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Barreto JOM, Romão DMM, Setti C, Machado MLT, Riera R, Gomes R, Machado DA, Abreu J, de Andrade KRC, Boeira LDS, Pozza L, Souza NM, Logullo P, Silva RB, de Oliveira SMDVL, Mota SEDC, Dias TS, Toma TS, da Silva SF. An evidence-informed policymaking (EIPM) competency profile for the Brazilian Health System developed through consensus: process and outcomes. Health Res Policy Syst 2023; 21:105. [PMID: 37828575 PMCID: PMC10571264 DOI: 10.1186/s12961-023-01052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Evidence-informed policymaking (EIPM) requires a set of individual and organizational knowledge, skills and attitudes that should be articulated with background factors and needs. In this regard, the development of an EIPM competency profile is important to support the diagnosis, planning and implementation of EIPM. PURPOSE To present the process and outcomes of the development of an EIPM competency profile by an expert committee, to be applied in different contexts of the Brazilian Health System. METHODS A committee of experts in EIPM shared different views, experiences and opinions to develop an EIPM competency profile for Brazil. In six consensus workshops mediated by facilitators, the committee defined from macro problems to key actions and performances essential for the competency profile. The development steps consisted of: (1) Constitution of the committee, including researchers, professionals with practical experience, managers, and educators; (2) Development of a rapid review on EIPM competency profiles; (3) Agreement on commitments and responsibilities in the processes; (4) Identification and definition of macro problems relating to the scope of the competency profile; and (5) Outlining of general and specific capacities, to be incorporated into the competency profile, categorized by key actions. RESULTS The development of the EIPM competency profile was guided by the following macro problems: (1) lack of systematic and transparent decision-making processes in health policy management; (2) underdeveloped institutional capacity for knowledge management and translation; and (3) incipient use of scientific evidence in the formulation and implementation of health policies. A general framework of key actions and performances of the EIPM Competency Profile for Brazil was developed, including 42 specific and general key actions distributed by area of activity (Health Management, Scientific Research, Civil Society, Knowledge Translation, and Cross-sectional areas). CONCLUSIONS The competency profile presented in this article can be used in different contexts as a key tool for the institutionalization of EIPM.
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Affiliation(s)
| | | | - Cecilia Setti
- Hospital Sírio-Libanês, São Paulo, Brazil
- Veredas Institute, São Paulo, Brazil
| | | | - Rachel Riera
- Hospital Sírio-Libanês, São Paulo, Brazil
- Unifesp (Federal University of São Paulo), São Paulo, Brazil
| | - Romeu Gomes
- Hospital Sírio-Libanês, São Paulo, Brazil
- IFF/Fiocruz (National Institute of Women, Children and Adolescents Health Fernandes Figueira), Rio de Janeiro, Brazil
| | | | | | | | | | | | | | - Patrícia Logullo
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases (NDORMS), and UK EQUATOR Centre, University of Oxford, Oxford, United Kingdom
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Riera R, de Oliveira Cruz Latorraca C, Padovez RCM, Pacheco RL, Romão DMM, Barreto JOM, Machado MLT, Gomes R, da Silva SF, Martimbianco ALC. Strategies for communicating scientific evidence on healthcare to managers and the population: a scoping review. Health Res Policy Syst 2023; 21:71. [PMID: 37430348 DOI: 10.1186/s12961-023-01017-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Health evidence needs to be communicated and disseminated in a manner that is clearly understood by decision-makers. As an inherent component of health knowledge translation, communicating results of scientific studies, effects of interventions and health risk estimates, in addition to understanding key concepts of clinical epidemiology and interpreting evidence, represent a set of essential instruments to reduce the gap between science and practice. The advancement of digital and social media has reshaped the concept of health communication, introducing new, direct and powerful communication platforms and gateways between researchers and the public. The objective of this scoping review was to identify strategies for communicating scientific evidence in healthcare to managers and/or population. METHODS We searched Cochrane Library, Embase®, MEDLINE® and other six electronic databases, in addition to grey literature, relevant websites from related organizations for studies, documents or reports published from 2000, addressing any strategy for communicating scientific evidence on healthcare to managers and/or population. RESULTS Our search identified 24 598 unique records, of which 80 met the inclusion criteria and addressed 78 strategies. Most strategies focused on risk and benefit communication in health, were presented by textual format and had been implemented and somehow evaluated. Among the strategies evaluated and appearing to yield some benefit are (i) risk/benefit communication: natural frequencies instead of percentages, absolute risk instead relative risk and number needed to treat, numerical instead nominal communication, mortality instead survival; negative or loss content appear to be more effective than positive or gain content; (ii) evidence synthesis: plain languages summaries to communicate the results of Cochrane reviews to the community were perceived as more reliable, easier to find and understand, and better to support decisions than the original summaries; (iii) teaching/learning: the Informed Health Choices resources seem to be effective for improving critical thinking skills. CONCLUSION Our findings contribute to both the knowledge translation process by identifying communication strategies with potential for immediate implementation and to future research by recognizing the need to evaluate the clinical and social impact of other strategies to support evidence-informed policies. Trial registration protocol is prospectively available in MedArxiv (doi.org/10.1101/2021.11.04.21265922).
