Procedimiento para la evaluación de la calidad percibida de los servicios bancarios

En el presente artículo se describe un procedimiento para la evaluación de la calidad percibida de los servicios bancarios, el cual cuenta con cuatro etapas y trece pasos. La propuesta garantiza la evaluación y mejora de la calidad percibida con un enfoque de gestión por procesos y mejora continua. Para la recopilación de información se utilizaron técnicas tales como: entrevistas, tormenta de ideas, revisión de documentos, trabajo con expertos, trabajo en equipo y observación directa. Se hace uso de herramientas clásicas de la calidad y de gestión de procesos, así como la técnica 5Ws y 1H (What, Why, Where, Who, When, How) y la metodología de Proceso Esbelto. Como resultados fundamentales de la investigación se identificaron las principales brechas de insatisfacción en la calidad del servicio, a partir de las percepciones de los clientes mediante el uso del cuestionario Servqual, así como la obtención de una calificación global de la calidad del servicio. Se determinó que para las 22 declaraciones del cuestionario Servqual, las percepciones de los clientes no superan las expectativas, donde las brechas con menor índice de calidad se relacionan con el tiempo de servicio para lo cual se propone un conjunto de acciones que contribuyen a la mejora de la calidad percibida.In the present paper is described a procedure for evaluating the perceived quality of banking services which has four stages and thirteen steps. The proposal ensures the evaluation and improvement of the perceived quality with a focus on process management and continuous improvement. For data collection are used techniques such as: interviews, brainstorming, review of documents, work with experts, teamwork and direct observation. It makes use of classical tools of quality and process management as well as 5Ws and 1H technique (What, Why, Where, Who, When, How) and the methodology of Lean Process. As fundamental research results were identified the main gaps of dissatisfaction on the service quality from the perceptions of customers, using questionnaire Servqual as well as a level of service quality. It was determined that for the 22 statements of the questionnaire Servqual customer perceptions no exceed expectations where the gaps with lower quality index are related to the length of service for which a set of actions that contribute to improving the perceived quality are proposed

Evaluación de la calidad del servicio percibida en entidades bancarias a través de la escala Servqual.

The research presented in this paper was developed in a banking branch in the province of Cienfuegos, Cuba, during the last three quarters of 2013, with the main objective of evaluating and improving the perceived quality while focusing on process management and continuous improvement. For this purpose, a procedure to evaluate the perceived quality of banking services based on in the multi-dimensional Servqual scale was designed and implemented. Data collection was accomplished by the use of different techniques, such as interviews, brainstorming, review of documents, working with experts, teamwork and direct observation. Classical tools of quality and process management were used, as well as the 5Ws and 1H technique, and the methodology of Lean Process. The results of the research led to the identification of the main gaps of dissatisfaction with the service quality from the perceptions of customers, as well as to the completion of an assessment of overall service. It was determined that for the 22 statements of the Servqual questionnaire, customer perceptions did not exceed expectations. The gaps with lower quality index are those related to the length of service, for which a set of actions that contribute to improving the perceived quality are proposed.El presente trabajo se realizó en una sucursal bancaria en la provincia de Cienfuegos, Cuba, durante los últimos tres trimestres del año 2013 con el objetivo fundamental de evaluar y mejorar la calidad percibida con un enfoque de gestión por procesos y mejora continua. Para ello, se diseñó e implementó un procedimiento para la evaluación de la calidad percibida de los servicios bancarios basado en la escala multidimensional Servqual. Para la recopilación de información se utilizaron técnicas tales como: entrevistas, tormenta de ideas, revisión de documentos, trabajo con expertos, trabajo en equipo y observación directa. Se hizo uso de herramientas clásicas de la calidad y de gestión de procesos, así como la técnica 5W y 1H, y la metodología de Proceso Esbelto. Como resultados fundamentales de la investigación se identificaron las principales brechas de insatisfacción en la calidad del servicio a partir de las percepciones de los clientes, así como la obtención de una calificación global de la calidad del servicio. Se determinó que para las 22 declaraciones del cuestionario Servqual las percepciones de los clientes no superan las expectativas. Las brechas con menor índice de calidad son aquellas que se relacionan con el tiempo de servicio, por lo que se propone un conjunto de acciones que contribuyan a la mejora de la calidad percibida

