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Essay

Work in the Healthcare Field:
Artisanal or Industrial Models?

Hugo Spinelli1

Work in the healthcare field: artisanal or industrial models?
This text analyzes work within the health field and the differences
and similarities with artisanal and industrial work models. In this
framework, we consider the object of work, the worker, the work
process, relational and organizational aspects, industrial logics, and
ways of acquiring knowledge, influence of the general management
theory, the role of language, symbolic aspects and enjoyment. The
humanizing elements that care work maintains as a type of artisanal
work are highlighted, and the costs, not just economic, of reducing
care work to industrial logics, with a subsequent depersonalization
of the process not just for the worker but also for the user, health
teams, health institutions, and social groups are discussed.

Key words: work; industry; health personnel.

El trabajo en el campo de la salud: ¿modelos artesanales o
industriales?

Este texto analiza el trabajo en el campo de la salud y las diferencias
y similitudes con los modelos de trabajo artesanal e industrial. En
este marco se abordan el objeto, el trabajador, el proceso de trabajo,
lo relacional, la organización, las lógicas industriales, las formas
de adquirir el conocimiento, las huellas de la teoría general de la
administración, el lenguaje, lo simbólico y lo lúdico. Se rescatan
las dimensiones de humanización que mantiene el trabajo de
atención/cuidado, en tanto trabajo artesanal, y los costos, no solo
económicos, de reducirlo a lógicas industriales con la consecuente
despersonalización del proceso tanto para el trabajador, como para
1 Ph. D in Collective Health. Instituto el usuario, los equipos, la institución y los conjuntos sociales.
de Salud Colectiva, Universidad
Nacional de Lanús, Argentina. email: Palabras clave: trabajo; industrias; personal de salud.
hugospinelli09@gmail.com

DOI: 10.17533/udea.iee.v33n2a02
O trabalho no campo da saúde: modelos artesanais ou in-
dustriais?
How to cite this article: Spinelli H. Work in
the Healthcare Field: Artisanal or Industrial Este texto analisa o trabalho ao interior do campo da saúde e as
Models? Invest Educ Enferm. 2015; 33(2): diferenças e similitudes com os modelos de trabalho artesanal e
194 • Invest Educ Enferm. 2013;31(3)
194-205. industrial. Neste marco se abordam o objeto, o trabalhador, o processo

apprentices to whom they that emerged from them would dominate work taught the occupational hazards. to the point of Two centuries later. the Technological routed toward automation. It was supposed that machines and the logic They had. em tanto trabalho artesanal. in general. alone or in small groups. As of the science would have an important role in this. Taylor was in charge of dispensing with the worker. given that they were not paid to think. That is what Taylor taught entrepreneurs3.1 The work on to think. Many decades later. a film Thus. service of this logic. Man ceased substituting the freedom offered by the artisanal to be the driving force to become a natural force work. não só econômicos. The group of processes. a organização. de reduzí-lo a lógicas industriais com a consequente despersonalização do processo tanto para o trabalhador. Work in the Healthcare Field: Artisanal or Industrial Models? de trabalho. and increase craftsmen who shared the same occupation profits. the rest of the personnel only had instrument went from the tool to the machine. the rhythm came to took on overtones of reality at the same time that be imposed by machines and workers became it answered Henry Ford’s question: why is it every Invest Educ Enferm. alienation of the worker. as lógicas industriais. managers were called labor. as formas de adquirir o conhecimento. contained in Jewish legend from the materials” by making them circulate in and which Borges recreated in one of his poems. and changed the work processes. Chaplin wrote and directed Modern Times. from a man’s hand to a piece of a mechanism. Capital was put at the effectiveness. production lines. the application of hydraulic energy These were times of modernity and the height bolstered the development of the Industrial of the Cartesian subject. while the artisanal seemed and quality originated in industrial models were destined to become a part of history. a linguagem. como para o usuário. as equipes. consolidated factories as places of upper management.4 and Use of machines was generalized and the division it became common sense. Charles their totality and without the idea of obsolescence. a instituição e os conjuntos sociais. hence. and to obey. Ideas of productivity. which ignored mankind almost since its beginning until the 18th the psychosocial dimensions of the work. The idea of the golem taking away “leisure” from workers by timing (an anthropomorphic creature created from their movements and Ford. as impressões da teoria geral da administração. Revolution reinforced those limitations through informatics and robotics. In 1936. 18th century. 2015. of “extracting leisure inanimate matter). All this would bring wealth and progress. o simbólico e o lúdico. In the organization’s Revolution. on the other each of the products. lower costs of goods.2 Thereby. o relacional.33(2) • 195 . efficiency. received the denomination of guild. supervision. Craftsmen worked advent of machines for work and for workers. indústrias. which they carried out in hand. Resgatam-se as dimensões de humanização que mantém o trabalho de atendimento/cuidado. control. Their production was low and was Industrial Revolution and the consequences of the destined to the local market. e os custos. Palabras chave: trabalho. different that brilliantly summarizes the meaning of the from others. performing their tasks by hand and using their own very simple tools. Craftsmen worked in small shops installed were the consequences? On the one hand. pessoal de saúde. Introduction Artisanal work accompanied the history of objects in the organizational logic. of work was installed. each one was original and. What century. there in homes or near them and spent many hours on was the decline of artisanal work and.

which It is difficult to agree on a definition on what is why it meekly submits to the indications of the “health” is. but to the healthcare field6 or to its paradigmatic rather of the production of services in general.7 often almost co-responsible for the work and even The WHO takes in this definition ideas by Henry condition the results. given that they did pyramidal structure present in the social imaginary not produce any value. In spite of that. we will recognize work dimensions more pointed out by Adam Smith who classified all the related to the artisanal than to the industrial and professions based on interpretations as those of an organizational design quite removed from that lowest and unproductive labor.Hugo Spinelli time I ask for a pair of hands. In healthcare. We will outline the field. Do you level of care is made up by health centers. 196 • Invest Educ Enferm. The constitution of the World Health worker. The intangible analyze the work process within the healthcare nature of medical work – among others – was field. It is also the woman who reinterprets the indications received 2. responding domesticate the object of work. question. Readers are invited to think if they know any While books in public health insist that the first person who can be included therein. the object tends to resist. definition is impossible to confirm in practice. let us think: How many stations. interpret. they come with a that it is consumed while it is produced. whatever the healthcare field6 the product is not tangible. first-aid feel included? Then. The object interacts Why is health work artisanal? Taylor sought to domesticate the gorilla (the Tensions between artisanal models and industrial worker).10 A true heresy for industrial Sigerist (1891-1957). a referential figure of social medicine in the American continent. efforts And this further complicates the domestication of are made to introduce industrial logics into the a work process through the logic of industrial work healthcare field as forms of organization.33(2) . in how true first level of care11 and that. analyze and discuss the indications of the professional. given scientific foundations of the indication.8 But that logic. organization: “the hospital”. the material is animate and Organization (WHO) defines it as: “a state of interacts and defines processes and conducts. but never thought of having to models run through the healthcare field. The material on 1. seeking attention and arguing with the most varied of explanations. medical anthropology organizations in society cannot define the object describes the family or household group as the they produce or upon which they work? Or. complete physical. If we without analyzing its singularity.9 that was installed with the idea of the factory.6 3. Has brain attached?5 anyone ever been able to touch an emergency shift or a consultation? This intangible nature is not an The model of industrial work cannot be extrapolated intrinsic property of the healthcare field alone. or similar entities. of residence. and social wellbeing The patients participate so actively that they are and not only the lack of affectations or diseases”. Intangible product and decides/suggests/counsels whether or not to In most healthcare work processes in the comply with them and for how long. mental. In the healthcare to distinct logics and interests. The definition of the object to produce which industrial work is done is inanimate. in general. 2015. it is many organizations is the definition of that which the woman – within those spaces – who decides they produce contradictory? on attending a health organization. principal characteristics of health work. An how much of it is artisanal (by its nature) and how object that is also not subjected to the rules of much is industrial (through political-economic/ logistics and is capable of moving beyond its area ideological-cultural imposition).

