Abstract
Working within a highly volatile scenario and subject to numerous interrelationships, institutions in the philanthropic healthcare sector must navigate both the efficiency and flexibility, characteristic of private entities, while retaining the focus on the purpose of social equity, typical of public entities. This dichotomy renders the implementation of a project portfolio a significant challenge. It was in recognition of the inherent features of this scenario that this research grounded its development in complex thinking. This allowed for learning rather than the imposition of pre-determinism, and critical reflection instead of hypothesis testing. Given the systemic nature of this research, the Soft System Methodology was chosen as the approach. Conducted within a philanthropic institution dedicated to oncological treatment, this unique case study originated from comprehending the organizational context through the lens of complex thinking to formulate an action plan centered on the implementation and management of a project portfolio. The outcomes demonstrated that steering this process guided by complex thinking enables greater flexibility and agility in project selection, as well as enhanced integration among stakeholders, along with reduced maturation time in the initiation and planning phases. On the other hand, this adoption opens discussions about the challenges of employing a holistic line of thought within a culture rooted predominantly in the positivist paradigm.
References
ABDEL-HAMID, T., MADNICK, S.E., 1991, Software Project Dynamics: An Integrated Approach, Englewood Cliffs, NJ: Prentice-Hall, Inc.
ACKOFF, R. A Lifetime of Systems Thinking. The Systems Thinker, v. 10, n. 5, 1999.
ACKOFF, R. L.; MAGIDSON, J.; ADDISON, H. J. Idealized Design. Creating an organization’s future. [s.l: s.n.].
ARITUA, B., Smith, N. J., & Bower, D. Construction client multi-projects: a complex adaptive systems perspective. International Journal of Project Management, 27(1), 72-79, 2009.
BACCARINI, D. The concept of project complexity - a review. International Journal of Project Management, 14(4), 201-204, 1996.
BAPTISTA, E. ET AL. MANUAL FOR THE ELABORATION AND STANDARDIZATION OF DISSERTATIONS AND THESES. In: BAPTISTA, E. ET AL (Ed.). . Manual de Procedures. 5th ed. Rio de Janeiro: UFRJ-SiBI, 2012. p. 111.
BARABÁSI, Alber-László. Linked: the new science of networks, how everything is connected to everything and what it means for business, social relationships and sciences. Barueri (SP): Leopardo Editora, 2009.
BARROS, M.O., WERNER, C.M.L., TRAVASSOS, G.H., 2000b, “L’ analyse de risques: un facteur de succès pour le développement de systèmes complexes”, Génie Logiciel, ISSN 0295-6322, September(24), pp. 14-20.
BASDEN, A; WOOD-HARPER, A. T. A philosophical discussion of the Root Definition in Soft Systems Thinking: An enrichment of CATWOE. Systems Research and Behavioral Science, 23, p. 61-87, 2006.
BERGVALL-KAREBORN, B; MIRIJAMDOTTER, A; BASDEN; A. Basic principles of SSM modeling: an examination of CATWOE from a soft perspective. Systemic Practice and Action Research, 17(2): 55–73, 2004.
BERSSANETI, Fernando Tobal; CARVALHO, Marly Monteiro. Identification of variables that impact project success in Brazilian companies. International Journal of Project Management 2015; 33:638-649.
BRAZIL. Law No. 12,101, of November 27, 2009. Provides for charitable social assistance entities; regulates the procedures for exemption from social security contributions; amends provisions of Laws No. 8,212 of July 24, 1991, 8,213 of July 24, 1991, 9,429 of December 26, 1996, 10,684 of May 30, 2003, and provides for other provisions. Official Gazette of the Union, Executive Branch, Brasília, DF, 30 nov. 2009. Available at: https://www2.camara.leg.br/legin/fed/lei/2009/lei-12101-27-novembro-2009-594805-publicacaooriginal-118829-pl.html. Accessed on: 07/29/2023.
BRAZIL (a). Ministry of Health. With resources from Health, the philanthropic sector represents almost half of procedures performed in the SUS. [Brasília]: Ministry of Health, August 2, 2021. Available at: https://www.gov.br/saude/pt-br/assuntos/noticias/2021-1/agosto/com-recursos-da-saude-setor-filantropico-representa-quase-metade-de-procedimentos-realizados-no-sus. Accessed on: 05/20/23
BRAZIL (b). Chamber of Deputies. Debaters complain about a gap in the values of the SUS table. [Brasília]: Agência Câmara de Notícias. Available at: https://www.camara.leg.br/noticias/556048-debatedores-reclamam-de-defasagem-nos-valores-da-tabela-do-sus/. Accessed in: 05/23/2023
BRAZIL (c). Ministry of Health. Project Management Methodology – MGP. [Brasília]: Ministry of Health, DATASUS. Available at: https://datasus.saude.gov.br/metodologia-de-gerenciamento-de-projetos-mgp/. Accessed on: 05/20/23
CAPRA, F. The Turning Point: Science, Society, and Emerging Culture. 1st ed. São Paulo: Círculo do Livro, 1982.
