title: Strategic Démarche in a mother and child hospital unit.
abstract: OBJECTIVE
  The strategic démarche approach questions the dissociation between the strategic direction and the operational level of an institution, in search of a continuous and flexible planning of projects. The objective of the study is to describe the application of this approach in the evaluation of a hospital unit.
  
  
  METHODS
  The approach was adapted to and applied at a mother and child unit of a public state hospital in the municipality of Serra, Northeastern Brazil. Hospital management analysis was conducted with the indirect involvement of institutional agents, who acted as key informants from April to July, 2006. Besides the meetings with key informants, data was also collected from the following sources for the year 2005: Inpatient records from the obstetric center, maternity and nursery wards, statistical report of the perinatal outcomes from the mother and child unit; records from the ambulatory care unit for breastfeeding.
  
  
  RESULTS
  The most valued segments were: The Neonatal Intensive Care Unit, The Obstetric Surgery Center, and The Obstetric Center. The Program of Humanized Care for the Mother and Newborn was also highly valued. The main weaknesses pointed out were the low level of articulation with the network (partnership with municipal network); the lack of hospital beds and technological investment necessary for responding adequately to the demand; excessive professional rotation due to temporary assignments and the deficient implementation of the humanization policies, compromising the strategic success factors of the segments.
  
  
  CONCLUSIONS
  The results indicate the method's potential for discussing the hospital mission and performing analysis of hospital management, pointing out strategies for improving the quality and competitiveness of the segments and for greater integration and insertion in the service network.
authors.affiliation: Programa de Pós-Graduação em Saúde Pública, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors.forename: Maria Angélica Carvalho
authors.initials: MA
authors.lastname: Andrade
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Artmann
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D006757:Hospital Units / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008430:Maternal-Child Health Centers / Q000458:organization & administration / Q000592:standards*; D010934:Planning Techniques; D011785:Quality Assurance, Health Care / Q000379:methods*