Micro strategies and hospital management: an analysis through the lens of complexity

Resumen

Hospital organizations play an important social role. Its management, however, has been challenged to seek greater efficiency, quality and relevance of health services provided.  The purpose of this study has been the analysis of innovative strategic practices that have affected performance of a hospital as an organization. This is a case study, focusing a community hospital, located in the State of Parana in Brazil. Data were collected through interviews, non-participant observation and document analysis. The analysis revealed that introducing innovative strategies in cost, medical and nursing areas have contributed decisively to the improvement in resource allocation and quality of the health services delivered. Factors such as the practice of micro strategies, support of top management and favorable organizational climate were decisive in this process. Results revealed that micro strategies employed in terms of cost contributed to the reduction of operational expenses, better reallocation of resources and greater investment in health services.  Changes in patient care in the nursing sector promoted a higher quality of service. The strategy of introducing the hospitalist provided better management of complications and of care of patients and their families.  Finally, we found a greater humanization of health services and improvement of organizational performance and image. The major contribution of this article is the finding that, in complex systems such as hospitals, the practice of micro strategies tends to be more effective in health services management.