Enfermagem Lean

 Existem cada vez mais Hospitais que se encontram a implementar sistemas de melhoria da qualidade com base nos princípios do pensamento "lean" derivados em grande parte do Sistema de Produção da Toyota (SPT). Este sistema, que distingue dois tipos de atividades de fabrico - as que agregam valor e as que criam resíduos/desperdícios, tem como objetivo eliminar o desperdício e maximizar o valor. Os conceitos SPT têm sido utilizados na Gestão das Organizações há várias décadas e tornaram-se, nos últimos anos, bastante populares no sector da saúde. Na Saúde, os líderes em Enfermagem acreditam que os doentes/clientes estão dispostos a pagar os cuidados (direta/indirectamente) e, por conseguinte, a qualidade inerente aos mesmos quando se deslocam a um hospital para serem diagnosticados, tratados e receberem alta, mas não estão dispostos a pagar mais do que isso (ou seja, os resíduos considerados). Então, surge a questão que é: como remover os desperdícios nos processos hospitalares para melhorar a eficiência e os resultados nos doentes/clientes? Antes dos desperdícios serem removidos, estes têm de ser claramente identificados. O SPT identifica sete resíduos que não agregam valor no negócio/fabrico. Mark Graban (2009) modificou as definições desses resíduos para se poder aplicar aos cuidados de saúde e enumerou-os da seguinte forma: potencial humano não usado, tempo de espera para os procedimentos, ausência de inventário dos recursos, tempo dos transportes (materiais e pessoas), defeitos (materiais e nos procedimentos), duplicação de informação, tarefas repetidas e processos desnecessários. O pensamento “magro” começa com a definição de uma cadeia de valor - processo específico que é usado para fornecer um serviço aos clientes. Korner et al. (2011) afirmam que para isto acontecer, a liderança deve responder a perguntas como: O que é que os doentes pretendem do hospital/serviço? O que é que os doentes estão dispostos a pagar? Respondendo a estas questões Korner et al. (2011) definiram um fluxo de valor com foco na melhoria do acesso e utilização dos serviços, o que reduziu o tempo de internamento, melhorou a satisfação dos doentes e encurtou os tempos de transferências de doentes. Para a implementação do pensamento “lean” é necessário o uso das ferramentas “lean” cuja aplicação visam a melhoria da qualidade dos processos e a eliminação dos desperdícios identificados. A Enfermagem desempenha um papel fulcral nesta filosofia da gestão desde o atendimento à alta do doente/cliente devido às acções que desempenha junto do mesmo.

Mapas mentais | Mind Maps

Os mapas mentais são excelentes ferramentas para organizar e relacionar ideias que tenhamos para determinado projeto ou investigação. Uma vez colocada a ideia no mapa outras surgem consequentemente e muitas vezes estabelecemos relações que mentalmente não o conseguiríamos, só mesmo depois de visualizadas no mapa desenhado.

"Relevance trees may also prove useful in generating research topics. In this instance, their use is similar to that of mind mapping (Buzan 2006), in which you start with a broad concept from which you generate further (usually more specific) topics. Each of these topics forms a separate branch from which you can generate further, more detailed subbranches."

Criar uma cultura de qualidade | Creating a culture of quality

In most industries, quality has never mattered more. New technologies have empowered customers to seek out and compare an endless array of products from around the globe. Shoppers can click to find objective data compiled by experts at organizations such as Consumer Reports and J.D. Power and go online to read user-generated reviews at sites such as Amazon; together, these sources provide an early warning system that alerts the public to quality problems. And when customers are unhappy with a product or service, they can use social media to broadcast their displeasure. In surveys, 26% of consumers say they have used social media to air grievances about a company and its products. And this issue isn’t limited to the consumer space—75% of B2B customers say they rely on word of mouth, including social media, when making purchase decisions.

But just as companies’ margin for error has decreased, the likelihood of error has risen. In many industries, cycle times are compressing. During the recovery from the Great Recession, output gains have outpaced employment growth, and employees report straining to keep up with demands.

As a result of these pressures, managers must find a new approach to quality—one that moves beyond the traditional “total quality management” tools of the past quarter century. For two years CEB has conducted research exploring how companies can create a culture in which employees “live” quality in all their actions—where they are passionate about quality as a personal value rather than simply obeying an edict from on high. We define a “true culture of quality” as an environment in which employees not only follow quality guidelines but also consistently see others taking quality-focused actions, hear others talking about quality, and feel quality all around them.