The origins and spread of domestic horses from the Western Eurasian steppes

This is the final version. Available on open access from Nature Research via the DOI in this recordData availability: All collapsed and paired-end sequence data for samples sequenced in this study are available in compressed fastq format through the European Nucleotide Archive under accession number PRJEB44430, together with rescaled and trimmed bam sequence alignments against both the nuclear and mitochondrial horse reference genomes. Previously published ancient data used in this study are available under accession numbers PRJEB7537, PRJEB10098, PRJEB10854, PRJEB22390 and PRJEB31613, and detailed in Supplementary Table 1. The genomes of ten modern horses, publicly available, were also accessed as indicated in their corresponding original publications57,61,85-87.NOTE: see the published version available via the DOI in this record for the full list of authorsDomestication of horses fundamentally transformed long-range mobility and warfare. However, modern domesticated breeds do not descend from the earliest domestic horse lineage associated with archaeological evidence of bridling, milking and corralling at Botai, Central Asia around 3500 BC. Other longstanding candidate regions for horse domestication, such as Iberia and Anatolia, have also recently been challenged. Thus, the genetic, geographic and temporal origins of modern domestic horses have remained unknown. Here we pinpoint the Western Eurasian steppes, especially the lower Volga-Don region, as the homeland of modern domestic horses. Furthermore, we map the population changes accompanying domestication from 273 ancient horse genomes. This reveals that modern domestic horses ultimately replaced almost all other local populations as they expanded rapidly across Eurasia from about 2000 BC, synchronously with equestrian material culture, including Sintashta spoke-wheeled chariots. We find that equestrianism involved strong selection for critical locomotor and behavioural adaptations at the GSDMC and ZFPM1 genes. Our results reject the commonly held association between horseback riding and the massive expansion of Yamnaya steppe pastoralists into Europe around 3000 BC driving the spread of Indo-European languages. This contrasts with the scenario in Asia where Indo-Iranian languages, chariots and horses spread together, following the early second millennium BC Sintashta culture

Termite sensitivity to temperature affects global wood decay rates.

Deadwood is a large global carbon store with its store size partially determined by biotic decay. Microbial wood decay rates are known to respond to changing temperature and precipitation. Termites are also important decomposers in the tropics but are less well studied. An understanding of their climate sensitivities is needed to estimate climate change effects on wood carbon pools. Using data from 133 sites spanning six continents, we found that termite wood discovery and consumption were highly sensitive to temperature (with decay increasing >6.8 times per 10°C increase in temperature)-even more so than microbes. Termite decay effects were greatest in tropical seasonal forests, tropical savannas, and subtropical deserts. With tropicalization (i.e., warming shifts to tropical climates), termite wood decay will likely increase as termites access more of Earth's surface

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evaluación de la calidad del servicio percibida en entidades bancarias a través de la escala Servqual.

