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Li QC, Karnon J, Codde J. Outcomes of completed quality activities in an Australian tertiary hospital, 2015-2019. Int J Qual Health Care 2023; 35:mzad074. [PMID: 37738459 DOI: 10.1093/intqhc/mzad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
Quality activities including quality assurance and quality improvement are an integral part of safety and quality governance for hospitals. Previous studies identified that (i) majority are for quality assurance and knowledge-acquiring purposes and (ii) adherence to the quality cycle as well as impact on patient-related outcomes at the hospital level are unclear, neither associated with costs. This study aims to (i) assess adherence to the quality cycle for quality activities in a large Australian tertiary hospital; (ii) report outcomes of quality activities at the hospital level, including impact on patient-related outcomes measured by the occurrence of hospital-acquired complications; and (iii) estimate time and costs for data collection. This quantitative study utilized three data sources. First is the hospital's electronic quality management system, Governance, Evidence, Knowledge and Outcome that identifies completed quality activities over a 5-year period; second is Tableau dashboards for hospital-acquired complication performance; third is Microsoft Teams Forms used to capture time of data collection for bedside observations and retrospective notes reviews. Median sample size and median hourly rates in 2018 were used for calculations. A total of 1768 quality activities were completed over a 5-year period representing an average of 353 quality activities per year, of which 87.8% were initiated by clinicians and 12.2% planned and coordinated by safety and quality or equivalent. The activity reports indicated that less than a fifth (17.1%) brought about improvement in process measures and only 7.1% improved outcome measures. Two-thirds of the quality activities (66.3%) provided recommendations based on their findings, but evidence of action plan was available in 14.1% of the reports only. No association was found between the number of activities completed and overall hospital-acquired complication performance. Retrospective data collection (64.7%) was common. The estimated time and cost for data collection averaged at 3490 h/year, equivalent to 1.8 full-time employees, for a cost of $171 000 at the nursing rate (A$49.0), $280 000 at the medical rate (A$79.5), and $200 000 at the Health Service Union rate (A$58.9). Most quality activities were clinician-initiated. Implementing change and achieving and sustaining improvement were the two challenging stages in the quality cycle. No clear association was observed between activities completed and improvement in patient-related outcomes although some improvement in processes. A paradigm shift may be needed to engineer quality activities in hospitals to be more outcome-oriented. Opportunities exist for hospitals to consider how quality activities can be organized to maximize returns from investment.
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Affiliation(s)
- Qun Catherine Li
- Clinical Services, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia 6150, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, The Flinders University of South Australia, Adelaide, South Australia 6052, Australia
| | - Jim Codde
- Institute for Health Research, The University of Notre Dame Australia, Perth, Western Australia 6160, Australia
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Steenbruggen RA, Maas MJM, Hoogeboom TJ, Brand PLP, van der Wees PJ. The application of the tracer method with peer observation and formative feedback for professional development in clinical practice: a scoping review. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:15-21. [PMID: 34762266 PMCID: PMC8733089 DOI: 10.1007/s40037-021-00693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The tracer method, commonly used for quality assessment, can also be used as a tool for peer observation and formative feedback on professional development. This scoping review describes how, by whom, and with what effect the tracer method is applied as a formative professional development instrument between healthcare professionals of equal status and aims to identify the types of scientific evidence for this use of the tracer method. METHODS The authors searched four electronic databases for eligible articles, which were screened and assessed for eligibility by two independent researchers. From eligible studies, data were extracted to summarize, collate, and make a narrative account of the findings. RESULTS The electronic search yielded 1757 unique studies, eight of which were included as valid and relevant to our aim: five qualitative, two mixed methods, and one quantitative study. Seven studies took place in hospitals and one in general practice. The tracer method was used mainly as a form of peer observation and formative feedback. Most studies evaluated the tracer method's feasibility and its impact on professional development. All but one study reported positive effects: participants described the tracer method generally as being valuable and worth continuing. DISCUSSION Although the body of evidence is small and largely limited to the hospital setting, using the tracer method for peer observation and formative feedback between healthcare professionals of equal status appears sufficiently useful to merit further rigorous evaluation and implementation in continuous professional development in healthcare.
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Affiliation(s)
- Rudi A Steenbruggen
- School of Health, Physiotherapy, Saxion University of Applied Sciences, Enschede, The Netherlands.
