Tomada de decisão e alta administração: a implantação de projetos de mudanças de gestão da clínica em hospitais do SUS

Résumé 0

"This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The method-ological design of this study is qualitative in na-ture taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for man-agers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as eco-nomic and financial factors in the decision making process. The incremental model and general poli-tics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to ana-lyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people’s working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice."