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

Abstract

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.

Atenção centrada no paciente na prática interprofissional colaborativa

“…These studies focused on PCC in connection with the following aspects: 1) Enlarged healthcare perspective, 2) Patients' participation in care and 3) Humane care. In regard to the Enlargement of the healthcare perspective there is a cluster of contributions on holistic care 13,[19][20][21][22][23][24][25][26] , comprehensive care 13,20,[24][25][26][27][28] and health needs oriented care 13,19,21,22,24,25,28,29 .…”

“…The need to improve the relationship patient-provider was cited as a basic condition to PCC 19,21,24,25,30 , both in the sense of valuing the human condition 19,24 , in the improvement of quality of care 22,24,25,28,30,31 or for therapeutic success 26 . Several values are underlined as crucial for PCC: empathy, respect, solidarity 30 , listening, psychosocial support 27 , sensitivity, affection, dialogue in healthcare 25 , receptivity and rapport 20,24 .…”

“…The national and international literature about the attributes of PCC points to a consensus around three core elements: 1) enlarged approach to care [16][17][18][28][29][30]53 as an answer to the need of acknowledging and responding in holistic way to users, families and communities' demands; 2) Patients' participation in their care 27,42,43 and the need of empowering and support for self care and autonomy 15,19,21,22,24-27, 30,34,42,43 and 3) Patientprovider relationship 13,14,[18][19][20]24,25,30,42,43 integrating the subjectivity of the parties, as autonomous subjects.…”

“…These studies focused on PCC in connection with the following aspects: 1) Enlarged healthcare perspective, 2) Patients' participation in care and 3) Humane care. In regard to the Enlargement of the healthcare perspective there is a cluster of contributions on holistic care 13,[19][20][21][22][23][24][25][26] , comprehensive care 13,20,[24][25][26][27][28] and health needs oriented care 13,19,21,22,24,25,28,29 .In the Patients' participation perspective the contributions cluster around the concepts autonomy 21,[24][25][26]30 , self-care 12,19,21,22,29,31 , valuing experience 20,23 and patients' participation 13,21,28,32 .Patients' participation in care is defined as an opportunity for the exercise of citizens' rights in the quest for autonomy (related to ideas of freedom, leading role, COMUNICAÇÃO SAÚDE EDUCAÇÃO 2016; 20(59):905-16 respect for subjectivity 33 as an important condition for self-care 19,20,33 . The concept of self-care is understood as a way of managing the healthcare process, implying the collaboration of the health te...…”

Apoio institucional como diretriz de gestão da 7ª Diretoria Regional de Saúde, Bahia, Brasil

“…Associado a isto e com o entendimento da necessidade de aumentar a participação dos trabalhadores no processo de gestão, foram sendo criados mecanismos de cogestão, através de rodas de conversas, do planejamento participativo e da inserção dos mesmos nos processos decisórios. Neste sentido, recorremos, mais uma vez, à tese Paidéia 3 , caracterizada por envolver trabalhadores e usuários no processo de reforma e reorganização, compreendendo que mudanças estruturais e organizacionais alcançam melhores resultados quando há alteração no modo de ser dos sujeitos envolvidos 4 .…”