Aplicación de sistemas fuzzy para la toma de decisiones del Plan Paso a Paso: análisis de los indicadores para la comuna de Valdivia / Artificial intelligence fuzzy system for the design of confinements during quarantines

BACKGROUND: Different modalities of quarantines were one of the main measures implemented worldwide to avoid the spread of SARS-CoV2 virus. AIM: To analyze and compare retrospectively the implementation of the Step- to-Step plan devised by the Chilean Ministry of Health during the pandemic. To propose a decision-making path based on an artificial intelligence fuzzy system to determine confinements in specific territories. MATERIAL AND METHODS: The Step-to-Step Plan threshold values such hospital network capacity, epidemic spreading, testing and contact tracing capability were modeled using fuzzy numbers and fuzzy rule-based systems. RESULTS: Ministry of Health's decision-making opportuneness were unrelated with the Step-to-Step Plan indicators for deconfinement. Such disagreements undermined epidemiological indicators. CONCLUSIONS: Using an artificial intelligence system could improve decision-making transparency, emergency governance, and risk communication to the population.

Implementing Hospital Self-Management Policy in Chile: Health Professionals' Perceptions / Implementando la política de autogestión hospitalaria en Chile: percepciones de profesionales de la salud / Implementando a política de autogestão hospitalar no Chile: percepções de profissionais da saúde

Context of the problem: Hospitals have been considered a main component for health systems success. Objective: To describe perceptions from hospital staff regarding the implementation of the hospital self-management policy in two highly complex facilities in Chile. Justification: A successful policy implementation demands aligned health professionals regarding policy changes. Methods: Descriptive and exploratory qualitative study based on semi-structured interviews for health professionals from two hospitals in southern Chile. A convenience sample of nineteen health professionals was selected for interviewing. The interviews' analysis was thought as the content analysis technique in its conventional approach. Results: For health professionals, a hospital's self-management policy is conceptualized from financial autonomy. Human resources for health and organizational capabilities still remain as weaknesses of the implementation process. Conclusions: Overcoming gaps between design and implementation processes are crucial for success in hospital reform implementation.

Contexto del problema: los hospitales son considerados claves para el éxito de los sistemas de salud. Objetivo: describir las percepciones de profesionales de la salud sobre la implementación de la política de autogestión en red en dos hospitales de alta complejidad en Chile. Justificación: una implementación exitosa demanda profesionales alineados con los cambios. Métodos: estudio cualitativo descriptivo y exploratorio basado en entrevistas semiestructuradas a profesionales de la salud de dos hospitales complejos del sur de Chile. Se seleccionó una muestra por conveniencia de diecinueve profesionales. Los datos se analizaron mediante análisis de contenido en su aproximación convencional. Resultados: para los profesionales, la política es conceptualizada desde la autonomía financiera. Como debilidad de la implementación persiste la ausencia de capacidades organizacionales y competencias de los recursos humanos en salud. Conclusiones: superar las brechas entre el diseño y la implementación es crucial para avanzar en la implementación de reformas a los hospitales.

Contexto do problema: os hospitais sao considerados chave para o sucesso dos sistemas de saúde. Objetivo: descrever as percepções de profissionais da saúde sobre a implementação da política de autogestão em rede em dois hospitais de alta complexidade no Chile. Justificação: uma implementacao exitosa demanda profissionais alinhados com as mudancas. Métodos: estudo qualitativo descritivo e exploratorio baseado em entrevistas semiestruturadas a profissionais da saúde de dois hospitais complexos do sul de Chile. Uma amostra por conveniencia de dezenove profissionais foi selecionada. Os dados analisaram-se mediante análise de conteúdo em sua aproximacao convencional. Resultados: para os profissionais, a política é concebida a partir da autonomia financeira. Como fraqueza da implementacao persiste a ausencia de capacidades organizacionais e competencias dos recursos humanos em saúde. Conclusoes: superar a fenda entre concepcao e implementacao é crucial para o progresso na implementacao de reformas aos hospitais.

Implementación de las redes asistenciales de salud en Chile: percepciones de los profesionales de la salud / Implementation of health care networks in Chile: perceptions of health professionals / Implementação das redes assistenciais de saúde no Chile: percepções dos profissionais da saúde

Contexto del problema: la fragmentación de los sistemas de salud afecta la provisión de serviciosde salud. Objetivo: describir la percepción de los profesionales de la salud respecto de laimplementación de la red asistencial de salud de la provincia del Ranco, región de Los Ríos,Chile. Justificación: las percepciones de los profesionales son claves para mejorar la implementaciónde la red. Métodos: estudio cualitativo de tipo descriptivo y exploratorio con baseen entrevistas semiestructuradas en profundidad a dieciséis profesionales. La información seanalizó a través de la técnica de análisis de contenido. Resultados: la implementación de la redasistencial mejoró la coordinación de la provisión de servicios de salud. Sin embargo, existendiferencias de acuerdo con el nivel de responsabilidad administrativa respecto de las fortalezasy debilidades de la implementación. Conclusiones: persisten brechas del diseño de la reformade la salud que afectan la implementación de la red...

Context of the problem: the fragmentation of the health care systems affects the provision ofhealth services. Objective: To describe the perceptions of health care professionals regardingthe implementation of the health care network of Ranco Province, region of Los Rios, Chile.Justification: Professional perceptions are key to improving the network implementation.Methods: A qualitative exploratory and descriptive study based on semi-structured in-depthinterviews to sixteen professionals. The information was analyzed through the content analysistechnique. Results: the implementation of the assistance network improved the coordinationfor the provision of health services. However, there are differences according to the level ofadministrative responsibility concerning the strengths and weaknesses of the implementation.Conclusions: design gaps persist related to the health care reform that affect the implementationof the network...

