Práticas gerenciais em unidades de pronto atendimento no contexto de estruturação da rede de atenção à saúde de Belo Horizonte

Abstract

The insertion of Emergency Care Units in the network of health care has set a challenge for the SUS, because many times this locus of health care does not assure the resolution, because of the inefficiency of strategies to assure the individual the continuity of care at another level of health care or other social equipments in the network. Then, the integration of this service to other network services is the foundation for continuity and comprehensive care. Considering the service managers one of the agents of the change process in these organizations, this study aimed to analyze the practices developed by managers of emergency care unit (UPA) in connection with the structuring of the Network of Health Care.It is the study of qualitative case made with twenty-four managers of eight UPAs, in the city of Belo Horizonte, Brazil. The data collection was accomplished through interviews with a semistructured script associated with the comic technique. The data were collected from February to May 2011. The results indicate the views of UPAs managers on the context of structuring the network in the city, as well as the complicating aspects to the development of this process, and highlighted the large and diverse number of patients treated in the UPAs, the indiscriminate pursuit of UPA by users; the role of UPA at the primary and tertiary health care, the discredit towards the insertion of this equipment and its real mission in the network, and the relationship between health services and other social equipments. In this context, we highlight the singularities of the managmentl function in UPAs, identified improvements in management practices related to integrated network management, viewed through the relationships established between the managers of UPAs and the various services that compose the network of the city. For the exercise of the management were identified as main challenges: the bureaucracy of the system, the dynamics and unpredictability of the work, the difficulties for the development of teamwork and computerization of the network and also the paucity of training and incentives for the management function. As evidenced management actions still focused on traditional management and remote management of care. Then, there is a need of development of management practices focusing on the health team and on the care process.