Skip to main content

Advertisement

SpringerLink
Log in

Patient visits in poorly developed territories: a case study with community health workers

  • Original Article
  • Published:
Cognition, Technology & Work Aims and scope Submit manuscript

Abstract

In this paper, we study the effects of poor conditions of territories in patient visits performed by community health workers and the consequences to primary care policies. We carried a case study with community health workers in Rio de Janeiro, Brazil, including ethnographic observations in two primary healthcare clinics. Moreover, we present an analysis of the collected data with the support of the function resonance analysis method and we point out relations between the findings and the execution of the primary healthcare policy in a systemic approach. Thus, our study highlights the impacts of work situations in the health assistance of poorly developed communities, indicating how community health workers cope with adverse conditions, and how such situations affect the effectiveness of primary care policies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17

Similar content being viewed by others

References

  • Aguilera MV, Fonseca BB, Ferris TK, Vidal MC, de Carvalho PV (2016) Modelling performance variabilities in oil spill response to improve system resilience. J Loss Prev Process Ind 41:18–30

    Article  Google Scholar 

  • Albery S, Borys D, Tepe S (2016) Advantages for risk assessment: evaluating learnings from question sets inspired by the FRAM and the risk matrix in a manufacturing environment. Saf Sci 89:180–189

    Article  Google Scholar 

  • Anderson JE, Ross AJ, Jaye P (2017) Modelling resilience and researching the gap between work-as-imagined and work-as-done. In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient health care: reconciling work-as-imagined and work-as-done. CRC Press, Boca Ratón, pp 133–142

    Google Scholar 

  • Blandford A, Furniss D, Vincent C (2014) Patient safety and interactive medical devices: realigning work as imagined and work as done. Clin Risk 20:107–110. https://doi.org/10.1177/1356262214556550

    Article  Google Scholar 

  • Braithwaite J, Wears RL, Hollnagel E (2017) Conclusion: pathways towards reconciling WAI and WAD. In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient health care: reconciling work-as-imagined and work-as-done. CRC Press, Boca Ratón, pp 171–178

    Google Scholar 

  • Chuang S, Hollnagel E (2017) Challenges in implementing resilient health care. In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient health care, volume 3: reconciling work-as-imagined and work-as-done. CRC Press, Boca Raton, pp 47–178

    Google Scholar 

  • Clay-Williams R, Hounsgaard J, Hollnagel E (2015) Where the rubber meets the road: using FRAM to align work-as-imagined with work-as-done when implementing clinical guidelines. Implement Sci 10:125

    Article  Google Scholar 

  • Crick F (1995) Astonishing hypothesis: the scientific search for the soul. Simon and Schuster, New York

    Google Scholar 

  • de Carvalho PV (2006) Ergonomic field studies in a nuclear power plant control room. Prog Nucl Energy 48:51–69

    Article  Google Scholar 

  • de Carvalho P (2011) The use of functional resonance analysis method (FRAM) in a mid-air collision to understand some characteristics of the air traffic management system resilience. Reliab Eng Syst Saf 96:1482–1498. https://doi.org/10.1016/j.ress.2011.05.009

    Article  Google Scholar 

  • de Carvalho PV, Righi AW, Huber GJ, Lemos CD, Jatoba A, Gomes JO (2018) Reflections on work as done (WAD) and work as imagined (WAI) in an emergency response organization: a study on firefighters training exercises. Appl Ergon 68:28–41

    Article  Google Scholar 

  • Fausto MC, Giovanella L, de Mendonça MH, de Almeida PF, Escorel S, de Andrade CL, Martins MI (2011) The work of community health workers in major cities in Brazil: mediation, community action, and health care. J Ambul Care Manag 34:339–353. https://doi.org/10.1097/JAC.0b013e31822cbe60

    Article  Google Scholar 

  • Hollnagel E (2004) Barriers and accident prevention. Ashgate, Farnham

    Google Scholar 

  • Hollnagel E (2012a) FRAM, the functional resonance analysis method: modeling complex socio-technical system. Ashgate, Farnham

    Google Scholar 

  • Hollnagel E (2012b) The ETTO principle: efficiency-thoroughness trade-off: why things that go right sometimes go wrong. Ashgate Publishing Ltd, Farnham

    Google Scholar 

  • Hollnagel E (2014) Safety-I and safety–II: the past and future of safety management. Ashgate Publishing, Farnham

    Google Scholar 

  • Hollnagel E (2015) Looking for patterns in everyday clinical work. In: Wears RL, Hollnagel E, Braithwaite J (eds) Resilient health care, volume 2: the resilience of everyday clinical work. Ashgate, Farnham, pp 145–162

    Google Scholar 

  • Hollnagel E (2017) Prologue: Why do our expectations of how work should be done never correspond exactly to how work is done? In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient health care, volume 3: reconciling work-as-imagined and work-as-done. CRC Press, Boca Ratón

    Google Scholar 

  • Hollnagel E, Woods D (2005) Joint cognitive systems: foundations of cognitive systems engineering. CRC Press, Boca Ratón

    Book  Google Scholar 

  • Jatobá A, Bellas HC, Bonfatti R, Burns C, Vidal MC, de Carvalho PV (2016) Designing for patient risk assessment in primary health care: a case study for ergonomic work analysis. Cogn Technol Work 18(1):215–231. https://doi.org/10.1007/s10111-015-0355-x

    Article  Google Scholar 

  • Maciazeki-Gomes RD, Souza CD, Baggio L, Wachs F (2016) The work of the community health worker from the perspective of popular health education: possibilities and challenges. Ciência Saúde Coletiva 21:1637–1646. https://doi.org/10.1590/1413-81232015215.17112015

    Article  Google Scholar 

  • Macinko J, de Souza MD, Guanais FC, da Silva Simoes CC (2007) Going to scale with community-based primary care: an analysis of the family health program and infant mortality in Brazil, 1999–2004. Soc Sci Med 65:2070–2080. https://doi.org/10.1016/j.socscimed.2007.06.028

    Article  Google Scholar 

  • Matheson C, Robertson HD, Elliott AM, Iversen L, Murchie P (2016) Resilience of primary healthcare professionals working in challenging environments: a focus group study. Br J Gen Pract 66:e507–e515. https://doi.org/10.3399/bjgp16X685285

    Article  Google Scholar 

  • Myers M (1999) Investigating information systems with ethnographic research. Commun Assoc Inf Syst 2:1

    Google Scholar 

  • Nardi B (1997) The use of ethnographic methods in design and evaluation. In: Helander M, Landauer T, Prabhu P (eds) Handbook of human-computer interaction. Elsevier, Amsterdam, pp 361–366

    Chapter  Google Scholar 

  • Nyssen AS, Bérastégui P (2017) Is system resilience maintained at the expense of individual resilience? In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient health care volume 3: reconciling work-as-imagined and work-as-done. CRC Press, Boca Ratón, pp 37–46

    Google Scholar 

  • Paim J, Travassos C, Almeida C, Bahia L, Macinko J (2011) The Brazilian health system: history, advances, and challenges. Lancet 377:1778–1797

    Article  Google Scholar 

  • Patriarca R (2017) Modelling complexity in everyday operations: functional resonance in maritime mooring at quay. Cogn Technol Work. https://doi.org/10.1007/s10111-017-0426-2

    Google Scholar 

  • Pavard B, Dugdale J (2006) The contribution of complexity theory to the study of sociotechnical cooperative systems. In: Proceedings of the third international conference on unifying themes in complex systems. Heidelberg, Baden-Württemberg, Germany, pp 39–48

  • Raben DC, Bogh SB, Viskum B, Mikkelsen KL, Hollnagel E (2017) Proposing leading indicators for blood sampling: application of a method based on the principles of resilient healthcare. Cognit Technol Work. https://doi.org/10.1007/s10111-017-0437-z

    Google Scholar 

  • Rasmussen J (1974) The human data processor as a system component: bits and pieces of a model. Danish Atomic Energy Commission, Report No. Riso-M-1722, Roskilde, Denmark

  • Rasmussen J (1980) The human as a systems component. In: Smith H, Green T (eds) Human interaction with computers. Academic Press, London

    Google Scholar 

  • Rosa LV, Haddad AN, de Carvalho PV (2015) Assessing risk in sustainable construction using the functional resonance analysis method (FRAM). Cogn Technol Work 17(4):559–573. https://doi.org/10.1007/s10111-015-0337-z

    Article  Google Scholar 

  • Saurin TA, Rosso CB, Colligan L (2017a) Towards a resilient and lean health care. In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient health care, vol 3. reconciling work-as-imagined and work-as-done. CRC Press, Boca Ratón, pp 3–16

    Google Scholar 

  • Saurin TA, Rosso CB, Colligan L (2017b) Towards a resilient and lean health care. In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient health care volume 3: reconciling work-as-imagined and work-as-done. CRC Press, Boca Ratón, pp 3–16

    Google Scholar 

  • The Ministry of Health of Brazil (2012) Brazilian Primary Healthcare Policy (Política Nacional de Atenção Básica). Brasília, DF, Brazil. disponível em http://dab.saude.gov.br/dab/docs/publicacoes/geral/pnab.pdf. Acesso em May de 2017

  • Underwood P, Waterson P (2013) Systemic accident analysis: examining the gap between research and practice. Accid Anal Prev 55:154–164. https://doi.org/10.1016/j.aap.2013.02.041

    Article  Google Scholar 

  • Vanderhaegen F (2015) Erik Hollnagel: safety-I and safety-II, the past and future of safety management. Cogn Technol Work 17:461–464

    Article  Google Scholar 

  • Woods D, Hollnagel E, Leveson N (2007) Resilience engineering: concepts and precepts. Ashgate, Farnham

    Google Scholar 

  • World Health Organization, & Unicef (1978) Primary health care: a joint report. Alma-Ata; USSR. disponível em http://www.opas.org.br/coletiva/uploadArq/Alma-Ata.pdf. Acesso em June de 2016

  • Zheng Z, Tian J, Zhao T (2016) Refining operation guidelines with model-checking-aided FRAM to improve manufacturing processes: a case study for aeroengine blade forging. Cogn Technol Work 18:777–791

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the family health care professionals who participated in this study. This work was produced with support from the Brazilian National Council for Scientific and Technological Development (CNPq).

Author information

Authors and Affiliations

  1. Fundação Oswaldo Cruz – FIOCRUZ, Rio de Janeiro, RJ, Brazil

    Alessandro Jatobá, Hugo Cesar Bellas & Isabella Koster

  2. Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa em Engenharia – COPPE, Universidade Federal do Rio de Janeiro – UFRJ, Rio de Janeiro, RJ, Brazil

    Rodrigo Arcuri & Mario Cesar R. Vidal

  3. Instituto de Engenharia Nuclear – IEN, Comissão Nacional de Energia Nuclear, CNEN, Rio de Janeiro, RJ, Brazil

    Paulo Victor R. de Carvalho

Authors
  1. Alessandro Jatobá
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hugo Cesar Bellas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabella Koster
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rodrigo Arcuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Cesar R. Vidal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paulo Victor R. de Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Jatobá.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jatobá, A., Bellas, H.C., Koster, I. et al. Patient visits in poorly developed territories: a case study with community health workers. Cogn Tech Work 20, 125–152 (2018). https://doi.org/10.1007/s10111-017-0455-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10111-017-0455-x

Keywords

Search

Navigation