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Marjo J M Maas
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul L P Brand
- Isala Hospital, Zwolle, The Netherlands
- University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Klimmeck S, Sexton JB, Schwendimann R. Changes in Safety and Teamwork Climate After Adding Structured Observations to Patient Safety WalkRounds. Jt Comm J Qual Patient Saf 2021; 47:783-792. [PMID: 34654669 DOI: 10.1016/j.jcjq.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient safety is essential for the reliable delivery of health care. One way to positively influence patient safety is to improve the safety and teamwork climate of a clinical area. Research shows that patient safety WalkRounds (WRs) are an appropriate and common method to improve safety culture. The aim of this study was to combine WRs with observations of specific patient safety dimensions and to measure the safety and teamwork climate. METHODS In this observational study, WRs took place in eight work settings across a 770-bed university hospital in Switzerland. During rounds, health care workers (HCWs) were observed in relation to defined patient safety dimensions. In addition, HCWs were surveyed using safety and teamwork climate scales before the initial WRs and six to nine months later, and implementation of planned improvement actions following the WRs was evaluated. RESULTS During WRs, 810 activities of HCWs were observed, of which 85.4% met the requirements for safe care. Safety and teamwork climate did not change significantly after nine months. A total of 36 action plan items were planned to address safety deficits that surfaced during WRs, but only 40.7% of the action items had been implemented after nine months. CONCLUSION WRs with structured in-person observations identified safe care practices and deficits in patient safety. Improvement action plans to address safety deficits were not fully implemented nine months later, and there were no significant changes in the safety and teamwork climate at that time.
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Kuo KM, Talley PC, Lin DYM. Hospital Staff's Adherence to Information Security Policy: A Quest for the Antecedents of Deterrence Variables. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211029599. [PMID: 34229507 PMCID: PMC8576356 DOI: 10.1177/00469580211029599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Information security has come to the forefront as an organizational priority
since information systems are considered as some of the most important assets
for achieving competitive advantages. Despite huge capital expenditures devoted
to information security, the occurrence of security breaches is still very much
on the rise. More studies are thus required to inform organizations with a
better insight on how to adequately promote information security. To address
this issue, this study investigates important factors influencing hospital
staff’s adherence to Information Security Policy (ISP). Deterrence theory is
adopted as the theoretical underpinning, in which punishment severity and
punishment certainty are recognized as the most significant predictors of ISP
adherence. Further, this study attempts to identify the antecedents of
punishment severity and punishment certainty by drawing from upper echelon
theory and well-acknowledged international standards of IS security practices. A
survey approach was used to collect 299 valid responses from a large Taiwanese
healthcare system, and hypotheses were tested by applying partial least
squares-based structural equation modeling. Our empirical results show that
Security Education, Training, and Awareness (SETA) programs, combined with
internal auditing effectiveness are significant predictors of punishment
severity and punishment certainty, while top management support is not. Further,
punishment severity and punishment certainty are significant predictors of
hospital staff’s ISP adherence intention. Our study highlights the importance of
SETA programs and internal auditing for reinforcing hospital staff’s perceptions
on punishment concerning ISP violation, hospitals can thus propose better
internal strategies to improve their staff’s ISP compliance intention
accordingly.
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Van Wilder A, Bruyneel L, De Ridder D, Seys D, Brouwers J, Claessens F, Cox B, Vanhaecht K. Is a hospital quality policy based on a triad of accreditation, public reporting and inspection evidence-based? A narrative review. Int J Qual Health Care 2021; 33:6278849. [PMID: 34013956 DOI: 10.1093/intqhc/mzab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since 2009, hospital quality policy in Flanders, Belgium, is built around a quality-of-care triad, which encompasses accreditation, public reporting (PR) and inspection. Policy makers are currently reflecting on the added value of this triad. METHODS We performed a narrative review of the literature published between 2009 and 2020 to examine the evidence base of the impact accreditation, PR and inspection, both individually and combined, has on patient processes and outcomes. The following patient outcomes were examined: mortality, length of stay, readmissions, patient satisfaction, adverse outcomes, failure to rescue, adherence to process measures and risk aversion. The impact of accreditation, PR and inspection on these outcomes was evaluated as either positive, neutral (i.e. no impact observed or mixed results reported) or negative. OBJECTIVES To assess the current evidence base on the impact of accreditation, PR and inspection on patient processes and outcomes. RESULTS We identified 69 studies, of which 40 were on accreditation, 24 on PR, three on inspection and two on accreditation and PR concomitantly. Identified studies reported primarily low-level evidence (level IV, n = 53) and were heterogeneous in terms of implemented programmes and patient populations (often narrow in PR research). Overall, a neutral categorization was determined in 30 articles for accreditation, 23 for PR and four for inspection. Ten of these recounted mixed results. For accreditation, a high number (n = 12) of positive research on adherence to process measures was discovered. CONCLUSION The individual impact of accreditation, PR and inspection, the core of Flemish hospital quality, was found to be limited on patient outcomes. Future studies should investigate the combined effect of multiple quality improvement strategies.
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Affiliation(s)
- Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Urology, University Hospitals Leuven, Belgium, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Bianca Cox
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
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Hut-Mossel L, Ahaus K, Welker G, Gans R. Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PLoS One 2021; 16:e0248677. [PMID: 33788894 PMCID: PMC8011742 DOI: 10.1371/journal.pone.0248677] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. METHODS A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs). RESULTS From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. CONCLUSIONS This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO REGISTRATION CRD42016039882.
