The development of telemedicine in the context of cross-border healthcare services in the European Union: comparative approach France / Czech Republic The role of the European Union, within the context of its support in the field of public health, consists of helping the Member States to achieve the goals defined in the multiannual framework program. Among these goals, telemedicine is a priority of eHealth. Telemedicine is a form of healthcare provided remotely using Information and Communication Technology (ICT). It aims to improve the efficiency of medical care systems faced with the ageing of the European population. This thesis is a study of cross-border telemedicine in the context of cross-border medical care as it is regulated by European Union law. However, the deployment of cross-border telemedicine depends on the competence of the Member States. A comparison between French and Czech legislation, in terms of the implementation of telemedicine in these Member States, reveals different strategies regarding the integration of telemedicine into their healthcare systems. In light of these two significant examples, it will be possible to show how the deployment of telemedicine in domestic law influences its cross-border development. European legislation encourages states to use cross-border...

Bakgrund: Demens är en sjukdom som inte tillhör det normala åldrandet och påverkar inte bara den som drabbas av en demenssjukdom men också alla i dess närhet. En stor del av den vård som sker av en demensdrabbad person sker i hemmet av en närståendevårdare. För att ge en optimal vård är det viktigt att kommunicera med de närstående och inkludera dem i vården såväl hemma som inneliggande på sjukhus eller på vårdboende. Syfte: Syftet med denna kvalitativa litteraturstudie var att belysa hur närståendevårdare till personer med demensdiagnos upplever vårdkontakten genom sjukdomsförloppet. Metod: Kvalitativ litteraturöversikt Resultat: Närstående upplevde att de inte fick de stöd de efterfrågade från hälso- och sjukvårdspersonal under sjukdomsförloppet. Hälso- och sjukvårdspersonal förnekade de observationer närstående hade gjort av den demensdrabbade personen vilket förlängde diagnosprocessen. Efter diagnos och under sjukdomsförloppet upplevde närstående att det fanns både bristande information och kommunikationsproblematik med vården, men när kommunikationen och samarbetet fungerade väl mellan närstående, den demensdrabbade och sjukvården upplevdes det som en lättnad och minskad börda.Konklusion: En demensdiagnos påverkar inte enbart personen som är primärt drabbad men även personer i dennes närmaste sociala nätverk. Närstående till demensdrabbade personer behöver stöd från hälso- och sjukvårdspersonal såväl före som efter diagnos och i de beslut som behöver fattas under sjukdomsförloppet. Studiens resultat visar att närstående till personer med demensdiagnos upplever att stödet som ges från sjukvårdspersonal inte tillfredsställer de behov de närstående har i alla situationer. / Background: Dementia is a disease that is not part of the normal ageing process and affects not only the person with the dementia diagnosis but also everyone close to that person. A big portion of the care surrounding the person with dementia is executed in their home by a relative. In order to provide optimal care, it is important to communicate with the relatives of the patient and include them in the care both at home, at the hospital and in a residential home setting.Aim: This literature review aims to review how relatives to persons with dementia experience contact with health care services through the course of the disease.Method: Qualitative literature reviewResults: Relatives felt they did not receive the support they asked for and needed from the health care services through the course of the disease. Health care personnel rejected the observations made by relatives which caused the process of getting a diagnosis to extend. After the diagnosis and through the course of the disease the relatives experienced a lack of information and communication with the health care services, however when the communication and cooperation worked between the health care, the relatives and the person with the dementia this resulted in feelings of relief and a reduced caregiver burden.Conclusion: A dementia diagnosis naturally affects the person who gets the diagnosis primarily but also has an impact on the people close to the person. Relatives need support from the health care services both before the diagnosis and after as well as in the decision making through the course of the disease. The results of this review establish that the relatives of people with dementia experience a lack of support in relation to the support they need in every step of the disease.

Thesis (M.A. (Nursing Science)) -- University of Limpopo, 2019 / Quality health care includes availability, accessibility, affordability, acceptability, competence of health care providers, reducing waiting time, ensuring privacy and confidentiality, ensuring safety and security, and reducing mortality and morbidity. Despite many initiatives made by the National Department of Health through the Minister of Health, provision of quality health care services remains a serious challenge in South Africa, especially in the public rural clinics. Communities from rural areas face many challenges at the public healthcare clinics such as poor infrastructure, attitudes from staff, old equipment, insufficient medicines, dirty healthcare sectors, and longer waiting times, which has led to provision of poor health care services. Methodology A quantitative research approach was used to conduct this study. The study was conducted in the Capricorn District of the Limpopo Province. Three municipalities; namely Blouberg, Lepelle-Nkumpi and Aganang, were selected from the five municipalities located in the Capricorn District because they are predominantly rural. A simple random sampling applying fish bowl method was used to select the public clinics in each municipality. A cross-sectional study design was used to conduct the study. Only professional nurses were selected to participate in this study. Data were collected using a structured self-administered questionnaire, over a period of three months. A total of 155 professional nurses were selected because they met the selection criteria. The response rate was 100% because all the 155 questionnaires distributed were completed. Data were analysed using the Statistical Package for Social Sciences program version 22.0 with the assistance of the University of Limpopo statistician. Results The findings of the study indicated that only 3 (2%) of the clinics operated for 24 hours, 72 (46%) operated for 8 hours and 80 (52%) operated for 12 hours. The majority of the professional nurses 123 (83%) said that the clinics are overwhelmed by large numbers of patients, whereas 26 (17%) of the professional nurses said that the clinics are not overwhelmed by large numbers of patients. Very few 29 (19%) professional nurses were satisfied with the salary they were paid, whereas the majority 124 (80%) were not satisfied with salary they were paid, and only 2 (1%) were unsure. Recommendations Recommendations were made to improve the quality of healthcare services in the public rural clinics: The Department of Health should review the salaries they pay professional nurses in rural clinics, particularly the Occupational Specific Dispensation, and they should be given a higher salary. Furthermore, the government should increase the salaries of nurses working in the public rural clinics to at least 10% higher than those in urban clinics within the next 5 years to attract more nurses to the public rural clinics. The Limpopo Provincial Department of Health should liaise with the treasury department to provide realistic budget to accommodate the population. Conclusion The findings of this study revealed the factors related to the provision of quality health care services at the selected public clinics in the rural areas of the Capricorn District, Limpopo Province. The study was limited to public clinics in the rural areas; therefore, the findings of this study cannot be generalised to the clinics that did not participate in the study. Keywords: Quality, healthcare services, public rural clinics.

BACKGROUND: This doctoral project describes an occupational therapy clinic created by this author within an outpatient health center located on a rural reservation serving the Navajo Native-American community residents. This was the center’s first occupational therapy program. Occupational therapy services included community outreach activities and innovative approaches that were inclusive, culturally appropriate, and client-centered. PROBLEM: Some challenges occurred during the implementation of the occupational therapy program such as: client resistance, cultural differences, lack of public transportation to the reservation, little to no awareness of occupational therapy, and limited funds and resources. METHODOLOGY: A thorough literature review on developing healthcare programs in rural areas was performed to collect relevant information on current methods and approaches. Moreover, programs that incorporated cultural orientation programs and awareness was taken into consideration to develop the occupational therapy program and its activities. This facilitated building a positive rapport and relationship with the Navajo community residents. RESULTS: Innovative approaches were developed to help reduce some of the barriers. Four key program elements were chosen to focus on developing a sustainable and culturally appropriate operating occupational therapy clinic to serve the Navajo Native Americans living on a rural reservation community. Collaboration with pertinent stakeholders, integration of some of the population’s cultural values, conveying cultural respect, and including community outreach events helped the development and operation of the new occupational therapy program. IMPLICATIONS: The development of the new occupational therapy clinic provided several occasions for the clinician to integrate culturally-based activities when providing services to an underserved community. It was able to set an example for future occupational therapy practitioners to create an academic course (and/or internship) to educate students about providing occupational therapy services to an indigenous population.

yes / Background: Experience-Based Co-Design (EBCD) is a participatory design method which was originally developed and is still primarily used as a healthcare quality improvement tool. Traditionally, EBCD has been sited within single services or settings and has yielded improvements grounded in the experiences of those delivering and receiving care. Method: In this article we present how EBCD can be adapted to develop complex interventions, underpinned by theory, to be tested more widely within the healthcare system as part of a multi-phase, multi-site research study. We begin with an outline of co-design and the stages of EBCD. We then provide an overview of how EBCD can be assimilated into an intervention development and evaluation study, giving examples of the adaptations and research tools and methods that can be deployed. We also suggest how to appraise the resulting intervention so it is realistic and tractable in multiple sites. We describe how EBCD can be combined with different behaviour change theories and methods for intervention development and finally, we make suggestions about the skills needed for successful intervention development using EBCD. Conclusion: EBCD has been recognised as being a collaborative approach to improving healthcare services that puts patients and healthcare staff at the heart of initiatives and potential changes. We have demonstrated how EBCD can be integrated into a research project and how existing research approaches can be assimilated into EBCD stages. We have also suggested where behaviour change theories can be used to better understand intervention change mechanisms.

Yes / We compare the performance of logistic regression with several alternative machine learning methods to estimate the risk of death for patients following an emergency admission to hospital based on the patients’ first blood test results and physiological measurements using an external validation approach. We trained and tested each model using data from one hospital (n=24696) and compared the performance of these models in data from another hospital (n=13477). We used two performance measures – the calibration slope and area under the curve (AUC). The logistic model performed reasonably well – calibration slope 0.90, AUC 0.847 compared to the other machine learning methods. Given the complexity of choosing tuning parameters of these methods, the performance of logistic regression with transformations for in-hospital mortality prediction was competitive with the best performing alternative machine learning methods with no evidence of overfitting. / Health Foundation; National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre (NIHR YHPSTRC)

Submitted by Natalie Mendes (nataliermendes@gmail.com) on 2015-07-25T15:33:44Z No. of bitstreams: 1 DISSERTA??O_FINAL_MARIANA.pdf: 1933246 bytes, checksum: cba7b57237fc6562b3b67a07e6bf6068 (MD5) / Made available in DSpace on 2015-07-25T15:33:44Z (GMT). No. of bitstreams: 1 DISSERTA??O_FINAL_MARIANA.pdf: 1933246 bytes, checksum: cba7b57237fc6562b3b67a07e6bf6068 (MD5) Previous issue date: 2014-03-14 / The access to health services in a global, equal and comprehensive way constitutes itself a civil right legally granted in the Brazilian Federal Constitution of 1988 which regulates and establishes the Unified Health System (SUS). However it is noticeable that the comprehensive access to health services has not been effectively put into practice, especially, in actions of medium and high complexity. Hence, this study aims to understand the organizational dynamic of the access of users of the Family Health Program (PSF) to the healthcare services of medium and high complexity of the SUS network and to analyze health practices performed by the primary care team, medium and high complexity for the feasibility of this access. We have analyzed the organizational dynamic of access to medium and high complexity healthcare services based on the guidelines of the dimensions of a political, technical and symbolical access analysis bounded by Giovanella and Fleury (1995) and supplemented with the theoretical model proposed by Assis et alii (2011). In the theoretical framework we discuss ways for the effectuation of the access to the healthcare services as a citizenship right as well as the organization of healthcare services in medium and high complexity under the focus of healthcare assistance models. This is a qualitative study, of critical and analytical approach in an approximate view of the dialectic method, which has as field of work the Family Health Units (USF), the Polyclinics and the Public Hospitals of Feira de Santana city in the State of Bahia. The participants of the study consisted of three groups: (1) healthcare professionals, (2) users and (3) managers/coordinators of healthcare services totaling 26 participants. We have used techniques such as data collection through semi-structured interviews, systematic observation and document analysis. The data analysis was an approximation of the hermeneutic-dialectic method. From the comparison of the studied data three categories rose up: (1) ORGANIZATIONAL DYNAMIC OF THE ACCESS OF THE USERS AND THE MATERIALITY OF ITS SENSES AND MEANINGS: the transversality of the political, technical and symbolical dimensions; (2) THE WORK PROCESS OF THE HEALTH PROFESSIONALS IN BASIC HEALTHCARE OF MEDIUM AND HIGH COMPLEXITY: an interweaving among healthcare; (3) THE ACCESS OF THE USERS TO THE SERVICES AND THE PRACTICES OF HEALTH OF MEDIUM AND HIGH COMPLEXITY: public/private relationship. The results make the senses/meanings of access to healthcare services that cross the political, technical and symbolical dimensions abundantly clear. The individual and collective practices, held by professionals working in primary care of medium and high complexity to promoting the access of the user to the SUS network, involve committed and welcoming actions by instituting bonds and enhancing the subjectivity of the users in some moments, and in other moments it involves a centered professional model geared towards the patients? concerns/conduct, medicalization and technicism co-existing dialectically an intertwining of lightweight, soft-hard and hard technologies in this process. Within the difficulties and limitations that the users have found to access healthcare services of medium and high complexity the demand was cited once these services are offered on a wider scale than its supply. We have come across several inputs used by users to access the health services of medium and high complexity. Furthermore the relationship between public and private is constitutive of the organization of this reality. The access of the user of the PSF to the practices of medium and high complexity still needs, for its embodiment, an all-embracing commitment of users, health professionals and health managers so as to operationalize it as a citizenship right. / O acesso aos servi?os de sa?de de forma universal, equ?nime e integral, se constitui em um direito de cidadania, garantido legalmente na Constitui??o Federal de 1988, a qual regulamenta e institui o Sistema ?nico de Sa?de (SUS). Contudo, percebemos que o acesso universal aos servi?os de sa?de n?o tem sido traduzido efetivamente na pr?tica, em especial nas a??es de m?dia e alta complexidade. Assim, este estudo teve como objetivos compreender a din?mica organizativa do acesso dos usu?rios do Programa Sa?de da Fam?lia (PSF) aos servi?os de sa?de de m?dia e alta complexidade da rede SUS e analisar as pr?ticas de sa?de realizadas pelos profissionais da aten??o b?sica, de m?dia e alta complexidade para a viabiliza??o deste acesso. Analisamos a din?mica organizativa do acesso aos servi?os de m?dia e alta complexidade, tendo como bases orientadoras as dimens?es de an?lise de acesso pol?tica, t?cnica e simb?lica, delimitadas por Giovanella e Fleury (1995) e complementadas com o modelo te?rico proposto por Assis e outros (2011). No referencial te?rico discutimos os caminhos para a efetiva??o do acesso aos servi?os de sa?de enquanto direito de cidadania, bem como a organiza??o dos servi?os de sa?de de m?dia e alta complexidade sob o enfoque dos modelos assistenciais em sa?de. Trata-se de um estudo qualitativo, de abordagem cr?tico-anal?tica, numa perspectiva aproximada do m?todo Dial?tico, tendo como cen?rio as Unidades de Sa?de da Fam?lia (USF), Policl?nicas e Hospitais p?blicos de Feira de Santana-BA. Os participantes do estudo foram constitu?dos de tr?s grupos: profissionais de sa?de (Grupo I), usu?rios (Grupo II) e gestores/ coordenadores dos servi?os de sa?de (Grupo III), totalizando 26 participantes. Utilizamos como t?cnicas de coleta de dados a entrevista semi-estruturada, a observa??o sistem?tica e a an?lise documental; a an?lise de dados foi uma aproxima??o do m?todo Hermen?utico-dial?tico. A partir do confronto dos dados emergiram tr?s categorias: 1) DIN?MICA ORGANIZATIVA DO ACESSO DOS USU?RIOS E A MATERIALIDADE DOS SENTIDOS E SIGNIFICADOS: a transversalidade