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The search for quality starts with the identification of client`s needs and expectations, as the essential foundation of any organization. In this search process, we identify improvement areas that enable specific actions that finish the closest to total client`s and other interested agents` satisfaction (Workers, shareholders, suppliers, etc). This approach is equally valid in the health care environment. Development of a quality improvement plan based on process management is a resource of important value for the search of excellence in a clinical unit. Great part of this monographic issue is dedicated to show the experience recorded in a Urological unit.
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OBJECTIVES: Many strategies have been proposed over the last years to ensure the Health Care System sustainability, mainly after the recent global economic crisis. One of the most attractive approaches is clinical management, which is a way of organizing health care units based on active participation of professionals who receive the transference of responsibilities proper patient centered care, taking into consideration the rational use of resources (Efficiency)For the start up of Health Care structures based on clinical management, it is necessary a previous management culture within the departments involved and the center`s executive board. Furthermore, to achieve the objectives proposed various tools must be used, such as evidence based medicine, clinical practice variability analysis, process management, in addition of quality and safety strategies.The units involved have to propose a management plan that will result in a management contract with the center`s executive board. This agreement will establish some activity, expense and quality objectives that will be quantifiable through various indicators. Risk transference to the unit must include certain budget allocation and incentive decision capacity. Clinical management must not be employed as a savings tool from the part of macro and meso management.There is not a health care structure based on clinical management that have a general character for all health care organizations, existing a great variability in the adoption of various organizational formulas, so that every center must perform its own analysis and decide the most adequate model. In our country there are many clinical management experiences, although there is a long way to go.
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Portfolio methodology is widely applied to training, particularly in medical education and for medical trainees. Some Spanish Institutions (National University of Distance Learning and National School of Public Health) are using a seven dimension Portfolio in the field of Clinical Management, which could be used as conceptual framework and checklist for building up different documents for planning, programming and evaluating the new experiences of Clinical Units based on clinical management initiatives. This paper describe the Portfolio in short, takes into consideration its potential use, and concludes addressing the relevance of good governance and accountability for the medical professionalism.
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OBJECTIVES: The objective of quality management is the identification of improvement areas to achieve total client and other involved agents satisfaction. In this paper we describe the start up of a Quality Improvement Plan (QIP) in a Urology Department.METHODS: We assessed the current maturity and performance of the Unit by means of self-evaluation with a questionnaire adapted to the 2009 ISO 9004 standard by all the professionals in the unit (Physicians and Nurses). All the items in the questionnaire are based in attributes and evaluation lines gathered in the five chapters of the Standard. The areas of improvement were identified and specific objectives were established and collected in the QIP with indicators for their measurement, responsible individuals, chronogram and results evaluation. After implementation of the quality improvement actions, a second self-evaluation was performed to start a new cycle.RESULTS: After the first evaluation we observed a high global performance (61%). Analyzed by sections, the highest level was achieved in the human resources management chapter (73%) and the lowest in quality management (30%) due to the absence of a process management approach. After identification of improvement areas, we defined projects and activities to be developed, in the process management context. The second evaluation, after the implementation of process management in the unit, showed an improvement in the maturity level of the Unit, reaching an 83%.CONCLUSIONS: The management of a clinical department cannot be limited to continuous improvisation. A process management approach is necessary, finishing with the usual defects of the generated product (variability, errors, omissions, waiting lists). Excellence in the quality of health care is an essential objective in every healthcare organization and standardization models, such as 2009 ISO 9004 standard, are the right way for that purpose.
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OBJECTIVES: The methodology for process management implantation consists of four phases with their corresponding stages.: The first consists of mobilizing the organization and gaining support of the executive board of the center, as well as the people that will conform the working team. The second phase, once the processes have been identified and classified, is o document and implement them with their review performed. Once the process has been implanted, with time, there is a third phase that consists of its management control that ends with the evaluation. Once the processes are evaluated, both from the internal point of view and comparatively with other organizations with the same clinical mission, there are two possibilities: to put them in a gradual or sustained improvement or to a radical improvement if a lack of performance or quality is noticed. In this article we describe the first two phases of implantation that are fundamental for organizational processes documentation and stabilization.
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Every organization with the intention to be oriented to processes management must know it is a system and what are the factors that characterize it. Health care institutions are open and mixed systems. It is in this system where the chain of value of the productive process occurs, generating a very complex integrated management system, as the productive system main recipients are people with health needs.The process management approach in clinical centers, departments and units means that, once the processes have been identified, they have to be set depending on their mission, establishing a boxes and connections architecture known as process maps.Therefore, a map of processes is the graphical representation of the organizational management system, which may be deployed applying modeling techniques at various levels. In this article we will review the conceptual framework of the health care productive system and management with the focus on processes, incorporating didactic products based on experiences from various centers and health services.
