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Publication
O serviço social, profissão e profissionalismo do contexto do Estado-proveniência em Portugal : os assistentes sociais nos hospitais do Serviço Nacional de Saúde
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Advisor(s)
Abstract(s)
Este trabalho tem como principal propósito de investigação estudar a relação entre o Estado e a profissão de Assistente Social, designadamente através do processo de profissionalização e profissionalismo no contexto hospitalar do Serviço Nacional de Saúde.
É hoje consensual na literatura especializada considerar o Estado como um elemento essencial na construção, manutenção e/ou ampliação do poder profissional. Esta perceção é ainda mais evidente no caso dos assistentes sociais, dado que a sua importância como profissão ficou a dever-se, em grande medida, ao alargamento das funções sociais do Estado. Este trabalho, através do estudo do exercício de liderança e definição de estratégias do assistente social diretor, permitiu explorar e caracterizar a posição do Serviço Social nas estruturas hospitalares de grande dimensão e de natureza pública empresarial.
Como conclusão, o enquadramento dado pelo novo regime jurídico empresarial, os processos de fusão e a produção de códigos e princípios de boa governação têm vindo a interferir no trabalho profissional dos assistentes sociais ao nível da organização, estruturação e coordenação do respetivo serviço. Os diretores ou coordenadores de Serviço Social percecionam uma maior atribuição de responsabilidade profissional enquadrada numa lógica organizacional definida por novas ferramentas de gestão: valorização do registo dos atos praticados, definição de objetivos e metas e a criação de indicadores de performance e avaliação dos resultados das práticas profissionais. Num ambiente que referencia e valoriza uma lógica de pendor gestionário, constata-se contudo que persistem na defesa da sua autonomia técnica e científica quer na relação com as equipas multidisciplinares, quer junto dos Conselhos de Administração.
Em Portugal, duas mudanças históricas acabaram por contribuir para a evolução e estatuto dos profissionais de Serviço Social: a constitucionalização do Estado Social, em 1976, e a sua progressiva implementação e universalização e a criação do Serviço Nacional de Saúde, em 1979.
Assim, no plano nacional, acompanhámos a evolução do discurso político e legal sobre a afirmação e o estatuto dos assistentes sociais hospitalares durante o Estado Novo Corporativo (1933-1974) e a transição para o quadro do atual Estado democrático.
O principal desafio analítico desta investigação passou por compreender como num contexto político e económico de reconfiguração do Estado-Providência, com reflexos evidentes nos atuais modelos de gestão hospitalar e no modo de organização do Serviço Nacional de Saúde em Portugal, os assistentes sociais se posicionam perante as mudanças nos contextos organizacionais hospitalares.
A adoção de novos modelos de gestão empresariais, os processos de fusão, a introdução de princípios de boa governação, a escassez de recursos financeiros na área da saúde, a pressão constante e necessária das populações por mais e melhores cuidados de saúde, colocam novos desafios aos assistentes sociais. Neste contexto, especial atenção é devida aos profissionais com funções de direção ou de coordenação das equipas de Serviço Social, os quais, diariamente, são confrontados com a necessidade de mediar interesses e valores, entre o Estado que regula e paga, a gestão empresarial que busca a eficiência económica de uma área sensível como a saúde, o utente que procura cuidados de saúde e sociais, e a dinâmica interna da equipa de assistentes sociais.
The main purpose of this investigation is to study the relation between the state and the process of professionalization and professionalism of social workers in hospitals of the National Health Service. It is, in the specialized literature, consensual to consider the state as an essential element in the construction, maintenance and/or amplification of the professional power. This perception is even more evident in the case of social workers, once its importance as a profession was due, in a large measure, to the extension of the social functions of the state. In Portugal, two historical changes ended up contributing to the evolution and status of the social work professionals: the constitutionalisation of the welfare state, in 1976, and its progressively implementation and universalization, and the creation of the National Health Service, in 1979. At a national level, we followed the evolution of the political and legal discourse on the statement and status of hospital social workers during the “new corporate state” (1933-1974) and under the current democratic state. The main empirical challenge of this investigation was to understand how, in a political and economic context of reconfiguration of the welfare state, with obvious consequences in the current hospital management models and the method of organization of the National Health Service in Portugal, social workers take position towards on the changes in hospital organizational contexts. The adoption of new models of business management, the fusion processes, the introduction of good governance principles, the lack of financial resources in the health sector, the constant and necessary pressure of populations for more and better health care services, bring new challenges to social workers. Especially to professionals with management and coordination functions of the social work teams, whom are daily confronted with the need to mediate interests and values between the state that regulates and pays, the corporate management that seeks economic efficiency of a sensitive area like health, the user who looks for health and social care, and the internal dynamic of the social workers teams. This work, through the study of the exercise of leadership and definition of strategies of the social work director, allowed to explore and to characterize the position of social work in the hospital structures of large dimension and of corporate public nature. In conclusion, the framework provided by the new corporate legal system, the fusion processes and the production codes and principals of good governance have been interfering in the professional work of social workers in the organization, structuring and coordination of the service. Directors or coordinators of social work perceive a bigger allocation of professional responsibility in an organizational logic defined by new management tools: appreciation for the registration of the acts performed, setting objectives and targets and the creation of performance indicators and evaluation of the professional practices results. However, they persist in the defense of its technical and scientific autonomy in relation to the multidisciplinary teams and with the management councils and discretionary power with the patients, families and communities.
The main purpose of this investigation is to study the relation between the state and the process of professionalization and professionalism of social workers in hospitals of the National Health Service. It is, in the specialized literature, consensual to consider the state as an essential element in the construction, maintenance and/or amplification of the professional power. This perception is even more evident in the case of social workers, once its importance as a profession was due, in a large measure, to the extension of the social functions of the state. In Portugal, two historical changes ended up contributing to the evolution and status of the social work professionals: the constitutionalisation of the welfare state, in 1976, and its progressively implementation and universalization, and the creation of the National Health Service, in 1979. At a national level, we followed the evolution of the political and legal discourse on the statement and status of hospital social workers during the “new corporate state” (1933-1974) and under the current democratic state. The main empirical challenge of this investigation was to understand how, in a political and economic context of reconfiguration of the welfare state, with obvious consequences in the current hospital management models and the method of organization of the National Health Service in Portugal, social workers take position towards on the changes in hospital organizational contexts. The adoption of new models of business management, the fusion processes, the introduction of good governance principles, the lack of financial resources in the health sector, the constant and necessary pressure of populations for more and better health care services, bring new challenges to social workers. Especially to professionals with management and coordination functions of the social work teams, whom are daily confronted with the need to mediate interests and values between the state that regulates and pays, the corporate management that seeks economic efficiency of a sensitive area like health, the user who looks for health and social care, and the internal dynamic of the social workers teams. This work, through the study of the exercise of leadership and definition of strategies of the social work director, allowed to explore and to characterize the position of social work in the hospital structures of large dimension and of corporate public nature. In conclusion, the framework provided by the new corporate legal system, the fusion processes and the production codes and principals of good governance have been interfering in the professional work of social workers in the organization, structuring and coordination of the service. Directors or coordinators of social work perceive a bigger allocation of professional responsibility in an organizational logic defined by new management tools: appreciation for the registration of the acts performed, setting objectives and targets and the creation of performance indicators and evaluation of the professional practices results. However, they persist in the defense of its technical and scientific autonomy in relation to the multidisciplinary teams and with the management councils and discretionary power with the patients, families and communities.
Description
Keywords
Estado e profissões Serviço Nacional de Saúde Hospital-empresa Assistente social diretor State and professions National Health Service Hospital corporatization Social work director