Introducción de la evaluación del grado de desarrollo de los servicios médicos en un hospital cubano. Metodología y resultados / Evaluation of medical departments’ development in a Cuban hospital. Implementation, methodology and results

RESUMEN

Objetivos: Diseñar y aplicar una metodología para evaluar el grado de desarrollo integral de los servicios médicos hospitalarios. Material y método: Durante los meses de agosto y septiembre de 2004 se planificó y llevó a cabo una investigación en servicios de salud. Después de varias "tormentas de ideas", mediante el método de juicio grupal ponderado, y por aproximaciones sucesivas, se identificaron 10 factores que se consideraron relacionados con el grado de desarrollo de cada servicio. Se confeccionó y aplicó un formulario, aprobado por 10 jueces seleccionados, y cada factor o acápite se calificó de 0 a 10 puntos. Se hicieron 3 evaluaciones independientes una autoevaluación por el jefe de servicio, una por el subdirector correspondiente y otra por un experto designado. Se obtuvo un promedio de las 3 que se tomó como la definitiva. Resultados: Se logró diseñar una nueva metodología fundamentada para evaluar integralmente cada servicio médico del hospital. Se aplicó exitosamente y se presentan los resultados parciales y finales de 36 servicios asistenciales. El rango de calificación osciló entre 53,4 y 89,6 puntos, lo que refleja que el método discrimina objetivamente lo que antes se hacía de modo subjetivo. En la división por cuartiles, las puntuaciones observadas fueron 8 servicios en 89,9-80,6; 18 servicios en 80,6-71,5; 5, en 71,5-62,4, y 5, en 62,4-53,4 puntos. Conclusiones: La metodología original, diseñada y aplicada en el hospital, constituye una herramienta útil, flexible, barata y fácil de aplicar, permite programar actividades específicas para el mejoramiento continuo de cada servicio, según sus características particulares

ABSTRACT

Objectives: To design and apply a comprehensive methodology for the evaluation of hospital medical departments. Material and method: During August and September, 2004, research into medical departments was planned and carried out. After several brainstorming sessions and weighting the group's ideas by successive approximations, 10 factors were identified as being related to the level of development of each of the departments. A form was designed, which was approved by 10 selected experts, and each factor was evaluated on a scale of 0-10 points. Three independent evaluations were performed a self-evaluation by the head of department, a second evaluation by the corresponding deputy director and a third by a designated external expert. The average of the three evaluations was considered as the final or conclusive evaluation. Results: A new methodology was outlined for a comprehensive evaluation of each medical department in the hospital. This methodology was successfully applied and partial and final results of the 36 medical departments were presented. The range of scores obtained was between 53.4 and 89.6 points, reflecting the methodology's discriminatory power. When the final scores were divided by quartiles, eight departments scored between 89.9 and 80.6 points, 18 departments between 80.6 and 71.55 points, five departments between 71.5 and 62.4 points, and five departments between 62.4 and 53.4 points. Conclusions: This original methodology, designed and applied in the hospital, is a useful, flexible, cheap and easy-to-apply tool for evaluating the level of development of medical departments. This methodology allows specific activities for the continuos improvement of each department to be planned, according to their particular characteristics