Os médicos e a racionalização das práticas hospitalares: novos limites para a liberdade profissional?

• Ano de defesa: 2010
• Autor(a) principal: Abou Jamra, Carolina Chaccur [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Accreditation; Hospital clinical board; Hospital-Physician relations; Professional autonomy; Hospital administration; Acreditação; Autonomia profissional; Corpo clínico hospitalar; Relações Hospital-Médico; Administração hospitalar
• Link de acesso: http://repositorio.unifesp.br/handle/11600/9892

Brazilian hospitals, either in public or private sectors, have experienced a remarkable rationalization process in their practices through strategies aimed at regulate, discipline and control the diverse dimensions of hospital life. Such strategies convey a specific, instrumental rationality that is outlined by the search for greater institutional efficiency and effectiveness. Regarding the existence of a dual system of authorities in hospitals composed by both medical and administrative powers, the introduction of a rationalizing logic by the hospital administration potentially impacts the power of decision-making within the clinical board, whose professionals, on their turn, activate autonomy conservation strategies ultimately concerned with the maintenance of their power in the institution. The present study is aimed at understanding how medical doctors experience and assign meaning to the rationalizing hospital management policies implemented by the management board of a hospital belonging to the State Health Department of São Paulo. This hospital is managed by a university through a formal agreement as a teaching hospital. It is also certified by the National Accreditation Organization as an institution of excellence. As a case study carried out through an analytical qualitative methodology, which, from semi-structured interviews performed with six medical doctors directly concerned with health care, this research is able to identify an apparent paradox involving the evident advancement of the institutional mechanisms of control over medical work as well as the ―subjective‖ perception of such advancements by the physicians, who do not recognize them as limits for their technical autonomy. In addition, it demonstrates how far the resistance of physicians against the rationalizing measures is made in act, when performing their work, when creating informal networks of contact and knowledge, which follow through by producing flows, ways of operation for the hospital, ways of producing care, which go far beyond the rationality, the formalism, and the previsibility as aimed by the administration.