- (Novembro de 2012) - Amor versus arame
- (Fevereiro de 2015) - "When is a company too big to manage?"
- (Fevereiro de 2015) - "quebrar os dentes ao SNS"
- (Julho de 2017) - Um clássico
- (Junho de 2018) - Mongo na saúde
Na última conversa oxigenadora o meu parceiro convenceu-me a comprar "Reinventing Organizations: An Illustrated Invitation to Join the Conversation on Next-Stage Organizations". Ontem, enquanto descia a A4 numa viagem de camioneta tive oportunidade de ler uma estória de que ele me tinha falado:
"Here is the story of neighborhood nursing in the Netherlands and of a pioneering organization called Buurtzorg. Since at least the eighteenth century, every neighborhood in the Netherlands has had one or more nurses that worked outside of hospitals, visiting the sick and the elderly in their homes. During the twentieth century, the social security system increasingly took over the costs of the system.
...
In the 1980s, the Dutch government had an idea that made a lot of sense, seen from an “Orange” [Moi ici: O termo "Orange" é usado pelo autor para designar as empresas do século XX, muito racionais e com uma crença ilimitada na inteligência e análise] scientific/industrial perspective: if all the nurses could be grouped into large organizations, economies of scale would kick in, generating savings for the taxpayer. Nurses were pushed to affiliate with large organizations that started implementing modern (Orange) management practices step by step. Quickly, these organizations decided it was inefficient that the client would always be seen by the same nurse. A different nurse was now dispatched to clients every day, based on availability. Higher flexibility meant less potential downtime for nurses between two clients. Call centers were set up in headquarters, now that clients could no longer call “their” nurse directly. Then, it was decided to have the nurses specialize. More experienced nurses must be paid more, so they were sent to do only the more difficult, technical interventions. All the rest—simpler things like shots and bandages—was now pushed to less expensive nurses, resulting in further cost savings.
...
Managers noticed that some nurses worked much faster than others, so time norms were established. Two and-a-half minutes to change a compression stocking, ten minutes for a shot. Everything was specified down to the minute. With time norms defined, planning departments were set up in headquarters. Every evening, each nurse now receives a sheet of paper with a detailed plan for the next day, prepared by someone in the planning department she most likely will never meet.
...
The care providers started merging in pursuit of further economies of scale. To “manage” the nurses in these big companies, layers of hierarchy were added. A district manager overseeing a few dozen nurses reports to a regional manager, who reports to a national manager. The managers today often have no nursing experience. Their role is simply to monitor and improve the nurses’ performance. They have lots of data they can slice and dice because nurses are asked to peg a small barcode sticker to the front door of all clients, scan that code when they go in to provide care, and scan it again when they leave. With all this data, managers can make continuous improvement; they can tell nurses for which kind of interventions they are slower than their peers. Every one of these changes—specialization, flexibility, economies of scale, continuous improvement—has resulted in efficiency gains, arguably a good thing for the Dutch health care system. [Moi ici: Como não pensar nos agrupamentos que geraram as escolas-cidade e os mega-hospitais-cidade]
...
But there is a dark side to the system Patients hate it For older, sometimes confused clients, having an unknown face come into the intimacy of their home every day is difficult. They have to share their story and their medical condition with a total—and hurried—stranger.
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Nurses hate it The way they are asked to operate hurts their vocation and integrity. They realize that they often give bad or insufficient care. But the system prevents them from doing what they know is called for."
