Gastão Wagner de Sousa Campos

Apoio matricial e equipe de referência: uma metodologia para gestão do trabalho interdisciplinar em saúde

The authors discuss a theoretical and conceptual management methodology based on reference teams and matrix support. Reference team is a structural organization intended to combine managerial power and interdisciplinary work. Matrix support changes the way traditional health systems work, with specialists organically linked to other teams who periodically require specialized consultation. Besides care support, there is another goal: to build new knowledge for each health professional through a continuing education process. The article analyzes the structural, political, cultural, theoretical, and subjective obstacles to this new model.

Saúde pública e saúde coletiva: campo e núcleo de saberes e práticas

O artigo discute o campo e o nucleo de saberes e de praticas da saude coletiva a partir de um metodologia dialetica, pensando-a para alem do positivismo e do estruturalismo e fazendo uma critica a sua tendencia de assumir posicao de transcendencia sobre o campo da saude. A partir dessa analise sao elaboradas sugestoes para debate, relacionadas centralmente com saude coletiva entendida como construcao sociohistorica de sujeitos concretos.

Equipes de referência e apoio especializado matricial: um ensaio sobre a reorganização do trabalho em saúde

Este artigo propoe um novo arranjo organizacional para o trabalho em saude. E desenvolvido e ampliado o conceito de equipe de referencia - proposto e experimentado pelo autor desde 1989. E tambem reelaborado o conceito de organizacao matricial do trabalho, invertendo-se em relacao ao esquema original o que seria permanente e aquilo que seria transitorio (recorte matricial) nos servicos de saude. Sao tambem apresentadas consideracoes teoricas que autorizam e justificam a construcao desta nova proposta.

A clínica ampliada e compartilhada, a gestão democrática e redes de atenção como referenciais teórico-operacionais para a reforma do hospital

This paper uses elements of the Paideia concept to suggest guidelines for contemporary hospital reform, particularly the reorganization of work processes based on the concepts of extended general practice and democratic management. Instead of production-line work processes, an alternative way of structuring patient care is proposed, newly crafted with professional autonomy and clearly defined clinical responsibilities. An analysis is also presented of the difficulties and consequences of integrating hospitals with public health systems.

O anti-Taylor: sobre a invenção de um método para co-governar instituições de saúde produzindo liberdade e compromisso

Descricao de um novo Metodo para Co-governar Organizacoes de Saude, considerando-se tanto os objetivos primarios destas instituicoes (a propria producao de saude) quanto outros, secundarios, ligados a funcao de assegurar sobrevivencia e realizacao profissional aos seus trabalhadores. O novo Metodo e denominado de Gestao Colegiada centrada em Equipes de Saude. Esta construcao resultou de um sistema de confrontacao triangular entre determinado corpo de Teorias, dados empiricos observados no Sistema Unico de Saude e a experiencia e conhecimentos do proprio pesquisador. Sao descritos alguns dispositivos organizacionais originais (novos ou reconceitualizados), entre eles: Unidade de Producao; Equipe de Referencia e Trabalho de apoio Matricial; Sistema de Gestao Colegiada; Co-governo; Supervisao Matricial; e o de Produto/Obra.This paper describes a new health care management method. A triangular confrontation system was constructed, based on a theoretical review, empirical facts observed from health services, and the researchers knowledge, jointly analyzed. This new management model was termed health-team-focused collegiate management, entailing several original organizational concepts: production unity, matrix-based reference team, collegiate management system, cogovernance, and product/production interface.This paper describes a new health care management method. A triangular confrontation system was constructed, based on a theoretical review, empirical facts observed from health services, and the researchers knowledge, jointly analyzed. This new management model was termed health-team-focused collegiate management, entailing several original organizational concepts: production unity, matrix-based reference team, collegiate management system, co-governance, and product/production interface.

Acolhimento e (des)medicalização social: um desafio para as equipes de saúde da família

This article discusses the relation between sheltering practice and social medicalization in the primary care. It begins with a revision about social medicalization and mentions some influences concerning the organization of the Brazilian primary care. It also indicates that the ground of receptivity proposal was provided by those influences. It argues the potentiality to accomplish the sheltering with a demedicalization and interdisciplinary action and its reverse effect, when restricted simply to emergency medic care. There are hereby suggested changes in the management and organization of routines, agendas as well as collective and individuals activities of the professionals with the intention to reduce medicalization. The conclusion favors the expansion of experimentation on sheltering as a strategy in dealing with unexpected events and with primary care spontaneous demand, always watching out for its medicalization potential.

Reforma política e sanitária: a sustentabilidade do sus em questão?

This paper presents seven strategies considered to be relevant to ensure the continuity of the Brazilian National Health Care System consolidation and health care reform.

O SUS entre a tradição dos Sistemas Nacionais e o modo liberal-privado para organizar o cuidado à saúde

Este ensaio analisa elementos da historia do SUS, buscando compreender os efeitos de duas fortes tradicoes sobre o modo para organizar o cuidado em saude: a liberal-privatista e a dos sistemas nacionais e publicos de saude. Procura caracterizar tambem a atuacao de alguns atores sociais, com destaque para o movimento sanitario.

Quality-of-care assessment in a university hospital pediatric clinic

This study focuses on the Pediatric Clinic of the UNICAMP University Hospital, teaching and care facility belonging to the Brazilian National Health System, providing secondary and tertiary health care for children aged 0 to 18 years. A total of 221 questionnaires were applied with users of the general pediatric out patient services and one of the specialties, allowing for comparison of various medical care indicators. Users were found to be quite knowledgeable about their health conditions and satisfied with the care received, despite a weak link in the physician-patient relationship. 43.4% reported problems related to the services, while only 17.6% made suggestions to improve them. Waiting time was found to be quite long. Users of specialized services differed from general care patients with regard to several indicators.

Análise crítica sobre especialidades médicas e estratégias para integrá-las ao Sistema Único de Saúde (SUS)

The implementation of medical specialization in Brasil has been relatively free of constraints. There has thus been a progressive fragmentation of medical work. The so-called root specialities are losing both their strength and clinical problem-solving capacity. Two operational concepts are proposed for achieving better administration of medical responsibilities and the role of medical professionals: 1) field of competence and 2) core competence. General goals are suggested for reforming specialized training and integration of specialists into the Unified National Health System.