Na gestão em saúde: a perspectiva da satisfação dos Profissionais de saúde das unidades de saúde familiar
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2010
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À medida que as nações procuram reforçar os Sistemas de Saúde, são frequentemente
confrontadas com a natureza multifactorial dos problemas de saúde, com a crescente
urbanização e globalização, com o recrudescimento das doenças infecciosas, criando deste
modo, novos desafios para os Sistemas de Saúde. É neste contexto que faz cada vez mais
sentido considerar os Cuidados de Saúde Primários, como o pilar de sustentação do Serviço
Nacional de Saúde. A reforma em curso nos Cuidados de Saúde Primários, com a
implementação das Unidades de Saúde Familiar pretende constituir a primeira linha de um
sistema acessível, eficiente e equitativo, com o objectivo de melhorar a acessibilidade aos
cuidados de saúde e obter ganhos em saúde dos indivíduos, famílias e comunidades.
Conscientes de que a mudança organizacional pode gerar níveis de satisfação, estabelecemos
como principais objectivos do estudo: caracterizar os profissionais das Unidades de Saúde
Familiar da Administração Regional de Saúde Norte, IP, quanto a variáveis socioprofissionais e
identificar de que modo a reconfiguração e a autonomia dos centros de saúde, no que respeita à
implementação das Unidades de Saúde Familiar, contribui para a satisfação dos profissionais de
saúde.
O presente estudo é de carácter exploratório, descritivo e transversal, inscrito num paradigma
quantitativo, desenvolve-se numa amostra não intencional e aleatória de 207 profissionais que
integravam as Unidades de Saúde Familiar da Administração Regional de Saúde Norte, IP, e
cuja recolha de dados foi obtida por um questionário que integrava variáveis socioprofissionais
e uma escala de avaliação da Satisfação com a Prática Profissional composta por seis
dimensões: Segurança com o Futuro da Profissão; Apoio da Hierarquia; Reconhecimento pelos
Outros do Trabalho Realizado; Condições Físicas de Trabalho; Relação com Colegas; e
Satisfação Profissional.
Dos 207 participantes, predomina o sexo feminino em todos os grupos profissionais, com os
enfermeiros em maior número de elementos (50,7%). A média de idades é mais elevada no sexo
masculino (43,18 anos) e no grupo profissional dos médicos (49,49 anos), sendo que a maioria
dos inquiridos detém um exercício profissional em cuidados de saúde primários, superior a 12
anos, com maior expressão nos médicos (24,44 anos). Em relação ao tipo de vínculo, predomina
o trabalhador do quadro, e do total de participantes, 75% integraram as Unidades de Saúde
Familiar por convite e 86% não receberam qualquer tipo de incentivos.
Quanto aos resultados mais significativos, podemos salientar que: o sexo masculino apresenta
valores médios mais elevados em todas as dimensões que compõem a escala de avaliação da satisfação com a prática profissional, com excepção para a segurança com o futuro da profissão
e satisfação profissional. O grupo profissional que congrega um maior número de dimensões em
que a satisfação com a prática profissional é superior, é o dos médicos, com excepção para as
dimensões, apoio da hierarquia e relação com os colegas, que é superior entre os secretários
clínicos. Os enfermeiros constituem o grupo profissional que não obtém nenhum valor médio
superior em cada uma das dimensões da escala em relação aos restantes grupos profissionais.
Da avaliação global da satisfação com a prática profissional, com base nas seis dimensões que
integram a escala, não ocorre diferenças estatisticamente significativas em relação ao sexo,
grupo profissional, tempo de exercício profissional, idade e tipo de vínculo, sendo que os
valores médios são superiores nos elementos do sexo feminino, nos médicos, nos profissionais
com menor tempo de experiência profissional, nos mais jovens e nos que detêm um vínculo
profissional mais seguro.
Os participantes no estudo sublinham como oportunidades com a implementação das Unidades
de Saúde Familiar a mudança organizacional, na medida em que promove o trabalho por
objectivos com reflexos no aumento da produtividade e na excelência profissional, o
desenvolvimento profissional, com todos os intervenientes a terem um papel activo, e a
prestação de cuidados ao garantir uma resposta de proximidade face às necessidades em saúde.
Como sugestões que potencializem a vitalidade da reforma, os participantes enumeram a
necessidade de um maior nivelamento de incentivos entre os diferentes grupos profissionais e a
optimização dos sistemas de informação.
When the nations try to strengthen their Health Systems, they have often to face several factors on the basis of the health problems, such as the increasing globalization and urbanization and the reappearance of infectious diseases as well, thus creating new challenges for the Health Systems. Bearing this in mind, it makes more sense to consider the Primary Health Care as the basis of the National Health Care System. The reforms the Primary Health Care are undergoing, with the implementation of the Family Health Units, aim to create the first accessible, efficient and equitable system, with the purpose of improving accessibility to health care and health gains concerning individuals, families and communities. As we are aware that organizational changes can generate levels of satisfaction, we decided to establish the main objectives of the study, as it follows: to characterize the professionals of the Family Health Units of the Northern Health Regional Administration, Public Institute, concerning social-professional variables and identifying how the reconfiguration and autonomy of the Health Centers, concerning the implementation of the Family Health Units, contributes to the satisfaction of health professionals. This study characterizes itself by being, descriptive and transverse, in a quantitative paradigm and develops itself in a random and unintentional sample formed by 207 professionals working in the Family Health Units of the Northern Health Regional Administration, Public Institute. Data was obtained through a questionnaire which included social-professional variables and a scale of evaluation measuring the level of satisfaction in the Professional Practice, consisting of six dimensions: Security with the Future of the Profession, Support of the Hierarchy; Recognition by the Others due to Work Done; Physical Conditions of Work; Relationship with Colleagues, and Work Satisfaction. The great majority of the 207 participants was female in all occupational groups, being the nurses at the top (50,7%). The average age is higher among men (43,18 years old) and doctors (49,49 years old) ; the majority of the inquirers have a professional practice in primary health care of more than 12 years, and this is can be seen mainly among doctors (24,44 years). As far as the type of bond there is between the place of work and the worker is concerned, the most common one is the worker who makes part of the boards of the place they work in 75% out of the total participants have been included in the Family Health Units by invitation and 86% did not receive any kind of incentives at all. As for the most significant results, one can highlight the following: men show higher average values in all dimensions that make part of the scale of evaluation that measures satisfaction with the practice, except in what concerns security with the future of the profession and professional satisfaction. The professional group which embraces a larger number of dimensions in which satisfaction with the professional practice is superior is that of the doctors, except in dimensions related with the support of the hierarchy and the relationship with colleagues; these two fields have higher values among doctors assistants. Nurses are the professional group that does not get any higher average value in any of the dimensions of the scale compared to the other professional groups. The overall assessment of satisfaction with professional practice, based on the six dimensions that make up the scale, shows that there is no statistically significant differences regarding gender, professional group, the amount of time already spent in the job, age and type of bond with the employer; the average values are higher among women, doctors, workers with less time in the job, younger and those who have a more secure professional relationship. The participants of this study emphasize the implementation of the Family Health Units as an opportunity to an organizational change, since it promotes the work per objectives, thus, increasing productivity and professional merit, professional development, with everybody having an active role, and caring as it gives an answer of proximity to the needs in health. As suggestions that enhance the vitality of retirement, the participants listed the need for a greater level of incentives among different professional groups and the optimization of information systems.
When the nations try to strengthen their Health Systems, they have often to face several factors on the basis of the health problems, such as the increasing globalization and urbanization and the reappearance of infectious diseases as well, thus creating new challenges for the Health Systems. Bearing this in mind, it makes more sense to consider the Primary Health Care as the basis of the National Health Care System. The reforms the Primary Health Care are undergoing, with the implementation of the Family Health Units, aim to create the first accessible, efficient and equitable system, with the purpose of improving accessibility to health care and health gains concerning individuals, families and communities. As we are aware that organizational changes can generate levels of satisfaction, we decided to establish the main objectives of the study, as it follows: to characterize the professionals of the Family Health Units of the Northern Health Regional Administration, Public Institute, concerning social-professional variables and identifying how the reconfiguration and autonomy of the Health Centers, concerning the implementation of the Family Health Units, contributes to the satisfaction of health professionals. This study characterizes itself by being, descriptive and transverse, in a quantitative paradigm and develops itself in a random and unintentional sample formed by 207 professionals working in the Family Health Units of the Northern Health Regional Administration, Public Institute. Data was obtained through a questionnaire which included social-professional variables and a scale of evaluation measuring the level of satisfaction in the Professional Practice, consisting of six dimensions: Security with the Future of the Profession, Support of the Hierarchy; Recognition by the Others due to Work Done; Physical Conditions of Work; Relationship with Colleagues, and Work Satisfaction. The great majority of the 207 participants was female in all occupational groups, being the nurses at the top (50,7%). The average age is higher among men (43,18 years old) and doctors (49,49 years old) ; the majority of the inquirers have a professional practice in primary health care of more than 12 years, and this is can be seen mainly among doctors (24,44 years). As far as the type of bond there is between the place of work and the worker is concerned, the most common one is the worker who makes part of the boards of the place they work in 75% out of the total participants have been included in the Family Health Units by invitation and 86% did not receive any kind of incentives at all. As for the most significant results, one can highlight the following: men show higher average values in all dimensions that make part of the scale of evaluation that measures satisfaction with the practice, except in what concerns security with the future of the profession and professional satisfaction. The professional group which embraces a larger number of dimensions in which satisfaction with the professional practice is superior is that of the doctors, except in dimensions related with the support of the hierarchy and the relationship with colleagues; these two fields have higher values among doctors assistants. Nurses are the professional group that does not get any higher average value in any of the dimensions of the scale compared to the other professional groups. The overall assessment of satisfaction with professional practice, based on the six dimensions that make up the scale, shows that there is no statistically significant differences regarding gender, professional group, the amount of time already spent in the job, age and type of bond with the employer; the average values are higher among women, doctors, workers with less time in the job, younger and those who have a more secure professional relationship. The participants of this study emphasize the implementation of the Family Health Units as an opportunity to an organizational change, since it promotes the work per objectives, thus, increasing productivity and professional merit, professional development, with everybody having an active role, and caring as it gives an answer of proximity to the needs in health. As suggestions that enhance the vitality of retirement, the participants listed the need for a greater level of incentives among different professional groups and the optimization of information systems.
Descrição
Dissertação de Mestrado em Gestão dos Serviços de Saúde