It was realized a Qualitative Case Study of exploratory / descriptive type. The objective was to evaluate the performance of a municipal Primary Care Network in view of the Strategies for the Development of Teams of Primary Care, proposed by the Pan-American Health Organization (PAHO, 2008), and based on the theoretical and methodological elements that offers the Theory of Social Systems of Luhmann (Luhmann N., 1998).
The specific objectives were, to analyze and describe the distinction between the system (Primary Care network) and the environment (hospitals, other sectors of the public politics and the community), by which the system constitutes itself; to describe the autopoiesis of the decisions (the mechanism by which the decisions are connected and generates other decisions and actions); to identify difficulties to displace the paradoxes associated to the decisions; and describe different types of noises in the communications and autolysis within the PC network.
Twenty in Depth Interviews were realized (a representative of each one of 17 Primary Care Centers, the Director of Primary Care, the Director of the municipal hospital and a government representative) and 2 Group Interviews. Documents Revision (that the interviewees offered spontaneously) and multiple Informal Conversations were secondary sources of information also used.
Centered on the processes of decision making, our approach allowed to make clear dimensions relative to the services that quality evaluation tools of more frequent use do not allow to capture, specially the not-linear nature of the relations between human beings. It proposes a rationality of different type to think of Primary Care Networks as complex systems, and offers a perspective from where observing, in an iterative way, the global behaviour of the system, the qualities of his constitutive parts (individual and institutional actors), the emergent phenomena of the interaction between them, and the relation of the system with other systems of his environment.
Keywords: Primary Care. Quality of Health Care. Complexity. Niklas Luhmann