Calidad en las instituciones y empresas del sector de servicios públicos del gobierno central en el departamento de Lima

La modernización de la Gestión Pública es un proceso que busca responder a como satisfacer nuevas necesidades que demandan los ciudadanos y las empresas en general, para ello urge contar con un estado moderno, rápido y eficiente.Los avances en la materia de reforma del Estado y modernización de la gestión pública son aún un proceso inconcluso; Además de la carencia de una política general y sistémica sobre la calidad en el paísy su funcionamiento como un sistema articulado, son pues entre otros factores, los causantes de que pocas Empresas del Sector de Servicios Públicos del Gobierno Central en el Departamento de Lima cuenten con un Sistema de Gestión de Calidad. El presente estudio tiene como objetivo, identificar si las instituciones y empresas del Sector de Servicios Públicos del Gobierno Central en el departamento de Lima que tienen un Sistema de Gestión de Calidad (SGC) tienen un mayor nivel de calidad comparado con aquellas que no tienen un SGC.Por lo que se procedió con el estudio de investigación, considerando una población de 158 unidades empresariales de las cuales obtuvimos una muestra de 79 empresas de dicho sector, identificándose que solo el 19% de éstas cuentan con un SGC. Además de diseñar y utilizar una encuesta basada en el instrumento del TQM propuesto por Benzaquen (2013). El esquema de trabajo desarrollado en la presente tesis, queda reflejado en los siguientes puntos: búsqueda de información general, estudio y elección del modelo de medición de calidad de servicios, relevamiento de información a través de encuestas enviadas a toda la población de este sector, tabulación y análisis de resultados, análisis y comparación de los nueve factores de calidad y elaboración de conclusiones y recomendaciones. Obteniendo como resultado diferencias significativas en los nueve factores de la calidad en ambas muestras, confirmándose así la hipótesis planteada en el presente estudio. Con estos resultados se dará a conocer a las instituciones y empresas del sector el impacto que genera el contar o no con SGC y como generar valor agregado en todos sus procesos de servicios al contar con estos tipos de herramientas.The modernization of Public Management is a process that seeks to respond tomeet news needsasdemanded bycitizens and companies in generalfor iturgently neededa modern,fast and efficient State. Advances in the field of state reform and modernization of public administration are still a work in progress; In addition to the lack of a comprehensive and systemic quality policy in the country and functioning as an articulated system are therefore among other factors, the causes of which few companies in the Utilities Sector Central Government in the Department of Lima have a Quality Management System. This study aims to identify if companies Public Sector Central Government in the department of Lima that have a Quality Management System (QMS) have a higher level of quality compared to those without a QMS. So we proceeded with the investigation, considering a population of 158 business units from which we obtained a sample of 79 companies in this sector, identifying that only 19% of them have a QMS.In addition to designing and using a survey instrument based on TQM proposed by Benzaquen (2013). The scheme of work developed in this thesis, is reflected in the following: general information search, study and choice of model of quality measurement services, collection of information through surveys sent to all the people of this area, tabulation and analysis of results, analysis and comparison of the nine factors of quality and elaboration of the conclusions and recommendations. Resulting in significant differences in the nine factors of quality in both samples, confirming the hypothesis in this study. With these results will be released to institutions and companies the impact generated by having or not having QMS and how to generate added value in all their service processes to have these types of tools.Tesi

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit