{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T23:24:39Z","timestamp":1776727479122,"version":"3.51.2"},"reference-count":42,"publisher":"FapUNIFESP (SciELO)","issue":"10","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cad. Sa\u00fade P\u00fablica"],"abstract":"<jats:p>O objetivo foi analisar arranjos tecnol\u00f3gicos na gest\u00e3o do cuidado e de leitos em um hospital p\u00fablico de refer\u00eancia em Portugal. Arranjos tecnol\u00f3gicos combinam tecnologias e pr\u00e1ticas de gest\u00e3o para maior efetividade em contextos organizacionais complexos. S\u00e3o utilizados para enfrentar desafios como demanda excessiva, aumento de custos e queixas sobre qualidade do cuidado. Sua aplica\u00e7\u00e3o em distintos contextos t\u00eam produzido diferentes resultados e faltam estudos sobre seus impactos nas rela\u00e7\u00f5es interprofissionais e na conex\u00e3o entre hospitais e redes de servi\u00e7os. Realizou-se estudo de caso qualitativo e etnogr\u00e1fico, envolvendo 15 entrevistas com 22 gerentes e trabalhadores e observa\u00e7\u00e3o participante de tr\u00eas arranjos tecnol\u00f3gicos: o Servi\u00e7o de Apoio \u00e0 Gest\u00e3o do Internamento, o Meeting das 11 Horas do Servi\u00e7o de Medicina e o Grupo de Resolu\u00e7\u00e3o High Users. Foram descritos arranjos tecnol\u00f3gicos para gest\u00e3o de entrada (input), cuidado (throughput) e altas hospitalares (output). A observa\u00e7\u00e3o em profundidade destacou a din\u00e2mica, o potencial e os desafios dos arranjos tecnol\u00f3gicos para integrar uma gest\u00e3o de leitos e altas. Quando bem implementados, os arranjos tecnol\u00f3gicos ajudam a enfrentar a superlota\u00e7\u00e3o hospitalar, mas n\u00e3o resolvem problemas sist\u00eamicos de alta e continuidade de cuidado em rede. Evidenciou-se a forte ades\u00e3o dos trabalhadores aos arranjos tecnol\u00f3gicos, com destaque ao protagonismo da enfermagem e o sil\u00eancio dos m\u00e9dicos, sugerindo novos desafios de autonomia e poder. Os arranjos tecnol\u00f3gicos demonstram efetividade na gest\u00e3o de leitos e cuidado, alteram pr\u00e1ticas multiprofissionais, e rela\u00e7\u00f5es interprofissionais, al\u00e9m de afetar a rede de servi\u00e7os externos. A produ\u00e7\u00e3o do hospital contempor\u00e2neo requer arranjos tecnol\u00f3gicos baseados em evid\u00eancias, que aumentem sua efici\u00eancia, sustentabilidade e capacidades t\u00e9cnica e organizacional.<\/jats:p>","DOI":"10.1590\/0102-311xpt001025","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T15:04:22Z","timestamp":1762527862000},"source":"Crossref","is-referenced-by-count":1,"title":["Arranjos tecnol\u00f3gicos de gest\u00e3o do cuidado em sa\u00fade: desafios para o hospital contempor\u00e2neo"],"prefix":"10.1590","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7184-2342","authenticated-orcid":false,"given":"Arthur","family":"Chioro","sequence":"first","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6015-3314","authenticated-orcid":false,"given":"Tiago","family":"Correia","sequence":"additional","affiliation":[{"name":"Universidade Nova de Lisboa,  Portugal"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"key":"ref1","series-title":"Strategic technology management: integrating product technology into global business strategies for the 1990s","author":"Dussauge P","year":"1992"},{"key":"ref2","first-page":"1349","article-title":"Interven\u00e7\u00f5es para solucionar a superlota\u00e7\u00e3o nos servi\u00e7os de emerg\u00eancia hospitalar: uma revis\u00e3o sistem\u00e1tica.","volume":"25","author":"Bittencourt RJ","year":"2009","journal-title":"Cad Sa\u00fade Publica"},{"key":"ref3","series-title":"The definitive guide to emergency department operational improvement","author":"Crane J","year":"2011"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/jep.12074","article-title":"Hospital-integrated general practice a promising way to manage walk-in patients in emergency departments","volume":"20","author":"Wang M","year":"2014","journal-title":"J Eval Clin Pract"},{"key":"ref5","series-title":"Efetividade das interven\u00e7\u00f5es para redu\u00e7\u00e3o da superlota\u00e7\u00e3o nos servi\u00e7os de emerg\u00eancia hospitalar","author":"Beltrammi DGM","year":"2015"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1197\/j.aem.2003.07.017","article-title":"Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS).","volume":"11","author":"Weiss SJ","year":"2004","journal-title":"Acad Emerg Med"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.annemergmed.2004.07.449","article-title":"The quality gap searching for