IV. Project description
4.1 Bibliographic background
The background is as follows:
Doris Elizabeth Macassi Vásquez (2008), elaborated the thesis called "Human resource management to achieve the quality of the gynecology service of the Daniel Alcides Carrión national hospital" to opt for the Master's Degree in Administration at the Federico Villarreal National University. According to the author, the poor quality of the health services provided by the national hospitals of our country is a fact verified by locals and strangers. The same panorama of lack of quality has been determined in the Gynecology Service of the Daniel Alcides Carrión National Hospital (HNDAC). The objective of this work is to determine the tool that can facilitate the efficiency, economy, effectiveness, continuous improvement, quality and competitiveness of the Gynecology Service of the Daniel Alcides Carrión National Hospital.
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". Said work was presented to opt for the Degree of Doctor at the Universidad Nacional Mayor de San Marcos. In the study, there is no evidence to accept that the perception of the quality of the care provided in the emergency service is good, in addition, the perception of the users about the structure of the emergency service of the Daniel A. Carrión National Hospital is of regular quality.. The study also 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. The conclusions of the study show that it is necessary to improve cleaning, improve ventilation and lighting in emergency service environments and improve signage, on the other hand, regarding the analysis of the warmth of the service offered, we recommend carrying out educational activities continuous in aspects of human relations directed to the technical-administrative staff (admission / cash, pharmacy and security personnel).Finally, a continuous quality improvement program must be designed that leads to the optimization of processes to reduce waiting time.
Luis Tipacti (2000) in his research called: "Evaluation of the quality of care in outpatient services in the public hospitals of Metropolitan Lima and Callao", part of the problem of the deficiency of outpatient care to users of the public hospitals of Metropolitan Lima and Callao, so it is necessary to carry out a performance evaluation of the workers to determine the labor efficiency in the attention to users. The investigation identified 2 homogeneous groups that characterize the quality of care in outpatient clinics. In group 1, the cashier treatment, the nursing technique and the comfort of the place were the ones that took the highest percentage of being fair or bad. In group 2 those who have a good opinion of the care given in the facilities,the attention of the nurse and the cashier. The variables that reached the standard values regarding the quality of patient care were only the pleasure upon returning to the hospital, recommending it and the treatment provided by the doctor to the patients. In the case of the doctors, none of the variables reached the standard values, having problems with the doctors with the working conditions, such as the clinical history arriving late, dissatisfaction with the work they perform in the outpatient clinics. 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.In contrast, 15% of the medical staff believed that the working conditions were good and that 37% were satisfied with the work they do.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 verified specific hypothesis 1 that stated that there were significant differences in the perception and assessment of the quality of hospital service in the area of "tangibility" between users of state and private centers,It verified specific hypothesis 2 that stated that there were significant differences in the perception and assessment of the quality of hospital service in the "reliability" area between users of state and private centers. Specific hypothesis 3 was verified, which stated that there were significant differences in the perception and assessment of the quality of hospital service in the “capacity for respect” area between users of state and private centers. Thus, it was detected that the quality of service offered by private healthcare centers has enabled better satisfaction of its users in relation to the satisfaction of users in the state sector.Specific hypothesis 3 was verified, which stated that there were significant differences in the perception and assessment of the quality of hospital service in the “capacity for respect” area between users of state and private centers. Thus, it was detected that the quality of service offered by private healthcare centers has enabled better satisfaction of its users in relation to the satisfaction of users in the state sector.Specific hypothesis 3 was verified, which stated that there were significant differences in the perception and assessment of the quality of hospital service in the “capacity for respect” area between users of state and private centers. Thus, it was detected that the quality of service offered by private healthcare centers has enabled better satisfaction of its users in relation to the satisfaction of users in the state sector.
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. The patient is,and it will be in the future the center of the public health system, demanding in its attention the ability to choose, immediacy, high resolution, continuity of care and personalized treatment.
Jorge Garrido (2003) carried out a study entitled “Analysis of the internal environment of the emergency service at the Santiago de Jinotepe Regional Hospital in Nicaragua”. The research starts from the problem of the existence of a high percentage of internal users who do not know the objectives, strategies, purposes, priorities and goals of the emergency due to the passive attitude and little interest that exists to get involved in the programmed activities. More than 40% of internal users disagree on the organizational structure, mainly on the assignment of work, fulfillment of objectives, formalization of functions and coordination mechanisms. In addition, there is a high percentage of users who have primary care health problems (Outpatient Consultation) due to little care provided by the Health Centers in Carazo.A small percentage of users do not agree with the treatment provided by doctors since the care they provide is quick and abrupt. Among the conclusions they mention that the perception of internal users about the organizational environment of the emergency service is contradictory, since in the case of leadership, they refer to having good acceptance of their immediate leadership, however there is resistance to the attitude to change due to the little participation in management activities (planning, evaluation, etc.). There is a deficiency in the referral system of the first level of care towards hospitals, which causes the high number of external consultations to the emergency, consuming a high percentage of the budget designated for this service.
Mirtha Cecilia Vásquez Aparria (2000), in her work called: Strategy for the detection of incipient gastric cancer in the Central Hospital of the PNP ”- (January 1992-December 1998), presented to opt for the Title as a Specialist in Gastroenterology of the Federico Villarreal National University; establishes that the objective of her work is to study the epidemiological characteristics, clinical symptoms, the history of diagnosis and treatment in relation to gastric ulcer in 42 patients with a pathological diagnosis of incipient gastric cancer.In another part of his work, he establishes that it is necessary to have adequate paraphernalia to provide gastroenterology services and especially emphasizes the role of the service that the doctor provides to the user of gastroenterological services as a way to facilitate the stabilization of their health.
Augusto Francisco Vera Calderón (2003) prepared the investigation called: Ulcerative colitis; clinical and epidemiological profile: Edgardo Rebagliati Martins National Hospital. 2001-2003, presented to opt for the Second Specialization Degree in Human Medicine at the Federico Villarreal National University. The objective of this work was to determine the clinical and epidemiological profile of Collitis. For this purpose, the study was carried out in 43 patients from the Department of the Digestive System of the Hospital, who were treated by hospitalization and on an outpatient basis. The research presents the corresponding results and mention is made of the need for an adequate infrastructure to provide services in the best conditions.
Enrique Picón Saldaña (2006) developed the thesis: “Measurement of the satisfaction of patients seen in outpatient consultation at the Orthopedics and Traumatology Service of the Guillermo Almenara Irigoyen National Hospital-2007”; presented to opt for the Master's Degree in Health Services Administration at the Federico Villarreal National University. The objective of the work was to determine the degree of satisfaction of the patients attended. The work develops the term satisfaction for the purposes of the users of the Service, also the process of achieving said satisfaction,the participation of the patient and the role of the service provider, which highlights the fact of having an adequate infrastructure as a basis to provide an adequate service and, on the other hand, the fact of putting human quality in the medical and paramedical personnel to achieve the best purposes.
4.2. Problem Statement
Symptoms:
The following facts or situations have been determined when analyzing the object of the investigation:
a) Lack of trust of users of the Gastroenterology Service
b) Lack of evaluations of efficiency and effectiveness of the Gastroenterology Service
c) Complaints of abuse by users of the Gastroenterology Service
d) Abandoned appointments
e) Abandoned treatments
f) Transfer to other hospital entities.
Causes:
The facts or situations produced by the existence of the aforementioned symptoms are the following:
a) Lack of rationality in the use of the scarce financial resources available that allow an adequate infrastructure and training of personnel in aspects of human quality.
b) Disjointed application of policies, strategies, processes and procedures that have not facilitated having an adequate infrastructure of the Gastroenterology Service.
c) Lack of biosafety measures and sufficient medical instruments for an adequate service to the user of the Gastroenterology Service.
d) The cleaning, ventilation, lighting and signage of the Gastroenterology Service is lacking as a way of having an adequate infrastructure.
e) Lack of human quality in the provision of the Service to the user.
f) Lack of planning activities, organization of resources, effective decision-making, poor coordination between resources and activities; and, finally, the lack of internal control that facilitates the provision of an adequate service to the user that guarantees their health and human quality.
Forecasts:
The situations that can occur if the aforementioned symptoms continue to occur are the following:
a) The Gastroenterology Service will not take advantage of the strengths and opportunities that allow it to meet its goals, which are transcendent elements within the framework of optimal management of health services.
b) The problematic situation will not allow the existence of an environment of continuous improvement, innovation and creativity in the use of the infrastructure.
c) The Gastroenterology Service will not have a suitable frame of reference on which to base the decision-making process for the improvement of its infrastructure and improvement of the service to the user as ways of guaranteeing human health.
d) The Gastroenterology Service will not be able to meet its objectives, which will generate confusion in the staff working in said Service.
e) The Gastroenterology Service will not facilitate the achievement of the objectives and mission of the hospital entity.
Prognosis control:
The actions by which it is possible to anticipate and control the identified situations are the following:
a) It is necessary to have an effective administrative and internal control system, as a basis for adequate planning, organization, direction, coordination and control of the management of the Gastroenterology Service.
b) It is necessary to evaluate the infrastructure of the Gastroenterology Service, to have information that allows feedback on actions to have the equipment, furniture and fixtures necessary for an adequate Service.
c) It is necessary that those responsible for managing the Service use the information and make decisions on that basis, to ensure the optimization of the Gastroenterology Service.
d) It is necessary to have plans; policies and strategies to overcome the problem and make the Gastroenterology Service competitive.
Main problem:
How can the infrastructure and customer service of the specialty of gastroenterology be improved; as ways to guarantee human health?
Secondary problems:
1. How is the perfection of the infrastructure of the Gastroenterology Service; can guarantee health prevention?
2. How can the perfection of the customer service of the gastroenterology specialty guarantee health treatment?
4.3. Theoretical framework
Improvement of the infrastructure of the gastroenterology service:
According to Abreu (2007), Gastroenterology is the specialty that studies diseases of the digestive system, including liver and bile duct. Gastroenterology is the medical specialty that deals with all diseases of the digestive system, consisting of: the esophagus, stomach, liver, small intestine (duodenum, jejunum, ileum), colon (large intestine), rectum.
Interpreting Sleisenger & Fordtran (2004), at the beginning of the 21st century the challenges in an increasingly globalized world stimulate us to continue in the search to generate a first-class infrastructure, consolidate research projects and train better specialists within Gastroenterology. The Gastroenterology Service should be framed in having Motility, Portal Hypertension, Viral and autoimmune hepatitis, Liver and bile ducts, Pancreas, Inflammatory Bowel Disease and Digestive System Cancer. It should be oriented towards having a commitment to the continuous medical education of patients, including an information section for the general population, in which they can find summaries on diseases of the Digestive System, as well as addresses and telephone numbers where to go to receive specialized medical attention.Curricular reviews of the members of the Service that can be consulted on the internet portal, as well as areas of interest and research. Said Service must have as objectives and goals: to promote excellence in user service, research service, personalized medical assistance and teaching of Gastroenterology.
Analyzing Abreu (2007; the Gastroenterology Service, is a service dedicated to the prevention, diagnosis and treatment of gastrointestinal diseases. The practices that must be carried out are the following: Special Therapeutic Endoscopies: (They include the following practices): Extraction Foreign body - high, Foreign body extraction - low, Varicose vein sclerosis or ligation, Esophageal dilation, Placement of esophageal prosthesis, Gastric endoscopic polypectomy, Colonic endoscopic polypectomy, Endoscopic gastrostomy, Gastric bleeding lesion hemostasis, Colonic bleeding lesion hemostasis, Colonic bleeding lesion removal Choledocian calculus, Bile duct and pancreas prosthesis. Subsequent replacement, therapeutic percutaneous biliary reassignment, etc.It is noteworthy that the Service develops practices under anesthesia having a place for the immediate recovery of the patient (recovery) to later finish his recovery in a room under the assistance of nursing staff. The Service must have a sector dedicated to Hepatology, with personnel trained in the diagnosis and treatment of liver diseases. In it, liver biopsy punctures should be performed, directed by Ultrasound and / or Computed Tomography with Helical Scanning. State-of-the-art color Doppler ultrasound should also be available. The Service must carry out serological studies for the diagnosis of different hepatitis, determination of autoantibodies, RNA and viral DNA by PCR technique. The Digestive Motility area of the Service,it should include the study and treatment of functional disorders of the digestive system. The Service must be able to carry out Manometry, Esophageal, Rectoanal studies; Colonic, Biliary, Antroduodenal and Rehabilitation of the rectoanal function through the performance of Biofeedback in constipation and anal incontinence. This would be done with a MycroSens multichannel Analog-digital Pressure Gauge. The Service must have the possibility of performing 24-hour Phimetry for the study of esophageal reflux disease. The area of Clinical Gastroenterology must be covered by highly trained professionals to respond to the needs that users demand. The care should take place in a comfortable place. At once,Modern Medicine and the commitment to the quality of care require having Advanced Technology and making the best use of it through the experience and training of professionals, acting in a multidisciplinary team. The Service must be sure of having all this and from there strive to achieve the fundamental objective of the Service, "Excellence in medical care."
Analyzing Arsenjo (2002), the Gastroenterology Service must be located in an exclusive sector within the Hospital or Clinic, have air conditioning (hot-cold) in all its rooms, equipped with all the comforts to make the stay in the hospital more pleasant. the same for patients and companions. The Endoscopy area must be equipped with state-of-the-art equipment, where diagnostic and therapeutic digestive videoendoscopy practices can be performed, with: Videoendoscope Processor, Videoesophagogastroduodenoscopies, Colonovideoendoscopes, DuodenumVideoendoscope, Video recorder, Video Printer, Electrosurgical unit. The Hepatology area must have state-of-the-art color Doppler ultrasound. The Digestive Motility area must have a MycroSens multichannel Analog-digital Manometer.
Customer service of the gastroenterology specialty:
Analyzing Bolaños (2008), the User Attention Service is the set of interrelated activities offered by the area where the specialty of gastroenterology is applied in order for the user to obtain the product at the right time and place and make sure correct use of it. Customer service is a powerful marketing tool. To determine the services that the user demands, periodic surveys must be carried out to identify the possible services to offer, and the importance that the consumer gives to each one must be established. You should try to compare with the closest competitors, so you will detect real opportunities to overtake and be the best. You must know what services users require,You have to detect the quantity and quality that they want, to do so, you can resort to several elements, among them; comparison shopping, periodic user surveys, suggestion boxes and complaints and claims systems. The last two blocks are extremely useful, since they maximize the opportunity to know the levels of satisfaction and what is failing.
According to Barquín (1988), the following are elements of the User Service: face-to-face contact; Relationship with the user; Correspondence; Claims and compliments; Adequate infrastructure.
Interpreting Chiavenato (2005) and Mendoza (2008), the importance of service to the user is given in that a good service can become a promotional element through the granting of discounts, advertising or personal sale. Attracting a new user is approximately six times more expensive than maintaining one. Therefore, the Gastroenterology services must choose to put the company's actions in writing. It has been observed that users are sensitive to the service they receive from their suppliers, since it means that the user will obtain lower inventory costs at the end. The Gastroenterology Service must be prepared to avoid problems that harm the user. All the people who come into contact with the user project attitudes that affect him, the representative of the Service,when calling you by phone, the receptionist at the door, the technical service when calling to install new equipment or service in the premises, and the personnel who attend and manage to provide the service. Conscious or unconscious, the user is always evaluating the way the Gastroenterology Service does its activities, how it treats other users and how it would expect them to treat it.
Interpreting Johnson & Scholes (2004), attitudes are reflected in actions: the behavior of the different people with whom the user comes into contact produces an impact on the level of user satisfaction including: The general courtesy with which the staff handles questions, problems, how it offers or extensive information, provides service and the way the Service treats other users. In User Service strategy, senior management leadership is the basis of the chain. Internal quality drives employee satisfaction. The employee satisfaction drives loyalty. The employee loyalty drives productivity. Employee productivity drives the value of the service. The value of the service drives user satisfaction.User satisfaction drives user loyalty. User loyalty drives profits and the acquisition of new users.
Analyzing Rosander (1998), the Ten Commandments of customer service are the following:
- The user above all. It is the user whom we must bear in mind first of all.
- There is nothing impossible when you want. Sometimes users request almost impossible things, with a little effort and desire, you can get what you want.
- Keep everything you promise. There are many companies that try, based on deception, to make sales or retain users, but what happens when the user realizes it?
- There is only one way to satisfy the user, give him more than he expects. When the user feels satisfied to receive more than expected, how to achieve it? Knowing our users very well, focusing on their needs and desires.
- For the user, you make a difference. People who have direct contact with users have a great commitment, they can make a user return or never want to return. That makes the difference.
- Failing at one point means failing at everything. Everything may work perfectly, we have everything under control, but what happens if we fail in the delivery time, if the merchandise arrives damaged or if at the time of packing the pair of shoes we make a mistake and give it a different number, everything goes to the floor.
- A dissatisfied employee generates dissatisfied users. Own employees are "the first user" of a company, if they are not satisfied as we intend to satisfy external users, therefore resource policies must go hand in hand with marketing strategies.
- The judgment on the quality of service is made by the user. The only truth is that it is the users who, in their mind and their feelings, qualify it, if it is good they return and otherwise they do not return.
- No matter how good a service is, it can always be perfected. If it is possible to achieve the proposed goals of service and consumer satisfaction, it is necessary to set new objectives, "the competition does not give up."
- When it comes to user satisfaction, we are all a team. All the people of the Service must be willing to work for the satisfaction of the user, be it a complaint, a request or any other matter.
Analyzing Setó (2004) and Terry (2004), it is determined that one of the paradigms that we normally find when we talk about user service has to do with a reductionist conception that consists in thinking that the success of a good user service is circumscribed to the service provider. This reflection aims to address the different elements that make up the user service and from there propose an alternative that allows us to think about a user-oriented business culture. In ancient times to speak of service was associated with minor and unworthy labors, however,after the fifties and especially during the seventies, the fortunate idea was positioned that user service was definitely not only an added value but also the factor that could make a difference in relation to the product or service that was delivered to the user final. User service, as a business culture, then addresses several complementary dimensions that establish a scale on which each of its components have the same weight, in this sense the user's report card has five major subjects on which the company must invest your best efforts in order to offer the user a true experience that goes beyond their expectations. These elements have to do with: i) The Product:It refers specifically to what each of the companies sells, it is its tangible or intangible product that the user receives and on which he issues a judgment according to the quality, opportunity, quantity and even the value delivered by him. A bad rating on the product affects the perception of the service offered to the user and although there are replacement and compensation mechanisms for the user, it is possible that even the level of loyalty that has been achieved will be affected; ii) The Procedures: It refers to the mechanisms that the company has institutionalized to establish orders, product delivery, payments and other procedures that allow the user to communicate and resolve the concerns that arise,when the procedures are complex or imply annoyance for the user, the rating is low, as those companies that have an agile, respectful and timely service model are preferred; iii) The Facilities: It is the site where the service is provided and at this point it is important to consider various aspects that will directly impact the moments of truth to which the company is subjected in the provision of its service, in this sense we can mention the access roads, ease of parking, spaciousness of the facilities, lighting, location of the products, visibility of the information and the corporate image, etc.,a bad rating at this point will cause the perception of the service to decline to the detriment not only of the product but also of the brand and this is a risk that no company is willing to take; iv) Available Technology: The importance of having robust information systems for the knowledge of users is fundamental, but its functionality must be reflected in the capacity of the user to make use of these resources, in this sense the possibility that users have to place their orders over the Internet or through closed communication systems, systems that allow users to consult online the status of their orders and billing and also that they can have access to the statistics of their purchases with the company, etc..,The impossibility of having technological tools that allow streamlining communication and relationship processes with the company will become an Achilles heel because the user will be attentive to new offers in the market that allow them to streamline their purchases and feel a service model personalized among other things; v) Information: One of the complex issues to solve in the design of a corporate user service strategy has to do precisely with the identification of the components of an adequate information system adjusted to the user's expectations, in such a way that Each type of business will have to find out if communication with the user is massive or personalized and if the efforts and resources devoted to this component are rewarded.The communication model must be analyzed not only in the way the company is present in the user and in its business if it has it, but also in the quality of the information it receives when it communicates with the company and in this sense it is worth the It is worth considering even the smallest details, such as the opportunity in the telephone service, inadequate, unclear, confused, incomplete or lacking information will have consequences in the user's purchase decision and will interpret these situations as carelessness of the company in front of to the user and perhaps he will judge harshly the situations in which he feels that he has not been taken into account or valued in his needs and expectations; vi) The Service Provider:It is the person who attends the user in the real contact that the company has through its products or services, depending on the type of business, the service provider will have the opportunity not only to offer the user a unique experience in front of the company and its product but also the possibility of creating a relational process with the user that goes beyond the purely transactional, in this sense the service provider will not only be the person who sells or serves but everyone who, due to their function, has direct contact or indirectly with the user, this concept refers to the fact that all the members of the organization have a responsibility with the user,not only with the product that is delivered but also with the permanent effort so that the rating offered by the user to each of the 5 points mentioned is satisfactory, the service provider then becomes part of an organizational culture that goes through the concept that has of the user, of the importance that it expresses, of the way in which it establishes its service relationship and of all those components that have to do with the attributes of the service to the user, in this sense it is not enough to have a good attitude and disposition to meet and exceed user requirements, it is necessary that it has autonomy and decision-making capacity regarding all those recurring aspects in the provision of the service. Finally,Creating a culture of service to the user implies a corporate strategy where all levels of the organization participate and begins with a deep diagnosis on which there is a determination on the part of the administration and management to intervene in order to establish clear indicators of improvement that will have its impact and its reward when the users themselves perceive and manifest higher levels of satisfaction, loyalty and even commitment to a management model capable of creating a significant differentiator in the provision of the Service to the User with their economic behavior.
Playing Robbins & Coulter (2005), definitely the service culture is something that is talked about a lot but that is rarely put into practice, and it is not that there is no interest in those who know that only through good service The user will not only make use of a service again, but will also attract new users who will finally enlarge the value chain that will make it possible for the Gastroenterology Service to remain in time and obtain profits. But something as simple as thinking that you have to treat the user well seems to be so difficult that it seems that instead of hiring allies, “double agents” have joined the ranks of the company who try to drive away those who are the real thing with their bad treatment reason for the company's existence.Subscription Television Companies that in the event of a complaint indicate that it is not their responsibility but that of the "contractor". Telephone services that take long periods of time to search for basic information. Restaurants where you practically have to pray to be served the first time and beg for the order to be served. Banks that boast of being interested in satisfying users' expectations and that when their services are required, an X-ray of the soul must be on hand so that, at least, they listen to the request. Technical service companies that do not even repair what is damaged and end up damaging what little was used.Restaurants where you practically have to pray to be served the first time and beg for the order to be served. Banks that boast of being interested in satisfying users' expectations and that when their services are required, an X-ray of the soul must be on hand so that, at least, they listen to the request. Technical service companies that do not even repair what is damaged and end up damaging what little was used.Restaurants where you practically have to pray to be served the first time and beg for the order to be served. Banks that boast of being interested in satisfying users' expectations and that when their services are required, an X-ray of the soul must be on hand so that, at least, they listen to the request. Technical service companies that do not even repair what is damaged and end up damaging what little was used.
Hospitals that neglect and disregard people who are willing to pay for their health. A list where it is the user who claims to be well attended in the place that should be grateful to have users interested in what they offer. Yes, in the field of customer service it is the rabbit who runs after the hunter. When will they realize that without users there is no Gastroenterology Service? And if there is no Gastroenterology Service, there are no salaries or benefits and bonuses at the end of the year. There is simply nothing. The user is the raison d'être of every Service, of every company and if it is not well served, if it is not valued, then that firm does not have to exist. It should be the Gastroenterology services or the companies that provide this Service and not the users,the ones who should beg for people to be interested in what they offer. It should be the companies that really worry about satisfying the demands in a broad and sufficient way, lest they lose the only secure source of income they have: their users. It cannot be that it is the prey who cries out to be hunted, that goes against the nature of things. Is it that they have not realized that there are competitors? The only justification that can be given to companies that seem to despise their users is that of a monopoly, since in the absence of competition people have no alternative but to go to the only provider that exists. But history is full of examples that show that the power that monopoly gives ends as soon as different options appear, there the lamentations begin:"If we had done" "If we had thought" "If we had attended"… then the post-morten plans, desperate ideas to recover what once belonged to him and that were subjected to his will by force. It is here when you start the promotions, royalties and all kinds of gadgets to enchant the lost user like a snake… and, finally, the guilt, the judgments and sentences come, where it is usually the least guilty who end up paying for the broken dishes. But the user is also to blame for the fact that there are companies where this procedural distortion exists. As long as they continue to buy or use the service, nothing and no one will convince them that they must improve the service to the user, because as long as there is income and economic stability is guaranteed. Want to stop running after the hunter? Well do it!Well, only when he is alone will he need to review his strategy and spend more time investing in the quality of his product or service. It is not impolite to demand quality, and it is easy to explain why: When a company offers a product or service, it establishes its price, duration and conditions. Very good. If what is demanded has been paid, what has been bought should be received, never less, because no less has been given for it. It's that simple. Remember, companies exist as long as they have users, without users there are no Services or companies. The User has the power. You have to learn to use it.And it is easy to explain why: When a company offers a product or service, it establishes its price, duration and conditions. Very good. If what is demanded has been paid, what has been bought should be received, never less, because no less has been given for it. It's that simple. Remember, companies exist as long as they have users, without users there are no Services or companies. The User has the power. You have to learn to use it.And it is easy to explain why: When a company offers a product or service, it establishes its price, duration and conditions. Very good. If what is demanded has been paid, what has been bought should be received, never less, because no less has been given for it. It's that simple. Remember, companies exist as long as they have users, without users there are no Services or companies. The User has the power. You have to learn to use it.You have to learn to use it.You have to learn to use it.
To provide an adequate customer service it is also necessary to have a management process and other appropriate elements such as the following:
ORGANIZATION. Analyzing Koontz / O'Donnell (2004), the meaning of this concept comes from the use that in our language is given to the word «organism». This necessarily implies: a) Parts and diverse functions: no organism has identical parts, nor of the same functioning; b) Functional unit: those diverse, yet have a common or identical purpose; c) Coordination: precisely to achieve this end, each one sets a different action, but complementary to the others: they work in view of the common end and help the others to build and order themselves according to a specific theology. In good account Organization is the technical structuring of the relationships that must exist between the functions, levels and activities of the material and human elements of a social organism,in order to achieve maximum efficiency within the stated plans and objectives. Organizing is the process of ordering and distributing work, authority, and resources among the members of an organization, so that they can achieve the goals of the organization. Different goals require different structures to achieve them. Managers must adapt the organization's structure to their goals and resources, a process known as organizational design. The organization produces the structure of an organization's relationships, and these structured relationships will serve to carry out future plans. The organization refers to structuring perhaps the most typical part of the elements that correspond to administrative mechanics. For the same reason, it refers to “what the functions, hierarchies and activities should be like.For the same reason, it always refers to functions, levels or activities that "are about to be structured", more or less remotely: go to the future, immediate or remote. The organization tells us specifically how and who is going to do each thing, in the sense of what position and not which person. The organization, being a final element of the theoretical aspect, completely gathers and reaches down to its last details everything that the planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.it always refers to functions, levels or activities that "are about to be structured", more or less remotely: go to the future, immediate or remote. The organization tells us specifically how and who is going to do each thing, in the sense of what position and not which person. The organization, being a final element of the theoretical aspect, completely gathers and reaches down to its last details everything that the planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.it always refers to functions, levels or activities that "are about to be structured", more or less remotely: go to the future, immediate or remote. The organization tells us specifically how and who is going to do each thing, in the sense of what position and not which person. The organization, being a final element of the theoretical aspect, completely gathers and reaches down to its last details everything that the planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.levels or activities that "are about to be structured", more or less remotely: go to the future, immediate or remote. The organization tells us specifically how and who is going to do each thing, in the sense of what position and not which person. The organization, being a final element of the theoretical aspect, completely gathers and reaches down to its last details everything that the planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.levels or activities that "are about to be structured", more or less remotely: go to the future, immediate or remote. The organization tells us specifically how and who is going to do each thing, in the sense of what position and not which person. The organization, being a final element of the theoretical aspect, completely gathers and reaches down to its last details everything that the planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.immediate or remote. The organization tells us specifically how and who is going to do each thing, in the sense of what position and not which person. The organization, being a final element of the theoretical aspect, completely gathers and reaches down to its last details everything that the planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.immediate or remote. The organization tells us specifically how and who is going to do each thing, in the sense of what position and not which person. The organization, being a final element of the theoretical aspect, completely gathers and reaches down to its last details everything that the planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.As it is a final element of the theoretical aspect, it completely gathers and goes down to its last details everything that planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.As it is a final element of the theoretical aspect, it completely gathers and goes down to its last details everything that planning has indicated regarding how a company should be. The importance of the organization is so great that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to its being contrasted with the latter, as if the former represented the theoretical and scientific, and the second is practical and empirical. This is inadequate, for all that we have seen before.that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to their being contrasted with the latter, as if the former represented the theoretical and scientific, and the latter the practical and empirical. This is inadequate, for all that we have seen before.that on some occasions they have made many authors lose sight of the fact that it is but a part of the administration, leading to their being contrasted with the latter, as if the former represented the theoretical and scientific, and the latter the practical and empirical. This is inadequate, for all that we have seen before.
DIRECTION. According to Terry (2004), it is the element of management in which the effective realization of what is planned is achieved, through the authority of the administrator, exercised based on decisions. This is to obtain the results that have been foreseen and planned. There are two strata to obtain these results: a) At the level of execution (workers, employees, and even technicians), it is a matter of "executing", "carrying out", those activities that must be productive; b) At the administrative level, that is, at the level of everyone who is the boss, and precisely as he is, it is about "directing" not "executing". The boss as such does not execute but makes others execute. However, they have their "own doing". This consists precisely of directing. Leading implies commanding,influence and motivate employees to perform essential tasks. Management gets to the bottom of managers' relationships with each of the people who work with them. Managers lead by trying to convince others to join them in achieving the future that emerges from the steps of planning and organizing. Managers by setting the right environment, help their employees do their best.
CONTROL. Analyzing Temes (1992), it can be defined as the process of monitoring activities that ensure that they are being carried out as planned and correcting any significant deviation. All managers must participate in the control function, even when their units are performing as planned. Managers cannot really know whether their units are operating properly until they have evaluated what activities have been performed and compared actual performance with the desired standard. An effective control system ensures that activities are completed in a way that leads to the achievement of the organization's goals. The criterion that determines the effectiveness of a control system is how well it facilitates the achievement of goals. The more you help managers achieve their organization's goals,the better the control system. The manager must be sure that the actions of the members of the organization lead her towards the established goals. This is the control function and consists of three essential elements: 1. Establish performance standards; 2. Measure present performance results and compare them to performance standards; 3. Take corrective action when standards are not met. Control is important, because it is the final link in the functional chain of administration activities. It is the only way managers know whether or not organizational goals are being met and why or why not. This process allows the organization to go on the right track without allowing it to deviate from its goals. Standards and guidelines are used as a means of controlling employee actions,But setting standards is also an inherent part of the process. And the corrective measures suppose an adjustment in the plans. In practice, the administrative process does not include the aforementioned isolated elements, but a group of interrelated functions.
INSTITUTIONAL EFFICIENCY: According to Chiavenato (2005), efficiency is the positive result after the adequate rationalization of resources, in accordance with the purpose sought by those responsible for management. Efficiency refers to the relationship between the goods or services produced or delivered and the resources used for that purpose (productivity), compared to an established performance standard. Entities will be able to guarantee their permanence in the market if they strive to carry out efficient business management, oriented towards the user and with a sustained level of quality in the products and / or services it provides. Efficiency can be measured in terms of the results divided by the total costs and it is possible to say that the efficiency has grown by a certain percentage (%) per year.This measure of cost efficiency can also be inverted (total cost in relation to the number of products) to obtain the unit cost of production. This relationship shows the cost of production of each product. In the same way, the time (calculated for example in terms of man-hours) that it takes to produce a product (the inverse of labor efficiency) is a common measure of efficiency. Efficiency is the relationship between the results in terms of goods, services and other results and the resources used to produce them. Empirically, there are two important measures: i) Cost efficiency, where results are related to costs, and, ii) Work efficiency, where achievements refer to a key production factor: the number of workers. If an auditor intends to measure efficiency,The audit should begin by analyzing the main types of results / outputs of the entity. The auditor could also analyze the results by ascertaining whether the combination of results achieved is reasonable or by verifying the quality of these. When we use an efficiency approach for this purpose, the auditor should assess, when analyzing how the program has been executed, how well the company has handled the situation. This means studying the audited company to check how the work has been organized. Efficiency refers to the relationship between the services provided or delivered by the entities and the resources used for that purpose (productivity), in comparison with an established performance standard. Efficiency,It is the relationship between costs and benefits focused on finding the best way to do or execute tasks (methods), so that resources (people, vehicles, various supplies and others) are used in the most rational way possible. Rationality implies adapting the means used to the ends and objectives that are to be achieved, this means efficiency, which leads to the conclusion that companies will be rational if the most efficient means are chosen to achieve the desired objectives, taking into account that the objectives that are considered are the organizational ones and not the individual ones. Rationality is achieved through rules and regulations that govern the behavior of the components in search of efficiency. Efficiency seeks to use the means,more adequate and properly planned and organized methods and procedures to ensure optimal use of available resources. Efficiency is not concerned with the ends, as it does with efficiency, if not with the means. Efficiency can be measured by the amount of resources used in the provision of services. Efficiency increases as costs and resources used decrease. It is related to the use of resources to obtain a good or objective.It is related to the use of resources to obtain a good or objective.It is related to the use of resources to obtain a good or objective.
INSTITUTIONAL ECONOMY: According to Alonso (1996), the economy in the use of resources is related to the terms and conditions under which the entity acquires resources, be they financial, human, physical or technological (computerized), obtaining the required amount, at a reasonable level of quality, at the appropriate time and place and at the lowest possible cost. If the auditor focuses on economics it will be important to correctly define expenses. This is often a problem. Sometimes it would be possible to introduce approximations of the real costs, for example defining the costs in terms of number of employees, quantity of inputs used, maintenance costs, etc. On the other hand, within the framework of the economy, the following elements have to be analyzed: cost, profit and volume of operations.These elements represent instruments in the planning, management and control of operations to achieve the integral development of the institution and decision-making regarding the product, prices, determination of benefits, distribution, alternatives to manufacture or acquire inputs, production methods., capital investments, etc. It is the basis for establishing the variable budget of the company. The economic treatment of operations provide useful guidance for profit planning, cost control, and administrative decision-making should not be considered as a precision instrument since the data is based on certain assumed conditions that limit the results. The economics of operations is developed under the assumption that the concept of cost variability (fixed and variable),it is valid and these components can be identified, including the semi-variable costs; the latter through technical procedures that require a special analysis of the historical data of income and costs for several successive periods, in order to determine the fixed and variable costs.
TRANSPARENCY: According to Gutiérrez (2003), transparency means the duty of the authorities to carry out their actions in a public manner, as a mechanism for controlling power and democratic legitimacy of public institutions. Transparency means letting light pass easily, in governmental terms, transparency is a quality that allows an adequate and sufficient flow of information and could be considered an antidote to curb corruption, to counteract any type of suspicion or suspicion of a certain dependency. or public body. Transparency is an environment of trust, security and frankness between the government and society, in such a way that responsibilities, procedures and rules are established,conduct and report clearly and are open to public participation and scrutiny. Transparency is also a sensitive, responsible and participatory citizenry that, in the knowledge of its rights and obligations, collaborates in promoting integrity and fighting corruption.
INSTITUTIONAL EFFECTIVENESS: According to Dueñas (2000), efficiency or effectiveness refers to the degree to which the entity achieves its objectives and goals or other benefits that it intended to achieve, provided for in the legislation or set by the Board of Directors. If an auditor focuses on effectiveness, he or she should begin by identifying the goals of the entity's programs and operationalizing the goals to measure effectiveness.
Guarantee of human health:
Cotton (1992) agrees with Imbrogno (2008), when they argue that a guarantee is a legal business through which it is intended to provide greater security to the fulfillment of an obligation or payment of a debt. Guarantees are very important to consumers. They allow you to be sure that in case of defects or detections that affect the correct operation of the service, those responsible will take charge of its repair so that the thing returns to meet the optimal conditions of use. It is also provided in the Consumer Defense Law that all services have a legal guarantee, when within thirty days after the end of the service deficiencies or defects in the work performed are evidenced.The guarantee on the provision of a service must be documented in writing and contain the description of the work carried out, a person in charge and the duration of the guarantee. The provider is obliged to correct the deficiencies and replace the materials and products used free of charge. The guarantee can be of three types: Personal guarantee: As, for example, a guarantee. Through the personal guarantee, a person guarantees the payment of a debt by committing to pay it in the event that the principal debtor does not comply with his obligation. Real guarantee: Like the pledge or the mortgage. The debtor guarantees the payment of a debt with an asset. In the case of default, the creditor may sell the asset and settle the debt with the money obtained, returning the excess (if any) to the debtor.The guarantee is the security of a good Gastroenterology Service.
In the 2012 constitution of the World Health Organization, health is defined as the state of complete physical, mental and social well-being, and not only the absence of diseases or illnesses. It can also be defined as the level of functional or metabolic efficiency of an organism at both the micro (cellular) and macro (social) levels. In 1992 a researcher added to the WHO definition: "and in harmony with the environment", thus expanding the concept. Benet Hernández de Gispert would change a word from the WHO definition: she would change the word "well-being" to "balance." Benet proposes the redefinition of the term "health".. »Health is measured by the shock that a person can receive without compromising their way of life. Thus, the system of life becomes a criterion of health."A healthy person is one who can live his unconfessed dreams fully"…
Moshé Feldenkrais, referred to by Mendoza (2008), a guarantee in physical form, is the ability of the body to perform any type of exercise where it shows that it has resistance, strength, agility, coordination and flexibility. There is also mental health, which is characterized by the good mental state of a person and her self-acceptance; in clinical words, it is the absence of any type of mental illness.
According to Abreu (2007), Physical Health is physical exercise, it is the operation of some activity to develop and maintain a balanced physical health. It is often directed toward affiliation of athletic ability and / or ability. Frequent and regular physical exercise is a necessary component in the prevention of some diseases such as heart problems, cardiovascular diseases, type 2 diabetes mellitus, overweight, back pain, among others. Physical exercise should be practiced in a measured and balanced way, paying attention to internal physical changes in order to learn to understand the cause-and-effect relationship between specific physical movement and its direct effect with perceived internal changes; to reach a higher level of self-knowledge. Excessive physical exercise is not recommended either,because it can lead to physical wear and tear on certain parts of the body. For this reason, it is necessary to insist on the balance of forces, both internal and external. Physical exercise is necessary for health. Physical exercise is necessary for balanced health, and exercise must be complemented with a balanced diet and an adequate quality of life. (Ortega, G. 2007, pps) Exercise is a good way to maintain good health since you exercise your muscles and give them strength. In addition to exercise, you should not forget to eat healthy (a balanced diet), but you should also know what is the right exercise for each person because people with asthma cannot run for half an hour as they could have problems.A healthy life is to exercise daily a series of habits that will help us to prevent diseases and for our body to function correctly. Among these habits are: good nutrition, adequate rest, physical exercise, hygiene, avoiding the consumption of substances that are harmful to the body, such as tobacco, alcohol, and other types of substances. These substances must be prevented.
According to Sleisenger & Fordtran (2004), nutrition is a science that studies the relationship between diet, health states and disease. Nutritionists are health professionals who specialize in this field. They are also the only highly trained health professionals capable of providing safe dietary advice and interventions. Between the extremes of optimal health and death from starvation or malnutrition, there are a variety of illnesses that can be caused or alleviated by changes in diet. The deficiencies, excesses and imbalances in the diet can produce negative impacts on health, which can lead to diseases such as scurvy, obesity or osteoporosis, as well as behavioral and psychological problems. Also,the excessive ingestion of elements that have no obvious role in health (eg lead, mercury, dioxins among others) can incur toxic and potentially fatal effects, depending on the dose. It is common knowledge that "we are what we eat", that "what is eaten is raised"; In other words, if we eat a lot of protein, we will have more protein in the body; and so on with fats and sugars, and other trace elements. The Krebs cycle should be mentioned in all the processing of the elements that make up the diet. Nutrition science tries to understand how and why specific dietary aspects influence health.that "what is eaten is raised"; In other words, if we eat a lot of protein, we will have more protein in the body; and so on with fats and sugars, and other trace elements. The Krebs cycle should be mentioned in all the processing of the elements that make up the diet. Nutrition science tries to understand how and why specific dietary aspects influence health.that "what is eaten is raised"; In other words, if we eat a lot of protein, we will have more protein in the body; and so on with fats and sugars, and other trace elements. The Krebs cycle should be mentioned in all the processing of the elements that make up the diet. Nutrition science tries to understand how and why specific dietary aspects influence health.
According to Plata (1997), mental health is a concept that refers to the emotional and psychological well-being of the individual. Merriam-Webster defines mental health as: "a state of emotional and psychological well-being in which an individual can use her cognitive and emotional abilities, function in society, and meet the ordinary demands of daily life." According to the WHO, there is no official definition of mental health. Cultural differences, subjective evaluations, and competing professional theories make it difficult to define "mental health." In general, most experts agree that mental health and mental illness are not opposite. In other words, the absence of a recognized mental disorder is not necessarily an indicator of mental health.
In ancient Greece nothing was known about viruses and bacteria, but they already recognized that personality and its characteristics play a fundamental role in the origins of the disease. Galen, a gigantic figure from the ancient world, has already observed the existence of a very close link between melancholy and breast cancer. Already in these early medical approaches there is a holistic criterion in the consideration of health and disease.
According to Abreu (2007), Plato remarked that good education is the one that strongly tended to perfect the mind together with the body. He recognized, in some way, that bodily health leads to mental hygiene, but, at the same time, that good mental state predisposes to good bodily health. Thus, he specifically stated that the "good" soul, by its own excellence, improves the body in every way. In modern times, especially since the 20th century, but also long before - and even in ancient oriental medicine - the need for a holistic conception of health is beginning to be recognized. In this sense, perhaps the definitive and thorough lesson to be learned is that "we are basically what we think."The psychosomatic conception forces us to attend to our interiority as a possible cause of disturbances in the body. This is unanimously recognized by the Western clinic, which sees that in the doctor's offices a very high percentage of consultations respond to distortions of the mind or personality, in a broad sense. This new approach is not dualistic in the Cartesian way. He conceives man as a unit, in which healing powers very often nest, which, when stimulated, help to solve somatic problems. Non-materialistic medical philosophy is thus increasing in the world in which conventional medicine could once predominate.who sees that in the doctor's offices a very high percentage of consultations respond to distortions of the mind or personality, in a broad sense. This new approach is not dualistic in the Cartesian way. He conceives man as a unit, in which healing powers very often nest, which, when stimulated, help to solve somatic problems. Non-materialistic medical philosophy is thus increasing in the world in which conventional medicine could once predominate.who sees that in the doctor's offices a very high percentage of consultations respond to distortions of the mind or personality, in a broad sense. This new approach is not dualistic in the Cartesian way. He conceives man as a unit, in which healing powers very often nest, which, when stimulated, help to solve somatic problems. Non-materialistic medical philosophy is thus increasing in the world in which conventional medicine could once predominate.Non-materialistic medical philosophy is thus increasing in the world in which conventional medicine could once predominate.Non-materialistic medical philosophy is thus increasing in the world in which conventional medicine could once predominate.
Interpreting Abreu (2007), the factors that influence health are, among others: Not smoking is one of the steps to have good health. According to the La Londe report, from the year 1974 carried out in Canada, it suggests that there are four general determinants that influence health, which he called, "human biology", "environment", "Form of life" and the "organization of the health care". In this way, health is maintained by science and the practice of medicine, but also by self-effort. Fitness, a healthy diet, managing stress, quitting smoking and abusing other harmful substances among other measures are steps to improve someone's health. On the other hand, lifestyle is the set of behaviors or skills that people develop, that is,they can be healthy or harmful to health and we can also find that it is the cause of diseases within the host factor. Human Biology, are those factors that influence from inside the body as a consequence of its basic biology and metabolism. Environment, are all those factors that come from outside and over which the human being "has no control." Domestic environment, are all those factors that come from outside and over which the human being does have control. Household chemicals seriously alter the domestic environment and pass to people through food, which they easily contaminate by being stored in the same rooms for periods of time. Lifestyle.It is the sum of decisions by individuals that affect their health in one way or another. Health care organization, consists of the quantity, quality and arrangement in the provision of health care.
Analyzing Cotton (1992), the concept of human health and its meaning and implementation must be of extreme importance in any society. Access to health is an inalienable right of the human being and its violation should, in practice, be strongly repudiated and punished. The health of the population makes, in its essence, the ethics, the quality of life, the degree of development and the viability of that population. The state of individual and collective health in a society profoundly and inevitably conditions its intellectual, economic, productive and social development. Historically and classically, health was defined as the absence of disease in the "body". In practice, even today for certain social sectors this criterion, unfortunately, persists.The modern concept of health arises from the complex and systemic conception of the human being as a psycho-physical and social entity and is represented by the state in which the human being performs all its functions, within these areas, normally. Health is qualified from the integral state of the body, mind, relationships with others and the organized community and with the environment in its broadest sense. The functional imbalance in one or more of these relationships, in its intensity and persistence, causes the deterioration of health in different degrees and always carries individual and collective consequences (disease).Health is qualified from the integral state of the body, mind, relationships with others and the organized community and with the environment in its broadest sense. The functional imbalance in one or more of these relationships, in its intensity and persistence, causes the deterioration of health in different degrees and always carries individual and collective consequences (disease).Health is qualified from the integral state of the body, mind, relationships with others and the organized community and with the environment in its broadest sense. The functional imbalance in one or more of these relationships, in its intensity and persistence, causes the deterioration of health in different degrees and always carries individual and collective consequences (disease).
According to Mora (2008), the state of health is an important indicator of the level of satisfaction of basic needs, represented by the state / quality of: food, medical coverage, housing, work, education and the environment. The inability to access basic needs is synonymous with deteriorating health and a prognosis of danger and damage. From this it follows that the organized community must, in an unavoidable and non-delegable way, generate the mechanisms through which the possibilities of access to health are offered to every human being. Every society and at different scales (neighborhood, regional, national and international), establishes a strong link with its environment and causes negative impacts of different magnitudes, whose impact on health takes various forms and consequences.In this way, environmental pathologies arise, defined as those diseases caused by external agents, generated by environmental modifications produced by man through their socioeconomic models.
According to Plata (1997), the degradation of natural environments and green spaces threatens the relationship that human beings need and must have with them, to satisfy primary mental, spiritual and emotional needs that allow them to rescue their sense of belonging to the natural world and its future. In this sense, large cities, their urban and suburban agglomerations, product of complex deforming socio-economic processes, constitute areas where the natural environment is absent or highly degraded and pollution processes of all kinds develop, causing highly harmful effects on individual and collective health.
Let us think, in this sense, of the effects that alienation, overcrowding, marginalization, aggressive behaviors, overstimulation of all kinds, noise, and the almost absence of structures of containment and solidarity cause on mental health.
According to Sleisenger & Fordtran (2004), health, under a global conception, depends on multiple factors; admitting and adopting this criterion would allow us to rethink aspects of our socioeconomic models and generate community life strategies aimed at achieving access to basic needs. The concern and occupation of a society for its health, that is, for the health of each of the human beings that compose it, must be a fundamental aspect in any government policy, since its quality and degree of development will affect the heritage most important part of a community: its human beings, its people, the people who build it, who will build it and who are its reason for being.
As a consequence of having an adequate infrastructure, providing a good service to the user of the gastroenterology specialty, optimal management will be obtained. Interpreting Koontz / O'Donnell (2004), the optimal management of the Gastroenterology Service is related to the fulfillment of the actions, policies, goals, objectives, mission and vision of the company; as established by modern business management. Optimal management is the process undertaken by one or more people to coordinate the work activities of other people in order to achieve high-quality results that one person could not achieve on their own. Competitiveness comes into play in this framework, which is defined as the extent to which a company,Under free market conditions, it is capable of producing goods and services that pass the test of the markets, while maintaining or expanding the real incomes of its employees and partners. Also in this framework, quality is conceived, which is the totality of the features and characteristics of a product or service that refer to its capacity to satisfy expressed or implicit needs. Optimal management is the set of actions that allow you to obtain the maximum performance from the activities carried out by the entity. Optimal management, which means that the members of an entity work together with greater productivity, that they enjoy their work, that they develop their skills and abilities and that they are good representatives of the company, presents a great challenge for its managers.When a management reaches the standard below, it can be considered optimal. Management can be considered optimal if: i) The entity's operational objectives are being achieved; ii) They have adequate information to the point of achieving the entity's operational objectives; iii) If the administrative, financial, economic, labor, patrimonial and other information of the entity is reliably prepared; and, iv) If the applicable laws and regulations are complied with. While institutional management is a process, its optimization is a state or condition of the process at a given moment, the same that when exceeding the established standards it facilitates achieving optimization. The determination of whether a management is optimal or not and its influence on the institution,It constitutes a subjective position taking that results from the analysis of whether the five components of Internal Control are present and functioning effectively: control environment, risk assessment, control activities, information and communication and supervision. The effective operation of management and control provides a reasonable degree of assurance that one or more of the categories of established objectives will be met. When those responsible for management are concerned with doing things correctly, they are moving through efficiency (adequate use of available resources) and when they use instruments to evaluate the achievement of results, to verify things well done are what in reality had to be done,then it is directed towards effectiveness (achievement of the objectives through the available resources) and when it seeks the best costs and greatest benefits it is within the framework of the economy. Efficiency, effectiveness and economy do not always go hand in hand, since an entity can be efficient in its operations, but not effective, or vice versa; It can be inefficient in its operations and yet be effective, although it would be much more advantageous if efficiency were accompanied by efficiency to optimize management.although it would be much more advantageous if effectiveness were accompanied by efficiency to optimize management.although it would be much more advantageous if effectiveness were accompanied by efficiency to optimize management.
4.4. Justification and importance of the work
Methodological justification:
In this work, in the first place, the problem has been identified consisting in that there is a guarantee for human health due to lack of infrastructure and inadequate service of attention to users of the Gastroenterology Service; On this problem, possible solutions have been formulated through hypotheses; then the purposes pursued by the work have been established through the objectives. All these elements have been formed based on the variables and subvariables of the investigation. All of the above is based on a research methodology that identifies the type, level and corresponding design; and, the population and sample to apply; as well as the techniques and instruments to collect, analyze and interpret the information.
Theoretical justification:
To guarantee human health, the Gastroenterology Service needs to have two very important components, such as the infrastructure and the customer service. The infrastructure in general is the set of technical means, services and facilities necessary for the development of the services that users require. The Gastroenterology Service's primary purpose is to provide optimal care to all people who, due to suffering from ailments attributed (primarily or secondarily) to the digestive system, need specialized professional care. The Service must also carry out teaching tasks and preventive and curative medicine actions. The infrastructure to guarantee human health is given because the Service must provide the following treatments and tests:Upper digestive endoscopies, Rectosigmoidosc. low, flexible, ERCPs, Complete colonoscopies, Percutaneous gastrostomies, Colonic polypectomies (loop), Colonic polypectomies (forceps), Gastric polypectomies, Sclerotherapy of esophageal varices, Esophageal dilations, Percutaneous liver biopsies, Colonic dilatations, Pyloric dilatations, Pyloric dilatations Esophageal polypectomies, Nasoenteral tubes (by endoscopy).Nasoenteral tubes (by endoscopy).Nasoenteral tubes (by endoscopy).
The customer service or simply user service is the service that a company provides to interact with its users. It is the set of interrelated activities that is offered in order for the user to obtain the gastroenterology medical care service at the right time and place and to ensure its correct use. Customer service is a powerful marketing tool. It is a tool that can be very effective in an organization if it is used appropriately for this, certain institutional policies must be followed. User Service is "A work concept" and "a way of doing things" that is the responsibility of the entire organization,both in the way of serving Users (who buy from us and allow us to be viable) and in the way of serving Internal Users, various areas of our own company.
Practical justification:
The work will present the improvement of the infrastructure and the customer service of the Gastroenterology Service; All of which will allow it to be put into practice by order of the authorities, considering that through these instruments human health is guaranteed.
Importance
This work will allow the entity:
a) Have the infrastructure and customer service of the Gastroenterology Service that guarantees human health
b) A properly planned, organized, directed, coordinated and controlled management process that allows meeting goals, objectives and mission; that is to say, that the management turns from poor and ineffective to optimal.
c) It will allow effective internal control, that is, linked to the objectives and mission of the Service; and not disjointed and separated from the management process.
d) It will allow the Service to specify its policies, strategies, tactics, goals, objectives, permanent and temporary actions and achieve the impact, result and product indicators that are very useful for optimal institutional management.
e) It will facilitate planning, structural and functional organization, direction for effective decision-making, teamwork creating the necessary synergies and closing the loop with effective control and very useful for management.
f) It will allow to capture the knowledge received in the Master's studies and the competences obtained in the professional field in solving problems.
V. Objectives
Overall objective:
Determine the way in which the infrastructure and the customer service of the gastroenterology specialty guarantee health.
Specific objectives:
1. Specify the way to improve the infrastructure of the Gastroenterology Service to guarantee health prevention.
2. Define the way to improve the service of attention to the user of the gastroenterology specialty to guarantee health treatment.
SAW. Hypothesis
General hypothesis:
If the Gastroenterology Service improves the infrastructure and customer service; then you can guarantee health.
Secondary hypotheses:
1. If the Gastroenterology Service improves the infrastructure; then, you can guarantee health prevention.
2. If the Gastroenterology Service improves the customer service; then, you can guarantee health treatment.
Research variables and subvariables:
7.1. 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 it is taken into account by the Gastroenterology Services of the Hospitals and clinics.
7.2. Research level
The research to be carried out will be of the descriptive-explanatory level, since the improvement of the infrastructure and the customer service will be described and it will explain how they guarantee human health.
7.3. Research methods
The following methods will be used in this investigation:
1. Descriptive.- Inasmuch as the process of improving the infrastructure and the customer service of the Gastroenterology Service will be described as ways to guarantee human health.
2. Inductive.- To infer the information of the sample in the research population.
7.4. Design of the investigation
Design is the plan or strategy that will be developed to obtain the information required in the investigation. The design to be applied will be Non-Experimental, Transectional or transversal, Descriptive, Correlational-causal. Non-experimental design is defined as research that will be carried out without deliberately manipulating variables. In this design, phenomena are observed as they occur in their natural context, and then analyzed. The cross-sectional or cross-sectional research design to be applied consists of data collection. Its purpose is to describe the variables and analyze their incidence and interrelation at a given moment. The descriptive transactional design that will be applied in the work, aims to investigate the incidence and the values in which the research variables are manifested.The correlative-causal Transectional research design to be applied will serve to relate two or more categories, concepts or variables at a given time. It will also be about descriptions, but not about categories, concepts, objects or individual variables, but about their relationships, whether they are purely correlational or causal relationships. Through this type of design the research elements are associated.Through this type of design the research elements are associated.Through this type of design the research elements are associated.
In this work, the design will facilitate the following:
OG = General objective
SO = Specific objectives
CP = Partial conclusions
CF = Final conclusion
HG = General hypothesis
This table summarizes the research design. It indicates that the General Objective is formed from the specific objectives, with which it is contrasted. In turn, the specific objectives constitute the basis for formulating the Partial Conclusions of the Research Work. Then the Partial Conclusions are properly correlated to formulate the Final Conclusion of the Investigation, the same that must be consistent with the General Hypothesis, which will constitute the answer to the problem posed in the investigation work.
7.5. Research population
The research population is made up of medical personnel, paramedics and users of the Gastroenterology Service of the Hospitals of the Armed Forces and National Police of Peru.
7.6. Research sample
The sample will be made up of medical personnel, paramedics and users of the Gastroenterology Service of the Peruvian Air Force.
Formula for determining the sample size:
To define the sample size, the probabilistic method has been used and the generally accepted formula has been applied for populations smaller than 100,000.
n It is the size of the sample that will be taken into account for the field work. It is the variable that you want to determine.
P and q represent the probability of the population being or not included in the sample. According to the doctrine, when this probability is not known by statistical studies, it is assumed that p and q have the value of 0.5 each.
Z Represents the standard deviation units that define a probability of error = 0.05 in the normal curve, which is equivalent to a 95% confidence interval in the sample estimate, therefore the value Z = 1.96
N The total of the population. This case 620 people.
SE Represents the standard error of the estimate, according to the doctrine, it must be 0.09 or less. In this case 0.097 has been 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
7.7. Data collection techniques
The techniques that will be used in the investigation will be the following:
1. Surveys.- It will be applied in order to obtain information on aspects related to the investigation.
2. Documentary analysis.- It will be used to analyze the norms, bibliographic information and other aspects related to the investigation.
7.8. Data collection instruments.
The instruments to be used in the research are related to the aforementioned techniques, as follows:
The following techniques will be applied:
- Document analysis Inquiry Data reconciliation Table tables with amounts and percentages Understanding graphs
7.10. Data processing techniques
The following data processing techniques will be applied:
- Sorting and classification Manual registration Computerized process with Excel Computerized process with SPSS
VIII. Schedule
IX. Budget
X. Bibliography
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