Objectives Although different forms of patient feedback are available, their use in hospital management is still limited. The objective of this study is to explore how patient feedback is currently used in hospitals to improve quality. Design This is a qualitative exploratory multiple case study. Data collection included nine interviews, of an average duration of 50 min, conducted between March and June 2019. Additionally, a document and secondary data analysis were performed. Setting This study was conducted in three Brazilian hospitals selected for their solid patient feedback practises. Participants Managers from the customer service, quality, nursing, operations, projects and patient experience departments of the three hospitals. Results Despite literature suggesting that organisational objectives regarding patient feedback are not clear, data show that there is managerial concern regarding the promotion of an environment capable of changing according to patient feedback. In these instances, organisational processes were structured to focus on patients’ feedback and its receipt by the staff, including a non-punitive culture. Several patient feedback forms are available: voluntary events, patient surveys and informal feedback. Instruments to measure patient feedback focused on specific aspects of healthcare, to identify and clarify the problems for addressal by the management. The net promoter score was the main strategic indicator of patient feedback, used to assess the impact of improvement action. Conclusions The hospitals had established objectives that valued the patient’s perspective. Involvement of the health team, availability of different channels for feedback and the use of quality tools are considered a good basis for using patient feedback to drive quality improvement.

Nas organizações de saúde, estudos de microcusteio possibilitam detalhar os recursos consumidos em diferentes procedimentos/processos assistenciais e os respectivos custos unitários, gerando informações que fundamentam as tomadas de decisão visando ao eficiente gerenciamento de custos. Para sua condução, são necessários a obtenção e o tratamento de dados relativos à massa salarial dos profissionais participantes, jornada contratual mensal de trabalho, dados de caracterização sociodemográfica de pacientes e profissionais, preço de aquisição e forma de apresentação dos insumos. Assim, a construção de uma ferramenta eletrônica de apoio ao pesquisador contribuiria à agilidade no tratamento dos dados Objetivo: Relatar a experiência do desenvolvimento do protótipo de um simulador de microcusteio bottom-up para calcular os custos diretos com pessoal e insumos (materiais, medicamentos e/ou soluções) requeridos à viabilização de procedimentos/processos em Saúde e Enfermagem. Método: Pesquisa metodológica para produção tecnológica fundamentada nos princípios do modelo de prototipação, na modalidade estudo de caso único. Resultados: O protótipo do simulador possui campos para inserção de dados de caracterização dos participantes, cotação da moeda (de escolha do pesquisador) para conversão dos valores em reais, massa salarial média, conforme a categoria dos profissionais envolvidos, e preço unitário de aquisição dos insumos. A partir desses dados, calcula, automaticamente, os números absolutos, percentuais e os valores médios, desvio padrão, mínimo-máximo e quartis de variáveis sociodemográficas e dos custos diretos com pessoal e insumos, disponibilizando-os na forma de quadros e tabelas sínteses. Eventuais customizações e ajustes poderão ser realizados pelo pesquisador, em suas planilhas de trabalho, com base nos templates sugeridos e resultados obtidos por meio do protótipo. Considerações finais: O protótipo do simulador é de fácil usabilidade e possibilita o tratamento dos dados de microcusteio por meio de estatística descritiva.

Objective: to investigate the contributions of applying the Lean methodology to improve work processes in health and nursing and its impact on associated financial aspects. Method: an integrative review, carried out in six databases, whose sample of ten (100.0%) studies was analyzed and summarized descriptively. Results: the outcomes obtained were stratified into: benefits/barriers to Lean Healthcare implementation; economic aspects involving Lean Healthcare implementation; and process improvements through Lean Healthcare implementation. The majority of studies (60.0%) were carried out in university hospitals, contexts that need to continually improve the quality of services provided, generally with scarce and limited resources, which support the viability of maintaining the teaching, research and extension tripod. Conclusion: three (30.0%) studies highlighted the financial aspects associated with Lean methodology application. The others only mentioned the possibility of financial gains through improving processes and reducing waste.

Background Patient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement. Objective To understand PFE in quality management (QM) in the hospital environment. Design A qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique. Setting and participants A total of seven Brazilian hospitals were selected based on the theoretical sampling technique. Results A total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of the community and the change in access to the information. At the centre of the change is the balance in power relations between patients and professionals, the sharing of information from the hospital and a proactive attitude towards improving services. Conclusions The PFE involves a cultural and process change. Cultural change is represented by ‘openness’, that is, openness to learn, to listen and to consider new perspectives. The change in processes is in turn characterised by the phrase ‘test and venture’ because the model to be adopted may be different between hospitals. The patient’s perspective allows actions to be driven towards what really matters to them, ensuring quality of service and safety, obtaining a new perspective to understand and solve problems, and stimulating a sense of urgency, more empathy and compassion in professionals.

This theoretical and reflexive study analyzed the risks related to the maintenance of patency of the Peripherally Inserted Central Catheter with the use of saline solution in comparison with saline-filled syringes, through the application of the Healthcare Failure Mode and Effect Analysis - HFMEA. The process was mapped, detailing the failure modes of each step. For the calculation of the Risk Priority Number, the severity and probability of the failure modes were analyzed. This analysis gave rise to the severity and probability matrix. Finally, actions to reduce the failure modes in the maintenance of patency were proposed, considering the use of saline-filled syringes in comparison to the use of saline ampoules. It was verified that the use of saline ampoules is associated with a greater risk, since it requires four stages more than saline-filled syringe does not, increasing the risk of contamination and the level of three different risks, which would result in additional hospital costs. The use of the saline-filled syringe would avoid risks that could negatively affect the patient’s health, the nursing professional and the health institution.