[The design of a monitoring system for the development of quality assurance programs]. / Diseño de un sistema de monitoría para el desarrollo de programas de garantía de calidad.

The need for the development of a monitoring system as a support emerged in Mexico from the experience acquired during the implementation of Quality Assurance Programs. The monitoring system is designed around the goals, activities performed to achieve the goals and the problems encountered in their achievement. The system conducts to the creation of indicators and standards for the monitoring of the essential activities for an optimal performance. The current article produces the grounds for the development of a quality assurance program through a monitoring system with the characteristics previously described.

[Quality circles as a strategy of a medical care quality assurance program at the Perinatology National Institute]. / Círculos de calidad como estrategia de un programa de garantía de calidad de la atención médica en el Instituto Nacional de Perinatología.

The present article shows the methodology of implantation of a quality guarantee program of medical attention through quality circles at the National Institute of Perinatology and it's results. Among them emphasize the following: organization's structure effects. The optimum on resources in it's own process of attention on the satisfaction of the patients and in the learning implicated in the adaptation of the technology to the hospital environment and the characteristics of a different culture from which that technology emerged. The project, conceived as investigation-action, was advised by Public Health Investigation Center and was created with the purpose to secure that the organized conditions under which the medical attention are given were those permitting to raise the quality as much in the among personal dimension as in the technical, through the participation of the personnel directly responsible of the services given. This led to the use of quality circles as participant technical of quality control and as main quality guarantee program of medical attention. Seven stages can be identified in the implantation of the quality assurance program using the quality circles: 1) to elaborate the proposal document and work protocol; 2) negotiation; 3) drawing of a guide for the elaboration of a quality guarantee manual; 4) selection the point of starting; 5) elaboration of the quality guarantee manual by service; 6) to operate the quality circles; 7) evaluation of the program. This experience has demonstrated it's feasible using the quality circles as fundamental components of a quality guarantee program of medical attention and permits to secure that, in general, it is possible to use this technology in the health services.

[Unit of quality assurance. A strategy to insure optimal levels of medical care quality]. / Unidad de garantía de calidad. Estrategia para asegurar niveles óptimos en la calidad de la atención médica.

The quality assurance unit of medical attention (UGC) is one of the outside programs of the National Institute of Public Health (INSP), which was created may 25 1989, as agreement of the government board (INSP) to coordinate the efforts of the same Institute on the field, developed the knowledge in quality assurance and to promote it's application at the health services. The task of the UGC is to promote a quality culture and to create consciousness on the health personnel, on the contribution that this quality has in the one service rendered, to make them participate in a determined, enthusiastic, and effective way for the success of the objectives and institutional goals. The areas which the UGC develops to obtain it's objectives are four: teaching, investigation, advising and information. The generality of the quality to all the functions of the health services is a priority task of UGC to favor, in a significative way, the progress of the health services in Mexico, and as possible, in Latin America.

[Program of quality assurance at the primary level of health care]. / Programa de garantía de calidad en el primer nivel de atención.

Health care quality assurance is an increasing demand of our social environmental, regarding not only high medical technology centers but, even more so, the services given at the primary care level, that covers the greater part of the population. In this paper we describe a quality assurance program implemented through "quality circles" within the immunization program of a primary health care center. The study was done in several stages. In the first two steps (preliminary diagnosis of the local immunization program, and coverage evaluation) the main problems affecting the program's quality were identified. In turn, these results allowed the implementation of the next phases: integration of the quality circles, elaboration of a quality assurance manual, and actual operation of the quality circles. A methodology first developed in a third level care institution was applied in this quality assurance program, which, on the other hand, showed immediate benefits on the services rendered.