Social actors and participatory mechanisms in hospitals: the case of Grupo Hospitalar Conceição-RS

Abstract

The paper aims at understanding the role of participatory mechanisms in hospital organizations. It is a case study, looking at the role and impact of these mechanisms in the Grupo Hospitalar Conceição, in Porto Alegre/RS. Participatory mechanisms were situated at different levels in hospital organization, and were all of them directed to increased participation of users and health workers. They are spaces where participants present their interests and demands and consensus is negotiated. There, themes of participants' interests could be included at the hospital agenda, whilst polemic issues were publicly discussed. These instances of debate favor alliances among different actors; they help building up political support for the hospital decisions the forums agreed with, contribute to the actors learning, facilitate the lessening of power asymmetries in the hospital's decision making process; finally, they help the diffusion of information about the hospital in society. Since their institution, there was an increase in users and health workers involvement with hospital matters, while the relationship among these actors was intensified. The participatory mechanisms motivated some degree of openness towards actors which were traditionally excluded from decision making processes in hospitals: users and health workers. At the same time, it diminished the power of medical professionals, favoring an alliance between hospital administration and those newcomer actors.