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Most of Health Services Waste (HSW) is similar to household waste. Therefore the proper waste segregation avoids the contamination of ordinary waste and that reduces the potential risk to public health, besides providing the recovery of recycling waste. Our main objective with this study was to promote the recovery of paper and to evaluate the disposal of recyclable waste or the reuse of the containers of infectious waste, in the maternity of a public hospital, located in São Paulo city. With this, a secondary objective was to promote the recovery of paper in such an environment. The initiative to recover recyclable paper took place in two stages: a period without orientation and a period with it. In the period without orientation we observed the loss of recyclable waste, due to the potential of contamination by the presence of infectious waste. On the other hand, during the period under orientation, the contamination of the wastes was avoided although inadequate segregation of other recyclable waste, such as plastic, occurred. In the containers of group A (infecting waste), we recorded 340 occurrences of waste that could be recycled or reused. Irregularities in the segregation stage demonstrate the need for continuing education programs on the importance of recycling and of proper segregation of HSW. [ABSTRACT FROM AUTHOR]

This paper presents the analysis of the relationship between the coverage of the Family Health Strategy (FHS) and the availability of respirators with the transmission and mortality rate of COVID-19 in the state of Santa Catarina between December 2019 and May 2020. This is an ecological study, which uses computational models of geospatial analysis on the progress of COVID-19 in the state for 295 cities the correlation between the FHS coverage and the number of respirators grouped in the mesoregions was calculated with the transmission and mortality variables of COVID-19. As a result of the analysis, it was found that the state had low infection rates of 0.07% and mortality of 1.72%, when compared to other states in Brazil. There was an increase in cases in smaller cities indicating the interiorization of the pandemic. There was no correlation between FHS coverage with infection and mortality. However, respirators are associated with lower mortality. As conclusions, it can be said that a regional disparity was found in the presence of respirators in the state's micro-regions, suggesting an imbalance in the quality of care for critically ill patients during the pandemic. [ABSTRACT FROM AUTHOR]

The Brazilian health sector has problems such as overcrowding of beds and long waiting periods. The Lean philosophy has recently covered health, being denominated Lean Healthcare, with the purpose of reducing or eliminating the problems faced by this area. This paper aims to conduct a bibliometric review about Lean Healthcare, in order to identify the regions of Brazil that do more researches about its application and detail the most used tools and respective medical areas in which they were applied. As methodology, it was adopted a systematic exploratory procedure for extracting works from Scielo, Google Academic, Science Direct, Engineering Village and Scopus databases, with qualitative analysis facilitated by StArt software. 66 studies from 137 were selected and it were found publications concentrated in the Midwest, South and Southeast of Brazil. The Value Stream Mapping (81.3%) and Kaizen (25.8%) were used the most, besides other tools that were used in different hospital areas. The surgical area (21.2%), the urgency and emergency area (16.7%) and the oncology area -- chemotherapy and radiotherapy -- (13.6%) had greater prominence in the studies. Only 25.8% of studies presented implementations of the recommendations made. This bibliometric review brings indicators that demonstrate the impacts of Lean Healthcare practice only in Brazilian hospitals, in addition to the disparity of the regions in which the practice was implanted, and the relationship between hospital areas and tools used. [ABSTRACT FROM AUTHOR]

Constitutional guarantees are constantly threatened, evidencing conflicts of agency between government and citizens. To achieve better efficiency and effectiveness in the management of federal university hospitals, the Brazilian Company of Hospital Services (Ebserh) was created. This study evaluates the quantitative evolution of the results in the increase of services offered to Brazilian Health System users through the Ebserh regarding the Clinical Hospital of the Federal University of Paraná. This exploratory, descriptive, bibliographical and documentary research, used a quantitative approach. In this paper, Ebserh did not materialize in a privatization process for federal university hospitals, as some authors have argued. However, despite favorable results in terms of staffing, intensive care unit beds, occupancy rate and mean length of stay, the Mann-Whitney test showed that the variation of hospitalizations, consultations and exams before and after the Ebserh was not statistically significant. [ABSTRACT FROM AUTHOR]

