A racionalização das condições de trabalho nos hospitais: uma análise crítica baseada em relatos de ginecologistas obstetras e pediatras atuantes na urgência e emergência

Hospitals are a big part of the service sector. Thus, such institutions are highly influenced by the logic of the capitalist accumulation, technology and forms of labor organization, especially by private organizations. Starting with the restructuring process motion and incorporation of technologies, many changes in the working process occur, therefore, the activities of medical professionals as well. During the preparation of this research items regarding the banalization of evil were identified. This banalization and resignation of the professionals face to violence are caused by the adoption of collective defense strategies. Therefore, this research aims to analyze how the rationalization of working conditions by gynecologists obstetricians and pediatricians working in the emergency rooms of public and private hospitals in Curitiba and metropolitan region occurs. An approach of mixed methods was used as methodological procedures. The naturalization of violence, the suffering which professionals are submitted to, are combined with the political and ideological control, bureaucratic control, the imaginary built about hospitals and collective defense strategies. It is therefore possible to understand that labor conditions of gynecologists obstetricians and pediatricians in emergency rooms are rationalized. When social injustice is naturalized, political strategies for changes are not possible. For this reason, the first step is to gather awareness, there is a need to unveil the reality, to understand the phenomena at its core and discard superficialities. It is also necessary that the actions and expressions of indignation to come hand in hand with political actions in order to change to happen.

A regionalização como instrumento de governança pública em saúde no estado do Paraná: análise dos vazios assistenciais como subsídio à ação do estado

Everyone has a right to health and the State’s duty is to provide it. SUS (unified health system) main principles are universalization, integrality and equality which are based on the decentralization, regionalization and hierarchization directives and shows the importance of a territorial perspective for planning healthcare actions. Decentralization was the strategy chosen to implant SUS, since municipalities were in charge of providing and organizing the municipal healthcare services. Nevertheless regionalization, that’s to say service, institution and practice integration, was not performed satisfactorily, thus jeopardizing the health system decision making process and causing disputes between municipalities over financial resources instead of developing an interdependent and cooperative net. This way, it is important to analyze if health regionalization has a good potential for being used as public governance tool. The present study aims at giving answers to the following research problem: What are the contributions of regionalism to the State of Paraná public governance applied to health? Besides that, it also aims at assessing the State of Parana health regionalization to identify healthcare gaps and help the State actions through public governance principles applied to healthcare. Therefore, the study used a quantitative-qualitative, exploratory and descriptive research, plus secondary data concerning bibliographic and documental research. The present study analyzed the current hospital bed distribution by compared to the ideal distribution allowing the identification of healthcare gaps in the regional healthcare centers, besides considering medical specialties in the State of Paraná. The study conclusion is that health regionalization is an important tool for reducing healthcare gaps concerning hospital beds permitting the use of seven to ten public governance principles applied to healthcare, as established in the present study, and shows health regionalization is an important pubic governance tool.