MASGC8G/ Mtro. Adrián Nava Zamora/ Teorías de la Calidad y Herramientas Básicas

Ready. Okay, then, everyone again.

Welcome to this first session of your

Master's degree in auditing and systems

quality management in health. My

His name is José Luis Catzalco. I'm going to

Make your host in this and some

of the consecutive classes that go

having. And I have the pleasure of

introduce them to the teacher

Adrian Navas Zamora.

that in their work experience

serves as head of office of

OPD training

Tezcala Health from July 2014 to the

date. He was also responsible for

quality of this Tlazcala health OPD

from March 2011 to 2014.

Quality Manager at the Hospital

Apisaco Power Plant

in 2010.

epidemiologist in jurisdiction 2 of

Hamantla Atlascala,

Professor at the School of Nursing

from the Autonomous University of Tlazcala and

Terrenate from 1999 to 2005.

in their professional training.

The teacher has a master's degree in

quality sciences

and a master's degree in health sciences

public by the Autonomous University of

Atlascala. Furthermore, he holds a degree in

medicine from the Meritorious University

Autonomous University of Puebla. has attended

various congresses and courses

update, among which the following stand out:

Workshop course for instructors

design of training courses based

in competitions

from the University of the Altiplano in

Santana Chautén Pantlascala.

a diploma

2013 by Kiwos SUCAU Consulting in

Puebla, Puebla.

He also completed a diploma in design

and hospital construction in 2013

at our CP Mexico school

in the city of Puebla.

Another diploma in certification of

hospitals

Diploma in quality of care

patient and safety

in Mexico by the DGCES

in 2012 in

Mexico City.

Diploma in quality improvement,

patient safety and leadership in

Health from the Monterrey Institute of Technology.

Well, his resume is very extensive,

then I'm not going to stop

to take more time away from the teacher so that

can take full advantage of this experience

It has to contribute to this first one

quality material. Well, I'll give it to him

Welcome, Dr. Adrian, welcome.

I'll give you the floor.

Thank you. This teacher José Luis. Well

Well, thank you for attending this first

session and well, I should also acknowledge them

due to the interest in registering for this

mastery that he currently has

a lot

in health systems we have many

challenges and one of these is a good one because

Let's not talk so much about supervision now.

of health services, let's talk about

audit of health services.

Well, it's completely about starting to have

another concept of how to improve

health systems or care that

It is offered, especially in institutions

public institutions, because in public institutions

private, well, these concepts already

They've been applying it a lot for the last 15 years.

years, they already work with tracers, already

health processes, but yes our

institutions, we're talking about the most

large at the national level, Secretariat

IMS or ISTE, well yes, this, we have to

start introducing more methodology to

health care. So, look,

Let's begin. Sí, este, les voy a

training they have and the role they play

They currently play a role. That aside for

we will revisit examples during the

another area. Entonces, vamos a iniciar a

please.

Oaxaca. y maestro en seguridad,

Thank you. This,

Let's see if we can move forward.

saying what you see here on the screen

And let's move on a bit. TO

see, um, my friend Andrea, um, by

"Please," he tells us,

"Hello, good afternoon. My name is

Andrea Exel Franco Montoya, I am a chemist

pharmacist, biologist

I am currently the health officer.

in a central hospital mixing system

in a private sector institution, eh

medical oncology clinic.

Thank you. Okay, Monce, um, please,

If you can give us your feedback.

Thank you, teacher. I'm from here in EP for

If you want, continue with this other one.

student.

Yes, sorry. Okay, Hugo, this one here.

We're seeing your name. I hope you can

comment.

Teacher, I already introduced myself. Yours truly

Hugo Sánchez.

The image appeared. Okay, Ricardo, for

favor.

Hello, good afternoon. Uh, I'm Dr.

Ricardo Hernández, I am a doctor

ophthalmology specialist,

currently a physician at the Hospital

Regional High Specialty

Acapulco, Guerrero, Iste, doctor

attached to the State Institute of

Guerrero Ophthalmology and Medical Doctor

attached to the Ins Bienestar Hospital of

Acapulco. Also

Nice to meet you.

Thank you. Hey, César, if you'd do us a favor...

to show up.

Yes of course. How are you? Good afternoon to

all. My name is César Abraham,

Rubí Arriaga. This one, a graduate in

nursing, currently working for

Nuevo León State Health Department

Lion. Uh, currently working for

Well, as I mentioned, the Ministry of Health

in OPD.

I am currently achieving this as well.

as a specialist oncology nurse

in a unit dedicated to oncology, but

focused on breast cancer.

Thank you. Okay, Paola, please,

if you can.

Yes. Hello, good afternoon. I am Paola

Gómez, I am a biomedical engineer and

I currently work at a company

where we are suppliers of several lines

of medical products, including

negative pressure therapy. I'm in

The commercial area is about to open

a quality department here in the

company and I'm going to be part of it.

Thank you. Okay, José, this colleague

José.

Yes, good afternoon.

Uh, my name is José Obeso, I am

licensed chemist, pharmacist,

I am a biologist and currently work for

LINS. A new area has just been opened

mixing center where I work as

quality analyst.

Thank you,

Alan. Okay, Alan.

How are you? Ah, how can you hear me?

Good afternoon everyone. I am Alan Arispe,

I am a pharmaceutical chemist from UABC,

University of Baja California and

I currently have a position at a center in

mixtures as a quality analyst at IMS.

Thank you. Okay, Rosa, hopefully we

can share,

No? Good afternoon, Rosa Mejía Santa

Maria, I have a medical degree.

family medicine unit of ISLcala.

Thank you. This, Rosa

Angelica,

Good afternoon. I am this Angelica

López, I am a pediatrician and currently

I am on the pediatric ward at the

Thank you. Okay, um, Vania.

Hello, good afternoon. Yo soy técnica en

nursing and biochemical engineering graduate

quality in engineering.

Thank you,

Brenda. Brenda, my friend.

Hello, good afternoon. This, I am

especialidad en área crítica. Uh, by the

Thank you, Román.

Thank you. I work at ISE.

Thank you.

Thank you,

Good afternoon. Eh, yo trabajo en el

Ecuadorian Institute of Security

Social.

here. Hey, nice to meet you all. Am

Oro, Machala. Thank you.

Thank you. Is anyone else missing?

Yes, good afternoon. My name is

en el IMS de Villahermosa, Tabasco. Am

Thank you. Well, maybe it's already done, and now yes

someone was missing during the course

Connect, then we can do this

hear. Let's see if you can share this

DPE colleague the presentation or the

I'm sharing this here.

I think that's it, it's with the teacher

Catzalco.

Uh, I don't have your presentation right now.

readily available, but if you don't have it,

I'll download it from the platform right now.

No, I do have it because if you tell me that

Here it is, I just need them to give me

like opening the sharing option for me

And no problem.

Of course, doctor. I'll make this with

host so that it can also have

platform domain.

Okay, now all that's left is to amplify it

to complete the presentation.

There at the bottom of your screen,

where is the volume indicator?

Right next to it, just click on the icon

from the little screen.

Your microphone, doctor, has been cut off.

Now he's sharing, right?

Yes, doctor. Everything is ready.

Okay, let's get started. This one already this

We listened to their presentation and well, then

almost all of them are this staff who

is working on the services of

public or private health services. Well, the

There is training available for these doctors, there is staff

from the nursing area, as well as engineers

and chemicals. So, I think that

It's a very complete group that we're going to

to have this experience of everyone a little bit

for this first session that has to

relate to quality theory and

basic quality tools.

So, look, the first task that

We're going to let each other go, and in the other

Class on Thursday they're going to do in a

slide, a definition that you

They are going to build what defines what it is

audit.

And then they're going to make another slide

same for next week when

Let's begin the class, they are going to present,

we're going to give three of them the opportunity

Students, we're going to tell you, "Let's see,

Okay, José, tell us your concept of

audit that you already built and

also another slide where they will

generate a management definition of

quality, but already understood from its

point of view, analyzed so that

Well, let's have this one, because

Look, sometimes it is very curious when

I completed a Master of Science degree at the

public health, because we were almost there

It was also four semesters and that's it

We were starting the fourth

semester and a teacher told us, "Let's see,

They say it's public health." And the

Yes, it was worrying.

because most of us weren't clear that

It was public health and the master's degree was

Master of Science in Health Sciences

public. So, at the very least, if

we would already have that time by then,

We've been pursuing the master's degree, because

to have a clear and understood, analyzed

the concept of public health.

So, that's why you right now

Let's begin, and I think that's how it is.

first task that they have well

analyzed the concept of auditing and of

quality management. two topics because

The master's degree is in auditing and systems

quality management in health so that

Well, from there we already have this sort of thing

points in favor to help understand the

subjects or materials that we are going to

reviewing. Entonces, miren, vamos a ver

Right now the first class is theories of the

quality and basic tools. Let's go

Here's the topic. I had already done this

They checked, and if not, well, then yes, they did.

I invite you to take a look at it.

that we keep moving forward a little more

easy and you'll understand what

You already know. Miren, vamos a a ver

de calidad o calidad. For example, here

The Royal Academy says it is a

property or set of properties

worth. Y si ustedes ven igual aquí

que la juzga. Let's see. Look, here

también hay algunos autores. So

audit.