Contexto do problema: a fragmentação dos sistemas de saúde afeta a provisão de serviçosde saúde. Objetivo: descrever a percepção dos profissionais da saúde no que diz respeito daimplementação da rede assistencial de saúde da província do Ranco, região de Los Ríos, Chile.Justificação: as percepções dos profissionais são fundamentais para melhorar a implementaçãoda rede. Métodos: estudo qualitativo de tipo descritivo e exploratório com base em entrevistassemi-estruturadas em profundidade a dezesseis profissionais. A informação analisou-seatravés da técnica de análise de conteúdo. Resultados: a implementação da rede assistencialmelhorou a coordenação da provisão de serviços de saúde. No entanto, existem diferenças deacordo com o nível de responsabilidade administrativa respeito das fortaleças e fraquezas daimplementação. Conclusões: persistem fendas do desenho da reforma da saúde que afetam aimplementação da rede...

Política de autogestión hospitalaria en Chile: percepciones de los tomadores de decisiones / Hospital self-management policy in Chile: perceptions of decision-makers

OBJETIVO: Conocer las percepciones de los tomadores de decisiones respecto de la etapa de implementación de la política de autogestión hospitalaria en dos hospitales de alta complejidad del sur de Chile. MÉTODOS: Se realizó un estudio cualitativo descriptivo y exploratorio basado en entrevistas semiestructuradas en profundidad a tomadores de decisiones de los hospitales Regional de la ciudad de Valdivia y San José de la ciudad de Osorno, durante el período de agosto de 2010 a diciembre de 2011. Se seleccionó una muestra por conveniencia de 26 tomadores de decisiones. Las 26 entrevistas fueron grabadas y transcritas en forma literal. El análisis de la información se hizo utilizando la técnica de análisis de contenido, en su aproximación inductiva. RESULTADOS: Para los entrevistados, la conceptualización de la autogestión está determinada por la autonomía para la toma de decisiones respecto de la asignación de recursos y el financiamiento de la provisión de servicios de salud en las instituciones hospitalarias. También manifestaron que para mejorar la etapa de implementación se deben incluir políticas de recursos humanos y de financiamiento de la función de provisión de servicios de salud. A las debilidades, por su parte, las relacionaron con la ausencia de capacidades organizacionales y competencias gerenciales de los equipos de salud para la implementación de los cambios. CONCLUSIONES: La política de autogestión hospitalaria es conceptualizada desde la autonomía financiera, y su implementación está determinada por las brechas de capacidad que persisten en el diseño de la política.

OBJECTIVE: To learn the perceptions of decision-makers concerning the imple­men­t­ation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. METHODS: A descriptive, exploratory, qualitative study based on semi-structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. RESULTS: The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. CONCLUSIONS: Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design.

Autonomía en la gestión hospitalaria en Chile: los desafíos para el recurso humano en salud / Hospital management autonomy in Chile: the challenges for human resources in health

En América Latina destacan experiencias de reforma sanitaria en donde se ha dado paso a la implementación de hospitales autónomos. En Chile, el sistema de salud implementa una reforma que introduce los Establecimientos de Autogestión en Red. Estos serán centros de alta complejidad que involucrarán una mayor diversidad técnica, centros de costos y mecanismos de evaluación de la satisfacción de los usuarios. Para el recurso humano en salud, la implementación de estos centros plantea desafíos en la planificación para la provisión de servicios, así como en la transición de la gestión clásica de los equipos a una basada en redes. Estos desafíos involucran la estimación de brechas de especialidades médicas, así como de otras profesiones del sector. Para el éxito de la autogestión en Chile, se deben establecer políticas globales y locales que aborden temas de formación y de organización de la provisión de servicios de salud en estas instituciones.

La participación social en salud: el desafío de Chile / Community participation in health: the challenge in Chile

Health care reforms implemented in Latin America and the Caribbean over the last 20 years have viewed community participation as a system-wide component. Nonetheless, these reform efforts have yet to break through the conceptual and operational barriers holding back the development and expansion of community participation. In Chile, changes introduced to the health care system are far from achieving any real participation from the community. Therefore, the consumer's role needs to be redefined from merely controlling the parts, to reaching across the whole system in a way that consumer input might identify and quickly correct any posible shortcomings in the health system's design, as well as its operations. With this in mind, the main challenges are to strengthen coordination among the various promotion and participation commitments, as well as community control, and to generate data and other evidence to assess the impact of community participation in health strategies.

Los recursos humanos de salud en Chile: el desafío pendiente de la reforma / Human resources for health in Chile: the reform's pending challenge

Omission of human resources from health policy development has been identified as a barrier in the health sector reform's adoption phase. Since 2002, Chile's health care system has been undergoing a transformation based on the principles of health as a human right, equity, solidarity, efficiency, and social participation. While the reform has set forth the redefinition of the medical professions, continuing education, scheduled accreditation, and the introduction of career development incentives, it has not considered management options tailored to the new setting, a human resources strategy that has the consensus of key players and sector policy, or a process for understanding the needs of health care staff and professionals. However, there is still time to undo the shortcomings, in large part because the reform's implementation phase only recently has begun. Overcoming this challenge is in the hands of the experts charged with designing public health strategies and policies.