistics has increased owing to environmental factors and recent legis... more The importance of reverse logistics has increased owing to environmental factors and recent legislations. In this context, the market for remanufactured goods has become attractive. Manufacturers, retailers, and third-party companies have improved return programs and operations that add value to the return chain for electronic appliances, rather than treating it as a secondary process. The objective of this study is to identify the variables related to value generation in the reverse logistics of electronic products from the perspective of third-party companies. Reverse logistics of electronic products depends much on the context and local regulations; in addition, the fact that there are few studies on developing countries points to an important gap in extant research. This study presents the influence of quality and warranties, processing time, and partnerships between third-party companies, manufacturers, and retailers on the value generation from remanufactured products. These variables are related to optimal results and optimistic expectations for growth among third-party companies. These internal factors, together with an analysis of external factors and product portfolios, complement the scenario description for the cases studied. The main contribution of this study is to highlight the major factors, which are presented in the framework. The lessons learned can be used in other contexts involving third-party companies.
Background Patient and family engagement (PFE) can positively impact the patient experience and c... more Background Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional’s perspective. Method A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an open-ended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. Results Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) a...
No Brasil, é crescente o número de instituições de saúde que estão buscando a certificação da qua... more No Brasil, é crescente o número de instituições de saúde que estão buscando a certificação da qualidade dos seus processos por meio da acreditação e está em aprovação um projeto de Lei que visa tornar obrigatória a obtenção de uma certificação para todas as instituições de saúde. Entretanto, as pesquisas sobre acreditação demostram a existência de lacunas sobre os seus reais benefícios e que não há uma abordagem única para a introdução do programa no mundo. O objetivo do estudo foi avaliar o impacto dos programas de acreditação nas instituições de saúde brasileiras, com foco em hospitais. O projeto de pesquisa foi desenvolvido em duas etapas: revisão da literatura e pesquisa empírica com a adoção de abordagem quantitativa, empregando o método pesquisa de avaliação (survey). O questionário foi elaborado a partir da revisão da literatura, outras pesquisas empíricas e opinião de especialistas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universid...
BackgroundPatient and family engagement (PFE) is considered an essential element of the transform... more BackgroundPatient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement.ObjectiveTo understand PFE in quality management (QM) in the hospital environment.DesignA qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique.Setting and participantsA total of seven Brazilian hospitals were selected based on the theoretical sampling technique.ResultsA total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of...
Este estudo traz inicialmente uma contextualizacao do aspecto estrategico da criacao do valor com... more Este estudo traz inicialmente uma contextualizacao do aspecto estrategico da criacao do valor compartilhado e sua relacao com a sustentabilidade no contexto social do conceito de triple-bottom-line . A partir deste referencial, trata da relacao entre o alinhamento participativo de stakeholders e do desenvolvimento de uma metodologia de planejamento para a exequibilidade de cenarios futuros almejados alinhados a sustentabilidade, denominado backcasting. Este foi o ponto de partida para a realizacao de um estudo inicial de bibliometria. O estudo foi realizado atraves de dados do banco de dados ISI Web of Knowledge e seu tratamento pelos softwares Sitkis e UCINET. Ao final do estudo sao apresentados resultados de estatistica descritiva com a evolucao das publicacoes mundiais na area e principais redes de relacionamento de autores, citacoes e palavras-chaves.
This study aimed to demonstrate the applicability of the Health Care Failure Mode and Effect Anal... more This study aimed to demonstrate the applicability of the Health Care Failure Mode and Effect Analysis tool (HFMEA) by reporting the experience in the planning of surgery. There was a reduction of errors, with reports of only three near miss in one year, indicating that the tool was highly effective.
Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vi... more Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vinicius e à toda a minha família que sempre me apoiaram incondicionalmente e incentivaram na realização dos meus sonhos.
There are an increasing number of health care organizations seeking quality certification of thei... more There are an increasing number of health care organizations seeking quality certification of their processes through accreditation and a new law is under approval to make the quality certification compulsory for all institutions in Brazil. However, the research on accreditation demonstrate that there are still gaps on its actual benefits and that there is no general approach to the adoption of this program in the world. The aim of this study was to evaluate the impact of accreditation programs in Brazilian healthcare institutions, focusing on hospitals. The research project was developed in two stages: a literature review and an empirical research with the adoption of a quantitative approach, applying survey method. The questionnaire was developed from the literature review, other empirical researches and experts' opinion. The project was approved by the Research Ethics Committee of the Faculty of Medicine from the University of São Paulo (Process number 1,416,014). The survey was conducted over the internet using the SurveyMonkey software, from February to May 2016. From the 161 responses received, 141 were considered valid, 74.47% (105/141) were from hospitals and 23.53 % (36/141) came from other institutions in the healthcare sector, such as ambulatories, laboratories, among others. The sample was non-probabilistic and can be classified as a "convenience sample". The respondents are from 18 Brazilian states and the Federal District. Regarding the profile of the participants, the average age was 40 years old, 88% were postgraduates, 81% held managerial positions and 75% presented more than 10 years of professional experience. To evaluate the results, it was performed the Spearman correlation and logistic regression analysis. The results showed that, in the sample, there is evidence of a significant (α = 5%) and moderate correlation between the status of accreditation and patient safety activities (correlation coefficient = 0.537), quality management (correlation coefficient = 0.590), planning-policies and strategies (correlation coefficient = 0.629) and involvement of professionals in the quality programs (correlation coefficient = 0.430). The correlation between the status of accreditation and the patients' involvement was significant (α = 5%), but weak (correlation coefficient = 0.252) suggesting that this issue should be treated with an exclusive policy. It was identified 13 organizational impacts of accreditation related mainly to internal processes, culture, training, reputation of the institution and competitive aspects. The accreditation impact on the results has not been confirmed as relevant in the financial dimension, however, related to financial issues, it has been validated the need for investment in infrastructure, technological innovation and information technology in the earlier stage. It was also analyzed the reliability and validity of the survey instrument, showing that the structure of the questionnaire was adequate. In addition to the assessment of accreditation impact, this research identified some issues that may support institutions that intend to implement accreditation, in the planning phase.
Background Patient and family engagement (PFE) can positively impact the patient experience and c... more Background Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional's perspective. Method A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an openended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. Results Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) and organizational levels (related to quality improvement). The PFE in the treatment is related to the development, discussion and decision-making about the therapeutic plan, participation in each step of care, and knowledge of the institution's quality and safety processes. At the organizational level, engagement in quality improvement includes the involvement of the P/F in all processes of the institution, from strategic planning to the design or improvement processes, as well as active participation in institutional committees or commissions. Conclusion The professionals defined engagement in two levels (individual and organizational) and the results suggest that their point of view can influence the practice in the hospitals. Professionals of hospitals that implemented mechanisms of consult defined PFE more in the individual level. On the other hand, professionals of hospitals that implemented mechanisms of involvement considered PFE more focus in the organizational level.
O tema \'engajamento dos pacientes e familiares\' na gestão da qualidade é caracterizado ... more O tema \'engajamento dos pacientes e familiares\' na gestão da qualidade é caracterizado por sua complexidade e dificuldade em demonstrar os resultados obtidos. Objetivo: Compreender a percepção dos profissionais acerca do engajamento dos pacientes e familiares na gestão da qualidade dos serviços. Método: Desenho misto, com coleta e análise dos dados,com abordagens qualitativa e quantitativa, realizadas concomitantemente. A pesquisa teve ênfase qualitativa, e os resultados foram integrados. Na etapa quantitativa, foi realizada uma pesquisa de avaliação com 90 hospitais, dos quais sete participaram da etapa qualitativa guiada pelo referencial teórico da teoria fundamentada nos dados. Foram aplicadas técnicas de análise estatística descritiva e multivariada para avaliação dos resultados. Resultados: As duas abordagens apresentaram resultados convergentes e complementares. Na etapa qualitativa, cinco categorias emergiram da análise das entrevistas: paciente parceiro, mecanismos...
OBJECTIVE To evaluate whether accredited health organizations perform better management practices... more OBJECTIVE To evaluate whether accredited health organizations perform better management practices than non-accredited ones. METHOD The study was developed in two stages: a literature review, and a study of multiple cases in 12 healthcare organizations in the state of São Paulo, Brazil. It surveyed articles comparing hospital accreditation with the EFQM (European Foundation for Quality Management) model of excellence in management. According to the pertinent literature, the accreditation model and the EFQM model are convergent and supplementary in some aspects. RESULTS With 99% confidence, one can say that there is evidence that accredited organizations scored better in the evaluation based on the EFQM model in comparison to non-accredited organizations. This result was also confirmed in the comparison of results between the categories Facilitators and Results in the EFQM model. CONCLUSION There is convergence between the accreditation model and the EFQM excellence model, suggesting ...
