Os médicos e a gestão do cuidado em serviços hospitalares de emergência: poder profissional ameaçado?

• Autor(a) principal: Luiz Carlos de Oliveira Cecilio
• Data de Publicação: 2020
• Outros Autores: Tiago Correia, Rosemarie Andreazza, Arthur Chioro, Graça Carapinheiro, Nelma Lourenço de Matos Cruz, Luciana Soares de Barros
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Cadernos de Saúde Pública
• Texto Completo: https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7306
• topic: Assistência Integral à Saúde; Serviço Hospitalar de Emergência; Assistência Centrada no Paciente

Kanban is a technical arrangement for the organization of hospital care focused on the management of beds and clinical care, aimed at the quality and comprehensiveness of care and greater hospital bed turnover, and thus a reduction in length-of-stay and hospital costs. The system’s most striking and innovative feature is constant, updated patient follow-up, shared by the professional team in systematic meetings. Characterize the probable impacts from the arrangement’s adoption on physicians’ professional power (autonomy and authority). Qualitative study in a municipal urgency-emergency hospital using the following data production techniques: ethnography of the hospital’s routine, with observation and records in field diaries, and shared seminars with researchers and teams. Physicians value multi-professional work for qualifying their practice, as an ancillary and complementary line. Kanban tends to be controlled by “hybrids” (physicians who accumulate management and clinical functions) that express synergies between “clinical management” and “hospital bed management”. Thus, in this arrangement interferences in physicians’ work are not exercised from outside, and physicians’ clinical decisions still condition the work of the other professional groups. Physicians do not see their authority and autonomy threatened by Kanban, given the linkage between management authority and professional authority. Still, aspects related to hybridization and internal stratification of the medical profession need to be better addressed in the debate on health professionals’ power.