das dimens?es pol?tica, t?cnica e simb?lica; 2) O PROCESSO DE TRABALHO DOS PROFISSIONAIS DE SA?DE NA ATEN??O B?SICA, DE M?DIA E ALTA COMPLEXIDADE: um entrela?amento entre as tecnologias de sa?de; 3) O ACESSO DOS USU?RIOS AOS SERVI?OS E ?S PR?TICAS DE SA?DE DE M?DIA E ALTA COMPLEXIDADE: rela??o p?blico x privado. Os resultados explicitam que os sentidos/ significados de acesso aos servi?os de sa?de transversalizam as dimens?es pol?tica, t?cnica e simb?lica. As pr?ticas individuais e coletivas realizadas pelos profissionais que atuam na aten??o b?sica, de m?dia e alta complexidade para a promo??o do acesso do usu?rio ? rede SUS envolvem a??es compromissadas, acolhedoras, com institui??o do v?nculo e a valoriza??o da subjetividade dos usu?rios em alguns momentos, e em outros passam pelo modelo profissional centrado, voltado para a queixa-conduta, medicaliza??o e tecnicismo, co-existindo dialeticamente um entrela?amento das tecnologias leve, leve-dura e dura nesse processo. Dentre as dificuldades e limites que os usu?rios t?m encontrado para acessar os servi?os de sa?de de m?dia e alta complexidade foi citada a demanda por esses servi?os ser maior que a sua oferta. Deparamo-nos com diversas portas de entradas utilizadas pelos usu?rios para acessar os servi?os de m?dia e alta complexidade. Al?m disso, a rela??o entre o p?blico e o privado ? constitutiva da organiza??o desta realidade. O acesso do usu?rio do PSF aos servi?os e ?s pr?ticas de m?dia e alta complexidade ainda necessita para a sua concretiza??o de um comprometimento dos usu?rios, profissionais e gestores da sa?de de modo a operacionaliz?-lo enquanto um direito de cidadania.

In a descriptive survey, the accessibility of primary healthcare services in Molemole was explored and factors impacting on accessibility were identified. The research sample consisted of 134 community members who visited one of five clinics (one a mobile clinic) in Molemole. Questionnaires, information lists, observations and field notes were used as research instruments. Ethical principles were adhered to, and validity and reliability maintained. Findings indicated that geographical, financial and cultural accessibility were satisfactory. Functional accessibility seemed problematic. The main reasons for dissatisfaction were attitudes, shortages of staff, unavailability of treatment, dysfunctional hours and fragmented services. Recommendations included optimal utilisation of staff and resources, improvements on infrastructure and support systems, community involvement in decision-making, as well as reassessing service point locations and policies on medications, supplies and equipment. / Health Studies / M. A. (Health Studies)

Este trabalho busca responder a pergunta de pesquisa: como ocorre a gestão da inovação em uma empresa de Medicina Diagnóstica? Para isso teve como objetivo aprofundar a compreensão sobre a gestão da inovação nesta empresa, entendendo as etapas do processo de inovação (ideação, conversão e difusão), entendendo como a estratégia da inovação se insere no processo de gestão da inovação, e entendendo como que pessoas e organização se inserem na gestão da inovação. Esta pesquisa fez uso de uma abordagem de natureza teórico-prática de enfoque qualitativo e objetivos de caráter exploratório por meio deum estudo de caso único em um centro de medicina diagnóstica de grande porte, reconhecido por práticas de gestão e inovação. Foram utilizadas as técnicas de entrevistas semiestruturadas, observação direta na empresa, e análise de documentos. Para a etapa de entrevista foi elaborado um protocolo semiestruturado com questões orientadoras conforme pesquisa bibliográfica a respeito de gestão da inovação, o setor de saúde e medicina diagnóstica.Foram entrevistados 12 líderes da empresa envolvidos com a gestão da inovação. Todas as fontes de dados foram analisadas e trianguladas chegando à apresentação e discussão de resultados do caso. Como resultados, a pesquisa evidenciou a importância da inovação em medicina diagnóstica, podendo reduzir custos e aumentar a qualidade, além de gerar valor para o restante da cadeia. A estratégia da inovação é alinhada à estratégia corporativa em diversos elementos e possui um processo de definição de drivers que direcionam a companhia no processo de inovação. O processo de inovação é influenciado por atores encontrados na literatura como órgãos reguladores, médicos, pacientes, fornecedores, universidades e operadoras. Além destes, outros foram citados, como