How to improve care in the gynecology service in a public hospital in Peru

The community in general refers to the lack of adequate treatment on the part of the majority of workers in the hospitals of the Health Sector. This same event occurs in the gynecology service of the Daniel Alcides Carrión National Hospital (HN-DAC), all of which affects the image of this service in particular and of the Hospital in general.

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This bad treatment is more alarming, when it comes to the named worker. This mistreatment consists of the lack of greeting, lack of courtesy, lack of a look that generates confidence, lack of patience for orientation; it also consists of giving him wrong information with the intention that it will affect him; It is also configured in the lack of adequate responses, lack of telephone response, lack of response in email; in short, a whole series of mistreatments that affect even the human dignity of those who make use of medical services.

BIBLIOGRAPHIC BACKGROUND

Guillermo Ballenato Prieto (2008), comments that quality arises from a special combination of pride and humility. It is a mix of initiative, creativity, motivation, courage, decision, ethics, learning, intelligence and passion. It is an excellent investment, and an attitude towards life that will make us be better and progress in building a better society. Undoubtedly, the staff that works in the gynecology service of the Daniel Alcides Carrión National Hospital (HN-DAC), should feel proud to provide their services to this entity and at the same time have to demonstrate a degree of humility and dedication in the services that facilitates.

Luis Gómez Bravo (2004), refers to the lack of human quality that exists in public and private entities, which creates animosity of the patients against the staff, which should not happen because the care and administrative staff of hospitals are a personnel who must have characteristics of a high quality of person, quality of people so that with their sole action they bring joy, well-being and tranquility to patients.

José Antonio Mendoza Aquino (2008), indicates that an improvement plan requires that a system be developed in the company that allows: Having skilled employees, trained to do the job well, to control defects, errors and perform different tasks or operations. Having motivated employees who put effort into their work, who seek to perform operations optimally and suggest improvements. Having employees willing to change, capable and willing to adapt to new situations in the organization.

Irene Imbrogno Irene (2008), the service to the user or client is the set of interrelated activities that a supplier offers in order for the client to obtain the product at the right time and place and ensure its correct use. Customer service is a powerful marketing tool. Good customer service can be a promotional item for sales as powerful as discounts, advertising, or personal selling. Attracting a new customer is approximately six times more expensive than keeping one. So the companies have chosen to put in writing the performance of the company.

Bedoya, Osvaldo (2003) developed a study entitled: "New people management and its performance evaluation in competitive companies", Universidad Nacional Mayor de San Marcos. The investigation starts from the problem of the deficiency of the personnel selection in the same companies that must be competitive, but for this the selection of qualified personnel is required and whose personnel must be in constant training with the new technologies in business management. The main objective of the study is to demonstrate that the new people management directly participates in the evaluation of the performance of its human resources to make companies highly competitive.

Ferrer, P. (1995), in his work titled: “Nursing center for the elderly, experience of the nursing school of the Inca Garcilaso de la Vega University. The research starts from the problem of the lack of a strategic plan in order to make nursing work more optimal, efficient and effective that benefits users, in this case the elderly. The objective of the research is to demonstrate the importance of the application of a strategic plan to improve care for elderly patients in a nursing facility.

Julio Zedeyda (2002), elaborated the thesis: "Perception of the quality of care by the external user of the Emergency service of the National Hospital of Callao-Callao". The study starts from the problem of the deficient attention that patients receive in the Daniel Alcides Carrión del Callao National Hospital, specifically in the Emergency Service. The lack of biosecurity measures and medical instruments and the quality of the service itself are deficient, affecting optimal patient care. The main objective of the research is to know the perception that patients have regarding the care they receive in the Emergency Service of said hospital institution.

Alejandro González (2000), carried out an investigation entitled: "Audit of the administration of human resources at the Central Military Hospital of the Army." The investigation bases the problem in the sense that the internal norms of administration of human resources limit the quality of the services, the processes of planning, selection, evaluation and development of the administrative career are carried out formally without reaching the established objectives. The primary objective of the study is to make known the importance of human resource control to perform an adequate service, both in efficacy and efficiency in a military hospital institution.

Tipacti, Luis(2000): "Evaluation of the quality of care of outpatient services in the public hospitals of Lima Metropolitana and Callao". It starts from the problem of the deficiency of the attention in external consultation to the users of the public hospitals of Lima Metropolitan and Callao, reason why it is necessary to carry out a performance evaluation to the workers to determine the labor efficiency in the attention to the users. The research findings show that 69% of patients stated that the care received was good, while 60% of patients stated that the facilities of the outpatient clinics were good and comfortable. While 80% of patients what bothers them most when going to outpatient clinics is the loss of time and queues.On the other hand, close to ¾ parts of the patients stated that the price of the outpatient clinic is cheap, thus 82% point out that there must be a staff to guide them upon hospital admission. In contrast, 15% of the medical staff believed that the working conditions were good and that 37% were satisfied with the work they do.

Hilda Sánchez (2003) developed a research paper titled: "The quality of service in the hospital sector: Comparative study between state and private entities". The research bases its problems in the sense that the quality of service in the hospital sector is not optimal, so a reengineering is required in order to ensure that patients obtain the right to health, as stipulated in the Political Constitution of Peru. The investigation found that there were significant differences in the perception and assessment of the quality of service.

Álvaro García (2004) elaborated the thesis: “Management of healthcare quality in oral and maxillofacial surgery: Analysis of 15 years of activity records of the surgery service of the 'Virgen del Rocío' University Hospital”, which was presented to the University of Seville, Spain. The technical quality of care is not measured through surveys, but with indicators such as survival and high quality of life. In addition, the logging of activities is crucial for the implementation and improvement of quality at the execution level. It concludes that the modern conception of the quality of care must consider both the economic aspects and the technical and relational scientists. In this sense, the definition of optimal care made by the World Health Organization seems correct.

FORMULATING THE RESEARCH PROBLEM

Also, this inadequate treatment is manifested in the lack of consideration for reasons of age, organic deficiency, race, size, skin color, religion, geographic origin. In other words, it is a gale of situations experienced by people who turn to the gynecology service, against their good faith.

The situation is so great that the appellants believe that there is a policy, with its strategies and everything aimed at affecting them.

The problem of deficiency of attention in the gynecological service of the HN-DAC, manifests itself in the delay of attention, the lack of human quality of care, the proper orientation they should receive regarding their state of health, etc.

There are several problems that affect the service itself, which does not allow for highly efficient and effective work. For example, the problem of the long waiting time for patients in outpatient clinics, which are attributed as causes the lack of training in timely user care and the indisposition of personnel for optimal care in outpatient clinics.

In the same way, there is the poor identification of the personnel with the service, with the Hospital, with the Sector and with the country; also the lack of an integrated hospital information system and weak administrative areas in information and processes; Incomplete management documents and new regulations on work incentives; etc., are other problems that plague the hospital institution.

Main problem:

How to obtain treatment improvement in the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region?

Secondary problems:

What elements can facilitate attitudes of good treatment in the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region? What should the staff have to facilitate the generation of confidence in the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region What elements can facilitate the quality of the gynecology service of the Daniel Alcides Carrión National Hospital?

THEORETICAL FRAMEWORK

GYNECOLOGY SERVICE OF THE DANIEL ALCIDES CARRION NATIONAL HOSPITAL.

According to the Hospital website, on December 30, 1941, the Daniel Alcides Carrión Men's Hospital was opened in the Constitutional Province of Callao, with Marshal Oscar R. Be-navides, Minister of Public Health, as president of the Republic. Dr. Gui-llermo Almenara and President of the Charity Dr. Rufino Aspiazu. The construction of this important health institution of the first port, destined to the attention of the working class of the province, was in charge of the Callao Public Charity, the same that concluded the works on September 5, 1939.

For its part, the San Juan de Dios Hospital, the teaching headquarters of the National University of San Marcos, opened its doors on June 15, 1968 for the exclusive care of women, later becoming a General Hospital. Its construction was also in charge of the Callao Public Charity with the contribution of the Public Works Board, the National Fund for Economic Development and the National Fund for Health and Social Welfare. At that time, Arch. Fernando Belaúnde Terry was President of the Republic, Dr. Javier Arias Stella was Minister of Public Health and Dr. Humberto Rafael Del Pino was President of the Callao Public Charitable Society. With both health institutions, the Constitutional Province of Callao, had some of the most important hospital centers in the country,The Beneficence was responsible for the San Juan de Dios, Daniel Alcides Carrión Hospitals and the Bellavista Maternity Hospital: while the Ministry of Health was in charge of the Maternal and Child Hospital. As of January 1, 1970, by Supreme Decree No. 00166-69-SA. dated October 23, 1969, the Callao Public Charity hospitals become directly Managed by the Ministry of Health, a portfolio that designates a commission to project its new organization and subsequently a commission to execute the project presented by the first. On January 14, 1970 through RS The commission was formed to execute the project, the same one that worked until the appointment of the Head of Hospital Area. As a consequence of the study or work of the commissions,The organizational and administrative integration of the San Juan de Dios and Daniel A. Carrión Hospitals into one was decided, which was called the General Hospital Base del Callao. In October 1971, through R.M. N ° 000189-71-SA / DS, the Minister designates this group of the Daniel A. Carrión Hospital Complex Hospital.

