Sistema informático para un cuadro de mando integral del control interno como apoyo a la gestión de la información hospitalaria / Information system for an integrated internal control panel in support of hospital information management

En Cuba se ha identificado la necesidad de dominar y de introducir en la práctica las tecnologías de la información y las comunicaciones y de lograr una cultura digital como una de las características imprescindibles para los hospitales, lo cual sigue constituyendo un reto con múltiples aristas, enfoques y puntos de vistas. En este sentido se destaca el control interno como un motor de gestión de la información. Este trabajo tuvo como objetivo desarrollar un sistema informático para la automatización del cuadro de mando integral como herramienta de control interno en entidades hospitalarias, que contribuya a la gestión de la información en ciencias de la salud. Se programó un software mediante el entorno de desarrollo integrado Embarcadero Delphi, el cual utilizó Object Pascal como lenguaje de programación. Para el proceso de elaboración del sistema informático se empleó la metodología SCRUM, con una la lista de productos que consiste en el conjunto de requerimientos funcionales y no funcionales que debe satisfacer la aplicación. Se logró el desarrollo del software MULTI-CONTROL-INTERNO, con una ventana principal que incluye un menú contextual para acceder a todas las ventanas de la aplicación e introducir los valores de las variables necesarias para calcular los indicadores y gráficos dinámicos de cada una de las perspectivas del cuadro de mando integral, y se obtuvo el diseño de las estrategias para la mejora del sistema sanitario según la gestión de la información en el hospital a través de los índices de cumplimiento de los objetivos, la eficacia, la eficiencia y los componentes del control interno. El sistema informativo en entidades hospitalarias cubanas es hoy un acápite pendiente por la dinámica del entorno sanitario(AU)

The purpose of the study was to develop an information system for the automation of the integrated control panel as an internal control tool in hospitals, thus contributing to health information management. A software application was programmed in the Embarcadero Delphi integrated development environment, using Object Pascal as programming language. Development of the information system was based on SCRUM methodology, with a list of products consisting in the set of functional and non-functional requirements to be met by the application. The software Multi-internal-control was thus developed, with a main window which includes a context menu to access all the windows in the application and enter the values of variables required to estimate the dynamic charts and indicators of each of the perspectives on the integrated control panel, obtaining the design of strategies for the improvement of the healthcare system according to the information management procedure in place at the hospital, through goal achievement indices, efficacy, efficiency and internal control components. The information system at Cuban hospital institutions is still a pending item due to the dynamics of the healthcare environment(AU)

Modelo del sistema de enfrentamiento a la COVID-19 soportado en un Cuadro de Mando Integral / Effectiveness of the system to face COVID-19 pandemic supported on a Balanced Scorecard

Introducción: El enfrentamiento a la COVID-19 impone importantes retos a los profesionales de la salud relacionados con la prevención y control de infecciones en la comunidad y en las instituciones de salud. Uno de los mayores retos a los que se enfrenta los hospitales es gestionar de una forma más eficiente sus recursos sin que ello suponga un deterioro de la calidad percibida por el paciente y personal sanitario. Objetivo: Modelar la efectividad del sistema de enfrentamiento a la COVID-19 basado en su eficacia y eficiencia. Método: Confección de un Cuadro de Mando Integral basado en indicadores de eficiencia y eficacia. Resultados: Se diseñó el Cuadro de Mando Integral para el sistema de enfrentamiento a la pandemia. Cuenta con cinco perspectivas: Financiera, Aprendizaje y Crecimiento, Procesos internos, Cliente y Vida, esta última relacionada con el indicador de letalidad del virus. Se tiene los indicadores globales de eficacia y eficiencia y el EFECOVID, que permite determinar la efectividad del sistema ante esta pandemia. Conclusiones: Se diseña el indicador EFECOVID para diagnosticar la efectividad del sistema de enfrentamiento a la COVID-19. Tiene como soporte un Cuadro de Mando Integral diferente al tradicional por estar dirigido a disminuir los efectos de la pandemia, además, detener como perspectiva adicional de desempeño a "Vida" que manifiesta que el fin es quebrantar la pandemia(AU)

Introduction: Facing COVID-19 adds important challenges for healthcare professionals in charge of the facilities, and the control and prevention of infections in the community. One of the biggest challenges faced by hospitals is to manage their resources with more efficiency without lowering the quality of the service. Objective: To shape the efficacy of COVID-19 management system, based on its effectiveness and efficiency. Method: A balanced scorecard was made based on indicators of efficiency and effectiveness. Results: The balanced scorecard was designed to support the pandemic management system, with 5 indicators of performance: Financial, Learning and Growth, Internal Processes, Client and Life (the last one related to virus lethality indicator). The global indicators of efficiency-effectiveness and EFECOVID serve as references to determine the usefulness of the system to face the pandemic. Conclusions: The EFECOVID indicator was designed to diagnose the efficacy of COVID-19 management system. It is supported by a balanced scorecard, different from the traditional one in order to stop the pandemic, contrary to ¨Vida¨ program, that was focused on dealing with the pandemic(AU)