Although health care providers have more than 47 million health insurance clients in Brazil, these companies still have processes that are manual. One of these processes is that of the medical audit that performs the analysis of each account with expenses that were incurred by the operator's beneficiary in any hospital, clinic or laboratory. Each account is reviewed to make sure that there is nothing outside the context of a surgery, examination or consultation. The costs of these audits are high and the outcome is varied and according to the auditor's individual knowledge. In addition to being a lengthy process, these bills will only be paid to those who provided the service after the auditors' review which brings dissatisfaction to those awaiting payment. Manual execution of this process is susceptible to failure and fraud. In this context, Machine Learning algorithms are used to assist in the audit process in various areas of knowledge. Thus, this paper presents a survey on the application of Machine Learning algorithms in medical audits, analyzing which algorithms are most used. [ABSTRACT FROM AUTHOR]

Risk management emerges as a management model in the public health area that aims at the best use of resources while ensuring the quality of services. This paper analyzes the main indications of the impact of adopting the risk management model implemented by the Sanitary Surveillance of Minas Gerais in pharmaceutical industries of the pharmaceuticals and active pharmaceutical ingredients segment. The study was characterized through bibliographic, documentary and field survey with questionnaires directed to representatives of the pharmaceutical industries producing pharmaceuticals and active pharmaceutical ingredients (API) of Minas Gerais, subjected to Visa supervision and semi-structured interviews with technical leaders of 4 drug industries located in the Belo Horizonte Metropolitan Region, Minas Gerais, Brasil, and with 2 managers and inspectors of the technical staff of the Minas Gerais Sanitary Surveillance, and participant observation in order to better understand the internal flows of the work routine of the State Visa. The research showed evidence and positive perceptions regarding the risk management model adopted by the Health Surveillance in pharmaceutical industries, and found indicative of favorable impact for both the government and the companies in question. [ABSTRACT FROM AUTHOR]

This paper presents the results of a study that aimed at analyzing the indebtedness determinants of medical cooperative Brazilian private healthcare providers (OPS) under the Supplementary Health Agency (ANS) regulation. It is a quantitative and explanatory study. The sample reports healthcare OPS 2010-2016 data which is publicly available on the ANS website. Data analysis followed these techniques: documental analysis, descriptive statistics and data panel regression. We verified that many of traditional variables employed in corporative environment were statistically significant. We also observed the significance of some variables related to regulation. This indicates that such variables influence OPS indebtedness. The main variable related to regulation in indebtedness models was OPS's size (TAM). Moreover, it is important to highlight that the variables significance level varies according to the time lag (short or long-term). [ABSTRACT FROM AUTHOR]

This paper presents a proposal of indicators to be used in health services, especially in rehabilitation clinics. This proposal provides inputs that enable managers to develop a more strategic view of services as business, as well as assisting them with information that influences the quality of services provided. Initially a mapping of the internal processes of a physical rehabilitation service was carried out, through the notation of the business process management methodology (BPMN), with the use of the Bizagi Modeler tool. Nine processes were identified. After the initial mapping and description of the processes, points of interest within the organization were raised, with the aim of optimizing and agility of the activities, reduction of rework and increase in the quality of service rendering. Based on this, the following indicators were proposed: total time of service, processing time and volume of reports, orthoses and prostheses dispensing time, rehabilitation process time, and time of service per consultation. The indicators created had as premise the use of information already available within the managerial environments of the clinic. Next work will carried out the implementation of the indicators and verification of the real impacts of these in the service. [ABSTRACT FROM AUTHOR]

The audit is an independent source of information, covering all the processes that make up a quality assurance system In this sense,this study had as main objective to analyze the scientific production on audit in the supplemental health and by specific objectives to identify the main themes present in the scientific production and to discuss possible approximations and distances in the researches that were the object of the analysis. It is an integrative review of the literature that adopted the thematic content analysis technique. The paper analyzed the studies in the Brazilian Digital Library of Theses and Dissertations (BDTD), in the Latin American and Caribbean Literature database in Health Sciences - LILACS and in the virtual library Scientific Electronic Library Online - SciELO. Fourteen studies were identified and the themes that emerged from the analysis of these studies were: health quality improvement and cost reduction. It was concluded that while some studies have underscored that the improvement of health quality and cost reduction may be considered as complementary actions, other productions have revealed tension and even antagonistic relations that emerge between these elements. [ABSTRACT FROM AUTHOR]

The paradigms of health service rendering have been deeply questioned. Complex and dynamic environments involving multiple factors, knowledge areas and possibilities for decision-making have turned hospitals into knowledge intensive organisations, demanding a strategic perspective for managing knowledge assets in healthcare organizations. This paper aims to propose an integrative model of knowledge management applied to the specific context of hospital healthcare administration. The research method comprises participant observation in one large Brazilian hospital network, literature review and validation of the framework by experts in the innovation and knowledge management fields. The main finding of the paper is a theoretical framework integrating information management practices, human resource management (HRM) approaches, knowledge-based process and decisionmaking routines in order to act on quality, effectiveness and welfare costs within the hospital context. The constructs of knowledge organisation (Choo, 2003), absorptive capacity (Zahra & George, 2002) and organization of learning processes (Argyris & Schon, 1996) constituted the proposed model. The paper conclusion emphasizes the pressing need for a systemic approach to deal with the knowledge management specific challenges in hospitals. [ABSTRACT FROM AUTHOR]

The paper refers to price regulation in Brazil performed by the Pharmaceutical Market Regulation Board (CMED) and its effects on public biddings of pharmaceuticals in the State of Minas Gerais. The prices of drugs purchased by Minas Gerais were compared with prices registered in the Healthcare Price Database (BPS) of the Ministry of Health, and price ceilings as defined by CMED. The results led to the conclusion that price regulation effects on public biddings in Minas Gerais depend on the level of competition seen in each specific product. Drugs belonging to therapeutic classes with higher levels of market competition were linked to wider differences among actual prices and regulatory ceilings, hinting toward CMED regulation inefficacy in these cases. On the other hand, therapeutic classes with only one or a few bidders corresponded to more similar levels of actual prices and regulatory ceilings, although both values were deemed higher than average international prices. CMED's annual readjustments formula was considered one of the main causes of the price regulation ineffectiveness to foster the public interest. The results imply possible economic losses in the public procurement of pharmaceuticals in the State of Minas Gerais. [ABSTRACT FROM AUTHOR]

This paper celebrates 25 years of the existence of the Brazilian National Health System (SUS). Through out the paper, one describes the political and institutional mechanisms from which SUS originated, as well as the transformations undergone in the past 25 years. The conquers obtained with the implantation of the system are specially highlighted, particularly those concerning access to health services gained by the population and health gains per se, once these are the ultimate objective of the system. Conversely, the difficulties that hinder the good functioning of SUS are also noted, mainly difficulties in access and financing. The paper points out that these two fundamental issues must be addressed in order for the system to become really equitable, as it proposes itself to be. [ABSTRACT FROM AUTHOR]

This paper aims to analyze the operational model of primary healthcare network in a Brazilian large size municipality, with more than 1 million inhabitants. It is a qualitative and exploratory study conducted through document analysis and semi structured interviews, in five primary healthcare clinic managers. In order to support the research, the article presents the main literature understandings for network in public sector and Family Health Strategy (FHS). To analyze the object, the authors mapped the local healthcare network, taking into consideration healthcare operation's structure, roles, responsibilities, contracts, and agreements. Research results are grouped into four main aspects: i) sourcing decision and network design, ii) service design and service standardization, iii) operational performance and effectiveness of the public health service delivery, iv) local manager autonomy [ABSTRACT FROM AUTHOR]

