Alternative proposals for hospital management and the protagonism of workers: why do things not always happen as expected by the leaders?

Abstract

The article presents and discusses the observational study performed in a public city hospital, with the objective of characterizing how workers, in their daily activities and with their concrete practices, take over a certain institutional policy established by the administration, particularly the implementation of new ways of managing and the guidelines to reorganize the working process. The study allowed showing that, in the hospital micropolitics, the administrative guidelines undergo a certain "distortion" as they cross the dense field of forces that result from the workers' protagonism and their uncountable strategies aimed at defending their self-government universe. Such guidelines are reinterpreted, resignified and translated into practices which rather seem to maintain certain institutionalized aspects of organizational life - particularly to the still expressive autonomy of the medical practice and of the domination relationship of the doctors in relation to other corporations - than effectively reinvent hospital life relations.