Springer Proceedings in Mathematics & Statistics, 2019
Quality management studies over time grow in importance both in the academic and the enterprise w... more Quality management studies over time grow in importance both in the academic and the enterprise world. What was previously treated in isolation, these days are essential to the survival of an organization. Thus, the parts that make up the quality processes of the institutions must be studied in a continuous way aiming at optimizing the whole process. In this context, risk management, which despite having a range of guidelines and frameworks, is little applied in the context of quality management, and does not play a relevant role in the implementation of processes. However, the latest version of ISO 9001:2015 presents requirements focused on risk management. Therefore, the present article aims to outline a profile on the insertion of risk management into the scientific productions focused on the study of the ISO 9001:2015 Quality Management standard. In order to reach the objective, a descriptive and a content analysis was carried out, with samples of documents belonging to the Web ...
There are an increasing number of health care organizations seeking quality certification of thei... more There are an increasing number of health care organizations seeking quality certification of their processes through accreditation and a new law is under approval to make the quality certification compulsory for all institutions in Brazil. However, the research on accreditation demonstrate that there are still gaps on its actual benefits and that there is no general approach to the adoption of this program in the world. The aim of this study was to evaluate the impact of accreditation programs in Brazilian healthcare institutions, focusing on hospitals. The research project was developed in two stages: a literature review and an empirical research with the adoption of a quantitative approach, applying survey method. The questionnaire was developed from the literature review, other empirical researches and experts' opinion. The project was approved by the Research Ethics Committee of the Faculty of Medicine from the University of São Paulo (Process number 1,416,014). The survey was conducted over the internet using the SurveyMonkey software, from February to May 2016. From the 161 responses received, 141 were considered valid, 74.47% (105/141) were from hospitals and 23.53 % (36/141) came from other institutions in the healthcare sector, such as ambulatories, laboratories, among others. The sample was non-probabilistic and can be classified as a "convenience sample". The respondents are from 18 Brazilian states and the Federal District. Regarding the profile of the participants, the average age was 40 years old, 88% were postgraduates, 81% held managerial positions and 75% presented more than 10 years of professional experience. To evaluate the results, it was performed the Spearman correlation and logistic regression analysis. The results showed that, in the sample, there is evidence of a significant (α = 5%) and moderate correlation between the status of accreditation and patient safety activities (correlation coefficient = 0.537), quality management (correlation coefficient = 0.590), planning-policies and strategies (correlation coefficient = 0.629) and involvement of professionals in the quality programs (correlation coefficient = 0.430). The correlation between the status of accreditation and the patients' involvement was significant (α = 5%), but weak (correlation coefficient = 0.252) suggesting that this issue should be treated with an exclusive policy. It was identified 13 organizational impacts of accreditation related mainly to internal processes, culture, training, reputation of the institution and competitive aspects. The accreditation impact on the results has not been confirmed as relevant in the financial dimension, however, related to financial issues, it has been validated the need for investment in infrastructure, technological innovation and information technology in the earlier stage. It was also analyzed the reliability and validity of the survey instrument, showing that the structure of the questionnaire was adequate. In addition to the assessment of accreditation impact, this research identified some issues that may support institutions that intend to implement accreditation, in the planning phase.
Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vi... more Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vinicius e à toda a minha família que sempre me apoiaram incondicionalmente e incentivaram na realização dos meus sonhos.
To cite: Saut AM, Berssaneti FT, Ho LL, et al. How do hospitals engage patients and family member... more To cite: Saut AM, Berssaneti FT, Ho LL, et al. How do hospitals engage patients and family members in quality management? A grounded theory study of hospitals in Brazil. BMJ Open 2022;12:e055926.
