Family Health Teams workers in Rio de Janeiro: leadership aspects in a study on organizational climate

DOI: 10.1590/1413-81232017223.33112016 Leda Jung dos Santos 1 Maurício Sangama Paranhos 2 Abstract Organizational climate is understood as the formal or informal perception of policies, practices, actions and organizational procedures, and is a factor of influence in the efficiency of the results, as well as in the conduct of people that are part of an organization. This paper describes one of organizational climate realms, namely, leadership, comparing the strata of professional categories of the Family Health Teams in the city of Rio de Janeiro. Thus, an administrative-based survey was carried out with a sample of n = 9,590 people in 187 primary healthcare units (71 Family Clinics and 116 Municipal Health Centers). The results show that all items that measure the realm of “leadership” were positively evaluated with differences between strata (p-value <0.001). We recommend conducting regular studies and holding leadership workshops in the very health units, as well as using distance-learning tools to exchange information and train staff. Key words Organizational climate, Family health teams, Primary healthcare Centro Universitário Serra dos Órgãos. Av. Alberto Torres 111, Alto. 25964000 Teresópolis RJ Brasil. 2 Secretaria Municipal de Saúde do Rio de Janeiro. Rio de Janeiro RJ Brasil. 1 ARTICLE Family Health Teams workers in Rio de Janeiro: leadership aspects in a study on organizational climate 759 Santos LJ, Paranhos MS 760 Introduction Organizational climate is understood as the formal or informal perception of policies, practices, actions and organizational procedures, and is a factor of influence in the efficiency of the results, as well as in the conduct of people who are part of an organization1,2. It should be noted that, in organizations with a favorable organizational climate, activities become more comfortable and easier, resulting in greater job satisfaction and increased potential for workers3. Loch4 quotes an article by Ducker and proposes eight practices for effective managers. Managers should: (i) ask what needs to be done; (ii) ask what is good for the institution; (iii) make plans of action; (iv) assume responsibility for the decision; (v) take responsibility for communication; (vi) focus on opportunities rather than problems; (vii) hold productive meetings; and (viii) say “we” instead of “I”. In its most usual definitions, the concept of leadership consists of three elements: influence, group and objective. Leaders try to influence, induce and affect the behavior of others, a process that occurs in a group context. The last element involves the idea of direction – the behavior of group members is influenced towards achieving certain goals. These elements were highlighted and applied in leadership theory and research, markedly until the mid-1980s.From then on, the definitions used the “symbolic management”concept. In the symbolic perspective, the fundamental characteristic of leadership would be to promote values that provide shared meanings about the nature of the organization5. Thus, leaders are those who “change the way people think about what is desirable, possible, and necessary”. With this in mind, we understand that the organization of work is the result of an intersubjective process, in which various subjects interact with a given reality, implying a dynamic of interactions proper to work situations, as a place of production of psychic meanings and building social relationships. Organizational climate studies are strategic management tools, since they allow internal and external analysis andmonitor employee satisfaction and commitment vis-à-vis the organization, ensuring, through strategies and actions, people growth and development and maximum productivity and quality, aiming at achieving and exceeding the results pre-set by central management. In the health sector, the manager or director of a primary health care facility should be pre- pared to deal with unexpected events that may occur with users at the health establishment or at home, to relate to multiprofessional teams, to be aware of medical procedures and to mediate possible conflicts in inter-relational situations, that is, this professional has to exercise and develop leadership in relation to family health teams, transforming ideas, intentions and goals into results, harmonizing the work environment of the professionals, actively participating in the planning processes, knowing the guidelines of the SUS and the Family Health Strategy in order to meet the demands and needs of the population6. In addition, managers need to be qualified, recognizing the tools most important to their work, enabling them to identify the potentialities and optimize teamwork, creating new leaders in order to exercise shared management, serving as an example of conduct for an efficient work that constantly improves its quality7. Maffei8 raises some questions in the work process of the Family Health teams: How can we combine institutional democratization with operational capacity and, therefore, with some level of vertical centralization, without which establishments would be lost in endless discussions or in particularisms? How can we provide independence and autonomy to each team, without losing the sense of network commitments, without losing the notion of system or without compromising the guideline of care comprehensiveness? How can we ensure a dialogue between users and professionals? How can we motivate professionals and how can we increase their capacity for reflection and self-esteem? How can we coordinate autonomy and creativity with professional responsibility? Thus, the execution of managerial activity requires the use of interdisciplinary tools, considering the technical capacity, but also the ability to articulate the political, economic and social relations in the work process and in the organization of health services. These professionals must act as leaders and be good listeners. They should know about planning, intervention strategies, agreement forms, work management, knowledge and people management, besides the organization of the network and issues related to maintenance and infrastructure of a health facility7,9. One of the ways to provide this type of training in Rio de Janeiro has been the Public Health Specialization Course of the National School of Public Health10. In this context, many of the hardships in implementing actions and procedures foreseen in primary healthcare proposed by the Municipal 761 Material and methodology We developed a cross-sectional administrative study, listing the universe of research from the National Register of Health Establishments (CNES), updated monthly by the Municipal Health Secretariat of Rio de Janeiro. We noticed, during the planning of the study, that we had to collect e-mails from the entire base of the Subsecretariat of Primary Healthcare, Promotion and Health Surveillance. The first great movement to do so, and thus make eff (...truncated)