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Affiliation(s)
- Lisanne Hut-Mossel
- Centre of Expertise on Quality and Safety, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Gera Welker
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Developing the Next Generation in Electronic Clinical Auditing. J Nurs Care Qual 2020; 35:317-322. [DOI: 10.1097/ncq.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Oliveira JLCD, Cervilheri AH, Haddad MDCL, Magalhães AMMD, Ribeiro MRR, Matsuda LM. Interface between accreditation and patient safety: nursing team perspectives. Rev Esc Enferm USP 2020; 54:e03604. [PMID: 32935752 DOI: 10.1590/s1980-220x2018053703604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 11/05/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the relationship between accreditation and patient safety from the perspective of the nursing team. METHOD A descriptive-exploratory study implementing a qualitative approach. It was developed with nursing workers from two Intensive Care Units in a hospital certified in excellence by Brazilian accreditation. The participants responded to individual semi-structured interviews guided by the question: "Tell me about the relationship between accreditation and patient safety in this hospital and unit". The corpus was transcribed in full, and the thematic content analysis technique was used. RESULTS There were 14 professionals interviewed. There are several specific improvements in patient safety mediated by accreditation between the two emerging categories. The workers reported that at times the advances in safe care are transversally visible to the certification/maintenance of accreditation visit, and at times they point to safety as something independent of the quality seal. CONCLUSION It was concluded that the investigated relationship was shown to be both dependent, as accreditation is a bridge for specific improvements, as well as independent, since patient safety goes beyond the certification process itself. In this context, criticality was revealed among nursing workers.
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Affiliation(s)
| | | | | | | | | | - Laura Misue Matsuda
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brasil
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Hanskamp-Sebregts M, Zegers M, Boeijen W, Wollersheim H, van Gurp PJ, Westert GP. Process evaluation of the effects of patient safety auditing in hospital care (part 2). Int J Qual Health Care 2020; 31:433-441. [PMID: 30137381 PMCID: PMC6819993 DOI: 10.1093/intqhc/mzy173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/31/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To identify factors that explain the observed effects of internal auditing on improving
patient safety. Design setting and participants A process evaluation study within eight departments of a university medical centre in
the Netherlands. Intervention(s) Internal auditing and feedback for improving patient safety in hospital care. Main outcome measure(s) Experiences with patient safety auditing, percentage implemented improvement actions
tailored to the audit results and perceived factors that hindered or facilitated the
implementation of improvement actions. Results The respondents had positive audit experiences, with the exception of the amount of
preparatory work by departments. Fifteen months after the audit visit, 21% of the
intended improvement actions based on the audit results were completely implemented.
Factors that hindered implementation were short implementation time: 9 months (range
5–11 months) instead of the 15 months’ planned implementation time; time-consuming and
labour-intensive implementation of improvement actions; and limited organizational
support for quality improvement (e.g. insufficient staff capacity and time, no available
quality improvement data and information and communication technological (ICT)
support). Conclusions A well-constructed analysis and feedback of patient safety problems is insufficient to
reduce the occurrence of poor patient safety outcomes. Without focus and support in the
implementation of audit-based improvement actions, quality improvement by patient safety
auditing will remain limited.
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Affiliation(s)
- Mirelle Hanskamp-Sebregts
- Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, HB Nijmegen, The Netherlands
| | - Marieke Zegers
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Wilma Boeijen
- Radboud University Medical Center, Department of Quality and Safety, Nijmegen, The Netherlands
| | - Hub Wollersheim
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Petra J van Gurp
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, The Netherlands
| | - Gert P Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
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Liberatti VM, Pedro DRC, Costa RG, Pissinati PDSC, Marcon SS, Haddad MDCFL. Percepção de gestores, prestadores e auditores sobre a contratualização no Sistema Único de Saúde. TRABALHO, EDUCAÇÃO E SAÚDE 2020. [DOI: 10.1590/1981-7746-sol00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo do estudo foi compreender a percepção de gestores, prestadores e auditores sobre o processo de contratualização do Sistema Único de Saúde. Tratou-se de um estudo descritivo, com abordagem qualitativa, realizado em Maringá, Paraná, em setembro e outubro de 2017, com gestores, prestadores de serviços e auditores que atuam no Sistema. Os dados foram coletados por meio de questões norteadoras. A análise levou à construção de duas categorias: potencialidades e barreiras no processo de contratualização com o Sistema Único de Saúde; avaliação e uso de instrumentos na auditoria do Sistema. Em relação às potencialidades, evidenciou-se que o processo de contratualização qualifica a gestão da saúde baseada nas legislações específicas e que a principal barreira se refere à tabela de valores praticada pelo Sistema Único de Saúde. Em relação à segunda categoria, analisou-se que o uso de instrumentos permite a padronização de parâmetros, o que confere à contratualização maior assertividade. Concluímos que é necessário o uso de instrumento de auditoria validado e acordado com prestadores, para se ter transparência e melhores resultados nas metas pactuadas.
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