[EFQM Model in the hospitals of Madrid Regional Health Service: full self-assessment cycle]. / Modelo EFQM en los hospitales del Servicio Madrileño de Salud: ciclo completo de autoevaluación.

AIM: To analyse a complete cycle of self-assessment using the European Foundation for Quality Management (EFQM) Model in the hospitals of the Madrid Health Service as regards the fundamental concepts of excellence (FCE). METHOD: Descriptive study of the EFQM self-assessments of the entire public hospital sector identifying the methodology and the information on strengths, weaknesses, evidence, RADAR matrix (Results, Approach, Deployment, Assessment and Review), and the related FCEs in the enabling criteria and in the prioritised action plans. RESULTS: The self-assessment was carried out in 85% of the hospitals (29/34), 86% of them required specific training (25/29), with a total of 329 teaching hours and 833 people in training. Multidisciplinary working groups were required in 83% of the hospitals (24/29), with 123 groups and 857 people involved. There were 3,686 strengths and 3,197 weaknesses identified: strengths and weaknesses were 78% (2,869) and 74% (2,355), respectively, for the enabling criteria and 22% (817) and 26% (842), respectively, for the results criteria. The mean score was 404 points with a median of 399. The main FCEs were managing with agility, developing organisational capability, sustaining outstanding results, creating a sustainable future, succeeding through the talent of people, and adding value for customers, with harnessing creativity/innovation and leading with vision, inspiration and integrity being placed in lower positions. A total of 113 action plans were identified for all the hospitals. CONCLUSION: A complete EFQM self-assessment cycle of the entire public hospital sector of a Regional Health Service is provided, linking the analysis and action plans with the FCE of the EFQM Model.

Utilización de los ejes transversales del modelo EFQM en el ámbito sanitario público / Use of the EFQM Red Threads in the Health Public Health System

Objetivo: Analizar la utilización de los ejes transversales (EETT) del modelo EFQM en la autoevaluación de las organizaciones de servicios en una comunidad autónoma, y describir el resultado de la autoevaluación para el conjunto del sistema sanitario público (SSP). Material y métodos: Estudio descriptivo en dos etapas: 1) evaluación del uso del modelo EFQM en el SSP, y 2) análisis de la metodología de trabajo mediante EETT. En la primera fase se analizó el 100% de los informes de autoevaluación (37 gerencias) de Atención Primaria (AP) y Especializada (AE) (2007). Se realizó un análisis cuantitativo de la distribución de puntos fuertes (PF) y áreas de mejora (AM), según nivel asistencial, centro sanitario y su agrupación en criterios y EETT del Modelo. Resultados: La utilización del modelo EFQM en el conjunto del SSP alcanza el 84% de las gerencias (32/37) y el 94% despliegan planes de mejora (30/32). Se describen 3.543 PF y 3.573 AM, para el SSP. Del total de PF, los criterios agentes suponen un 67,6%.ResultadosLos resultados por EETT resaltan la dominancia de los ejes de gestión de la organización, personas, clientes, proceso y comunicación. Resultados: Las dificultades para su aplicación derivan del liderazgo de la organización en gestión de la calidad, de las estrategias formativas para su despliegue, del carácter novedoso que supone la herramienta en determinados entornos, y de la potencial carga de trabajo generada. Conclusiones: Los EETT se perciben como un método de trabajo factible para la agrupación y síntesis de las AM, precisando una formación adecuada para optimizar su utilización (AU)

Objective: To analyse the use of transversal axes (TA) of the EFQM Model in the self- assessment of the service organisations in an Autonomous Community and to describe the self assessment results for the health care system (HCS) as a whole. Material and methods: Descriptive study divided in two phases: 1) evaluation of the use of the EFQM model in the HCS, and 2) analysis of the methodology using TA. All (37) of the self-assessment reports corresponding to Primary Care and Hospitals in 2007 were analysed. A quantitative analysis was performed on the strengths (S) and areas of improvement (AI) identified, stratifying them according to level of care, centre and EFQM criteria and TA. Results: The use of the EFQM in the HCS reaches 84% of the organizations (32/37), and 94% deploy improvement plans (30/32). A total of 3543 S and 3573 AI were described for the HCS as a whole. From the total identified S, enablers reach 67.66%. Results: Results according to TA the organization management axes are the dominant ones: people, clients, process and communication. Results: Application difficulties derive from the organizations’ leadership in quality management, the training strategies for deployment, the innovation character of the model in certain settings and the potential workload generated. Conclusions: TA are perceived as a feasible work method to gather and synthesize AI. However it requires appropriate training to optimize its use (AU)

[Use of the EFQM red threads in the health public health system]. / Utilización de los ejes transversales del modelo EFQM en el ámbito sanitario público.