VISION:

The Hospital's Vision is to be a technically accredited and socially prestigious National Hospital, with efficient and innovative management at all levels, leaders in the field of hospital medical care, teaching and research; achieving the satisfaction of our patients and workers.

MISSION:

The Mission of the Hospital is to prevent risks, protect from harm, recover health and rehabilitate the capacities of patients, in conditions of full accessibility and care for the person from conception to natural death. We are a Hospital of the Ministry of Health located in the Constitutional Province of Callao, which provides comprehensive health care at a specialized level, with quality and social commitment. As a Teaching Hospital we participate in the training and specialization of health professionals.

OPERATING DATA:

The "DANIEL ALCIDES CARRIÓN NATIONAL HOSPITAL" is an Executing Unit of the Ministry of Health and is part of the Health Services Network of the Health Department (DISA I Callao). Within the structure of the Callao Health networks, the Daniel Alcides Carrión National Hospital is a Category III-1 teaching institution of the highest complexity, so the Institutional Operational Plan (POI) 2008 is framed in the Guidelines of the National Concerted Health Plan 2007-2020, in the objectives of the government plan 2006-2011 and our Strategic Plan established for the years 2003 - 2008. The POI,It is based on the provisions of Administrative Directive No. 124 / MINSA "Administrative Directive for the Formulation of the 2008 Operational Plan" of the Dependencies and Entities of the Ministry of Health issued by the General Office of Strategic Planning of the headquarters; with the participation of the Management team and the heads of Departments, Services and Offices who have evaluated our goals and objectives to be achieved. Regarding financing, it considers the resources by the sources of financing, ordinary resources, resources directly collected, and by donations and transfers of the Comprehensive Health Insurance.Regarding financing, it considers the resources by the sources of financing, ordinary resources, resources directly collected, and by donations and transfers of the Comprehensive Health Insurance.Regarding financing, it considers the resources by the sources of financing, ordinary resources, resources directly collected, and by donations and transfers of the Comprehensive Health Insurance.

The hospital is the most complex provider of health services in the network of MINSA health establishments in the province, with administrative dependency of the Directorate of Health I Callao and the Ministry of Health. With the implementation of

Comprehensive Health Insurance, the Hospital is a reference for the subregions of Tumbes, Luciano Castillo, Piura, Jaén, Ancash and in burns for twenty-two of the health regions. We are a National Teaching Hospital and our installed capacity has:

468 beds, 124 offices, 11 incubators, 24 cribs, 6 beds in the Adult ICU, 4 cribs in the Neonatal ICU, 3 beds in the Pediatric ICU, 8 beds in the Adult NICU, 6 Elective operating rooms (5 operative), 3 Emergency surgery rooms, 1 ophthalmic surgical center, 2 ambulances. The Hospital provides medical services in various specialties of Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, through the Outpatient Services, Hospitalization, Emergency and Intensive Care; as well as treatment support services, also having Preventive-Promotional Programs for Communicable and Non-communicable Diseases. To provide its services, it has 208 medical assistants and 125 residents, 293 "other health professionals" plus 62 inmates,596 non-professional care workers and administrative staff are 93 workers. Based on the population of Callao, the availability of its services during 2002 was 5.7 functional clinics for every 10,000 inhabitants, 4.6 operating rooms for every 100,000 inhabitants and 2.1 beds for every thousand inhabitants. During the year 2002 the population that demanded services was 84 818 patients for outpatient visits, in addition 16 970 patients were hospitalized and 70 130 patients were treated in emergencies. During the year, 318,322 services were provided by external clinics, 23,633 sessions of physical medicine and rehabilitation, and 7,022 surgical interventions.the availability of its services during 2002 was 5.7 functional clinics for every 10,000 inhabitants, 4.6 operating rooms for every 100,000 inhabitants and 2.1 beds for every thousand inhabitants. During the year 2002 the population that demanded services was 84 818 patients for outpatient visits, in addition 16 970 patients were hospitalized and 70 130 patients were treated in emergencies. During the year, 318,322 services were provided by external clinics, 23,633 sessions of physical medicine and rehabilitation, and 7,022 surgical interventions.the availability of its services during 2002 was 5.7 functional clinics for every 10,000 inhabitants, 4.6 operating rooms for every 100,000 inhabitants and 2.1 beds for every thousand inhabitants. During the year 2002 the population that demanded services was 84 818 patients for outpatient visits, in addition 16 970 patients were hospitalized and 70 130 patients were treated in emergencies. During the year, 318,322 services were provided by external clinics, 23,633 sessions of physical medicine and rehabilitation, and 7,022 surgical interventions.in addition, 16 970 patients were hospitalized and 70 130 patients were treated in emergencies. During the year, 318,322 services were provided by external clinics, 23,633 sessions of physical medicine and rehabilitation, and 7,022 surgical interventions.in addition, 16 970 patients were hospitalized and 70 130 patients were treated in emergencies. During the year, 318,322 services were provided by external clinics, 23,633 sessions of physical medicine and rehabilitation, and 7,022 surgical interventions.