Modelo del sistema de enfrentamiento a la COVID-19 soportado en un Cuadro de Mando Integral / Effectiveness of the system to face COVID-19 pandemic supported on a Balanced Scorecard

RESUMEN Introducción: El enfrentamiento a la COVID-19 impone importantes retos a los profesionales de la salud relacionados con la prevención y control de infecciones en la comunidad y en las instituciones de salud. Uno de los mayores retos a los que se enfrenta los hospitales es gestionar de una forma más eficiente sus recursos sin que ello suponga un deterioro de la calidad percibida por el paciente y personal sanitario. Objetivo: Modelar la efectividad del sistema de enfrentamiento a la COVID-19 basado en su eficacia y eficiencia. Método: Confección de un Cuadro de Mando Integral basado en indicadores de eficiencia y eficacia. Resultados: Se diseñó el Cuadro de Mando Integral para el sistema de enfrentamiento a la pandemia. Cuenta con cinco perspectivas: Financiera, Aprendizaje y Crecimiento, Procesos internos, Cliente y Vida, esta última relacionada con el indicador de letalidad del virus. Se tiene los indicadores globales de eficacia y eficiencia y el EFECOVID, que permite determinar la efectividad del sistema ante esta pandemia. Conclusiones: Se diseña el indicador EFECOVID para diagnosticar la efectividad del sistema de enfrentamiento a la COVID-19. Tiene como soporte un Cuadro de Mando Integral diferente al tradicional por estar dirigido a disminuir los efectos de la pandemia, además, detener como perspectiva adicional de desempeño a "Vida" que manifiesta que el fin es quebrantar la pandemia.

ABSTRACT Introduction: Facing COVID-19 adds important challenges for healthcare professionals in charge of the facilities, and the control and prevention of infections in the community. One of the biggest challenges faced by hospitals is to manage their resources with more efficiency without lowering the quality of the service. Objective: To shape the efficacy of COVID-19 management system, based on its effectiveness and efficiency. Method: A balanced scorecard was made based on indicators of efficiency and effectiveness. Results: The balanced scorecard was designed to support the pandemic management system, with 5 indicators of performance: Financial, Learning and Growth, Internal Processes, Client and Life (the last one related to virus lethality indicator). The global indicators of efficiency-effectiveness and EFECOVID serve as references to determine the usefulness of the system to face the pandemic. Conclusions: The EFECOVID indicator was designed to diagnose the efficacy of COVID-19 management system. It is supported by a balanced scorecard, different from the traditional one in order to stop the pandemic, contrary to ¨Vida¨ program, that was focused on dealing with the pandemic.

[Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation]. / Utilidad del presupuesto y del cuadro de mando integral en la gestión de centros de atención primaria. Impacto sobre la motivación del personal.

OBJECTIVE: To analyse the utility perceived by managers of centers of primary care about management tools (budget and balanced scorecard), together their impact on human resources motivation. DESIGN: Qualitative study (case study) based on grounded theory performed between January and June 2014. LOCATION: Units of Clinical Management of Primary Health (UGCAP) in Metropolitan Health Area of Seville, Spain. PARTICIPANTS: UGCAP managers and Health Area (CEO) managers. METHOD: Data were collected through 8 semi-structured interviews using non-probabilistic intentional sampling with representation and sufficiency criteria of discourse. Interviews were recorded, literally transcripted and analysis through in-vivo codes. RESULTS: Both tools are fully implemented but differently used in primary care centers. Budget is perceived as a coercive management tool, which has been imposed for cost saving; however, it is scarcely adequate for day-by-day management. While balanced scorecard is a more flexible tool that allows identifying financial and welfare problems, budgeting limits heavily reduce the possibility of implementing adequate solutions. The policy of incentives is not adequate either, leading on de-motivation. CONCLUSIONS: This study shows that budgeting restrictions have led to a significant reduction in autonomy of Spanish Primary Care centers. Management decision making is much centralised, also focused on cost saving over quality of healthcare. As a result, two needs emerge for the future: increasing centers' autonomy and improving staff commitment through training and professional development programs.

[Development and evolution of a balanced scorecard in primary health care: Lessons learned]. / Desarrollo y evolución de un cuadro de mando integral en atención primaria: lecciones aprendidas.

OBJECTIVES: To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up. METHOD: Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation. RESULTS: As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals. CONCLUSIONS: There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim).