Abstract
Hospital managers should target occupational risks and harm prevention since this can contribute to the quality of life at work and patient safety. This article aims to elucidate the activity of prevention of occupational risks and injuries in the hospital setting based on analysis of historical and empirical contradictions of the activity system. An exploratory qualitative study grounded in the Cultural-Historical Activity Theory was conducted at a university hospital in the state of São Paulo. Data were collected between September 2021 and January 2022 via individual semi-structured interviews of 9 professionals from the Occupational Health and Safety services and of five hospital managers, involving 20 hours of field observation and document analysis. Despite the expansion of the object of prevention activity, the other elements of the activity system did not adapt to the new demands, causing incompatibilities and contradictions that compromised the attainment of the expected outcomes. The main response actions observed were centered on complying with regulatory items, such as team composition, medical examinations and others, that contribute little toward promoting occupational health and safety.
Key words:
Occupational health; Occupational health services; Health management; COVID-19; Hospitals
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Contradictions in activity system: 1 = primary contradiction: reduction of object of prevention; 2 = secondary contradiction instruments x object: lack of infrastructure x need to provide worker care; 3 = secondary contradiction subject x object: undersized team x workers’ demands and needs; 4 = secondary contradiction subject x division of labor: professionals with OHS service roles x those in other sectors; 5 = secondary contradiction subjects x rules: emphasis on rule compliance x rules not covering growing complex needs of workers. Abbreviations: CIPA = Internal Board for Accident Prevention; PPE = personal protective equipment; NR = regulatory standard; PCMSO = Occupational Health Medical Control Program; PPRA = Environmental Risk Prevention Program; SCIH = Hospital Infection Control Service; AS = activity system.Source: Adapted from Engeström (1987).
Contradictions in activity system: 1 = primary contradiction: reduction of object of prevention; 2 = secondary contradiction subject x object: undersized team x workers´ demands and needs; 3 = secondary contradiction instruments x object: limited physical space x need to provide worker care; 4 = secondary contradiction subject x object x instruments: increased mental health demand (object) x unpreparedness of team to meet these demands x lack of support instruments; 5 = secondary contradiction subject x instruments x object x community; communication breakdowns (instruments) x OHS team (subjects) x for workers’ care (object) x and in relation to other sectors of hospital (community); 6 = secondary contradiction rules x object x community: insufficient set of standards (rules) x new health demands of workers (object) x poor coordination with other sectors involved in management of crisis (community). Abbreviations: CIPA = Internal Board for Accident Prevention; PPE = personal protective equipment; NR = regulatory standard; PCMSO = Occupational Health Medical Control Program; PPRA = Environmental Risk Prevention Program; SCIH = Hospital Infection Control Service; AS = activity system.Source: Adapted from Engeström (1987).