The research presented in this paper was developed in a banking branch in the province of Cienfuegos, Cuba, during the last three quarters of 2013, with the main objective of evaluating and improving the perceived quality while focusing on process management and continuous improvement. For this purpose, a procedure to evaluate the perceived quality of banking services based on in the multi-dimensional Servqual scale was designed and implemented. Data collection was accomplished by the use of different techniques, such as interviews, brainstorming, review of documents, working with experts, teamwork and direct observation. Classical tools of quality and process management were used, as well as the 5Ws and 1H technique, and the methodology of Lean Process. The results of the research led to the identification of the main gaps of dissatisfaction with the service quality from the perceptions of customers, as well as to the completion of an assessment of overall service. It was determined that for the 22 statements of the Servqual questionnaire, customer perceptions did not exceed expectations. The gaps with lower quality index are those related to the length of service, for which a set of actions that contribute to improving the perceived quality are proposed.El presente trabajo se realizó en una sucursal bancaria en la provincia de Cienfuegos, Cuba, durante los últimos tres trimestres del año 2013 con el objetivo fundamental de evaluar y mejorar la calidad percibida con un enfoque de gestión por procesos y mejora continua. Para ello, se diseñó e implementó un procedimiento para la evaluación de la calidad percibida de los servicios bancarios basado en la escala multidimensional Servqual. Para la recopilación de información se utilizaron técnicas tales como: entrevistas, tormenta de ideas, revisión de documentos, trabajo con expertos, trabajo en equipo y observación directa. Se hizo uso de herramientas clásicas de la calidad y de gestión de procesos, así como la técnica 5W y 1H, y la metodología de Proceso Esbelto. Como resultados fundamentales de la investigación se identificaron las principales brechas de insatisfacción en la calidad del servicio a partir de las percepciones de los clientes, así como la obtención de una calificación global de la calidad del servicio. Se determinó que para las 22 declaraciones del cuestionario Servqual las percepciones de los clientes no superan las expectativas. Las brechas con menor índice de calidad son aquellas que se relacionan con el tiempo de servicio, por lo que se propone un conjunto de acciones que contribuyan a la mejora de la calidad percibida

DISEÑO DE UN PROCEDIMIENTO PARA REALIZAR EL AUTOCONTROL DEL SISTEMA DE GESTIÓN INTEGRADO DE CAPITAL HUMANO / DESIGN OF A PROCEDURE TO DEVELOP THE SELF-CONTROL TO THE INTEGRATED HUMAN CAPITAL MANAGEMENT SYSTEM

La investigación considera como caso de estudio la experiencia de la Empresa Comercializadora de Combustibles de Cienfuegos (ECC), la cual trabaja en implantar el Sistema de Gestión Integrada de Capital Humano (SGICH) desde el año 2008. En el presente artículo se exponen los resultados del proceso de autocontrol realizado al SGICH en la ECC, visualizando las experiencias obtenidas desde el comienzo del proceso de implantación del Modelo de Gestión Integrada de Capital Humano. El autocontrol se realiza utilizando la metodología del ciclo Deming y las herramientas propias que plantea el modelo (tecnología de diagnóstico), así como entrevistas, tormenta de ideas, revisión de documentos, técnicas de normación de competencias, de mapeo de proceso y trabajo con expertos. Para el procesamiento de los datos obtenidos se utiliza el paquete estadístico SPSS versión 16.0 y el Microsoft Excel. Finalmente, se propone un procedimiento enfocado a facilitar el desarrollo del autocontrol al SGICH como proceso de mejora continua y que, además, permita la certificación de la empresa según los requisitos de las Normas Cubanas 3000.The investigation takes as a case of study the experience of Cienfuegos's Fuel Trading Company (ECC), which works in the implementation of the Integrated Human Capital Management System since 2008. This system is integrated by eight processes, being the self-control one of them. The results of the self-control process to the human capital management system in the ECC are exposed in the present article, visualizing the experiences obtained from the beginning of the implementation process of the Integrated Human Capital Management Model. The self-control is carried out using the methodology of the Deming cycle and the very own tools that are presented by the model (technology of diagnostic), as well as others: interviews, brainstorming, review of documents, techniques of regulation of competences, mapping of processes and the work with experts. For the processing of obtained data we used the statistical package SPSS version 16.0 and Microsoft Excel. Finally a procedure is proposed, focusing in making easier the development of the self-control to the Integrated Human Capital Management System like a process of continual improvement and that it also allows the certification of the enterprise according to the requirements established in the Cuban Standards 3000

Estructura de los contratos en la prestación de servicios en el sector salud

Se desarrollará conocimientos en el uso de este recurso tecnológico de una manera significativa se podrá adquirir un conocimiento específico acerca de la estructura del contrato, permitiendo así desarrollar competencias particulares en base a las partes del contrato y su función