The Daniel A. Carrión National Hospital is a reference IV level Hospital, a teacher that trains health professionals and technicians who then carry out their activities throughout the country, and as a highly complex hospital it can receive patients from all over the national territory. The patients who arrive at the HN “DAC” come from the 6 districts of Callao, with Callao Cercado contributing 80.3%. Patients also come from neighboring districts such as San Miguel and Los Olivos, among others. In Hospitalization, 50% of the demand belongs to women of childbearing age, and both vaginal and cesarean delivery correspond to more than 30% of total discharges. The distribution of patients seen in outpatient clinics according to their origin and sex in 2002, out of a sample of 58,015 patients seen, shows that 90.1% come from Callao, 91% from Lima and 0.8% from the interior of the country. In relation to sex, 60.6% belongs to the female and 39.4% to the male.

GYNECOLOGY SERVICE:

Gynecology literally means the science of women, but in medicine this is the medical and surgical specialty that treats diseases of the female reproductive system (uterus, vagina, and ovaries). In addition, there is, in relation to the above, the specialty of obstetrics, to the point that almost all modern gynecologists are also. According to Suda, the ancient Greek physician Soranus practiced in Alexandria and subsequently in Rome and was the chief representative of the medical school known as the Methodists. His treatise on gynecology is extensive-first published in 1838 and then in 1882 by V. Rose, with a 6th century Latin translation by Moschio, a physician of the same school. Then, as in the rest of the medical practice,The main tools for gynecological diagnosis are medical history and physical examination. However, the gynecological exam has always been much more intimate than the routine physical exam. It also requires profession-specific instruments, such as the speculum, which allows vaginal tissues to be retracted to explore the cervix. Gynecologists are specialists in the diagnosis and treatment of symptoms associated with diseases such as: Cancer and pre-cancerous diseases of the reproductive organs, Urinary Incontinence, Amenorrhea (absent menstrual periods), Dysmenorrhea (painful menstrual periods), Infertility, Menorrhagia (periods abnormally bulky menstrual periods) - a frequent indication of a hysterectomy, pelvic organ prolapse, scabies, etc.

All the services that correspond to this specialty are provided by the Gynecology Department. This department is divided into the following services: Gynecology; Obstetrics and Gynecological Surgery. The Department of Gynecology and Obstetrics provides care services for all diseases related to women's reproductive organs in the gynecology service. The pregnant woman in the Obstetrics service, the couples who cannot have children in the Fertility Unit, the couple who wants to space the pregnancies and have no baby for some time or definitively in the Family Planning Program.Teenagers who want differentiated attention in the Youth Office and finally women who want to do their Gynecological and Breast Cancer Screening or be treated for gynecological cancer at the Oncology, Gynecology and Breast Service. The service provides some special procedures such as: Video Surgery or Surgical Laparoscopy: Hysterectomy Abdominal hysterectomies, Genital Plasma Anexextomy, Total or partial ovariectomy Ovarian and adnexal cystectomies; Myomectomy Surgical cure of urinary incontinence with special techniques (TOT - Burch), release of adhesions, Colprascropexy, treatment of endometriosis, Vaginal hysterectomies, Surgical hysteroscopy and diagnosis. She also performs special exams, such as: cervical pap smears, endometrial biopsy, clinical cystometry.

Playing Pfiffner & Sherwood (2005), a public sector entity like the HN-DAC is the set of departments, sections, and other areas that depend on the State in a national economy. The role and volume of this entity depend largely on the services they provide to the community, which is why they require a very strong philosophy on user satisfaction.