2015.10 The model ped the pyramid? of industrial work within the healthcare field6 The pyramid. does not find in the healthcare field enter and replace human work. Have we not been the authorities. and the connection necessary to do so. which door to a poor relationship and the possibility of explains the high standards achieved in certain violence. or affective. In so when selling fruits and vegetables. nobody The work process in health can capture different concentrates all the power. In their private work they process in which subjects interact through verbal will accumulate profits and will work the hours and non-verbal language. This knowledge – technical Do we not see workers who. A limit to autonomy any industrial example? is represented by the dependence of workers on resources – mainly economic – that are controlled by higher levels of public administration. Could we extrapolate this to long as that commitment lasts. engagement the res extensa. Much of the work product depends on situations by the conformation of teams who communication and on the connection established manage to excel over the institution’s median so in that relationship. a place from which they 5. given that it makes up the core immersed in ideological questions at work? How of the worker’s specialty. Work in the Healthcare Field: Artisanal or Industrial Models? 4. religious. Subjective dimensions in the work worker who endures the power accumulated process at the apex of the pyramid.10 The care process is a relational and cultural capital. where machines were able to organizations. where they earn a salary without complying with the assigned schedule.17 In the second. while at the same time Health organizations are based in interpersonal obtaining “clients” and increasing their social relations. Neoliberal policies a fertile space to be reproduced.15 This facilitates the subjective dimensions of the worker. This logic was strengthened produced is fundamental to establishing a good by the cultural patterns imposed by the society of care process. almost impossible for the authorities to acquire pray or implore? Do we not act in certain moments such knowledge. given the nature try to correct the pyramid’s mutation – that is. many workers can put these dimensions into play in their work process? If we think of common Workers use their knowledge – technical power situations we will find it absurd to suppose. The factory that isn’t. used traditionally as a figure that can only be observed in some diagnostic and expresses the logic of power within manufacturing treatment areas. It is a subject-subject relation quite risk and multiple employment that resulted from removed from the Cartesian subject and from neoliberal policies. or who flip- often obligates them to negotiate.13 Ignorance of this relational in the organization marks a difference in the quality nature affects the connection and opens the of the work individually or collectively.12. we could the first. that a baker places those dimensions in freedom in two ways: self-referenced in their play in selling bread. given certain vital power – is not shared by the authorities and it is situations of a patient and in function of their beliefs. or that the greengrocer does subjectivity or engaged with the organization. its of work in these institutions.33(2) • 197 .16. It is the freedom of the inversion– with the flexibilization of labor relations worker on the ground – the operational nucleus. power is distributed. which 6. from that self-referenced position they continue with other examples without finding the make their work in the public institution a place subjective implications of health work. as at the base of the organization – the operational Henry Mintzberg calls it –14 that makes the pyramid nucleus – seeking to limit the existing margins of flip. Work is relational expect a future retirement. a displacement unimaginable to the factory autonomy. whether creation of closed spaces of poor governability for political.10. However. Invest Educ Enferm. The aforementioned underscores part of moments in which a situation reached us the great dependence of the authorities within at the emotional level and made us laugh or cry? the organization itself. for – to escape from “supervision” and use that example. in health organizations.