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Affiliation(s)
- Rachel Riera
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Carolina de Oliveira Cruz Latorraca
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | | | - Rafael Leite Pacheco
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil.
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Davi Mamblona Marques Romão
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Instituto Veredas, São Paulo, Brazil
| | - Jorge Otávio Maia Barreto
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Fundação Oswaldo Cruz, Brasília, Brazil
| | - Maria Lúcia Teixeira Machado
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Carlos, São Carlos, Brazil
| | - Romeu Gomes
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Fundação Oswaldo Cruz, Brasília, Brazil
| | | | - Ana Luiza Cabrera Martimbianco
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Metropolitna de Santo (Unimes), Santos, Brazil
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Barreto JOM, Romão DMM, Setti C, Machado MLT, Riera R, Gomes R, da Silva SF. Competency profiles for evidence-informed policy-making (EIPM): a rapid review. Health Res Policy Syst 2023; 21:16. [PMID: 36755283 PMCID: PMC9909856 DOI: 10.1186/s12961-023-00964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Evidence-informed policy-making (EIPM) requires a set of individual and organizational capacities, linked with background factors and needs. The identification of essential knowledge, skills and attitudes for EIPM can support the development of competency profiles and their application in different contexts. PURPOSE To identify elements of competency (knowledge, skills and attitudes) for EIPM, according to different professional profiles (researcher, health professional, decision-maker and citizen). METHODS Rapid umbrella review. A structured search was conducted and later updated in two comprehensive repositories (BVSalud and PubMed). Review studies with distinctive designs were included, published from 2010 onwards, without language restrictions. Assessment of the methodological quality of the studies was not performed. A meta-aggregative narrative synthesis was used to report the findings. RESULTS Ten reviews were included. A total of 37 elements of competency were identified, eight were categorized as knowledge, 19 as skills and 10 as attitudes. These elements were aggregated into four competency profiles: researcher, health professional, decision-maker and citizen. The competency profiles included different sets of EIPM-related knowledge, skills and attitudes. STRENGTHS AND LIMITATIONS This study is innovative because it aggregates different profiles of competency from a practical perspective, favouring the application of its results in different contexts to support EIPM. Methodological limitations are related to the shortcuts adopted in this review: complementary searches of the grey literature were not performed, and the study selection and data extraction were not conducted in duplicate. FINAL CONSIDERATIONS CONCLUSIONS AND IMPLICATIONS OF THE FINDINGS: EIPM requires the development of individual and organizational capacities. This rapid review contributes to the discussion on the institutionalization of EIPM in health systems. The competency profiles presented here can support discussions about the availability of capacity and the need for its development in different contexts.
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Affiliation(s)
- Jorge Otávio Maia Barreto
- Hospital Sírio-Libanês (HSL), São Paulo, Brazil. .,Fundação Oswaldo Cruz (Fiocruz), Brasília, Brazil.
