Evaluación de la gestión del conocimiento en el Centro Nacional de Cirugía de Mínimo Acceso / Evaluation of knowledge management at the National Center for Limited Access Surgery

RESUMEN Introducción: La gestión del conocimiento es vital para las organizaciones de salud con vistas a garantizar la calidad de sus servicios. Objetivo: Evaluar la gestión del conocimiento en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó una investigación descriptiva de tipo transversal. Se elaboró, validó y aplicó una encuesta a 20 trabajadores del Centro en los meses de noviembre y diciembre de 2018. Se estudió la variable gestión del conocimiento, a través de sus elementos caracterizadores, los cuales fueron evaluados en dos dimensiones: importancia y frecuencia. Los datos se procesaron mediante los métodos de estadística descriptiva con el uso del programa SPSS v.21. Resultados: Se identificaron el compromiso de la alta dirección del centro con la gestión del conocimiento, la existencia de una infraestructura tecnológica suficiente para apoyar sus actividades, así como la necesidad de fortalecer los intercambios entre especialistas para compartir los resultados de investigación y aprovechar las lecciones aprendidas de los errores médicos y las no conformidades, para lo cual se requirió destinar tiempo y recursos. Conclusiones: El Centro Nacional de Cirugía de Mínimo Acceso es una institución con una destacada actividad en gestión del conocimiento. La aplicación de la encuesta para evaluar la gestión del conocimiento en el centro permitió identificar las oportunidades de mejora necesarias en apoyo a la innovación y la calidad del servicio de salud que se presta, lo que potencia aún más actividades como la formación profesional y el intercambio de las lecciones aprendidas entre los especialistas para el aprendizaje organizacional.

ABSTRACT Introduction: Knowledge management is vital for health organizations in order to guarantee the quality of their services. Objective: To evaluate knowledge management at the National Center for Limited Access Surgery. Methods: A descriptive cross-sectional investigation was carried out. A survey was prepared, validated and applied to 20 employees at this institution from November to December 2018. The knowledge management variable was studied, through its characterizing elements, which were evaluated in two dimensions: importance and frequency. The data were processed through descriptive statistics methods with the use of SPSS v.21 program. Results: The investigation identified the institution top management commitment with knowledge management, the existence of a sufficient technological infrastructure to support its activities, as well as the need to strengthen exchanges between specialists to share research results and take advantage of lessons learned from medical errors and non-conformities, for which time and resources were required. Conclusions: The National Center for Limited Access Surgery is an institution with outstanding activity in knowledge management. The application of the survey to evaluate knowledge management in the institution allowed identifying the necessary improvement opportunities in support of innovation and the quality of the health service provided, which further enhances professional training and exchange of lessons learned among specialists for organizational learning.

Evaluación de la estructura para la atención a diabéticos tipo 2 / Assessing the Structure for Assisting Type 2 Diabetic Patients

Fundamento: la diabetes tipo 2 en Cuba constituye un creciente problema de salud. Para la mejora continua de la calidad de la atención prestada a estas personas es necesario identificar los problemas de salud del paciente, a partir de evaluaciones, donde también se tenga en cuenta la estructura y las mejoras en el acceso a los recursos. Objetivo: evaluar la estructura que posee el Policlínico Comunitario José Antonio Echeverría de Cárdenas para la atención a los pacientes diabéticos. Método: se realizó una investigación en sistemas y servicios de salud de tipo evaluativa. Se utilizó un muestreo por conglomerado bietápico estratificado. Las variables estudiadas se relacionaron con la cobertura de los recursos humanos, capacitación y disponibilidad de recursos materiales. Los instrumentos aplicados fueron construidos y validados por expertos. Se calcularon números y porcientos como medida de resumen para variables cualitativas. El procesamiento se realizó por medo del paquete estadístico SPSS versión 21,0. Resultados: resultaron ser satisfactorios 11 de 19 indicadores, para un 57,9 %, por lo que se evaluó dicha dimensión de insuficiente. Conclusiones: la estructura resultó insuficiente, existieron deficiencias de índole material, estructural, organizacional, funcional y metodológica que repercutieron en la calidad de las prestaciones de los servicios brindados a los pacientes diabéticos.

Foundation: type 2 diabetes in Cuba constitutes an increasing health problem. For the continued improvement of the assistant quality provided to these patients, it is necessary to identify the patients health problems, upon the evaluations, where the structure and the improvements in the access to resources are also taken into account. Objective: to assess the structure of the Community Polyclinic José Antonio Echeverría of Cárdenas for assisting diabetic patients. Method: an evaluation research in health systems was developed using a sampling by stratified two stage conglomerate. The studied variables were related to coverage of human resources, training and availability of material resources. The instruments applied were built and validated by experts. Numbers and percentages were calculated in percentages as a summary measure for qualitative variables by statistic package SSPS. Results: eleven out of nineteen indicators were satisfactory, representing 57 %, so this dimension was evaluated as insufficient. Conclusion: the structure resulted insufficient, there were material, structural, functional and methodological problems which influenced the quality of the services provided to diabetic patients.

Bases legales de la calidad en los servicios de salud / Legal basis of quality in health services

La calidad de los servicios de salud se fundamenta en la satisfacción de la población, la excelencia profesional, la eficiencia en el uso de los recursos, en ofrecer una atención con un riesgo mínimo para los pacientes y en la evaluación del impacto final de las acciones en términos de ganancia en salud para los ciudadanos. Para el logro de este fin los servicios deben organizarse de forma adecuada y establecer o aplicar las normas, guías de práctica clínica, procedimientos y protocolos diagnóstico terapéuticos necesarios, además de realizar los procesos relacionados con la verificación de los instrumentos de medición y de la tecnología biomédica basados en el cumplimiento de las legislaciones vigentes. Con el objetivo de identificar el marco legal relacionado con la calidad de los servicios asistenciales en el sector de la salud se realizó una revisión del tema y se identificaron los Decretos leyes y Resoluciones Ministeriales correspondientes que refrendan y soportan la calidad en los servicios de salud. Estos decretos y resoluciones están vigentes y su conocimiento es indispensable para su control y cumplimiento

The quality of health services is founded on the population's satisfaction, the professional excellence, the efficient use of resources, the provision of care with minimum risks for the patients, and the evaluation of the final impact of actions in terms of better health for the citizens. To this end, the services must be adequately organized and one must set or apply the required standards, clinical practice guidelines, procedures and therapeutic diagnosis protocols, in addition to implementing methods related to checking of measuring instruments and of biomedical technology, on the basis of the fulfillment of the present legislation. With the objective of identifying the legal framework associated to the quality of medical assistance services, a literature review on this topic was made and then the corresponding decree-laws and resolutions passed by the Ministry, which endorse the quality of health services, were identified. These decree-laws and resolutions are in effect, so it is indispensable to know them for their control and compliance

Measuring the efficiency of dental hospitals with measurement of the service quality / 대한구강보건학회지

OBJECTIVES: Traditional nonparametric efficiency analysis was based on the relationship between the quantitative input and output measures. This study performed nonparametric efficiency analysis, which uses the results of dental hospital accreditation with quantitative output measures. METHODS: Data came from 35 hospitals between 2008 and 2010 that participated in the demonstration projects of dental hospital accreditation. The study employed two-stage double bootstrapping (TSDB) method to overcome the shortcomings and biased results of the traditional Data Envelope Analysis (DEA). Input measures included staffs, dental hygienists, other chair-side assistants, and administrative personnel, as well as dental equipment (dental chairs). Production measures were total revenues and the number of patients that visited the participating hospitals. We considered the environmental variables, which would affect the efficiency score of dental hospitals, dental hospital types, accreditation scores, and patients' satisfaction scores. RESULTS: There was a large split between the traditional DEA scores and TSDB scores. A total of 22 out of 35 hospitals had perfect efficiency in the traditional method, but none of those showed 100% efficiency in the TSDB. Overall efficiency score was the highest in the dental facility of general hospitals (71% mean efficiency), and dental teaching hospitals were the lowest (55% mean efficiency score). The factors that affected the efficiency of dental hospitals were the types of the dental hospital and the accreditation score. CONCLUSIONS: Traditional DEA scores had biased estimates and tended to be higher. The study found that organizational efforts for improving service qualities and patient safety would affect the efficiency, as well as the accreditation results.

