The innovation process in hospital services: a case study in an occupational therapy

The theoretical debates in the literature point to the need of innovations in hospital services. The objective of this article is to identify the conditions of services that facilitate or hinder the process for different types of innovation in hospital services. For this, case studies were developed that allow the identification of the types of innovation found in the physical rehabilitation outpatient clinics of the Occupational Therapy unit (OT) of the Orthopedics and Traumatology Institute (OTI) of the Clínicas’ Hospital of the Faculty of Medicine of the University of São Paulo (HCFMUSP). The data collected reveal that the results of hospital services are related to the process of developing innovations in the various stages of the workflow, from the generation of ideas to the diffusion within the hospital unit. On the other hand, the review of the literature based on the reverse cycle of Barras and the complements of Gallouj and Djellal show that the paths of innovation in hospital services and innovations in industrial organizations are opposite. Therefore, the results of the analysis of the five cases selected for study reveal that, under the integrative approach, a process change leads to a product change. Thus, the article concludes that, in hospital services, innovations are born within the organizational structure as well as in external contact with professionals, researchers and surgeons

Development and Evaluation of a Head-Controlled Human-Computer Interface with Mouse-Like Functions for Physically Disabled Users

OBJECTIVES: The objectives of this study were to develop a pointing device controlled by head movement that had the same functions as a conventional mouse and to evaluate the performance of the proposed device when operated by quadriplegic users. METHODS: Ten individuals with cervical spinal cord injury participated in functional evaluations of the developed pointing device. The device consisted of a video camera, computer software, and a target attached to the front part of a cap, which was placed on the user's head. The software captured images of the target coming from the video camera and processed them with the aim of determining the displacement from the center of the target and correlating this with the movement of the computer cursor. Evaluation of the interaction between each user and the proposed device was carried out using 24 multidirectional tests with two degrees of difficulty. RESULTS: According to the parameters of mean throughput and movement time, no statistically significant differences were observed between the repetitions of the tests for either of the studied levels of difficulty. CONCLUSIONS: The developed pointing device adequately emulates the movement functions of the computer cursor. It is easy to use and can be learned quickly when operated by quadriplegic individuals

CARACTERIZAÇÃO FUNCIONAL DE IDOSOS COM ARTRITE REUMATÓIDE

A artrite reumatóide (AR) é uma das principais causas de incapacidades em idosos, pois suas deformidades geram dificuldades para as atividades cotidianas.  Assim, fazem-se necessários estudos que avaliem em que medida ela interfere na capacidade funcional e como essa população minimiza seus efeitos. Com este propósito, foi conduzido estudo em um Hospital Escola da Cidade de São Paulo, em 2008 para caracterização funcional de idosos com esse problema. Participaram da pesquisa 12 pessoas com AR, com pelo menos sessenta anos, que deambulavam, apresentavam comprometimento de mão e punho e estavam em seguimento clínico com reumatologista. Utilizou-se o Mini-Exame do Estado Mental (Folstein, 1975) para inclusão no estudo. Para a caracterização sócio-demográfica e funcional foram utilizados os seguintes instrumentos: Classificação de Idosos quanto à Capacidade para o Autocuidado (Almeida, 2003), Escala Numérica Verbal (Andrade et al, 2006), goniômetro e dinamômetro computadorizados. Os resultados apontam para o comprometimento da capacidade funcional e escassez de respostas de enfrentamento a esta condição. Os participantes apontaram dificuldades para em média 5,6 atividades, sendo que 100% possuía dificuldades físicas para duas ou mais atividades. Em média houve redução da força de preensão palmar e pinça, e da amplitude de movimento. Práticas de autocuidado foram adotadas para somente 36,7% do total de suas atividades diárias. Considerando-se a cronicidade da AR e o próprio envelhecimento, a tendência é que este quadro piore. Dessa forma, evidencia-se a necessidade de serviços de saúde que tenham infraestrutura para manter ou melhorar a capacidade funcional de idosos, visando sua independência e participação social