| | - Davi Mamblona Marques Romão
- grid.413471.40000 0000 9080 8521Hospital Sírio-Libanês (HSL), São Paulo, Brazil ,Instituto Veredas, São Paulo, Brazil
| | | | - Maria Lúcia Teixeira Machado
- grid.413471.40000 0000 9080 8521Hospital Sírio-Libanês (HSL), São Paulo, Brazil ,grid.411247.50000 0001 2163 588XUniversidade Federal de São Carlos (UFSCar), São Paulo, Brazil
| | - Rachel Riera
- grid.413471.40000 0000 9080 8521Hospital Sírio-Libanês (HSL), São Paulo, Brazil ,grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Romeu Gomes
- grid.413471.40000 0000 9080 8521Hospital Sírio-Libanês (HSL), São Paulo, Brazil ,grid.418068.30000 0001 0723 0931Fundação Oswaldo Cruz (IFF/Fiocruz), Rio de Janeiro, Brazil
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Padilha RDQ, Gomes R, Lima VV, Soeiro E, Oliveira JMD, Schiesari LMC, Silva SFD, Oliveira MSD. Principles of clinical management: connecting management, healthcare and education in health. Cien Saude Colet 2019; 23:4249-4257. [PMID: 30540008 DOI: 10.1590/1413-812320182312.32262016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 01/06/2017] [Indexed: 05/30/2023] Open
Abstract
This paper aims at proposing validated principles to underpin clinical management as a means to transform healthcare for integrated healthcare systems. The starting point was the conception of clinical management based on structuring elements that do not separate management, care and education. The authors' proposal was submitted to specialists so that a consensus could be reached. At the end of the process, the following principles of clinical management were presented: (1) Focus on health needs and comprehensive care, (2) Quality and safety in healthcare, (3) Articulation and legitimation of different health practices and types of knowledge to face health problems, (4) Power sharing and co-accountability among managers, health professionals and citizens in healthcare production; (5) Education of people and organizations; (6) Focus on outcomes that add value to health and life; (7) Transparency and accountability regarding collective interests. It is concluded that the principles of clinical management express connections that shed new light on management, healthcare, and education in integrated healthcare systems, requiring critical awareness in relation to the simultaneity of "permanence" and change in practices.
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Affiliation(s)
- Roberto de Queiroz Padilha
- Universidade Federal de São Carlos. Rodovia Washington Luís s/n, Jardim Guanabara. 13565-905 São Carlos SP Brasil.
| | - Romeu Gomes
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês. São Paulo SP Brasil
| | - Valéria Vernaschi Lima
- Universidade Federal de São Carlos. Rodovia Washington Luís s/n, Jardim Guanabara. 13565-905 São Carlos SP Brasil.
| | - Everton Soeiro
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês. São Paulo SP Brasil
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Conill EM, Xavier DR, Piola SF, Silva SFD, Barros HDS, Báscolo E. Social Determinants, Conditions and Performance of Health Services in Latin American Countries, Portugal and Spain. Cien Saude Colet 2018; 23:2171-2186. [PMID: 30020373 DOI: 10.1590/1413-81232018237.07992018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022] Open
Abstract
Comparison can be an important resource for identifying trends or interventions that improve the quality of health services. Although Portugal and Spain have accumulated important knowledge in primary health care-PHC driven national systems, the Ibero-American countries have not been object of comparative studies. This paper presents an assessment using an analytical dashboard created by the Ibero-American Observatory on Policies and Health Systems. It discusses aspects that have stood out in monitoring the service systems of Argentina, Brazil, Colombia, Spain, Paraguay, Peru, and Portugal throughout the 21st century's first decade. Forty-five indicators and time series showing the highest completeness degree divided into social determinants, conditions and performance were analyzed. Three trends are common to almost all countries: overweight increase, negative trade balance for pharmaceutical products, and an increase in health system expenditure. This convergence trend reveals the need for changes in the way of regulating, organizing and delivering health services with public policies and practices that guarantee comprehensive care, including health promotion actions enabling systems sustainability.
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Affiliation(s)
- Eleonor Minho Conill
- Observatório Iberoamericano de Políticas e Sistemas de Saúde. SCLN 406 Bloco A 2º andar, Asa Norte. 70847-510 Brasília DF Brasil.
| | - Diego Ricardo Xavier
- Observatório Iberoamericano de Políticas e Sistemas de Saúde. SCLN 406 Bloco A 2º andar, Asa Norte. 70847-510 Brasília DF Brasil.
| | | | - Silvio Fernandes da Silva
- Observatório Iberoamericano de Políticas e Sistemas de Saúde. SCLN 406 Bloco A 2º andar, Asa Norte. 70847-510 Brasília DF Brasil.
| | - Heglaucio da Silva Barros
- Observatório Iberoamericano de Políticas e Sistemas de Saúde. SCLN 406 Bloco A 2º andar, Asa Norte. 70847-510 Brasília DF Brasil.