the consequences of emergency department crowding","volume":"44","author":"Magid DJ","year":"2004","journal-title":"Ann Emerg Med"},{"key":"ref8","first-page":"283","article-title":"Nurses in the Kanban: are there news meanings of professional practice in innovative tools for hospital care management?","volume":"25","author":"Cecilio LCO","year":"2020","journal-title":"Ci\u00eanc Sa\u00fade Colet"},{"key":"ref9","series-title":"The definition of quality and approaches to its assessment","first-page":"77","volume-title":"Basic approaches to assessment: structure, process and outcome","author":"Donabedian A","year":"2003"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jen.2005.04.007","article-title":"Placing emergency department crowding on the decision agenda","volume":"31","author":"Bradley VM","year":"2005","journal-title":"J Emerg Nurs"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/j.1553-2712.2011.01033.x","article-title":"A conceptual model for assessing quality of care for patients boarding in the emergency department structure-process-outcome","volume":"18","author":"Liu SW","year":"2011","journal-title":"Acad Emerg Med"},{"key":"ref12","series-title":"Saberes e poderes no hospital. Uma sociologia dos servi\u00e7os hospitalares.","author":"Carapinheiro G","year":"1993"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1016\/j.healthpol.2015.02.002","article-title":"Lean in healthcare: a comprehensive review.","volume":"119","author":"D'Andreamatteo A","year":"2015","journal-title":"Health Policy"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1590\/S1413-81232007000400007","article-title":"A cl\u00ednica ampliada e compartilhada, a gest\u00e3o democr\u00e1tica e redes de aten\u00e7\u00e3o como referenciais te\u00f3rico-operacionais para a reforma do hospital.","volume":"12","author":"Campos GWS","year":"2007","journal-title":"Ci\u00eanc Sa\u00fade Colet"},{"key":"ref15","series-title":"Understanding hospitals in changing health systems","first-page":"25","volume-title":"Hospital governance","author":"Dur\u00e1n A","year":"2020"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.healthpol.2020.04.008","article-title":"Lean thinking in healthcare findings from a systematic literature network and bibliometric analysis","volume":"124","author":"Akmal A","year":"2020","journal-title":"Health Policy"},{"key":"ref17","series-title":"Pr\u00e1ticas e m\u00e9todos de investiga\u00e7\u00e3o em ci\u00eancias sociais","author":"Albarello L","year":"2000"},{"key":"ref18","series-title":"Medicina. O agir numa sa\u00fade em mudan\u00e7a","author":"Correia T","year":"2012"},{"key":"ref19","series-title":"Pistas do m\u00e9todo cartogr\u00e1fico: a experi\u00eancia da pesquisa e o plano do comum","first-page":"150","volume-title":"Por uma pol\u00edtica de narratividade","author":"Passos E","year":"2014"},{"key":"ref20","series-title":"Ren\u00e9 Lourau: analista institucional em tempo integral","author":"Alto\u00e9 S","year":"2004"},{"key":"ref21","series-title":"Proceedings of the 12th International Joint Conference on Biomedical Systems and Technologies","first-page":"123","volume-title":"Clinical caremap development: how can caremaps standardise care when they are not standardised?","author":"McLachlan S","year":"2019"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1590\/1413-812320232810.11092023en","article-title":"Planned discharge and the inter-professional relationship from the perspective of the nursing actions during the COVID-19 pandemic.","volume":"28","author":"Andreazza R","year":"2023","journal-title":"Cienc. Sa\u00fade Colet"},{"key":"ref23","article-title":"Pull processes in health care a systematic literature review","volume":"29","author":"Vega RC","year":"2022","journal-title":"Gest\u00e3o & Produ\u00e7\u00e3o"},{"key":"ref24","series-title":"Gest\u00e3o hospitalar no SUS","first-page":"27","volume-title":"Aten\u00e7\u00e3o hospitalar no SUS","author":"Chioro A","year":"2021"},{"key":"ref25","article-title":"Beds management in the urgency and emergency using kanban","volume":"9","author":"Oliveira IS","year":"2020","journal-title":"Res Soc Dev"},{"key":"ref26","series-title":"Pr\u00e1ticas e saberes no hospital contempor\u00e2neo: o novo normal","author":"Beltrammi DGM","year":"2017"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1590\/0103-1104201912105","article-title":"Implanta\u00e7\u00e3o do Sistema de Classifica\u00e7\u00e3o de Risco Manchester em uma rede municipal de urg\u00eancia","volume":"43","author":"Sacoman TM","year":"2019","journal-title":"Sa\u00fade Debate"},{"key":"ref28","series-title":"The