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¿Sueñan los gerentes con determinantes sociales?

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Taller realizado en la II Jornada de Médicos Jóvenes, organizada por el Colegio de Médicos de Toledo.
Octubre de 2019

Published in: Health & Medicine
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¿Sueñan los gerentes con determinantes sociales?

  1. 1. Taller 4¿Sueñan los gestores con determinantes de salud?
  2. 2. Las decisiones
  3. 3. ¿Qué y/o quién influye en las decisiones de los gestores?
  4. 4. Barends, E., Villanueva, J., Rousseau, D. M., Briner, R. B., Jepsen, D. M., Houghton, E., & Ten Have, S. (2017). Managerial attitudes and perceived barriers regarding evidence-based practice: An international survey. PloS one, 12(10), e0184594. ¿Existe la gestión basada en la evidencia?
  5. 5. Los pliegos de contratación pública.
  6. 6. Pliego de prescripciones técnicas del contrato servicios para la gestion integral del servicio de alimentacion de los pacientes y autoservicio del personal y cafetería del publico del hospital XXXYYYZZZ (marzo de 2018)
  7. 7. "Los presupuestos no se negocian. Se pueden negociar otro tipo de objetivos pero los presupuestarios no". Ramón-Jerónimo, J. M., Flórez-López, R., & Domínguez-Lario, N. (2018). Utilidad del presupuesto y del cuadro de mando integral en la gestión de centros de atención primaria. Impacto sobre la motivación del personal. Atención Primaria, 50(3), 166-175.  Objetivo: cumplir a 31/12.  Dificultad de medidas a largo plazo.  Eficiencia para hoy.
  8. 8. Noticias miopes
  9. 9. Rumbos parecidos Objetivos equipo Objetivos dirección
  10. 10. La parte social
  11. 11. Diseño de servicios • Tener en cuenta variables que afectan al paciente y que están en su entorno. • La pobreza como epidemia. • Toda sanidad debe ser social. Wallace DJ, Ray KN, Degan A, et al Transportation characteristics associated with non-arrivals to paediatric clinic appointments: a retrospective analysis of 51 580 scheduled visits BMJ Qual Saf 2018;27:437-444.
  12. 12. Clausulas sociales en los contratos de servicios Ley 9/2017, de 8 de noviembre, de Contratos del Sector Público
  13. 13. Tecnología y cultura
  14. 14. Dorsey, E. R., & Ritzer, G. (2016). The McDonaldization of medicine. JAMA neurology, 73(1), 15-16.
  15. 15. Pearl, R. (2014). Kaiser Permanente Northern California: current experiences with internet, mobile, and video technologies. Health Affairs, 33(2), 251-257. La ilusión óptica del mundo digital
  16. 16. Tener en cuenta todos los factores Ray, K. N., Shi, Z., Gidengil, C. A., Poon, S. J., Uscher-Pines, L., & Mehrotra, A. (2019). Antibiotic prescribing during pediatric direct-to- consumer telemedicine visits. Pediatrics, 143(5), e20182491.
  17. 17. However, the direct daily contact with a nurse that goes with the programme may be more important. Ojo con la transformación digital
  18. 18. Problemas de transformación: la HCE En algunos países se ha creado la figura del “medical scribe”, un profesional especializado que transcribe todo lo que se dice en la consulta/visita.
  19. 19. Parafraseando a Marmot, "si los principales determinantes de la salud son sociales, así deberán ser los sistemas de información". Cantor, M. N., & Thorpe, L. (2018). Integrating data on social determinants of health into electronic health records. Health Affairs, 37(4), 585-590.
  20. 20. T I E M P O
  21. 21. Innovación frugal
  22. 22. Ojo con las buenas prácticas y los grandes éxitos del mundo de la gestión. Scott, T. I. M., Mannion, R., Davies, H. T., & Marshall, M. N. (2003). Implementing culture change in health care: theory and practice. International journal for quality in health care, 15(2), 111-118.
  23. 23. Personas
  24. 24. Contratos programa: indicadores de salud, accesibilidad, calidad, seguridad, humanización 1. Realizar de forma periódica encuestas de clima laboral. 2. Incluir indicadores en el contrato programa: trabajo en equipo, comunicación, burnout, etc.
  25. 25. La tiranía del objetivo
  26. 26. ¿Motiva más la igualdad o la desigualdad? 1. Cuando cobras más, parece que estás en un status mayor. Generar jerarquía incluso cuando no la hay (↓cooperación). 2. Diferencias salariales generan sentimientos de maltrato e injusticia. 3. Efecto Dunning-Kruger (creer que soy mejor de lo que soy): puedo pensar que los que cobran más que yo no son tan buenos y genera desmotivación.
  27. 27. Badia, J. G. (2007). Basta de «clicar» casillas. Atención primaria: Publicación oficial de la Sociedad Española de Familia y Comunitaria, 39(4), 169- 170.
  28. 28. Declaración del Comité de Bioética de Aragón: “Etica de los incentivos a los profesionales sanitarios”
  29. 29. Romper la costumbre
  30. 30. Berwick, D. M., Loehrer, S., & Gunther-Murphy, C. (2017). Breaking the rules for better care. Jama, 317(21), 2161-2162. Romper las reglas y cuestionar la realidad para mejorar los cuidados.
  31. 31. http://horizonsnhs.com/school/THE SCHOOL FOR CHANGE AGENTS 2019
  32. 32. La pseudoinnovación, las modas y el humo Walshe, K. (2009). Pseudoinnovation: the development and spread of healthcare quality improvement methodologies. International Journal for Quality in Health Care, 21(3), 153-159.
  33. 33. Ningún problema debería resolverse dos veces
  34. 34. De la jerarquía al punk 1. Hazlo tu mismo. 2. Desprecia las modas. 3. Desconfía de los dogmas.
  35. 35. Miguel Ángel Máñez @manyez manyez @ gmail.com

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