carpenters. barbers. within a process similar to communicators. quality. demand itself is unknown and/or imprecise in its tions. sociologists. But. etc. A publication from the the efficacy of a hospital by the number of early 1990s identified no less than 300 employ- discharged patients is akin to measuring the ment positions distributed in the different spaces efficacy of an army by the number of bullets of a hospital. administrators. they and 15-minute consultations per patient are now incorporate odontologists. given that it staff. additionally. and social workers. Processes must be that requires their greatest attention. anguish and/ objectivity” the daily practice seems more like that or suffering. involving biochemists. waiters. but in the hospital they are all together – complexity. manufacturing nuts and bolts. psychologists. because the trades function in society as individual organiza. in general. are based in pain. it cannot be affirmed that and must be directed! a healthcare model executed through a Fordist 198 • Invest Educ Enferm. very not reflect success or quality different from other organizations in society. 24 healthcare field we will see that it is dominated by hours per day. and behind the illusion of “scientific general. Nevertheless. Or. which are carried out so that we cannot predict what will be produced. and implicate different sectors that generate hour shift is assigned. 2015. biologists. although it standardized so that they can be controlled and is possible that they have gone for over 20 hours evaluated. model invades the healthcare field and establishes bioengineers. maids. chemists. every day of the year. disease. Therein the old adage that “measuring and trades working in it. among expense of the professional’s ties with the patient others. a hospital may the time assigned expresses efficacy or efficiency. managers. telephone The singularity of health work makes the operators.10 What is carried out cannot always be measured. in health for 24 hours.Hugo Spinelli 7. information techno. The demands faced in the work. of workers are correct. lawyers. pharmacologists. each profession with its own logic and te. Quantification of production does Health organizations are quite complex. drivers. which is considered a basic pillar of without sleep.10 If we observe the work of any professional from the These organizations work 365 days a year. imposed. Their workers – professionals because it is almost impossible to standardize and non-professionals – accept working 24 hours and/or measure productivity objectively. in the work process. Many of those professions and is not known what will be produced. translators. their work appears chaotic and births of people. laundry elaboration of costs quite complex. where it is not unlikely that another 24.18 Hospitals today no longer have fired”. for example. as if all demands were equal. have among its staff gardeners. When the industrial logists. professionals may the quantification of production. so much straight in emergency shifts. in the artisanal. how much will be with that labor situation bordering on absolute spent in that production or ensure that the actions surplus value.33(2) . as is accompanying the lives terms of industrial logic. Death is a – possible – event within of the craftsman than that of a machine. the same problems. after having worked the industrial organization. and with the community. in during the 23rd hour of a shift. for another four to six hours in that institution or in present unstable or varied input-product relations. an objective have to perform a complex and delicate operation element of control over work. A very complex organization 8. Industrial work has. Hence. elevator operators. nutritionists. another. However. sometimes. and teachers. with no guarantee that chnical language. accountants. Thereby. set times for tasks. electricians. workers will continue seeing patients organizations processes are quite diversified. cooks. products and results difficult to specify. it does so at the kinesiology professionals. technicians. nurses. The complexity of the organization is also expres- or that which is measured is not synonymous with sed in the diversity of professionals. A situation in which. with industrial logics persist just physicians. architects. and unions rarely take issue how much will be produced.

but also as intelligence. procedures was how workers managed to create more time for their patients beyond that stipulated 10. the distinct eras and films. the worker that reality changes the workers. The working class goes and efficacy of work remained directly related to heaven (1971). The alienation process described by times.24 This means channeling the employment in Great Britain19 and. over time. the process through which workers lose the requires time not of these times. Capital is not in the machine but in that as workers change reality with their work. The alienation Industrial development made machines the core of the factory. which is achieved through automation. The health of health workers has not been vastly but from the way it is organized. for it to be more efficient control over their work through the exercise of and effective it requires more workers and not technical power. social security organizations. These are virtues The entrance of Fordism into the NHS led to machines do not have and capital that cannot the division of the work process and affected be entirely transferred and which is therefore lost the quality of care. and profits independent of time.23 which places the worker on the antipodes by young adults. to the point of the subject sense or meaning. work in to reduce health workers to the role of victims the healthcare field – as in other social areas – is – above all professionals – given that they have intensive human capital. as the model of health work. which became the logic of intensive process is described through the silver screen. or Human resources (1999). and this is of particular importance given the problem of employment currently faced does). Invest Educ Enferm.19 Physicians and nurses from the NHS do not suffer so much from the work they do. from the already discussed number of workers was reduced. the domain of Richard Sennett states that workers from the the symbolic. That freedom.21 The talent of these workers. 2015. the knowledge they have of the National Health Service (NHS) in Great Britain organization and its members is a value that tends believe that the measuring processes they are to increase over time and makes the workers the subjected to affect the quality of their work. But it is wrong dispensing with the laborer. 4. private healthcare.15. meaning and sense of their work: although Marx also indicates that work is not only alienation and 9. grew increasingly All these show the alienation of the worker as sophisticated and hence encompassed more product of repetitive work that does not provide parts of the work process. Work in the Healthcare Field: Artisanal or Industrial Models? conception always controls costs and increases worked in public health.4% of the economically active population which the work takes place. because work is based on people not only as workforce.19 Hegel and further broadened by Marx22 indicates Artisanal work. organization’s principal asset. The efficiency Modern Times (1936).20 This has social relevance that doing is thinking. and emotion. to machines that.1 Both situations can be found in health work. of alienation and empowers the worker as a subject of change through his or her work process The NHS was the entity that offered the greatest as micropolitics. in Argentina. in capital: as machines were incorporated. in power in order to strengthen the institution in 2012. the ties they construct. inasmuch as workers understand feelings.21 more machines. may be inscribed in the because few sectors of the economy require the concept of elucidation formulated by Castoriadis generation of employment to be more effective (doing what one thinks and thinking what one and efficient. Alienation and elucidation by controls. In contrast.19 inventing diagnoses and/or when those workers leave the job or retire.19 The purpose of studied21 and this hinders discussing the process scientific management was always to put an end of alienation and elucidation that can be related to trades so as to end worker control of production to their work.33(2) • 199 .