órgãos representativos e o Ministério da Ciência e Tecnologia. Dois processos estruturados de inovação foram evidenciados: de novos produtos e de novos processos. O processo de novos produtos é alinhado ao modelo destagegates, enquanto que o processo de novos processos é mais amplo seguindo o modelo hegemônico. A etapa de ideação ocorre com geração de ideias tanto por fontes internas como externas, sendo as principais fontes os médicos e técnicos assessores, e os colaboradores. Técnicas como brainstorming, observação do comportamento dos clientes, e pesquisas acadêmicas são utilizadas. Na etapa de conversão, a seleção e avaliação é feita de maneira colegiada ou individual, por meio de fóruns presenciais ou virtuais. Os critérios de seleção são o alinhamento estratégico, as análises financeiras, técnicas e comerciais. No desenvolvimento e implantação, destaca-se a aplicação de pilotos e testes antes da efetiva implantação da inovação, treinamentos e acompanhamentos da implantação. Por fim, a etapa de difusão ocorre externamente, por meio da equipe comercial junto às operadoras, e com a equipe de médicos e técnicos assessores, junto aos clientes médicos, além dos canais de divulgação como eventos e congressos. A divulgação com clientes finais se dá por meio dos sites, redes sociais, e revistas. Já internamente, a comunicação ocorre principalmente na forma de murais e portais virtuais de comunicação, na atualização de documentos técnicos, e por meio de eventos internos de divulgação do conhecimento, premiação e reconhecimento. Em pessoas e organização, a pesquisa evidenciou que a cultura influencia o processo de gestão da inovação, sendo formada historicamente sobre os pilares de geração de conhecimento e relacionamento acadêmico nas universidades. Objetiva-se gerenciar os recursos humanos capturando pessoas alinhadas ao valor da inovação desde a fase de contratação, passando por treinamentos, avaliação anual de desempenho, premiação e reconhecimento. Não somente os colaboradores internos recebem incentivos e reconhecimentos, como também há incentivos a fornecedores, médicos e universitários por meio de programas específicos. / This master thesis seeks to answer the research question: how works the management of innovation in a case of Diagnostic Medicine? The purpose of this study was to deepen the understanding of innovation management in a diagnostic medicine company, understanding the stages of the innovation process (ideation, conversion and diffusion), understanding how the innovation strategy is embedded in the process of innovation management, and understanding how people and organizations are involved in managing innovation. This research made use of a theoretical-practical approach of qualitative approach and exploratory objectives through a case study in a large diagnostic medicine center, recognized by management and innovation practices. The techniques of semi-structured interviews, direct observation in the company, and document analysis were used. For the interview stage, a semistructured protocol was developed with orienting questions according to bibliographic research regarding innovation management, the health sector and diagnostic medicine. We interviewed 12 company leaders involved in innovation management. All data sources were analyzed and triangulated, arriving at the presentation and discussion of the results of the case. The research highlighted the importance of innovation in diagnostic medicine, which can reduce costs and increase quality, and generate value for the rest of the chain. The innovation strategy is aligned with the corporate strategy in several elements and has a process of definition of drivers that guide the company in the process of innovation. The innovation process is influenced by several stakeholders found in the literature. Besides these others were cited as representative bodies, and the ministry of science and technology. Two structured innovation processes were evidenced: process of new products and new processes. The process of new products is aligned with the stage gates model, while the process of new processes is broader following the hegemonic model. The stage of ideation occurs with the generation of ideas by both internal and external sources, the main sources being the doctors and technical advisors, and collaborators. Techniques such as brainstorming, customer behavior observation, and academic research are used. In the conversion stage, the selection and evaluation can