Abstract
This article analyzes the process of shaping the care profile of federal hospitals in the city of Rio de Janeiro. This is a qualitative, descriptive study that draws on semi-structured interviews with hospital administrators. Data analysis used the Collective Subject Discourse approach. Managers believe this process is the result of a set of emerging strategies, proposals and need for change, which result in adaptive reactions that hospitals develop with no coordination between them to resolve problems identified by professionals and managers. The process is analyzed much more from a political point of view than from a rational and systemic one. Some of the experience with the hospital mission, such as the focus on a strategic approach, already signals a more collegiate approach to defining the profile of care, where the hospital is one component of an integrated network of services, with a decision process that is less incremental and more integrating.
Highlights
The hospital is the strategic space for reorganizing the healthcare system
Are the results of the study split into two blocks: the process of hospital change and strategy definition, and the design of the care profile and organizational perspectives
When we discussed the main changes the interviewees perceive in the recent care profile of each hospital, we found two core themes in the collective subject discourse: the first are the changes themselves, both perceived and mentioned by managers, and the second is made up of a set movements that, unlike the perception of change, were made to resist change (Chart 1)
Summary
The hospital is the strategic space for reorganizing the healthcare system. It is where much of the care is provided and concentrates most of the financial, material and human resources. Important factors such as changing epidemiological, demographic and social profiles, an increase in the use of technology, population aging and a need for greater integration across the different services of the healthcare network have required changes in the model of care, which have directly impacting hospitals and their role in the system[1,2]. The care profile comprises the full range of care or services provided by the hospital. Change means introducing a new service, a new disease/condition or a new technology, as well as excluding, reducing or expanding the range of services offered
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