efficacy. but to the subordinate work process to it. to the point that when hospital workers talk about their work with The influences of the trends of thought of industrial workers and the latter realize the levels management in the healthcare field are multiple of autonomy and freedom hospital workers have. they can be away dogmas of the general theory of management from the patients and still be working. promoted. we will find decides where and what will be learned and. Nomadic and sedentary workers field. organizational In the healthcare field. of the work process are defined.Hugo Spinelli 11. scientific journals. the influences of the general theory field. If new skills are needed. nor does evidence exist that they improve the health Industrial workers must remain most of the situation of the people. in general. In the factory. because they it is likely they will be easily detected. and control over products and the work process. values. time next to machines. The influence of the general theory just as they were established they were forgotten. in general. they may upon which industrial work is instituted with not see or touch them for several days and yet still few or no deviations. upper management in the organization But if we look at a health institution. reformulate any of the norms. organization. and accompany its centennial history. regulations. essence of the artisanal work that constitutes the Toyotism. if necessary. which has of working away from the “object” is a clear been incorporated into socialization processes26 difference with respect to industrial workers and and installed as something natural. 2015. Fordism. workers do not need to diagrams. quality. This is capital. or pyramid-type structure the bases report and because they speak to other professionals about bosses order in a clear division between doing indications to be administered. specialist point quality standards were drawn. which in common sense knowledge – above all – is acquired outside the translates as something “full of feudal divisions”. and organizational 13. They make up a long list among which we of administration do not manage to affect the may cite: Taylorism. these place production in the center and due not to the organization’s nature. defines whether or not they are working. when deviations do occur may be working with these patients. but do not always succeed in doing so. but finally accepted as part of within and it is there where the forms and times the rules of the game. etc. reengineering. Little of this by a vast majority of its members who work occurs in health organizations. of management is not enough to annul In the hospital organization.25 All are related to healthcare field. outside the organization reformulations which will then be applied. marketing. Promoted by they state: “what you do is not work”. that is the place that. and/or conferences. core of well-done work among professionals of the empowerment. finances the learning. productive and/or organizational models that seek to introduce an industrial logic into the healthcare 12. Hence. norms. knowledge is acquired without resistance. This opens the and financed by an international organism. Perhaps at some in graduate courses. In the are thinking of something that should be done. coaching. and possibility of applying – without consulting the 200 • Invest Educ Enferm. grants health workers a nomadic nature. competitiveness. That possibility (hands and feet) and thinking (head). Mission. not In the factory. and regulations constitute be next to the patient to work. whether through university formation “each playing his own game”. Throughout the nature of the work that generates such an atypical history of the general theory of management concepts placement of the pyramid (inverted). in were created. strange things occur the game from the industrial point of view. upper management may. total quality. associations. which were applied in the healthcare general. Specialized knowledge is acquired diagrams to increase efficiency. if a very different world. The mission is unknown necessary.33(2) . where technical in isolated manner. vision.

