title: Framing the difficulties resulting from implementing a Participatory Management Model in a public hospital.
abstract: OBJECTIVE
  This study aims to address difficulties reported by the nursing team during the process of changing the management model in a public hospital in Brazil.
  
  
  METHODS
  This qualitative study used thematic content analysis as proposed by Bardin, and data were analyzed using the theoretical framework of Bolman and Deal.
  
  
  RESULTS
  The vertical implementation of Participatory Management contradicted its underlying philosophy and thereby negatively influenced employee acceptance of the change. The decentralized structure of the Participatory Management Model was implemented but shared decision-making was only partially utilized. Despite facilitation of the communication process within the unit, more significant difficulties arose from lack of communication inter-unit. Values and principals need to be shared by teams, however, that will happens only if managers restructure accountabilities changing job descriptions of all team members.
  
  
  CONCLUSIONS
  Innovative management models that depart from the premise of decentralized decision-making and increased communication encourage accountability, increased motivation and satisfaction, and contribute to improving the quality of care. The contribution of the study is that it describes the complexity of implementing an innovative management model, examines dissent and intentionally acknowledges the difficulties faced by employees in the organization.
authors.affiliation: Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil. andreab@eerp.usp.br
authors.forename: Andrea
authors.initials: A
authors.lastname: Bernardes
authors.forename: Greta
authors.initials: G
authors.lastname: Cummings
authors.forename: Yolanda Dora Martinez
authors.initials: YD
authors.lastname: Évora
authors.forename: Carmen Silvia
authors.initials: CS
authors.lastname: Gabriel
mesh_terms: D001938:Brazil; D003142:Communication; D006779:Hospitals, Public; D017146:Models, Organizational; D009746:Nursing, Team; D010557:Personnel Administration, Hospital / Q000379:methods*