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Gomes R, Lima VV, de Oliveira JM, Schiesari LMC, Soeiro E, Damázio LF, Petta HL, de Oliveira MS, da Silva SF, Sampaio SF, Padilha RDQ, Machado JLM, Caleman G. The Polisemy of Clinical Governance: a review of literature. Cien Saude Colet 2015. [PMID: 26221808 DOI: 10.1590/1413-81232015208.11492014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The article aims to explore the concept of clinical management, with a view towards understanding the diverse meanings that could be attributed to that expression. This discussion can contribute to the planning and organization of health services geared to the management of clinical practices, as well as to set forth principles to draft actions in that field. Methodologically, the study consists of a qualitative literature review, using keywords of the Virtual Health Library (VHL). In terms of results, seven topics stand out that synthesize the analysis of sources: management, quality promotion, clinical monitoring or auditing, education, responsibility or accountability, safety in care and a systemic dimension. The conclusion is that the variation of meanings relates to the way in which the authors of the studies reviewed express or unfold the structuring conceptual components broadly accepted as clinical governance. What we observe is a lack of a greater focus on discussions regarding planning and policies relating to clinical governance.
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Affiliation(s)
- Romeu Gomes
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil,
| | | | | | | | - Everton Soeiro
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil,
| | | | - Helena Lemos Petta
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil,
| | | | | | | | | | | | - Gilson Caleman
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil,
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Silva SFD, Souza NM, Barreto JOM. Fronteiras da autonomia da gestão local de saúde: inovação, criatividade e tomada de decisão informada por evidências. Ciênc saúde coletiva 2014; 19:4427-38. [DOI: 10.1590/1413-812320141911.16612013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/21/2013] [Indexed: 11/21/2022] Open
Abstract
O propósito deste artigo foi identificar as fronteiras da autonomia da gestão municipal no contexto do pacto federativo do Sistema Único de Saúde brasileiro e a importância e possibilidade de fomentar inovação, criatividade e tomada de decisão, informada pelas melhores evidências pelos governos locais. Metodologicamente partimos de questões que propiciaram diálogo com a literatura específica, visando identificar a influência das políticas com formulação centralizada nos espaços de autonomia local para, em seguida, identificar estratégias de incentivo à inovação, criatividade e uso sistemático da evidência de pesquisas na implementação de políticas em saúde. Constatamos uma redução gradativa da autonomia decisória pelo maior comprometimento financeiro dos municípios, decorrente das novas responsabilidades assumidas, bem como a possibilidade de reversão dessa tendência no contexto mais recente. Analisamos também determinantes e desafios para a difusão de práticas inovadoras e apresentamos experiências nacionais e internacionais com essa finalidade. Concluímos ser possível tornar mais efetivo o processo decisório local, desde que se consolidem iniciativas que estimulem essa cultura e a formulação e implementação de políticas informadas por evidências.
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Silva SFD. Organização de redes regionalizadas e integradas de atenção à saúde: desafios do Sistema Único de Saúde (Brasil). Ciênc saúde coletiva 2011; 16:2753-62. [DOI: 10.1590/s1413-81232011000600014] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 12/16/2010] [Indexed: 11/22/2022] Open
Abstract
O artigo refere-se às causas da segmentação/fragmentação na atenção à saúde e aos benefícios da integração e constituição de redes para racionalizar gastos, otimizar recursos e promover uma atenção condizente com as necessidades dos usuários. Tem como principal objetivo analisar os desafios presentes no Sistema Único de Saúde para promover uma melhor integração entre os serviços e organizar redes. Entre os desafios abordados, destacam-se os relacionados à insuficiência de recursos decorrentes do baixo financiamento público, aos processos de formação e educação e seus reflexos na disponibilização dos profissionais para o sistema público e às dificuldades inerentes à descentralização de ações e serviços de saúde no contexto do pacto federativo brasileiro. O artigo conclui que, além de esforços para enfrentar esses desafios, a organização de redes regionalizadas e integradas no SUS depende de aperfeiçoamento na gestão intergovernamental nas regiões de saúde para qualificar a pactuação de responsabilidades entre as esferas de governo e de qualificação da atenção primária à saúde para coordenar o cuidado e ordenar sua continuidade nos outros níveis do sistema.
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da Silva SF. [Interfaces between the management of the Unified Health System and the regulation of private health plans]. Cien Saude Colet 2008; 13:1403-6; discussion 1406-8. [PMID: 18813642 DOI: 10.1590/s1413-81232008000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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