"Fiefdoms" and co-management: the paradox of autonomy in an experience of democratization of hospital management.

Abstract

This study aimed to analyze the implementation of Management Committees and Production Units in a hospital in Rio de Janeiro based on the views of the actors responsible for this process, focusing on the issue of autonomy of the subjects involved in care delivery. This case study adopted a qualitative clinical psychosociological research approach using mainly semi-structured interviews. The management arrangements were valued by the interviewees principally as a way of increasing worker commitment, since the inclusion of workers in the Management Committees is likely to widen decision-making capacity and, at the same time, make staff more committed to care delivery. On the other hand, workers mentioned resistance arising from a struggle to maintain the concentration of power within the professional categories, and the challenge of dealing with differing conflicts of interests. The study suggests that the Management Committees and Production Units should include possibilities of addressing conflicts and intersubjective processes to avoid becoming excessively idealized and ineffective spaces.