Challenges in the Care to the Injured Worker at SUS: From the Anger Network to the Shared Construction of a Care Line

  • Amanda Aparecida Silva-MacaiaEmail author
  • Mara Alice Conti Takahashi
  • Sayuri Tanaka Maeda
  • Jairon Leite Chaves Bezerra
  • Rodolfo Andrade de Gouveia Vilela


In this chapter, we address the Change Laboratory (CL) conducted at the network of public health-care institutions in charge of working accident-injured workers in a town in the state of São Paulo. According to Engeström’s expansive learning, this activity comprises a network of systems called “boundary crossing,” as different services share aspects of the same work object. Ethnographical research revealed a fragmented health-care network, which did not have coordination between services or shared responsibilities for injured workers’ cases. Based on the results of applying this Boundary Crossing CL on the development of a new health-care model, we discuss the methodological innovations and the lessons about ease and difficulties learned by the researchers during this experience. It is worthy of note to highlight the tension between the current municipal management model and the formative methodology in the context of an intervention with health professionals from many different services, with different levels of development. We conclude that such obstacles affected the participants’ expectation of implementing the changes they collectively elaborated.


Workers’ health Formative intervention Primary health care 


  1. Almeida, I. M., Vilela, R. A. G., Silva, A. J. N., & Beltrán, S. L. (2014). Model of analysis and prevention of accidents - MAPA: Tool for operation health surveillance. Ciência & Saúde Coletiva, 19(12), 4679–4688. Scholar
  2. Bodrožić, Z., & Adler, P. S. (2017). The evolution of management models: A neo-Schumpeterian theory. Administrative Science Quarterly, 63(1), 85–129. Scholar
  3. Dianous, D. V., & Fiévez, C. (2006). ARAMIS project: A more explicit demonstration of risk control through the use of bow-tie diagrams and the evaluation of safety barrier performance. Journal of Hazardous Materials, 130(3), 220–233. Scholar
  4. Engeström, Y. (2008). From teams to knots: Activity-theoretical studies of collaboration and learning at work. Cambridge: Cambridge University Press.Google Scholar
  5. Engeström, Y., & Sannino, A. (2010). Studies of expansive learning: Foundations, findings and future challenges. Educational Research Review, 5(1), 1–24. Scholar
  6. Hale, A. R., Ale, B. J. M., Goossens, L. H. J., Heijer, T., Bellamy, L. J., Mud, M. L., et al. (2007). Modeling accidents for prioritizing prevention. Reliability Engineering and System Safety, 92(12), 1701–1715. Scholar
  7. IBGE- Instituto Brasileiro de Geografia e Estatística. Censo demográfico de 2010. Acessed 3 April 2019.
  8. Kerosuo, H. (2008). Putting the patient in the middle: Managing chronic illness across organizational boundaries. In R. Sorensen & R. Ledema (Eds.), Managing clinical processes in health services (pp. 73–86). Chatswood: Elsevier.Google Scholar
  9. Marinho, C. S. (2016). Consequências econômicas com acidente de trabalho: realidade do município de Piracicaba [dissertation]. São Paulo: Universidade de São Paulo; Portuguese.
  10. Mendes, E. V. (2011). As redes de atenção à saúde (2ª ed.). Brasília: OPS.Google Scholar
  11. Merhy, E. E., Chakkour, M., Stéfano, M. E., Santos, C. M., Rodrigues, R. A., & Oliveira, P. C. P. (1997). Em busca de ferramentas analisadoras das tecnologias em saúde: a informação e o dia a dia de um serviço, interrogando e gerindo trabalho em saúde. In E. E. Merhy & R. Onocko (Eds.), Agir em saúde: um desafio para o público. São Paulo: Hucitec.Google Scholar
  12. Paim, J. (2012). Modelos de atenção à saúde no Brasil. In L. Giovanella, S. Escorel, L. V. Costa, J. C. Noronha, & A. I. Carvalho (Eds.), Políticas e sistema de saúde no Brasil (2ª ed., pp. 459–491). Rio de Janeiro: FIOCRUZ.Google Scholar
  13. Pereira, I. B., & Lima, J. C. F. (2008). Dicionário da educação profissional em saúde. Rio de Janeiro: EPSJV.Google Scholar
  14. Pinheiro, R., Ferla, A., & Silva, A. G., Jr. (2007). Integrality in the population’s health care programs. Ciência & Saúde Coletiva, 12(2), 343–349. Scholar
  15. Seppänen, L., Takahashi, M. A. C., Cerveny, G. C. O., & Vilela, R. A. G. (2016). Laboratório Interfronteiras: uma ferramenta possível para a integralidade no atendimento aos acidentados de trabalho. In 18° Congresso Brasileiro de Ergonomia; 2016 May 23-27; Belo Horizonte, MG, Brasil. Belo Horizonte: ABERGO. Portuguese.Google Scholar
  16. Serpa, G. R., & Falcón, A. L. (2015). La formación de conceptos: una comparación entre los enfoques cognitivistas y histórico-cultural. Educação e Pesquisa, 41(3), 615–618. Scholar
  17. Takahashi, M. A. C., & Cerveny, G. C. O. (2016). Impacto social dos acidentes de trabalho no município de Piracicaba (SP): intervenção e busca compartilhada pela integralidade em saúde. In F. Asensi, R. Pinheiro, & P. A. Mutiz (Eds.), Bioética, trabalho e educação em saúde (pp. 67–77). Rio de Janeiro: Multifoco.Google Scholar
  18. Vilela, R. A. G., Jackson Filho, J. M., Querol, M. A. P., Gemma, S. F. B., Takahashi, M. A. C., Gomes, M. H. P., et al. (2018). A expansão do objeto da vigilância em acidente do trabalho: história e desafios de um centro de referência em busca da prevenção. Ciência & Saúde Coletiva, 23(9), 3055–3066. Scholar
  19. Virkkunen, J., & Newnham, D. S. (2013). The Change Laboratory: A tool for collaborative development of work and education. Rotterdam: Sense Publishers.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Amanda Aparecida Silva-Macaia
    • 1
    Email author
  • Mara Alice Conti Takahashi
    • 1
  • Sayuri Tanaka Maeda
    • 2
  • Jairon Leite Chaves Bezerra
    • 1
  • Rodolfo Andrade de Gouveia Vilela
    • 1
  1. 1.Department of Environmental HealthSchool of Public Health, University of São PauloSão PauloBrazil
  2. 2.Department of Public Health, School of NursingUniversity of São PauloSão PauloBrazil

Personalised recommendations