What is quality, what is safety?

patient and we talked about some topics that

which seem a bit more theoretical. By

That has made things much more difficult at the level

national, since the implementation of a

management system of the

quality, because sometimes, well, you know

We understand all the theory, but when

We are already providing our services, then

We've already said, so where do we begin?

implement a management system of the

quality. So, well, yes, we're going to...

Our challenge is how to understand the models

Because it happens to everyone, right?

That's the difference between accrediting a

service or a hospital or a unit of

first level and certify and then it

What we have are the standards, and this,

But what we need to start with

to understand what the models of the

quality from the point of view of the

theories and then the tools.

So, we're going to do this.

passing by quickly. Denim,

We already have Crosby, Yuran, and everyone here.

Those are authors, well, they have

been worldwide as pioneers

some and some have modified some

concepts, but hey, everyone with the

always focus on what is done

because some requirements must be met, or

Not with some, but with all standards

established service to what the

company is dedicated to. So, let's go

See here, for example, this gift Abediam

which says it is the obtaining of the

greater benefits with lower risks

for the patient depending on the

available resources and values

prevailing social norms. So, see how

really our medicine in these

times with all the technology that

We have, so it would have to be a

very safe medicine throughout the

technology and the progress we have, but

when we do not have implemented the

quality management systems, then

even if we have all the technology

and all the technological advances up to

at this moment, because our processes

They remain unsafe processes and

our practice that involves risks

for patient care. By

For example, from administering a vaccine, the

vaccines even today because they have

vaccine development has evolved considerably.

they generate fewer adverse effects when

It was the vaccines, and for every 100,000 that were

During vaccination, an event occurred

adverse event or an event

secundario la aplicación de la vacuna. AND

sure things that say more in over 1 million

mild adverse event, for example, in

a lot in the technology section of

Because? Porque si no tenemos una buena

cold chain, for example, because it can be

que esa vacuna se nos inactive. Or else

We have, for example, right now that there are

nursing staff, the actions

medical. Entonces, fíjense, aquí habla de

reasonable. Entonces, vean como desde el

trabajar con la gestión de riesgos. But

Uh-huh. Y aquí algunas unidades que han

desired.

comply, because now it not only has to

to see with good practices, with the

safe attention, effective tension, that

I achieved the goal. For example, if

We are in a prevention program of

early detection, prevention and

early cancer detection

cervicouterine, because now we

We should be worried because it

achieve the objectives, that a

prevention and at least one detection

timely treatment of bicerin cancer. By

For example, in Mexico we have a big problem

Right now with breast cancer, well

The detection is late, the

patients we are diagnosing

breast cancer in Mexico. So,

Notice how if we apply this

The WHO definition, then

We are probably no longer getting the

desired results, for example, for

This program.

And look at the quality according to the model

ISO 9000, which is quality management,

according to the model of this standard which is the

9001 says that the quality is of the grade in

that which a set of characteristics

inherent meets the requirements

requirements being understood as need or

implicit or obligatory. Let's see, here

Let's start talking because this

The definition seems very general, but yes

It's the one we have to try to...

to keep in mind so that, well, then

to be clear, for example, about what the

requirements.

What are the requirements for medical care? by

for example, in a care unit

intensive care in the nursing area or in

In general, what would the requirements be?

of the

mandatory for providing this

quality services in the

health facilities?

Okay, let's ask José what

the requirements,

Because they set, it says that this rule, the

set of inherent characteristics

implicit or obligatory. ia

This, for example, in a unit of

intensive care that we have

Yes. And where is this established?

How should the teams be positioned in

maintenance? How should they be in

calibration? And up to what type of equipment

or what characteristics these should have

teams? por ejemplo, en esta cuidado

intensive care unit,

Because look, from here we have to

For example, from the audit.

So, if we have to have this

very light. Miren, los requisitos no es

We have infrastructure standards,

For example, right now that there's measles

hitting Mexico with many cases,

Well, there's the surveillance one.

of standards, because in health we are,

the world that we have more rules for its

compliance. Pero fíjense cómo desde

aquí viene el el el asunto. For example,

as

volunteers. Y fíjense, aquí dice que

este claro algunas situaciones. By

004

of what is already established, something of

that you propose and that does generate a

benefit to the patient. So,

We have used interchangeably

The phrase "improvement actions" is often used. AND

He says, "I'm going to improve the record, the

integration of my clinical record

hospital

of hospital immunity,

as a requirement in an official standard

Mexican, well then you're not going to

implement improvement actions. which

You are going to implement actions

corrective measures because you are not complying

with what is already established. But

We always say, "Ah, improvement actions

and for, for example, if there is someone

quality, even if it's not from another brand

country, because he thinks we're going to improve

the standard, for example, of integration

of the clinical record."

We're going to take improvement actions, no, he

He doesn't think we're going to take action.

corrective measures to comply with the standard.

to make it clear that when we talk about

audit

We need to have a regulatory framework

It's a little different from the...

concepts sometimes of supervision that if

Do field supervision and see what

we are finding. And then there now

that you work with this

a systematic way of collecting

evidencia objetiva. In other words, it has to be

evidencia demostrable. It's not quite like that.

that someone says, "No, we do of

we do here in my service. He

The auditor's thinking has to

gather the evidence and verify that it is true

that the application is being implemented

the essential action, for example, number

three. Enfermería lo maneja un poquito

a

water. Ahorita si se la paso en la

hand.

Hm. pudiera ser que este verificar los

what's it called?

Mm.

This,

less. Este, no sé, es lo que se me

Yes, yes, yes. Lo que usted A ver, este,

auditaría esa botella de agua. A

security. Después verificaría que no

product. Los terceros sería el

original. Pues normalmente nosotros

Okay, yes, thank you. Este, Ricardo, a

Okay. Bueno, para empezar tendría yo que

to know specifically what it would be

Well, that's what I would have to audit, right? AND

the guidelines and in my opinion,

Now, giving my point of view, nothing.

Moreover, if it were colorless, odorless and

if it were in a liquid state, because

I would need to know the guidelines,

No? What are the concepts?

What specifically do I need to check?

Thank you.

Well, look, Ricardo already gave us the

this afternoon's learning. Look

when we talk about auditing and when

Someone tell them, "Are you going to audit?"

this?" For example, the service of

emergency room, pediatrics, the

the auditor has to think first

What are the audit criteria, which

This is my frame of reference, what are they?

my standards, what are they?

requirements that I'm going to audit, because if

No, then we no longer collect from him

objective evidence, because sometimes, due to

For example, it happened, I was responsible for the

quality area almost 5 years here in my

state and was at that moment very much

fashion the accreditation part

And then the lenders came from

other states, but oh well, either we went

to other states as well, we from

Txcala and we didn't have this training

Well, from the auditors, then it remained

We were going to do or very things were being done

subjective and said, "Well, it's just that I in

My state is working like this, in my

We've been working like this in my state.

jurisdiction and in my hospital." And

So, you see, that can't be anymore.

a systemic approach, because in the end

is it your perception or perhaps your

knowledge

And then no, the auditor has to be

a very solid character, must have

knowledge and when someone tells them

Right now the whole group if I go back to

other classes, let's see, this one, listen to me.

computer or O, what would you audit of me from

emergency department of my hospital? EITHER

So remember, the first thing is the

First, they have to say what they are.

the criteria we will use

audit, because that takes away all the

part of subjectivity and perception and

It already helps them gather evidence

objective. If the rule says that it must

clinical, the clinical record, because it

It should have, for example, in 004.

It's no longer like you can say, "Well,

But here in my hospital,

We'll leave the medical history until...

have the criteria with which

They're going to establish their audit, okay?

So, that's the first lesson of

This afternoon it's important that when someone

Will you tell them, "Are you going to audit this?" Well

Very well, Ricardo says, "Well, I need

to know what the standards are with

which ones I am going to audit or which ones are

what is my frame of reference with the

No, so when I tell them the

experience and sometimes one reaches a

supervise or as we have already said,

Help us audit and well, then, to the

pediatrics and I'm even going to focus on a

definition, that's why I'm telling you that we're going to

audit thinking. That's why they

find. Esto ya nos va a permitir

darle otro enfoque, ¿sale? So,

we do here. Sí, tenemos que hablar que

a service. Everything we

service. Entonces, miren, aquí vamos a

calidad en los servicios de salud. AND

Look, fundamental elements of the

quality. The first element is the

professional excellence,

Then comes the efficient use of the

resources. Then it has to do with the

minimal risks to the patient, the high

degree of satisfaction and impact

final impact on health.

So, look, here if you

Look at this slide, because everything has

that has to do with human resources. So,

That's why they say, let's see, in our

services, at our hospital, in

our care facility

primary, in our laboratory,

because the most valuable resource has to

see about the staff section,

because they are the ones who operate the processes.

That's why our processes, many say,

"We simply cannot standardize them."

Because yes, well, really, in a

process that introduces more variability, than

is the number one enemy of the

processes, because it is the human resource."

So, that's why, look, we're talking about

professional excellence. So, here

We also need to understand how, therefore

For example, our health services,

How can we know about excellence?

professional. Okay, who can tell me how

we can this

objectively

such as evaluating or auditing this concept

of professional excellence?

Okay, is there anyone who can...

comment.

Through the certifications that are

They obtain, that is, for example, as

Healthcare workers, you have to be

certifying every so often. Hm. AND

That tells us that...

You are up to date according to the

regulations, well, fine, agreed

to the guidelines established in that

year.

Mm could be the part of the

certificates and the title, the ID card.

Okay, can someone else tell me how?

we can gather objective evidence of the

professional excellence

of the truth, sorry. Forward,

partner.

Oh, sorry. Uh, that could also be it,

teacher, with the standard 019, which there

It stipulates that, for example, the

nursing categories and from there

depending on what needs to be collected

of information, or rather to document

which must be general,

specialists, etc.

and the scope of each one

Yes, them? For example, the requirements.

Yeah.

What other one? Okay, so, who can tell me

This other comment? There is a method

that tests can be established between

the different professionals of the

same category and tests are done

repetitive ones which they will give us

a result. There is a test that

reproducibility. So that would be a

hard data on how good the nurse is,

surgical or a procedure.

because it all has to do with searching for the

professional excellence, but now, because

For example, the Y Commission or for example

standards with the Y Commission of

General Council of

Health with the model of

health. Ya, si ustedes revisan cuando ya

They were established in 2010 and began to

By 2011, people were already talking about the

professional skills and then

certification, a whole chapter of

skills. Imagínense un pediatra que

Pediatrics. Entonces, imagínense, lo

Oaxaca y donde además hay paludismo. AND

management. Entonces, fíjense, cuando él

Well, it's better if they don't evaluate me, better yet

"Train me first, then evaluate me."

And that's why these standards of

certification, now you see that we are going to

talk later about the MUEC where

He created an evaluation model of the

quality, but since the 25th

September 2025 is already called the process

certification and standardization of

good health practices, but has

This whole concept has come from

professional skills. So,

the establishments that have these

certifications and some others that

I'm sure I just heard that they work

Some in private hospitals have

some other certifications, but for

to achieve excellence

professional

They have to establish, for example, by

service their skills, for example,

the surgical area, the area of

emergency room, the pediatrics area, the area

gynecology. And then they have to be

training and evaluating those

skills. Something told us

partner of the RR, because in the end you have

that are validating the skills.

The experts, who are they? Well, let's see, the

pediatricians who are already experts in that

hospital in management and diagnosis and

malaria management, because they have to

evaluating the new members

of the team. Because look, this happens here

something very, if you want a

not very worrying. If we don't start

to understand quality in this way, by

For example, in Mexico, in my state, we're going to

to speak in the state of Puebla, state

from Oaxaca, Veracruz, where you

want.

We have a detection program

timely detection of cervical cancer.

So, I once did a study there.

that I did

graduates with a nursing degree and

We would ask them, "Hey, how many cytology tests?"

"Did he take?" And he would say, "Well, the truth is, none."

I only saw how they were taking it

sometime and this and then the

My colleagues reach their year of service and

Now we entrust you with the task of being the

responsible for 500 women for the

detection of cervical cancer. So,

Look, the colleague or this resource

that takes a good shot of the

detection.

the resources. Seguramente pues va a

wasting gloves, all the material,

Do you think it is inadequate or limited? either

ausencia de células endoes. And look,

Do you think so? Que le vamos a volver a tomar la

result

reliable.

cervicouterine. So, notice how

manner. Excelencia profesional, vamos a

empezar con la parte documental. Let's see,

Yes, yes, go ahead.

So, if

Okay. Hablando de la excelencia

option. En México se ocupa por

applicable

parámetros que debes dominar. you

las asociaciones. Because? Because the

Technical Standards Commission

Labor competition has already set its standard

based on ISO standards, CE standards that

They are from the European Commission and E standards,

England norm. These have a

characteristics that are very very

demanding, beyond the regulations

and leaves a matrix, it leaves you a

document outlining the competencies and

service skills,

But they have to give you training.

prior to 6 months in a

intermittent, where this week you see, eh,

For example, cannulation in veins

of the right upper limb, the

Next on the left, and so on.

until you fill that matrix and

When you complete it, everyone is approved.

Now you're ready to do it.

NTCL, the technical standard of competence

work and it goes by areas. The group is the same

The model does this by areas and subareas that

It has everything from the simplest one, which is

pre-sellers

up to the managerial level. And there, as already

They have a parameter, they already have nothing.

plus the regulations applicable to the country, but

international standardization and there they go

comparing. They already have their checklist of

compliance, non-compliance, there is no

mitad, sí, la mitad. There are no lukewarm ones. are

cold or hot, a yes or a no for

their audits because they already have a

previous model that marks them. That was

mi comentario, maestro. Thank you for the

time.

ID card. Por ejemplo, soy especialista de

emergency room. A ver, ¿cómo justifico la o

those processes. Por eso en los estándares

atiende con mayor frecuencia. So that?

el de gabinete. So that? Well, then

hospital. Entonces, fíjense, ahorita

mama en México? Because it probably isn't.

la para la detección oportuna. So,

breast cancer. Y entonces, fíjense,

pues no se va a obtener. Because? Well

the other four. o nos ayuden a dar

punto es la excelencia profesional. Yeah

frequency and from there the services will

define their skills, but

They have to be established,

They have to be there, there must be

the teaching team must be

working to generate those

skills in personnel and also

There has to be a group that is...

auditing. So that? Well, so that

operating in the services that are

provide health. For example, what

He was also talking about vaccination, why?

What are the flaws? I was there too, I went

epidemiologist of a jurisdiction 6 years

And we had problems with what, well, in the

failures in the application of the biological agent.

Because? Well, because staff are arriving.

intern and comes the first week

national, well, at that time they were the

National health weeks, now there are

new resource, and well, what do you think?

I already gave her the BCG from her botanical shop and

He already did the absorbing thing. I was coming back in 15

days the child with the abso and was

Epidemiologist, listen, look, we already have

an adverse event associated with the

vaccination. And then I had the

abscess and we were already with the staff,

Who applied it? Well, that's not it.

Intern, what is the application process?

No, you [ __ ], and don't let her.

applied a dose. The bottle is for

10 patients and they applied the 10 this the

intradermal, and that's why.

from the little one. So, notice how

of health services, because we have

to begin with excellence

professional. So, in their

audit. That's what I'm telling you now, no.

so many concepts that they learn this, no,

no no. so that if someone...

He says, "Audit my service, then."

First, what are the standards?

quality in this service.

From there we started saying, I doubt

a little bit that is indeed being generated

So, look, in the world there are some

quality guidelines that are

processes and costs. But notice how in

We have some debts in health. Imagine

that the council the John Commission or

Someone starts auditing how we...

We use the resources, because right now

Our secure processes are audited or

effective and that comply with

standards, but look, costs, well, no

a lot. So we still have it there.

challenges in our quality models,

especially in the I speak in the

ver a través de de de los costos. AND

nursing or some other profession

In healthcare, they tell us about costs, like...

We lose, we say, hey, no, well no

We have no indicator here that has

that has to do with costs and yes, for example,

be present in every aspect of therapy?

debe haber una enfermera, ¿no? To the

manera eficiente el recurso. Are

tiene que ver con los costos. Let's see,

que es una atención segura? With their

words. ¿Quién me dice atención

Are you sure? This is it.

safe that care where

prevent failures from occurring during the

strain. These barriers can be of

process, they can be technological, they can

to be infrastructure.

So, let's see, who can tell me one

barrier? Especially the area of

Nursing, right? of the female colleagues or

colleagues from the nursing area,

Tell me one process barrier that we

help provide safe care.

In the file of a patient who is going to

to be undergoing eye surgery or

ophthalmological,

then the eye is marked

to perform the surgical procedure. That

It would be like a barrier

barrier. But in addition to the file, it

can mark his eye

physical way so that there is no

mistake.

So let's go to the... well, the...

all,

For example, in harassing installation

withdrawal,

the listed ones.

Uh-huh. The sound cuts out a little.

Ah, I was saying that they would be on the lists.

checklists, too

checklist at the facilities, in the

device maintenance and removal

doctors. Devices. Yeah.

Did anyone else want to comment? It was heard

another voice.

The simplest and most common is the one that

the correct ones. correct patient,

correct surgery, or treatment

correct, correct medication, route

correct. From there we start working

a series of compliances

user.

Ale,

I mean, let me clarify, it's nothing against it.

of the institution, but that has

memes, jokes, lawsuits and the side

pejorative acronym for the Institute

Mexican Social Security.

because of the iatrogenic effects that occurred and because

those mistakes

some of which cost

anatomical pieces, anatomical parts,

But we didn't all have that at that time.

These are the correct ones and the checklists and

all the other requirements for

safe care.

Sí. Sí, este, Hugo, gracias. Yes, everything

which they say is very correct. The attention

We agreed that we have to

define as that where

They implement security barriers for

prevent failures from occurring during the

strain. There aren't many definitions, huh?

but something more workable and more understandable

This is it. Y entonces, barreras este de

process, exactly, are all the

patient from 1 to 6, for example,

the correct ones in the medication. All

the tension. Por ejemplo, la acción

So, it's a safety barrier

con hombre y fecha de nacimiento. But

Look, here's what we have to

documentary.

Uh-huh. Ahora vamos a hablar mucho de cómo

audit, how to audit, because it is the

This master's degree, how to audit. So,

Look, we're going to some hospitals and

essential action number one, which is the

"Correct identification." Here is my

birth. Y vemos que tiene un

el momento que se debe realizar. And for

We are going to apply blood or blood products,

the moment they have to identify him,

because the evidence is not documentary

It has to be collected when we audit

the essential security actions of

patient. We need to audit the

implementation

because that's what works as

barrier and prevents the failure from occurring

during care. Because if we go to

hospital and I tell them, show me your

training program and show me

where he already provided training in essential action

number one. Show me where I already...

They signed that everyone already knows the

essential action number one and at the end

It's just a documentary part. AND

So, regarding these barriers right now,

We're talking about safe care,

The implementation needs to be audited.

of the safety barrier, for example,

the correct ones for medication. If I

They say, "Oh, look, they already signed me here from

who have already been trained and everything

The world has the training, and as I said,

Ah, well, they're already working with the

correct in the for safe medication."

No, because we have to see that

are, for example, this, implemented

at the moment

that need to be implemented for

that function as barriers of

security. For example, what he was talking about

the companion of the procedures

insurance, which used to be the goal

international safe surgery. have

to carry out the process to ensure that

that surgery reduces the risk, because

Well, there's a risk you'll operate on him, because

where they are paired organs, kidney, for example.

has to establish the site where

is going to do the procedure

surgical, because if someone tells me,

For example, when I was doing this

verificación de cirugía segura. Let's see,

no, pues es que aquí no lo hacemos. It

clinical. Ya llenamos la hoja. So,

auditan en que estén implementadas. Already

ocurran fallas durante la atención. By

lavado de mano. Also, for example, the

nivel de cloro. That has to do with

be safe. Exit. Entonces, ya les quedó

implementation. Ya cuando veamos la ISO

implementaciones. How are you?

operando en sus procesos? And pay attention

effective. A ver, ¿quién me dice que es

good practice, scientific evidence,

For example. So, here, how

We would audit the effective tension in a

For example, an emergency service? TO

So, who can tell me how we would audit the

effective attention in a service

emergencies?

Well, I don't know if it would be, for example, the

response times can be audited.

Hey,

attention span. Mm, wow, what

It occurred to me just now.

Yes, yes. The attention time does have

which has to do with effective care, because

Remember that there is a triash and that

Triash sets the minutes in which it

must have, for example, a

real urgency or a felt urgency.

So, yes, yes, the fact that you stick to

that triag, to the triash guideline,

Well, that already tells you about the attention.

effective. Yes. Yes, mate, that's it.

effective care.

And the other would be,

The other would be how much

They adhere to the rules of the file

clinical, the medical history, the note

medical consultation request,

informed consents completed, the

nursing record.

I think that would be one of the most

important.

See then how now if that is the

I want you to go, let's go now, like

that is structuring thought.

Now, when they tell you, "Okay, audit

the effective care guideline."

Exactly. Let's see, I'm going to see from the

I'm going to fill out the medical record.

see compliance with the regulations of

triage, for example, in the service of

emergency room. We're going to check, by

For example, adherence to protocols of

management. For example, in the services of

urgency, because it also has to have

their procedure manuals. I mean,

How much? Because I can have the manual

procedural,

But maybe they don't even know him or he's not even there.

They check it and well, they don't stick to it.

And the procedure manual

Surely, because everything has a

support of the regulations and all the good

practice or scientific evidence.

So yes, we do need to verify.

If compliance is being ensured, yes?

Or that the manuals be followed

procedures, because many times

They are there, but maybe they aren't.

implemented. So, look, now

the audit, that's why I'm telling you, now

I am now almost

We're going to push the current a lot.

auditing in healthcare processes, because

This will allow us to, like,

structure our processes in a way

different. And the audit many of it

We look to disapprove and say, "Ah, I see

The auditor confidently arrived. Someone gave them to us

He sent it to show us that he didn't

We are functioning and we are not

giving this

No, we are not creating that expectation.

head nurse or head of

laboratory, no. The audit

It really has the main objective

It is therefore about pushing that management system.

quality. La auditoría es para eso,

to push that management system

quality. And? Pues garantizar una

quality care in what satisfaction

user, safe care, care

effective and also what has to do

con costos. Is it going out? So, two

very important concepts, pay attention

segura, atención efectiva. Now, the

user satisfaction, because it has to

"See with the part," said Don Abediam, "with

which here has to do with the treatment

that it's working, because also,

insatisfacción en este momento? Well

mi paciente ni cuál es el plan. HE

manejo de la información. And this is a

user,

del sistema de información. Also, because

This is going to be the cost, because that

It also generates a lot of dissatisfaction,

especially in private hospitals

Because, well, we don't tell him and the other one

We gave it to him one or two days later.

"Do you know that's already 200,000 pesos?" AND

So that generates a lot

dissatisfaction. he says, "Listen, but

I thought she was younger." And then

also the establishment in the

certification standards are

obliged to calculate the of

the costs of care in the

first 8 hours. In other words, let's see,

family members, look, so far

We bear this cost. If it's already there

Once your patient is stabilized, if we are going to

to continue with your treatment, the cost

It would be like that in 24 hours. you take the

decision because otherwise this generates

A lot of user dissatisfaction, isn't it?

No, well, they already charged me for things I didn't even know I should have.

They did it to the patient and well, that's it

We have Tick in our services of

healthcare, especially private healthcare, right?

Because the public generally doesn't...

This is generated

a cost, yes, but not for the

patient, for the institution and for

some insurance company or all of this.

So, are these four now clear?

quality guidelines in services

health-related or what they want to do, do they have any

comment, any question or anything that

Yes, doc, as for where can I read

about the costs, because I work

in a private hospital and that has been a

a very important topic in our hospital,

So, I'd just like to know...

bibliography about this

costs.

Look, as far as costs go, we're not going to

Well, it has one, it was made somewhere.

I've been trying for years to establish the

costs, especially when it was discussed as

We were excited, just like right now.

"Universalize, let's be universal"

este momento como que establecer. By

years. Y para Lims estamos hablando casi

of 60,000 pesos. Entonces, con base a

que te diga ahorita, ¿sabes qué? Can

this review this this regulation or this

costos de atención hospitalaria. And for

variation. Por ejemplo, a lo mejor no

other costs. O sea, ahí sí yo creo que

también se elevan los costos, ¿no? HE

hospitalaria, por ejemplo, al IMS. EITHER

like hospitals, but that can

help to get started, how to have

these parameters of their costs

I say there isn't one. We'll look and hopefully

we find it and even expose it in

the group and we found this. Someone

more than I have any comments,

Any questions? Good night. Uh, it's been a while.

I didn't introduce myself for a little while. I am Dr.

Alejandro Ancona, I am the director of

medical center and medical unit set

Dr. Juan Puy Palacios. It is a unit

family doctor. I haven't been around for a while.

I presented and have also worked in a formal way

private for the Air hospital as

medical coordinator also of some

insurance companies. Uh, I can put it on.

two examples of costs. One in the

question of costs for the

insurance companies.

We love our doctors when

they get out of certain areas or

Angeles or Hospital Air or class B for

Guadalupe Hospital or another one around here,

The costs are between 25,000 and 30,000.

My costs are rising by 40 or

It was coming out to 40,000, 45,000, they're making me

ENT surgeries with surgery

plastic.

So the costs are manageable in

based on parameters of what the

cirugía de torrin. And here in the in the

talking about a unit of function

public. We have the technology costs

It gives us the average cost of the doctor.

monthly. Mi costo promedio mensual del

una receta máxima de 2,000 pes. When

ethics. Muchas veces son para darles dos

pacientes y no reciclarlos tanto. But

tratamiento es mes con mes. If anyone

todo nuestro sistema de insumos. also

monthly, right? Entonces, los costos

Thank you.

Thank you, doctor. No, pues su aportación

It is very valuable. Lo que yo les decía que

costs. Imagínense en México que

This power

So, right? Pues sí nos exige a que

processes, right? garantizado una calidad

if they don't control spending.

Thank you. This one, and we're going to follow him.

Look, evolution, a topic

extremely important in these theories of the

Quality has to do with the

evolution of quality systems.

So, look, let's take two here.

dates that are from '87 and '94, which

It is quality assurance. Right now

Let's see how we understand this

quality assurance. And that's it.

In 2000 there was talk of managing the

quality through processes, but right now

Let's see, we've already added some

slides that have to do with the

2017 with risk management. Further

Before this, well, maybe we won't go

There's a lot to mention, but yes, here in

quality assurance.

So, look, let's see what it is

So, quality management, that's how it is.

in a simple and illustrative way

so that you too, when you do your

concept of quality management, then

already have some elements that they

help to understand and above all how

to be operable this management system of

quality in their work areas or in their

institutions. So, look, it says that

Quality management is differentiating

between doing and achieving

the company that you go to and

See what this company says.

implemented a management system of the

They are establishing everything

Its objectives are to be achieved. For example,

There's this light bulb, for example,

That's incandescent, so let's put

that maybe the two-month period would turn out in

50 pesos to rent a room. Probably

technology, well maybe we'll get 5

pesos in the two-month period, this, give them to a

room. So, look how here

no, the thought was not, is not to do,

but to achieve

to make the use of the

energy.

what we have, the examples that we have, this

estado platicando. For example, it's not the

cervical cancer detection

I will achieve

in the initial lesions of dysplasia

población de mujeres. So, take a look

mama en el año en mi estado. I am the

responsable estatal. So, I'll go

No? El el sistema de gestión de la

breast cancer. Y eso implica ¿qué? Well

distinct. Fíjense que el pensamiento

parece que fuera permanente. By

cirugía, es de medicina interna. AND

sé qué diagnóstico tiene el paciente? Yeah

past, for example,

More than 10 years and it still hasn't been possible

understand, let alone implement these

essential security actions of

patient. And this is something nursing knows.

And he's very clear about it. When we started to

also talk about clinics

intravascular,

Well, there's also a lot of resistance.

Because the thought process is kind of...

arrested and tells the team

nursing or those related to

the intravascular clinics and there is a

very strong resistance to what they have already

Done, right? Listen, well, we've done this

It's been done for 30 years, 20 years, right?

And in the management systems of the

For quality, we need to think differently. by

For example, with the Mixing Center and

Single dose. Also when we started to

try to implement in a hospital

all this methodology and this service,

Well, it was also very difficult to start it.

I worked, and it wasn't just a year, you know, because

Someone might say, "Hey, new model

for medication management and so

Let's see how security is achieved with

This new area, the security of

patient and reduce costs and improve

satisfaction and many things that it has

of advantages,

So, what do you think it costs? And look,

If you look back to 1910

What was the position for the high jump?

And look at how things were in 2000

the jump was completely reversed and reached

Well, the man is over 255

and in 1910

the 2.5 m. So, look, here

This changed the way of thinking, because

Do something different, because someone

I could say, "Hey, why not from

Did 1920 make the leap in this way?

For example, look, there it is like the

It stops and years go by, years go by, years,

Years have passed and we're still the same. For example, I

I can tell you that in all states

in most states of Mexico,

40 años por lo menos. There are no new ones.

processes that guarantee a pharmacy,

pharmacy security policies,

For example. Just like that, from the

who staffs the pharmacies in our

hospitals, now there are graduates of

pharmacy and well, they continue operating them

staff who may not have

training in undergraduate matters in

So, when we talk about a

surely

processes. Pero para que logremos esto,

We need to

first

birth? Pero fíjense, es que ella se

siente insegura, pero no. Sometimes not

barrier."

thought

ver con algo reactivo. For example,

At that moment we say, "Okay, let's go

This is to discuss the case of the death

maternal." And look, we used

tools that are reactive, such as

fishbone, the chicagua or this

that tool that we're going to see, but that

The tool is not proactive. That

tool, because it is a tool that

It helps us to take action

corrective.

Now what we need to use

tools that are proactive, that

anticipate the risk. That's why I tell them

We're going to see what's available from 2017.

risk management standard that is the

31,000 and that talks about this whole part

which now needs to be audited

the implementation of risk management.

It's no longer just the management aspect of

processes, now we have to manage

quality and already with a focus on management

of risks to migrate from the

reactive administration to a

proactive management. For example,

Now the biomedical engineers, the other

One day I was talking to an engineer and

I was telling him, "Hey, this is

This is extremely important, the maintenance

preventive measures." and he says to me, "What do you think that

You are like 20 years old

10-year thought? because now it is

predictive maintenance. So,

Look, that's even more proactive.

because they no longer anticipate what

This maintenance says nothing more.

preventive. They already use others

models are probably algorithms, not it

I know, but they do maintenance

predictive, which is still much

It is further ahead of maintenance

Preventative, right? So, notice how

That has to be the thinking in

These issues of quality and

audit, each time having the management of

risks. Let's see a little more

forward. Look, risk, this is a

The definition is part of ISO 31000

What does that have to do with the risk?

probability of not meeting the

goals. So, let's see that

financial and legal. The new one from the

I'm highlighting 2017 very clearly because it's

the way we're going to do it

quality management systems,

also implementing the management of

risks. For example, hospitals that

They are certified by the Council

General Health, with the

Y Commission standards or with the

There's another one east of Canada, another one others

standards and other certification of

establishment, especially the

private. Entonces ellos aplican mucho,

They are working a lot with matrices.

risk management. For example, the

chemicals. Ahorita tenemos a varios este

that are in the laboratories, well

You know it much better when you are

certifying their hospitals with ISO standards,

because they are working a lot with the

risk management matrix. So,

part of the risks according to this

standard, well let's see that there are

technical risks, financial risks and

legal risks. Look at the

health systems, what we have to

Working a lot involves risks

technicians. For example, everything that

We were talking about vaccines, if anyone

diluents are technical risks. That's why

We don't respect triage and we don't say,

"Ah, it's a real emergency and it has to

to be seen in less than 15 minutes,

Well, this is a technical risk.

complicate matters, even die. By

As my colleague said, they operate on him.

the right eye and it wasn't the right one

technicians

the area of

of

extremely expensive antibiotics, and just imagine

all the financial risk, because they were

80 patients who had to

attend, increased the stay

hospital spending increased all expenses

nursing care, expense of

medical care, all supplies. But

Look, there were also legal matters,

Because imagine if a family member...

sue and say, "Well, my relative here

He was infected; he came here without

infection and here, well, because of the evil

"Management." So, he's going to sue us now.

He's going to say, "Well, my patient

He passed away, my patient is in serious condition and

I already got it out, I already took it to a

private hospital and now you have

to pay the expenses."

So, look, in the area of ​​the

Health is something we have a lot of work to do on.

They are related to technical risks, because of

That's where we're minimizing or

reducing risks, because it has to

to see with the part about protecting

financial risks and risks

legal in our institutions.

So, now review all the

definitions that we went through very quickly

of what quality is and they're going to see how

He was talking about the results of the

strain. So, now it makes sense.

This has to do with the part of

of risk management. And now

our thinking has to be in a

quality management system, but with

focus on risk management, because

That will allow us to establish

barriers,

the mechanisms to control the

risks, if not eliminate them, but for the

We're less likely to control them. So,

Look, risk management. Here

I also add a little bit because this is true

We need to make this very clear from the beginning.

Right now, in the management part of the

quality and in auditing, the management of

risks. First we need to identify

a risk, then we have to

to analyze it, then we have to evaluate it

And then we have to establish the

management. Notice, every time you

listen to the word management of the

Quality is a cycle. Let's see, who am I

What does the quality management cycle say?

Okay, who can tell me the cycle of

quality management?

Okay, so once you've identified it

es planearlo, ¿no? These are the phases of

planning, execution, implementation and

then the measurement.

Mm,

because everything that planning entails

strategic.

So, look, that's another question.

of secure exam. Eh, ¿cuál es el ciclo

de gestión de la calidad? Son is a

cycle. Todos donde ustedes vean la

cycle. So, quality management

That's what my colleague says, it's about planning.

do, verify, and act. Right now

Let's make this clear regarding these cycles or

risks.

Well, I didn't hear it, but let's see if I can

Uh-huh.

Yeah? O ciclo de Demit. También algunos,

hacer, verificar y el actuar. Yeah.

management. Por ejemplo, ya en en la parte

risk management. For example, if

patient. Y luego se analizaron, a ver,

concentrated? Pues casi es igual que la

Wrong, isn't it? Si le ponemos algún

baking soda,

concentrates. So, look,

They identified the risk, then

such as identifying what its effect is

to say, let's see, if this happens, that

Someone should give it a ceric electrolyte

concentrated, because it is almost the same as the

immediate death.

So, this is high

priority. Then, they evaluated

the risk assessment established

It is established through the MEF. You

Many have probably already done so.

listened. What is the probability of

What will happen? What is the damage that

What could cause that, the severity of the damage?

And how do I perform the detection, for example,

So here it is already established, because

concentrated on risk management. AND

What is the risk management strategy? If you

They remember, when they were goals

international security of

patient and now essential actions,

Well, double verification. they say, "A

See, where you use electrolytes

concentrated ricinos, you have to

"Establish double verification." And

What is that? Ya es el manejo del riesgo.

Look, they identified the risk that

you got the wrong patient, they analyzed the

risk and said, "Well, let's do

another essential action that has to do

with concentrated serum electrolytes or

high-risk medications." And then

They assessed the risk, they gave it to him

FMEA a score to see what the

what is the probability of it happening?

severity if it occurs and what it is like for me

I detect that risk, the detection of that

risk. And based on this I have already established

the handling. For example, right now that

We're talking about these high-dose medications

risk in an essential or goal action

international, since it has already been established

risk management and it is through the

double verification.

So, notice how this has a lot

reason for having this

thought. For everything you

carry out their care processes or the

same laboratory procedures,

We need to analyze it, we need to

evaluate it and establish a management plan

control. Because look here the

risk management in areas

We all know about the hospital issue.

hospital, laboratory, everything that

This implies. And you will tell me, well it is

that we cannot eliminate any risk

As we mentioned at the beginning, all of this

It has to do with the operation of

processes and the human being, the resource

Humans are the ones who operate the processes.

check.

accept. Notice how we can control

the risk. Pues estableciendo el ciclo

risk management controls. But,

How can we transfer the risk? By

For example, in some states or in some

establishments.

office studies.

I take it here at my hospital

CT scan and I send it so that

Perhaps interpret another institution

private. Y entonces, fíjense cómo yo

Ya, ¿quién adquiere el riesgo? the

service. Por eso en las en la

audit

established. Y entonces, fíjense, yo

comparto también ese riesgo. So,

compartir y podemos aceptar. By

"Whatever you do, you can't do this

"Control." Let's see, a doctor who can tell me

how, at what point can we accept a

risk, because it is very common in the

clinical practice.

For example, in medication we say,

"Are you allergic to any medication?"

Well, I don't know, because I've never been through that.

applied, for example, a cephalosporin

And now they're going to apply it to me. Then the

The doctor, therefore, accepts the risk he mentions.

"Well, I won't know until I tell him."

apply."

And so there are several situations that

He has to accept the risk in some

hospital care processes, by

example. Okay, someone help me

To give another example.

It could also be the risk-benefit ratio

of the medication, type and toxicity,

but the benefit is greater for the

treatment of the diagnosis.

And if there are things, that's what I tell them in

This matter, perhaps if it were another

type of services, because it could be that

Some eliminate, some, but almost

we in

we have that our thinking is to

control the risks. and control

quiere decir disminuirlos. That's why

You search now in the

initial definitions of this

presentation as a safe practice

And so now it makes sense in 2017.

as is already understood,

risk management, because this of

From 2017 onwards, globally it is a

a very, very powerful current of the

quality management systems, the

risk management. Because before,

It was done better, but not everything was available.

this clarity that we now have in the

part of the management systems of

quality with a management approach

risks. Look, it's 6:4,

we're going to give

15 minutes

Okay?

So that they drink water, get up a

Just a little, because if we continue like this it could

ser que ya ni pongan atención. And this is

This entire first session is extremely important.

Is it coming out? Entonces, este 620 nos nos

We link up again,

teacher. Nada más para corrolar este

aseguradoras y que te enseñen su guía. and

from South America. son los más este viables,

calculation. Y con eso, Paulina, te abriste

camino al infinito y más allá. Thank you,

teacher.

Thank you. Entonces, 620 nos estamos

connecting. Thank you. Eh, gracias, Hugo.

Uh-huh. Entonces, vamos a a ver todo lo que

risks. Entonces, miren, este esquema

de un modelo centrado en el paciente. Yeah

new. Esto ya desde el 2008, cuando la

patient. Incluso los nuevos modelos de

user. Entonces, fíjense este modelo

community. Ahora, los que trabajan

1985, los que tenemos ya más tiempo. In

The institutions, we know that it was a

care model for population

open.

Then, in 2005, there was another one as well.

He tried to implement another model that was

the Midas. Then, in 2016 it also

He took or modified a model that was the

famous M, who was talking about networks this

services and some other issues that

So far, it hasn't been possible.

to comply by 2019, if

You also remember this with the

another model of the famous Insabi that

This was also intended to be implemented

Then, in chapters 22 and 23, this comes out...

greater well-being. If you have checked

This model, well, it talks about a

person-centered model, the

family and community. So, it

We need to understand, therefore, that everything that

let's implement in our system

Quality management has to do with the

The focus has to be on our patient.

For example, right now that

the group's attendees mainly

They are staff who work in areas

hospitals.

So, the patient, the family, and the

community. But look, we also have

that you understand in this little diagram. This

I recommend that you even use this little diagram.

Print it out so you can understand how

What is this management system?

quality. So, look, the sustenance,

Everything we do must have a

livelihood. If you look at the policies

national, state policies, by

For example, for their private companies, the

policies of your company, by

For example, everything that is also sustenance is

all the laws that have to do with,

For example, in the area of ​​health, those who

We work at IMS, at IST, at the

Ministry of Health, there are also

regulations also that help to give

compliance with these laws. There are also

official Mexican standards, already

We were saying that there are rules from

infrastructure, standards for the

operation of the services also, by

for example, the integration of the file

clinical, standard 007 which has to do

with the attention of the delivery and the

pregnancy, childbirth and postpartum and many

normas también. If we talk about the seal,

Well, there are also many regulations for

sealing areas, for operating rooms there are

mucho mucha normatividad también. Equal

Also, all the manuals of

procedures that we have in our

institutions, in our company, because

Now they're making the new celebrities

to standardize these guides a bit more

They will remember the famous critical paths

guías de práctica clínica. Also another

del mismo establecimiento. For example,

rules. Ah, esto va a ser a través de

las guías de práctica clínica. This is a

enfermería, por ejemplo. And then

the community. Todo lo que hagan

calidad de la atención médica. We already saw

of resources. So, what are we doing here?

puede ayudar este esquema? Well, for

officers,

los manuales de procedimiento. Let's go

audit user satisfaction,

information systems, for example,

for

the relatives, for the same entity

and all.

It's working

This communication system.

So, look at how the resource...

But look, now we're putting management here

of risks because now everything that

Let's also identify the risks.

that can cause those things not to happen

goals.

For example, now if I'm going to audit the

hospital emergency department,

Well, I'm going to ask him for the manual.

procedures. Can I ask you for the manual?

from the organization manual to see

the functions that the person in charge has or

the different areas of the same

emergency service.

I'm going to ask him for his

their procedure manuals, I'm going to

request an evaluation system, how

Are they there, are they conducting the evaluation, or what?

indicators, your dashboard

from that emergency service.

But I'm also going to ask you for a matrix

risk management. Because? Because

That will allow it to be like...

that allows it to move forward or guarantees

meet the objectives. If my goal or

My part of my mission at the hospital is

to provide quality care, because

I definitely have to be

identifying risks and doing the

management. We already agreed to manage things.

The risk assessment involves identifying it,

evaluate it, what does that have to do with whether it

It presents the risk, what its effect is.

We need to do the same evaluation

of the risk, what is the probability

if it happens, what the severity is and

What is the way to do it?

detection of that risk to establish

a risk control, because now they

I audit the emergency room, because almost more than that

I'll go see, show me your matrix of

risk management of your service and I'm going

Let's see if they've been identified.

risks in this area and that are

prioritized and established

When we assess a risk, it helps us

to prioritize it through, for example,

from the FMEA tool,

But that's what I'm going to look for,

What treatment are they giving him?

giving that risk in order to control it, already

We agreed that the majority is for

control it. So, look, this

This little diagram might be very useful for

that you understand a system of

we can begin to comply with

risk management, because the

Risks will be present in the operation of

the services and that has to do with

safe care, with effective care,

user satisfaction and

efficient use of resources.

So, look, if we

we declare

the mission of the hospital, of a hospital and

sure

provide quality service

Well, we need to know how we're going to

to fulfill those services

quality. And then, look, this

a patient-centered model,

for the operation. Pero también tengo

blue,

institution. Lo que les estaba diciendo

items. El enfoque centrado en el

guidelines. Seguridad del paciente,

resource. Entonces, fíjense, ahora sí, si

quality. He says it should be an approach to

customer. First point, it has to be

customer focus. Second approach,

You have to work with processes

standardized. that they look at the

sustenance, because we try, it is given

compliance with standardized processes.

Thirdly, it says that it has to

This involves risk management.

The 2015 version of ISO 9000 already speaks

much of risk management. By

For example, those who work in a laboratory.

already since 2015, when he emigrated from

ISO 9000 by 2015 is already required.

much the risk management matrix.

Exit. So, look, with this

model, this little diagram, we've already started to

comply with what ISO 9000 says.

Let's see, customer-centric approach,

standardize the processes, do the

gestión de riesgo y generar valor. By

For example, the value here is that you have

a certified establishment and the

Elements that are orange are

the values. For example, there he didn't

We set values, um, the little arrows,

But we can put the values ​​there.

institutional as well. this figure and

then it becomes much more complete and

Everything that's green helps us

It's like the hospital's vision.

So, look, this little diagram,

You all go work with him and go

making it seem like a scheme of

audit, for example, by service.

For example, maybe I'll go to the restroom

emergency room,

I'm going to look for everything, I'm going to do my

folder of regulations for everything

that must be fulfilled in infrastructure,

processes, procedures in the

emergency department, for example, of

my hospital, which is my entire livelihood. AND

Then I'm going to identify which ones are the

patient safety guidelines

that should be implemented in my

emergency services, for example,

essential security actions of

patient, which ones have to

to be implemented and I'm leaving, because

For example, to audit the customer service section

effective. I'm going to see if they're sticking together.

to all the regulatory aspects of the guidelines

clinical practice, triage, this, the

triage, everything that the care says

effective of an emergency service,

depending on the type of patients that

You guys drive. If they are traumatized,

Well, this will most likely be the regulation of

traumatology. If they are in a place where they see

more hemodynamics, since surely more than

matters of hemodynamics. And they're also going to

see which elements are

generating user satisfaction,

which indicators, for example, of their

emergency service. So, do it.

exercises because this is going to start

to help you audit a

service,

This, audit the surgery service or

So you guys are going to...

start like when they see what they

You audit the water, oh well, I'm going to

I'm going to audit the infrastructure.

It will allow them to obtain evidence

objective. Entonces, hagan el ejercicio a

Start taking this approach and look for

patient. Al final digan, "Bueno, lo que

genera es una tensión de calidad. Because

Look, in Mexico we have something that we have

We say quality and safety of

patient. Cuando realmente el concepto

of quality, when someone says a

quality service in customer care

hospital,

effective care, standards of

national guidelines say

calidad y seguridad del paciente. It

patient safety. Ever

I spoke with someone who has dictated

of the appeal. ¿Algún comentario que

Ah, well then I say that when in in

Hospitals create their vision of

Unity, then, is a double-edged sword.

It doesn't look very nice, the way it's drawn, but

You know when they're going to audit you, well with

That's the same one where they're going to...

to thunder, so to speak.

Yes, yes, because when they audit it

You have to comply as the

values,

because generally they are the only ones

And then, if someone audits them,

For example, I went to a company where

where he won the Ibero-American Prize and the

national quality award and its values

equality. Decía, miren, aquí un valor en

la empresa es igualdad. And then

we call equality, that the one with the highest

level of responsibility of the manager,

responsibility, we use the same

In the dining room, for example, we use the

same bathrooms, for example, the

sanitary,

We have the same destinations as

Two vacations a year, this one and this one.

company responsibility, because

Imagine if they say equality and go to the

director, because his bathroom smells and

with others

con otros servicios. And the one of the

esa parte de la igualdad? Here in the

company, right? En el establecimiento o en

the hospital. Entonces sí, cuando se se

does so that the mission is implemented

porque se tiene que auditar. That's why in

Txcala, which is in this group,

school of the Autonomous University of

cuartilla de misión. So,

declaring. Y aquí es como que dice,

misión de una atención de calidad. AND

No, quiero comentar algo. This, nothing more

scope. Esto no quiere decir que yo me

áreas o en todos los procedimientos. Them

I'm going to give an example. Let's suppose

billing. Y está claro, porque cuando

messages,

service. Más sin embargo, en en el caso

So when we go to

scope. No quiere decir que vamos a

hacerlo en todos. That's why we need to

scope.

utilizan las certificaciones? well for

compliance. Por ejemplo, yo trabajo,

quality management system, because

We need to strive for certification

such as the substantive processes of the

institution, because for example, if I

I work in a trauma hospital and I say,

nothing more from my requirements validation

for admission, for example,

No, what I should be worried about is

through the substantive process, which is

because of patient care, which

For example, many private schools also

They certify, for example,

My process is certified in the

admission documentation, for example,

but not. What they need to do is

certify their teaching processes,

Because certification is also necessary, well, it's

quality services, but also

Many use them as if to

We are certified in this and really

Perhaps it is not a substantive process.

So we also need to have

Let's be careful, because we're doing our best.

substantive processes, which are the reason

for example, if you were from that institution,

from the hospital. Y entonces eso es lo que

The best part is some support processes, then.

benefit.

educational, if someone tells us, "We are

he

when someone

maintenance,

patient. vigilar la calidad del agua

preventive maintenance and

patient. Por eso la planta de luz, si

certification

entra esta planta de luz. It also has

entra en la parte de seguridad. AND

She's going to say, "Yes." "¿Y sabes cómo

seguridad al paciente. The quality of

areas. También tenemos método cómo hacer

traes aquí la misión atrás del gafet. AND

quality management models and

Certainly from the point of view that

We have now been trying to reinforce

a little bit of the audit of the processes of

health care, which is now already

you know how to audit the mission of

hospital and then look, for example, in

what guideline can you look for?

objective evidence. and says one attention

timely and of high quality and everything, everything

They can give it to him, but nothing more than that he has

quality, because the four of them are already in.

guidelines automatically and enter the

implemented a management system

quality, well, look for it to be of good quality

standardized processes with ISO

9000 that has the matter of the that the

First point, the most important thing is the

patients that are standardized and that

The hospital does have one.

Okay, let's take a look here.

Look, here it is

quality. Entonces, fíjense aquí,

the year 2000

of quality. Entonces, aquí nada más

do. Recuerden que el ciclo de gestión

hacer, verificar y el actuar. So,

accreditation

una semana antes en un hospital. I

accreditation. A ver, llenen las

example. Y fíjense, esto pues sí se

pharmacy. So, it's not that no

que te revisaron. So, look,

because maybe

of quality.

of quality. Sí, porque lo que auditas

nada más es el planear y el hacer. And in

verificar y el actuar. This has to

audit. Entonces, esto yo ya no lo

General Health in the process of

certification, they have to work

minimum 6 months or a year for their processes

in order to be evaluated. In other words, no

You can tell me, "I'm 3 months old

functioning as a hospital and well, come on

"Have me audited."

No, you must be at least a year old

more operating so I can make you your

visita de auditoría. So, take a look

the example. Let's look at some examples

Because this is something we really need to remember.

Of course, because it's part of the matter

from the audit. So, look, if

I apply this insurance policy.

quality in hospital accreditation,

For example, I'm going to check the...

clinical record, standard 00, 0404

of the clinical record. So,

Notice what the elements of

planning that I have to audit. TO

Hey, who can help me? Who can tell me what

elements we are going to audit to see about

the implementation of standard 04 of

medical record,

What is an element of planning?

so that all patients have their

file, that is properly

identified, that it's in order, eh

eh all informed consents.

the result, the one that is integrated

With those criteria, it's already like that.

result of the implementation of the

standard 04.

But some elements that you

Tell me, this hospital has implemented

the rule that relates to the

clinical record. So, take a look

what could be some elements of

planning. Por ejemplo, tiene que

See the training area. AND

entonces, ¿qué le vamos a pedir? By

For example, in the accreditation that we

They asked, let's see, give me your program

capacitación anual de tu hospital. AND

So I'm going to look for one that has

scheduled courses that have to do with

with the clinical record, with the standard

004.

hospital training.

For example, the descriptive charts of the

training. Ah, yes, it's here in your

that you're going to give it every 3 months, because

example. Okay, show me your cards.

descriptive to see how you're working

that you are going to use, the teaching technique

clinical. Es otro elemento de la

planning. Mm.

presentation

train. Fíjense, son elementos de la

planning.

do. A ver, ¿quién me dice un elemento

Could be

training

Yeah,

Yeah,

the ones of

photographs,

procedure.

do. Entonces, fíjense, a ver, ya

tengo los elementos del planear. Now,

Show me your

mother

Dale. Pero entonces, fíjense, aquí nada

to be verified. Entonces, miren, planear

Uh-huh. Entonces, ahora para verificar, yo

February. Aquí él asistió, está firmada y

evaluations. So, now I'm going to

hospitalization. Let's go find the

doctor. Listen, doctor, we're from

council and we've come to audit the part of

of standard 004 of the clinical record and

You have already been trained. Look, here

We have the attendance list and we have

until your evaluation that you attended and

He still passed with 10 his

post-evaluation. Here it is. I'm going to

ask some questions

so that you can answer them for me.

So, we're going to say to him, "Hey, can you tell me

can you say which are the elements that

carry a hospital admission note

according to the standard?"

Imagine if he tells me, says, "No,

So there you have the five elements that

This is a receipt. Me

can tell you which elements

It carries the note of evolution

of hospital care according to the

Norma tells me, listen, can you

say what elements the note contains

"I'm leaving?" and he tells me, look, I'm

Checking. Digo, "Ah, bien, pero ahora

I'm going to go to the medical records and I'm going to

Let me say, okay, pass me 10 files of

Dr. Juan.

We are verifying

And then we look at their files and that's it

We saw that he knows it, but it's not written down.

putting the elements in place. For example, in

The entrance grade we see only says

three and they don't put the five that he told us

In the progress note, he also told us

So, look, that's why I'm telling you

earlier, but already in a management model

certification, that's why not all of them

establishments certify.

have read the rule and also has to

be recorded in the medical record

your knowledge.

ejemplo, en la nota de egreso. So,

hospitable. Entonces, fíjense cómo ya

verificar y el actuar. So, that's why

audit,

So that? para que bueno, pues en

It's the hardest part

y luego el actuar. For example, let's go

seguridad al paciente. The boss of

that have to do with the

implementation. So that's where

sistema de gestión de calidad. Which

verificar la implementación, ¿no? AND

automático el verificar. So,

implementation. Entonces, fíjense, el

you have tools

in order to verify what has been implemented,

because maybe the documentary...

