Diagnóstico operativo del Banco Internacional del Perú Interbank

El presente diagnóstico operativo se ha desarrollado siguiendo la estructura propuesta por D‟Alessio (2012), pero considerando que se trata de un servicio. Se consultaron diversos autores, para luego revisar los procesos que se desarrollan en la empresa, identificar debilidades y proponer mejoras. Interbank es una organización peruana dedicada a brindar servicios financieros, que cuenta con 270 tiendas distribuidas a lo largo de todo el territorio nacional. Ha sido muy innovadora con el diseño de sus tiendas, ya que ha implementado el esquema Imagine, que busca el acercamiento entre los colaboradores y los clientes. Cada oficina tiene metas de ventas, detalladas por cada producto, que son la base para determinar el número de representantes financieros y de otros ejecutivos que se necesitan por punto de atención. En general, las propuestas de mejora están encaminadas al desarrollo de los canales electrónicos, que permiten el ahorro de costos para la organización y el incremento de los ingresos, en la medida en que los clientes puedan comprar nuevos productos por este medio. Además, se propone que también sirva para captar ideas de los clientes, invitándolos a brindar su opinión. La información obtenida se utilizará para innovar mediante el desarrollo de nuevos servicios, tanto para clientes actuales como para captar nuevos clientes. Finalmente, la forma de incentivar el uso de la banca electrónica y el aplicativo para teléfonos celulares será principalmente a través de los mobile leaders, que son unos jóvenes ubicados en cada tienda con el fin de educar a los clientes sobre el uso de estas dos herramientas. El conjunto de propuestas de mejoras que se plantean a lo largo de este documento tienen un costo total de S/ 13‟406,240 para producir beneficios por S/ 44‟495,492The present operative diagnosis has been developed following the structure proposed by D'Alessio (2012), but considering that it is a service. Several authors were consulted, to then review the processes that take place in the company, identify weaknesses and propose improvements. Interbank is a Peruvian organization dedicated to providing financial services, which has 270 stores distributed throughout the country. It has been very innovative with the design of its stores, implementing an Imagine scheme that seeks the rapprochement between employees and customers. Each office has sales goals, detailed by each product, that are the basis for determining the number of Financial Representatives and other executives needed per point of care. In general, the improvement proposals are aimed at the development of electronic channels, which allow the cost savings for the organization, as well as lead to increase revenue, to the extent that customers can buy new products by this means. In addition, it is proposed that it also serve to capture ideas from customers, inviting them to give their opinion, which will be used to innovate developing new services, both for current customers and to attract new customers. The way to encourage the use of electronic banking and the application for cell phones will be mainly through the mobile leaders, which are young people located in each store in order to educate customers about the use of these two tools. All the proposals included in this document require a cost of S/ 13‟406,240 in order to generate benefits to the organization for S/ 44‟495,492Tesi

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients