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* L'Enfant, Pierre-Charles, 1791, describing Washington, D.C. (quoted in Caemmerer 1950: 136, 151) <ref>
* L'Enfant, Pierre-Charles, 1791, describing Washington, D.C. (quoted in Caemmerer 1950: 136, 151) <ref ></ref>
:"[11 March, in a letter to Thomas Jefferson] . . . The remainder part of that ground towards Georgetown is more broken. It may afford pleasant seats, but, although the bank of the river between the two creeks can command as grand a
:"[11 March, in a letter to Thomas Jefferson] . . . The remainder part of that ground towards Georgetown is more broken. It may afford pleasant seats, but, although the bank of the river between the two creeks can command as grand a
Revision as of 20:32, March 18, 2015
In the discourse of landscape design, seat possessed two distinct yet equally prevalent meanings, as indicated by Thomas Sheridan's 1789 dictionary entry. One sense referred to seat as a large estate, usually marked by a country house or mansion, for example, William Hamilton's Woodlands, near Philadelphia; or Gen. Charles Ridgely's Hampton, in Baltimore County, Md. A seat was also a garden structure for sitting.
The meaning of seat as estate was exemplified in colonial America by William Byrd II's Westover, on the James River, Va., and Henry Pratt's Lemon Hill in Philadelphia [Fig. 1]. Such country houses were often featured in portraits that flattered the owner and signaled to the public that the colonies and new republic were home to a cultured elite rivaling that of Great Britain. These images typically located the house at the center of the property, with the landscape and various outbuildings extending beyond it. This placement, which communicated the importance of the house as the base of operations for the landowner, was a visual shorthand for the landowner's affluence and power. Observers such as William Hugh Grove (1732) and Thomas Gwatkin (1770) often likened seats to small villages. By the mid-eighteenth century, however, the community-like aspects of seats were downplayed in favor of their rural associations, which contrasted sharply with the increasingly crowded conditions of America's cities. English emigré William Russell Birch, in his series The Country Seats of the United States of America (1808), depicted the homes of the mid- Atlantic elite situated in naturalistic landscapes in emulation of British tableaux [Fig. 2].[1]
As a category of garden furniture, seat could refer to either the object upon which one sat [Fig. 3] or the structure housing such objects [Fig. 4]. Accounts found in foreign treatises available in America (such as those by A.-J. Dézallier D'Argenville, Isaac Ware, William Marshall, Humphry Repton, and John Abercrombie) focused on seats as places of rest, terminations to walks, or vantage points from which to contemplate views. Like other garden structures, such as pavilions or summerhouses, seats influenced the viewer's experience of the garden by providing points of rest that framed vistas in the garden and views beyond. The use of seats to direct one's route through a garden was demonstrated by A. J. Downing in his 1847 description of Montgomery Place, Dutchess County, N.Y. Downing noted the placement of various seats and related views that he encountered on the course of his walk through the grounds. Many other garden observers, including Henry Wansey (1794), John Cosens Ogden (1800), and Eliza Caroline Burgwin Clitherall (active 1801), also commented upon the interrelationships between seats, walks, and views. Popular gardening journals likewise recommended placing seats along walks. For example, in 1841 Alexander Walsh proposed a number of seats in a garden design published in The New England Farmer. Two seats were situated at cross-walks and another two were ensconced in an arched arbor, placed alongside the main axial walk.
Garden seats took on a variety of forms. In the eighteenth century, European and British pattern books and design manuals such as James Gibbs's A Book of Architecture (1728) were an important source for American seat designs [Fig. 5]. Drawings by Thomas Jefferson and by his granddaughter, Cornelia Jefferson Randolph [Fig. 6], demonstrate the influence of William Kent's designs on garden furniture, which appeared in William Chambers's Plans, Elevations, Sections and Perspective Views of the Gardens and Buildings at Kew in Surrey (1763), a volume that Jefferson owned.[2]
Seat designs could be differentiated by national and historical styles, as well as by placement and function. Batty and Thomas Langley, for instance, proposed a seat in keeping with the Gothic style in their 1747 text about Gothic architecture [Fig. 7]. J. C. Loudon, in An Encyclopaedia of Gardening (1826), distinguished among seats found inside garden buildings, roofed seats that could be either fixed or portable, and those lacking any sort of roof. Loudon explained that in form, seats could be simple (like the trunk of a tree) or more complex (such as a cast-iron couch with decorative treatment). These distinctions were echoed by Jane Loudon in Gardening for Ladies (1845), a book that was co-edited by Downing in America.
In A Treatise on the Theory and Practice of Landscape Gardening (1849), Downing himself provided an extensive illustrated typology of seat styles, emphasizing the propriety of certain styles for different landscapes. For example, he believed that Grecian or Gothic seats were appropriate for elegant grounds, whereas rustic seats were more suited to the irregular aesthetic of the landscape garden. Such rustic seats were quite popular in the nineteenth century, as suggested by the discussion of them in horticultural journals, such as the Horticultural Register, and in descriptions by both treatise writers and observers of the American landscape. See, for example, Thomas Bridgeman (1832), Edward Sayers (1838), Anna Cora Ogden Mowatt Ritchie (1839), C. M. Hovey (1840), and Georges Jaques (1852).
--- Anne L. Helmreich
- Anonymous, n.d., advertising design and construction services for parks and gardens (quoted in Chase 1973: 37–39): [3]
- "Designs all sorts of Buildings, well suited to both town and country, Pavilions, Summer-Rooms, Seats for Gardens . . . also Water-houses for Parks . . . Eye Traps to represent a Building terminating a walk, or to hide some disagreeable Object, Rotundas, Colonades, Arcades, Studies in Parks or Gardens, Green Houses for the Preservation of Herbs."
- Strachey, William, 1612, describing the seats of Powhatan in Virginia (quoted in Wright and Freund 1967: 57) [4]
- "He hath divers seates or howses, his Chief when we came into the Country was upon seat Pamunky-River, on the North side which we call Pembrook-side, called Werowocomaco, which by interpretacion signifyes Kings-howse."
- Byrd, William, II, c. 25 June 1729, describing Westover, seat of William Byrd II, on the James River, Va. (quoted in Tinling 1977: 1:410) [5]
- "My habitation has the na[me of] the prettyest seat in this country."
- Grove, William Hugh, 1732, describing Williamsburg, Va. (quoted in Stiverson and Butler 1977: 26) [6]
- "I went by ship up the [York] river, which has pleasant Seats on the Bank which Shew Like little villages, for having Kitchins, Dayry houses, Barns, Stables, Store houses, and some of them 2 or 3 Negro Quarters all Seperate from Each other but near the mansion houses make a shew to the river of 7 or 8 distinct Tenements, tho all belong to one family."
- Anonymous, 17 August 1747, describing property for sale in Somerset County, N.J. (New York Gazette)
- "TO BE SOLD, A pleasant Country Seat, fitting for a Gentleman or Store-keeper . . . a good Orchard, containing about 200 Apple Trees, and may be extended at Pleasure."
- Gwatkin, Prof. Thomas, 1770, describing the appearance of seats in Williamsburg, Va. (Colonial Williamsburg Foundation; hereafter CWF)
- "And the huts of the Negroes which are situated round about give the seat of a substantial planter something of the Air of a small village."
- Rush, Dr. Benjamin, 15 July 1782, describing the country seat of John Dickinsen, near Philadelphia, Pa. (quoted in Caemmerer 1950: 87) [7]
- "The ground contiguous to this shed was cut into beautiful walks and divided with cedar and pine branches into artificial groves. The whole, both the buildings and walks, were accommodated with seats."
- Shippen, Thomas Lee, 31 December 1783, describing Westover, seat of William Byrd III, on the James River, Va. (1952: n.p.) [8]
- "I have markd some little crooked ugly figures for Gentlemen's seats, which tho' they do not beautify indeed the picture, add much to the prospect, about as many Seats are to be seen on the other side." [Fig. 8]
- Cutler, Rev. Manasseh, 13 July 1787, describing The Hills (later Lemon Hill), estate of Robert Morris, Philadelphia, Pa. (1987: 1:256–57) [9]
- "We continued our route, in view of the Schuylkill, and up the river several miles, and took a view of a number of Country-seats, one belonging to Mr. R. Morris, the American financier, and who is said to be possessed of the greatest fortune in America. His country-seat is not yet completed, but it will be superb. It is planned on a large scale, the gardens and walks are extensive, and the villa, situated on an eminence, has a commanding prospect down the Schuylkill to the Delaware."
- G., L., 15 June [1788?], describing the Woodlands, seat of William Hamilton near Philadelphia, Pa. (quoted in Madsen 1989: 19) [10]
- "[The walks were] planted on each side with the most beautiful & curious flowers & shrubs. They are in some parts enclosed with the Lombardy poplar except here & there openings are left to give you a view of some fine trees or beautiful prospect beyond, & in others, shaded by arbours of the wild grape, or clumps of large trees under which are placed seats where you may rest yourself
& enjoy the cool air."
- Constantia [pseud.], 24 June 1790, "Description of Gray's Gardens, Pennsylvania" (Massachusetts Magazine 3: 415)
- "At every turn shaded seats are artfully contrived, and the ground abounds with arbours, alcoves, and summer houses, which are handsomely adorned with odoriferous flowers."
- L'Enfant, Pierre-Charles, 1791, describing Washington, D.C. (quoted in Caemmerer 1950: 136, 151) [11]
- "[11 March, in a letter to Thomas Jefferson] . . . The remainder part of that ground towards Georgetown is more broken. It may afford pleasant seats, but, although the bank of the river between the two creeks can command as grand a
prospect as any of the other spots, it seems to be less commendable for the establishment of a city, not only because the level surface it presents is but small, but because the hights from beyond Georgetown absolutely command the whole. . . .
- "[22 June, in a report to George Washington] . . . I next made the distribution regular with streets at right angle north-south and east west but afterwards I opened others on various directions as avenues to and from every principal places, wishing by this not merely to contrast with the general regularity nor to afford a greater variety of pleasant seats and prospect as will be obtained from the advantageous ground over the which the avenues are mostly directed but principally to connect each part of the city with more efficacy."
- Wansey, Henry, 1794, describing Worcester, Mass. ([1794] 1970: 64)
- "Most of the houses have a large court before them, full of lilacs and other shrubs, with a seat under them, and a paved walk up the middle."
- ↑ Emily Tyson Cooperman, "William Russell Birch (1755–1834) and the Beginnings of the American Picturesque" (Ph.D. diss., University of Pennsylvania, 1999). See also Emily T. Cooperman, introduction to The Country Seats of the United States of North America, by William Russell Birch (1808; reprint, Philadelphia: University of Pennsylvania, 2009).
- ↑ William Bainter O'Neal, Jefferson's Fine Arts Library: His Selections for the University of Virginia Together with His Own Architectural Books (Charlottesville: University Press of Virginia, 1976), 57.
- ↑ David B. Chase, 'The Beginnings of the Landscape Tradition in America', Historic Preservation, 25 (1973), 34–41 view on Zotero
- ↑ Louis B. Wright and Virginia Freund, eds., The Historie of Travell into Virginia Britania (1612) (Nendeln and Liechtenstein: Kraus, 1967) view on Zotero
- ↑ Marion Tinling, ed., The Correspondence of the Three William Byrds of Westover, Virginia, 1684-1776, 2 vols. (Charlottesville, Va.: University Press of Virginia, 1977)view on Zotero
- ↑ Gregory A. Stiverson and Patrick H. Butler III, eds., 'Virginia in 1732: The Travel Journal of William Hugh Grove', Virginia Magazine of History and Biography, 85 (1977), 18–44view on Zotero
- ↑ H. Paul Caemmerer, The Life of Pierre-Charles L'Enfant, Planner of the City Beautiful, The City of Washington (Washington, D.C.: National Republic Publishing Company, 1950). view on Zotero
- ↑ Thomas Lee Shippen, Westover Described in 1783: A Letter and Drawing Sent by Thomas Lee Shippen, Student of Law in Williamsburg, to His Parents in Philadelphia (Richmond, Va.: William Byrd Press, 1952). view on Zotero
- ↑ William Parker Cutler, Life, Journals, and Correspondence of Rev. Manasseh Cutler, LL. D (Athens, Ohio: Ohio University Press, 1987). view on Zotero
- ↑ Karen Madsen, 'To Make His Country Smile: William Hamilton's Woodlands', Arnoldia, 49 (1989), 14–23 view on Zotero
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs named
Caemmerer 1950


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Signed into law on December 3, 2004, the Individual with Disabilities Education Act of 2004 (IDEA) authorized the establishment of the National Center for Special Education Research (NCSER), along with the transfer of responsibilities for research in special education including national studies to the new center. The center is located within the Department of Education's Institute for Education Services.
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Proteomic, Glycomic and Autoantibody Lung Cancer Biomarker Validation
We are testing the performance of proteomic, glycomic and autoantibody biomarkers to predict subsequent onset of lung cancer using independent prediagnostic samples collected as part of the Prostate, Lung, Colon, Ovarian (PLCO) cohort. Biomarkers that pass this and subsequent validation steps should significantly reduce lung cancer mortality of smokers through early detection of cancer.
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A customer service representative with the New York Yankees accidentally e-mailed out personal details on close to 18,000 season ticket holders, the baseball team said Thursday.
According to a Yankees fan who received the spreadsheet, it was accidentally attached to a "Season Ticket Licensee Homestand Newsletter" sent Monday evening by a customer service representative.
The e-mail went out to several hundred season ticket holders, and contained names, addresses, phone numbers, fax numbers and e-mail addresses, along with the fans' seat numbers and Yankees account numbers.
The list contained data belonging to 17,687 non-premium season ticket holders, according to recipients, who posted details of the incident on a Yankees discussion forum. Because some ticket holders have several blocks of tickets, the total number of entries in the spreadsheet was even higher: 21,467.
The message was recalled by the sales representative within minutes, one recipient said. But by then it was too late.
The spreadsheet didn't have sensitive data such as Social Security numbers or credit card data, the Yankees said Wednesday in a press release, adding, "immediately upon learning of the accidental attachment of the internal spreadsheet, remedial measures were undertaken so as to assure that a similar incident could not happen again."
On its own, the type of information is not considered to be particularly sensitive. But security experts worry that big e-mail lists like this could be used as a stepping stone by phishers to create targeted attacks that then trick victims into disclosing more valuable information or installing malicious software.
Hackers have repeatedly gone after this information in the past. In recent weeks both Epsilon and software vendor Ashampoo acknowledged that they'd been hacked and e-mail addresses and customer names were stolen. In Ashampoo's case, the company's customers were then sent fake order confirmation e-mails that looked like they came from PurelyGadgets, a U.K.-based online retailer. These files contained maliciously encoded pdf documents that could install malicious software on the victim's computer if opened, according to Ashampoo.
In a breach that could affect tens of millions, Sony said this week that someone had hacked into its PlayStation and Qriocity networks and stolen some personal information, possibly including credit card data.
Because it includes the addresses of thousands of season ticket holders, the spreadsheet could also give thieves a pretty reliable list of people to burglarize during Yankees games.
On the NYYFans.com discussion forum, fans were split — some calling for the sales rep's job, others for forgiveness. "It's a big mistake, but it's still a mistake," wrote one poster, named TheYankee. "To call for a man's job over this seems heartless."
Kathleen Keough contributed to this story.
Robert McMillan covers computer security and general technology breaking news for The IDG News Service. Follow Robert on Twitter at @bobmcmillan. Robert's e-mail address is firstname.lastname@example.com


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(RNS) On April 14, the school board in Mustang, Okla., voted to institute an elective Bible course. This is not news. More than a thousand U.S. public schools offer Bible as literature courses.
But the curriculum for the Mustang course was developed by Steve Green, president of the Oklahoma-based Hobby Lobby craft store chain, which is committed, according to its website, to "honoring the Lord in all we do."
In March, Hobby Lobby argued before the Supreme Court for a religious liberty exemption to the Affordable Care Act. Now Green is promoting the Bible curriculum the Mustang school board just adopted — a curriculum he predicts will soon be adopted in hundreds, perhaps thousands, of American public schools.
In its decisions on religion in public education, the Supreme Court has distinguished sharply between preaching religion (which the First Amendment prohibits) and teaching about religion (which it allows). Courses that explore the Bible "objectively as a part of a secular program of education" are in its view constitutional.
But will the Green-funded Bible curriculum be secular and objective?
Andrew Seidel, staff attorney for the Freedom From Religion Foundation, argued in a November letter that this partnership between Hobby Lobby and the Mustang school board "casts doubt on the objective nature of the class." In an April follow-up, he wrote that the draft textbook demonstrates "a clear Christian bias."
"It's not about teaching the Bible as literature," Seidel told me. "It's about teaching a particular religion that uses the Bible."
Timothy Dalrymple, editor at Patheos.com and one of many evangelicals consulting on this project, said he signed on only after hearing that Green was determined to produce a "fact-based and non-sectarian" textbook.
Counseling patience, Dalrymple is confident that problems with the current draft will be fixed. "It's the best Bible curriculum for public schools that I've seen by a long shot," he said.
You cannot make sense of Western art or American literature without basic biblical literacy, and in a country in which Christianity so deeply informs political rhetoric, knowledge of the Bible is essential for citizenship. So I am an advocate of public school Bible courses. And there is much to praise in the 200+ pages of the April "working draft" of the textbook I reviewed. The writing is clear, catchy even. Its emphasis on the Bible's impact on music, literature and film is laudable.
Nonetheless, I have two key objections.
First is the tendency of the authors to view virtually every Bible story through a Christian lens. The story of Adam and Eve in the Garden of Eden is presented here as a narrative of "The Fall" of humanity from innocence into sin. But that is a Christian interpretation. Jews, who do not typically believe in original sin and therefore do not seek salvation from it, do not read the story this way. Yet this is the sole interpretation offered.
My second objection concerns the inability of the textbook's authors to resist the temptation to assert the Bible's truth. This claim is asserted repeatedly, sometimes through leading questions ("How do we know that the Bible's narratives are reliable?"), sometimes through graphics that provide check marks in boxes regarding the text's "reliability" and "historical accuracy," and sometimes through maps that, by pinpointing where biblical events occurred, shut down all doubt about their historicity.
In one "summary" box, this draft reads: "We can conclude that the Bible, especially when viewed alongside other historical information, is a reliable historical source."
I do not doubt that Green's team sincerely wants to produce a non-sectarian textbook. I am skeptical, however, that the scholars that Green has assembled for this job — a group that tilts like a listing ship toward evangelicals working at evangelical institutions — are capable of producing a textbook beholden to facts rather than faith.
In an April 2013 speech to the National Bible Association, Green described the Bible as "true" and "good." He has every right to this belief. But it is not a self-evident proposition, and there is no place under the Constitution for a textbook that requires public school students to pledge their allegiance to it.
(Stephen Prothero is a professor in Boston University's religion department and the author of The American Bible: How Our Words Unite, Divide, and Define a Nation.)


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Interface - Comunicação, Saúde, Educação
Print version ISSN 1414-3283
Interface (Botucatu) vol.4 no.se Botucatu 2008
Internal management contracts within the context of the Humanization Policy: experimenting with methodology within the reference frame of co-management
Contratos internos de gestão no contexto da Política de Humanização: experimentando uma metodologia no referencial da cogestão
Contratos internos de gestión en el contexto de la Política de Humanización: experimentando una metodología en el referencial de la cogestión
Serafim Barbosa Santos FilhoI; Vera de Oliveira Nunes FigueiredoII
IMinistério da Saúde, Política Nacional de Humanização (MS/PNH), Rua Gonçalves Dias, 60/901, Belo Horizonte, MG, Brasil 30.140-061, <email@example.com>
Translated by Maria Aparecida Gazotti Vallim
Translation from Interface - Comunicação, Saúde, Educação, Botucatu, v.13, supl. 1, p. 615 - 626, 2009.
This paper describes the experience of implementing internal management contracts in a public hospital. These contracts are understood as tools within the context of co-management and, within the perspective of humanization, as interventions in healthcare and management practices. With this focus, the methodological lines of the collective construction of such contracts and the indicators for the implementation process are presented. Through the process of agreed targets and participative evaluation, the following results were observed: in addition to increasing the institutional efficiency and effectiveness, the effects unleashed through these tools revealed their potential for transforming the work relationships, promoting co-responsibility between subjects and teams, adding value to workers and forming commitment networks for improved care.
Keywords: Management contract. Humanization of care. Planning. Health management.
Neste artigo descreve-se a experiência de implementação de contratos internos de gestão em um hospital público. Os contratos são compreendidos como dispositivos no contexto da cogestão e na perspectiva da humanização como intervenção nas práticas de atenção e gestão em saúde. Nesse enfoque, apresentam-se os eixos metodológicos de sua construção coletiva e os indicadores do processo de implementação. Com o processo de pactuação de metas e avaliação participativa, observam-se os seguintes resultados: além de aumentar a eficiência e eficácia institucional, os efeitos desencadeados com esses dispositivos revelam seu potencial de transformação das relações de trabalho, promoção de corresponsabilização entre os sujeitos/equipes, valorização dos trabalhadores e formação de redes de compromisso para melhoria da atenção.
Palavras-chave: Contrato de gestão. Humanização da assistência. Planejamento. Gestão em saúde.
En este artículo se describe la experiencia de implementación de contratos internos de gestión en un hospital público. Los contratos se entienden como dispositivos en el contexto de cogestión y en la perspectiva de Humanización como intervención en las prácticas de atención y gestión en salud. En este enfoque se presentan los ejes metodológicos de su construcción colectiva y los indicadores del proceso de implementación. Con el proceso de pactación de metas y evaluación participativa, se observan los siguientes resultados: además de aumentar eficiencia y eficacia institucional, los efectos desencadenados con tales dispositivos revelan su potencial de transformación de las relaciones de trabajo, promoción de co-responsabilización entre los sujetos/equipos, evaluación de los trabajadores y formación de redes de compromiso para mejoría de la atención.
Palabras clave: Contrato de gestión. Humanización de la asistencia. Planeamiento. Gestión en salud.
The National Humanization Policy/NHP (Política Nacional de Humanização/PNH) articulates a set of frameworks and instruments for triggering processes.
In the theoretical-political milestone of the NHP (Brasil, 2008; Benevides, Passos, 2005), principle is understood as what gives support to and triggers a certain movement in the perspective of public policy. There are three basic principles: the transversality principle, indicating new standards of relationship and communication between subjects and services and seeking the change of the knowledge borders and of the power territories; the undissociability principle, indicating the undissociability between care and management and affirming that there is an inseparable relation between ways of caring and ways of work management and appropriation; and the assertion of the protagonism and the autonomy of subjects and collectives, implying attitudes of co-responsibility in the management and caring processes. Guidelines are understood as general orientation of policies, capable of directing changes in the scope of care and management in the following sense: co-management, extended clinic and patient reception; work and health workers' valorization; defense of the user's rights and of the fomentation to collectives and networks. On the other hand, tools are understood as the translation of guidelines into work processes arrangements which are in operation in order to either stimulate or boost attention and management practices. There are several tools incorporated by the NHP. This paper highlights two of them: the tools of collegiate management (collegiate managers) and the tools of contractualization (management contracts) because of their direct relations with the co-management guideline, approach of this paper.
The discussion presented here takes as a reference the debate that Campos has been making on the management practices of the healthcare sector (Campos, 2006, 2003, 2000). The conception of co-management presumes the expansion of collective and public spaces, making feasible the exercise of the dialogue and of the consensus on differences. It is a model that includes the different individuals in the analysis and decision-making processes. One of the co-management hallmarks is the perspective of shared construction of knowledge (and interventions), considering the subjectivities and singularities of subjects and collectives (Brasil, 2008; Campos, 2006, 2003, 2000). The collegiate managers and the equivalent collective spaces are tools which incorporate that conception as an strategy for extending and transversing a 'participatory' and 'co-managed' way of operating services and teams. The collegiates are conceived as spaces/instances that bring together workers and management representatives used to conceive and to evaluate proposals made by several actors (workers, managers and users), deciding on directive and operational plans and ensuring the sharing of power of different members, the co-analysis, the co-decision and the co-evaluation of proposals, targets, indicators and specific aspects of the articulation of the local process of work.
Those guidelines and instances merge into a perspective that NHP nominates the way to 'triple inclusion' in the health production process: inclusion of different subjects (managers, workers, users); inclusion of the collectives (whether the workers in their group organization or the organized social movement); and inclusion of the social analyzers, here understood as everything that can trigger analysis of what/on what is established, provoking other forms of being and doing health care (Barros, 2007).
The proposal of Internal Management Contracts/IMC (Contratos Internos de Gestão/CIG) is enclosed in that context. Contracts as negotiation and agreement between parties, as tools of dialogue and engagement of commitments and responsibilities (the bias of co-responsibility) on objectives and targets in tune with the needs of the parties negotiating/agreeing. It is especially considered with regard to its potential to foster interactions, to place subjects/teams in dialogue to build changes, generating new relationship and communication standards within the health care organizations/health services.
Campos (2006, p.59) reiterates the concept of social contract in its sociological sense, which says "establishing new relationships that alter rules, laws and behaviors according to a well set out agreement." He considers that, according to that perspective, the contract means or points to building commitment between subjects, a situation that is realized from "displacements" of position and of new compositions within institutions and organizations. That conception hinges on the theory/method that the author proposes to co-management of collectives, comprising as coproduction of situations, subjects and organizations (Campos, 2006, 2000).
This paper describes the experience of implementing an internal management contract in a public hospital, seeking to enhance its potential for mobilizing the subjects in their workplaces/workrelations, giving rise to a routine exercise of sharing in the form of what is proposed as co-management. When analyzing that experience, the main objective is to stand out its process, highlighting the methodological lines (of conduction) put into practice to ensure coherence with the desired pedagogical-participatory perspective regarding the contracts.
The service/hospital and the context of implementing the management contract
The Hospital Odilon Behrens (HOB/BH) is integrated to the municipal network of the Unified Health System (Sistema Único de Saúde - SUS) of Belo Horizonte, being a reference to other regions of Minas Gerais State as well. The 63-year old hospital is both a general and an emergency hospital. It has about four hundred beds, offering 35 medical specialties and attending around five hundred patients a day in clinic, traumatologic and dentistry emergencies.
Amid the advancements in the quality of services offered, the Hospital has taken important initiatives towards improving its care and management model. In that sense, systematic actions were taken by the group that took over management in 2003[1], emerging with the challenge of reorganizing its structure and dynamics, creating a collective availability (of management, interest, and will) for carrying out institutional changes (availability deemed essential for the success of interventions).
As development of a Seminar held in 2003, several workshops and other seminars were organized for broadening discussions and for guiding action fronts in different scopes, all of them towards 'ex1periencing co-management', that is, making several institutional movements converge on an exercise enhancing co-management as an expected process and result (by introducing a different management model). Thus, the following was made: administrative reforms, restructuration of physical facilities and other investments for fitting the work spaces/environments, rebuilding of multiprofessional teams, permanent negotiation tables resumption (tripartite tables of negotiation on labour related issues), reorganization and expansion of ongoing education activities and implementation of collective and collegiate management instances.
In order to help deepening those reforms and building workteams, a Management Development course2 started in 2005, lasting a year and a half, with subsequent occasional updating. That institutional agenda was permeated by the discussion of a management participatory model.
From that period it has been consolidated the implementation of a set of tools straightly related to the National Humanization Policy/NHP, covering the diverse spheres of management/care. Important tools for reorganizing the work process, as the 'Patient Reception with Ratings' (organization of the process and teams for the attendance protocol based on the users' clinical priorities), were being articulated to other innovations, such as the 'open visit' (hospital reorganization for extending the visiting hours to the inpatients) and several projects in tune with the co-management guidelines, besides all the investment in the perspective of 'ambience' (new architectural design of the physical facilities for providing more comfort and interaction of users and workers).
This paper aims to illustrate how the internal management contracts were constituted as a tool guiding all those movements. They will be addressed in their methodology of implementation and in what is proposed as a perspective of evaluative monitoring, an area (of evaluation) that has also been subject of discussions/methodological adjustments in the frame of NHP (Santos-Filho, 2008, 2007a, 2007b; Brasil, 2006). With that analytic approach, the objective is to contribute by highlighting some 'ways of doing' that can function as 'indicators-analyzers' of the implementation/monitoring process, thus helping strengthening those instruments as 'catalysts tools' of many other ones as well as helping in the sustainability of those initiatives.
Co-management guideline and the embryo of the management contract at HOB
It is necessary to emphasize that the investments in the organization of collegiate managers can be considered as the embryo of the Internal Management Contracts, spreaded across all sectors of the Hospital, therefore leaving the co-management hallmark as an institutional guideline.
Those collegiates, composed by managers, coordinators and workers of each unit, started to function as systematic moments of discussion on issues of collective interest, proposals, targets, setting priorities and challenges. The proposals built in those spaces were also presented to the Local Board of Health and priorities were defined for the Master Plan of the Hospital (plan for the years 2005 to 2008).
It is thus established an initiative that will be the setting for the introduction of management contracts. It is also determined that the proposed articulation implies a political-methodological direction of analysis towards drawing attention to the fact that it comprises the implementation (and continuity) of that contratual logic necessarily within the co-management guideline.
The bases of internal management contracts in the local reality
The proposal of management contracts was implemented in the context of the collegiate work spaces. And what is defined as contract bases would be: (i) the conception of management exercised in the routine of the Hospital; and (ii) what they (the contracts) can bring as 'components/challenges', that is, the potential of being 'indicators/analyzers' of the entire management. Therefore, the act of evaluating the contracts (and their 'fulfillment of targets') would not be an act (action) connected to them, but rather an act inherent to their experimentation/insertion (Santos-Filho, 2008).
And what was/is the management conception that was validated at the HOB? The one that is referred to as collegiate management, in a political-institutional model to enhance the relationships among workers, users and management aiming at: (i) democratization of work processes; (ii) care qualification for users; and (iii) inclusion of health professionals in the scope of management.
The methodology of implementing internal management contracts: spiral movements
The context previously mentioned opens all the movements described afterwards and performed together, but which are separated here only to emphasize certain 'passages'. Analytical categories are built inside them, providing information that can serve to guide new experiences. The idea of movement that is intended to emphasize implies the spiral perspective, coming and going in understanding, planning, carrying out and monitoring the implementation of management contracts.
That is to say that a systematic methodology is also being applied (inside what is proposed as 'evaluative monitoring'), enabling the recovery of daily tasks as a recording-reflection form of that/on that way of doing.
First movements
The management contracts were offered as a proposal/target within the discussions of the "Management Development Course" held between 2005 and 2006. Since then the implementation of the contracts was treated as a priority by the Hospital Board and broadly discussed and validated by the Extended Collegiate Management/ECM (composed by a representative of each Production Unit, managers, teaching coordinators and board). That process triggered a growing interest of managers, coordinators and workers, who saw in it the potential to change the work processes in their production units as well as in the whole Hospital. In this manner, the decision of implementing the tool was a collective commitment to make the HOB a referral hospital at the Unified Health System (SUS) in care humanization and health management.
The contract as a means of agreed guidelines embodied in the objectives, targets and indicators (linked to the care and management model) was set as objective and local strategy, and for that purpose it would be implemented in a decentralized manner and with the participation of everybody, profiting by the existing collegiates. It should make explicit the commitments between the hospital board and the hospital units/teams, pressuposing the involvement, appreciation and quality, reaching managers, workers and users.
Deepening the understanding of contracts was taking place with the continuous resumption of their objectives in the reality and situation of the HOB and thought as involvement of the 'sectorial' collectives (units) in the definition of (quantitative and qualitative) targets, processes and and outcomes indicators and design of action plans based on targets. The process would be formalized by means of a term of commitment.
Second movements
Those movements enhance the launched initiatives and funnel temselves into a more focused methodological perspective. Thus, it is being defined a political-operational work agenda through several meetings distributed throughout the Hospital and aiming to directly or indirectly involve all the workers. One could say that the meetings were organized in two or three types, first as 'preparatory' meetings and then as 'sensitization' meetings, following up with local situational diagnostics.
The diagnosis 'phase' was an extensive process, guided by specific instruments and intensive monitoring by management advisors, including the support of a consultant linked to the National Humanization Policy. The elaboration of the diagnosis, since the moment of drafting specific tools for each production unit (elaboration that took place in the Management Development Course), was already a broad and intense process of involvement of the units collectives, leading to a real opportunity for workers to understand the meaning and reach of those initiatives. Together with the diagnosis should start the discussions on investment priorities, that is, discuss about in what should be 'invested to change in that unit'.
The conclusion of diagnosis, discussions about problems and investment priorities close what is considered here as second movements, around which began a more systematic monitoring by a group that was being built up with that function.
Third movements
The third movements represent returns to the collectives of what had been previously discussed (in the context of diagnoses) and articulate themselves with the definition of priorities to be translated into 'targets', giving rise to action plans with monitoring indicators.
At that point it was important a more focused and formative discussion on the composition methodology of the action plans as well as of meaningful indicators for its monitoring. It was then held a workshop with representatives from the entire Hospital, addressing specific planning and evaluation categories and adjusting them to both the context of the contracts and the of formative evaluation, which is a reference NHP has been working with. Thus, the first 'standardization' of categories to make the contract instruments is constituted, clarifying the extent and the specificities of the triad objectives-targets-indicators.
Movements of making the contract instruments followed, now showing the 'background definitions' (needs, choices and priorities) but also exercising the objective formatting of targets and plans (as the standardizations previously validated).
That work phase was intensively monitored by a team set up for closer monitoring of the work. And that monitoring begins to assume a strategic function of team formation (particularly of the support group) to get familiar with the planning and evaluation categories. The moment becomes interesting by what can be collectively clarified in terms of 'effectively viable changes' taking into account the diverse contextual variables, rather than the formatting issues in themselves. In other words, by trying to translate the 'priorities' into 'concrete targets and indicators', one can notice that several 'intentions' need more 'problematization' and negotiations in order to be implemented and thus to be predicted as 'viable targets' (within the planned time). On the other hand, it is also an important opportunity of settlement (and compatibilization) with regard to what was thought as 'priorities' and in which 'scope of targets and indicators' they 'fit' to truly demonstrate the extent of change.
The process culminated in the drafting of 44 internal management contracts, representing all production units of the Hospital.
A special movement
Concluding the stages of elaboration, it must be emphasized the important movement of articulation with the Local Board of Health in the contracting process. That was the movement that culminated in the formal signature of the 44 contracts (in May 2007, approximately six months after informal conversation started), denominated in terms of commitment, with the presence of all participants who helped elaborating them. That movement was full of meaning in the scope of 'commitments', co-responsibility, until the scope of 'festive', of shared satisfaction with the process. It is relevant to mention this 'movement indicator', of 'inclusion indicator'.
Movements of monitoring the implementation of contracts
For the monitoring of the implementation of contracts (for the year 2007) a Strategic Group of Support for Monitoring the Management Contracts (GEACG) was established in February. The group was composed of management advisers, a representative of the Education and Research Coordination and a representative of the Medical Records and Statistics Service Coordination. The role of the Group was to elaborate the methodology and the instruments for the execution of work.
The Group already began to take an active role in the preparatory phases of the contracts, designing monitoring strategies with managers and board. Its operation was being established according to the own requirements of the process, which demands different types of skills for its conduction. The first steps included/have included the formulation of instruments/matrices along with the direction and they will be offered for adjustments and collective validation insofar each unit works in the contract. It was necessary to define the parameters for distributing incentives/ rewards and a systematic agenda for monitoring as well.
The processes were resumed and updated in that agenda, and strategies for their deployment/continuity were agreed upon. It was conducted a survey per unit of production/board of the already established or in process contracts. Moreover, it was carried out a mapping of the situation and beginning of the discussion with managers, coordinators and directors and developed instruments to facilitate the operationalization/completion of contracts. Understanding that targets and indicators of the overall contract of the Hospital (signed with the Municipal Secretary of Health and the Ministry of Health) are challenges to the entire body of the hospital, they started being integrated to all internal contracts. It was also necessary the completion and refinement of the whole planning 'chain' inserted in the contract, with the discussion of verification sources of targets/indicators, deadlines and responsibles, besides the detailing of actions to the viability of the targets. Everything was carried out in meetings with representatives of the collectives/units. It is noteworthy that the movement was not only an instrumental one, but rather a movement to the collective validation of the entire process expensive attitude in the perspective of participatory evaluation and fomented by the Hospital management.
Movements of evaluative monitoring and measurement of targets
In order to subsidize measurement, a support agenda for the Contract Monitoring Group (GEAC) was emphasized, helping to define a measurement methodology which was not guided by a simple 'accomplishment review' of targets, but rather a methodology that would bring a pedagogical perspective in its essence. It was proposed that the measurement would be established from a logic of evaluative-formative monitoring. That methodology has been applied in NHP, based on the convergence of references of the participatory-formative evaluation with the NHP principles/guidelines (Santos-Filho, 2008; Hartz, Silva, 2005; Silva, 2004; Hartz, 1997). We have built a methodology using a logical-evaluation model, incorporating classical evaluation categories such as 'targets' and 'indicators', but aiming at expanding and resignifying some of their dimensions and attributes (processes and outcomes dimensions; reliability and accuracy attributes etc). Above all, we have explored and expanded its formative perspective towards being put into effect/exercised as moments of learning, of redirections, and of course corrections in the process itself. A logic in which the collectives, instead of feeling themselves supervised and punished (as in an external audit) feel themselves included to discuss problems related to targets and their extent and, above all, to repactuate what is deemed relevant and agreed between the parties - this whole process being in itself a learning-by-doing, doing-learning process. Here attention is called not only for the 'contracts implementation,' but for the need to simultaneously 'analyse them', exercising an evaluation of and on the process, a dimension that is very expensive in evaluative monitoring in NHP and that also had the opportunity of experimenting while giving support to that process at HOB.
The monitoring agenda included: (i) evaluative moments with each collective (with a dialogical measurement framework, identifying and explaining the problems and their immediate causes; explanations of objectives, targets and indicators that were not clear in their 'intent' and formulation; adjustments and redefinitions of targets and indicators); (ii) summaries of evaluations and discussions with the Hospital management, emphasizing the critical aspects; (iii) systematized return of evaluations to the collectives with a 'new measurement' based on what had been agreed upon and redefined; (iv) report writing with situation mappings, joining different understanding focuses (not only as rough results, but aggregate to deeper analysis, justifications etc.). Next, (v) all the systematized material was presented to the collectives, already pointing to pertinent targets for the coming year contracts. At the end of ten months of work/movements, (vi) the entire analysis and evaluation process of the contracts was presented in a moment of 'celebration of results' at a meeting including managers, coordinators, workers, administrators and guests. It was an assessment workshop to analyse the management contracts (its power and prospects for sustainability).
The activity of direct monitoring/targets measurement is proposed to be held every two months.
Indicators of processes and movements
All the effort to address the actions related to humanization policies, always under an evaluative perspective, seeks to evaluate if they have been able to help "changing" the services' routine (processes and work relationships).
What the internal management contracts allowed?
Afterwards, some lines of 'consequences' of the contracting process are synthesized, understanding them as movement 'indicators' and their achievements/results. These lines were marked from the direct monitoring of that process in different 'intervention-observation, participant-support' situations. That monitoring was carried out sometimes with the extended team of the Hospital, other times with a smaller monitoring group, and other times in a dialogue on the forms of support for specific conceptual and methodological problematizations. That is a relevant information to demarcate that the formative evaluation requires a concrete proximity between the actors who experience and the ones who help to explore-analyze the whole situation, therefore neither happening externally nor by an external actor to the process.
As for the results achievement on the basis of predicted targets
The achievement of the planned targets is detailed in other documents. The results show the process success in achieving/carrying out what was considered being priority and relevant for the first contract. In this paper, some illustrative data of the 'overall performance' of contracts closely bound to the boards (the 44 production units are linked to five boards) are mentioned and the 'indicatives' of the triggered/changed processes are highlighted.
84% of all contractualised targets between the production units and the Hospital management were achieved, demonstrating the effort of each Production Unit (hospital sector) and their respective boards. Each contract fulfilled (achieved targets) was matched to an incentive (proportional to performance) as a reward.
Some examples of targets illustrate important results be it in the organization of each unit be it in its performance. Some management indicators are emphasized below.
In the Technical Board: therapeutic projects design (attendance care project, considering the uniqueness and the needs of each case) to 100% of critically ill patients of the Medical Clinic; multiprofessional teams formation which are established as a reference for users and increased family support to the therapeutic project of the patient in the Surgical Unit; 5% reduction of average hospital stay (admission), considering the previous period; 50% reduction in the number of pressure ulcers acquired in the wards; optimization of the units occupancy rate from the update (routine and in real time update) of the handling of patients (deaths, transfers, hospital admissions and hospital discharges); reduction of time concerning bed replacement interval for up two hours; communication improvement among all related units; increased dialogue among the committees (Hospital Infection Control, Medical Records Review Commission, Hospital Deaths Commission); and protocols standardization and/or updating in several units and implementation of employee satisfaction questionnaire.
In the Diagnostic and Therapeutic Support Board: reduction of delivery time for laboratory test results; reduction in more than 95% in the use of glutaraldehyde (at the Sterilization Central); development of medication coding with bar codes to implement the computerized system in the pharmacies central storeroom; reduction in the preparation of not used blood components (transfusional agency); elaboration of the parenteral and enteral nutrition manual; implementation of the radiation protection plan; implementation of new routines in the Human Milk Bank, in the Laundry and in other sectors, in addition to the standardization and/or updating of protocols in several units.
In the Urgency and Emergency Board (and Ambulatory Care) the focuses were the changes in the Red Room/Polytrauma Room by directing investments in order to monitor care for different types of cases/demands. It is also worth mentioning the right of patients to receive visits in the Red Room and in the Yellow Room at the Urgency and Emergency Unit. In relation to the Observation Room, it is emphasized the care of the multiprofessional team regarding the inpatients as well as the systematic way of night shifts, once the leveling is assured during the day period. As for the Ambulatory, a very important target achieved for the municipal Unified Health System (SUS) of Belo Horizonte was the consolidation of the Medical Specialties Center, with the regionalization of the secondary care for 35 specialties (establishing itself as a reference for important areas of the city). Other meaningful results include: implementation of oral health program for patients of the Cerebrovascular Accident Unit; expansion of active search to include patients in the home care program, contributing in the reduction of unnecessary hospitalization; reorganization of flows, work processes, implementation of new routines, systematic way of shifts, improvement of records and conducting surveys of user satisfaction.
In the Administrative Board, the management contract provided more speed in the release of processes for purchasing and interface improvement with the units in general. That currently represents an important change for ensuring material without shortages, having in mind the large consumption derived from the expansion of the health care complexity degree of the Hospital. Additionally, there are also significant improvements in the fulfilment of purchases regarding acquisitions prior to the contracts.
In the Work, Education and Research Administrative Board, it deserves to be highlighted the approval and actions to implement the Multiprofessional Residency Project and the evaluation of internships with the training institutions with operations in the hospital. The Unit responsible for those actions achieved 100% of its targets. It is also worth noticing the strong movement of the entire team of the People Management Unit to achieve important targets such as the regularization of more than 80% of the staff, turning into effective workers the candidates approved in the public examination, and the implementation of a new personnel management system (payroll and frequency). It must be added the satisfaction survey with the internal users of SAME, which represents an important target in improving work flows and work relationships among the sectors.
It is necessary to reaffirm the importance not only of the achievement of those targets in the strict sense, but also of what was put in motion/of what was changed throughout the hospital, reminding that everything involved from the technical and health care areas up to the most commonly peripheral sectors, as the legal and administrative areas.
The following topics focus some of the indicators of the processes that supported and reflected a general expansion of the intra-institutional dialogue.
Regarding the capacity of mobilization, of network heating and of co-management learning
The contracting process generated movement within the Hospital, causing displacements of different natures: displacements of physical facilities, of workflows and affectives establishments, reflecting an attitude of constructive solidarity (it was evident the movement of sectors helping each other in order to face difficulties and to achieve targets). There was an increase of people inclusion (a larger number and different actors) to take part in pacts, looking for the allies increase to carry forward the work plans/targets. A resource and a consequence of all that were the communication establishment or improvement and the integration between subjects/production units based on the needs, including interface needs to achieve/fulfill common targets.
We consider that those are indicative situations of the co-management strengthening by observing their repercussion in different contexts: in attitudes that express a different way of clinical management (sharing of knowledge and behavior among professionals, advancing towards a stronger integration to direct approaches to users); and in attitudes related to the work processes reorganization (re-articulation of actions, practices and arrangements, with the agreed incorporation of protocols guiding the practice) which are permeated by attempting a different way of managing the production units/sectors (a different way that 'involves' subjects, aiming at inducing their participation which values listening, welcomes suggestions and operates with sharing and joint deliberations).
There are multiple situations that illustrate that ability to set up a process of co-management and co-managed networks at the Hospital. Some interrelated examples are mentioned here as they are seen as the real chance of consolidating that way of working. The pediatric area emphasizes an outstanding difference between its first contract (in 2007) and the following one (in 2008) - the latter already being elaborated to include all areas related to the infant, broadening its scope of processes, sectors, services, subjects, focuses, flows etc., carrying out all the necessary changes to achieve the care line for child care, a fact that was generated by the movement of the first contract. Another example to be mentioned was the contract of the laboratory/diagnostic support, which extrapolated internal targets and moved towards seeking the 'network satisfaction', that is, looking for the mutual satisfaction of workers and client sectors.
Regarding the ability to give rise to situations-analyzers
The process was giving rise to problems, therefore gaining visibility not only the 'innovation' initiatives in management, but also the 'inconveniences' felt and expressed by means of 'difficulties in understanding', tensions arising out of the need of problematizations, dealing with different opinions and interests and with competing projects, situations that in many times led to attitudes of 'resistance' and of 'retreat', but also attitudes of being alert to strategies for avoiding demobilization. We emphasize that the main 'strategy' was the one of including the problems, dealing with them as collective 'topics of agenda'. Thus, aiming at understanding the situations-problems as analyzers (Barros, 2007), they started showing the lacks and the potentialities of the process lacks that showed annoyance of various orders and potentialities in the sense of valuing indications of people's availability for dealing collectively with situations. These observations attest the challenges that come with the institutional choices/ institutional decisions, the concrete challenges to operate the democratization of work processes, the 'choices' that bring many consequences and require constant vigilance in setting directions.
As for people's satisfaction
Perception of increased satisfaction of all involved -- managers, coordinators, workers and Hospital Board -- manifested in a more collective way in several meetings. That satisfaction was expressed both in relation to what had been achieved and to the way of working, getting involved, managing. In the following topic it is presented an illustrative satisfaction indicator of that situation.
Regarding learning in the way of evaluating, measuring and perceiving the own work
It is noteworthy that scope of repercussion considering the learning that occurred in the way to evaluate, enabling to materialize (in an instrumental practice) the discourse/guidelines of co-management and of formative evaluation. In other words, it was in the day by day evaluative monitoring that the 'group responsible for measurement' was learning the following: not to have a prescriptive and supervisory approach; have more security/autonomy for 'having an appraising look without having to exclude anything'; learn how to engage the colleague as a partner, rather than as 'someone who has to reach a target/pay a debt'; learn how to analyse the very concept of targets their understanding and formulation within a specific objective, their ability to reflect intentions, their constraints, parameters and sources of verification, their possibility for prediction rather than their hardness of looking for a result at any cost' or for guiding the measurent/outcome to obtain an absolute value.
It is also very important to highlight that the attitude of the 'evaluator' changes to one of 'help', of giving support, in order to both helping to reformulate the contract and helping the collectives to make actions and targets feasible, assignment that was once considered as 'unthinkable', 'inappropriate', according to the discourse of some members of the group.
Thus, the contracts were experienced operating with a (successful) logic of successive adjustments, linked to the evaluative monitoring (Santos-Filho, 2008). It is a matter of methodological logic that, having as a reference the formative evaluation, allows making adjustments whenever necessary to match (or get closer to matching as much as possible) the planning of actions, targets, of the real needs indicators of processes and of subjects in their environment.
From the perspective of the evaluative monitoring, the contract is reframed as a locus/agreement space with regard to what makes sense in the context of each collective.
In a moment of extended evaluation, we mentioned two situations indicating the richness of the movement. In one of them, we called attention to the fact that a great deal of targets/results of those contracts could have been dealt with by means of a harder and linear perspective of 'certification' or of 'quality control' (within a prescriptive and externally controlled perspective). However, they were being treated in a co-constructive way, therefore being the challenge and the innovative character of the contracts. Hence, it is not only the definition of 'good' targets (pertinent targets), but the process of defining, enabling and measuring them as well. The other situation was related to the perception of people's satisfaction with both what they had carried out and achieved and with the reflection they were doing collectively about it and with the readiness for organizing the next contract. We are talking about a 'coefficient of passion' that was being expressed in that work mode, with that type of insertion. And by means of that alive 'information-indicator' of satisfaction, we associate to what we understand on the field of Workers' Health as a need to understand that the workers' motivation neither takes place nor can be 'demanded' in an abstract way, but rather that motivation is something that emerges with the work, from within a (special, unique, collective) way to perform the work, to make it come true.
The internal management contracts function, therefore, as a tool that strengthens the shared management, producing other ways to advance the accomplishment of proposals for the organization of hospital care and of the work process of producing health and subjectivity.
Levels of challenges
It is proposed to address the challenges also as axis of analysis of the entire process and that bring 'indicatives' of what can/needs to be changed, including to help the sustainability of the open fronts.
Being essential tools for strengthening the co-management model, the contracts (i) should be better tailored as tools-means to increase integration and inter-relationship among the production units in order to achieve related targets; (ii) should also be a means to provoke increased workers' participation (in the case of some production units); and (iii) should consolidate the collegiate of the units as the legitimate instances to validate and collectively operate the process.
From the most instrumental point of view, in the new contracts one should take care of the refinement of its directive-organizer line - the tripod objectives-targets-indicators by: (i) reviewing the 'quality of the objectives' so as to give them more precision and guiding, linking them to the overall objectives in a more consistent and targeted way; (ii) improving the evaluation criteria and the criteria of dealing with the categorizations, mixing parameters not to be bound to 'measures/absolute coefficients'; (iii) improving, on the other hand, specific measurement criteria, especially regarding the indicators that depend on each other sectors. Moreover, one should permeate the entire evaluation scheme with simplified but significant techniques of careful consideration and of 'correction factors'.
It is important to anticipate and to agree upon a 'contracting agenda' inside the evaluative monitoring that can be a reference as regards the definition of timelines and responsibles for 'pulling' the different movements, steps, systematizations etc.
In the context and in the track of this whole process, the challenge that presents itself as the most necessary for an 'institutional agenda' seems to be that of strategies to increase the degree of agreement with the workers' network to carry forward the principle and the concrete co-management instruments.
The authors worked together in all stages of this manuscript production.
BARROS, R.B. Grupo: a afirmação de um simulacro. Porto Alegre: Sulina/Ed. UFRGS, 2007.
BENEVIDES, R.; PASSOS, E. A humanização como dimensão pública das políticas de saúde. Cienc. Saude Colet., v.10, n.3, p.561-71, 2005.
BRASIL. Ministério da Saúde. Humanizasus: documento base para gestores e trabalhadores do SUS. Brasília: Ministério da Saúde, 2008.
BRASIL. Ministério da Saúde. Monitoramento e Avaliação na Política Nacional de Humanização na rede de Atenção e Gestão do SUS: manual com eixos avaliativos e indicadores de referência. Brasília: Ministério da Saúde, 2006.
CAMPOS, G.W.S. Clínica e saúde coletiva compartilhadas: teoria Paidéia e reformulação ampliada do trabalho em saúde. In: CAMPOS, G.W.S. et al. (Orgs.). Tratado de Saúde Coletiva. São Paulo: Hucitec/ Fiocruz, 2006. p.53-92.
______. Saúde Paidéia. São Paulo: Hucitec, 2003.
______. Um método para análise e co-gestão de coletivos. São Paulo: Hucitec, 2000.
HARTZ, Z.M.A. Avaliação em saúde: dos modelos conceituais à prática na análise da implantação de programas. Rio de Janeiro: Fiocruz, 1997.
HARTZ, Z.M.A.; SILVA, L.M.V. Avaliação em saúde: dos modelos teóricos à prática na avaliação de programas e sistemas de saúde. Rio de Janeiro: Fiocruz, 2005.
SANTOS-FILHO, S.B. Avaliação como dispositivo de humanização da atenção e gestão em saúde. Relatório de consultoria. Brasília: Ministério da Saúde, 2008.
______. Perspectivas da avaliação na Política Nacional de Humanização: aspectos conceituais e metodológicos. Cienc. Saude Colet., v.12, n.4, p.999-1010, 2007a.
______. Indicadores de valorização do trabalho e trabalhadores da saúde: construindo o conceito de valorização a partir de uma perspectiva analítica. In: SANTOS-FILHO, S.B.; BARROS, M.E.B (Orgs.). Trabalhador da saúde: muito prazer! Protagonismo dos trabalhadores na gestão do trabalho em saúde. Ijuí: Ed. Unijuí, 2007b. p.143-71.
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1 Team composed of: Susana M. Moreira Rates (Hospital Superintendent), Miriam M. Souza, Yara C. N. Barbosa, Andréia A. Torres e Maria Helena dos Santos (Board members) Group responsible for articulating and fostering the entire local management renewal process, incorporating support, conducting and sharing the implementation of actions, building together day by day the strategies of facing different problems that were emerging in the own process.
2 Course conducted by Gastão Wagner de Sousa Campos.


text: cropped-a4a8a4b6-94b5-405c-bef5-2033451c6b34.jpeg Dave Allen Grady June 29, 2019 Share this:TweetPrintWhatsAppEmailMoreRedditShare on TumblrPocketTelegramLike this:Like Loading... Published by Dave Allen Grady I enjoy cycling, cooking, and travel. I get to be married to the best wife and mother in the world. I've got a cool kid and enjoy soaking up life, being a clergy person, and savoring the joys and trials of parenting. View all posts by Dave Allen Grady Published June 29, 2019


text:
Written by Duana
Email exchange:
Lainey: Unless - do you care about Neve Campbell? Because YIKES.
Me: She is my girl crush
Lainey: Oh Christ.
Yes, 'another one'. The facts are as follows: Campbell is Canadian, and before she was Julia Salinger, she played a parallel-universe Brenda Walsh type (well, if Brenda was chilled) called Daisy on a show called Catwalk. It was about a band. It aired at 10 PM Wednesdays. I wanted to be her.
And then came Julia Salinger, whom we loved (until the Ned years), a super-successful horror franchise, a series of ever-weirder art films, including a 'controversial' 'sexy' one. (When Will I Be Loved, you pervs).
So OK. She took the non-traditional route. No problem. She took her Scream money and made some for-the-heart projects, and she's actively not an ingénue and not a starlet. She's adopted London as her home with her (then) husband, and is an actor. Not an actress. Distinction mine (but probably hers as well).
But, since she's not trying to be seen as the girl next door (Scream revival aside, and I cannot WAIT), she's not dressing young, desire-me, and still she's certainly not old enough to dress 'I am a grande dame, take me seriously' . Also, it must be said, she doesn't have the credits for that either. I hold out hope for Campbell in her 40s, though. Either way, people who are born the same age as her include Heidi Klum, Kate Beckinsale, Tori Spelling – not exactly known for their demureness. I don't know what her plan is for her image in the next little while – obviously she has some or she wouldn't be at the BAFTAs – but I'm not sure who she wants to be, wearing this. Of course – sometimes a dress really is just a dress.
Having said that, there's no excuse for the makeup. That is Campbell going 'who wants to waste time in the chair? I'm just going to do it myself', and slapping it on before she heads out the door. I believe the moral here is that if you need to choose between makeup artist and no makeup artist, the answer is always, cough up the cash and call them.
Which makes me wonder if there was a charter flight of American makeup artists all headed over to the BAFTAs to do their favourite people's faces. You think they get fought over?
Photos from Wenn.com
BAFTA Worst Maroon Matron: Neve Campbell
Written by Duana


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When a burglar broke into more than two dozen apartments in Baltimore County, it wasn't the items he took that were unusual. It was what he left behind.
Renters in Cockeysville returned home to find holes in their walls as big as 4 feet by 4 feet. The studs had been removed to allow a grown man to squeeze through from one apartment to the next — without ever unlocking the door.
Police chased reports of the so-called drywall burglar for a month before they arrested Robert White. They say they caught him taking electronics from a housing complex on Saddletop Court.
"Cutting through the drywall, that's definitely one way of doing it," said Dennis Delp, Cockeysville Precinct commander. "He was bound to be caught."
Police say White, 30, could complete a multi-unit job by breaking into a single apartment, then busting through shared walls to neighboring homes.
The only time anybody saw the Cockeysville man, police say, was as he made off with the goods. Investigators collected a physical description of the suspect, his beat-up silver car and its license plate number.
The information eventually led to 49 counts of burglary and related charges against White. His trial is scheduled to begin next month.
White could not be reached for comment for this article. Messages left for his public defender were not returned.
Nick Reese arrived at Steeplechase Apartment Homes off Cranbrook Road in May to find his door pried open. A hole in the wall led to his neighbor's place. An officer at the scene told him the burglar had most likely used a crowbar.
Missing were Reese's TVs, a laptop, $50 to $70 worth of change, an iPod and an old cellphone.
"I was so angry when it happened," Reese said. But he allowed as how the method was "kind of smart."
"He didn't have to break through two doors," Reese said. "I guess it's easier to knock a hole through two pieces of drywall."
Witnesses to the burglaries told officers they had seen an unfamiliar man, sometimes with electronics in tow, but hadn't given him much thought. One witness told police he didn't recognize the man but waved at him — and the man waved politely back.
Police got their first burglary report April 19, when a woman told officers someone had pried her front door open, punched a large hole in her living room wall and walked off with her 42-inch TV.
A witness later told police she saw a man carry a large television set away from the apartment building on Limestone Valley Drive and drive away in a gray vehicle.
Two weeks later, officers were called to nearby Gelding Drive, where someone had pried open a locked door and left a large hole in a wall.
Jason Koehler said his neighbor's door was pried open, but they both came home to a large hole in the shared wall.
"The whole wall was just dug out," he said.
Koehler said his television, laptop computer and checkbook were missing. He said an external hard drive was the most difficult to replace because it had pictures, music and other data he had downloaded. He also had to get a new checking account.
A woman who had been walking her dog told an officer she saw a man in a white T-shirt and baggy pants carrying a large flat screen TV outside Koehler's building. He put it into a beat-up silver car, she said, and even briefly spoke with her.
At Heathrow Court Apartments in Perry Hall, an off-duty Baltimore police officer noticed a man carrying a flat-screen TV. He was able to provide county police with a full description of the man, the silver two-door sedan and a license plate number.
Police say they tracked White's girlfriend's 2004 Toyota Solara to an apartment on Clover Crest Way in Cockeysville. Detectives obtained a search warrant to put a GPS unit on the car to follow it.
In May, police say, a burglary unit surveillance team followed White through several apartment complexes along Cranbrook Road, according to charging documents. Detectives say he was casing the buildings to see which apartments were occupied.
White parked outside a building on Saddletop Court, police say, and carried a bag inside. Police say he emerged with what appeared to be a laptop. He went back in, police say, carried out another computer, and then made a third trip for a 42-inch TV.
He returned to the building one more time, police say, and came back with the remotes in his pockets.
Officers then followed White across Cranbrook Road, police say, and arrested him at his girlfriend's apartment on Clover Crest Way. Police say officers found the TV remotes still in his pockets.
"I didn't take anything inside," White told officers, according to court documents.
At the last apartment officers say White visited, police found the door pried open, and a hole punched through the wall to the next unit.
Officers took White back to the Cockeysville Precinct, where police say he said he had sold the stolen goods to support a $300-a-day drug addiction, according to charging documents.


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Never before in history have active-duty American troops been invited to march in the Victory Day parade, according to the United States military. The occasion is the 65th anniversary of the defeat of Nazi Germany in World War II, a date that carries an almost sacred meaning in Russia.
Ukrainian and Russian sailors wearing in World War II-era Soviet soldiers' uniforms march during a parade rehearsal in the central Ukrainian city of Sevastopol, the main base of the Russian Black Sea Fleet.
Anyone know what make / model guns those are?
Full Photo Set – HERE


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WiP Wednesday #17
String Me Along March block
do.Good.Stitches March blocks
Making progress on:
Margaret's Hope Chest Quilt - This quilt is the biggie wip at the moment. I must finish it up by the end of the month and mail it off to Kayla. Kayla will be turning 18 and her father is currently in prison. I wanted to make something that will stay with Kayla for a long time, so I'm trying to make something that's a little bit young and a little bit modern at the same time, just right for a young woman. These blocks have been super fun to work on, and I've made a good bit of progress. Just another 20 or so blocks to go...
Single Girl King Size quilt - I'm taking a break here at the moment, to work on my MHC quilt, and to try to regain some of the sanity I lost, adding all of those inner background pieces to my blocks. I've still got another 60 curves to sew, but I've done 100 so far, so I'm past the halfway point, I just need to recharge my creative batteries a little before I can pick this one back up again.
Make Mine Modern swap - I'm working on my final sketch and measurements at the moment so I can start to actually sew my big piece. I pulled some fabrics yesterday and I'm starting to get really excited about this project! I've gotten a few small things to add to my one small sewn item, a pincushion, but I don't want to give too much away!
