Working in public health services in Brazil: the relationship between different rationalities

Success in a public health system is related to its ability to change its production process and to deal with general principles of the health system, such as universality and equity. The frameworks proposed by service marketing scholars have been developed primarily for private services; they focus on acceptance by the targeted client-users, and on the technical specifications of the new service delivery processes. Little attention has been given to the employees’ point of view and their activities to maintain service operations modulated by innovation. In a public health system, workers make decisions in real time related to users’ needs and the technical specifications of the process; therefore, it is very important to understand how the changes impact on employees’ activities and on the quality delivered for citizens. This article discusses how changes implemented in Sao Paulo, Brazil impact the organizational parameters and working activities for front-line workers.