This paper aims to present the mapping of variables in the perception of managers are relevant in the management of beds in private hospital organizations. One of the critical processes that hospitals have faced is bed management. Therefore, it is necessary to identify clearly the processes that interact in the occupation of the beds, and then to propose improvements. This work used the Systematic Literature Review (SLR) based on the bibliographical research and theoretical discussion based on cases of private hospitals, in addition to the theoretical comparison of several empirical studies that led to the mapping of variables essential for the management of beds in private hospital organizations. Thus, the theory advocates that bed management involves strategic processes and, for its management, knowledge that goes beyond administrative routines is necessary, justifying the need to professionalize these services, as well as investment in infrastructure and personnel. In health, requesting beds should be considered a strategic process, and should be redesigned, if necessary to ensure support for reaching organizational strategies. It's considered that the management aims to seek the use of the available beds in their maximum capacity, with safety within the established criteria to the objective of optimizing the waiting time for hospitalization and satisfaction of internal and external clients of the hospital environment. [ABSTRACT FROM AUTHOR]

Hospital activity in Brazil has a growing demand, because it's a basic need of population. In this way, the hospitals work like businesses that need to be sustainable in the market. In this sense, cost systems, important tools in decision-making that they are, help in review of processes and pricing of service to the patients,. So, it sought in the present paper, by a case study in a hospital of Cascavel, in the State of Paraná, applies the conceptual model developed by Dall'Asta e Barbosa (2014), intending to improve the currently used cost system by the hospital studied and verify if may arise benefits from this deployment. Literatures were used for theoretical foundation, such as identification of the current scenario of Brazilian hospitals as regards cost systems. First, it was necessary to identify the cost system currently used, through interviews with the executive director of the studied organization, questionnaires and documentary analysis. Then the six phases that compose the conceptual model were applied. Finally, perceptions of accounting related to the application of the model were collected in order to add value to the current search, and the whole process was analysed so as to check out the performance. [ABSTRACT FROM AUTHOR]

The aim of this paper was to verify how the transformational leader's role might influence the reconstruction of shared meanings as regards strategic corporative changes considering a restructuring process of Business Units which have different and inter-related portfolios. The strategy for research has been characterized as a case study because it presents the singularity of a unique organization, as well as the use of a triangulation of different data sources. Such triangulation allowed not only for the definition of analysis categories supported by theoric development and by the questionnaire, but also for the confirmation of such categories along with data collecting, including 106 respondents and 20 managers (called "transformational leaders"). It was possible to conclude that even though there are structural problems, leaders are well accepted by employees and their role is highly significant on the change process and on the building of meanings, specially considering the interpretation of the directors' expectations and work conditions that are offered and perceived. [ABSTRACT FROM AUTHOR]

The entirety in health care has as one of its dimensions the access to the several levels of technological density of the system, which includes basic units and specialty hospitals and clinics. The Intensive Care Unit is the hospital sector for people at risk of worsening of conditions that could not be avoided or controlled whatsoever. This paper aims at describing the profile of hospitalizations in adult intensive care units in the city of Anápolis, Goiás, in 2012. It is a descriptive, documental and retrospective research with a quantitative approach to information. The data show that hospitalization average was lower than a thousand cases per year, mostly males; and the prevalent age groups corresponded to more advanced adulthood and elders; from the three analyzed units, two had a permanence average lower than other studies, except an emergency hospital; the main reasons for hospitalization were acute myocardial infarction, stroke and Congestive Heart Failure. The mortality rate was higher than the average found in most studies. The results point out the impact of demographic and epidemiological transition in demand and the use of health services. [ABSTRACT FROM AUTHOR]

