Management of patient care for a hospital in Argentina

In the present work, it will be carried out during the course of the labor practice workshop subject, at the national university Arturo Jauretche, in which the teacher Laura Saavedra, will guide us to efficiently carry out the report.

An attempt will be made to analyze the problem of the ¨Mi pueblo¨ general acute care hospital, seeking to analyze patient management.

hospital-patient-care-management-argentina

On the other hand, improvements in the subject will also be sought, such as systematization of medical records or better management of medical records in accordance with compliance with Law 26,529, creation of a specialized procedures manual according to cases from the same hospital with a flow chart connection and realization of meetings to analyze future decision-making.

Firstly, a brief description of the organization to be dealt with from its beginnings, in its new location, by how it is divided, starting from internment sectors and lastly clearly detailing how the area that has the most problems in management is divided. of the patient.

Likewise, authors of relevance for their greater understanding of the axes to touch on the objectives will be taken, from Taylor to authors such as Dr. Ramón Carillo, the nation's prime minister of health, creator of the famous book Theory of Hospital.

Finally, interviews will be conducted with relevant employees in the case, they will be carried out on slopes, taking into account for their subsequent analysis and future improvements in the patient management system. Then stop reaching the conclusions that will be the last to be detailed in the following report.

DESCRIPTION OF THE ORGANIZATION

The Zonal General Acute Hospital "MI Pueblo" (HMP), is located in Florencio Varela, a town in the Segundo Cordón del Conurbano Bonaerense, 35 km southwest of the Autonomous City of Buenos Aires and 40 km from the City of La Plata. Its surface is 206 km2.

Its population is 426,005 (2010 Census) . The population structure of the district shows a predominantly young population, since 44.2 of the population is under 21 years of age, the average age of the population being 25 years. According to the 2008 Permanent Household Survey, 76.9% are below the poverty line; households with Unsatisfied Basic Needs (UBN) reach 26.7; and 65.3 does not have Social Work coverage.

Source: systematized information Ministry of Health Province of Buenos Aires.

Table 1. Florencio Varela's population, demographic characteristics:

	% LARGE GROUPS OF AGE
FLORENCE VARELA	MALES	WOMEN	MALE INDEX	DEPENDENCY INDEX	0-14	15-64	> 65
426,005	212,909	213,096	99.9	57.32	30.36	63.67	5.97

Source: INDEC Census 2010

Local Health System, brief review:

In order to understand the complexity of this process, it is necessary to know some historical background on the “Mi Pueblo” hospital as an integral part of the local municipal health system.

Florencio Varela's health system went through different stages, accompanying the historical-political processes. For the better functioning of the system, the district was regionalized in four program areas and, based on the proposal of the Maternal, Child and Nutrition Program (PROMIN), the reference-counter-reference office was incorporated to improve the link between levels of care.

The Second Level in those years was represented by the "Nicolás Boccuzzi" Hospital, opened in the 1940s as a "First Aid Room", it grew with a very precarious building infrastructure, its capacity was 64 beds, for a population of 200,000 population.

In 1984, the first assumptions to improve the infrastructure of the Second Level began with the opening of the outpatient clinics in the place where the "Mi Pueblo" hospital currently operates, in 1990 the diagnostic services, the service were transferred of pediatrics with the hospitalization, the guard and the administrative area; In 1992, the transfer of all the services that were still operating at the Boccuzzi Hospital was completed.

In 2004 the government of the Province of Buenos Aires expressed its will to take over the administration of the Hospital; the process is completed on January 1, 2005 with the provincialization of the Hospital. Currently Florencio Varela's health system is made up of 35 health centers, which represent the first level of care; of municipal dependency, the Acute General Hospital "Mi Pueblo", second level of care, provincial dependency and the third level represented by the Interzonal Hospital "El Cruce" (SAMIC) of mixed provincial and national dependency, inaugurated in 2007.

The Hospital "Mi Pueblo" has a medium complexity level "6" according to the classification of health institutions of the Ministry of National Health, the provision of beds until 2010 was 177, that same year the expansion of the maternal area was completed infant becoming 215 beds, distributed in the Services of Pediatrics, Obstetrics, Progressive Care, Intensive Care, Emergency and Neonatology. In addition, it is a school hospital, since techniques are taught in:

• NursingPharmacySterilization

Also links with the internships of the Bachelor of Nursing degree courses, among other careers, with universities such as UBA, UNLP, UNAJ, UNQUI. As well as postgraduate degrees as medical residency specializations.

In turn, it has the external consulting sector with a total of 40 consulting rooms, in which approximately 950 people are served daily in the consulting rooms and per year it is 344,878 (2015), they occur from 7:00 a.m. to 4:00 p.m. Counting on the following specialties:

• AlergiaCardiologíaCirugía Children and adults (general, gynecological, plastic, orthopedic and traumatology) Clinic MedicaDiabetologíaDermatologíaInfectologíaGastroenterología child and adultoGinecología infantilGinecología (cervical pathology, urogynaecology, breast disease) NefrologíaNeurologíaPsiquiatría adultoNutriciónObstetricia controlesOdontologíaOncologíaOrtopedia and traumatologíaPsicología Infant and child and adultoClínica AdultoFisiatríaChagasUrologíaNeumonología of adolescenciaClínica of orientaciónControl Newborn sanoPediatríaFonoaudiologíaPlanificación Family High Pregnancy Pregnancy HIV counseling and counseling

The shifts for the attention, in the external clinics are carried out in the same hospital, that from 5:00 am the numbers are distributed to get the shift that approximately only 200 numbers are distributed for the other week to be attended. If there is no space for the specialty or professional, data is taken from the patient to be able to write it down on the waiting list, which then over time will be called to be able to make their shift. Another option that the patient has is to make the shift by phone at 0800-222-5190 Monday through Friday from 7:00 am to 1:00 pm, another way is when from caps. (Primary health care center) ward rooms in charge of the health secretary of the municipality of Florencio Varela, in which the professionals consult with the specialties that they request,but they must send it to the secretary of health who then, the municipal entity, requests the shifts to the hospital. After carrying out the same process, the hospital sends the information of the shifts to the municipal health secretary and then the secretary distributes it to the primary health care centers (CAPS).

