Strategic analysis of a medical genetics center at a national health research institute in Brazil: challenges for the country's public health system.

Objective: to discuss strategic challenges in complex health organizations sustained by an analysis in a Medical Genetics Center at a National Health Research Institute in Brazil.

Method: Démarche Stratégique adapted for use with research institutes, including the policy formulation function. The study used institution's databases and workshops with key actors between Dec/2014 and Jun/2015.

The process of defining the hospital care profile in federal hospitals in the city of Rio de Janeiro, Brazil.

This article analyzes the process of shaping the care profile of federal hospitals in the city of Rio de Janeiro. This is a qualitative, descriptive study that draws on semi-structured interviews with hospital administrators. Data analysis used the Collective Subject Discourse approach.

Innovation and communicative action: health management networks and technologies.

This article discusses elements of a theory of innovation from the perspective of innovation networks and social construction of technology, based on Habermas' Theory of Communicative Action and authors from the Sociology of Innovation. Based on the theoretical framework of the communicative production of scientific facts, we focus on innovation management as a basic dimension that must meet some organizational and methodological requirements in order to power its results. We present and discuss instruments such as Situational Planning, Prospective Analysis, Strategic Portfolio Management, and Networks Management that can help deal with the challenge of innovation and exploration of the future.

Physician-patient argumentation and communication, comparing Toulmin's model, pragma-dialectics, and American sociolinguistics.

This article discusses the application of theories of argumentation and communication to the field of medicine. Based on a literature review, the authors compare Toulmin's model, pragma-dialectics, and the work of Todd and Fisher, derived from American sociolinguistics. These approaches were selected because they belong to the pragmatic field of language.

[Challenges for the discussion of a complex institutional mission: the case of a health research institute].

This study is based on an adaptation of the Strategic Démarche Approach applied to the Evandro Chagas Institute of Clinical Research (IPEC) in Brazil, from April to July 2009. The results are related to the experience of the Leishmaniasis Laboratory. A strategic analysis of four homogeneous segments was performed, considering the administration of care and specific teaching and research indicators.

[Communication management of collaborative networks of science, technology and innovation in health].

The objective of the article was to propose a model of communication management of networks for the Health Innovation System in Brazil. The health production complex and its relationship with the nation's development are addressed and some suggestions for operationalization of the proposed model are also presented. The discussion is based on Habermas' theory and similar cases from other countries.

[The contracting of teaching hospitals in the Brazilian Unified Health System].

This study identifies the potential and limitations of contracting to improve health care management, accountability and quality, and expand the participation of teaching hospitals in the health service network in the context of the Restructuring Program of Teaching Hospitals in the Brazilian Unified Health System. It is a case study of four teaching hospitals and their contracting State Health Departments. According to the hospital managers, the association is weak between contracting and the presence of mechanisms for hospital insertion into the health service network with practices and structures for managerial and healthcare qualification in the hospital.

[Argumentation and construction of validity in Carlos Matus' situational strategic planning].

This study analyzes the process of producing a situational plan according to a benchmark from the philosophy of language and argumentation theory. The basic approach used in the analysis was developed by Carlos Matus. Specifically, the study seeks to identify the inherent argumentative structure and patterns in the situational explanation and regulatory design in a plan's operations, taking argumentative approaches from pragma-dialectics and informal logic as the analytical parameters.

[Planning and management in health: historical and tendencies based on a communicative view].

This article aims to present a condensed overview of major trends in Brazil, establish a general taxonomy of models of health management and planning, based on the international scene and support the proposal for a communicative planning. In a context of democratization,argues for a pluralistic conception and concludes that the various currents, albeit with different perspectives and referrals theoretical and methodological dialogue in a process of mutual exchange and learning.

[Networks for dialogue and coordination of health activities: a study on a regional mobile emergency care service].

Coordination of health services networks is one of the main challenges for health systems and requires an intricate web of interactions between service providers. This study assumes a model that uses communications networks as a central component of coordination and analyzes such networks in the Mobile Emergency Care Service (SAMU) in Greater Metropolitan Rio de Janeiro State Area II, Brazil. The study specifically seeks to analyze how verbal interactions influence this process.

Healthcare organizations, linguistic communities, and the emblematic model of palliative care.

The linguistic-communicative paradigm offers some interesting perspectives in a context where the perception of patient needs is considered a critical step in high-quality care. This study describes healthcare organizations as linguistic communities based on the conceptual framework of Habermas' communicative action theory. Four communicative models are present in healthcare settings: objectifying-instrumental (hegemonic model), where elements of interaction are objectified for clinical purposes; dialogic model with strategic perspectives, in which conversations are used unilaterally as tools to access subjective states; non-dialogic-transmissional model, in which linguistic exchanges are replaced with artifacts to transmit information; and full communicative model (present in palliative care based in homecare and informal caregivers, emphasizing health team/family interactions).

[The Integrar Project: an evaluation of comprehensive health care services in Vitória, Espírito Santo, Brazil].

This article describes an experience with the integration of various healthcare services, called the Integrar Project, in Vitória, capital of the State of Espírito Santo, Brazil, and analyzes the project's contribution to the development of comprehensive healthcare practices. The case study used a qualitative approach and covered the period from 2000 to 2003, identifying the project's potential in the areas of maternal and child health, continuing health education, and the family health strategy, but also identified difficulties in establishing integrated treatment projects involving both the Family Health Program teams and the various medical specialties. To a major extent the work proposal failed to materialize, highlighting the need to review the strategy to include new forms of communications and developing greater formal cooperation, beyond the existing informal coordination between individuals, teams, or services, based on a contractual logic in public healthcare services.

[Regional health systems management: a case study in Rio Grande do Sul, Brazil].

This article analyzes the management system in a health district in the State of Rio Grande do Sul, Brazil, through qualitative analysis, using a case study as the methodology and macro-organization theory as the analytical framework. For the current management system in the 6th Health Region, a clear mission statement and wide acceptance by health workers are facilitating factors for the current organizational practices within the health system. Nevertheless, the way health coordinators are currently prioritizing their time has diverted necessary resources from critical problems towards more remedial issues.

[Instrumental, directive, and affective communication in hospital leaflets].

This study focuses on the typical semantic systems extracted from hospital staff communicative resources which attempt to validate information as an "object" to be transferred to patients. We describe the models of textual communication in 58 patient information leaflets from five hospital units in Brazil, gathered from 1996 to 2002. Three categories were identified, based on the theory of speech acts (Austin, Searle, and Habermas): 1) cognitive-instrumental utterances: descriptions by means of technical terms validated by self-referred, incomplete, or inaccessible argumentation, with an implicit educational function; 2) technical-directive utterances: self-referred (to the context of the source domains), with a shifting of everyday acts to a technical terrain with a disciplinary function and impersonal features; and 3) expressive modulations: need for inter-subjective connections to strengthen bonds of trust and a tendency to use childish arguments.

[Communication prostheses and behavioral alignment in hospital leaflets].

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda.