Institute for Healthcare Improvement

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Einstein (São Paulo)  vol.11 número3

Einstein (São Paulo) vol.11 número3

Várias iniciativas lideradas pelo Institute of Healthcare Improvement e pelas Sociedades de Cardiologia nacio- nais e internacionais, além da demanda de indicadores de desempenho pelas agências de acreditação hospi- talar, especialmente de infarto agudo do miocárdio e insufi ciência cardíaca, têm contribuído para que as ins- tituições criem estruturas de monitorização da prática e desenhos de projetos de melhoria contínua da qua - li dade (2,3) . Apesar disso, poucos estudos nessa área tem

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Arq. NeuroPsiquiatr.  vol.73 número11 X anp X20150147

Arq. NeuroPsiquiatr. vol.73 número11 X anp X20150147

data-driven, stance in healthcare management. Lean thinking, derived from Toyota’s Production System, has been adopted in many healthcare setting with success. Lean thinking is not a set of tools, but is rather a more philosophical approach to- wards management, founded on the concepts of relentless elimination of waste and continuous improvement. For ex- ample, eight broad types of waste have been identiied, often summarized with the acronym DOWNTIME: Defect (give a wrong medication), Overproduction (ask for exams that are not needed), Waiting (a patient waiting for consultation, a surgical team waiting for an operating room), No use of staf (not listening to employee’s suggestions), Transportation (pa- tients need to go to several places), Inventory (expired medica- tion), Motion (employee walks to distant areas to get supply), and Extra processing (generate duplicate documents). he Institute of Healthcare Improvement has developed a tool 3 to
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Einstein (São Paulo)  vol.11 número3 en a02v11n3

Einstein (São Paulo) vol.11 número3 en a02v11n3

Through initiatives from the Institute of Healthcare Improvement and national and international Cardiology Societies, as well as performance indicators demanded by hospital accreditation agencies (mainly on acute myocardial infarction and heart failure), health services have created a support structure to monitor practice and design projects for continuous quality improvement (2,3) .

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Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review.

Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review.

Table S2 Measured mean pass rate of QIs per condition and proportion of unique (matched) QIs with mean score above 50% per condition. {: The pass rate is reported for both delirium and dementia. {: These QIs were about physical functioning. QI: quality indicator, VE: vulnerable elder(s), NH: Nursing home, PC: Primary care, PIM: Prescribing indicated Mediations, AIM: Avoiding Inappropriate Medication, ECD: Education, Continuity, and Documentation, MM: Medication Monitoring, GEM: Geriatric Evaluation and Management, CHF: Chronic Heart Failure, IHI BTS: Institute of Healthcare Improvement’s Breakthrough Series, PC: Primary Care. *: The same patient population and dataset was used as in the Wenger et al. study [21], for these common QIs we only considered the pass rates reported in [21] for our analysis.
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Lean healthcare: uma revisão da realidade nacional

Lean healthcare: uma revisão da realidade nacional

Nos EUA, com o Institute for Health Improvement, como no Reino Unido com o NHS e o Institution for Innovation, adotaram esta visão nos seus primeiros anos de existência, conseguindo resultados muito promissores (18,25). O primeiro evento para difusão de conceitos Lean na área da saúde, o Lean Healthcare Forum, ocorreu em 2006 e foi organizado pelo Lean Enterprise Academy do Reino Unido. A Lean Enterprise Academy é uma organização com clara intenção de expandir esta visão de gestão na área da Saúde. É necessário ter em mente que o Lean ainda se encontra numa fase de muita investigação e início de aplicação na Saúde (26). Dos estudos já feitos, a maior parte tem-se desenrolado a nível hospitalar (7), especialmente nos Serviços de Urgências e no Internamento. Além disso, através da sua otimização dos seus processos tanto de entrega como e processamento é possível reduzir os períodos de espera, elemento tão discutido no mundo da Saúde. (27).
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MARKETING PLANNING IN HEALTHCARE INDUSTRY

MARKETING PLANNING IN HEALTHCARE INDUSTRY

The hospital industry has taken some major changes in the last years according to some famous researchers in the literature like Dawley et al. 1999 and Egger 1999[2]. All these changes since the 2000 faced the latest economical crises, and the price paid by consumers in order to get access to the healthcare services on for fee revenues. In the newly developed economies, attacked by economic crises, the hospitals had to undergo major restructuring or even closure trying to survive by emerging, acquiring facilities or marketing planning.

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PUBLIC FINANCING OF HEALTHCARE SERVICES

PUBLIC FINANCING OF HEALTHCARE SERVICES

Abstract Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ), state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.
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Paying for Performance in Healthcare Organisations

Paying for Performance in Healthcare Organisations

A number of theories of cause and effect were contained within the CQUIN Impact Assessment prepared as part of the process of developing and implementing the CQUIN policy. CQUIN was intended to embed quality improvement and innovation through making the payment system reflect quality according to the Department of Health’s Impact Assessment (15). Although a nationally mandated scheme was considered within the Impact Assessment, a scheme which encompassed mainly local goals was seen as preferable since this would ensure that clinical staff in healthcare providers would get involved in developing schemes and build on local initiatives and enthusiasm using standard metrics (15). This emphasis on local goals and provider involvement appears to have been intended to get ownership from clinical teams, thereby increasing the likelihood that desired changes would be delivered. In practice, however, mechanisms to engage clinicians were largely absent. This suggests that rather than ramping up pressure by increasing the size of the incentive, efforts should be made to understand why anticipated benefits are not forthcoming. Whilst, it is important to learn from failure, there is some evidence that FIs can be successful in reducing inequalities in access to care (16). Incentive schemes can encourage a focus on aspects of care that are incentivised, but they can also ‘crowd out’ important issues, such as patient concerns (17). Furthermore, there is some evidence suggesting that rather than embedding improvements in care, FIs are associated with a diminution in performance once incentives are withdrawn (18).
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Polytechnic Institute of Bragança, Quinta S

Polytechnic Institute of Bragança, Quinta S

World-wide competition among enterprises led to the need for new systems to perform the control and supervision of distributed manufacturing, through the integration of information and automation islands [1,2]. The market demands should be fulfilled by manufacturing enterprises to avoid the risk of becoming less competitive. The adoption of new manufacturing concepts combined with the implementation of emergent technologies, is the answer to the improvement of productivity and quality, and to the decrease of price and delivery time.

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Stockholm I nternational Peace Research Institute

Stockholm I nternational Peace Research Institute

- or can. be made unmanageable on the basis of confrontation. A global strategy for food and energy is urgently required. The United States believes four principles should guide a glob[r]

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A Survey on Infertility in Royan Institute

A Survey on Infertility in Royan Institute

Material and Methods: In this descriptive retrospective study, 2492 infertile couples were studied. These couples were selected by systematic sampling among couples referred to Royan institute between 1995 and 2001.All existing demographic data and diagnostic methods were recorded in questionnaires .Results were analyzed using SPSS version 11.5.

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Uma análise das barreiras e dificuldades em lean healthcare

Uma análise das barreiras e dificuldades em lean healthcare

Processos que envolvem pacientes são muito mais delicados do que a simples transformação de uma matéria-prima. Por isso, a modificação de processos na área da saúde precisa ser feita com maior atenção e previsibilidade. Essa é uma dificuldade adicional que se encontra no Lean Healthcare quando compara-se com a manufatura, mas que não é vista como negativa. Sobre isso, A3 afirma: “Como eu tenho essa visão de Engenharia de Resiliência e complexidade, eu não me sinto segura sem fazer uma abordagem muito profunda do estado atual. O Lean não quer muito saber como está o estado atual, quer partir logo para a ação. Mas na saúde, é mais complicado, se a gente mapear um processo mal e fizer uma implementação sem pensar muito no contexto da variabilidade envolvida, pode-se matar pessoas”.
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Paths towards efficiency in healthcare

Paths towards efficiency in healthcare

A large proportion of the maintenance of quality and extensive inclusion of the population within the Brazilian healthcare systems, both public and private, is achieved at the cost of reduced payments to healthcare professionals. However, as we have been saying here for many years, there is a new path that can be taken: that of the search for effi cacy, effectiveness, effi ciency and safety, based on clinical research that is adequately designed and conducted in order to constitute good evidence.

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Assessing the interaction between leadership and management competencies and health services accreditation

Assessing the interaction between leadership and management competencies and health services accreditation

18 reviewed, updated and spread in an organization (Feldman, 2005) and once the organization progresses to a quality improvement framework, there is also a need to encourage self-monitoring and reflection to encourage sustainability (Desveaux 2017). Accreditation also has impacts on organizational policies, environments, guidelines, regulations and procedures. Hinchfiff (2012) conducted a narrative synthesis and systematic identification of health service accreditation literature and identified 62 studies published up to 2013 that addressed this issue, exploring themes such as increased compliance with programs and guidelines, development of organizational culture leading to quality and patient safety, implementation of continuous quality programs, leadership and staff involvement, information management. His study also suggested a positive relationship between clinical outcomes and indicators and accreditation. In a recent study, Greenfield (2019), in a longitudinal study of 311 Australian hospitals, found evidence that participation in accreditation enhanced Human Resources performance and stimulated the establishment of policies related to quality and strategic planning and Jha(2010) showed that accredited hospitals in the United States tend to have better performance and improvement over time compared to hospitals that are not accredited when considering KPI measures in the database Hospital Compare from Centers for Medicaid and Medicare.
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Evidence-based healthcare for all: a new era?

Evidence-based healthcare for all: a new era?

There is very strong pressure for similar events to be held again. Those who took part learned about evidence-based medi- cine, had fun and were able to confirm that there was a complete absence of conflicts of interest. All who participated and col- laborated receive our gratitude and recognition of their great contribution towards healthcare quality and ethical improve- ment of national and international continuing education.

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Evidence-based medicine for better healthcare

Evidence-based medicine for better healthcare

The modes of practising EBM, CATs, best practices and other like developments have made EBM much less time consuming. The tools of EBM like number needed to treat (NNT), absolute risk reduction (ARR), Likelihood to benefit/harm (LHH), make the outcomes easier to understand, more meaningful and generalizable. In developing countries where it is difficult to find a study done on similar population, more often than not, clinicians have to depend on the evidences produced by studies done on a different population. EBM aids to make these results generalizable and applicable to the local population. Now that the time and skill constraints have been taken care of, with all its characteristics, if warmly accepted, understood and applied, EBM can be utilised to provide better healthcare, more acceptable to the individual patients.
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Knowledge in transition in healthcare

Knowledge in transition in healthcare

Like any piece of research, this paper features some limitations. First, the case study investigates one specific sector. Thus, its replicability to other industries has yet to be proved. Moreover, the limited number of respondents may bias the results. We think that these limitations could be the basis for further developments of the research, enlarging the sample and applying the same methodology to other healthcare departments or different industries. Future research avenues may deepen such aspects, conducting the analysis in other sectors or locations.

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Identification, Causes and Consequences Doctoral Programme of Public Health

Identification, Causes and Consequences Doctoral Programme of Public Health

Background: Unwarranted variations in healthcare are thought to describe healthcare provision beyond what is clinically necessary and without additional clinical ben[r]

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Institute of European Studies UC Berkeley

Institute of European Studies UC Berkeley

The presence of Members of the Armed Forces with higher educational studies remained constant until the Third legislature and then oscillated; the highest parliamentary pre[r]

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Interface (Botucatu)  vol.13 suppl.1 en a12v13s1

Interface (Botucatu) vol.13 suppl.1 en a12v13s1

This article arises from guided reflection on concrete experiences that we have had as consultants of the National Humanization Policy (Política Nacional de Humanização, NHP) and as workers in the field of the formation of health professionals. The questions and discussions covered in the text emerged and are permeated by these practices, by our actions of institutional support 1 and by training experiences that we have developed both within and outside of this policy. In this article, we propose to articulate the referentials of the NHP with some aspects of work processes in health, placing their analysis into perspective in a dialogue with the methodological approach of this policy. Thus, we strive to reflect on questions concerning the contribution of the NHP, with regards to the discussion of work processes and the organization of healthcare services. The NHP is constituted as a "policy" based on a set of principles and directives that operate through devices 2 (Brasil, 2006, 2004). In principle, we understand what drives actions, triggering changes in position in terms of public policy. In the case of NHP, the displacement that is proposed involves changes in the models of care and management grounded in biomedical rationality (fragmented, hierarchical, disease focused and hospital care). It is established as public health policy based on the following principles: the inseparability of clinical practice and politics, which implies the inseparability of care and management of production processes of health; and transversality, understood as an increasing degree of open communication within and between groups; i.e., expansion of the forms of intra- and intergroup connection, promoting changes in healthcare practices (Passos, 2006).
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