Currently, the organization has approximately 1,000 human resources. They carry out their functions, respectively, in the area that we address the problem of patient care management, 2 people are in charge of telephone shifts, 2 people in window giving shifts, 2 people who attend reports within a limited hours from 07:00 a.m. to 1:00 p.m., 1 person in charge in the shift area requested by the health secretary by the local health center.

Continuing the description of the hospital, it has a file in the basement where there are medical records of patients attended by hospitalizations, on-call or medical follow-up consultations. The same account is divided into two parts A0 and A1, in the part of A0 there are medical records that are from medical consultations or that were only on duty for less than a day or six hours in observation. Consequently, in the other area are all the medical records of the patients who were treated for hospitalizations for more than a day and / or 6 hours, depending on the risk of complexity of the case. It should be clarified that all the data on patient benefits are paper and not digitized, only in the systems there is a general diagnosis, days of stay,from what day and until what day were you in the hospital and other personal information (address, telephone number, date of birth, if you have social work, etc.).

MISSION

Contribute to improve the health level and quality of life of the population through the provision of health services, with criteria of equity, gratuitousness, accessibility, comprehensiveness and quality of care, through actions of promotion, prevention, recovery and rehabilitation Of the health; developing a humanized, efficient and effective care system that takes into account the needs and interests of the different social actors as well as their participation in decisions, respecting their idiosyncrasy; having a trained, committed and identified human resource for these purposes and integrated the hospital into a local and regional network, articulated with a management model of health services aimed at scientific and technical excellence, optimizing existing resources.

VISION

1. It will be a model of health organization, with a hospital Strategic Plan prepared in a participatory manner by workers and community representatives, which will guide and regulate hospital activity. Mi Pueblo Hospital will be a benchmark in the development of prevention and health promotion strategies, which will improve the health level and quality of life of the population. It will have an organization focused on the needs and satisfaction of the citizen / user, where the perception of the same, as well as that of the workers, is systematically evaluated, tending to achieve the best levels of satisfaction. The health services it provides will guarantee accessibility to the population and the quality of services,with criteria of equity and efficiency, always maintaining their gratuitousness and universality. It will be an integral part of the local, regional and Provincial Health network, actively participating in the organization, articulation and integration between different levels of care, in the vertical dimension and horizontal, within the framework of the primary health care strategy guaranteeing access and continuity of care for those who need it most. It will promote integration with the Private Health System and Social Work. It will maintain a physical plant and equipment that will evolve according to the planned activities and according to the needs that arise at all times. It will promote the active participation, expression, criticism, proposals and suggestions, both of the citizens / users and of the workers,within the management control system. It will promote the training of all workers, research and teaching, taking into account their needs and ensuring equal access to organized activities. Horizontality in decision-making will be fostered, allowing them to be adopt and execute in the place where the problems develop. It will develop its healthcare activity in a programmed way, with rules based on scientific evidence, implemented by consensus, and subject to review and adaptation by all members of the network. It will have a management with a democratic, participatory leadership style, oriented to the fulfillment of the objectives formulated in the Institutional Strategic Plan, to the coordination of activities,to the creation of collective work areas and to facilitate internal communication. It will have an efficient accounting administrative system that allows for the adequate control of the use of resources, and that makes it possible to have a hospital cost system that serves as a tool for decision-making. The Hospital Budget will be the reflection of a process agreed by all the services in a Participatory way.

VALUES

The workers of the “MI Pueblo” Hospital will be recognized by:

• Sense of belonging, Commitment to public health, Responsibility for care, Respect for diversity, Equity as a central value, Respect for patient's rights, Democratic participation, Ethics

OBJECTIVES:

1. Generate the areas of encounter between the different social actors: hospital workers, community representatives for the elaboration of the strategic plan. Strengthen existing spaces (diabetics, non-smokers, etc.) and promote new spaces (eg avoid sedentary lifestyle, run walks, etc.) Evaluate through surveys and other axis mechanisms. Mailbox for complaints and suggestions for the satisfaction of the external and internal user. Adapting the hospital organization to the health requirements of the population. Deepening the articulation mechanisms between all levels of care; generating new devices in the R-CR. Strengthen the strategies of: cost recovery, participation of health care providers from the private system outside the hospital in the process of improving the quality of services.Facilitate meeting areas with private entities and OS to discuss, agree and exchange information and standards of care. Create the relevant spaces (offices of attention to internal and external users.) Survey the training needs and design an annual plan that respond to it. Build the functional profiles of each area of ​​the hospital. Generate links with the actors of the different levels. Prepare a system of hospital costs. Generate the meeting areas for the discussion of the annual hospital budget.Survey the training needs and design an annual plan that responds to it. Build the functional profiles of each area of ​​the hospital. Generate links with actors at different levels. Develop a system of hospital costs. Generate meeting areas for the discussion of the annual hospital budget.Survey the training needs and design an annual plan that responds to it. Build the functional profiles of each area of ​​the hospital. Generate links with actors at different levels. Develop a system of hospital costs. Generate meeting areas for the discussion of the annual hospital budget.

PROBLEM

The problem that we will address next, emphasizes the factors that affect the existence of a weakness in patient care, in relation to communication between the patient and reports from the Floodcio Varela General Acute General Hospital in Pueblo, in which the issuer (public employee) does not have the guidelines, in a procedure manual and / or training for said resolution.

But also not only that problem stands out from the issues that we will deal with but also the lack of professionals, endless waiting lists to obtain a shift, excessive hours to be able to get a number and then request a shift.

In turn, not only the capture of messages and other aspects of treatment or the structuring of schools, but also how the archaic medical history is used, for new advanced systems, according to theories and / or concepts in which its prejudice through a SWOT analysis.

Also, its courses or flow charts detailing the circuit of the same medical history in a binding relationship with the management that is carried out in the hospital of Florencio Varela.

The general question that we can ask:

• What are the problems of patient management at Florencio Varela General Acute General Hospital "Mi Pueblo"?

From this great question questions will emerge that can give it a form, for the explanation of the topic that we will address.

• How does training influence an employee who is in contact with the patient? Can there be weaknesses in the organization due to the loss of information (medical history) in the care? Can the patient's dissatisfaction be linked to an extensive list waiting to get a shift? Currently the number of patients has increased, but the medical staff has been reduced? What consequences does the hospital have for poor patient care?

JUSTIFICATION

We are clear that patient care is a right that everyone in Argentina has free of charge. At present, patient-centered hospital management is taken into account; there is no doubt that over time the hospitals that follow the changes in society are being transformed.

Today many public hospitals do not take into account the patient's discomfort, there is a law that regulates the rights that every patient has, whether in the public and private sphere, through the so-called patient law which grants them these benefits to all people served in them:

• To assistance. To dignified and respectful treatment. To privacy. To confidentiality. To the autonomy of the will ("To accept or reject certain medical or biological therapies or procedures"). To health information. To medical consultation ("To receive the health information in writing, in order to obtain a second opinion. ") Informed consent: (" the declaration of sufficient will made by the patient, or by their legal representatives, where appropriate, issued after receiving, by the professional intervening, clear, precise and adequate information ”) To the medical record (“ The patient is the owner of the medical record. A simple copy of the record, authenticated by the competent authority of the healthcare institution, must be provided upon request.The delivery will be made within forty-eight (48) hours of request, except in case of emergency ”).

In turn, a use of a procedures manual for people who are in contact in patient care, the steps, guidelines, tasks and / or other things they do is appropriate to satisfy the patient. On the other hand, that the managers in charge of the personnel who are in contact with the patient, hold meetings to plan decision making in the short or long term. From analyzing a SWOT analysis, to delineate the strengths and weaknesses that may arise in the organization that affect it, be an example, the extension of more shifts so that there are no shifts on the waiting list. In addition, the expansion of external offices so that each patient is cared for in decent spaces.

In conclusion, apart from what was previously mentioned, it is essential that the coordination of work in the archive sector be improved through the formation of courses for the greater understanding of the personnel working in this sector or the possibility of digitization of medical records such as this is the case of the crossing hospital, one of the 3 best hospitals in Latin America.

OBJECTIVES

Our general objective will be:

• The search for the best performance in the patient management sector to improve the quality of care.

For this we will also have specific objectives such as:

• Try to create procedure manuals for the sectors with the greatest influence on customer service, quickly solving any inconvenience that arises. Identification of processes to arrive at the creation of a flowchart for the best provision of the archive area where the medical history is located. External clinics. Achieve the least number of shifts on the waiting list. Proposal for weekly, biweekly or in any case monthly meetings with results of the proposals before the hospital management.

HYPOTHESIS

The central hypothesis is that the greater coordination in planning in patient care, the more efficient patient management will be. This includes within the central hypothesis:

• The greater the coordination through the organization's specialized procedures manuals, curricula, and organization chart, the better the solution to the problems in patient management. The more training and more efficient the personnel of the area will be, the more patients will be admitted more paper and less physical space in the archive sector, but if there is a greater update in technology, the stories can be digitized and the archive sector can be improved. Greater accessibility in obtaining a shift by other means (via web or mail), less number of queues in the hospital.Finally, the lack of communication with department heads would cause an increased entropy in the organization, if there is more communication (meetings of department heads), it would cause greater efficiency with respect to the central problem.

THEORETICAL FRAMEWORK

To begin, some theoretical concepts will be cited, which will serve to support the research and be able to adapt it to the organization where the aforementioned problem occurs.

Amanti Etzione (1975) makes a contribution from the base of the Administration that causes us, which emphasizes that organizations are human units or groups, deliberately built or rebuilt to achieve specific ends. However, they are characterized in three:

• The division of labor, power, and communication responsibilities. The presence of one or more centers of power that control the concentrated efforts of the organization and direct them toward its ends.

Continuing along the lines, to clarify what are the administrative functions, Fayol (1916) defines the act of managing as planning (visualizing the future to outline the action program), organizing (building the material and social structures of the organization), direct (guide and orient personnel), coordinate (link, unite and harmonize all collective acts and efforts) and control (verify that everything happens according to the established rules and the orders given).

According to the creator of classical theory, the general principles of administration are

1. Division of labor: Specialization of tasks and people to increase efficiencyAuthority and responsibility: authority is the right to give orders and the power to expect obedience; responsibility is a natural consequence of authority and implies the duty to be accountable. Both must be balanced. Discipline: depends on obedience, dedication, energy, behavior and respect for established norms. Unity of command: each employee must receive orders from only one superior is the principle of sole authority. Unity Management: establishment of a boss and a plan for each group of activities that have the same objective. Subordination of individual interests to general interests: general interests must be above the interests of individuals. Staff remuneration:There must be a fair and guaranteed satisfaction for the employees and for the organization, in terms of remuneration. Centralization: concentration of authority at the top of the organization's hierarchy. Hierarchy or scalar chain: line of authority that goes from the highest echelon to the lowest.Order: there must be a place for everything and everything must be in its place. It is the material and human order. Equity: kindness and justice to achieve the loyalty of the staff. Stability of the staff: the rotation has a negative impact on the efficiency of the organization. The longer a person stays in a position, the better. Initiative: ability to visualize a plan and personally ensure its success. Team spirit: harmony and unity between people are great strengths for the organization.

For these reasons, Lardent (1993) states that administrative systems as a network of related procedures according to an integrated scheme aimed at achieving the goals of an organization, this in turn is related to the profound changes experienced in recent years in The socio / political / economic environment in which the modern organization develops, combining this with the advances in technology, forces us to urgently face the need for remodeling and adaptation to the system concept.

Extending, Luz Arabany Ramírez C. (2002) develops the concept of entropy, which comes from the Greek entrope that means transformation or return. It is a process by which a system tends to be disorganized and die. For general systems theory, entropy is due to the loss of information in the system, which causes the absence of integration and communication of the parts of the system.

In this way Hall (1983) makes an important critique of the organizational environment, through the conditions that surround the organization:

• Technological conditions: since this topic, and the research that has been done on it, has already received enough attention, it may be the starting point of the stage. according to the works of Perrow, Lawrece and Lorsch, among others; Organizations that operate in an ecologically uncertain and dynamic environment have different structures and processes than those that live in a certain and technologically stable situation. These results have that technology is essential in the operation of organizations in environmental transactions. Legal conditions: an environmental consideration that is often forgotten, but is potentially critical, that are part of the organization's environment. Most of them,They operate outside the law, and the legal system responds through their attempts to evade the law and remain hidden. Many probably must live, as constants of their environment, with federal, state and local laws. Demographic conditions: this is another factor, the number of people served and their distribution by age and sex, makes a big difference for all organizations. As a general rule, an organization can predict its "market" probably in the future from information found in censuses, but changes in population are less predictable and thus make organizations more vulnerable.This is another factor, the number of people served and their distribution by age and sex, makes a big difference for all organizations. As a general rule, an organization can predict its "market" probably in the future from information found in censuses, but changes in population are less predictable and thus make organizations more vulnerable.This is another factor, the number of people served and their distribution by age and sex, makes a big difference for all organizations. As a general rule, an organization can predict its "market" probably in the future from information found in censuses, but changes in population are less predictable and thus make organizations more vulnerable.

There are also ecological, cultural, economic, and political conditions.

Extending the aforementioned, the PEST analysis is used in many organizations, which allows studying the organization's environment at a certain moment through the variables that most influence it, it provides us with a map to analyze political, economic, social and technological factors. that can influence the organization, this process is part of the approach of the unit to be treated, which allows designing a strategy so that the organization can be maintained and last over time. Its function is to counteract the negative influence that variables can have, obtaining various growth opportunities that without this study could not be identified.

For these reasons, Dr. Ramón Carillo and O´Donelll (2012/2014) define hospitals as organizations to care for the disease, and also as cultural expressions of the society to which they belonged, built and maintained by political structures. contemporary, in any of its expressions. It is undeniable, therefore, that the hospitals were transforming following the changes of the societies, to reach today the challenge that society as a whole faces: technological progress, global access to information, changes in ethical principles. The change in the patient / client-consumer conception with the derived demands and the increasing participation of the media is not unrelated to this.

Moving forward in time we find, the progress of the investigation the law

26,529 Rights of the Patient in his Relationship with Professionals and

Health Institutions. Which was sanctioned: October 21, 2009 and promulgated in fact: November 19, 2009 , the most important articles are as follows:

ARTICLE 2 - Patient's rights. The following constitute essential rights in the relationship between the patient and the health professional (s), the health insurance agent (s), and any effector concerned:

1. Assistance: The patient, primarily children and adolescents, has the right to be assisted by health professionals, without impairment and distinction, product of their ideas, religious, political beliefs, socioeconomic status, race, sex, sexual orientation or any other condition. The acting professional may only be exempt from the duty of care, when another competent professional has effectively taken charge of the patient; Dignified and respectful treatment.The patient has the right that the agents of the intervening health system, grant him a dignified treatment, with respect to his personal and moral convictions, mainly those related to his sociocultural conditions, gender, modesty and his privacy, whatever the suffering that it presents, and it is extended to the relatives or companions; Privacy: All medical-care activities tending to obtain, classify, use, administer, safeguard and transmit information and clinical documentation of the patient must observe strict respect for human dignity and autonomy of will., as well as the due protection of the privacy of the same and the confidentiality of your sensitive data, without prejudice to the provisions contained in Law No. 25,326; Confidentiality: The patient has the right that everyone who participates in the preparation or manipulation of the clinical documentation, or has access to the content of the same, keeps due reserve, unless expressly provided otherwise by the competent judicial authority or authorization from the own patient; Autonomy of the Will. The patient has the right to accept or reject certain medical or biological therapies or procedures, with or without an expression of cause, as well as to subsequently revoke their manifestation of will.Children and adolescents have the right to intervene under the terms of Law No. 26,061 for the purpose of making decisions about medical or biological therapies or procedures that involve their life or health; Health Information. The patient has the right to receive the necessary health information related to her health. The right to health information includes the right to not receive the aforementioned information. Medical consultation. The patient has the right to receive the health information in writing, in order to obtain a second opinion on the diagnosis, prognosis or treatment related to their health status.

Chapter II

OF HEALTH INFORMATION

ARTICLE 4 - Authorization. Health information may only be provided to third parties, with the patient's authorization.

In the event of the patient's incapacity or inability to understand the information due to his physical or mental state, it will be provided to his legal representative or, failing that, to the spouse who lives with the patient, or the person who, without be your spouse, live with or be in charge of the assistance or care of the same and the relatives up to the fourth degree of consanguinity.

Chapter III

OF INFORMED CONSENT

ARTICLE 5 - Definition. It is understood by informed consent, the declaration of sufficient will made by the patient, or by his legal representatives in his case, issued after receiving, by the intervening professional, clear, precise and adequate information regarding:

1. Your state of health; The proposed procedure, with specification of the objectives pursued; The expected benefits of the procedure; The risks, discomfort and foreseeable adverse effects; The specification of alternative procedures and their risks, benefits and damages in relation to the proposed procedure; The foreseeable consequences of not carrying out the proposed procedure or the specified alternatives.

ARTICLE 11. - Advance directives. Any capable person of legal age can have advance directives on their health, being able to consent or reject certain medical, preventive or palliative treatments, and decisions regarding their health. The directives must be accepted by the attending physician, except for those that involve developing euthanasic practices, which will be considered as non-existent.

ARTICLE 14. - Ownership. The patient is the owner of the medical record. A simple copy of the same, authenticated by the competent authority of the healthcare institution, must be provided upon request. Delivery will be made within forty-eight (48) hours of request, except in an emergency.

On the other hand, Mintzberg (Marco, Loguzzo, & Fedi, 2013) emphasizes with the design of individual positions where three design faces are presented here: the specialization of the task, the formalization of the behavior to carry out the task and the quality and indoctrination required for the task.

The first parameter can be specialized in two dimensions, horizontal and vertical. The horizontally specialized one is related to how many different tasks are assigned to a position and how wide each task is, when we talk about this specialization we would have a multipurpose worker (can perform several tasks), the key factor is repetition, which facilitates standardization. On the other hand, vertical task specialization considers the depth of the position, the extent to which the worker is responsible and has authority over his own work, and measures his degree of autonomy.

The second parameter, the formalization of behavior, is related to individual positions and represents the organization's way of limiting the freedom of its members, essentially of standardizing their work processes. Behavior can be formalized in three basic ways:

• By the position: giving specifications of the task By the work stream: the specifications being attributed to the job, as in the case of orders from a printing press, or a workshop By rules: issuing specifications in general, regulations, from clothing to forms contained in manuals.

Formalization is used to impose efficient procedures, to ensure coordination they are generally called bureaucracies.

The third parameter, in the case of training, refers to the process by which the knowledge and skills related to the position are taught, while indoctrination is the process by which organizational norms are incorporated.

In this way, Mintzberg highlights the following control mechanisms:

1. Mutual adaptation: Coordination through direct informal communication between people or areas that carry out the work, which belong to the same hierarchy of the organization. It is the simplest and most natural mechanism used in small and simple organizations. Direct supervision: one person is responsible for the tasks of others. Of course, this responsibility must be accompanied by the corresponding authority that allows the supervisor to give instructions and control the tasks of the supervised. Standardization: this is coordination by standards. the conditions that must be fulfilled in a certain element are pre-established, in it there are 3 subcategories.

• Standardization of work processes: implies the precise and direct specialization of the contents of the tasks Normalization of the results: the characteristics that the result of the production process must have, of what it seeks to achieve are specified. They standardize the knowledge necessary to occupy a certain position in the organization. A professional profile is specified, a certain preparation is required by training and education institutions or by experience.

It should be included, as detailed in the notes of the teacher Fedi Javier (2016), in which, according to the Spanish Royal Academy, the administrative manuals are the set of documents, in the form of a book, that contains all the referring information in an orderly and systematic way. to the objective, policies, structures, functions and procedures of an organization, constituting itself as an instrument of administrative support for the management of the organization. In turn, the advantages of the use of pampering are detailed:

1. It allows the organization's objectives to be institutionalized. Formalizes the organization's structure, policies, and norms and procedures that become mandatory for all members of the organization. Formalizes the operation of the organization as a whole; eliminating or reducing improvisation in the development of tasks, avoiding unnecessary discussions, causing jurisdictional conflicts and the extra positions of functions within the organization. It increases the quality, speed and security in decision-making, eliminating errors and false interpretations. control efficiency in relation to the different labor practices, be it operational or administrative. It allows efficient communication by standardizing the language,the criteria and terminology within the organization. Contributes to improving operational efficiency, by saving time and effort in the execution of work, avoiding duplication of processes and repetition of instructions. This implies a better use of both human and material capital. It improves the organizational behavior of the organization's employees, by allowing the staff to clarify their expectations about their work, which increases their willingness to assume their responsibilities. They allow continuity and coherence in the procedures and rules that govern the organization. In this sense, the manuals become a permanent source of information regarding the way in which the tasks were executed and carried out, in the organization, over time.They are useful instruments in the training of personnel, in their entry into the organization. Finally, it systematizes a methodology for the approval of modifications in the structure and procedures of an organization, as well as its publication, validity and scope of the themselves.

Continuing with the guideline, the procedure manuals are classified:

• Organization manual or manual of functions: describes the formal organization, mentioning, for each job, its objectives, functions, authorities and responsibility. Policy manual: contains the basic principles that will govern the actions of executives in taking of decisions.Manual of procedures and norms: it describes in detail the operations that integrate the administrative procedures in the sequential order of their execution and the norms to be fulfilled by the members of the organization compatible with the said procedures.Manual for specialists: contains norms or indications referring exclusively to certain types of activities or trades. This manual seeks to guide and standardize the performance of employees who fulfill the same functions. Employee Manual:It contains information that is of interest to employees who join a company on topics related to their relationship, and which is given to them at the time of incorporation. These topics refer to company objectives, activities that develops, incentive plans and career programming of employees, rights and obligations.Multi-purpose manual: replaces all or part of those mentioned above, in those cases in which the size of the company or the volume of activity does not justify its preparation and maintenance.Incentive plans and career scheduling of employees, rights and obligations.Multi-purpose manual: replaces all or part of those mentioned above, in those cases in which the size of the company or the volume of activity does not justify its preparation and maintenance..Incentive plans and career scheduling of employees, rights and obligations.Multi-purpose manual: replaces all or part of those mentioned above, in those cases in which the size of the company or the volume of activity does not justify its preparation and maintenance..

Similarly, the UNAJ teacher defines the course as a diagram that allows administrative procedures to be represented graphically. It constitutes important instruments for the global and schematic visualization of the set of administrative tasks. Through them, it is possible to determine if the description of the procedure is complete, detect errors, omissions, repetitions or overlaps of tasks in order to correct them and achieve more efficient procedures.

Similarly, the teacher Javier Fedi (2016) in another of his notes from the chair of Administrative Systems points out that the organization chart is the graphic representation of the organizational structure, it is an abstract model that allows us to obtain an idea about an organization, in particular of its formal aspects, such as the division of labor, specialization, the hierarchy of the different levels, authority, responsibility, coordination, etc. Its two primary functions are:

1. An informative role, by disclosing the general characteristics of the organization, both to its members and to interested third parties. Structural and functional analysis of the organization, through the graphic representation of its particularities of the organization.

In addition, the use of organizational charts has the following advantages:

• It informs the structure. It diversifies the activities and functions, whether specialized or not. It indicates the way in which these activities and functions are grouped by the area of ​​responsibility. It represents different units or departments that make up the organization. It shows the relationship established between the different units. of an organization and its hierarchy. It allows analyzing the structure of the organization and making a diagnosis of it, indicating the design flaws of the departmentalization, hierarchy and internal control relationship. Lastly, its use within the Organization allows training personnel and locating the newly entered members of the organization.

According to IRAM 34.504 standards, according to the technique or way of graphing, the different types of organization charts can be:

• Vertical pyramid Horizontal pyramid Circular Semicircular Afnor or French System Radical diagramming Chain diagramming

For this reason, the organization charts must be carried out under a common technique of providing understandable information to the different users. For this reason, in Argentina, the Argentine Institute for the Rationalization of Materials (IRAM) has undertaken the task of setting conventional rules for the design of organization charts. The first was 34,501 in 1975, which was periodically reviewed and updated. In this sense, currently, rule 34,504 of the year 1986 governs, which adopts the pyramidal figure for its representation.

Therefore, explained in the manual of Federico marco, Héctor Aníbal Loguzzo and Javier Leonel Fedi, there are models to define the strategies, which can guide the new strategic actions of the organization. The SWOT analysis distinguishes the favorable and unfavorable aspects of an organization by crossing them with its internal and external factors. In this way the matrix is ​​divided with two rows and two columns.

On the one hand, the internal aspect, which aims to identify the current and potential strengths and weaknesses of the organization, in order to meet its objectives. Obviously, the strengths refer to the positive elements (material and immaterial resources, such as operational capacities, knowledge management, etc.), the weaknesses refer to the internal elements that hinder the good performance of the organization (technological backwardness, little institutional recognition by the population, etc.).

Opportunities and threats are elements that can affect the organization, but in this case it is about the environment. Examples of opportunities are the possibilities of establishing cooperation networks with other organizations, etc. Examples of threats with the possibility of changes in economic factors, new disease mutations.

On the other hand, the following table details the internal and external analysis, stating the "Mi Pueblo" General Zonal Hospital of Acute as the central axis:

	Positive elements	Negative elements
Internal analisis	STRENGTHS • Motivated employees • Ability to adapt to change • Technologically updated • Good management systems • Loyal customers • Quality product	WEAKNESSES • Bad work environment • Organizational rigidity • Poor accessibility to credit • Technological backwardness • Inefficient management systems • Poor positioning • Low quality products
External analysis	OPPORTUNITIES • New market segments • Possibility of building cooperation networks with other organizations • Possibility of competing in the international market	THREATS • Entry of new competitors • Changes in consumer tastes • Increased rivalry in the segment • Increased foreign competition

On the other hand, communication as detailed in the text "Institutional communication: a strategic tool" (2004) is the power to coordinate our efforts with the other elements of a human group lies in two fundamental factors: the first is the ability to use symbols when detailing, specifying, reviewing, or explaining experiences with the surrounding environment; the second lies in the possibility of deploying or relaxing a uniform and common procedure, plan, method, rule or technique -language-, which allows us to share experiences with our fellow men.

Particularly in the text he talks about the fact that communication occurs naturally in any organization as it is an important social process for the development of man. In organizations it can be considered as a central nervous system that acts in coordination between the organization and the environment, which articulates messages, relationships and generates interactions. For this reason, organizational communication is understood as that which occurs within organizations, between them and the context. It is divided into internal and external communication, in addition, the study of communication can consider the public and private spheres. The first refers to communication that occurs in public institutions or those belonging to the state or to society in general, and the second to that present in the private sectors,such as companies or for-profit organizations. These areas influence when analyzing the conduct and behaviors of people in the institution. But it is not necessary to stop at this differentiation since communication is in both sectors of work activity.

Firstly, the internal communication of the institutions is considered as a management tool and is an external sign of modernity for those companies or state institutions that apply it. It can be defined as "the model of shared messages between the members of the organization".

In addition, the institution also has the management of external communication that, through the harmonization of the interests of the institution with those of its external audiences, will allow the achievement of the objectives of both and through it the achievement of national development. This harmonization of interests will be possible to the extent that the institution through its institutional communication system knows its external audiences, determining its location, its characteristics, its needs, etc. The management of external communication influences the formation of the image of the institution, which is in the collective imagination and has an impact on the success or failure of the institution.

Likewise, Watzlawick (1990) defines organizational communication as communication can be defined as the integrated behavior system that calibrates, regularizes, maintains, and therefore makes possible relationships between men. Consequently, we can see in communication the mechanism of social organization. On the other hand, Losada Vázquez (1998), institutional communication can be taken as the set of interactions in which the organization, as a collective entity (possessing its own and differentiated personality) becomes the recognizable subject of a communication process social that takes place both within the organization and in the social environment.

METHODOLOGICAL APPROACH

In this research, it will take place between the months of August and December 2016, we will base ourselves on an exploratory, descriptive and qualitative research design, for which each one is understood as:

In the first place, the design is emphasized (Carbonelli, Esquivel, & Irrazabal, 2014). This design is exploratory and necessary when, after the bibliographic review, we find that there are no works that develop our topic. They are regular studies where information is scarce.

Secondly, Hernández Sampieri (1991) points out that a descriptive design is common in the social sciences, where the researcher decides to specify the properties of some phenomenon of the same. He himself will seek to characterize, understand, interpret the phenomenon of study looking for relationships between phenomena or causal relationships between phenomena.

Finally, in the Qualitative Research (Cruz, 2009) described, reality is conceived from multiple perspectives; one of its main characteristics is that it attends to the diversity and particularity of these different ways of conceiving them.

Collection techniques are as follows. On the one hand, an interview open to all the key actors involved in those covered by the object of study. What are they:

• Director Secretaries (user service coordinator and communication coordinator) Heads of service (statistical service and quality service) Administrative (shifts sector window and telephone waiting list)

On the other hand, a survey of the main actor in this investigation who is the patient. There will be different responses, which will then show the total number of respondents in the annex. Kotler (2012) emphasizes that survey research is the most widely used method to collect primary data and the ideal approach to obtain descriptive information on the object of study.

In turn, I will use primary and secondary sources that Kotler details

(2012), “the secondary data consists of information that already exists somewhere because it was collected for another purpose. Primary data consists of information that is collected to fulfill a specific purpose. ”

Likewise, the teacher Saavedra Laura (2016) describes in her class guide that the primary data sources are collection techniques that the researcher builds and by which he reveals the qualitative data. In addition, the secondary data sources are which are second-hand, for example, census data.

