Hospitais públicos de ensino: padrões de evolução do desempenho gerencial [original title]

What is the best way to manage Brazilian public university hospitals when seeking maximum performance? Management contracts, social organizations, public enterprises, Public-private partnerships… The reality of the hospital sector confronts us with a variety of concepts and structures that make it difficult for us to understand how the Brazilian public administration manages these organizations.

Starting from a classification of university hospitals in six types that make this complex reality intelligible, this book begins to answer this question by recounting how the Brazilian health system was reorganized around the principle of efficiency.

Efficiency as a principle does not necessarily mean high performance in the concrete world. To investigate this phenomenon, only abstract discussions are not enough. The author turns therefore our sight toward the empiric field. He carried out a study that compared the evolution of the performance in assistance, teaching and research activities of hospitals participating in the Evaluation System of University Hospitals of São Paulo, for five years, by using 26 production, productivity and quality indicators.

The empirical reality was revealing. Even immersed in a context of incentives to efficiency, teaching hospitals reacted differently, not always with an improvement in their performance. Numerous are the managerial variables that can determine these differences in the pattern of performance evolution; but there are three of them that should get our attention first. They will be the variables that will be discussed in depth in this work, a mandatory reading for health professionals who are interested in hospital administration and for managers who are concerned with the Brazilian health sector.

Brazil and India share structural similarities. Both countries have vast territories, multiethnic populations, and are politically organized along the lines of mass democracies-albeit in the process of solving serious social inequalities. In addition to the abundance of natural resources, the two emerging giants have a high degree of industrialization owed to import substitution policies carried out during the second half of the last century. This inward-looking orientation has created complex yet incomplete industrial bases, marked by the coexistence of production sectors with a high-level of technological development, with others whose incorporation of technology is still incipient. This article draws attention to a sector in which India and Brazil, if considered individually, have the potential to reach high levels of technological development and productivity; and, if considered in partnership, meet all the necessary conditions for auspicious bilateral cooperation: the biotechnology sector. The biotechnology sector could serve as a substrate for the implementation of broader adjustments in the methods of conducting the general STI cooperation between India and Brazil. The proposed adjustments follow guidelines that bind them to an organic whole, here called Brotherhood Science Diplomacy. The cornerstone of the concept of Brotherhood Science Diplomacy is that cooperation in biotechnology, in particular, and in Science, Technology and Innovation, in general, could go beyond the formal legal linkage between governments, to achieve direct and continuous contact between managers, professionals, and researchers in the production microenvironment of high technology.