Purpose: To understand and analyze the role of physicians in the implementation of the care model outlined in the hospital decentralization policy in Mendoza, Argentina, between 1990 and 2015. Methodology: A qualitative study, with a constructivist approach, was conducted. A total of 30 semi-structured interviews were carried out with an intentional sample of physicians in strategic positions in the Ministry of Health and from six decentralized high- and medium-complexity hospitals. Data were analyzed using Framework Analysis. Results: Participants’ account indicate that the setting of healthcare priorities for hospitals is more influenced by the negotiation capacity of medical and administrative directors than by sanitary criteria delineated by the central government. The coordination of healthcare networks is seen as a responsibility of the hospital by interviewees from less complex centers. In contrast, those interviewed from high complexity hospitals view the coordination effort with primary care as a ministerial responsibility. Clinical standardization is legitimized when it is constructed in a participatory manner. Best practices monitoring, while promoted by administrative systems, is ultimately resolved in clinical medical spaces. Conclusions: Shared beliefs, which are the result of professional socialization, operate as criteria by which physicians in relevant positions adopt and / or adapt values and instruments of the care model that underlies hospital decentralization. The management tools that are inherent to it coexist but do not eliminate forms of self-government rooted in services.
Author Biography
Cecilia Molina, Universidad Nacional de Cuyo
Problemática de la Salud (Facultad de Ciencias Políticas y Sociales) y Especialización en Salud Pública (Facultad de Ciencias Médicas).
Molina, C. (2019). Hospital self-management and changes in the care model. physicians in the implementation of the policy in Mendoza, Argentina. Revista Chilena De Salud Pública, 22(2), p. 145–154. https://doi.org/10.5354/0719-5281.2018.53245