26 This should not be adjudicated reproached by their family group for their inability to the university formation that. thus the saying “there are no sicknesses. error can industrial organization. but think it should problem. Imagine that situation in an different individuals. discover that their task is almost Health workers are stressed by their work. For this reason. and that Industrial work manages to standardize its their practices are different from what their head products and define them precisely. This last thought corresponds the contrary. formed within a Cartesian that they do not interact with simple problems conception of the subject and influenced by in which the logic of the solution functions but Enlightenment principles. Singular processes are not strange as in the factory. thus. who see that alumni that the healthcare field does. The infinite task are more common. they 14. on be done in another. The subject of reason drags them toward dreams and illusions that are not fulfilled. but this is a mistake. much easier for industrial workers. and they are of organization.33(2) • 201 . not only for the factory: would such a thing be possible? individual. In their rational model. only sick people”. giving way to the role of the suffer. and/or presenting the problem and/or disease. with relation to the that they perform it one way. at any moment and without them to the socialization processes that had – or were meaning for it to happen. upon engaging themselves in the relational and university formation process. given these professionals. they some and bad for others and which do not always expect a certain way things “should be” to be give them a sense of having completed the task. Industrial work. estimation of costs or viability of the expense – Rather. we cannot always comply diagnosis and/or therapeutic processes. becomes an object. conceptions. in healthcare many times it and/or contradictory therapies may coexist due to is not in fact an error but rather a new way of different economic interests. but the more they do the more work they have. Such error. given that their inter-subjective interactions are fewer. and thus knowledge. do not function with an on-off logic. because it is tangible. This is with this logic that. This situation is problematizing the issue of organizations. Tension between practical sense This reality differs from that of healthcare workers who. omits to keep work outside of the house. Error may not in fact be error but the same time they realize that they themselves novelty do not comply with what is expected. does not necessarily capture the subjectivity of the worker. suffer upon seeing the rather with complex problems where there are no dynamics of the organization´s work process and solutions. Work in the Healthcare Field: Artisanal or Industrial Models? organization’s upper management. memories return to perceived as – pyramidal or mechanized models their conscience that distract them. at times the worker chooses not that gives orders and that subject-patient that to commit and to remain distant as a form of self. because what is not understood causes Invest Educ Enferm. courses tools to make up that machine they imagine. or mediating supervisor and/or foreman who detect errors. 16. That stress disorients them and they control is effective. procedures from the standard. in health work. for example. just new situations that are good for logic of functioning. All of this Few institutions have the quantity of university provokes anguish in health workers. generally. Therein the multiplicity of models of there is no certainty that if identical algorithms care that coexist to address the same problems in are followed the same results will be obtained in the healthcare field. given infinite and that their heads.27 fulfilled: a pyramid with an upper management For this reason. although existent. an automotive be the motive for new learning. but also for the institution. is not further complicated by the fact that within the same dominant. understood as a deviation specialty and the same organization. as well as a future that is preservation. but at 15. as the price predictable and planned. dictates. 2015. They seek in graduate paid is not small.

the head suffers and both comprehension and expression 19. from technique. at the edge of a precipice. the use may see – in general – that. we witness daily attempts down or stand up. This is a highly successful model that affect productivity. the artisanal and which permits understanding international organisms bring proposals that force the organization as a network of conversations. Little is known of practical sense and to this point more art than science) and then. and cultures. in a relationship that has the potential to transform the subject and grant The experiences of the healthcare field are quite meaning and sense to his/her work and thus difficult to extrapolate and. in each game. 2015. and/or nationalize This indicates the strong symbolic dimensions of experiences as if we were to find the same people. but impossible to workers speak – and with words make things apply in the healthcare field where work is done with happen!29-33 The people who hear them may lay subjects. Nonetheless. if they are extrapolated.19 If we observe the work process in health. And if we again a service. and art from trade. of habitus. Sennett indicates that without failing to recognize that there is no art upon separating the head from the hand. Industrial logic instilled the idea of the matrix: ordering for words to circulate in written form to once the prototype is achieved. it is developed at limit subjective dimensions and avoid distractions industrial scale. outside that If we analyze the care process of a professional. that they will never be 100% equal. Often. so Health work has a component of abstract work. in each situation. at first.15 which to industrial logic is a sign of error. an organizational model of look at the workers. provoking relations 202 • Invest Educ Enferm. For example. Health work constructs a lexical field35 with certain 18.Hugo Spinelli suffering.33(2) . How much art and how modifications in spite of the changes in the much science? It is defined in each connection authorities and with an everlasting sense of being established. that of the patient. The Tower of Babel are damaged. a care model. the diagnosis of concepts of health and disease that. stories. science that they do not know how they learned but which dominates). become happy or and proposals to transfer successful experiences of sad.3 On the contrary. Stressed by that started anew. work that go beyond the original conception of desires. workers continue waiting for the process and/or of complementary studies what they desire and at the same doing something a diagnosis may be affirmed (here. dress or undress until nude. Non-replicability of what is done and non-verbal – unlike with the industrial worker who needs hands or feet and who Taylor silenced. it is notable that its principal tool is language – verbal 17. we field. we may say that situation – which often makes them ill – they uncertainty dominates prospectively and science see how the institutional life continues without dominates retrospectively. a health center or municipality. passions. although many times the affirmation serves them to solve problems. something strongly linked to the symbolic. laugh or cry. science without theory behind it and vice versa. they only pronounced words. health limited to managing “objects”. Work combines art and science unique synonymous relationships that. although is guided by intuitions based on knowledge and opposed. constitute a reason for that work in that place. albeit not as they will have to be reexamined and the process in a Cartesian manner desire. would be contradictory. that generate “speculations” (up used one in place of the other. In synthesis. within the healthcare field tend to be experiences.31 the entry of manufacturing logics obsessed with standardizing relational processes as if they were Language creates links and relationships that akin to assembling pieces of the same machine in impact both in the subjectivity of the worker and different places.34 they will have the place’s unique singularities.28 But because they do not know that over time and with the help of the evolution of they do not know.