Brazil is Latin America's biggest pharmaceutical market, but it produces only about 2% of all Active Pharmaceutical Ingredients (API) - substances responsible for the therapeutic efficacy - compared to total imports. The aim of this paper was to analyze the national dependency on the Navirapine imported pharmaceutical input for the production of an antiretroviral drug (ARV) by the Farmanguinhos Official Pharmaceutical Laboratory. It demonstrated that the API used for the production of antiretroviral drug Nevirapine was imported from 2001 to 2013 and represented over 70% of the final cost of the drug. The acquisition of API in the international market is leading to impact on the deficit in the trade balance and for this deficit to be reduced it iss necessary to strengthen the Health Industrial Economic Complex, like the national pharmochemical industry, through coordinated public policies and financing mechanisms to technological innovation. [ABSTRACT FROM AUTHOR]

The aim of this paper was to assess effects of municipal health expenditure on the percentage of ambulatory care sensitive conditions (ACSC). We analyzed 853 municipalities in the state of Minas Gerais in the years 2004 to 2013 by way of a fixed-effects panel model. The results showed that municipal investing on health is important to ACSC percentage variation, along with variables related to basic sanitation and specific individuals such as children and pregnant women. Results also suggest that increasing municipal health investment would not be the most efficient alternative, since it would require a relatively high increase in per-capita health investment in order to obtain a minimum ACSC unit reduction. [ABSTRACT FROM AUTHOR]

This paper describes a study on the Queuing Theory in a Social Security Agency (SSA). In order to suggest improvements in services so as to reduce waiting time and optimise process flow, a case study was conducted in a SSA in the State of Rio Grande do Sul. The data were collected through structured observation techniques and statistically analyzed. As an intervention instrument, tools used were the ones provided by the Queuing Theory, such as Single Queuing Nodes, Service Disciplines, Queueing Networks and Arrival and Service Processes. As a result, it was possible to determine the arrival processes, customer service and output, as well as the proximity to a service model as described in queuing theory, which allowed us to establish a profile of queue behaviour at the Agency. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the influence of self-esteem, the person's self-appreciation of his/her body, and materialism on the acceptance of cosmetic surgery (ACS), both in Sao Paulo (Brazil) and in Porto (Portugal), using a cross-cultural perspective. The concepts of self-esteem, body appreciation, materialism and acceptance of cosmetic surgery are revised. The main studies that guided the measurement of such constructs in this paper are the following: Rosenberg (1965) and Dini, Quaresma and Ferreira (2004) for self-esteem; Marsh and O'Neill (1984) for body appreciation; Richins (2004) and Ponchio and Aranha (2008) for materialism; and Henderson-King and Henderson-King (2005) and Swami et al. (2011) for acceptance of cosmetic surgery. Two samples were obtained, comprised of 217 and 148 respondents, from the cities of São Paulo and Porto, respectively. The main findings indicate that: (i) there is a gender effect -- women accept cosmetic surgery better than men; (ii) there is a country effect -- respondents from Sao Paulo accept cosmetic surgery better than those from Porto; (iii) there is no relationship between self-esteem and ACS; (iv) the association between body appreciation and ACS is weak; and (v) there is strong evidence that materialistic people accept cosmetic surgery better than those less materialistic. [ABSTRACT FROM AUTHOR]

The scope of this paper is to contribute to the understanding processes, context and challenges of medical audit and its integration with cost management, quality and risk in the health sector. For this purpose a case study in the medical audit department of a medical professional cooperative, located in northeastern Brazil was conducted. This choice was strengthened by the interest in examining the issues of integration in an institution whose main goals are to preserve the professional enrichment and provide quality in health care. The interpretation of the results indicated that the main focus of attention is given to the accounts audit whilst minimum priority is giving to analytical auditing. The audit sector is not perceived by the members as an ally and there are no programs focused on the involvement of cooperative members with this area. The over- estimation of the auditor's experience may be inhibiting the investment in professionalization and in management models and more sophisticated auditing tools. Evidence-based medicine is used in a very restricted way. No effective audit integration with the information systems, the strategy of the organization, quality programs, cost management and use of evidence-based medicine was observed. [ABSTRACT FROM AUTHOR]