Technological innovations in the management of hospital care: the impacts of the Hospital Attention National Policy on the micro politics and on the production of health care in a Unified Health System (SUS) reference Hospital in Sao Paulo, Brazil

Abstract

The restructuring of the health care system requires effective transformations in the practices of care and in the functioning of hospital organizations, which must be closely articulated with the other services that compose the health network. Processes that are only guided by the rationalization of hospital life have proved to be insufficient to support the construction of a new hospital of and for (SUS).. Technological arrangements that aim at bettering the practices and instances of management are intervention modalities that have a multi professional character, which allow for the improvement of the capability of embracing and identifying risks, for the betterment of patient admittance at the hospital, for the qualification of the clinic management and for the generation of hospital discharges that are more articulated with other attention services in the network. Several technological arrangements specified by PNHOSP have been being used. In a study conducted using the line of research of the Healthcare and Health Work Management Group in a public hospital of emergency and urgent care, it was observed that the technological arrangements - Manchester and Kanban - have a high adhesion by health professional who recognize in them a potent way of organizing care with a high level of plasticity, as they assume different configurations. The study also indicated different formats of interprofessional relations, but which have not changed the power relations and the professional autonomy, particularly among doctors. Based on this study and on the experience of the group in carrying out studies for and in SUS with a micropolitical approach, we propose an investigation aiming at deepening the results of the previous studies and with the objective of analyzing the technological arrangements in the management of care projected by PNHOSP in a SUS reference hospital in the city of São Paulo. Specify, identify, analyze and characterize: a) what arrangements projected by PNHOSP are operationalized in the hospital being studied and how they are lived by the care team in their routines; b) the intra and inter professional relationships in the operationalization of the technological arrangements; c) the relationship between the hospital teams, users and their families in the operationalization of the technological arrangements; d) the relations between the hospital and the health service network from the perspective of the integrality and continuity of care. A qualitative study will be carried out, case study type, cartographic, with ethnographic elements. Multiple techniques to produce the data will be used: 1. documental analysis; 2. workshops with hospital directors and team; 3. participative observation of the technological arrangements selected in common agreement with the hospital team; 4. follow-up of guide-users hospitalized mainly as a result of chronic health conditions. The place of the study will be Hospital Santa Marcelina, which is responsible for the managements of different health establishments: hospitals, basic healthcare units, medical clinics, emergency and urgent care services; it is responsible for the care of 1,806,164 inhabitants in the east zone of the city of São Paulo and part of the local SUS network due to the relationship with the São Paulo state and city health secretaries. The main expected outcomes are: the deepening of theoretical-conceptual formulations related to the intra and interprofessional dynamics, the identification of new hospital bureaucracy, including the systemic functioning of the hospital, scientific contribution to enlarge theoretical thought regarding organizational dynamics, helping to overcome overly simplified theoretical models and hegemonic operations. The inclusion of institutional players and of the users and their families in all phases of the studies will contribute to the scientific formation of the team and also qualify the care and management of health. (AU)