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The implantation of total quality management models in clinical departments can better adapt to the 2009 ISO 9004 model. An essential part of implantation of these models is the establishment of processes and their stabilization.There are four types of processes: key, management, support and operative (clinical). Management processes have four parts: process stabilization form, process procedures form, medical activities cost estimation form and, process flow chart. In this paper we will detail the creation of an essential process in a surgical department, such as the process of management of the surgery waiting list.
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New models in clinical management seek a clinical practice based on quality, efficacy and efficiency, avoiding variability and improvisation. In this paper we have developed one of the most frequent clinical processes in our speciality, the process based on DRG 311 or transurethral procedures without complications. Along it we will describe its components: Stabilization form, clinical trajectory, cost calculation, and finally the process flowchart.
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OBJECTIVES:To evaluate the performance of a one-stop clinic in terms of proportion of diagnostic-therapeutic orientation during 2013.METHODS: All patients were referred from primary care facilities in the district of Fuenlabrada, Madrid, Spain (population 221.705). Previously, referral protocols were agreed. Seven senior urologists participated. 6674 referrals (January-December 2013) were eligible.RESULTS: 4534 referrals (4535/6674, 68%) were eventually evaluable. Patients taking advantage of the one-stop format were significantly younger than those needing extra consultations (chi2<0,001). Overall, reasons for consultation clearly affected the feasibility of the one-stop approach (chi2<0.001), the one-stop policy being substantiated in most consultations due to subfertility (89.4%), male sexual dysfunction (89.2%), testicular complains (88.3%) and other male genital complains (80.3%). On the contrary, extra consultations were the rule for degenerative diseases of the urinary tract (45%), malignancy (57%) and renal colic pain or urinary lithiasis (63.2%). No relationships could be identified between the referral centre and the feasibility of the one-stop approach (p=ns).The multivariate analysis confirmed the independent effect of the health problem (p<0.001) and patient age (p<0002) on the chances of having a successful one-stop approach.CONCLUSIONS: a one-stop philosophy should be the standard for all patients in urology clinics.
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The traditional health care model is currentlyfacing new health requirements. The implementationof integrated urologic health systems can be one ofthe possible solutions to these needs. It is mandatoryto explore a new health care model, which includesstructural and organizational changes. The adequacyof the urology departments of IDCsalud-Madrid networkhospitals, creating URORed, is a new system adaptableto constant changes, in order to offer professionalismand quality health care.OBJECTIVE: To describe the administrative/clinicmanagement in the urology service of a health caremodel of Hospitals network (URORed at IDCsalud.Madrid), that has been included in a model of anIntegrated network in a health care service.METHODS: In the period between November2007 to October 2014, the urology departments ofIDCsalud Madrid Group, have been included in a neworganizational system, including 4 hospitals, currentlywith 27 urologists. Each center offers specific urologicservices, sharing benefits and human resources. Thesame directive line leads all centers.RESULTS: The model offers an integrated and uniformurologic service to a specific population of 811.390habitants (Population Census 2012), with capability totreat specific urologic diseases and to perform a correctclinical follow-up.CONCLUSIONS: Belonging to a health care modelin network involves a change of attitude. It creates anorganizational change, based on the processes andthe results, which enables control of the managementanalytically, detecting the points that need to beoptimized as well as those that are satisfactory. It impliesdeveloping a culture of learning and cooperation, sothat the processes are fluent and have quality, to createclinical and technological projects in favor of newresource-generating research, based on the needs ofthe joint management of the hospitals network. Thecomplexity of this model requires a work focused onthe human resources, their concerns and their ability tocoordinate actions to get results in terms of quality healthcare and professionalism.
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OBJECTIVES: In the urology clinics there is an important volume of limited-complexity pathology that consumes an important part of resources. Delegating some tasks of this type to Nurses may imply a competitive advantage in economic terms without decrease in the quality of the care given to patients and their level of satisfaction. This is an example of the concept of inverse innovation. In this work we try to make public our experience in the management by nursing staff of features of the urology consultation traditionally reserved to physicians, as well as the design of the related processes.METHODS: We developed the most frequent processes competence of the nursing staff in the unit: 1) Care of ambulatory urological surgery pathology; 2) Urologic ultrasound; 3) Traditional urologic nurse consultation.RESULTS: During 2013 the nursing staff performed 423 ambulatory urologic surgery pathology clinic visits, 931 urologic ultrasounds and 1019 varied actions corresponding to traditional urological nurse work.We developed stabilization formularies and flow diagrams of the aforementioned processes. We performed a quantification of the amount of money saved in comparison with the costs generated if a nurse or a physician was employed. Such saving was 2,78 and 4,00 Euros in the ambulatory urological surgery pathology and urologic ultrasound, respectively. Total savings in both processes was 4900 Euros.CONCLUSIONS: Implication of urological nursing staff in certain care tasks traditionally reserved to the physician is possible without increase in quality defects, obtaining an advantage in terms of economic cost and flexibility in staff organization thanks to the expansion of the competence array.
