Estudo avaliativo do processo de trabalho das Equipes de Atenção Básica a partir do PMAQ-AB

Medrado, Josiane Ribeiro Silva; Casanova, Angela Oliveira; Oliveira, Catia Cristina Martins de

doi:10.1590/0103-110420161070360

Cited by 21 publications

(28 citation statements)

References 3 publications

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“…That happens when the assessment of these actions is seen as a part of the work process instead of an imposition merely aimed at reaching targets. (7) The assessment process should be broad and provoke changes, (8) a daring and innovative proposal that demands time to mature and incorporate it into the work culture of the Primary Health Care services.…”

Section: Discussionmentioning

confidence: 99%

“…This fragmentation is related to the managers and teams' limitation to understand the planning, monitoring and assessment as parts of an ongoing work process for improvements. (7) This discontinuity emerged in the interviewees' reports about external assessment.…”

Section: Discussionmentioning

confidence: 99%

“…(4,7) To support the transformation of reality, the results should be disseminated and discussed (9) among the manager, team and evaluators, a gap the study subjects appointed. Result-based financial incentives have been more effective to produce short-term changes instead of promoting great transformations, (10) by supporting decision processes, improving the organization of Primary Health Care, communication, management transparency and the education of the subjects involved.…”

Section: Discussionmentioning

confidence: 99%

“…Result-based financial incentives have been more effective to produce short-term changes instead of promoting great transformations, (10) by supporting decision processes, improving the organization of Primary Health Care, communication, management transparency and the education of the subjects involved. (7) According to the interviewees, the managers and teams hardly work with standards and indicators. Their use disseminates the quality culture and favors the modulation of the professional profile, (6,11) which can contribute to overcome the fragmentation of the work processes in PHC.…”

Section: Discussionmentioning

confidence: 99%

“…The managers often treat the assessment as supervision and punishment, as they charge the achievement of targets and the improvement of indicators without qualifying and encouraging the professionals in parallel. (7) In addition, the services' shortages are observed, which the management should improve through continuing education and improvements in the structures and work relations. (12) The interviewees treated continuing education and institutional support as synonyms.…”

Section: Discussionmentioning

confidence: 99%

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Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

et al. 2017

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Objective: To analyze the implementation of the National Improved Access and Quality Program according to Primary Health Care managers. Methods: The thematic oral history was used, through semistructured interviews with five managers from Primary Health Care Services who participated actively in the two cycles of the Program in an administrative district of São Paulo City. The subjects answered the question "How do you assess the implementation process of the National Improved Access and Quality Program at this Primary Health Care Service?", among others. The analysis of the testimonies revealed the categories "The managers' perception of the implementation of the National Improved Access and Quality Program" and "Changes in the work processes since the implementation of the National Improved Access and Quality Program". Results: The managers acknowledged the Program as a well-structured proposal, which permits a broader management view on the health services. The interviewees evidenced the use of the quality indicators, which was hardly addressed and understood in the managers and teams' daily reality though. The interviewees demonstrated that they do not understand the concepts of continuing education and institutional support. The external evaluation phase was considered subjective and without standardization, producing data that did not contribute to the assessment of the changes the teams made. Conclusion: The systematic incorporation process of the assessment culture to support the continuing quality improvement in Primary Health Care is incipient. Despite the continuing distance between the proposals of Primary Health Care and the practice at the Primary Health Care services studied, the Program favored the organization of the work processes and contributed to the managers' focus on the teams' practice and their own activities. ResumoObjetivo: Analisar a implementação do Programa Nacional de Melhoria do Acesso e da Qualidade segundo gerentes de Unidades Básicas de Saúde. Métodos: Utilizou-se a história oral temática, por meio de entrevistas semiestruturadas com cinco gerentes de Unidades Básicas de Saúde que participaram ativamente dos dois ciclos do Programa em um distrito administrativo do município de São Paulo. Os sujeitos responderam, dentre outras, à questão "Como você avalia o processo de implementação do Programa Nacional de Melhoria do Acesso e da Qualidade nesta Unidade Básica de Saúde?" e da análise dos depoimentos emergiram as categorias "Percepção dos gestores quanto à implementação do Programa Nacional de Melhoria do Acesso e da Qualidade" e "Mudanças nos processos de trabalho a partir da implementação do Programa Nacional de Melhoria do Acesso e da Qualidade". Resultados: Os gerentes reconheceram o Programa como uma proposta bem estruturada, que permite ampliar a visão gerencial nos serviços de saúde. O uso dos indicadores de qualidade foi evidenciado pelos entrevistados, mas pouco trabalhado e compreendido no cotidiano dos gestores e equipes. Os entrevistados demonstraram não compr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

et al. 2017

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Work overload and associated factors in healthcare professionals during the COVID-19 pandemic

Leite,

Sato,

Fraga Maia

et al. 2024

Journal of Healthcare Quality Research

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Does pay-for-performance design matter? Evidence from Brazil

Russo,

Powell-Jackson,

Borghi

et al. 2024

Health Policy and Planning

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Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil (PMAQ) and exploring the association of alternative design typologies with the performance of primary health /care providers. We carried out a nation-wide survey of municipal health managers to characterize the scheme design, based on the size of the bonus, the providers incentivized, and the frequency of payment. Using OLS regressions and controlling for municipality characteristics, we examined whether each design feature was associated with better family health team performance. To capture potential interactions between design features, we used cluster analysis to group municipalities into five design typologies and then examined associations with quality of care. A majority of the municipalities included in our study used some of the PMAQ funds to provide bonuses to family health team workers, while the remaining municipalities spent the funds in the traditional way using input-based budgets. Frequent bonus payments (monthly) and higher size bonus allocations (share of 20–80%) were strongly associated with better team performance, while who within a team was eligible to receive bonuses did not in isolation appear to influence performance. The cluster analysis showed what combinations of design features were associated with better performance. The PMAQ score in the ‘large bonus/many workers/high-frequency’ cluster was 8.44 points higher than the ‘no bonus’ cluster, equivalent to a difference of 21.7% in the mean PMAQ score. Evidence from our study shows how design features can potentially influence health provider performance, informing the design of more effective P4P schemes.

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Estudo avaliativo do processo de trabalho das Equipes de Atenção Básica a partir do PMAQ-AB

Cited by 21 publications

References 3 publications

Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

Work overload and associated factors in healthcare professionals during the COVID-19 pandemic

Does pay-for-performance design matter? Evidence from Brazil

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