As práticas de gestão de recursos humanos e as equipas de alta performance

As práticas de Gestão de Recursos Humanos (GRH) desempenham um papel vital para o sucesso das organizações bem como das organizações de saúde. É neste âmbito que se insere este trabalho que visa a análise das práticas de GRH na Saúde e o seu impacto na performance através da perceção dos enfermeiros do bloco operatório. O objetivo deste estudo foi analisar a relação entre as práticas de GRH de alto envolvimento e a performance. Como instrumentos de análise da performance utilizou-se o de Birkinshaw & Gibson (2004) da avaliação da ambidextria contextual, e o seguido por Gittel, et al. (2010) para a Coordenação Relacional entre os enfermeiros e outros profissionais do bloco operatório. O inquérito foi aplicado ao universo dos enfermeiros do bloco operatório de um Hospital Privado de Lisboa, com uma taxa de resposta de 100%. Complementou-se o estudo com uma entrevista à Direção da Gestão de Recursos Humanos sobre as práticas de Recursos Humanos para a caracterização do estudo. Dos resultados do estudo pode-se inferir que, nesta população, as práticas de alto envolvimento se relacionam positivamente tanto com a performance como com a coordenação relacional. Face aos resultados a estratégia de intervenção proposta passou por uma mudança quer a nível das estruturas (formação, partilha de sistemas de informação, reuniões de equipas e resolução de problemas), quer a nível relacional (criação de um espaço de reuniões e coaching).Human Resource Management (HRM) practices play a vital role in the success of organizations as well as health organizations. It is within this scope that this work is inserted that aims at the analysis of the practices of HRM in Health and its impact on the performance through the perception of the theatre nurses. The objective of this study was to analyze the relationship between high involvement HRM practices and performance. As instruments of performance analysis, we used Birkinshaw & Gibson (2004) of contextual ambidextria, and that followed by Gittel, et al. (2010) for Relational Coordination among nurses and other professionals in the theatre room. The survey was applied to the universe of nurses in the operating room of a private hospital in Lisbon, with a response rate of 100%. The study was complemented with an interview with the Human Resources Management Department on the Human Resources practices for the characterization of the study. From the results of the study it can be inferred that, in this population, the high involvement practices are positively related to both performance and relational coordination. In view of the results, the proposed intervention strategy has undergone a change in structures (training, information systems sharing, team meetings and problem solving), and at the relational level (creation of a meeting space and coaching)

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Resumos concluídos - Saúde Coletiva

Resumos concluídos - Saúde Coletiv