Abstract
This study aimed to analyze organizational processes of change in the hospital care management by using qualitative evaluation developed in the case study. The study was developed at the Hospital Fornecedores de Cana de Piracicaba, in São Paulo State, Brazil, in September and October of 2012. There were 25 interviews with members of the senior board of directors of the hospital, managers and health professionals linked to healthcare of adults, in addition to the analysis of managerial documents and observations of some activities. In this article it is analyzed part of the results, dividing the organizational change in three axes: the planning process developed in the healthcare sectors; The protocol/creation of assisted routines in order to obtain better efficiency and safety for the patient; and the work of hospitalist physicians. The study highlights the complexity of the processes of change in the care management sphere in hospitals and the dynamism between a given management concept and its rational tools and the subjects and groups that seek, in the micropolitic and intersubjective processes, meanings to their practices.
Highlights
The debate on health management in the national and international contexts highlights the importance of hospital management in governmental policies, as an almost natural corollary of cost reduction policies and the search for greater efficiency for the sector
The issue of cooperation/agreement between managers and agents or actors in general involved in health sector is an important challenge in a scenario in which the presence of conflicts of interests and the fragmentation of processes of health care has been a trend[1,3]. Involved in this discussion we presented the study developed in the Hospital Fornecedores de Cana de Piracicaba (HFCP), philanthropic hospital of high complexity of the SUS (Unified Health System), which analyzed the care management experience and the possibilities of changes implementation in the work processes and in the improvement of hospital assistance quality, considering the complex and multidimensional nature of health care
The HFCP, located in Piracicaba, is a reference for the 26 municipalities belonging to the Regional Health Department of Piracicaba, São Paulo State
Summary
The debate on health management in the national and international contexts highlights the importance of hospital management in governmental policies, as an almost natural corollary of cost reduction policies and the search for greater efficiency for the sector. The issue of management and especially the one linked to the excellence and quality of care in hospitals has developed an increasingly important role in the daily routine of the managers, health professionals and users. In this context, intense studies and initiatives for adoption of guidelines and clinical protocols of hospital accreditation, standard definition and a search for a high level of security for the patients, among other measures whose purpose is the qualification of hospital health care[2,3,4,5]. In the last decade, issues such as the comprehensiveness of care, care promotion, teamwork, reception and health services humanization are increasingly occupying a noticeable position in the sectoral discussions of the country[6,7,8,9].
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