Despite the introduction of social innovation in the 1996 White Paper on Science and Technology, the concept of social innovation has not been actively implemented or even diffused outside of the policy arena in South Africa. Perceptions about what the concept of social innovation should encompass are contested and range from ideas of social welfare outcomes, public goods and a primary focus on the poor. More recently, the emphasis has been on inclusive development that embraces and supports the poor as innovators and which incorporates elements of social and economic development. While contestation in terminology persists, evidence from South Africa's rural areas suggests that although there may be limited state intervention, hampered by structural constraints, and limited understanding of contemporary ideas about innovation and social innovation, local actors practise a variety of forms of social innovation. In most instances, the purpose is to improve social and economic well-being of the poor. Such innovation activities occur almost as widely and as often as strictly commercially oriented innovation activities. However, it is unclear from observed social innovation practices who should benefit from these practices (the poor or everyone), how (directly or indirectly) and when (immediately or gradually). It is suggested that extensive use of the actor-oriented sociological approach to understanding social dynamics in both science and development can provide a means of understanding the subtleties involved in innovation practices and its use should be adopted to address structural challenges within the National System of Innovation that mediate against the contribution of innovations to the poor for inclusive development.

FUNDAMENTO: Tempo porta-balão adequado (< 120 minutos) é a condição necessária para que a eficácia da angioplastia primária no infarto se traduza em efetividade. OBJETIVO: Descrever a efetividade de um protocolo de qualidade assistencial para redução do tempo porta-balão. MÉTODOS: Entre maio de 2010 e agosto de 2012, foram analisados todos os indivíduos que realizaram angioplastia primária em nosso hospital. O momento porta foi registrado eletronicamente, pela retirada de senha para atendimento na emergência, o que antecede o preenchimento da ficha e a triagem. O momento balão foi definido como o início da abertura da artéria (passagem do primeiro dispositivo). Os primeiros 5 meses de monitoramento corresponderam ao período pré-implementação do protocolo. O protocolo se constituiu de definição do fluxo de ações, desde a chegada do paciente ao hospital, a sensibilização da equipe quanto à priorização do tempo e a apresentação periódica de parecer dos resultados e de possíveis inadequações. RESULTADOS: Foram avaliados 50 indivíduos, divididos em cinco grupos de 10 pacientes sequenciais (um grupo pré e quatro grupos pós-protocolo). O tempo porta-balão referente aos 10 casos registrados antes da implementação do protocolo foi de 200 ± 77 minutos. Após a implementação do protocolo, houve progressiva melhora do tempo porta-balão, para 142 ± 78 minutos nos 10 primeiros pacientes, seguida de 150±50 minutos, 131±37 minutos e, finalmente, 116 ± 29 minutos no três grupos sequenciais de 10 pacientes, respectivamente. Regressão linear entre pacientes sequenciais e tempo porta-balão (r = - 0,41) evidenciou coeficiente de regressão de - 1,74 minutos. CONCLUSÃO: A implementação do protocolo se mostrou efetiva na redução do tempo porta-balão.

BACKGROUND: An adequate door-to-balloon time (<120 minutes) is the necessary condition for the efficacy of primary angioplasty in infarction to translate into effectiveness. OBJECTIVE: To describe the effectiveness of a quality of care protocol in reducing the door-to-balloon time. METHODS: Between May 2010 and August 2012, all individuals undergoing primary angioplasty in our hospital were analyzed. The door time was electronically recorded at the moment the patient took a number to be evaluated in the emergency room, which occurred prior to filling the check-in forms and to the triage. The balloon time was defined as the beginning of artery opening (introduction of the first device). The first 5 months of monitoring corresponded to the period of pre-implementation of the protocol. The protocol comprised the definition of a flowchart of actions from patient arrival at the hospital, the team's awareness raising in relation to the prioritization of time, and provision of a periodic feedback on the results and possible inadequacies. RESULTS: A total of 50 individuals were assessed. They were divided into five groups of 10 sequential patients (one group pre- and four groups post-protocol). The door-to-balloon time regarding the 10 cases recorded before protocol implementation was 200 ± 77 minutes. After protocol implementation, there was a progressive reduction of the door-to-balloon time to 142±78 minutes in the first 10 patients, then to 150±50 minutes, 131±37 minutes and, finally, 116±29 minutes in the three sequential groups of 10 patients, respectively. Linear regression between sequential patients and the door-to-balloon time (r = - 0.41) showed a regression coefficient of - 1.74 minutes. CONCLUSION: The protocol implementation proved effective in the reduction of the door-to-balloon time.

OBJETIVO: Analisar variáveis relativas aos atendimentos realizados em unidade de emergência que aplica protocolos. MÉTODOS: Objeto da análise: pacientes admitidos no serviço de emergência do Hospital São Rafael, Salvador, Bahia, de 1 de junho de 2000 a 31 de maio de 2001. Estudo das variáveis idade, sexo, procedência, data, hora, especialidade médica, doença, complexidade e tempo de permanência. RESULTADOS: Dos pacientes estudados, 35,4% tinham até 14 anos de idade; 86,11% dos atendimentos ocorreram das 8h às 22h59 78,96% de todos os atendimentos foram consultas seguidas de alta; 17,86% necessitaram de observação. Desses, 10,37% tiveram alta e 7,49% foram internados. Permanência média de 282,9 minutos(± 242,54). O grupo de CID-10 "R" foi mais freqüente (29,5%). As três principais causas de atendimento foram febre, diarréia e dispnéia. Dos procedentes de até 5 km do hospital, 12% necessitaram de observação e 5,8% de internamento. Dos procedentes de mais de 15 km, 20,23% necessitaram de observação e 12,63% de internamento. CONCLUSÕES: A maioria dos pacientes que procuram a unidade de emergência necessita de atendimentos de baixa complexidade, principalmente quando procedem de bairros próximos ao hospital.

OBJECTIVE: Analysis of patient care variables in an emergency unit that applies care protocols. METHODS: Subjects: Patients admitted to the emergency unit of the São Rafael Hospital in Salvador, Bahia, Brazil, between July 1, 2000 and May 31, 2001. Study of the variables: age, gender, origin (city, district), admission date and hour, medical specialty, patient's disease (coded by ICDM-10), destiny (discharge, observation and discharge, observation and hospital admission), length of stay. RESULTS: 35.4% of the patients were under 14 years old. 86.11% of the admissions took place from 08:00 am to 10:59 pm. 78.96% of all patients were discharged after consultation. 17.86% required observation. Of these, 10.37% were discharged and 7.49% were admitted to the hospital. Length of stay was on the average of 282.9 (± 242.54) min. The ICDM-10 "R" group had a higher frequency, (29.5%). The three main causes for emergency unit admissions were fever, diarrhea and dyspnea. 12% of those who came from a distance of up to 5km required observation and 5.8% needed hospital admission. 20.23% of those that came from a distance farther than 15km required observation and 12.63% needed hospital admission. CONCLUSIONS: The majority of patients cared for in this emergency unit required low complexity care and the number increases when patients come to the hospital from a shorter distance.