OBJECTIVE: To analyse the use of transversal axes (TA) of the EFQM Model in the self- assessment of the service organisations in an Autonomous Community and to describe the self assessment results for the health care system (HCS) as a whole. MATERIAL AND METHODS: Descriptive study divided in two phases: 1) evaluation of the use of the EFQM model in the HCS, and 2) analysis of the methodology using TA. All (37) of the self-assessment reports corresponding to Primary Care and Hospitals in 2007 were analysed. A quantitative analysis was performed on the strengths (S) and areas of improvement (AI) identified, stratifying them according to level of care, centre and EFQM criteria and TA. RESULTS: The use of the EFQM in the HCS reaches 84% of the organizations (32/37), and 94% deploy improvement plans (30/32). A total of 3543 S and 3573 AI were described for the HCS as a whole. From the total identified S, enablers reach 67.66%. Results according to TA the organization management axes are the dominant ones: people, clients, process and communication. Application difficulties derive from the organizations' leadership in quality management, the training strategies for deployment, the innovation character of the model in certain settings and the potential workload generated. CONCLUSIONS: TA are perceived as a feasible work method to gather and synthesize AI. However it requires appropriate training to optimize its use.

[Evaluation of continuous education: from the satisfaction to the impact. With regard to a formative programme in minor surgery in a health area]. / Evaluación de la formación continuada: de la satisfacción al impacto. A propósito de un programa formativo en cirugía menor en un área de salud.

OBJECTIVE: To compare the evaluation of reaction of an activity of continuous education (CE) in minor surgery (MS), with the impact in the realization of MS in a health area. DESIGN: Observational cross-sectional study. Setting. 27 centers in a health area that offer MS between their services. MEASUREMENTS: The valuation was studied in a scale from 1 to 10, of 9 theoretical-practical activities of CE in MS and the consideration of its utility. The number of activities of MS (NMS) carried out in all the units, was picked up during one year, and a model of lineal regression was built. The independent variable was the NMS, and the explanatory ones the assistance pressure (AP), the postgraduate formation (PF), the staff of the unit, the equipment (E), and the carried out CE. RESULTS: The valuation of the CE had a median of 8 (with interquartile range 1), 85.1% of the people who realized CE in MS said that this would be of utility. However in the explanatory regression model the PF was the only significant variable (beta = 6.7; 95% CI, 0.12-12.22). Neither the CE, nor the AP, nor the E, explained the variability among the NMS. CONCLUSION: The CE in MS with conventional methodology has a very positive reaction evaluation, but its impact in the later realization of MS is not significant.

Evaluación de la formación continuada: de la satisfacción al impacto. a propósito de un programa formativo en cirugía menor en un área de salud / Evaluation of the continuous education: from the satisfaction to the impact. With regard to a formative programme in minor surgery in a health area

Objetivo. Comparar la evaluación de reacción de una actividad de formación continuada (FC) en cirugía menor (CM) con el impacto en la realización de CM en un área de salud. Diseño. Estudio descriptivo, transversal. Emplazamiento. Ventisiete centros de un área de salud, que tienen la CM en su cartera de servicios. Metodología. Se estudió la valoración en una escala de 1-10, de 9 actividades teóricoprácticas de FC en CM y la consideración de su utilidad. Se recogió el número de actividades de CM (NC) realizado en todas las unidades durante un año, y se construyó un modelo de regresión lineal cuya variable independiente era el NC, y las explicativas la presión asistencial (PA), la formación posgrado (FP), la plantilla de la unidad, el equipamiento (E) y la FC realizada. Resultados. La valoración de la FC tuvo una mediana de 8 (amplitud intercuartil, 1). Un 85,1 por ciento de los discentes opinó que la FC sería de utilidad. Sin embargo, en el modelo explicativo sólo la FP resultó significativa ( = 6,7; IC del 95 por ciento, 0,12-12,22). Ni la FC, ni la PA, ni el E, explicaban la variabilidad entre el NC. Conclusión. La FC en CM con metodología convencional tiene una evaluación de reacción muy positiva, pero su impacto en la realización posterior de CM no es significativo (AU)

[Analysis of a program of early breast cancer detection in a rural area]. / Análisis de un programa de detección precoz de cáncer de mama en una zona rural.

OBJECTIVE: To find the results of a breast cancer early-detection programme run in a rural area, in terms of the activities corresponding to primary care. DESIGN: Cross-sectional, observational study. SETTING: Rural district in Primary Care Area 11, Madrid. The programme was run in this area between 1st February and 31st March 1999. PATIENTS: Women from 50 to 64, both inclusive, who had been called for a mammography. INTERVENTIONS: Inclusion in the breast cancer early-detection programme and open telephone survey of those who did not take part to find the reasons for not taking part in the randomised sample. MEASUREMENTS AND MAIN RESULTS: In the period mentioned, 3902 women were called for screening (60.07% of all women between 50 and 64. The rest will be called in a second round in the year 2000). 2099 women attended for mammography (participation index 53.79%), with the following results: 5 (0.24%) highly likely to be malignant; 6 (0.29%) probably malignant; 172 (8.19%) probably benign; 1393 (66.36%) found to be benign; 438 (20.87%) negative; and 85 (4.05%) who needed further evaluation. The main reasons why 46.21% of the women called did not attend for mammography were: they had had one recently (29.9%); could not attend (22.7%); did not want to have one (17.5%); had not received the notification (17.5%). CONCLUSIONS: The participation rate was acceptable, with fewer malignant cases found than in other programmes. It would be important to call again those women who could not attend.

Análisis de un programa de detección precoz de cáncer de mama en una zona rural / Analysis of a breast cancer early-detection programme in a rural area

Objetivo. Conocer los resultados de un programa de detección precoz de cáncer de mama llevado a cabo en una zona rural, desde el punto de vista de las actividades que competen a la atención primaria Diseño. Estudio observacional transversal. Emplazamiento. Zona rural del Área 11 de Atención Primaria de Madrid. Ámbito temporal. El programa se llevó a cabo en dicha zona entre el 1 de febrero y el 31 de marzo de 1999. Pacientes. Mujeres de 50-64 años, ambos inclusive, citadas para hacerse una mamografía. Intervenciones. Inclusión en el programa de detección precoz de cáncer de mama y encuesta telefónica abierta para conocer los motivos para no participar en una muestra aleatoria de quienes no participaron. Mediciones y resultados principales. Durante las fechas mencionadas se citaron 3.902 mujeres (60,07 por ciento de todas las mujeres de 50-64 años. El resto serán citadas en una segunda ronda en el año 2000). Acudieron a hacerse las mamografías 2.099 mujeres (índice de participación, 53,79 por ciento), obteniéndose los siguientes resultados: 5 (0,24 por ciento) altamente sugestivas de malignidad; 6 (0,29 por ciento) probablemente malignas; 172 (8,19 por ciento) probablemente benignas; 1.393 (66,36 por ciento) con hallazgos benignos; 438 (20,87 por ciento) negativas, y 85 (4,05 por ciento) que necesitaban evaluación adicional. Los motivos fundamentales por los que un 46,21 por ciento de las mujeres citadas no acudió a realizarse las mamografías fueron: por tenerla recientemente hecha (29,9 por ciento), no poder asistir (22,7 por ciento), no querer hacérsela (17,5 por ciento) y no haber recibido la cita (17,5 por ciento). Conclusiones. La tasa de participación fue aceptable, habiéndose encontrado una proporción de casos malignos inferior a otros programas. Sería importante recaptar a las mujeres que no pudieron asistir (AU)