Patients' perception of service quality in a healthcare not-for-profit organisation

Service organisations should be aware of those elements that are perceived as excellent quality and incorporate these as part of their service offering. However, a not-for-profit (NPO) healthcare organisation consists of a diverse group of stakeholders who have different perspectives and interests. Service quality therefore requires a multidimensional definition that comprehends all their needs and expectations.Methods: Perceived service quality experienced by patients was measured by completion of the Service Performance (SERVPERF) questionnaire. A total of 111 patients completed the questionnaire across three mobile clinics supported by an NPO.Results: The research results suggested that service quality at the mobile clinics was of a very high standard, with no meaningful differences between clinics, age groups or gender. However, the responses had very little variance and could have been subjected to response bias or extreme bias. The absence of a comparator organisation could also have had an influence on responses given by respondents. Conclusion: Healthcare service organisations should strive towards maintaining high standards and engage in continuous measurement and improvement of their service quality as part of their quality management process. By measuring the current level of service experienced by patients, insights have been identified where adjustments might have a positive effect on perceived value. Future research recommendations include suggestions to increase the sample population, taking the service setting into account and further studies to confirm the validity and reliability of solicited service quality questionnaires in a NPO setting.

Inclusión de la práctica colaborativa interprofesional para la promoción y prevención de la salud bucal / Inclusion of interprofessional collaborative practice for the promotion and prevention of oral health / Inclusão da prática interprofissional colaborativa para a promoção e prevenção da saúde bucal

Resumen Las actividades de promoción y prevención en Salud son relevantes en la Atención Primaria; no obstante, las relacionadas con el Programa de Salud Oral, en Chile, aparecen asociadas a los programas preventivos y no formando parte de ellos, situación que también ocurre en otros países. La presente revisión tiene como objetivos evidenciar las actuales políticas y lineamientos internacionales que indican que se debe propender a una Práctica Colaborativa Interprofesional para una mejor calidad en la atención; y proponer un trabajo interprofesional donde las acciones de promoción y prevención en Salud Bucal se incluyan en los programas preventivos existentes. La Práctica Colaborativa Interprofesional ocurre cuando los miembros del equipo de salud se organizan, planifican, gestionan y proporcionan servicios integrales de salud, evitando la fragmentación de los cuidados. Esto se logra estructurando las competencias comunes, colaborativas y específicas. El trabajo interdependiente permite complementar conocimientos y habilidades que contribuyen a cumplir con las políticas de Calidad de la Atención y Triple Meta en salud. De modo que, se proponen estrategias de trabajo en promoción y prevención de Salud Bucal a incorporar y ejecutar en los diversos programas preventivos ya existentes a lo largo del ciclo vital. En conclusión, es necesario un cambio de paradigma en la atención bucodental donde el foco ya no esté en el programa sino en el individuo, familia y comunidad para lograr una salud integral. Resulta relevante compartir experiencias de atención interprofesional y a incorporar la Educación Interprofesional y Practica Colaborativa en el proceso formativo de las futuras generaciones.

Abstract Health prevention and promotion actions are relevant in primary care; nevertheless, those related to the Oral Health Program in Chile are associated with preventive programs and are not part of them, which occurs in other countries as well. The objectives of this review are to display the current international policies and guidelines that indicate that an Interprofessional Collaborative Practice should be promoted for a better quality of care as well as to propose interprofessional work including promotion and prevention actions in Oral Health in the existing preventive programs. Interprofessional Collaborative Practice occurs when members of the health team organize, plan, manage and provide integral health services, avoiding fragmentation of care. This is achieved by structuring common, collaborative, and specific competencies. Interdependent work allows complementing knowledge and skills that contribute to comply with the policies of Quality of Care and Triple Aim in health. Therefore, work strategies in oral health promotion and prevention are proposed to be incorporated and implemented in the various preventive programs already in place throughout the life cycle. In conclusion, there is a need for a paradigm shift in oral health care, where the focus is no longer on the program but on the individual, family, and community to achieve comprehensive health. Finally, it becomes relevant to share experiences of interprofessional care, and incorporating Interprofessional Education and Collaborative Practice in the formative process of future generations.

