A Sociotechnical Approach to Analyze Pharmaceutical Policy and Services Management in Primary Health Care in a Brazilian Municipality

Abstract

The decentralization of the Brazilian health system required that municipalities took responsibility for the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system. We adopted a multi-methods approach and various data sources. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analyzing the External System (health system, stakeholders, financing) and Internal System (goals, management, workforce, infrastructure, processes, technology and culture). The “objective” component of the PPS system was identified as the central element. The lack of a unified objective and of a central coordination and unmanaged pharmaceutical services prevented integrated internal planning and planning with other sectors. Stakeholders and documents referred only to technical elements of the system: Infrastructure, technical process, and technology. The social components of the workforce and culture were not mentioned. The organizational culture established was the culture of isolation: “Each one does his own”. The pharmacists working in the municipal health system did not know each other. There was no integration strategy between pharmacists and their work processes. Consequently, the municipal PPS had limited scope as a public policy. It had constrained the characteristics of PPS as a complex and open system. Understanding the municipal PPS as a sociotechnical system can push the development of a new level of policy and practice to ensure the population’s right to the access to and rational use of medicines.

Digital Disparities in Patient Adoption of Telemedicine

“…STS perspectives have a long history of application in the information systems field. Scholars have used STS to explain the use of technology in practice (Bostrom & Heinen, 1977;Orlikowski, 2000;Sarker et al, 2019), and, inspired by calls to action more than a decade ago (Whetton & Georgiou, 2010), health informatics research using an STS lens has expanded (e.g., Bernardo et al, 2020;Mohr & Dessers, 2019;Sittig & Singh, 2015).…”

Technical Factors Associated with Polypharmacy Management Through Leavitt’s Sociotechnical Model

“…As a complex adaptive system, interpreting the health system as a socio-technical system can promote the development of a new level of policy and practice. To ensure the elderly access to the rational use of medicines and manage polypharmacy among those with comorbidities, it is crucial to address the health system's technical and social aspects at any level (16). For this aim, our investigation was strictly based on the initial framework by Leavitt, who depicted every organization as a multivariate dynamic system with complicated interactions of four key variables: task, structure, technology, and actors (17).…”

Pharmaceutical Services Management Capacity and the Municipal Socioeconomic Scenario: Persistent Inequalities

“…PS in the municipal health system comprises an open subsystem characterized by complexities related to the organizational culture, the structure of services, procedures and workforce, and also the political and economic context in which it operates [27]. As PS is part of this complex arrangement of municipal health management, it is understood that it is necessary to analyze which contextual factors are involved in its development capacity and which can collaborate so that investments in PS can meet local needs [3-5, 10-19, 23, 26, 28-32], considering PS within the socioeconomic environment in which it is inserted.…”