Projects still on my plate, though I haven't touched them:
Birdie Stitches March block
Project Modern: Monochromatic Challenge - The chances of me getting to this quilt are looking slim, but I'm still hoping against hope that it works out. I've never worked monochromatically before, and I think it would be an interesting challenge to participate in.
Zilch! (for once)
WiP Wednesday #17 Recap
Last week's total: 7
Done: 2
Still in progress: 5
New: 0
This week's total: 5
20 comments:
I'm just starting out my own quilting blog today, and I'm browsing through other quilters blogs to see who's out here.
I just wanted to say I love your work! Those blocks for the hope chest quilt are just stunning!
~ Paula
Wow, that MHC quilt is looking stunning, as is your single girl. That's inspiring in itself, just looking at those pictures - keep going!ReplyDelete
The hope chest quilt looks really fantastic. Such a great story too.ReplyDelete
WOW - that's a lot of blocks for the single girl quilt. I would need a rest too from that one.
And I love your MMM fabrics, I hope they are for me. ;)
(found your blog while surfing the WIP links - hope you don't mind a comment)ReplyDelete
Yes, that Hope Chest quilt is amazing. :D Will be fun to see your Single Girl blocks when they're together!
Love the Hope Chest quilt it's shaping up beautifully!! Your colours are so vibrant in it! And I can't wait to see how the Single Girl quilt turns out, it looks so complicated tho, not sure I'd have the patienceReplyDelete
KING sized single girl??? Man, you are ambitious! Love it so far! And your hope chest quilt is great :-)ReplyDelete
Wow, the Single Girl is coming along nicely! I'm not brave enough to try one curve, much less 160!ReplyDelete
I'm loving your hope chest quilt! It's perfect for an 18-year-old, and she'll love it as she grows older too!ReplyDelete
I just signed up to make a quilt for Margaret's Hope Chest! Thanks for the reminder about that organization. I'm sewing for a 3-year-old who likes "dirt bikes and orange." Should be fun! :)ReplyDelete
I didn't realize you are making a KING-size quilt! That's going to be awesome!ReplyDelete
I love your Hope Chest quilt. I bet she'll love it too!ReplyDelete
The SG blocks look delish, though I completely understand the need for a break from them! Doing that quilt king-size really is an undertaking, but you're doing great. Kayla's quilt is just perfect - like you said, girly but modern at the same time!ReplyDelete
As always, thanks for linking up, have a great week!
You must have great will power since you didn't start any new projects this week! I feel like I start something new every other day :)ReplyDelete
The MHC quilt is beautiful! Kayla will love it!ReplyDelete
I understand why you would need to take a break from the Single Girl, but I selfishly hope it's a small one...I can't wait to see the final product!
Your Margaret's Hope Chest quilt is beautiful, the pink is perfect -- a great combination of modern and girly. Love it!ReplyDelete
Do you need any more fabric for your MHC quilt? I have some cute pink/green fabric that I really like but can never think of a proper project. Let me know if you are interested. I can send you a picture.ReplyDelete
Wow! your MHC is just fabulous, I love all those fun girlie prints and the arrangement is perfect. Also in awe of your patience! 100 curves, wait, 100 AWESOME looking curves?? Wow, just wow. Great WIPs!ReplyDelete
It all looks great Elizabeth! I especially love your MHC quilt so far, can't wait to see more!ReplyDelete
Hi Elisabeth! Kayla's quilt is going to be so beautiful! I love those happy colours! MHC quilt is amazing - it needs lots of work!ReplyDelete
Have a lovely day!
Wow! Your projects are just awesome. You're way more than halfway on those curves. (NERD ALERT) 100/160 is just about two-thirds of the way. YAY you!ReplyDelete
Thank you for leaving a comment for me! I appreciate each and every one of them and try to respond when time allows. Your comments totally brighten my day :)


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Swinging Bridge 2018
Well, again I met the front runners on trail. The smoke created an interesting challenge. It won't show in finished work. Maximize your screen for best results! Lightly processed proofs--anything ordered will be hand-finished; you'll see those start to replace the proofs as they're ordered. Use the arrow keys to move left and right through the proof gallery instead of using the mouse. If you're new to my site, my frequently asked questions [can be found here], especially about digital image prices. Save some $$, there's package pricing under the "Buy" button, can be the same or different images. E-mail/FB digitals are $15 or free with 8x10 and above, $10 as an add-on to a print purchase, but all digitals come from me directly, not through the cart. Scanning prints for use online is specifically prohibited! Please buy a digital version instead.Read More


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Heart Star: Larry Fitzgerald Of Arizona Cardinals Always Watches His Health
As one of the best receivers in the NFL, Arizona Cardinals' star wide receiver Larry Fitzgerald is serious when it comes to his health and well-being. Although he's "very thankful" that heart disease and stroke don't run in his family, Fitzgerald isn't taking any chances. His "job," as he calls it, requires him to stay fit and healthy at all times.
"I pride myself on eating right and exercising regularly. During the season, of course, exercising is a part of my job each day I go to work," Fitzgerald says.
The 6-foot-3, 218-pound Pro Bowler has made wellness part of his daily routine.
"The team has 'on field' practices and we are also required to lift weights, as well. Breakfast and lunch are provided, and I choose to make healthy eating choices," Fitzgerald says. "During the off season I try to stick to these same rules."
His dedication to a healthy diet and daily exercise has paid off. Following an amazing career at the University of Pittsburgh, Fitzgerald was the third overall pick in the 2004 NFL Draft by the Cardinals. His best season came in 2008, when he caught 96 passes for 1,431 yards and 12 touchdowns. That was the same year the Cardinals went to the Super Bowl.
Fitzgerald says his formula for health is simple.
"First, everyone should be sure to take an active role in their health and well-being by making sure to regularly participate in some form of physical exercise," he says. "There are many components to staying in shape, such as looking after your cardiovascular fitness level, increasing your strength ability, as well as working on your range of motion, otherwise known as flexibility.
"Second, you have to eat right," Fitzgerald continues. "Portion control is the key, I think. Just watch what you eat and be sure to eat a variety of foods each day."
Clearly the plays Fitzgerald makes off the field are as important as the ones he makes on the field.


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For the past couple of years, men have seemed to dominate the tech industry. The 2018 Consumer Electronics Show (CES) lineup echoed this will have a mostly male lineup of speakers. But times are changing as more and more women are hacking the tech world and positioning themselves in prominent roles.
CES 2018 Controversy
Instead of making headlines for its products and technological feats, CES found itself in a negative spotlight shining on unequal gender representation at 2018's event.
When confronted about the mostly male lineup of speakers, CES representatives stated that a lack of diversity among employees in the tech industry is to blame. According to a study by the United States Government Accountability Office, female tech employees only made up 22 percent of the workforce.
Following the event, the lack of female representation attracted serious negative attention across social media platforms. CES has committed to getting more female speakers in the future.
A Call for Gender Equality
With calls for gender equality, especially in the wake of the #MeToo movement, CES changed its wiring. Instead of just sticking to the most notable and popular tech companies, it has reached out to find where women are most in the tech industry: small operations and startups.
2019's CES has added more women keynote speakers to its itinerary. Ones to note are U.S. Transportation Secretary, Elaine Chao, and IBM CEO, Ginni Rometty. About 57 percent of total speakers are also women, with 40 percent being women of color.
Despite this change at CES, there's still a greater call for gender equality in the tech industry, which — despite uprising trends and numbers — is still a male-dominated industry.
What CES Change Means for Women in Tech
With more women coming to prominence and topping areas of the tech industry, praises and accomplishments will become more common. More successes and recognition will lessen this stigma that tech is a man's field.
We will see changes in the demographics and attitudes in the workplace — not just in the tech industry, but in other sectors, as well. More job opportunities may also open up for women, especially those in leadership and executive positions.
Companies like Google are starting to seek out women and employ their unique perspectives to help bring new and innovative ideas and perceptions to tech and its possibilities.
Also, more female-run tech companies and startups may start seeing more willing investments of venture capital, which has been found to receive less investment than those run by men.
That's why it's important to recognize and support the women and organizations who empower women in the tech industry as they continue to become factors for change and development.
Is this a win for women in tech? Yes, but there's still so much more to improve.
How to Get More Women in Tech
To support women's efforts and increase their equality in the tech industry, here are some actions we can take:
- Smash the stigma that technology is a male-dominated industry
- Encourage women and girls who have an interest in tech
- Teach girls about tech, programming and computer science at a younger age
- Close the wage and gender gap between men and women
- Inspire activism and change at the business and federal level
- Support each other, regardless of gender, race or ethnicity
The Future of Women in Tech
There's no denying that there are strong female voices in the tech industry and that more are following right behind them. Eventually, maybe there won't be a question of whether women will stay in tech. But, changes within companies and events like CES need to continue.
The future of women in tech does look bright, as long as support and encouragement follow with each little crack in the glass ceiling everyone has been chipping away at.