Resumo As atividades de promoção e prevenção da saúde são relevantes na Atenção Básica; no entanto, aqueles relacionados ao Programa de Saúde Bucal no Chile aparecem associados aos programas preventivos e não fazem parte deles, situação que também ocorre em outros países. A presente revisão visa demonstrar as atuais políticas e diretrizes internacionais que indicam que uma Prática Interprofissional Colaborativa deve ser promovida para uma melhor qualidade de atendimento; e propor um trabalho interprofissional onde as ações de promoção e prevenção em Saúde Bucal estejam incluídas nos programas preventivos existentes. A Prática Colaborativa Interprofissional ocorre quando os membros da equipe de saúde organizam, planejam, gerenciam e prestam serviços de saúde integrais, evitando a fragmentação do cuidado. Isso é conseguido através da estruturação de competências comuns, colaborativas e específicas. O trabalho interdependente permite complementar conhecimentos e competências que contribuem para o cumprimento das políticas de Qualidade da Assistência e Triplo Objetivo em saúde. Assim, são propostas estratégias de trabalho na promoção e prevenção da Saúde Bucal a serem incorporadas e executadas nos diversos programas preventivos já existentes ao longo do ciclo vital. Conclui-se que é necessária uma mudança de paradigma na higiene bucal, onde o foco não seja mais o programa, mas sim o indivíduo, a família e a comunidade para o alcance da saúde integral. É relevante compartilhar experiências de cuidado interprofissional e incorporar a Educação Interprofissional e a Prática Colaborativa no processo de formação das futuras gerações.

Lineamientos y estrategias para mejorar la calidad de la atención en los servicios de salud / Guidelines and strategies to improve the quality of care in health services

RESUMEN El desafío de la Cobertura Universal en Salud (CUS) orientó a los países a desplegar sus mayores esfuerzos en la ampliación de la proporción de población protegida, la delimitación y ampliación de sus planes de beneficios, así como en la provisión de recursos financieros que permitan respaldar el pago de las prestaciones brindadas. En nuestro país, a través de la implementación de la política de aseguramiento en salud, ha sido posible arribar a importantes logros, evidenciando, sin embargo, un insuficiente efecto en el acceso oportuno y en la satisfacción de las necesidades de salud de gran parte de la población. En el presente artículo partimos por destacar los principales avances y limitaciones en el proceso hacia una CUS, orientando el desarrollo de la agenda pendiente, sobre la base de los planteamientos emitidos por Organizaciones Internacionales que apuntan hacia una mejora de los sistemas de salud a nivel global. Los desafíos pendientes incluyen esfuerzos de involucramiento y articulación de los diversos actores, en la tarea de rediseñar los procesos de atención, fortalecer la dimensión ética de su ejercicio, así como promover la participación ciudadana en la generación de un sistema de salud de alta calidad, que permita un acceso efectivo y oportuno a servicios de salud; ello obliga a adoptar medidas que alcancen a todo el sistema de salud, orientadas en una visión compartida y liderada por los responsables de su conducción y gobierno.

ABSTRACT The challenge of Universal Health Coverage (UHC) led countries to make greater efforts to increase the proportion of population protected, to define and expand their benefit plans, and to provide financial resources to support payment for the benefits provided. The implementation of the health insurance policy in our country has allowed reaching important milestones, evidencing, however, an insufficient effect on timely access and on meeting the health needs of a large portion of the population. In this article we begin by highlighting the main advances and limitations in the process towards a UHC, guding the development of the pending agenda, based on the proposals issued by international organizations aimed at improving health systems globally. The pending challenges include efforts to involve and articulate the various actors in the task at hand of redesigning healthcare processes, strengthening the ethical dimension of their practice, as well as promoting citizen participation in the generation of a high-quality health system that would facilitate effective and timely access to health services. This requires the adoption of measures that extend to the entire health system, based on a shared vision and led by those responsible for its execution and governance.

