Cooperação transversal, proximidade e organização do trabalho na gestão de OPMES em um Hospital Universitário : uma análise multinível, longitudinal e histórica das quebras de estoque endovasculares

Abstract

The recurrence of shortages in Endovascular Implantable Medical Devices (IMD) stock at the Hospital das Clínicas from UFMG (HC) prompted the opportunity for an in-depth study. Managing these materials presents added complexity due to their diversity, similarity, and the individual characteristics of each patient. This leads to uncertainties regarding the sizes and models that will be effectively used, with such decisions being made during the ongoing endosurgery. In a Federal University Hospital (HU-F) like HC, the specifics of public procurement make this management even more challenging, with bureaucracy and payment deadlines directly impacting material availability. Situated in a context marked by past crises of HUs-F and the subsequent establishment of the Brazilian Hospital Services Company (EBSERH), IMD management interconnects various functions within HC's administrative and healthcare areas, with a particular emphasis on the often undervalued and overlooked backoffice work. To explore these themes, a multidisciplinary approach was adopted, incorporating elements of Ergonomie de l'activité and Grounded Theory, with concurrent collection, analysis, and categorization of qualitative data, as well as a multilevel approach mapping underlying determinants through AcciMap diagrams. The research identified that, in conjunction with variabilities and uncertainties, shortages, greater leeway in an endovascular subspecialty, and productivity pressure within the team lead to the phenomenon known as organizational silence. While shortages have substantial implications, affecting costs and the safety of patients and healthcare workers, endosurgeons avoid reporting them out of fear that the use of similar IMD in place of the missing ones may be misunderstood by actors removed from the reality of their healthcare activities. Organizational analysis revealed how failures in various processes are linked to shortages and identified their systemic determinants, such as issues escalating between processes and inadequate control tools for monitoring. However, the lack of cross-functional cooperation and the weakening of proximity management, which we identified as organizational gaps, emerged as crucial factors. These gaps are related to changes that occurred after joining EBSERH, resulting in high turnover and insufficient support for newcomers. Our results underscore the interdependence between administrative support functions and healthcare areas of care and cure, identifying shortages not as isolated events but as symptoms of structural dysfunctions within the sociotechnical system of the hospital, in other words, as organizational accidents. The current structure has proven inadequate both for retaining knowledge and for fostering the development of intangible resources and the return of experience. Therefore, this study contributes to a better understanding of the complexities involved in IMD management at HUs-F, emphasizing the importance of a backoffice work organization that prioritizes cross-functional cooperation and proximity management in preventing shortages and strengthening system resilience in the face of experienced workers' departures.