Study of the work and of working in Family Health Care Support Center

OBJECTIVE To understand the organization of and the working conditions in family health care support centers, as well as subjective experiences related to work in two of these centers. METHODS This was a case study carried out during 2011 and 2012 in two family health care support centers in Sao Paulo, Southeastern Brazil. Data were collected and analyzed using two theoretical-methodological references from ergonomics and work psychodynamics influenced, respectively, by ergonomic work analysis, developed based on open observations of a variety of tasks and on interviews and in practice in work psychodynamics, carried out using think tanks about the work. RESULTS The work of the Family Health Care Support Centers in question is constituted on the bases of complex, diversified actions to be shared among the various professionals and teams involved. Innovative technological tools, which are not often adopted by primary health care professionals, are used and the parameters and productivity measures do not encompass the specificity and the complexity of the work performed. These situations require constant organizational rearrangement, especially between the Family Health Care Support Centers and the Family Health Care Teams, causing difficulties in carrying out the work as well as in constituting the identity of the professionals studied. CONCLUSIONS The study attempts to lend greater visibility to the work processes at the Family Health Care Support Centers in order to contribute to advances in public policy on primary healthcare. It is important to stress that introducing changes at work, which affect both its organization and work conditions, is above all a commitment, which to be effective, must be permanent and must involve the different levels of hierarchy.

研究目的
旨在了解家庭医疗照护支持中心（Family Health Care Support Centers）的组织架构与工作环境，并探究在其中两家中心开展工作的相关主观体验。

研究方法
本研究为2011至2012年间于巴西东南部圣保罗市的两家家庭医疗照护支持中心开展的案例研究。数据收集与分析采用两大理论-方法学框架，二者分别源自工效学与工作心理动力学领域：其一为工效学工作分析法，其开发基于对各类工作任务的开放式观察与访谈；其二为工作心理动力学研究法，其基于工作心理动力学的实践开发，并依托针对工作开展的研讨小组实施。

研究结果
本次研究涉及的家庭医疗照护支持中心，其工作以复杂多元的行动为基础，需由各相关专业人员与团队协同开展。基层医疗照护（Primary Health Care）专业人员普遍较少采用的创新型技术工具，在本研究的中心中得到了应用；同时，现行的工作参数与生产力衡量指标未能涵盖实际开展工作的特殊性与复杂性。此类情形要求各方持续开展组织重构，尤其在家庭医疗照护支持中心与家庭医疗照护团队之间，这不仅给工作推进造成困难，也阻碍了受访专业人员的职业身份建构。

研究结论
本研究旨在提升家庭医疗照护支持中心工作流程的可见度，以期为基层医疗照护公共政策的完善提供参考。需着重强调的是，对工作组织与工作环境产生影响的职场变革，本质上是一项持续性的系统性承诺；若要取得实效，该变革需保持长效性，并覆盖不同层级的管理体系。