A implementação da política nacional de humanização do Sistema Único de Saúde em um hospital privado da 28ª Região de Saúde/RS.

Abstract

This dissertation aimed to explore how staff discretionary power and interactions with users shape the implementation of the National Humanization Policy at Hospital Santa Cruz. As a non-profit private institution, besides users in the Private and Health Plan Categories, serving users of the Brazilian Unified Health System (SUS), it represents a context reflective of many similar institutions nationwide. Given that the National Humanization Policy is an initiative of SUS, this study critically examined the implications of this configuration for policy implementation. The study adopted a qualitative case study approach, utilizing various data collection methods. These included attending meetings of the Humanization Working Group (a key tool of the policy), conducting semi-structured interviews with the director of care, the institution's director, and three members of the Humanization Working Group, analyzing relevant documents, and observing activities in the hospital's main reception area. The empirical data was contextualized within the framework of Public Policy Implementation literature, offering a critical perspective on the challenges encountered and the strategies employed to address them at a local level. The research findings are consistent with theoretical discussions on Public Policy Implementation, highlighting several key factors that influence the policy's execution. These include financial constraints, the involvement of a multidisciplinary team in the Humanization Group, the notable absence of physicians in this group, and the hospital's ongoing ONA Accreditation process, among others. Staff members employ adaptive strategies to reorganize their work, leveraging both organizational and relational resources at their disposal. Additionally, the interplay of territorial dynamics—encompassing relationships between individuals, groups, institutions, and government entities—plays a pivotal role in shaping the actions and decisions taken in the implementation process.