We interviewed the quality function leaders at more than 60 multinational corporations, conducted an extensive review of academic and practitioner research, and surveyed more than 850 employees in a range of functions and industries and at all levels of seniority. Some of what we learned surprised us. Most notably, many of the traditional strategies used to increase quality—monetary incentives, training, and sharing of best practices, for instance—have little effect. Instead, we found, companies that take a grassroots, peer-driven approach develop a culture of quality, resulting in employees who make fewer mistakes—and the companies spend far less time and money correcting mistakes.

Going Beyond Rules

What embeds quality deep in a company’s culture? And how, precisely, does an organization benefit as a result? These questions were at the heart of our “culture of quality” survey.

A minority of the employees we surveyed believe their company has succeeded in making quality a core value: Roughly 60% said they work in an environment without a culture of quality, especially when it comes to having peers who go “above and beyond.” Such companies are missing out on significant benefits. Employees who ranked their company in the top quintile in terms of quality reported addressing 46% fewer mistakes in their daily work than employees in bottom-quintile companies. In our surveys, employees report that it takes two hours, on average, to correct a mistake. Assuming an hourly wage of $42.55 (the median for CEB client companies), a bottom-quintile firm with 26,300 employees (the median head count) spends nearly $774 million a year to resolve errors, many of them preventable—$350 million more than a top-quintile firm. Although figures will vary according to industry and company, here’s a broad rule of thumb: For every 5,000 employees, moving from the bottom to the top quintile would save a company $67 million annually.

We also studied quality-improvement actions in eight different categories and conducted regression analyses to understand the relationship between those actions and employees’ appraisals of how rigorously their company focuses on quality. We found little or no correlation between the use of standard tools and the achievement of a culture of quality. We are not suggesting that companies abandon those tools; however, they should use them to support rules-based quality measures, not as the underpinnings of a true culture of quality.

We pinpointed four factors that drive quality as a cultural value: leadership emphasis, message credibility, peer involvement, and employee ownership of quality issues. Our research indicates that companies could do much better with all four. Nearly half the employees surveyed reported insufficient leadership emphasis on quality, and only 10% found their company’s quality messages credible. Just 38% reported high levels of peer involvement, while 20% said that their company has created a sense of employee empowerment and ownership for quality outcomes.

The Four Essentials of Quality

In our research, we examined tools commonly used to make employees care about quality, including training, best-practices sharing, and monetary incentives. We concluded that only four attributes actually predict a culture of quality:

Leadership Emphasis

Managers are told that quality is a leadership priority.

Managers “walk the talk” on quality.

When evaluating employees, bosses emphasize the importance of quality.

Message Credibility

Messages are delivered by respected sources.

Workers find that communications appeal to them personally.

Messages are consistent and easy to understand.

Peer Involvement

Most employees have a strong network of peers for guidance.

Peers routinely raise quality as a topic for team discussion.

Like members of a sports team, peers hold one another accountable.

Employee Ownership

Workers clearly understand how quality fits with the job.

Workers are empowered to make quality decisions.

Workers are comfortable raising concerns about quality violations and challenging directives that detract from quality.

in http://hbr.org/2014/04/creating-a-culture-of-quality/ar/1

O que todos os líderes deveriam saber sobre os seguidores |

What Every Leader Needs to Know About Followers

Neste artigo Barbara Kellerman enumera os diferentes tipos de seguidores dentro de uma organização. Esta tipificação baseia-se em anos de observação e estudo e que nos ajuda a compreende de que forma os trabalhadores de uma empresa se encontram comprometidos com a visão do seu líder.

There is no leader without at least one follower—that’s obvious. Yet the modern leadership industry, now a quarter-century old, is built on the proposition that leaders matter a great deal and followers hardly at all.

Good leadership is the stuff of countless courses, workshops, books, and articles. Everyone wants to understand just what makes leaders tick—the charismatic ones, the retiring ones, and even the crooked ones. Good followership, by contrast, is the stuff of nearly nothing. Most of the limited research and writing on subordinates has tended to either explain their behavior in the context of leaders’ development rather than followers’ or mistakenly assume that followers are amorphous, all one and the same. As a result, we hardly notice, for example, that followers who tag along mindlessly are altogether different from those who are deeply devoted.

