Gestão de organização social e acreditação no Sistema Único de Saúde (SUS): implicações na saúde do trabalhador

Abstract

ABSTRACT INTRODUCTION: In the context of the Unified Health System (SUS), the recognition and consequent inclusion of policies, strategies and practices are recent, with an emphasis on protecting the occupational health. The practices in force in this field are incipient and fragile, with regard to the study of the causes of the illness of the worker, as well as their sociological analysis through the concepts of psychodynamics of work. Health care workers are usually subjected to precarious working conditions, stress and occupational risks typical of the profession. In addition, there was the introduction of new public management requirements, through social organization (OS), accompanied by the implementation of standards and of the quality evaluation/certification, seeking the fulfillment of the eligibility requirements of the Organization's 'Accreditation' National Accreditation (ONA) for heath units. Although this latest innovation generates a recognized continuous improvement in care and quality in the health care of its users, paradoxically, it results in increased demands and overload of duties, with possible implications for the occupational health. OBJECTIVE: To evaluate the implications of management of social organization and ‘quality accreditation’ on the occupational health at a SUS unit, under the perception of workers and managers. METHODOLOGY: Qualitative study, supported by thematic content analysis. Developed in a mixed health unit (basic attention; specialized ambulatories; e urgency and emergency), of the municipal SUS network, administered by OS and inserted in the evaluation/certification of quality ONA. The techniques of focus group (FG) and individual interview (EI) were used, 38 participants were selected, being: 30 health care professionals (higher education degree), 14 (GF) and 16 (EI) and 8 managers (EI), by intentional sampling. RESULTS: Workers and managers legitimize ‘Accreditation’, as it promotes qualification, with continuous improvements in work processes and health care. However, workers consider, aggravating their health and well-being, the episodes of overload of assignments and high requirements of mandatory targets/indicators (semi-participatory), added to excessive documentary records, to the detriment of attention to the user. In contrast, managers recognize the fulfillment of productivity requirements and goals (by the worker), inherent to the duo - ‘commitment and responsibility’ with work. They do not recognize the presence of overload of duties, stress and the resulting illness of the worker, resulting from the quality standards of accreditation. They reflect ‘Accreditation’ exclusively for its benefits, disregarding its burden on the development and / or worsening of health conditions, whether they are occupational or not. Still, in their view, ‘OS Management’ transfers profitability to municipal management and favors the health of the population, in addition to gains in transparency and public control. The workers, on the other hand, consider that the employment relationship and the absence of career progression lead to insecurity, fear of dismissal from work, low prospect of appreciation, professional dissatisfaction and illness. This problem is compounded by sporadic and fragmented health education, structural and ambience inadequacies. In addition, there were pressures caused by high and exigent care demand from users and managers and the resulting use of medication by workers. These aggregate factors result in a stressed and unmotivated professional, with serious implications on his health (physical and mental). Managers and workers indicate protective factors for workers' health and highlight the expansion of benefits, the implementation of continued training for the formation of leaders and the preparation of teams for quality processes. Workers point to career progression and job stability; the development of resilience and resistance; the union between pairs; good interpersonal and team relationships; family and friendship relationships; physical exercise routine; implementation of action plans, aimed at relaxation/stretching, relaxation and psychological support, to balance the stressful effects of work. CONCLUSION: The OS management, with emphasis on the adopted ONA quality assessment, brings with it requirements for goals, standards and protocol follow-up, creating overload of attributions and expansion of clinical care work and responsibilities in documenting procedures, which are not always compatible with the structural, physical and psychosocial conditions granted, causing illness of its workers. In contrast, they result in benefits for users and good practices in organizing work processes. The results indicate the need for valorization, progression and work stability of the worker, creation of spaces for negotiation and adjustment of goals and norms, conflict mediation, formation of groups and sharing strategies (of perceptions and feelings) and psychological support to workers. The agreement of managers, in view of the expansion of health promotion and preventive actions for workers' diseases and conditions, even if they conflict with the deleterious effects of 'accreditation' and OS management, in their illness, may indicate openness to introduce horizontalization processes and symmetry in labor relations, promoting democratic negotiation spaces, essential for equitable, co-participating and effective decision-making in protecting workers' health.

Keywords: Occupational Health; Health Policy; Health Management; Accreditation.