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The nursing professional and creation of values in health

In Brazil and in the world, Health is “sick”: rising costs and poor quality have characterized health services in many countries. Despite their high and rising costs, a deterioration in the quality of services and a large mass of unassisted people are seen. The public services are not able to adequately serve the Brazilian population, which totaled about 208 million people in 2015.(11. Organização Mundial de Saúde: site: http://www.who.int/countries/bra/es/, [citado 2016 Set 18].
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This scenario highlights the pressing need for innovative solutions involving every aspect of health management - its delivery to the patient, its technology, and business model. The central contradiction of the health system is that medical knowledge and technologies have been improved, but in general medical care accessibility to the population has not increased.(22. Porter M. A strategy for health care reform - toward a value-based system. N Engl J Med. 2009; 361(2): 109-12.,33. Porter M. What is value in health care? N Engl J Med. 2010; 363(26): 2477-81.) The little valuation of human capital, mainly of nursing professionals, exactly in an environment dedicated to care of people, is another major contradiction in the sector.

In the healthcare environment, both administration power decision and patient care are distributed among several professionals (including physicians, nurses, and nutritionists), and service quality results from cooperation between these several actors and team work.(44. Martins MIC. A transição tecnológica na saúde: desafios para a gestão do trabalho. Trabalho, Educação e Saúde. 2004; 2(2): 287-310.) However, Unfortunately, team work is still a rhetorical figure in many hospitals, and the various services are seen by each other as obstacles, not facilitators.(55. Pedroso M, Malik A. As quatro dimensões competitivas da saúde. Harvard Business Review Brasil. 2011; 89: 58-67.,66. Bohmer R. Managing the New Primary Care: The New Skills That Will Be Needed. Health Affairs. 2010. 29(5): 1010-1014.) Such work environment generates dissatisfaction among professionals involved in assistance, affecting quality perception by patients and families.

The nursing professionals, who are responsible for the daily care of patients, are the engine of continuous improvement in care quality. Any change in the health business model necessarily passes by rethinking the role of these professionals within the organization. The needs of patients and especially nursing professionals (who deliver the patient care), must be at the heart of innovation, business model, and health management.(77. Omachonu V, Einspruch N. Innovation in healthcare delivery systems: a conceptual framework, The Innovation Journal: Pub Sec Innovat J. 2010; 15(1): 1-20.)\

Several expressions are found in the literature for the concern with the human element within organizations: quality of internal services, internal quality of services, quality of life at work, endomarketing, internal marketing, service climate, internal climate, etc. Each of these names arose in several knowledge areas, such as Service Management, Marketing, Human Resources, Organizational Behavior, and Social Sciences including Psychology and Sociology. Regardless of the name chosen for it, offering a good working environment is what is needed for professionals to feel happy and thus develop positive attitudes in relation to the organization where they work.

There is no consensus on the factors that determine satisfaction of nursing professionals. In the 80s, two lines of understanding emerged: the first emphasized psychological factors, such as perception that the work fills or allows that important values for persons are met; and the second highlighted factors relative to the working environment, such as acknowledgement, appropriate team size, autonomy, and adequate facilities to care for patients. In the 90s, the satisfaction of nursing professionals came to be seen as a complex construct, composed of objective and subjective factors, such as the nature and level of autonomy, authority, and responsibility, as well as recognition, reward and personal satisfaction with the work performed, in addition to the perspective of growth in the career. Patient care was recognized as fundamental for nurses’ satisfaction.

Currently, it is believed that a good work environment for nursing professionals is characterized by a friendly relationship between colleagues and based on trust in their superiors. Trust is nourished by effective internal communication, clarity of hospital mission and objectives, and respect for the professionals, which is translated into avoiding physical and mental overload at work and offering safety at work. The work overload and stress are often pointed by studies as triggers of nursing professionals’ dissatisfaction with their jobs.

Thus, hospital managers should concern about establishing a clear communication with these professionals, investing in their training, fostering an environment guided by fairness and justice, and encouraging a good relationship among collaborators. With these actions, it is intended to ensure better health care results for patients, i.e., create values. Values should be the main goal of health systems, since it matters for both patients and other actors in the system. However, values are not created only with processes and technology, but mostly with people.

Claudia Affonso Silva Araujo
Professor at the Instituto de Coordenação de Programas de Pós-Graduação em Engenharia e Administração da Universidade Federal do Rio de Janeiro

Referências

  • 1
    Organização Mundial de Saúde: site: http://www.who.int/countries/bra/es/, [citado 2016 Set 18].
    » http://www.who.int/countries/bra/es/
  • 2
    Porter M. A strategy for health care reform - toward a value-based system. N Engl J Med. 2009; 361(2): 109-12.
  • 3
    Porter M. What is value in health care? N Engl J Med. 2010; 363(26): 2477-81.
  • 4
    Martins MIC. A transição tecnológica na saúde: desafios para a gestão do trabalho. Trabalho, Educação e Saúde. 2004; 2(2): 287-310.
  • 5
    Pedroso M, Malik A. As quatro dimensões competitivas da saúde. Harvard Business Review Brasil. 2011; 89: 58-67.
  • 6
    Bohmer R. Managing the New Primary Care: The New Skills That Will Be Needed. Health Affairs. 2010. 29(5): 1010-1014.
  • 7
    Omachonu V, Einspruch N. Innovation in healthcare delivery systems: a conceptual framework, The Innovation Journal: Pub Sec Innovat J. 2010; 15(1): 1-20.

Publication Dates

  • Publication in this collection
    Jul-Aug 2016
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