In reality, the distinctions among followers in groups and organizations are every bit as consequential as those among leaders. This is particularly true in business: In an era of flatter, networked organizations and cross-cutting teams of knowledge workers, it’s not always obvious who exactly is following (or, for that matter, who exactly is leading) and how they are going about it. Reporting relationships are shifting, and new talent-management tools and approaches are constantly emerging. A confluence of changes—cultural and technological ones in particular—have influenced what subordinates want and how they behave, especially in relation to their ostensible bosses.

It’s long overdue for leaders to acknowledge the importance of understanding their followers better. In these next pages, I explore the evolving dynamic between leaders and followers and offer a new typology for determining and appreciating the differences among subordinates. These distinctions have critical implications for how leaders should lead and managers should manage.

A Level Playing Field

Followers can be defined by their behavior—doing what others want them to do. But for the purposes of this article, and to avoid confusing what followers do with who they are, I define followers according to their rank: They are low in the hierarchy and have less power, authority, and influence than their superiors. They generally go along to get along, particularly with those in higher positions. In the workplace, they may comply so as not to put money or stature at risk. In the community, they may comply to preserve collective stability and security—or simply because it’s the easiest thing to do.

History tells us, however, that subordinates do not follow all the time. As the ideas of the Enlightenment took hold in the eighteenth century, for instance, ordinary people (in industrialized societies especially) became less dependent on kings, landowners, and the like, and their expectations changed accordingly—as did their sense of empowerment. The trend continues. Increasingly, followers think of themselves as free agents, not as dependent underlings. And they act accordingly, often withholding support from bad leaders, throwing their weight behind good ones, and sometimes claiming commanding voices for those lower down in the social or organizational hierarchy.

Witness the gradual demise of communism (and totalitarianism) in the former Soviet Union, Eastern Europe, and now China. And consider the social and political upheavals, all of them antiauthority, in the United States and elsewhere during the 1960s and 1970s. Similarly, there has been a dispersion of power at the highest levels of American business, partly because of changes in the cultures and structures of corporations as well as the advance of new technologies. CEOs share power and influence with a range of players, including boards, regulators, and shareholder activists. Executives at global companies must monitor the activities of subordinates situated thousands of miles away. And knowledge workers can choose independently to use collaborative technologies to connect with colleagues and partners in other companies and countries in order to get things done. The result is reminiscent of what management sage Peter Drucker suggested in his 1967 book The Effective Executive: In an era dominated by knowledge workers rather than manual workers, expertise can—and often does—trump position as an indicator of who is really leading and who is really following.

Types of Followers

Over the years, only a handful of researchers have attempted to study, segment, and speak to followers in some depth. To various degrees, Harvard Business School professor Abraham Zaleznik, Carnegie Mellon adjunct professor Robert Kelley, and executive coach Ira Chaleff have all argued that leaders with even some understanding of what drives their subordinates can be a great help to themselves, their followers, and their organizations. Each researcher further recognized the need to classify subordinates into different types. (See the sidebar “Distinguishing Marks: Three Other Follower Typologies.”)

Kellerman’s typology specifies five types of followers: isolates, bystanders, participants, activist and diehards.

a) Isolates are completely detached. These followers are scarcely aware of what’s going on around them. Moreover, they do not care about their leaders, know anything about them, or respond to them in any obvious way. Their alienation is, nevertheless, of consequence. By knowing and doing nothing, these types of followers passively support the status quo and further strengthen leaders who already have the upper hand. As a result, isolates can drag down their groups or organisations. Bystanders observe but do not participate. These free riders deliberately stand aside and disengage, both from their leaders and from their groups or organisations. They may go along passively when it is in their self-interest to do so, but they are not internally motivated to engage in an active way. Their withdrawal also amounts to tacit support for whoever and whatever constitutes the status quo.

b) Participants are engaged in some way. Regardless of whether these followers clearly support their leaders and organisations or clearly oppose them, they care enough to invest some of what they have (time or money, for example) to try to make an impact.

c) Activists feel strongly one way or another about their leaders and organisations, and they act accordingly. These followers are eager, energetic and engaged. They invest heavily in people and processes, so they work hard either on behalf of their leaders or to undermine and even unseat them.

d) Diehards are prepared to go down for their cause – whether it’s an individual, an idea, or both. These followers may be deeply devoted to their leaders, or they may be strongly motivated to oust their leaders by any means necessary. They exhibit an allconsuming dedication to someone or something they deem worthy.

in http://hbr.org/2007/12/what-every-leader-needs-to-know-about-followers/ar/1