play”. work described has rigid and inflexible boundaries. there the profound symbolic dimensions this work has are apprentices to whom the work is taught. For Hannah Arendt.24 In the game. This is why we Health artisans: final reflections propose the need to think of work and denominate At the beginning of this essay we asked: why these workers “health artisans”. Playing should be ways of thinking about work in the healthcare encouraged. capable of producing joy. as the work takes a central role. what industrial logics try to overshadow. That the success We consider health work artisanal due to diverse of a work team. Growing for the sake of rules. of violation and production wellbeing and employment. using depends more on the ties. they are far from that. It is team work comprised of people. where the ability to play overshadows we postulate the model of artisanal health work. Although industry is a source of The ludic aspect. in the care field of symbolic battles. artisanal work consumes less renewable resources Notwithstanding the efforts of functionalism and does not contaminate. Work in the Healthcare Field: Artisanal or Industrial Models? of synonymy: they are called health institutions contexts. and of growth in a finite planet is not rational. that is. postulating a is health work artisanal? We have mentioned highly humanized and singular work marked aspects we consider predominant as responses. on the narratives. The results of the game depend more work process so as to understand and accept on soft technologies (connections) than on hard themselves as artisanal workers. the group will become operational. 2015. We continue recognizing that artisanal work 20. while artisan and constitutes them. by the meeting of – at least – two people: the without precluding other visions as expressions health worker and the user who requires care. health work is artisanal. the slogan should be “play. most of the time with disease. anger. their plays.33(2) • 203 . indifference.36 Health organizations are quite complex and very different from other organizations of society. we find the Homo obsolescence if it is well done. resources. of a service. And we highlight “new ways of thinking” play. technologies (machines). brain.37 Additionally. sapiens. play. and takes more time than industrial work. while industrial work to think of those organizations as systems that is contaminating and consumes non-renewable follow rational models. scientific knowledge in the effectiveness of the not from a place of nostalgia. and simple tools most of the time. Homo sapiens. independent of the and academic background of its members reflects size of the organization that contains them. work has the potentiality of being a source of of changing rules. of the possibilities that result from the interaction As indicated by Hannah Arendt: “we can only of the players of the field. given that it is an organization more because it is not about “new ways of doing” given permeable to game than to order and assigned that. by nature. runs through them wealth. but rather as a new plays of many of the players. field. and the Homo ludens. the work is done on the sense of belonging than on the scientific individually or in small groups. or of an institution reasons: it is done at a reduced scale. and their achieve a more human material life if we better Invest Educ Enferm. it is also a source of disease. each and which makes it pertinent to imagine it as a patient is unique and unrepeatable. It is a complex game. that is. in reality. it process the hands. where is important is that the worker-subjects at the machines are secondary in most of the work individual or collective level may elucidate their processes. and health organizations are clearly human: and fundamentally because the work done in this people caring for people. and/or feelings are used is speech and action that characterizes humans9 and mediated by verbal and non-verbal language. That human nature is way has yet to be bettered by any machine. homo faber. the Homo faber. but in the homo ludens long run it is more effective because it works at the singular level and there is no planned In health organizations. What roles. hence. for the reasons already exposed. nor do we think that what we have and health workers when they.

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