Analyzing Chiavenato (2005), the work contributed by all the employees or collaborators of a hospital entity must be aimed at comprehensive care, within the framework of the entity's goals, objectives, mission and vision. The work carried out by the personnel must be facilitator and not hindering the efficiency and effectiveness of a service or of the institution itself; for which it is necessary to plan, organize, direct, coordinate and adequately control all available resources.

According to Arsenjo (2002), hospitals are a combination of the human and material resources available, aimed at achieving an end, according to their precise scheme of dependencies and interrelationships that constitute it. From this definition, it can be deduced that the objectives have been decisively determined by the configuration of the dependent scheme and determining interrelationships in the environment of the organization.

For your part you fear(1992) adds that the hospital, like many other organizations and institutions in our country, has had to adapt its structure and operation to the society that has been changing from a totalitarian political model to a democratic model, which is why there are determining factors that have affected the environment of organizations such as: historical, political, economic and social factors, which have determined the behavior of institutions influencing daily activities. The model of health care in the different hospital services and most evident in emergencies is determined by the way in which health systems are organized, interrelated between the three levels of care, which are linked to the way society, before the social and biological determinants of health.It organizes its human, technological and material resources to comprehensively face health risks and provide the health care services established by the community itself.

According to Robbins (1993), in general, the care model, and particularly the ways in which medical benefits are organized, many have been governed by the supply and the estimate of assumed needs. Recently, there is a tendency to let demand determine the organization of services, to introduce market mechanisms such as competition, and money to follow the patient.

According to Arsenjo (2002), within the current processes of the health sector, a profound modification of relations and working conditions is observed. In this transformation, labor conflicts become relevant and increase their complexity as new power relations emerge within a context shortened by flexibility, decentralization and autonomy of management or service organization oriented to users. The demands that hospital managers, unions and unions have to face change radically and demand to modify the vertical style of management, the traditional corporate representation and the fight for isolated benefits.

Huamán(2005), considers human resources policies in health as a doctrinal framework of action that is accompanied by implementation strategies, objectives and goals; They constitute social pacts that attempt to resolve the tension between the demands of the population to exercise the right to health, the demands and rights of health personnel and the objectives of the health system. Human resources policies in health are medium policies of health policies, since they serve the models of care and the strategic objectives of the sector; therefore, they are in service of the care, financing and management models. They seek that workers are competent, motivated, adequately remunerated and protected, perform efficiently in the appropriate services,where and when they are needed.

According to Padilla(2002), most of the human resource planning efforts in the world, have basically focused on the doctor. Very few processes have included other professionals, and in these cases they were mainly nursing. Much fewer have been the cases that directed the workforce as a whole. The need (and the ability) to have the "right" number of a mix of professions, with the right skills in the right place and time, has been the interest of those who have always tried to plan. The human resources policy of a health organization is directly related to the mission, vision and policy of institutional development. It is subordinate to the orientation that she proposes,which in turn can only be achieved if there are human resources capable and convinced of leading the way proposed by institutional policy.

Interpreting Brito (2002), to design a policy, it is necessary to carry out a strategic analysis of the internal positioning of the organization's actors, as well as of the external determinants, for the management of human resources, that is, consider the issue of the resource human as a strategic aspect, with implications for negotiation and change both intra and supra-institutional. The contents of the human resources policy must include ideologies, values and define the direction of the organization.

According to Temes(1992), in health institutions, in general, the conflicts between the operational and the strategic nucleus are cushioned by the professional ethical motivations of the staff, unlike what happens in other organizations, where the material motivation has a greater weight.. According to Barquín (1988), he adds that for these reasons, there are fewer problems, compared to other large organizations, in motivating Hospital staff towards their objectives. In the work process, doctors, nurses and staff remains cannot and should not function separately or independent from each other. The work is mutually supplementary, concatenated, and independent. Unlike other organizations, the hospital is highly dependent on skills,the ability and behavior of its staff to achieve and maintain proper coordination.

According to Udaondo (1992), due to the intrinsic characteristics of hospitals in terms of authoritarianism and verticality guaranteed by rigid rules and procedures, directive supervision, rigorous discipline added to individual behavior, it allows to achieve some uniformity in the behavior of members, regulating their interaction and their performance is evaluated .For his part, Morales (1998) says that the increase in professionalism within the Hospital has guaranteed the existence of certain minimum levels of aptitude and capacity, with a direct impact on the performance and effectiveness of the organization's actions, which it is reflected in how effectively it works. This professionalism dilutes the concept of formal authority and replaces it with functional authority. This motivation creates the absence of a single line of authority, generating operational and administrative as well as psychological problems related to the power of influence of doctors, board members, administrators and others, on the operation of the organization.

HUMAN QUALITY

According to Aguilar (2008), at this time everyone talks about product quality, process quality, service quality, system quality… Very few people talk about human quality, quality of life… and without it, everything else is appearance., without foundation. To speak of human quality is to take care of our ties with others. We need to remake our human ties. It is useless working from sunrise to sunset in a place where we have no friends and arriving tired to a home where no one is interested in knowing how it went. It is sad to read a book and not have someone to discuss it with, it is painful to feel worried and not have someone to open your heart to.

Playing Mora(2008), the foundation of human quality is the capacity of authentic interest in realities as they are, regardless of the benefit that may or may not be obtained as a result of that interest. The authentic interest in realities, mental, perceptual and sensitive interest, is not conditioned by my own advantage, it is independent of it. If I were conditioned by my own benefit, it would be nothing more than interest in myself and not interest in realities. For interest to be real, it is necessary not to be involved in situations or in relation to the realities in which we are interested; You need to be able to distance yourself from situations and relationships. This supposes the ability to access realities with a mind and feel detached, free and independent. Who depends on what he tries to understand and feel,he has the mind and the feeling that he is a slave to himself, therefore he is incapable of authentic interest and authentic alertness to realities.

According to Mendoza(2008), the triple aspect of what is human quality, interest, detachment and inner silence, forms an inseparable unit. Each of those aspects involves the others. This is the general law of human quality, of the wisdom required to conduct all questions, both individual and collective; It is the wisdom required to cultivate the sciences and technologies, art, religion, etc. That is the structure of human quality that is required for any matter of importance. This human quality was cultivated by our ancestors based on religious beliefs or ideological beliefs. This quality is always necessary for human affairs to function properly;it is most necessary when we no longer have accredited life projects to lean on when our personal and collective quality fails. Individuals and collectives who can no longer be governed by life patterns received from God or the nature of things, because they have to live from continuous change and continuous creation, need quality more than ever.

IMPROVING THE DEAL

According to Valarie, Parasuraman and Berry (2005), the quality of customer service is a process for the total satisfaction of their requirements and needs. Clients are the lifeblood of any organization. However, few companies are able to adapt to the needs of their clients in terms of quality, efficiency or personal service. That is why managers must start the process of improving the quality of the service they offer to their clients, since it is not a matter of choice: the image of the company depends on it. To maintain the company's image, it is necessary, among other things, to continually improve the workplace, focusing on quality and continuous improvement.

According to Abell(2004), continuous improvement requires a strong discipline, be it in terms of productivity, customer satisfaction and cycle times, since we consider that in the Kaizen philosophy it is not enough for the executive or administrator to have an information system to notify you from time to time, but you should visit the workplace several times a day to personally assess what is happening and why. Kaizen administrators give greater prominence to everything related to processes, unlike most Western managers who focus on the written reporting of results. In our case, there are several factors necessary to achieve continuous improvement in Customer Service. One of the most outstanding is having all the necessary tools (equipment, materials, methods,trained and motivated employees) to provide the customer with the care they expect. We believe that if you want to improve results, you must improve processes, which will allow you to improve, with certain actions, the satisfaction of your employees and your customers, the raison d'être of institutions.

Interpreting Johnson and Scholes (2004), it can be considered that improving customer service is a real challenge for any entity that does not want to be displaced by more aggressive competition and by customers who are increasingly aware of the power of choice that They are more sophisticated in their needs and expectations and much more demanding than they were a few years ago. And this is so for a simple reason: The competitiveness of companies today depends on their ability to attract and retain a customer base, consumers or users large enough to generate the resources that will allow them to cover their costs and invest. in their own development and progress and in that of all those who are part of them.

Interpreting Ishikawa and Cárdenas (2003), quality is a concept that has been changing over the years and that there is a great variety of ways of conceiving it in companies, below are some of the definitions that are commonly used today. The quality is:

Fully meet customer needs. Meet customer expectations and more. Wake up new customer needs. Achieve products and services with zero defects. Do things right the first time. Design, produce and deliver a product of total satisfaction. Produce an article or a service according to the established norms. Give an immediate answer to the requests of the clients. Smile despite the adversities. A category always tending to excellence. Quality is not a problem, it is a solution.

Rosander (1998), presents the quality concepts of various authors, such as:

Edwards Deming: "Quality is nothing more than" A series of questions towards continuous improvement ".J. They swear: quality is "Fitness for use meeting customer needs." Kaoru Ishikawa defines quality as: "Developing, designing, manufacturing, and maintaining a quality product that is the most economical, useful, and always satisfactory for the consumer ". Rafael Picolo, General Manager of Hewlett Packard: defines" Quality, not as an isolated concept, nor that is achieved overnight, rests on strong values that are presented in the environment, as well as in other that are acquired with effort and discipline ».

With the above it can be concluded that quality is defined as a process of continuous improvement in everything the entity does, where all areas of the Hospital actively participate in the development of services that meet the needs of patients, thereby achieving efficiency, effectiveness and increased productivity.

La capacidad resolutiva del Hospital es sin duda desde el aspecto formal de alta complejidad. Sin embargo la realidad nos muestra un panorama que permite afirmar que buena parte de las atenciones que se brindan corresponden a patología del primer nivel de atención. Al respecto es importante analizar que si bien se es un hospital de nivel IV, la demanda no está educada para utilizar los servicios del nivel local, y a la vez la capacidad resolutiva de los establecimientos del primer nivel de atención no está debida y uniformemente organizada. Adicional a ello hay que tener en cuenta que la demanda no puede quedarse sin atender, y que en modalidades de aseguramiento público como hoy se promueven, puede ser una fuente de ingresos importantes a la economía del hospital (por supuesto en el entendido que se garanticen los reembolsos oportunos por las prestaciones brindadas). En estricto sentido no se puede hablar de competencia con los otros establecimientos del sector público, puesto que entre todos se debería desarrollar un comportamiento de complementariedad en relación a la atención de las necesidades sanitarias de la población. Pese a ello, puede existir el riesgo de aplicar enfoques de competencia con otros establecimientos; en el caso de nuestro hospital esto no es así, pues tenemos muy claro que por el nivel del establecimiento, por la capacidad resolutiva que le corresponde, y por ser parte de una red de servicios, nos interesa desarrollar nuestra competitividad, entendida como la superación de nuestras propias deficiencias y limitaciones, y que nos permita haciendo un uso más eficiente de nuestros recursos poder atender mejor y satisfacer las expectativas de nuestros usuarios.

OF JUSTIFICATION

Methodological justification.

This work will be carried out taking into account the process of scientific research. In this regard, the problem is identified, on the basis of which the corresponding solutions are formulated through the hypotheses. The methodology to be used and all the complementary elements are specified.

Theoretical justification

The main theories on human quality, improvement of treatment and other important elements will be identified.

Without human quality in the people who provide gynecological services, this service cannot be conceived. Human quality is the recipe that patients of the service need. Without human quality nothing is conceived.

The gynecology service could have doctors, nurses, midwives, auxiliaries and personnel in general highly trained, trained and perfected; but if they do not have human quality, it does not make sense that they continue to provide hospital services.

The gynecology service could have the best place, environment, instruments and other elements of gynecological paraphernalia; but it would not make sense if there is no human quality in the care of the users of this service.

Human quality stems from the gift of people, also from instruction and education, from the scale of values, from the criteria and even from common sense that must be developed by the gynecology service personnel. You cannot conceive of medical and paramedical personnel without human quality.

Human quality, humanizes the service, makes it affordable, generates reasonable trust in the service, regains confidence, creates a kind of promotion for users; that is, it is the best alternative within the framework of an adequate treatment.

Importance

This work will be a contribution that contributes to the solution of the continuous complaints of lack of human quality in the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region; because it will complement the great assistance and administrative effort made by the corresponding authorities.

OBJECTIVES

general

Identify the instrument that generates treatment improvement in the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region.

Specific

Determine the facilitating elements of good treatment attitudes in the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region. Analyze the instrument that the staff must have to facilitate the generation of trust. in the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region. Specify the elements that can facilitate the quality of the gynecology service of the Daniel Alcides Carrión National Hospital.

HYPOTHESIS

Main hypothesis

If the personnel that attend the gynecology service of the Daniel Alcides Carrión National Hospital were endowed with human quality, then the improvement of the treatment of the patients of said service would be achieved.

Secondary Hypotheses

If the staff of the gynecology service at the Daniel Alcides Carrión National Hospital in the Callao Region had adequate instruction and education; Then, the attitudes of good treatment needed by the users of said service would be facilitated. If the staff of the gynecology service of the Daniel Alcides Carrión National Hospital in the Callao Region, showed a reasonable scale of values; Then, the generation of confidence in the users of the service would be facilitated. If the gynecology service personnel of the Daniel Alcides Carrión National Hospital in the Callao Region had criteria, common sense and logic; then, the quality of the service would be facilitated.

KIND OF INVESTIGATION:

This research work will be of the applied type, since all aspects are theorized, although its scope will be practical to the extent that they are applied by the Gynecology Service of the Daniel Alcides Carrión National Hospital in the Callao Region.

INVESTIGATION LEVEL:

The research to be carried out will be at the descriptive-explanatory level, since the problems experienced by the Gynecology Service of the Daniel Alcides Carrión National Hospital in the Callao Region will be described, regarding the lack of treatment of users and then it will be explained that through human quality the solution to this problem.

INVESTIGATION METHODS:

The following methods will be used in this investigation:

Descriptive.- Because the entire theoretical framework of human quality and improvement of treatment will be specified so that the Gynecology Service of the Daniel Alcides Carrión National Hospital in the Callao Region has the trust of the users. Inductive - To infer the information of the sample in the population and determine the conclusions that the investigation merits. Information on motivation and productivity in the effectiveness of Banco Continental's customer service will be inferred.

DESIGN OF THE INVESTIGATION

This work will have a pure analytical and explanatory design.

POPULATION OF THE INVESTIGATION:

The population will be made up of the staff and users of the Daniel Alcides Carrión National Hospital in the Callao Region

INVESTIGATION SAMPLE

The sample will be made up of the staff and users of the Gynecology Service of the Daniel Alcides Carrión National Hospital in the Callao Region.

Formula to determine the sample size:

To define the sample size, the methodological formula for finite populations will be applied:

Where:

n	It is the size of the sample to be taken into account for the field work. It is the variable that you want to determine.
P and q	They represent the probability of the population to be included or not in the sample. According to the doctrine, when this probability is not known from statistical studies, it is assumed that p and q have a value of 0.5 each.
Z	Represents the standard deviation units that in the normal curve define an error probability = 0.05, which is equivalent to a 95% confidence interval in the sample estimate, therefore the Z value = 1.96
N	The total population considered by the researcher.
EE	Represents the standard error of the estimate, according to the doctrine, it must be 0.10 or less. In this case 0.097 will be taken

Substituting:

n = (0.5 x 0.5 x (1.96) ² x 620) / (((0.097) ² x 619) + (0.5 x 0.5 x (1.96) ²))

n = 100

DATA COLLECTION TECHNIQUES

The techniques that will be used in the investigation will be the following:

Surveys.- It will be applied to workers, users and the community, in order to collect information about the research. Documentary analysis.- This technique will be used to analyze the norms, bibliographic information and other aspects related to the investigation.

DATA COLLECTION INSTRUMENTS:

The instruments that will be used in the investigation are the following:

Survey questionnaire.- This instrument will be applied to carry out the survey. Documentary analysis guide.- This instrument will be useful to write down the information of standards, books, magazines, Internet and other sources.

ANALYSIS TECHNIQUES:

The following techniques will be applied:

Documentary analysis. - This technique will allow knowing, understanding, analyzing and interpreting each one of the norms, magazines, texts, books, Internet articles and other documentary sources. Inquiry.- This technique will facilitate the availability of qualitative and quantitative data of a certain level of reasonableness. Data reconciliation.- The data of some authors will be reconciled with other sources, so that they are taken into account. Tabulation of tables with quantities and percentages.- The quantitative information will be ordered in tables that indicate concepts, quantities, percentages and other useful details for the investigation. Graphics understanding.- The graphics will be used to present information and to understand the evolution of the information between periods, between elements and other aspects. Others.- The use of instruments, techniques, methods and other elements is not limiting, it is merely referential; therefore, as necessary, other types will be used.

DATA PROCESSING TECHNIQUES

The following data processing techniques will be applied:

Ordering and classification. - This technique will be applied to treat qualitative and quantitative information in an orderly manner, in order to interpret it and make the most of it. Manual registration.- This technique will be applied to enter the information from the different sources. Computerized process with Excel.- To determine various mathematical and statistical calculations useful for research.

Computerized process with SPSS.- To enter, process and analyze company data and determine average, association and other indicators.

______

www.hndac.gob.pe/html/historia.htm

en.wikipedia.org/wiki/Gynecology

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