Calidad de la atención desde la perspectiva del usuario en una comunidad terapéutica en Veracruz, México / Quality of care considering the user perspective in a therapeutic community in veracruz, Mexico

Introducción. En México, uno de los problemas de salud pública son las adicciones, las cuales constituyen un fenómeno social con graves secuelas sanitarias y socioeconómicas de dimensiones considerables. Objetivo. Evaluar la calidad de la atención desde la perspectiva del usuario, en una comuni-dad terapéutica del estado de Veracruz, México.Métodos. Estudio transversal y analítico; la población fueron usuarios de la comunidad. Se utilizaron las pruebas ro de Spearman, biserial puntual, tau c de Kendall y ji al cuadrado (p≤0,05). Resultados. Se incluyeron61 usuarios, con media de edad de 33 años y primer consumo entre los 8 y los 17 años. La mayor frecuencia de estancia fueron, cuatro meses (62,3 %). El 96,7 % estaba conforme con la ubicación de la comunidad terapéutica y, el 95,1 %, a gusto con los servicios disponibles. A mayor edad, más miembros de la comunidad consideraron: adecuadas la ubicación (rbp=0,25) y la distancia al núcleo urbano más próximo (rbp =0,27); suficiente el tratamiento psicológico individual (p=0,015; ro=0,311), y suficientes las salidas individuales durante el tratamiento (p=0,028; ro=0,281). A mayor tiempo en el centro, más miembros de la comunidad consideraron insuficientes (p=0,036; ro=-0,187) las salidas indi-viduales durante el tratamiento y suficiente la diversidad del grupo (p=0,031; ro=0,193). La mayoría de los residentes consideraron suficientes el tiempo en la comunidad, la formación profesional y la variedad de profesionales, y como muy bueno, el trato del personal. Conclusiones.Las variables e indicadores estudiados fueron evaluados satisfactoriamen-te. Sin embargo, es importante la evaluación permanente para detectar áreas que pueden mejorar y hacer la corrección oportuna, como una estrategia organizativa fundamental para fortalecer los indicadores de calidad en la prestación del servicio.

Introduction: Addictions are one of the public health problems in México. They establish a social phenomenon that leads to serious consequences on the sanitary and socioeconomic field. Objective: To evaluate the quality of care considering the user perspective in a therapeutic community located in Veracruz, México. Methods: Cross-sectional and analytic study. Population: Users of the Therapeutic Commu-nity. The following tests were applied: Spearman's rho, Point-biserial correlation, Kendall's Tau-c and Chi-squared (p≤ 0.05). Results: Sixty one users were included, average age 33 years, first drug use between 8 and 17 years; the highest frequency was 4 months (62.3%). 96.7% expressed agreement with the location of the T.C. and 95.1% were satisfied with the available services. The older members of the community considered more suitable the location of the facility (rbp =0.25), also the distance to the closest city (rbp =0.27). They considered adequate the amount of Individual psychological treatment (p=0.015, rho=0.311) as well as adequate, the reinser-tion activities during treatment (p= 0.028, rho=0.281). Those with higher inpatient stay considered that these reinsertion activities were not enough (p=0.036, rho=-0.187) and they estimated as adequate the diversity of the group (p= 0.031, rho=0.193). Most users considered that the time they spent in the therapeutic community, the professional training, and diversity of the staff members were adequate and the care staff behavior was conside-red as very good. Conclusion: The variables and indicators studied were successfully evaluated. However, it is important ongoing assessment in order to identify areas to improve and make the due co-rrection, as a key organizational strategy to strengthen the quality indicators in the service.

Identificação do paciente nas organizações de saúde: uma reflexão emergente / Identificación del paciente en las organizaciones de salud: una reflexión emergente / Patient identification in healthcare organizations: an emerging debate

O processo de identificação do paciente é essencial para garantir a segurança e a qualidade da assistência nas instituições de saúde. O emprego de pulseira para identificação é uma prática usual. Contudo, fatores culturais, organizacionais, materiais e humanos concorrem para sua não conformidade, induzindo a erros ou acarretando eventos adversos. Este artigo teve como objetivos destacar os elementos constituintes do processo de identificação do paciente por meio de pulseiras e refletir acerca da implementação desse processo nas instituições hospitalares. Adotaram-se referenciais teóricos e normatizações de organizações e órgãos acreditadores que discutem a temática da segurança no âmbito hospitalar, bem como as iniciativas destinadas à identificação segura do paciente. Conclui-se que a identificação do paciente por meio de pulseira é uma prática recomendada internacionalmente, porém há lacunas no que tange à instituição de protocolos, à execução efetiva e à avaliação do processo para subsidiar ações gerenciais e assistências.

El proceso de identificación del paciente es esencial para garantizarla seguridad y la calidad de la atención en las instituciones de salud. El uso de la pulsera de identificación es una práctica común; sin embargo, factores culturales, organizativos, materiales y humanos compiten por su no conformidad, induciendo a errores o eventos adversos. Este trabajo tuvo como objetivo resaltar los elementos constituyentes del proceso de identificación del paciente por medio de las pulseras y reflexionar acerca de la implementación de este proceso en los hospitales. Hemos adoptado marcos teóricos y normas de organizaciones y organismos acreditadores que discuten la temática de seguridad en los hospitales, así como las iniciativas para la identificación segura del paciente. Se concluye que la pulsera de identificación del paciente es una práctica internacionalmente recomendada, pero hay brechas respecto al establecimiento de protocolos, la implementación eficaz y la evaluación del proceso para apoyar las acciones de gestión y asistencia.

The patient identification process is essential to ensure safety and quality of assistance in healthcare institutions. The use of a wristband for identification is common practice, although cultural, organization, material and human factors cause non-conformity resulting in errors or adverse events. The aim of this article is to highlight constituent elements of the patient identification process by means of wristbands and discuss topics related to the implementation of this process in hospitals. This study was based on theoretic references and standardizations of accrediting organizations and bodies that debate security in the hospital environment and incentives for safe patient identification. It was concluded that patient identification by means of wristbands is recommended internationally although there are loopholes in relation to protocol, effective execution and evaluation of the process to support management and healthcare actions.

Gestión de gobiernos locales en la calidad de la atención de la salud para niños / Local government management regarding the quality of children's healthcare

Objetivo Evaluar el componente de calidad de los programas de atención en salud dirigidos a niños, niñas y adolescentes establecidos por los gobiernos locales de Colombia en cumplimiento de las normas legales. Métodos Estudio descriptivo en el que se evaluó la evidencia de rectoría de los sistemas de calidad y del cumplimiento de los atributos de accesibilidad, oportunidad, seguridad, continuidad y pertinencia como indicadores de la calidad en la prestación de servicios. Resultado No se encontró evidencia que demuestre que los gobiernos locales examinados desarrollen programas de salud orientados a la niñez que sean específicos a su realidad epidemiológica. Las actividades que se ejecutan corresponden al mínimo legal y no son evaluados en su componente de calidad, por tanto no hay un enfoque de mejoramiento en los mismos. Conclusión Se proponen estos resultados como línea base y dado que la función de los gobiernos locales, en materia de calidad en salud, va desde la planeación, pasando por la rectoría y el control de la calidad de los prestadores, se hace inaplazable la implementación de programas de gestión de la calidad antes que nuevos programas de atención.

Objective Assessing the quality of healthcare programs aimed at children and adolescents set by Colombian local governments in compliance with current legal standards. Methods This was a descriptive study which evaluated the evidence regarding surveillance of quality systems and compliance with accessibility, opportunity, safety, continuity and relevance as indicators of quality concerning service delivery. Results No evidence was found showing that the local governments so examined were developing child-orientated health programs specifically addressing epidemiological reality. Ongoing activities complied with minimum legal requirements and were not being evaluated regarding their quality, meaning that an approach aimed at improvement was not being adopted. Conclusion The above results are thus proposed as a working baseline and, given that the role of local government in terms of healthcare quality ranges from planning, to surveillance and quality control concerning providers, quality management programs must be implemented before new healthcare programs are introduced.

