Construindo ações coletivas nas instituições municipais de saúde: bases para uma gestão estratégica participativa

Abstract

The present study has as its chief objective the identification of the psychosociological conditions that have affected the functioning of strategic management in healthcare on a municipal level. The guiding hypothesis in this research is that tacit relationships of cooperation and trust between teams from diverse municipal strategic levels had influence over the functioning of the healthcare system. In regard to methodological choices, I have taken the ethnographical standpoint as the basis for understanding of work, both in the real situations lived by the health workers and in researching, given that, in addition to seeking an understanding of situations, I made a point of intervening in and modifying them. The results of this research brought to evidence two distinct moments, which are further divided into first and second moments of changes. The first refers to the apprehension of the established psychosocial rupture; the second, to the reestablishment of relationships between the members of the situation room, the coordinator of the Family Healthcare Program, and the teams from First Care Units, which culminates in qualitative and quantitative improvement of work in public healthcare. The tacit relationships of cooperation and trust between teams from different municipal strategic levels influenced positively the functioning of the healthcare system, since these relationships are background elements which fostered professional relationships and improved the functioning of strategic management practices. At the same time, the lack of such elements deters strategic management in healthcare from fulfilling its purpose. Pertaining to the establishment of the relationship of trust between professionals, I can state that it corresponds adequately to the image of circles of social interaction that strengthen each other, as in a spiral, and move according to a pattern, without the necessity of going through all the elements and stages involved in building trust. In the first moment of changes, social actors employ external resources (power, control). But these resources will be rendered useless at the second moment, when the actors will have shared experiences and observed each other's actions. The time, the knowledge, and the experience of health technicians, the lack of knowledge of and experience in management on the part of the new FHP coordinator, and the feeling that not only he, but also the teams from the Family Healthcare Program, could count on the technicians' aid fostered an approximation between them. The resulting interaction, in the form of dialogue and sharing of experiences and advice, marked the beginning of a renewed closeness in the relationships of cooperation between healthcare and participative management professionals, for they had opportunity to express their opinions concerning the emergent demands of healthcare situations. This accrued to qualitative and quantitative improvement of healthcare service.