That's as far as we've gotten in planning and

do. There are my manuals for

procedure, there's everything that

If you want, the practice guides

clinic and all, but there isn't a

a methodology or a tool that

are applying to verify their

implementation and compliance. By

ejemplo, con higiene de manos. Look,

Checking. Entonces, fíjense, ahora ya

objetivos de lograr, no solo de hacer. AND

sure. Por ejemplo, en las clínicas de

management. de calidad del laboratorio que

es su vecino. So, notice how

weakness. Están las acciones

No,

act. Porque si ustedes leen así nada

part. Yo quiero pensar que desde su

la calidad, pero nosotros no. So,

certification. Y entonces decían los

quality assurance. Even though you

reply. Entonces, no puede ser que el

quality. O sea, tienes que trabajar ya

the way in which the implementation of this

thoughts of an auditor that I give you

a one that you compare 1000 pages for a

hospital. It was in 1000 pages

content more than 1000, like 100. It was something

inoperable. So, what do you think? It must

to have gotten angry, he must have said, "This

"He doesn't know." He's saying that's not going to

to be able to function. Ahora lean el nuevo

model that came out in September of

Then, look, it was a model for 5

años los que lo leyeron. we had to

first two with the accreditation,

quality assurance and then three

the director or the board of directors.

of the

of the administration. So, now

certification. y tiene el mismo esquema

hacer, verificar el actuar. And now with

este nuevo modelo? It's stuffy,

a lot? Pues la compañera o el compañero,

What to do? Pues nada más las encuestas.

Ahí va a ser unas encuestas. Look

más es un inventadero de cosa. And so,

ha funcionado ni funcionará. So,

mastery. Yo creo que es realmente es

Where are we going? We're going to...

estar viendo en el tiempo. So,

They stopped doing it. Entonces, fíjense, no

era buen supervisor ni buen auditor. He

Exit. Entonces, vean la línea del tiempo

cómo es importantísimo. That's why the

risk management. Acuérdense en

They were certified in 2008 with the 9000

quality management system did not have

the risk management approach. For

procedure. Here are my five

procedure manuals. Let's see,

risks of each of each manual of

processes are very unsafe because they don't

tienen analizados. They don't have them

el tratamiento de de riesgo, ¿no? Try

presentación en sus áreas. Okay, let's go

verify? Y y cómo audito el actuar.

act. Claro, ya con el modelo de la

forward. Exit. ¿Alguna pregunta que

tengan de estos modelos? Because this is

many things,

Very cool. Yo traje un hospital público

new model. Cada vez se nos complica

calidad teníamos un reto. Then in the

debt. Después en el 2015 con el enfoque

lo estamos realizando. And if we understand

a ir midiendo aquí por área. I'm going to be

tiene que ver con el actuar. So,

elementos de actuar. Exit. So,

verificar y el actuar. But look,

certification. O sea, y en nuestros

The governing bodies are stable

They are changing every year. And then now

We'll put the other one here.

certification and standardization of

good health practices, which is

Right now, the one our colleague is telling us...

We also put the certification there

capítulo importantísimo. And look at

y educación del personal. So, now

assessment. Por ejemplo, el manual este

cada 6 meses mucho mejor. And also in

patient. Miren, aquí está lo que les

he said. Entonces, esquemita que ahí les

certification. centro, el paciente, la

communication. ¿Cómo manejas toda la

internal communication

within

hospital y fuera del hospital? also

entender y puedan ser operables. Even

simples, ¿para qué? So that it

Easy, huh? Porque ya desde la figura

model. Y bueno, este ya no está, ya lo

models, right? Lo que estaba comentando

No, everything's fine.

all good. Entonces, sí, bueno, eso

audit.

Okay, let's see. Miren, este esquema

patient. Entonces, fíjense, hay cinco

levels. El primer nivel es el

pathological. La seguridad se ve como

hospitals. Hasta el mismo director

He says, "Ah, we're going to suspend the chemical,

Chemistry, because it's producing results.

erroneous."

So, you see, the security is visible

like the safety culture, which is that

It has to do with the essential action

number

eight, which is the

Number seven is about adverse events,

everything related to analysis, everything it has

that has to do with it and number eight has to do with the

cultura de calidad. So, look,

porque dio resultados erróneos. Look,

legal. Porque el primer implicado en la

managers. Y fíjense, el nivel 12

severe. Fíjense, donde hay muerte

y la muerte materna están reuniéndose. AND

herramientas no se recomiendan mucho. It

grave y la muerte materna. So,

el AMEF. Because? Pues porque eso nos

the damage. Y si ustedes ven, por ejemplo,

So let's go back. And that's why

final la paciente falleció. So, it's

reactive. Fíjense, el calculador es el

empirically. A veces dicen, "Oye, es

hospital. ¿Qué hicimos?" Pues seguro

algo hicimos que esto ya bajó. to the

cuidado de la salud. Once upon a time

desacelerar la muerte materna. And now the

risks.

And with that, we've already said it, right? This

críticos y todo esto, ¿no? We are

reagent. Y el nivel cinco ya es una

security. México sí tiene hospitales,

Nutrition,

cosas que han modificado. For example,

infectious disease specialist.

institute. Él era responsable de

to become contaminated. Y si ustedes revisan la

six. Entonces, fíjense, es un una

brindar atención más segura. Like this

point 7, point 8, point or one.

buscando, son generadores. The

security. Igual hace un estudio de

time. Entonces, por eso se cambian

cuatro, por ejemplo, proactivo. Equal,

escuelísima para este servicio. does

hospital.

security. Pero con esto lo que estamos

esperemos que pase el daño, ¿no? Management

proactive. ¿Algún comentario que tengan?

from this side.

And a question, professor, for example,

in a system already implemented in a system of

Speaking of quality management, could you

monitoring deviations, eh the one of

process and Chicago which is reactive and

consider one and already have implemented the

process of management and control of

riesgos con AMET? In other words, they can

coexist within the same management system

or should we completely migrate what

We do with Ichik in a reactive theme to the

ME.

Yes, look, the experts recommend that

migrate now to a proactive system that

company that is performing

coats and then it is making

coats and I this

coats. Entonces, 90 salen bien y 10

I use action thinking

corrective measures only, so I'm going to

to say, "Okay, let's fix it and the

"So, 90% is fine." Then, I'll go

to establish a mechanism, an area where

that come out. Entonces, fíjense, nunca voy

to correct

botones de manera correcta. So, I

I work only for the fault, the

No. Entonces, yo tengo que utilizar

llevan a este efecto. And when

For example. Pero fíjense, ya con la

presented. Entonces, lo ideal, yo igual

like

que ocurran esas fallas. So,

private companies. Seguramente la parte

quality management systems. Already from

that

remediando, haga de cuenta. So,

critics. Yo desde que entré a la

problem. Pero fíjense, si alguien ha

tools. So, I think that

Its name has now been changed to committee

prevention of severe morbidity and

maternal mortality and we have to use

failures during care. For example,

He says, "Ah, well there was a delay here, look,

establishing a control mechanism

para el para el riesgo. And notice that

done and for years and we say, "Listen, this

states. Entonces, ahora que identifico,

La mamá tiene menos de 18 años. The mother

vehicle. Pues fíjate, todos estos son

What can I say? Bueno, ese niño no lo puedes

dejar que se vaya a su casa. So

economic,

un mecanismo de control. So,

control. Si el niño tiene vómito, vómitó

like those

risk management. Pero ahora analicen

risk management. Eh, esto que le

Do you have any other comments?

Thank you,

a dar lo de Kigwsukao, ¿ven? That right now

continued.

So, I'm already in hospitals.

I mean, let's do my improvement plan

continuous quality integration

of the clinical record. So

excited in the first month, two months and now

The time comes when they will be a month old.

They reviewed my project, and who reviewed it?

Well, he's Japanese, and then he says to me, "Ah,

"This whole thing is fine and all." But already

in the second review, then he

I say, "But according to the

"This thing about the medical record?" I tell him,

"Yeah." He says, "Let's see, where is it?" Already,

saw. He says, "Well, what do you think this isn't?"

Is it an improvement plan?

Because in Japan, we all...

The rule must be followed. In other words, no

What you have to do here is not a plan

Look. And we have understood,

He says, "Ah, this is hand hygiene,

acciones de mejora continua. and says that

propose or implement improvement actions

complying with the official Mexican standard of

clinical."

rise

weight

detected. Entonces, la propuesta así de

quarter. Y eso nos puede ayudar a qué,

Do you have any questions so far?

that

like what

van a tener muchos conceptos. Right now

control. Y ya si les digo cuáles son los

is having the documentation of the

processes. But if I tell you, let's see,

What is the management model of the

quality and what is used in them

Hospital certification? I already

They say, "Oh, well, it's because they have

that the four elements of the

do, verify, and act. So,

Is all this really what you

They need to know in this part of this

first class. Si ya les dicen, "A ver,

MIS made me 9000?" Well, you're going to

to say, "Ah, well the focus is centered

health, family and community. And all

This has a basis or should have one

support that in ISO 9000 serves us

which is to provide quality care and

We provide it with the four guidelines.

Patient safety, care

risk management. So, take a look

No? Ya vamos a hacer el enfoque de de

operation. Que fíjense, igual cuando les

expedientes y laboratorio y todo. AND

audit. Porque imagínense si ya

director. Let's see, Mr. Director,

patient safety

hospital. Well, I don't have them. TO

teaching. Muéstreme su plan de

training. Show me this. Show me

knowledge.

hemodialysis.

Imagine the recommendations. Let's see,

it

quality,