Springer proceedings in mathematics & statistics, 2019
Quality management studies over time grow in importance both in the academic and the enterprise w... more Quality management studies over time grow in importance both in the academic and the enterprise world. What was previously treated in isolation, these days are essential to the survival of an organization. Thus, the parts that make up the quality processes of the institutions must be studied in a continuous way aiming at optimizing the whole process. In this context, risk management, which despite having a range of guidelines and frameworks, is little applied in the context of quality management, and does not play a relevant role in the implementation of processes. However, the latest version of ISO 9001:2015 presents requirements focused on risk management. Therefore, the present article aims to outline a profile on the insertion of risk management into the scientific productions focused on the study of the ISO 9001:2015 Quality Management standard. In order to reach the objective, a descriptive and a content analysis was carried out, with samples of documents belonging to the Web of Science Core Collection and the Scopus database, from 2015 to 2018. After the analyzes, it was possible to identify the consistent evolution of the publications, diversity of journals interested in the subject, interdisciplinarity between quality management and risk management and finally the relevance of the risk-based thinking, the influence of ISO 31000:2009 and the integrated management system.
Conflitos de interesse: não há conflitos de interesse a declarar. Resumo Objetivo: Identificar o ... more Conflitos de interesse: não há conflitos de interesse a declarar. Resumo Objetivo: Identificar o estágio de envolvimento dos pacientes nas Instituições de saúde brasileiras, nos programas de melhoria da qualidade e segurança. Métodos: Abordagem quantitativa, através de uma pesquisa de avaliação com 141 Instituições, localizadas em 18 estados e no Distrito Federal, no período de fevereiro a maio de 2016. Para coleta dos dados foi aplicado um questionário pela web, utilizando o software de questionários e pesquisas SurveyMonkeyÒ. No questionário, além das perguntas para caracterização das Instituições e dos respondentes, sete perguntas foram relacionadas às atividades de participação dos pacientes nos processos de gerenciamento da qualidade. Resultados: As atividades realizadas pela maior parte das Instituições foram "pesquisa de satisfação dos pacientes" e "processo formal para comunicação com os pacientes em relação às suas dúvidas, sugestões e reclamações". A média de atividades realizadas foi de 3,84 de um total de 7 atividades avaliadas. Conclusão: Considerando uma escala de 0 a 3, aproximadamente 70% das Instituições foram classificadas entre os estágios 0 (paciente não é envolvido) e 1 (participação na avaliação das metas de qualidade).
Objectives Although different forms of patient feedback are available, their use in hospital mana... more Objectives Although different forms of patient feedback are available, their use in hospital management is still limited. The objective of this study is to explore how patient feedback is currently used in hospitals to improve quality. Design This is a qualitative exploratory multiple case study. Data collection included nine interviews, of an average duration of 50 min, conducted between March and June 2019. Additionally, a document and secondary data analysis were performed. Setting This study was conducted in three Brazilian hospitals selected for their solid patient feedback practises. Participants Managers from the customer service, quality, nursing, operations, projects and patient experience departments of the three hospitals. Results Despite literature suggesting that organisational objectives regarding patient feedback are not clear, data show that there is managerial concern regarding the promotion of an environment capable of changing according to patient feedback. In these instances, organisational processes were structured to focus on patients' feedback and its receipt by the staff, including a non-punitive culture. Several patient feedback forms are available: voluntary events, patient surveys and informal feedback. Instruments to measure patient feedback focused on specific aspects of healthcare, to identify and clarify the problems for addressal by the management. The net promoter score was the main strategic indicator of patient feedback, used to assess the impact of improvement action. Conclusions The hospitals had established objectives that valued the patient's perspective. Involvement of the health team, availability of different channels for feedback and the use of quality tools are considered a good basis for using patient feedback to drive quality improvement.
The importance of reverse logistics has increased owing to environmental factors and recent legis... more The importance of reverse logistics has increased owing to environmental factors and recent legislations. In this context, the market for remanufactured goods has become attractive. Manufacturers, retailers, and third-party companies have improved return programs and operations that add value to the return chain for electronic appliances, rather than treating it as a secondary process. The objective of this study is to identify the variables related to value generation in the reverse logistics of electronic products from the perspective of third-party companies. Reverse logistics of electronic products depends much on the context and local regulations; in addition, the fact that there are few studies on developing countries points to an important gap in extant research. This study presents the influence of quality and warranties, processing time, and partnerships between third-party companies, manufacturers, and retailers on the value generation from remanufactured products. These variables are related to optimal results and optimistic expectations for growth among third-party companies. These internal factors, together with an analysis of external factors and product portfolios, complement the scenario description for the cases studied. The main contribution of this study is to highlight the major factors, which are presented in the framework. The lessons learned can be used in other contexts involving third-party companies.
Background Patient and family engagement (PFE) can positively impact the patient experience and c... more Background Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional’s perspective. Method A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an open-ended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. Results Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) a...
