The author uses the short story "The Death of Ivan Ilyich", by Leo Tolstoy, to explore the theme of the multiple dimensions of healthcare management (professional, organizational and systemic) by pointing out the omnipresence and complementariness of these dimensions. Although recognizing that there is no hierarchy between these three dimensions, the discussion focuses on the professional dimension, within which professionals meet users, and highlights how this has been the favored territory for management strategies governed by the search for increasing rationality, predictability and control over current health practices, either in the public or in the private healthcare sector. The author points out the risk that "qualification" and "humanization" healthcare programs might be contributing towards instrumentalization and excessive formalization of the meeting point between workers and users, which adds further difficulty to truly caring encounters like the one narrated by Tolstoy in his short story, or even makes them impossible.
Healthcare management; Healthcare work; Healthcare micropolicies