Cecílio, Luiz C.

Abstract: Both the role of hospitals in health professionals education and hospital's needs in terms of professionals for health care and hospital management are changing as health systems move towards quality, comprehensiveness, efficiency and costs control. The article intends to analyze dilemmas and challenges in each of these fields, acknowledging hospitals' complexity, their critical role on healthcare delivery and their deep involvement in the hegemonic orientation for health education and practice.

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Abstract: The author examines the possibility of understanding ordinary conflicts within health care organizations as a management object. He thus proposes the use of an "analytical matrix" aimed at allowing the actors involved in conflictive situations (always in a self-analytical position) to achieve a broader understanding of such conflicts. There would be new possibilities for contractibility in the management of the health service's daily routine, as well as new shapes in the relations among workers; this would include bringing previously concealed conflicts to the surface and helping them reach the service's decision-making arena. The author also indicates possible difficulties for adopting this type of managerial practice.

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Abstract: O artigo enfoca a temática do poder nas organizações de saúde, em particular no hospital, dando ênfase à sempre presente tensão entre controle versus autonomia no seu processo de gestão. Examina-se, em particular, a hipótese de modelos de gestão democráticos e participativos, com forte publicização da vida institucional, estarem sendo vistos como controlistas pelos trabalhadores, o que seria um aparente paradoxo com seu discurso de criação de autonomia. A criação de múltiplos dispositivos ou contextos de negociação, nos quais se encontram e se confrontam as múltiplas racionalidades organizacionais, é apontada como alternativa para uma gestão radicalmente democrática, apoiada na idéia de que nenhum macroator (a direção ou o governo) tem o poder de imprimir a racionalidade da organização, sem enfrentar um complexo, permanente e dialógico processo de negociação que envolveria todos os atores organizacionais.

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