Francisco Javier Uribe Rivera

Planejamento e gestão em saúde: flexibilidade metológica e agir comunicativo

Este artigo pretende ser uma reflexao acerca das possibilidades e das lacunas do planejamento situacional no que tange ao desenvolvimento da imagem-objetivo de organizacoes dialogicas ou comunicantes. Estabelece, ainda, um inicio de dialogo com as correntes de planejamento de saude mapeadas no Brasil e define algumas tematicas de investigacao que podem oferecer o necessario complemento para que o planejamento cumpra sua funcao como agir comunicativo.

Planejamento e gestão em saúde: histórico e tendências com base numa visão comunicativa

This article aims to present a condensed overview of major trends in Brazil, establish a general taxonomy of models of health management and planning, based on the international scene and support the proposal for a communicative planning. In a context of democratization, argues for a pluralistic conception and concludes that the various currents, albeit with different perspectives and referrals theoretical and methodological dialogue in a process of mutual exchange and learning.

Networks for dialogue and coordination of health activities: a study on a regional mobile emergency care service

Coordination of health services networks is one of the main challenges for health systems and requires an intricate web of interactions between service providers. This study assumes a model that uses communications networks as a central component of coordination and analyzes such networks in the Mobile Emergency Care Service (SAMU) in Greater Metropolitan Rio de Janeiro State Area II, Brazil. The study specifically seeks to analyze how verbal interactions influence this process. The research used direct observation and taping of meetings with data collection and analysis of conversation as the methodological strategy. The findings feature the identification of two main conversation networks as the mechanism for coordinating actions. The article highlights the importance of the concept of dialogical coordination as a tool for the analysis and improvement of coordination in health services systems.

Projeto Integrar: avaliação da implantação de serviços integrados de saúde no Município de Vitória, Espírito Santo, Brasil

This article describes an experience with the integration of various healthcare services, called the Integrar Project, in Vitória, capital of the State of Espírito Santo, Brazil, and analyzes the projects contribution to the development of comprehensive healthcare practices. The case study used a qualitative approach and covered the period from 2000 to 2003, identifying the projects potential in the areas of maternal and child health, continuing health education, and the family health strategy, but also identified difficulties in establishing integrated treatment projects involving both the Family Health Program teams and the various medical specialties. To a major extent the work proposal failed to materialize, highlighting the need to review the strategy to include new forms of communications and developing greater formal cooperation, beyond the existing informal coordination between individuals, teams, or services, based on a contractual logic in public healthcare services. Standards and norms that are negotiated through dialogue and a management contract would allow the involvement of professionals in sharing common goals and changing work processes. Such changes would involve management tools and new values to ensure accountability.

A contratualização nos Hospitais de Ensino no Sistema Único de Saúde brasileiro

Sao discutidas as possibilidades e os limites da contratualizacao para a melhoria do desempenho, o incremento da prestacao de contas, o aprimoramento da gestao, a melhoria da assistencia e a maior insercao dos hospitais de ensino na rede de servicos no âmbito do Programa de Reestruturacao dos Hospitais de Ensino no Sistema Unico de Saude/SUS. Quatro hospitais contratados e suas secretarias contratantes sao entrevistados. Segundo os dirigentes de hospitais, e fragil a associacao entre contratualizacao e a presenca de mecanismos de insercao na rede, de praticas e estruturas de qualificacao assistencial e gerencial nos hospitais. Hospitais mais estruturados assistencial e gerencialmente apresentaram uma contratualizacao mais estruturada com a secretaria. Houve um aumento de producao da media complexidade ambulatorial e uma diminuicao dos procedimentos de atencao basica em todos os hospitais. Sugere-se o desenvolvimento gerencial continuo do hospital e da secretaria, a revisao do plano operativo, orcamento, mecanismos de monitoramento e sistema de incentivos, pactuacao com as equipes, dentre outros.

A démarche stratégique (gestão estratégica hospitalar): um instrumento de coordenação da prática hospitalar baseado nos custos de oportunidade e na solidariedade

Este texto e uma apresentacao geral da metodologia de gestao estrategica hospitalar de M. Cremadez e F. Grateau (Franca), incluindo os objetivos, as fases e as principais ferramentas do enfoque. O trabalho destaca os aspectos microeconomicos do mesmo e suas possibilidades para estruturar redes de servicos atraves da pactuacao de metas e objetivos entre hospitais. Inclui a apresentacao de um caso de aplicacao do enfoque como instrumento de coordenacao regional da especialidade de cirurgia geral dos hospitais de uma area programatica (AP-4) da cidade do Rio de Janeiro.

A liderança como intersubjetividade lingüística

This paper sums up some concepts regarding leadership and seeks to highlight the growing importance of the vision of a leader in assisting in organizational learning, based on team-work, and in coordinating linguistic communication processes oriented towards understanding the organizations mission, structure, and dynamics. Upholding that, in addition to their ability to implement strategic management, leaders must also develop communication skills and support change, in order to manage more effectively intersubjective relationships among organizational subjects, to make the organization more competent.

Agir comunicativo, redes de conversação e coordenação em serviços de saúde: uma perspectiva teórico-metodológica

This paper discusses a theoretical and methodological approach for studies within the field of integration of healthcare services. The intersubjective aspects of the coordination processes are emphasized. The discussion starts from the assumption that the coordination of healthcare actions and services, which is a process central to integration, is essentially a communicative action. Among the methodological aspects, the potential of conversation analysis is highlighted as a tool for analyzing the interactions that are established within the processes of coordinating healthcare actions and services.En este articulo se discute un planteamiento teorico-metodologico para estudios en el area de la integracion de servicios de salud, destacando el aspecto inter-subjetivo de los procesos de coordinacion. Se parte del supuesto de que la coordinacion de acciones y servicios de salud, proceso central de la integracion, es esencialmente una accion comunicativa. Entre los aspectos metodologicos se destacan las potencialidades del Analisis de Conversaciones (AC) como herramienta para analizar las interacciones que se establecen en los procesos de coordinacion de acciones y servicios de salud.

Trabalho em equipe interdisciplinar de saúde como um espaço de reconhecimento: contribuições da teoria de Axel Honneth

This theoretical study aims to correlate the discussion about interdisciplinary teamwork in public health institutions with the key concepts of contemporary philosopher Axel Honneth with regards to what he called the Struggle for Recognition. We start by revising the notion of subject in Honneths theory, especially based on his dialogue with Donald Winnicotts psychoanalysis. We highlight that this subject is eminently social; its constitution depends on the recognition of others regarding its otherness and the legitimacy of its belonging to a social group. Next, we show that this recognition occurs through a process of struggle, which is essential for developing the capacity to love and to relate to others. We then argue that the work in interdisciplinary teams can be configured as a potent space for the recognition of professionals, as discussed by Honneth. Teams may thus facilitate the development of creative work and innovations in the organization of care provided to patients.This theoretical study aims to correlate the discussion about interdisciplinary teamwork in public health institutions with the key concepts of contemporary philosopher Axel Honneth with regards to what he called the Struggle for Recognition. We start by revising the notion of subject in Honneths theory, especially based on his dialogue with Donald Winnicotts psychoanalysis. We highlight that this subject is eminently social; its constitution depends on the recognition of others regarding its otherness and the legitimacy of its belonging to a social group. Next, we show that this recognition occurs through a process of struggle, which is essential for developing the capacity to love and to relate to others. We then argue that the work in interdisciplinary teams can be configured as a potent space for the recognition of professionals, as discussed by Honneth. Teams may thus facilitate the development of creative work and innovations in the organization of care provided to patients.

Planejamento em Saúde e Epidemiologia no Brasil: casamento ou divórcio?

O presente artigo discute a relacao entre o instrumental epidemiologico e os metodos de planejamento das atividades de Saude Publica no Brasil Para isso, sao apresentadas, de forma resumida, concepcoes e atuais tendencias de ambas disciplinas. Tambem e considerado um esquema de analise da racionalidade no processo de planejamento. Por fim, aventa razoes para explicar o fracasso do planejamento em saude no Brasil e o papel da epidemiologia nesta situacao.