No Brasil, é crescente o número de instituições de saúde que estão buscando a certificação da qua... more No Brasil, é crescente o número de instituições de saúde que estão buscando a certificação da qualidade dos seus processos por meio da acreditação e está em aprovação um projeto de Lei que visa tornar obrigatória a obtenção de uma certificação para todas as instituições de saúde. Entretanto, as pesquisas sobre acreditação demostram a existência de lacunas sobre os seus reais benefícios e que não há uma abordagem única para a introdução do programa no mundo. O objetivo do estudo foi avaliar o impacto dos programas de acreditação nas instituições de saúde brasileiras, com foco em hospitais. O projeto de pesquisa foi desenvolvido em duas etapas: revisão da literatura e pesquisa empírica com a adoção de abordagem quantitativa, empregando o método pesquisa de avaliação (survey). O questionário foi elaborado a partir da revisão da literatura, outras pesquisas empíricas e opinião de especialistas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universid...
BackgroundPatient and family engagement (PFE) is considered an essential element of the transform... more BackgroundPatient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement.ObjectiveTo understand PFE in quality management (QM) in the hospital environment.DesignA qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique.Setting and participantsA total of seven Brazilian hospitals were selected based on the theoretical sampling technique.ResultsA total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of...
Este estudo traz inicialmente uma contextualizacao do aspecto estrategico da criacao do valor com... more Este estudo traz inicialmente uma contextualizacao do aspecto estrategico da criacao do valor compartilhado e sua relacao com a sustentabilidade no contexto social do conceito de triple-bottom-line . A partir deste referencial, trata da relacao entre o alinhamento participativo de stakeholders e do desenvolvimento de uma metodologia de planejamento para a exequibilidade de cenarios futuros almejados alinhados a sustentabilidade, denominado backcasting. Este foi o ponto de partida para a realizacao de um estudo inicial de bibliometria. O estudo foi realizado atraves de dados do banco de dados ISI Web of Knowledge e seu tratamento pelos softwares Sitkis e UCINET. Ao final do estudo sao apresentados resultados de estatistica descritiva com a evolucao das publicacoes mundiais na area e principais redes de relacionamento de autores, citacoes e palavras-chaves.
This study aimed to demonstrate the applicability of the Health Care Failure Mode and Effect Anal... more This study aimed to demonstrate the applicability of the Health Care Failure Mode and Effect Analysis tool (HFMEA) by reporting the experience in the planning of surgery. There was a reduction of errors, with reports of only three near miss in one year, indicating that the tool was highly effective.
Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vi... more Com amor e gratidão, dedico este trabalho ao meu pai Alcione, à minha mãe Rosita, ao meu filho Vinicius e à toda a minha família que sempre me apoiaram incondicionalmente e incentivaram na realização dos meus sonhos.
There are an increasing number of health care organizations seeking quality certification of thei... more There are an increasing number of health care organizations seeking quality certification of their processes through accreditation and a new law is under approval to make the quality certification compulsory for all institutions in Brazil. However, the research on accreditation demonstrate that there are still gaps on its actual benefits and that there is no general approach to the adoption of this program in the world. The aim of this study was to evaluate the impact of accreditation programs in Brazilian healthcare institutions, focusing on hospitals. The research project was developed in two stages: a literature review and an empirical research with the adoption of a quantitative approach, applying survey method. The questionnaire was developed from the literature review, other empirical researches and experts' opinion. The project was approved by the Research Ethics Committee of the Faculty of Medicine from the University of São Paulo (Process number 1,416,014). The survey was conducted over the internet using the SurveyMonkey software, from February to May 2016. From the 161 responses received, 141 were considered valid, 74.47% (105/141) were from hospitals and 23.53 % (36/141) came from other institutions in the healthcare sector, such as ambulatories, laboratories, among others. The sample was non-probabilistic and can be classified as a "convenience sample". The respondents are from 18 Brazilian states and the Federal District. Regarding the profile of the participants, the average age was 40 years old, 88% were postgraduates, 81% held managerial positions and 75% presented more than 10 years of professional experience. To evaluate the results, it was performed the Spearman correlation and logistic regression analysis. The results showed that, in the sample, there is evidence of a significant (α = 5%) and moderate correlation between the status of accreditation and patient safety activities (correlation coefficient = 0.537), quality management (correlation coefficient = 0.590), planning-policies and strategies (correlation coefficient = 0.629) and involvement of professionals in the quality programs (correlation coefficient = 0.430). The correlation between the status of accreditation and the patients' involvement was significant (α = 5%), but weak (correlation coefficient = 0.252) suggesting that this issue should be treated with an exclusive policy. It was identified 13 organizational impacts of accreditation related mainly to internal processes, culture, training, reputation of the institution and competitive aspects. The accreditation impact on the results has not been confirmed as relevant in the financial dimension, however, related to financial issues, it has been validated the need for investment in infrastructure, technological innovation and information technology in the earlier stage. It was also analyzed the reliability and validity of the survey instrument, showing that the structure of the questionnaire was adequate. In addition to the assessment of accreditation impact, this research identified some issues that may support institutions that intend to implement accreditation, in the planning phase.
