Expansion of the object of surveillance for occupational accidents: history and challenges underwent by a reference center aiming at prevention

Vilela, Rodolfo Andrade de Gouveia; Jackson Filho, José Marçal; Querol, Marco Antônio Pereira; Gemma, Sandra Francisca Bezerra; Takahashi, Mara Alice Conti; Gomes, Marcos Hister Pereira; Duracenko, Sandra Renata Canale; Almeida, Ildeberto Muniz de

doi:10.1590/1413-81232018239.21952016

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FREE THEMES • Ciênc. saúde colet. 23 (9) • Sept 2018 • https://doi.org/10.1590/1413-81232018239.21952016 copy

Expansion of the object of surveillance for occupational accidents: history and challenges underwent by a reference center aiming at prevention

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The Surveillance System for Occupational Accidents (Sistema de Vigilância em Acidentes de Trabalho - SIVAT) established by Reference Center for Workers’ Health (Centro de Referência em Saúde do Trabalhador - CEREST-Piracicaba) in 2003 represents an experience consolidated according to the guidelines formulated by the National Network for Integral Care of the Workers’ Health (Rede Nacional de Atenção Integral à Saúde do Trabalhador - RENAST). The present article analyzes the history and development of SIVAT at CEREST - Piracicaba from the perspective of cultural-historical activity theory. The historical data comprise interviews, documents and observations performed by the researchers. Analysis showed that the studied activity underwent two cycles of expansion. During the first cycle, CEREST actions sought to adequate the targeted companies to the legislation in vigor. During the second cycle, actions aimed at introducing changes relative to organizational determinants in the targeted companies that CEREST staff identified as causes of accidents. A new modality of formative intervention, called Change Laboratory (CL), seems to be useful to attain the goal of prevention; it involves analysis of the causes of accidents, activity remodeling and implantation of solutions by developing agency in the targeted organizations.

Workers’ health surveillance; Occupational health services; Working conditions; Expansive learning theory

1^st cycle/period	Strategy	Outcomes/impact
Subcycle 1.1 1997-2008	1. Surveillance of the companies with the highest rates of accidents followed by systematic intervention for severe and fatal cases. Object: adequacy of companies to OSH regulation. Instrument: epidemiological information (CATs or SIVAT) to orient intervention priorities. Subject: WHP agents in partnership with LEM auditor. Community: unions’ representatives. Companies and workers had limited participation. Rule: company-by-company action (fragmented).	Ações orientadas por prioridades. Primeiro período detecta que 20 empresas respondem por 45% dos acidentes no município⁹. Segundo período amplia notificação para mercado formal e informal. Intervenção em aspectos previstos em normas. Impacto limitado. A idéia do SIVAT é implantada em outros municípios da região e do Estado. Acidentalidade permanece alta. Aspectos organizacionais ficam invisíveis, intocados. Postura reativa da empresa.
Subcycle 1.2 2003- 2016	2. Cast Net Operation: sectoral action on sentinel cases and specific risks. Object: adequacy of the full set of companies to legal norms. Instrument: sectoral collective notification; Subjects: Cooperation Agreement with LPO, which brought more autonomy to the subjects’ action without political interference. Community: enlarged via inter-institutional forums.	Broader reach of collective actions. Created room for dialogue. Increased adherence and articulation with public professionals and private companies. Cooperation with LPO brought greater autonomy and respect to the service.

2^nd cycle period	Strategy	Outcome / impact
Subcycle 2.1 2006- 2009	2.1 SIVAT improvement. Strategy: 2nd FAPESP research project involving universities, LPO, LEM and workers’ unions Object: work process at selected (high priority) companies and the sugarcane industry. Instruments: Model for Analysis and Prevention of Accidents (MAPA); diagnosis is included in negotiations with companies, unions and LEM; WA Forum, developed as a continued education strategy, including in-person and virtual activities (courses, virtual debates, videos and Facebook).	- The internal actors in companies did not participate in the diagnosis. During negotiations, they agreed to changes in narrowly focused technical aspects, but resisted organizational changes, the challenges posed by which remained. - WA Forum consolidated, with satisfactory access to its webpage and satisfactory attendance to in-person meetings. 2.1.3 Training in and onset of MAPA application at RENAST-SP. Incipient social network targeting prevention. - The activity system with an enlarged object coexists with the older system, subjected to tension resulting from the demands and quantitative goals. Paradoxes and tension emerged between the new and the older systems.
Subcycle 2.2 2013 - 2016	2.2 Attempts to overcome the organizational diagnosis and attain prevention through involvement of the internal actors in organizations. New (thematic) research project sought to overcome the diagnosis and develop tools for formative intervention. Instrument: Change Laboratory (CL). In the pilot stage, the staff decided to apply a CL intervention to reshape CEREST’s activity system.	- The initial interventions are still in course. The staff applies CL to the surveillance system, thus it succeeds in reshaping and developing expansive solutions: new division of labor, new rules and community enlargement³⁷.

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[1] Collaborations

All authors participated in the article project, development and review from design and the design proposed by RAG Vilela, which was reworked and improved in production workshop of the article. MHP Gomes and SRC Duracenko participated in the collection and organization of of documentary data. All authors contributed writing, analysis and review.