CHAPMAN, R. J. A framework for examining the dimensions and characteristics of complexity inherent within rail megaprojects. International Journal of Project Management, 34(6), 937-956, 2016.
CHECKLAND, P. Towards a systems-based methodology for real-world problem solving. Journal of Systems Engineering, v. 3, n. 2, p. 87-116, 1972.
CHECKLAND, P. Soft systems methodology: a thirty year retrospective. Systems Research and Behavioral Science, v. 17, n. S1, p. S11-S58, nov. 2000.
CHECKLAND, P.; POULTER, J. Learning For Action: A Short Definitive Account of Soft System Methodology and Its Use For Practioners, Teachers and Students. Chichester, England: John Wiley & Sons, 2006.
CHECKLAND, P.; HOLWELL, S. Action research: Its nature and validity. Systemic Practice and Action Research, v. 11, n. 1, p. 9–21, 1998.
COLLDÉN, C. Managing management innovations: contextual complexity and the pursuit of improvement in healthcare. Applied Intelligence, 2022. Springer Nature.
CONFORTO, Edivandro Carlos; AMARAL, Daniel; SILVA, Felipe Barreto; REBENTISCH, Eric. Hybrid models combining complexity, agility and innovation. Mundo PM Magazine, v. 81, n. 6, p. 10-17, 2015.
CRESWEU, J. W. Research Project. 2nd ed. Porto Alegre: Artmed, 2007.
DAVIS, J.; MACDONALD, A.; WHITE, L. Problem-structuring methods and project management: an example of stakeholder involvement using hierarchical process methodology. Journal of the Operational Research Society, 61(6), 893-904. 2010.
FORRESTER, J.W. Industrial Dynamics, Cambridge, MA: The MIT Press, 1961.
Global Alliance for the Project Professions. A framework for performance based competency standards for global level 1 and 2 project managers. Global Alliance for Project Performance Standards, 2007.
GIL, A. C. Methods and techniques of social research. 5th ed. São Paulo: Atlas SA, 1999.
GOMES, L. F. A. M.; ARAYA, M. G. C.; CARIGNANO, C. Decision-making in complex scenarios. 1st ed. São Paulo: Thomson, 2003
HASS, K. B. Managing complex projects: a new model. Vienna, VA 22182: Managemente Concepts, 2009.
JU, Y.; WANG, A.; LIU, X. Evaluating emergency response capacity by fuzzy AHP and 2-tuple fuzzy linguistic approach. Expert Systems with Applications, v. 39, n. 8, p. 6972-6981, 2012.
KAUFFMAN, Stuart A. The origins of order: self-organization and selection in evolution. New York: Oxford University Press, 1993.
LAFLEUR, R. Project Management: Getting Control and Keeping Control of Complex Projects. American Programmer, (April), pp. 23 – 28, 1996.
LALOUX, F. Reinventing Organizations. 2015. 1st ed. Curitiba: Voo, 2017.
LATOUR, Bruno. Reaggregating the Social: an introduction to the Actor-Network Theory. Salvador: Edufba, 2012.
LIMA, M.; FARIAS, J. Integrated management in the management of complex projects. Annals of the VIII National Congress of Excellence in Management, Rio de Janeiro, 2012.
LOTFI, R.; WEBER, G.; OZCEYLAN, E. Special issue: recent advances on viability and sustainability in project scheduling by considering the complexity of networks. Applied Intelligence, 2023. Springer Nature.
LONG, K,; McDERMOTT, F,; MEADOWS, F. Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research. BMC Medecine, 2018. Springer Nature.
MAHMOUDI, A.; ABBASI, M.; YUAN, J.; LI, L. Large-scale group decision-making (LSGDM) for performance measurement of healthcare construction projects: ordinal priority approach. Applied Intelligence, 2022. Springer Nature.
MAJEED, M.; MAHMOOD, R.; SOM, H.; MUNIR, S. Impact of Project Management Strategies and Project Complexity on Project Success. Advances in Economics, Management and Political Sciences. 6. 283-294. 2023.
MINGERS, J. Questions and suggestions in using soft systems methodology. Systemist, 14, 54–61. 1992.
MORIN, E.; LE MOIGNE, J.-L. The Intelligence of Complexity. 1st ed. São Paulo: Peirópolis, 1921.
MORIN, E. Science with consciousness. Rio de Janeiro: Bertrand Brasil, 1996.
NASON, R. Challenges of implementing complexity in healthcare. Healthcare Management Forum, 2023. Springer Nature.
OCELOTL, P. Uncomplicated complexity: How the concept of complexity promotes a more conscious management. 1st edition. Paraná: Curitiba, 2021.
PAES, J. E. Foundations and Social Interest Entities: legal, administrative, accounting and tax aspects. 3rd edition, Brasília : Brasília Jurídica, 2001
KREHER, H. Self-Organization and Soft System Methodology: And Inquiry in to Their Mutual Relationship and Relevance. [s.l.] University of Lancaster, 1995.
MINGERS, J.; ROSENHEAD, J. Problem structuring methods in action. European Journal of Operational Research, v. 152, n. 3, p. 530–554, 2004.MORECROFT, J. D.; STERMAN, J. D. Executive Knowledge, Models, and LearningModeling for Learning Organizations Portland, 1994.
P. RIEHMANN, M. Hanfler, B. Froehlich. “Interactive Sankey Diagrams”. IEEE Symposium on Information Visualization, pp. 233-240, 2005.
PMI, PROJECT MANAGEMENT INSTITUTE. Organisational Project Management Maturity Model (OPM3). Maryland, USA: Project Management Institute Inc; 2003.
POUPART, J. et al. Qualitative Research. Petrópolis: Vozes, 2008.
RAU, T, Z.; KOCH-GONZALEZ, J.; Many voices one song: shared power with sociocracy. Institute for Peaceable Communities, Inc; Illustrated edition, 2018.
RIBEIRO, H. P. The Hospital: history and crisis. São Paulo : Cortez, 1993
RHODES, M. L. et.al. Current state of public sector performance management in seven selected countries. International Journal of Productivity and Performance Management, v.61, n.3, p. 235-271, 2012.
ROSE, J. Soft systems methodology as a social science research tool. Systems Research and Behavioral Science, v. 14, n. 4. p. 249-258, 1997.
SAATY, T. L. How to make a decision: The analytic hierarchy process. European Journal of Operational Research, v.48, n.1, p.9-16, 1990.
SAATY, T. L. Decision making for leaders: the analytic hierarchy process for decisions in a complex world. New Edition, v.2. 2001. Analytic Hierarchy Process Series.
SANTAELLA, Lucia. Liquid languages in the age of mobility. São Paulo: Paulus, 2007
SANTAELLA, Lucia; LEMOS, Renata. Digital social networks: the connective cognition of Twitter. São Paulo: Paulus, 2010.
SENGE, P. M. The Fifth Discipline: The Art and Practice of Learning Organization. 33rd ed. Rio de Janeiro: [s.n.], 2017.
SERVA, M. The paradigm of complexity and organizational analysis. Journal of Business Administration/Eaesp/FVG, 32(2), 26-35, 1992.
SLOANE, E. B. et al. Using the analytic hierarchy process as a clinical engineering tool to facilitate an iterative, multidisciplinary, microeconomic health technology assessment. Computers & Operations Research, v. 30, n. 10, p. 1447-1465, 2003.
TARHAN, A.; TURETKEN, O.; REIJERS, H. A. Business process maturity models: A systematic literature review. Information and Software Technology, v. 75, p. 122–134, 2016.
THAMHAIN, H. Managing risks in complex projects. Project Management Journal, 44 (2), 20-35. 2013.
THOMAS, J., & MENGEL, T. Preparing managers to deal with complexity - advanced project management education. International Journal of Project Management, 26(3), 304-315. 2008.
THOMÉ, A. M. T., Scavarda, L. F., Scavarda, A., & Thomé, F. E. S. S.. Similarities and contrasts of complexity, uncertainty, risks, and resilience in supply chains and temporary multi-organization projects. International Journal of Project Management, 34(7), 1328-1346. 2016.
WHITTY, S. J. & Maylor, H. And then came complex project management revised. International Journal of Project Management, 27(3), 304–310. 2009.
Wood Jr., T. Chaos: the creation of a new science? The applications and implications of chaos theory in business administration. Journal of Business Administration/Eaesp/FGV, 33(4), 94-105. 1993.
VERGARA, S. Métodos de Pesquisa. 1st ed. São Paulo: Atlas SA, 2005.
WEBER, B.T. The healing arts: medicine, religion, magic and positivism in the Rio-Grandense Republic - 1889-1928. Edusc - Editoraufms, 1999.
WYSOCKI, Robert K. Adaptive Project Framework: Managing Complexity in the Face of Uncertainty. Boston: Addison-Wesley Professional, 2010.
WYSOCKI, Robert K. Rethinking Project Management: A Structured Literature Review with a Critical Look at the Brave New World. Project Management Journal, v. 47, n. 6, p. 26-38, 2016.

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