new public governance?","author":"Osborne SP","year":"2010"},{"key":"ref29","series-title":"17th ESHMS Biennial Conference: Old Tensions, Emerging Paradoxes in Health Rigths, Knowledge, and Trust. Book of Abstracts.","first-page":"277","volume-title":"Micropolitics of an urgent care\/emergency hospital: machinic functioning and subjectivization.","author":"Cec\u00edlio LCO","year":"2018"},{"key":"ref30","series-title":"Understanding hospitals in changing health systems","first-page":"49","volume-title":"Models of care and hospitals","author":"Dur\u00e1n A","year":"2020"},{"key":"ref31","series-title":"Seguran\u00e7a do paciente: conhecendo os riscos nas organiza\u00e7\u00f5es de sa\u00fade.","first-page":"315","volume-title":"Superlota\u00e7\u00e3o de servi\u00e7os de urg\u00eancia","author":"Grabois V","year":"2019","edition":"2\u00aa"},{"key":"ref32","series-title":"17th ESHMS Biennial Conference: Old Tensions, Emerging Paradoxes in Health Rigths, Knowledge, and Trust. Book of Abstracts.","first-page":"112","volume-title":"Doctors and the process of rationalizing hospital life: what is their place.","author":"Cec\u00edlio LCO","year":"2018"},{"key":"ref33","article-title":"Portaria n\u00ba 3.390, de 30 de dezembro de 2013. Institui a Pol\u00edtica Nacional de Aten\u00e7\u00e3o Hospitalar (PNHOSP) no \u00e2mbito do Sistema \u00danico de Sa\u00fade (SUS), estabelecendo- se as diretrizes para a organiza\u00e7\u00e3o do componente hospitalar da Rede de Aten\u00e7\u00e3o \u00e0 Sa\u00fade (RAS).","year":"2013","journal-title":"Di\u00e1rio Oficial da Uni\u00e3o"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1001\/jama.2018.2074","article-title":"The risks to patient safety from health system expansions","volume":"319","author":"Haas SAG","year":"2018","journal-title":"JAMA"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1590\/0102-311X00055913","article-title":"O agir leigo e o cuidado em sa\u00fade a produ\u00e7\u00e3o de mapas de cuidado","volume":"30","author":"Cecilio LCO","year":"2014","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"335","DOI":"10.4000\/etnografica.2819","article-title":"Inventar percursos, reinventar realidades doentes, trajet\u00f3rias sociais e realidades formais","volume":"5","author":"Carapinheiro G","year":"2001","journal-title":"Etnogr\u00e1fica"},{"key":"ref37","article-title":"Apontamentos sobre os desafios (ainda) atuais da aten\u00e7\u00e3o b\u00e1sica \u00e0 sa\u00fade.","volume":"34","author":"Cecilio LCO","year":"2018","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"13","DOI":"10.7861\/clinmedicine.10-1-13","article-title":"Managing capacity and demand across the patient journey","volume":"10","author":"Allder S","year":"2010","journal-title":"Clin Med (London)"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1177\/0163278716665882","article-title":"Organizational capabilities for integrating care a review of measurement tools","volume":"39","author":"Evans JM","year":"2016","journal-title":"Eval Health Prof"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"5609","DOI":"10.3390\/ijerph17155609","article-title":"Assessing the impact of lean healthcare on inpatient care a systematic review","volume":"17","author":"Zepeda-Lugo C","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1108\/IJPPM-04-2020-0176","article-title":"Understanding alignment between lean and agile strategies using Triple-A model","volume":"71","author":"Ahmed W","year":"2022","journal-title":"International Journal of Productivity and Performance Management"},{"key":"ref42","series-title":"Constru\u00e7\u00e3o da integralidade: cotidiano, saberes e pr\u00e1ticas em sa\u00fade","first-page":"197","volume-title":"A integralidade do cuidado como eixo da gest\u00e3o hospitalar","author":"Cecilio LCO","year":"2003"}],"container-title":["Cadernos de Sa\u00fade P\u00fablica"],"original-title":["Technological healthcare management arrangements: challenges for contemporary hospitals"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0102-311X2025001001402&tlng=pt","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T15:04:28Z","timestamp":1762527868000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-311X2025001001402&tlng=pt"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025]]}},"alternative-id":["S0102-311X2025001001402"],"URL":"https:\/\/doi.org\/10.1590\/0102-311xpt001025","relation":{},"ISSN":["1678-4464","0102-311X"],"issn-type":[{"value":"1678-4464","type":"electronic"},{"value":"0102-311X","type":"print"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e00001025"}}