Avaliação da qualidade da atenção básica em 37 municípios do centro-oeste paulista: características da organização da assistência / Evaluation of the quality of primary care health services in 37 municipalities in the State of Sao Paulo, Brazil: organizational dimensions of care

No Estado de São Paulo, existe uma rede extensiva de serviços de Atenção Básica (AB) com perfil organizacional heterogêneo e pouco conhecido. Este estudo objetiva caracterizar a organização dos serviços de AB em 37 municípios do Centro-oeste paulista, como primeira etapa de um projeto de avaliação da qualidade desses serviços. Trata-se de um estudo transversal conduzido mediante questionário estruturado, autorrespondido pelos gerentes e equipes locais, com questões que abordam características institucionais e de organização e gerência do trabalho. Esses questionários foram enviados para 131 UBS, distribuídas em 37 municípios. Obteve-se resposta de 113 unidades (87 por cento) localizadas em 32 municípios (86,4 por cento). Do total de unidades, 57 (50 por cento) são UBS tradicionais, 26 (22,8 por cento), Unidades de Saúde da Família, e 31, (27,2 por cento) organizadas segundo formas mistas. A maioria dos serviços (62 por cento, 70/113) não trabalha com área de abrangência delimitada de modo planejado. Os serviços se polarizam entre aqueles que realizam entre 70 e 100 por cento de consultas médicas agendadas (37,6 por cento, 41/109), e aqueles que realizam entre 70 e 100 por cento de não agendadas (39,4 por cento, 43/109). Não possuem conselhos locais organizados 65 unidades (63,7 por cento, 65/102). Os dados coletados permitem discutir as características dos principais programas, procedimentos e ações realizados pelos serviços. Os perfis organizacionais predominantes apontam a presença de deficiências de estrutura e processo em relação às diretrizes do SUS. O desenvolvimento de instrumentos de autoavaliação permite que as equipes se apropriem, de forma crítica, de seu trabalho, e possam elaborar novos arranjos tecnológicos para melhoria da qualidade.

Inadequate utilization of prenatal care in two Brazilian birth cohorts

Data for two birth cohorts from two Brazilian municipalities, Ribeirão Preto in 1994 and São Luís in 1997/1998, were used to identify and compare factors associated with inadequate utilization of prenatal care and to identify factors capable of explaining the differences observed between the two cities. Prenatal care was defined as adequate or inadequate according to the recommendations of the Brazilian Ministry of Health. The chi-square test and Poisson regression were used to compare differences in the inadequacy of prenatal care utilization. The percentage of inadequacy was higher in São Luís (34.6 percent) than in Ribeirão Preto (16.9 percent). Practically the same variables were associated with inadequacy in both cities. Puerperae with lower educational level, without a companion or cohabiting, who delivered in public health units, younger than 20 years, multiparae and smokers, with low family income presented higher percentages of inadequate prenatal care utilization. However, the effects of some variables differed between the two cities. The risk for inadequate use of prenatal care was higher for women attended in the public health sector in São Luís and for cohabiting women in Ribeirão Preto. The effect of the remaining factors studied did not differ between cities. The category of admission accounted for 57.0 percent of the difference in the inadequate use of prenatal care between cities and marital status accounted for 45.3 percent of the difference. Even after adjustment for all variables, part of the difference in the inadequacy of prenatal care utilization remained unexplained.

La calidad del cuidado y la satisfacción de la persona / Quality care and client satisfaction

En este ensayo se plantea en primer lugar las diferentes concepciones y aportaciones de varios autores sobre el significado de la calidad, se hace énfasis en la calidad de los servicios de salud para dar paso a algunas reflexiones sobre las características específicas que tiene el cuidado Enfermero en cuanto a la calidad de la atención se refiere. Se caracterizan según varios autores los factores que producen satisfacción o insatisfacción del usuario de los servicios de salud, así como la complejidad que implica la evaluación de la calidad de la atención de Enfermería. Se presenta el modelo de Jurán de prevención de errores y la importancia que tiene el garantizar la seguridad de los pacientes a través de la aplicación del proceso de dirección de riesgos. Finalmente se analiza la importancia que tiene la satisfacción de la persona a la que se cuida así como el cumplimiento de sus expectativas con respecto a su atención y el papel protagónico que al respecto tiene el personal de Enfermería.

In this essay we discuss the different concepts and approaches of several authors related to the meaning of quality. Em-phasis is made in the quality of health services that give place to some reflexions over the specific characteristic that nursing care has in relationship to the quality of care. An analysis is made related to the factors that produces satisfaction or lack of satisfaction of the users of health services as well as the complexity that and evaluation of Nursing care. A model is presented as portend out by Juran on how to prevent errors and the importance that the security of a patient has through a process of risk direction. Finally the importance of the person satisfaction that is being taken care of is analysed as well as the fulfillment of the expectations hat he has in relation to his care and the protagonic role that in this context the nurses personnel have.