Background Patient and family engagement (PFE) can positively impact the patient experience and c... more Background Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional's perspective. Method A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an openended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. Results Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) and organizational levels (related to quality improvement). The PFE in the treatment is related to the development, discussion and decision-making about the therapeutic plan, participation in each step of care, and knowledge of the institution's quality and safety processes. At the organizational level, engagement in quality improvement includes the involvement of the P/F in all processes of the institution, from strategic planning to the design or improvement processes, as well as active participation in institutional committees or commissions. Conclusion The professionals defined engagement in two levels (individual and organizational) and the results suggest that their point of view can influence the practice in the hospitals. Professionals of hospitals that implemented mechanisms of consult defined PFE more in the individual level. On the other hand, professionals of hospitals that implemented mechanisms of involvement considered PFE more focus in the organizational level.
O tema \'engajamento dos pacientes e familiares\' na gestão da qualidade é caracterizado ... more O tema \'engajamento dos pacientes e familiares\' na gestão da qualidade é caracterizado por sua complexidade e dificuldade em demonstrar os resultados obtidos. Objetivo: Compreender a percepção dos profissionais acerca do engajamento dos pacientes e familiares na gestão da qualidade dos serviços. Método: Desenho misto, com coleta e análise dos dados,com abordagens qualitativa e quantitativa, realizadas concomitantemente. A pesquisa teve ênfase qualitativa, e os resultados foram integrados. Na etapa quantitativa, foi realizada uma pesquisa de avaliação com 90 hospitais, dos quais sete participaram da etapa qualitativa guiada pelo referencial teórico da teoria fundamentada nos dados. Foram aplicadas técnicas de análise estatística descritiva e multivariada para avaliação dos resultados. Resultados: As duas abordagens apresentaram resultados convergentes e complementares. Na etapa qualitativa, cinco categorias emergiram da análise das entrevistas: paciente parceiro, mecanismos...
OBJECTIVE To evaluate whether accredited health organizations perform better management practices... more OBJECTIVE To evaluate whether accredited health organizations perform better management practices than non-accredited ones. METHOD The study was developed in two stages: a literature review, and a study of multiple cases in 12 healthcare organizations in the state of São Paulo, Brazil. It surveyed articles comparing hospital accreditation with the EFQM (European Foundation for Quality Management) model of excellence in management. According to the pertinent literature, the accreditation model and the EFQM model are convergent and supplementary in some aspects. RESULTS With 99% confidence, one can say that there is evidence that accredited organizations scored better in the evaluation based on the EFQM model in comparison to non-accredited organizations. This result was also confirmed in the comparison of results between the categories Facilitators and Results in the EFQM model. CONCLUSION There is convergence between the accreditation model and the EFQM excellence model, suggesting ...
Springer Proceedings in Mathematics & Statistics, 2019
Quality management studies over time grow in importance both in the academic and the enterprise w... more Quality management studies over time grow in importance both in the academic and the enterprise world. What was previously treated in isolation, these days are essential to the survival of an organization. Thus, the parts that make up the quality processes of the institutions must be studied in a continuous way aiming at optimizing the whole process. In this context, risk management, which despite having a range of guidelines and frameworks, is little applied in the context of quality management, and does not play a relevant role in the implementation of processes. However, the latest version of ISO 9001:2015 presents requirements focused on risk management. Therefore, the present article aims to outline a profile on the insertion of risk management into the scientific productions focused on the study of the ISO 9001:2015 Quality Management standard. In order to reach the objective, a descriptive and a content analysis was carried out, with samples of documents belonging to the Web ...
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