Aportaciones e inconvenientes de la incorporación de metodología cualitativa en la evaluación de servicios sanitarios. Un caso práctico: la evaluación de una consulta de alta resolución / Advantages and disadvantages of incorporating qualitative methodology in the evaluation of health services. A practical case: evaluation of a high-resolution clinic

Objetivo. En el marco de una evaluación sobre la calidad asistencial en una Unidad de Cardiología de Alta Resolución (UCAR) realizada con técnicas cuantitativas, se analizó la utilidad de incorporar una fase cualitativa a la investigación. Material y métodos. Se realizó una investigación cuantitativa con cuestionario estructurado y selección de sujetos por muestreo aleatorio sistemático (n=320) y una investigación cualitativa mediante entrevistas semiestructuradas a pacientes seleccionados por criterios de conveniencia (n=11), observaciones en el circuito asistencial y una entrevista en grupo con los profesionales de la UCAR. Posteriormente, el equipo de investigación, multidisciplinar, analizó individualmente la información recabada en las fases cuantitativa y cualitativa, evaluando los diferentes resultados obtenidos en ambas fases y los posibles sesgos derivados del uso de métodos cualitativos. Se realizaron tres reuniones siguiendo la técnica «brainstorming», para identificar las diversas aportaciones de cada una de las metodologías empleadas, utilizando diagramas de afinidades. Resultados. La investigación cualitativa permitió profundizar en algunos aspectos concretos del servicio que habían sido recogidos en la fase cuantitativa, matizando los resultados obtenidos en la fase previa, ahondando en las razones de insatisfacción con aspectos específicos, como los tiempos de espera y las infraestructuras disponibles, e identificando cuestiones emergentes del servicio, no evaluadas anteriormente. Conclusiones. Globalmente, la fase cualitativa enriqueció de forma sustantiva los resultados de la investigación. Es adecuado y recomendable incorporar este enfoque metodológico en investigaciones encaminadas a evaluar la calidad del servicio en un determinado contexto sanitario puesto que aporta, de primera mano, la voz del cliente(AU)

Objective. We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. Design and methods. A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. Results. Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. Conclusions. Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer(AU)

[Advantages and disadvantages of incorporating qualitative methodology in the evaluation of health services. A practical case: evaluation of a high-resolution clinic]. / Aportaciones e inconvenientes de la incorporación de metodología cualitativa en la evaluación de servicios sanitarios. Un caso práctico: la evaluación de una consulta de alta resolución.

OBJECTIVE: We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. DESIGN AND METHODS: A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. RESULTS: Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. CONCLUSIONS: Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer.

Sistemática para la protocolización de los cuidados de enfermería / A program to protocolize nursing care

Objetivo. Disminuir la variabilidad de la práctica clínica y homogeneizar y sistematizar los cuidados que prestan los profesionales mediante la protocolización de los cuidados de enfermería. Material y métodos. La dirección de enfermería del Hospital Gregorio Marañón en 2004 decidió desarrollar una sistemática para la protocolización de los cuidados de enfermería en 5 fases temporales: preparación, elaboración, difusión, evaluación y actualización, y que adquiriera el carácter de actividad continuada basada en la metodología del ciclo de mejora continua (PDCA). Se presta especial atención a la fase de la evaluación y a los tres tipos de herramientas utilizadas: evaluación de los indicadores de proceso, evaluación de los indicadores de resultados y encuesta sobre la percepción de los profesionales. Resultados. Elaboración de 30 protocolos y 80 procedimientos basados en la evidencia, accesibles, actualizables y con indicadores de evaluación. Discusión. La protocolización de los cuidados de enfermería disminuye la variabilidad de la práctica clínica, homogeneiza los cuidados y aumenta la implicación de los profesionales. La evaluación de proceso, de resultados y de adhesión de los profesionales es una parte imprescindible para la mejora continua(AU)

Objective. To decrease variability in clinical practice and to standardise and develop a systematic care programusing nursing care protocols. Materials and methods. The Directorate of Nursing of the Gregorio Marañón Hospital decided to develop a systematic program to produce nursing care protocols in 2004. It followed 5 phases: preparation, processing, dissemination, evaluation and updating. The program was based on the methodology for continuous improvement cycle (PDCA). Particular attention was paid to the evaluation phase, and to the three types of tools used: evaluation of the process and performance indicators and a survey on the perception of professionals. Results. A total of 30 protocols and 80 procedures were developed. They were evidence based, accessible, available for updating and with evaluation indicators. Discussion. Nursing care protocols decrease the variability of clinical practice. They homogenize care and increase the involvement of professionals. The evaluation of the process, outcomes and adherence of professionals is imperative for continuous improvement(AU)

[A program to protocolize nursing care]. / Sistemática para la protocolización de los cuidados de enfermería.

OBJECTIVE: To decrease variability in clinical practice and to standardise and develop a systematic care programusing nursing care protocols. MATERIALS AND METHODS: The Directorate of Nursing of the Gregorio Marañón Hospital decided to develop a systematic program to produce nursing care protocols in 2004. It followed 5 phases: preparation, processing, dissemination, evaluation and updating. The program was based on the methodology for continuous improvement cycle (PDCA). Particular attention was paid to the evaluation phase, and to the three types of tools used: evaluation of the process and performance indicators and a survey on the perception of professionals. RESULTS: A total of 30 protocols and 80 procedures were developed. They were evidence based, accessible, available for updating and with evaluation indicators. DISCUSSION: Nursing care protocols decrease the variability of clinical practice. They homogenize care and increase the involvement of professionals. The evaluation of the process, outcomes and adherence of professionals is imperative for continuous improvement.