Modelo de consultoria interna para o preparo de unidades hospitalares para a certificação de acreditação / Internal consultancy model for the preparation of hospital units for accreditation certification

Acreditação é um sistema de avaliação e certificação da qualidade de serviços de saúde, de caráter educativo, voltado à melhoria contínua, que confere à organização acreditada vantagens, como segurança para os clientes e profissionais e qualidade da assistência. A fim de preparar as unidades e os serviços para a avaliação de certificação de acreditação são necessárias consultorias internas, conduzidas por profissionais detentores de competência técnica, visão horizontal da organização e conhecimento de seus produtos e processos, responsáveis por incentivar as diversas equipes, facilitar o entendimento sobre os requisitos e estratégias necessárias para a referida certificação e supervisionar o processo. Diante de lacunas na literatura brasileira sobre consultoria interna com foco na gestão da qualidade na área da saúde, e também na acreditação, pelos padrões do Sistema Brasileiro de Acreditação, torna-se relevante a estruturação de um modelo de consultoria interna para o processo de preparo de unidades para a certificação de acreditação. Nesta perspectiva, os objetivos desse estudo foram a construção de um Modelo Lógico-Teórico de consultoria interna para o preparo de unidades ou serviços hospitalares para a avaliação de certificação pela acreditação, a aplicação do modelo a uma unidade do hospital, e a análise da sua aplicabilidade. Trata-se de uma pesquisa participante, com abordagem qualitativa, que foi realizada na Unidade de Clínica Pediátrica do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR), com nove integrantes do Grupo Interno da Qualidade. Utilizou-se a metodologia da problematização mediante o Arco de Maguerez, contemplando as etapas de Observação da Realidade, Pontos-chave, Teorização, Hipóteses de Solução e Aplicação à Realidade. A coleta de dados realizou-se no período de março a agosto de 2011 e a técnica utilizada foi a de grupos operativos viabilizados por meio de oficinas. O Modelo Lógico-Teórico desenvolvido mostrou-se eficaz e aplicável, por meio de processo participativo de construção da autonomia de um grupo, o qual atuou como agente de transformação da unidade de estudo, provendo um ambiente de cuidado seguro e de qualidade. Considera-se que o modelo pode ser replicado em organizações de saúde de qualquer natureza e porte, focalizando os demais programas e processos de gestão da qualidade, com as adequações apropriadas.

Accreditation is a system for evaluation and certification of the quality of healthcare services, of educational value, to achieve continuum improvement, which gives advantages to the accredited organization, such as safety for clients and staff and quality of care. In order to prepare unities and services to the evaluation for certification of accreditation, internal consulting is necessary, lead by professionals with technical competencies, horizontal view of the organization and knowledge of their products and processes, responsible for promoting the various teams, to facilitate understanding of the requirements and strategies needed for such certification and oversee the whole process. Because of the gaps in the Brazilian literature on internal consultancy with a focus on quality management in health care, and also on accreditation by the standards of the Brazilian System of Accreditation, becomes relevant research that builds an internal consultancy model for the process of preparing units for certification of accreditation. In this perspective, the objectives of this study were the development of a Logic-Theoretical Model of the internal consulting to prepare hospitals for the evaluation of the accreditation certification, and use this model in an unit of the hospital units and services, and the analysis of its applicability. It is a participatory research with a qualitative approach, which was held at the Pediatric Unit of the Hospital de Clinicas of Universidade Federal do Paraná (HC-UFPR), with nine members of the Internal Group of Quality. We used the methodology of questioning by the Arch of Maguerez, comprising the steps of Observation of reality, Key Points, Theorizing, Possible solutions and Application to reality. Data collection took place from March to August 2011 and the technique used was the operative groups, enabled through workshops. The Logic -Theorical Model developed proved to be applicable and effective in the development of a participatory process of building autonomy of a group, wich act as agent of transformation of the unit of the study, providing a safe environment of care and quality. Hence, it can be replicated in health organizations of any nature and size, focusing on other programs and processes for quality management, with appropriate adjustments.