Sensemaking e identidade profissional médica no contexto da mudança estratégica
DOI:
https://doi.org/10.5585/2024.24087Palavras-chave:
sensemaking, sistemas adaptativos complexos, identidade profissional, autonomia médica, mudança estratégicaResumo
Objetivo do estudo: Identificar como os médicos de um grande hospital brasileiro percebem a mudança proposta nos modelos de pagamento pelos serviços prestados e se a mudança proposta afeta elementos da identidade profissional dos médicos entrevistados.
Metodologia/abordagem: Este estudo baseia-se na teoria que aborda sensemaking, identidade profissional médica e implementação de estratégias em organizações complexas. Foi realizada uma pesquisa qualitativa através de entrevistas semi- estruturadas com um grupo de médicos que trabalha em um grande hospital brasileiro que estava enfrentando mudanças no modelo de reembolso.
Originalidade/Relevância: Pesquisas abordando as razões pelas quais os médicos tendem a resistir é importante para ajudar os estrategistas a projetar uma abordagem para obter aderência profissional.
Principais resultados: Os participantes da pesquisa percebem ameaças a sua autonomia em dois atributos, Autonomia Clínica e Autonomia Financeira. Quanto à mudança no modelo de pagamento pelos serviços prestados, alguns entrevistados percebem sua necessidade, mas demonstram um desejo de participação mais ativa na discussão e elaboração de novos modelos, configurando assim a necessidade de manter sua Autonomia Política.
Contribuições teóricas/metodológicas: Este trabalho contribui para a literatura ao trazer avanços para a compreensão dos estímulos sensoriais e demonstrar como e por que as ameaças à identidade profissional podem dificultar o processo de implementação de estratégias em organizações complexas.
Contribuições sociais / para a gestão: a implementação de estratégias nas organizações hospitalares é um tema de grande relevância para os gestores da indústria da saúde, devido à sua multiplicidade de atores e interesses, além da evolução tecnológica exponencial.
Downloads
Referências
Ackerhans, S., Huynh, T., Kaiser, C., Schultz, C. (2024) Exploring the role of professional identity in the implementation of clinical decision support systems—a narrative review. Implementation Science (2024) 19:11. https://doi.org/10.1186/s13012-024-01339-x
Anderson RA. & McDaniel RR Managing health care organizations: Where professionalism meets complexity science. Health Care Manag Rev. 2000;25(1):83–92. doi: https://10.1097/00004010-200001000-00010
ANS, Guia para Implementação de Modelos de Remuneração baseados em valor (Guide to Implementing.
Azevedo CS, Sá MC, Cunha M, Matta GC, Miranda L, Grabois V. (2017). Racionalização e Construção de Sentido na Gestão do Cuidado: uma experiência de mudança em um hospital do SUS (Rationalization and Sensemaking in Care Management: na experience of strategic change in a SUS hospital). Ciência & Saúde Coletiva 22(6) (Jun.). 1991–2002. doi: https://10.1590/1413-81232017226.13312016
Balogun J., & Johnson, G. (2005). From Intended Strategies to Unintended Outcomes: The Impact of Change Recipient Sensemaking. Organization Studies 26(11) (nov.). 1573– 1601. https://doi.org/10.1177/0170840605054624
Balogun, J, Jacobs, C, Jarzabkowski, P, Mantere, S & Vaara, E. (2014), Placing Strategy Discourse in Context: Sociomateriality, Sensemaking, and Power. Journal of Management Studies, 51(2), 175-201. doi: https://10.1111/joms.12059
Bloor G, Dawson P. Understanding professional culture in organizational context. Org Stud. 1994;15(2):275–295-h doi: https://10.1177/017084069401500205
Burgelman RA. A process model of internal corporate venturing in the diversified major firm. Admin Sci Q. 1983;28(2):223. doi: https://10.2307/2392619
Cornelissen J, Schildt H. (2015). Sensemaking in Strategy as Practice: A Phenomenon or a Perspective? In D. Golsorkhi, L. Rouleau, D. Seidl, & E. Vaara (Eds.), Cambridge Handbook of strategy as practice (second edition ed., pp. 345-364). Cambridge University Press.
Day, L, Balogun, J & Mayer, M. (2023). Strategic Change in a Pluralistic Context: Change leader sensegiving. Organization Studies, 44(8), 1207–1230
Denis J, Langley A, Rouleau L (2007). Strategizing in pluralistic contexts: Rethinking theoretical frames. Human Relations. 60(1):179–215. https://10.1177/0018726707075288
Doolin D.(2002) Enterprise discourse, professional identity and the organizational control of hospital clinicians. Org Stud. 2:369-390.
Edmondson AC, Bohmer RM, Pisano GP. (2001). Disrupted Routines: Team Learning and New Technology Implementation in Hospitals., Administrative Science Quarterly, (46) 4.
Flitter MA, Riesenmy KR, van Stralen D. (2012)Current medical staff governance and physician sensemaking: A formula for resistance to high reliability. Adv Health Care Manag. 13.3–28. doi: https://10.1108/S1474-8231(2012)0000013006
Fournier P, Chênevert D, Jobin M (2020). The antecedents of physicians behavioral support for lean in healthcare: The mediating role of commitment to organizational change. Int J Prod Econ. 107961. doi: https://10.1016/j.ijpe
Gioia DA, Thomas JB, Clark SM, Chittipeddi K.(1994) Symbolism and strategic change in academia: The dynamics of sensemaking and influence. Org Sci. 5(3):367.
Glouberman S, Mintzberg H (2001). Managing the care of health and the cure of disease— Part I: Differentiation. Health Care Manag Rev. 26(1):56–69. doi: https://10.1097/00004010-200101000-00006
Glover WJ, Nissinboim N, Naveh (2020) Examining innovation in hospital units: A complex adaptive systems approach. BMC Health Serv Res., 20(1). https://10.1186/s12913-020-05403-2
Hardy, C., & Thomas, R. (2014). Strategy, Discourse and Practice: The Intensification of Power: Strategy, Discourse and Practice. Journal of Management Studies, 51(2). (mar.) .320–48. https://doi.org/10.1111/joms.12005
Hendrikx W. Priced not praised: professional identity of GPs within market-oriented healthcare reform, J Prof Org. 2018;5(1):12–27. doi: https://10.1093/jpo/jox011
Hoff TJ & McCaffrey DH (1996). Adapting, resisting, and negotiating: How physicians cope with organizational and economic change, Work Occup. 23(2):165-189.
Hoof T. J., & McCaffrey, D. H. (1996). Adapting, resisting, and negotiating_How physicians cope with organizational and economic change, Work and Occupations, 23(2) (May). 165- 189.
Jarzabkowski P.(2003) Strategic practices: An activity theory perspective on continuity and change: Strategic practices. J Manag Stud. 40(1):23–55. doi: https://10.1111/1467- 6486.t01-1-00003
Jarzabkowski P (2004). Strategy as practice: Recursiveness, adaptation, and practices-in-use. Org Stud. 25(4):529–560.
Jolemore S. (2018). A Narrative Inquiry of Physician Leadership. [dissertation]. Retrieved from http://dc.msvu.ca:8080/xmlui/bitstream/handle/10587/1917/ShawnJolemorePhDT hesi s2018.pdf?sequence=1&isAllowed=y
Kraft, A, Sparr, J L, & Peus, C. (2015). The Critical Role of Moderators in Leader Sensegiving: A Literature Review. Journal of Change Management, 15(4) (oct.). 308–31 https://doi.org/10.1080/14697017.2015.1091372
Kyratsis Y, Atun R, Phillips N, Tracey P, George G.(2017 Health systems in transition: Professional identity work in the context of shifting institutional logics. Acad Manag J. 60(2):610–641. doi: https://10.5465/amj.2013.0684
Leonardi, P. M. (2015). Materializing Strategy: The Blurry Line between Strategy Formulation and Strategy Implementation: Materializing Strategy. British Journal of Management 26 (jan.). S17–21. https://doi.org/10.1111/1467-8551.12077
Lusiani M &Langley A. (2019)The social construction of strategic coherence: Practices of enabling leadership. Long Range Planning 52(5):101840. doi: https://10.1016/j.lrp.2018.05.006
Maitlis S & Christianson M.(2014) Sensemaking in organizations: Taking stock and moving forward. Acad Manag Ann. 8(1):57–125. doi: https://10.1080/19416520.2014.873177
Maitlis S. (2005) The social processes of organizational sensemaking, Acad Manag J. 48(1):21–49. Mantere S.(2005) Strategic practices as enablers and disablers of championing activity. Strat Org. 3(2):157–184. doi: https://10.1177/1476127005052208
McDaniel RR & Driebe DJ. (2001)Complexity science and health care management. Adv Health Care Manag. 2:11–36. doi: https://10.1016/S1474-8231(01)02021-3
Meyer Jr V, Pascuci L & Murphy PJ. (2012)Implementing strategies in complex systems: Lessons from Brazilian hospitals. BAR - Brazilian Admin Rev. 9:19–37. doi: https://10.1590/S1807-76922012000500003
Mintzberg H & Waters JA (1985). Of strategies, deliberate and emergent. Strategic Management J. 6(3):257-272.
Mintzberg H (1979. Patterns in strategy formation. Int Stud Manag Org. 1979;9(3). Behavioral Models of Strategy Formulation - I (Fall), Taylor & Francis, Ltd.67-86.
Mitra M, Hoff T, Brankin P & Dopson S(2019). Making sense of effective partnerships among senior leaders in the national health service. Health Care Manag Rev. 2019;44(4):318–331. doi: https://10.1097/HMR.0000000000000166
Pascucci L & Meyer Jr V. (2013). Estratégia em contextos complexos e pluralísticos (Strategy in complex and pluralistic contexts). Revista de Administração Contemporânea 17(5) (Oct.): 536–55. doi: https://10.1590/S1415-65552013000500003
Pascucci LM, Meyer Júnior V, Crubellate JM (2017). Strategic management in hospitals: Tensions between the managerial and institutional lens. BAR – Brazilian Admin Rev. 14(2). doi: https://10.1590/1807-7692bar2017160092
Patton, M. Q. (1990). Qualitative evaluation and research methods. SAGE Publications, inc.
Plsek PE, Wilson T (2001). Complexity science: Complexity, leadership, and management in healthcare BMJ. 323(7315):746–749. doi: https://10.1136/bmj.323.7315.746
Plsek P., Greenhalgh T. (2001)The challenge of complexity in healthcare. BMJ. 323 (7313):625-628.
Reis, A (2018) IESS. Instituto de Estudos de saúde Suplementar. Projeção das despesas assistenciais da Saúde Suplementar (Projection of Supplementary Health Care Expenses
Salvatore D, Numerato D, Fattore G (2018). Physicians professional autonomy and their organizational identification with their hospital. BMC Health Serv Res. 18 (1). doi: https://10.1186/s12913-018-3582-z
Schuler, B. A., Orr, K. & Hughes, J. (2023). My colleagues (do not) think the same: Middle managers’ shared and separate realities in strategy implementation. Journal of Business Research, 160, 113782
Scott, R. D., 2nd, Solomon, SL, & McGowan, Jr J. E. (2001). Applying Economic principles to health care. Emerging Infectious Diseases, 7(2), (March – April).
Smircich L & Stubbart C(1995). Strategic management in an enacted world. Acad Manag Rev. 1985;10(4):724-736.
Sturmberg JP, O’Halloran DM, Martin CM (2012). Understanding health system reform - a complex adaptive systems perspective: Understanding health system reform. J Eval Clin Pract. 2012;18(1):202–208. doi: https://10.1111/j.1365-2753.2011.01792.x
Takahashi ACD (2011), Análise do Modelo de Remuneração Hospitalar no Mercado de Saúde Suplementar Paulistano (Dissertation), São Paulo, SP, Brazil,. Escola de Administração de Empresas da Fundação Getulio Vargas.
Weick KE.(1995) Sensemaking in Organizations. Thousand Oaks, California, USA, SAGE Publications.
Weiser, A.-K. (2021). The Role of Substantive Actions in Sensemaking During Strategic Change. Journal of Management Studies, 58(3 May ). "White MD & Marsh EE (2006). Content analysis: A flexible methodology. Lib Trend. 55(1):22–45. doi: https://10.1353/lib.2006.0053
Whittington R. (2007). Strategy practice and strategy process: Family differences and the sociological eye. Org Stud. 2007;28(10):1575–1586. doi: https://10.1177/0170840607081557
Whittington, R. (1996). Strategy as Practice. Long Range Planning, 29(5), 731-735. Gioia DA, Chittipeddi K. (1991). Sensemaking and Sensegiving in Strategic Change Initiation, Strategic Management Journal, 12(6), 433-448, 1991;
Yin RK. Estudo de Caso: Planejamento e Métodos (Case Study: Planning and Methods), Porto Alegre, RS, Brazil: Bookman; 2015, p. 2.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2024 Revista Ibero-Americana de Estratégia
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
