Aplicação do mapeamento da cadeia de valor: um estudo de caso em uma lavanderia hospitalar / Application of value stream mapping: a case study in a hospital laundry

O principal objetivo do presente artigo é a aplicação da ferramenta gerencial de engenharia value stream mapping (vsm) e a elaboração de um mapa de future state em uma lavanderia hospitalar, buscando uma melhor utilização dos recursos existentes e uma redução na complexidade do fluxo processual, visto que este setor pode ser comparado a um setor industrial por apresentar entradas e saídas específicas e ciclos processuais padronizados. A metodologia utilizada para o desenvolvimento do presente trabalho foi de natureza aplicada, os objetivos foram definidos como descritivos e a abordagem foi qualitativa, por meio do método de estudo de caso, sendo o cenário estudado no presente artigo o setor de lavanderia de um hospital regional do sul de minas gerais. O cenário atual do setor foi mapeado por meio do vsm e esperou-se que a aplicação do mapeamento da cadeia de valor (vsm) trouxesse benefícios analíticos sobre questões processuais, e que o uso dessa técnica ajudasse a identificar desperdícios, perdas processuais e a levantar sugestões de melhorias, as quais possibilitam uma tomada de decisão muito mais efetiva e direcionada às metas buscadas. Os objetivos da aplicação do vsm foram alcançados no presente estudo

Feminist academic organizations: Challenging sexism through collective mobilizing across research, support, and advocacy

This paper examines the establishment of a feminist academic organization, GENMAC (Gender, Markets, and Consumers; genmac.co), serving gender scholars in business schools and related fields. In so doing, it builds on the emerging literature of feminist academic organizations, as situated within feminist organizational studies (FOS). Through a feminist case study and by assessing the reflections of GENMAC\u27s board members, we tell the story of the emergence of GENMAC and detail the tensions the organization encountered as it formally established itself as a feminist organization within the confines of a business school setting, a patriarchal system, and a neoliberal university paradigm. We build on the FOS literature by considering how our organization counters cultures of heightened individualism and builds collective action to challenge sexism through the nexus of research, support, and advocacy pillars of our organization. We demonstrate how, through these actions, our organization challenges hierarchies of knowledge, prioritizes the care and support needed for the day-to-day survival of gender scholars in business schools, and spotlights and challenges structural inequalities and injustices in the academy

(Il)Legitimisation of the role of the nation state: Understanding of and reactions to Internet censorship in Turkey

This study aims to explore Turkish citizen-consumers' understanding of and reactions to censorship of websites in Turkey by using in-depth interviews and online ethnography. In an environment where sites such as YouTube and others are increasingly being banned, the citizen-consumers' macro-level understanding is that such censorship is part of a wider ideological plan and their micro-level understanding is that their relationship with the wider global network is reduced, in the sense that they have trouble accessing full information on products, services and experiences. The study revealed that citizen-consumers engage in two types of resistance strategies against such domination by the state: using irony as passive resistance, and using the very same technology used by the state to resist its domination

Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93528/1/gps2830.pd

Persistence and Remission of Musculoskeletal Pain in Community‐Dwelling Older Adults: Results from the Cardiovascular Health Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93534/1/jgs4082.pd

Comparative effect of collaborative care, pain medication, and duloxetine in the treatment of depression and comorbid pain in outpatient care: results of a randomized, placebo-controlled, multi-center trial

Objective: Evidence exists for efficacy of collaborative care (CC) against MDD, for efficacy of consequent use of pain medication against pain, and for efficacy of duloxetine against both MDD and neuropathic pain. However, their relative effectiveness in comorbid major depression (MDD) and pain has never been established so far. This study evaluates the effectiveness of CC, pain medication and duloxetine, and CC, pain medication and placebo, compared to duloxetine alone, on depressive and pain outcomes. Methods: Three armed cluster randomized multi-centre placebo controlled trial in consecutive patients presented at three specialized mental health outpatient clinics who screened positive for MDD. All interventions lasted 12 weeks. In the CC groups duloxetine or placebo was prescribed. Pain medication was administered according to an algorithm that avoids opiate prescription as much as possible as an alternative to the current WHO pain ladder, with paracetamol, COX inhibitors and pregabalin as steps before opiates are considered. Patients who did not show up for three or more sessions were registered as noncompliant. Explorative, intention-to-treat and per protocol, multilevel regression analyses were performed. The trial is listed in the trial registration (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1089; NTR number: NTR1089). Results: This study was prematurely terminated because of massive reorganisations and reimbursement changes for mental health care during the study. 60 patients completed the study. Patients in all treatment groups reported significant less depressive and pain symptoms after 12 weeks. CC with placebo condition showed the fastest decrease of depressive symptoms compared to the duloxetine alone group (b = -.78; p = .01), Noncompliant patients did not improve over the 12 weeks period. Pain outcomes did not differ between the three groups. Conclusions: In MDD and pain, compliance of patients and placebo effects are more important than choice of one of the three treatments. Active pain management in CC with COX inhibitors and pregabalin as alternatives to Tramadol or other opiates might provide an attractive alternative to the current WHO pain ladder as it avoids opiate prescription as much as possible. The study was sufficiently powered to show an exploratory result, but the generalizability is limited due to the small sample size. Larger studies are needed

Does Screening for Pain Correspond to High Quality Care for Veterans?

Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear. To assess adherence to measures of pain management quality and identify associated patient and provider factors. A cross-sectional visit-based study. One hundred and forty adult VA outpatient primary care clinic patients reporting a numeric rating scale (NRS) of moderate to severe pain (four or more on a zero to ten scale). Seventy-seven providers completed a baseline survey regarding general pain management attitudes and a post-visit survey regarding management of 112 participating patients. We used chart review to determine adherence to four validated process quality indicators (QIs) including noting pain presence, pain character, and pain control, and intensifying pharmacological intervention. The average NRS was 6.7. Seventy-three percent of charts noted the presence of pain, 13.9% the character, 23.6% the degree of control, and 15.3% increased pain medication prescription. Charts were more likely to include documentation of pain presence if providers agreed that “patients want me to ask about pain” and “pain can have negative consequences on patient’s functioning”. Charts were more likely to document character of pain if providers agreed that “patients are able to rate their pain”. Patients with musculoskeletal pain were less likely to have chart documentation of character of pain. Despite routine pain screening in VA, providers seldom documented elements considered important to evaluation and treatment of pain. Improving pain care may require attention to all aspects of pain management, not just screening