Gestão de organização social e acreditação no Sistema Único de Saúde (SUS): implicações na saúde do trabalhador

Abstract

INTRODUCTION: In the context of the Unified Health System (SUS), the recognition and consequent inclusion of policies, strategies and practices are recent, with an emphasis on protecting the occupational health. The practices in force in this field are incipient and fragile, with regard to the study of the causes of the illness of the worker, as well as their sociological analysis through the concepts of psychodynamics of work. Health care workers are usually subjected to precarious working conditions, stress and occupational risks typical of the profession. In addition, there was the introduction of new public management requirements, through social organization (OS), accompanied by the implementation of standards and of the quality evaluation/certification, seeking the fulfillment of the eligibility requirements of the Organization's 'Accreditation' National Accreditation (ONA) for heath units. Although this latest innovation generates a recognized continuous improvement in care and quality in the health care of its users, paradoxically, it results in increased demands and overload of duties, with possible implications for the occupational health. OBJECTIVE: To evaluate the implications of management of social organization and 'quality accreditation' on the occupational health at a SUS unit, under the perception of workers and managers. METHODOLOGY: Qualitative study, supported by thematic content analysis. Developed in a mixed health unit (basic attention; specialized ambulatories; e urgency and emergency), of the municipal SUS network, administered by OS and inserted in the evaluation/certification of quality ONA. The techniques of focus group (FG) and individual interview (EI) were used, 38 participants were selected, being: 30 health care professionals (higher education degree), 14 (GF) and 16 (EI) and 8 managers (EI), by intentional sampling. RESULTS: Workers and managers legitimize 'Accreditation', as it promotes qualification, with continuous improvements in work processes and health care. However, workers consider, aggravating their health and well-being, the episodes of overload of assignments and high requirements of mandatory targets/indicators (semi-participatory), added to excessive documentary records, to the detriment of attention to the user. In contrast, managers recognize the fulfillment of productivity requirements and goals (by the worker), inherent to the duo -'commitment and responsibility' with work. They do not recognize the presence of overload of duties, stress and the resulting illness of the worker, resulting from the quality standards of accreditation. They reflect 'Accreditation' exclusively for its benefits, disregarding its burden on the development and / or worsening of health conditions, whether they are occupational or not. Still, in their view, 'OS Management' transfers profitability to municipal management and favors the health of the population, in addition to gains in transparency and public control. The workers, on the other hand, consider that the employment relationsh...