Humanização e Cogestão na Atenção Básica: as relações de trabalho no cotidiano

Abstract

The National Humanization Policy (NHP) goal is to promote the Sanitary Reform focusing the centrality of daily relationships. Despite its complexity, humanization is often understood only as the quality of relationships between health professionals and users, thus undermining its potential. Management issues, including work relations, are debated in the theoretical field but little explored empirically. This research aims to understand how the humanization of management-based on the model adopted by the policy, the Co-management-is considered and practiced by health professionals in the daily work of Primary Care context. Two health units were included in the research, one traditional (Basic Health Unit-BHU) and one with the Family Health Strategy (Family Health Nucleus-FHN). The corpus construction was carried out in two stages. During the first one, immersion in the field, we observed some context aspects and the interaction of health professionals, which were written as field notes. This immersion provided subsidies for the second stage, group or individual interviews, and for general analysis of the corpus. A semi-structured script, which was constructed from the analysis of the field notes to cover each context's specificities, guided the interviews. The conversations were audio-recorded and full transcribed. The analysis of field notes describes the way each health unit works, and the analysis of interviews describes the meanings about management humanization and the practices identified as such by health professionals. The results are separated for each unit, from three focuses: the contextual, the relational dynamics and the meaning-making process. These aspects are analyzed separately, although in practice they overlap. We describe contextual and relational elements that contribute to or hamper the construction (in the case of BHU) or maintenance (in the case of FHN) of a participatory culture and shared management. In regard of the meanings, in both contexts participation in decision-making, teamwork and actions focused in resolution of demands are identified as humanized management, but what these aspects and practices mean, differ in each context analyzed. We concluded it is necessary, in order to construct a co-management culture, to act on the stablished relationships, and, at the same time, on how professionals understand and signify their practices together. Moments of collective talk do not necessarily generate participation and shared management. It is how these moments work that matters and this will depend directly on how the team understands and builds itself. Our thesis describes participatory culture, a central aspect of co-management, as a social construction, something that occurs in relationships and language. Therefore, in order to develop a co-management model, it is necessary to work the group process involved in daily activities. Social Psychology, group studies, and especially social constructionist epistemology provide resources to work the group process in order to build participa...

Conception of workers in a municipal health network about the service-management relationship

“…However, for the realization of the co-management guideline, Galavote et al (2016) underscore the need to create new channels of dialogue, which implies civilizing borders, dissolving existing barriers between managers and workers, specialists and generalists, between clinic and management, among those who formulate and those who execute (Iglesias & Avellar, 2017 ). In this same direction, Dorici (2018) points out that one of the factors that favors co-management is correlated with the way health teams relate to users and the community. The author highlights the importance of horizontality in the relationships, the bond, the inclusion of different knowledge and the co-responsibility of all the actors involved with the health issues that emerge in the territory.…”