Interview guide

Guide 1: Director

Good morning, my name is Néstor Andrés Martínez and I am a student of the Bachelor of Administration degree at the Universidad Nacional Arturo Jauretche. I am conducting academic research in the governmental organization in which you work, my object of study is the issue of patient management. I inform you that all the information you provide is confidential and will be used exclusively for educational purposes. From now on, I thank you for your time and willingness.

Name: ___________________

Task or function in the organization: _______________

1. Are there strategic plans in the hospital for employees to carry out their tasks, such as courses, procedure manuals and / or organization charts? What is the way to obtain the shift? How do you think care is today? day at the hospital? Do you know what the patient's law is (law 26529)? Could you tell me some of the most important items for you. How many people are served approximately by external clinics? patient care? Do you think technology is a key factor in hospital care in the last 5 years? (On the axis of patient care, from a management perspective).Are training sessions held for employees to improve patient care? Do you consider that due to the high demand in the locality, more human resources are needed, both professional and non-professional?

Guide 2: Heads of services and Administrative (in contact with the public)

Good morning, my name is Néstor Andrés Martínez and I am a student of the Bachelor of Administration degree at the Universidad Nacional Arturo Jauretche. I am conducting academic research in the governmental organization in which you work, my object of study is the issue of patient management. I inform you that all the information you provide is confidential and will be used exclusively for educational purposes. In advance, I thank you for your time and willingness.

Name: ___________________

Task or function in the organization: _______________

1. Do you know if there are procedures manuals, courses and organization charts to plan the tasks? What is the way to obtain the shift? How do you think care is nowadays in the hospital? Do you know that it is the law of the patient (Law 26529)? Could you tell me some of the most important items for you. How many people are served approximately by external offices? Do you have meetings with the management where there are brainstorms, for future improvements? Do you think that technology is a key factor in hospital care in the last 5 years? (On the axis of patient care, from an administration perspective.) Do you frequently have training on improving public care? Do you consider that due to the high demand of the locality, more human resources are needed, be professional and unprofessional?

Guide 3: Patients (to be done by Google Forms) Your Hospital and everyone's.

Good morning, my name is Néstor Andrés Martínez and I am a student of the Bachelor of Administration degree at the Universidad Nacional Arturo Jauretche. I am conducting academic research in the government organization in which you attend, my object of study is the issue of patient management. I inform you that all the information you provide is confidential and will be used exclusively for educational purposes. From now on, I thank you for your time and willingness.

NAME: ______

Age: ___________

Did you attend My town hospital in outpatient clinics?

• If not

Do you know what the patient's law is (law 25,529)?

• If not

Do you think that the patient law (law 25.529) is complied with in the hospital?

• Yes No Does not know

How would you rate the attention at the time of obtaining the shift?

• Satisfied

Would you like there to be more methods to get your turn as web or via email?

• If not

When were you treated, did you have your medical history in the office?

• Yes No Unknown

Got a response you were looking for in reports?

• Satisfied

Activity Schedule August 2016 / December 2016

The following table shows the stages with which this investigation was carried out:

STAGES OF THE WORK PROCESS	MONTH I	MONTH II	MONTH III	MONTH IV	MONTH V
Diagnosis and relevant theoretical approaches
Bibliographic survey relevant theoretical approaches	X	X	X	X
Systematization and bibliographic analysis		X	X	X
Data analysis collection
Development of the interview guide			X	X
Application of the interview guide			X	X
Information processing			X	X
Analysis of the information			X	X
Outcome development			X	X
Development of action guidelines			X	X	X

ANALYSIS OF RESULTS

Next, the results obtained through the investigation carried out by interviews with the actors that influence within the organization to be treated will be shown and, on the other hand, the actor outside the organization will be analyzed, but it is the main actor of this investigation trying to unravel the improvement in patient care management.

To begin, we will first analyze all the interviews, interlinking them, with respect to the problems of the organization, taking reference to all the problems that can be strengthened in the organization.

Continuing with the guidelines of the aforementioned, it is proposed that there be procedural manuals, organization charts and / or courses, several interviewees state that some of the above exist, but they are not updated or they lack a specific one for the institution.

In which the following occurs, 71 people do not know what the patient's law is (law 25,529), and 29 people know what the patient's law is according to the 100 cases that the survey was conducted. On the other hand, the second graph shows, if the patient believes that the law is being complied with in the government organization, of which only 2 people believe that it is being followed, 33 people think that it is not being followed in the hospital and 65 people they do not know if the same law is followed in the establishment.

On the other hand, another question which can solve the problem in the management of the patient is the communication in the seventh question that was made to the actors of the government establishment, which dealt with whether meetings are held where improvements are proposed, that is, where There is a time when all department heads and / or employees can have common goals. The most interesting answers for the analysis are:

IMPROVEMENT PROPOSAL

On this section, the future improvements that will strengthen the problems that exist in the organization will be detailed:

Create a marketing plan

Executive Summary: Brief summary of the main objectives and recommendations of the plan, which is addressed to the top management of the organization and quickly allows the main points of the plan. In the case of research, the objectives would be:

1. Reduce the number of waiting lists, expanding new professional agendas. Satisfy the user's attention as much as possible. Establish jointly with heads of services, training and the creation or updating of procedure manuals, which will gradually increase the professionalization of the staff.

Plus the creation of a file-system course.

1. Implementation of new shifts methods, via the web, to satisfy the whole of the town that has a notion and access to the internet platform. Digitize only consulting offices, until a complete digitization program can be carried out Provide information about the patient's law to the entire community, so that each staff has a copy of them.

Current marketing situation: The target market (the group of clients to which it will capture, serve and direct market efforts) that the organization has is to the entire Florencio Varela community and anyone who needs to be served in it since the “Mi Pueblo” hospital is not restricted if you do not live in Florencio Varela's party.

It is one of the three axes of Florencio Varela's health system, the CAPS are on the first level and the “El Cruce” hospital is on the third level.

There is competition from the private sector, which is very low in the district, which is approximately 25 consultations from private organizations, the entire community focuses on the hospital, to meet their basic needs, since the district has a quantity from the last census in 2010 of 426,005, 38.1% have no social coverage.

Analysis of threats and opportunities: It is based on evaluating the main ones that the organization could face, and helping management to anticipate important positive or negative events that could affect the organization and its strategies.

OPPORTUNITIES • Possibility of setting up cooperation networks with other organizations, whether from the public or private health networks, to decongest the hospital. • New Tools of Ministry of health of the Buenos Aires province (Humanized Hospital Program)

THREATS • Paros • Lack of Materials or Budget • Lack of medical graduates in some specialties and received only work in the private sector for remuneration.

Objectives and key points These are the points that the organization must achieve during the term of the plan and analyze the key points that would affect its achievement. In the case of research, it is proposed that it gradually strengthen the problems in patient management.

Firstly, to establish jointly with heads of services, training and the creation or updating of procedure manuals, which will progressively increase the professionalization of the personnel, thus achieving that half of the personnel find the basic notions for decision-making regarding patient management. This in turn will lead to improved patient satisfaction in consultations, obtaining shifts or other movements made in the institution.

Secondly, the implementation of the new method for obtaining a shift would increase patient satisfaction once again. Then the extension of predated (turns to give to the community) by each professional to eradicate the waiting list.

Finally, implementation of digitized medical records, only the inter-consultations by external offices, until they find a strategy to completely modify and digitize the file.

Marketing strategy: It is to outline the general logic with the drive that you are expected to achieve your marketing objectives and the specific characteristics of the market. In this case they were previously named as carried out in the previous sections.

Action Programs: Details how marketing strategies become a specific action program that answers the following questions: What will be done? When will it be done? Who will do it? How much will it cost to do it?

Himself, answering the questions of What will be done ?, What has already been raised as user attention will be strengthened. But with a mark of marketing to obtain profitable relationships with the neighbors of the community, in which the neighbor has the value in mind, an effort that the organization puts to solve all or most of its health problems.

When will it be done? , it was explained as it will be done in the section of objectives and key points, to carry the same marketing plan and obtain the maximum profitable relationships with the user of the Florencio Varela community.

Who will do it? All the hospital staff as a whole will do it from the professional and non-professional areas, as one unit and sharing an organizational culture and organizational communication to obtain empathy with the patient.

How much will it cost? The cost that is evaluated at the moment is cost 0, since it is a redistribution of tasks and improves the quality not only of the user service, but also in how the staff is, thinking that the staff is well. of the hospital.

Budgets: It is basically a projected income statement that shows satisfaction waiting. Once approved by senior management, you can plan your marketing operations.

For this part, it is calculated that it would take time to implement the proposal, but it would be a matter of carrying it out in phases, so that it is perfectly detailed, since the hospital has a direction, which executes all the projects it carries out.

Controls: It is to define the way in which progress will be monitored and to allow senior management to study the results of the implementation and detect the products that are not achieving their goals.

In this section, emphasis should be placed above all on the midline, bone, the department heads and coordinators who are in charge of the tasks. That they carry out an exhaustive analysis of each process, how is it done? Who does it? And why does this patient response occur ?, through various parameters and field information methods.

However, that the fundamental actor who is the patient is consulted and consulted how he feels in that process and if this improvement satisfies that phase in which the person in charge or coordinator is the one who oversees that process, which will later be essential for the future implementation of the marketing plan or modification thereof.

CONCLUSION

Concluding, in this report the diagnosis of the problems that arise in user care was made.

Firstly, it can be affirmed that government institutions, linked to the Argentine health system, are suffering many declines in patient management. From here my problems started, how to improve this service, which in turn is governed by a law that protects the patient's rights. On the other hand, there were the problems that were linked to the main theme, such as that there are no procedures manuals for carrying out tasks, or there is no training from the organization's strategic pencil.

Therefore, the central hypothesis is that the greater coordination in planning in patient care, the more efficient patient management will be, this is true, given that the interviews carried out with the seven actors who are part of the institution, indicate the non-existence of internal communication. On the other hand, the aims of strengthening the organization are clearly seen by the new management that began with Dr. Hernández, who with his team wants to strengthen the weaknesses that may arise in the health institution.

Finally, to close this report, this case allows us to express, an improvement model in which it is up to the organization to publish its use.

BIBLIOGRAPHY

• Alarcon, F., & Mantinian, M. (2004). Institutional communication: a strategic tool. Asuncion, Paraguay: Catholic University headquarters Asuncion.Carbonelli, M., Esquivel, JC, & Irrazabal, G. (2014). Introduction to knowledge and research methodology methodology. Florencio Varela: National Arturo Jauretche University. Carrillo, R. (2012). Hospital Theory. Buenos Aires: Ediciones Biblioteca Nacional.Chiavenato, I. (2007). Introduction to the general theory of administration (Vol. Chapter 4). Mexico: McGraw-Hill Interamericana. Cruz, J. (2009). Qualitative research. Mexico.Etzioni, A. (1975). Modern Organizations (Vol. Chapter 1). Mexico: Hispano Editorial Typographical Union, Fayol, H. (1916). Industrial and general administration. Fedi, JL (04 of 2016). Administrative Manuals / Courses. 2016.Florencio Varela, Buenos Aires, Argentina.Hall, RH (1983). Organizations structure and process. (AL Betancourt, Trad.) Madrid, Spain: Dossat.Lardent, AR (1993). Organization techniques, systems and methods (fourth ed.). Buenos Aires: Study Club, Losada Vazquez, A. (1998). "Institutional communication in change management, the university model". Spain: Editorial Publicaciones Univ. Pontificia de Salamanca. Marco, F., Loguzzo, HA, & Fedi, JL (2013). Introduction to management and administration in organizations. Florencio Varela: Arturo Jauretche National University, Mintzberg, H. (1990). Design of efficient organizations (Vol. Second edition). (RM Capmany, Trad.) Buenos Aires: The Athenaeum, Philip, K. (2012). Marketing Information Management (Fourteenth ed.). mexico: Pearson Educación.Ramirez, L.A. (2002). Systems theory. Colombia: National University of Colombia, Rodríguez, J., Dackiewicz, N., & Toer, D. (2014). Hospital management focused on the patient. Arch Argent Pediatr, 1 (112), 55-58. Watzlawick, B. (1990). "The new communication" (Third Edition ed.). Spain: Editorial Kairos.

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