Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals.

José Márcio Da Cunha Pacheco Júnior,Romeu Gomes

doi:10.1590/1413-81232015218.20012015

José Márcio Da Cunha Pacheco Júnior, Romeu Gomes

Open Access

https://doi.org/10.1590/1413-81232015218.20012015

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Abstract

This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice.

Highlights

The process of changing public policies in Brazil has gained prominence due to the realignment in the direction of reforms from the federal Government which involves improving the make-up of the primary health care network
Hospitals stand out as one of the main organizations in relation to the above due to providing medium and highly complex medical interventions and because they consume a considerable amount of resources to provide these services[6]. Continuing on this vein, when the discussion is on primary health care in SUS, hospitals and the innumerable aspects that surround them ought to be taken into consideration[6]
Based on the above understanding, the purpose of this study is to objectively analyze the decision making process of senior management in public hospitals in SUS in relation to projects aimed at changing clinical management

Summary

Introduction

The process of changing public policies in Brazil has gained prominence due to the realignment in the direction of reforms from the federal Government which involves improving the make-up of the primary health care network. With specific reference to social policies, there has been a redefinition in the functions and possibilities involved in the administration of public bodies that are responsible for providing services directly to users[1,2,3] This has occurred due to the increasing costs in health services. Health care is an area that involves technical discussions and debates around policies, projects and strategies for implementing reforms with the acceptance that this area is complex and that this complexity has ramifications at all levels of government[4,5] In this ambit, hospitals stand out as one of the main organizations in relation to the above due to providing medium and highly complex medical interventions and because they consume a considerable amount of resources to provide these services[6]. Continuing on this vein, when the discussion is on primary health care in SUS, hospitals and the innumerable aspects that surround them ought to be taken into consideration[6]

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