The resilience of the Brazilian Unified Health System is not (only) in responding to disasters.

Coping with the recent COVID-19 pandemic has shown that the Brazilian Unified Health System (SUS) needs to improve its resilience to handle the rapid spread of communicable diseases while ensuring the necessary care for an aging population with comorbidities and in a vulnerable situation. This article identifies, analyzes, and discusses critical aspects of the resilience of the SUS, calling into question the prevailing focus on the robustness and volume of resources mobilized during the outbreak of major disasters. Recent studies demonstrate that the skills that favor adaptation to unexpected situations emerge from the daily functioning of organizations.

Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory.

Background: Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources.

Objective: This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics.

Methods: A qualitative case study was carried out in the municipality of Rio de Janeiro.

Ergonomics management model based on good practices of large industrial companies: Structured elements through the fuzzy set theory.

Background: Most organizations perceive the concept of ergonomic actions as a local tool used to improve workplace issues. Ergonomics however is not included in global management systems. The paradigm of ergonomics action in large organizations proposed by this study is that of management systems whose primary objective is the pressing need for continuous performance improvement, acquisition of excellence, and integration into all aspects of the business.

Transformative dimensions of resilience and brittleness during health systems' collapse: a case study in Brazil using the Functional Resonance Analysis Method.

Background: As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic.

Unveiling conflicting strategies in the Brazilian response to COVID-19: A cross-sectional study using the Functional Resonance Analysis Method.

By the time the present study was completed, Brazil had been the second epicenter of COVID-19. In addition, the actions taken to respond to the pandemic in Brazil were the subject of extensive debate, since some diverged from recommendations from health authorities and scientists. Since then, the resulting political and social turmoil showed conflicting strategies to tackle the pandemic in Brazil, with visible consequences in the numbers of casualties, but also with effects on the resilience of the overall health system.

Analysis of government agencies and stakeholders' twitter communications during the first surge of COVID-19 in Brazil.

Background: Official authorities are in charge of communicating with the public in a consistent and coherent manner. The impact of social media on managing the coronavirus 2019 (COVID-19) pandemic potentially influenced social behavior in Brazil.

Objective: Using Twitter, this study analyzes communications about the COVID-19 pandemic from official agencies of the Brazilian government and key public sector decision-makers.

Complex systems design based on actual system functioning: Coping with variability in a national water ambulances service.

Background: In Brazil, the Mobile Emergency Medical Service (SAMU) is a model of mobile assistance and care for emergencies standardized throughout the country. The water ambulance service within the SAMU operates in riverside and coastal areas, and faces challenges and peculiarities that increase the complexity of providing a high-quality and safe emergency care service.

Objective: To develop organizational design guidelines aiming to improve resilient performance of complex systems, with an application to riverine and coastal mobile emergency care in Brazil.

Interactions between e-commerce users during the COVID-19 pandemic period: What came and what remained.

Background: During the COVID-19 pandemic, the online sales industry experienced record-breaking growth. The number of businesses that decided to enter the e-commerce market for the first time was enormous. At the height of the quarantine, Brazil was registering a new virtual store every minute.

Community health workers' non-technical skills for delivering primary healthcare in low-income areas.

Background: To overcome the poor conditions of low-income areas in developing countries like Brazil, Community Health Workers (CHWs) are required to exceed the regular set of formal skills they are used to employ.

Objective: In this study, we aim at identifying the non-technical skills CHWs must develop to cope with the extraordinary situations that occur in vulnerable communities.

Methods: 41 CHWs based in two primary healthcare clinics in Brazil underwent two rounds of in-depth interviews.

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In Brazil, public hospitals are managed according to several different models. The participation of private or third-sector organizations has been growing in a significant manner, especially in the past decade. The present study explores the perception of public administrators and health councilors on the main aspects of outsourcing the management of public health services to the private sector.

Community health workers' attitudes, practices and perceptions towards the COVID-19 pandemic in brazilian low-income communities.

Background: Community Health Workers (CHW) are a category of social workers described in many countries' health systems as responsible for engaging people in their residences and communities, and other non-clinical spaces to enable access to health services, especially in low-income areas. These professionals have been exposed to numerous new risks during the COVID-19 pandemic.

Objective: This study describes how the COVID-19 pandemic is perceived by CHWs who work in poor communities or slums in Brazil.

Social networks applied to Dengue, H1N1, and Zika epidemics: An integrative literature review.

Background: Health crises occur both regionally and globally. Online social networks are widely used technical resources that allow users to share large amounts of information with increasing reach and velocity. Thus, the capacity of spreading information about epidemics through social media allows members of a population and health professionals or agencies to collaborate.

Roadmap for the development of a resilience indicator system for protection and civil defense organizations: A literature review of the evidence.

Background: Disasters are the result of adverse events that cause human, material, environmental, and economic and social damage. To deal with disaster management, prevention, response, and recovery organizations need a system of indicators to measure their resilience.

Objective: To develop a road map to select indicators of organizational, institutional and governmental resilience to be applied to evaluate the resilience of public Protection and Civil Defense Organizations (PCDOs) of developing countries.

Designing for Risk Assessment Systems for Patient Triage in Primary Health Care: A Literature Review.

Background: This literature review covers original journal papers published between 2011 and 2015. These papers review the current status of research on the application of human factors and ergonomics in risk assessment systems' design to cope with the complexity, singularity, and danger in patient triage in primary health care.

Objective: This paper presents a systematic literature review that aims to identify, analyze, and interpret the application of available evidence from human factors and ergonomics to the design of tools, devices, and work processes to support risk assessment in the context of health care.

A program to support the construction and evaluation of resilience indicators.

The main objective of this work is to propose a method and a tool to support the development of indicators able to inform an organization about the state of its resilience through a cyclical process of identifying its resilience factors, proposing resilience indicators, assessing its organizational resilience followed by assessing and improving the resilience indicators. The research uses concepts from complex adaptive systems and from resilience engineering to establish an initial set of indicators able to assess elements that contribute to organizational resilience, and structures them temporarily as a hierarchy. A software application to support indicator definition and structuring, questionnaire generation, and result assessment activities was built to assist in speeding up the experiment-adjust cycle.

A computerized system to monitor resilience indicators in organizations.

The concepts developed by resilience engineering allow the understanding and monitoring the functioning of organizations and, particularly, to map the role of human activities, in success or in failure, enabling a better comprehension about how people make decisions in unexpected situations. The capture of information about human activities in the various organization levels gives managers a deeper real-time understanding of what is influencing the people performance, providing awareness of the factors that influence positively or negatively the organizational goals initially projected. The monitoring is important because the correct functioning of complex systems depends on the knowledge that people have to perform their activities and how the system environment provides tools that actually support the human performance.

Normal people working in normal organizations with normal equipment: system safety and cognition in a mid-air collision.

A fundamental challenge in improving the safety of complex systems is to understand how accidents emerge in normal working situations, with equipment functioning normally in normally structured organizations. We present a field study of the en route mid-air collision between a commercial carrier and an executive jet, in the clear afternoon Amazon sky in which 154 people lost their lives, that illustrates one response to this challenge. Our focus was on how and why the several safety barriers of a well structured air traffic system melted down enabling the occurrence of this tragedy, without any catastrophic component failure, and in a situation where everything was functioning normally.