be done collegially or individually, through forums that can be even virtual. The selection criteria are strategic alignment, financial, technical and commercial analysis. In the development and implementation, we highlight the application of pilots and tests before the effective implementation of the innovation, the training and follow-up of the implementation. Finally, the diffusion stage occurs externally, through the commercial team with the operators, and with the team of medical and technical advisors, with the medical clients, in addition to the channels of dissemination such as events, congresses. Publicity with end customers is through websites, social networks, and magazines. Already internally the communication occurs mainly in the form of virtual murals and portals of communication, in the updating of technical documents, and through internal events of dissemination of knowledge, awards and recognition. In people and organization, the research evidenced that culture influences the process of innovation management, being historically formed on the pillars of knowledge generation and academic relationship in universities. It aims to manage human resources by capturing people aligned with the value of innovation from the hiring stage, through training, annual performance evaluation, awards and recognition. Not only do internal collaborators receive incentives and recognition, but there are also incentives to suppliers, doctors and university students through specific programs.

Esta dissertação apresenta uma discussão sobre trabalho coletivo, gerada a partir de pesquisa realizada com profissionais que atuam na prestação de serviços de saúde em uma organização pública. O objetivo principal é abordar o trabalho em grupo considerando o contexto de serviços de saúde e investigar como os trabalhadores pertencentes às equipes de composição multiprofissional, se mobilizam para a realização do trabalho. Como referencial teórico partiu-se dos pressupostos da teoria sociotécnica para trabalho em grupo, aprofundando a discussão com premissas da ergonomia da atividade para trabalho coletivo. Realizou-se estudo de caso em uma Unidade Básica de Saúde e como método para coleta de dados e informações, foi utilizada a análise ergonômica do trabalho (AET), que incluiu a técnica de observação de atividades de trabalho na unidade, entrevistas com os profissionais envolvidos e reuniões de validação dos resultados da pesquisa. À luz dos resultados da coleta de dados em campo e revisão bibliográfica, procurou-se fazer uma reflexão sobre as hipóteses de pesquisa. Como resultado concluiu-se que o trabalho coletivo permite lidar com situações de imprevisibilidade e variabilidade, em ambientes dinâmicos como o de prestação de serviços. O trabalho coletivo permite que os trabalhadores desenvolvam estratégias para enfrentar dificuldades e constrangimentos do trabalho. Através da mobilização coletiva, os profissionais regulam suas ações e re-elaboram as demandas dos usuários, tornando os objetivos estabelecidos pela organização compatíveis com a situação real de trabalho. / This dissertation deals with the collective work on healthcare services of a public healthcare organization. The main objective is to discuss teamwork considering the healthcare services environment and to investigate how the workers of teams composed with mixed professional categories, mobilize themselves to accomplish their job. The theoretical discussion considers two main stream approaches to teamwork, the socio-technical theory to teamwork and ergonomics of the activity to collective work. Following, a case study was conducted in a public healthcare center using the ergonomic work analysis (EWA) as the main tool to data gathering. This method includes observation techniques of the work activity in the unit, interviews with the professionals and validation sessions of the researchs results. From the results of the field research and the literature review, it was analyzed the research questions previously stated. As a result, it was observed that collective work allows the workers to more properly face the situations of unpredictability and variability in a dynamic service environment. Collective work also allows the workers to develop strategies to face work difficulties and constraints. With collective mobilization, the professionals regulate their actions and re-elaborate the users demands, turning the goals established by the organization compatible with real situation of work.