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As competências de liderança nas emergências de saúde pública
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RESUMO - Antecedentes: Um corpo de conhecimento significativo de estudos (14-16) referente à
ambiguidade e à incerteza das organizações de saúde, como sistemas adaptativos
complexos, reconheceu que estas não estão preparadas para o inesperado devido ao
domínio do paradigma da norma que se apoia em pressupostos de planeamento e
controlo (19,20). Assim, a liderança deve envolver dinâmicas, dimensões ou práticas
que permitam interações entre os agentes heterogéneos para gerir os desafios
associados à incerteza e às situações emergentes dos sistemas adaptativos complexos.
Objetivo: Identificar os desafios e respetivas competências de liderança, reportados
pelas equipas, nas organizações de saúde que devem estar presentes em eventos
extremos e inesperados como surto de COVID-19, especificamente no serviço de
urgência e numa unidade de cuidados intensivos hospitalar.
Metodologia: Foi adotada uma metodologia qualitativa através da realização de 30
entrevistas semiestruturadas com profissionais de saúde (médicos e enfermeiros) de
uma unidade de cuidados intensivos e de um serviço de urgência. Para a elaboração do
guião consideraram-se as dimensões da liderança transformacional, distribuída e
humilde. A análise temática foi utilizada para analisar as entrevistas.
Resultados: Cinco grandes dimensões principais emergiram e constituem as
dimensões fundamentais de liderança durante um evento extremo numa unidade de
cuidados intensivos e num serviço de urgência: o equilíbrio entre o comando e a decisão
partilhada, o equilíbrio ambidextro, a ação interconectada, a consciência transcendente
e o capital relacional.
Conclusão: O estudo contribuiu para o desenvolvimento da teoria das lideranças de
emergências em emergências saúde de saúde pública. Os dados mostraram que mais
do que competências especificas, a liderança durante eventos extremos deve ser
compreendida como uma cocriação de atos combinados de líderes e liderados num
paradoxo que precisa de equilibrar competências antagónicas ou duais.
ABSTRACT - Background: A significant body of knowledge of studies (14-16) about ambiguity and uncertainty of healthcare organizations, as complex adaptive systems, has recognized that they are not prepared for the unexpected due to the domain of the norm paradigm that relies on assumptions of planning and control (19,20). Thus, leadership must involve dynamics, dimensions or practices that allow interactions between heterogeneous agents to manage the challenges associated with uncertainty and emerging situations of complex adaptive systems. Aim: Identify the competencies of leadership in healthcare organizations that must be present in the management of unexpected and extreme events such as the COVID-19 outbreak, specifically in an intensive care unit and in a hospital emergency service. Methodology: The study followed a qualitative approach using 30 semi-structured interviews with healthcare professionals (doctors and nurses), from an intensive care unit and a hospital emergency service. In order to ask the questions, the dimensions of transformational, distributed and humble leadership are considered. Thematic analysis was used to analyze the interviews. Results: Four major main dimensions emerged and constitute the fundamental dimensions of leadership during an extreme event in a hospital organization: the balance between command and shared decision, the ambidextrous balance, the interconnected action, transcendent awareness and relational capital. Conclusion: The study contributed to the development of the leadership theory of emergencies in public health emergencies. The data showed that more than specific competences, leadership during extreme events must be a co-creation of combined acts of leaders and subordinates in a paradox that must needs to balance antagonistic or dual competences.
ABSTRACT - Background: A significant body of knowledge of studies (14-16) about ambiguity and uncertainty of healthcare organizations, as complex adaptive systems, has recognized that they are not prepared for the unexpected due to the domain of the norm paradigm that relies on assumptions of planning and control (19,20). Thus, leadership must involve dynamics, dimensions or practices that allow interactions between heterogeneous agents to manage the challenges associated with uncertainty and emerging situations of complex adaptive systems. Aim: Identify the competencies of leadership in healthcare organizations that must be present in the management of unexpected and extreme events such as the COVID-19 outbreak, specifically in an intensive care unit and in a hospital emergency service. Methodology: The study followed a qualitative approach using 30 semi-structured interviews with healthcare professionals (doctors and nurses), from an intensive care unit and a hospital emergency service. In order to ask the questions, the dimensions of transformational, distributed and humble leadership are considered. Thematic analysis was used to analyze the interviews. Results: Four major main dimensions emerged and constitute the fundamental dimensions of leadership during an extreme event in a hospital organization: the balance between command and shared decision, the ambidextrous balance, the interconnected action, transcendent awareness and relational capital. Conclusion: The study contributed to the development of the leadership theory of emergencies in public health emergencies. The data showed that more than specific competences, leadership during extreme events must be a co-creation of combined acts of leaders and subordinates in a paradox that must needs to balance antagonistic or dual competences.
Descrição
Palavras-chave
Organizações de saúde liderança de emergência em saúde sistemas adaptativos complexos eventos extremos emergências de saúde pública Healthcare organizations emergency leadership in healthcare complex adaptive systems extreme events public health emergencies