Introduction: The Change Laboratory (CL) is a theoretical and methodological approach based on expansive learning concepts of Vygotsky and followers. It was developed in the 1990s by Prof. Engeström and his team at the University of...
moreIntroduction: The Change Laboratory (CL) is a theoretical and methodological approach based on expansive learning concepts of Vygotsky and followers. It was developed in the 1990s by Prof. Engeström and his team at the University of Helsinki and has been applied in several countries, in various branches of production of goods and services. Its interventionist methodological emphasis is focused on the transformation of processes of work activities into organizations. In this approach, crises, dilemmas and conflicts in the activity are understood as manifestations of the contradictions in the system composed of subjects, the instruments used, material and immaterial means, rules, division of labor and communities. Rationale: The Workers’ Health Reference Center (CEREST) is a service that acts in the prevention and health promotion of workers ́ formal and informal sectors of the economy. Its activities are divided into two main sectors: counseling / rehabilitation and monitoring, which are dialectically connected. The goal of the rehabilitation/counseling to care for the pathological consequences of the activities performed by the employees, whereas the goal of the monitoring is to investigate such work processes to prevent new cases. Nevertheless, professionals of this service complain of a crisis in preventive action (dispersion performance without focusing on priorities, use of checklists that follows the regulations norms do not reach the organizational determinants). In this sense, the CL is justified to meet the challenge of prevention and was applied to improve the efficiency of the service performance, especially on the issue of surveillance with an integrated view. Those difficulties generated isolation of the professionals and loss of community at work. It was required a remodeling of the CEREST activity system. The LM in this service had the goal to engage with CEREST professionals, so that they could take ownership of the methodology and at the same time, intervene and improve the activity of the system itself, what would finally contribute for the actions in prevention of workers accident on the industries from region attended by CEREST Objective: To contribute to the remodeling of the actions of the service studied, to equate and create solutions to the structural problems faced by the service; take ownership of the formative intervention methodology; improve prevention actions performed by CEREST. Methodology: The study site was the CEREST of a municipality in the state of São Paulo / Brazil. The method used was the Change Laboratory, which allows the combination of ethnographic research with training intervention. Interventional researchers began by collecting mirror data through semi-structured interviews with Assistance and Monitoring professionals for CEREST, partners and the Coordinator of the union health
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surveillance area, and by observing the work as well as carrying out document analysis. The session topics of the Change Laboratory (LM) followed the proposed sequence for Engström: 1) Identification of the current situation and needs; 2) Double blind: Analysis and search for solution; 3) New design model and new tools; 4) Application test of the new model; 5) Consolidation and reflection of the new model. At the time of writing this article, the intervention is in phase 4. The sessions began in September and there have already been 11 2-hour weekly meetings,. The material was recorded, which facilitated its analysis and orientation of the conduct of training intervention sessions. The number of participants ranged from 9 to 14 people, reaching 19 in moments of decision on the change proposals in the past sessions. Results: In the early sessions, the object and the system of activities, difficulties perceived, the historical aspects of development of the work as a whole and the possible causes of the reported problems were identified. In the intermediate sessions the contradictions previously identified were discussed in depth and, in the final session, the group built a proposal for a new working model. In short, the group reflected that its object is transformed to produce a socially expected result, i.e., preserve workplaces and healthy workers. The contradictions raised by participants are related to the growth of demand and low number of staff, therefore, since its implementation in 1997, there have been advances in the quality of employment arising from search and appropriation of new tools for in-depth analysis of occupational accidents and care for the victims. It became evident the conflict between meeting the high number of demands and the failure to carry out a more skilled labor, using the broader approach of tools, most of the requests received, which creates significant contradictions between the subject and their object. It was also pointed out the decrease of exchange of information between sectors over the years, making it difficult to integrate activities. The new model proposed provides for an information room, which will update the data for the work-related accident victims and patients, as well as feed the planned actions of the service. A new division of labor is on trial, established to balance the demand, with the replacement of individual supervision by a multidisciplinary team, through a daily duty system in order to analyze the emergency demands, meet the priorities or refer them to the schedule of planned actions. At the sitting scheduled for next April, the results of the operation of the service will be discussed in the pilot format for validation and future remodeling of the activity system. Conclusion: The discussion about the origin of the contradictions and conflicts by Change Laboratory method allowed the participants to understand that the problems are systemic in nature, alleviating conflicts previously explained as the result of individual behavior. The engagement of participants resulted in the learning of the methodology, the beginning of more decentralized and democratic decision-making processes as essential attributes to implement the desired changes which were the re-design of the actions in prevention of workers accident performed by CEREST We thank all CEREST team for the availability to participate in the interventions and the writing of this article. The study is part of the thematic research project "Work Accident: The technical partner analysis to the social construction of change," Prot. FAPESP 2012 / 04721-1.