Research in Health Services and Systems, a management tool in health care

EDUMECENTRO 2023;15:e2664

RESEARCH PAPER

 

Research in Health Services and Systems, a management tool in health care

Las Investigaciones en Servicios y Sistemas de Salud, instrumento de gestión en la atención sanitaria

 

Belkys Lorenzo González1 https://orcid.org/0000-0001-6079-8219
Benita Mavel Beltrán González1 https://orcid.org/0000-0001-8773-6384
Jesus Endo Milán1 https://orcid.org/0000-0002- 0616-4204
Juan José Pulido López1 https://orcid.org/0000-0003-1226-4866

 

1 University of Medical Sciences of Villa Clara. Villa Clara. Cuba.

 

* Corresponding author. Email: belkyslg@infomed.sld.cu

 

 

ABSTRACT

Improving care processes in health services is a priority of the Ministry of Public Health in Cuba and Research in Health Services and Systems. The projections in this field can be aimed at the description of health problems and services, the evaluation of health interventions (promotion, prevention, cure, and rehabilitation) and those focused on determining problematic situations that arise in the application of health activities with the objective of analyzing the possible causes and finding solutions. Research in health services and systems facilitate the planning, organization, evaluation, and control of services and provide evidence for the scientific direction of the health system, so the objective of the article is to analyze the methodological and organizational aspects of Research in Health Services and Systems and enable the participation of professionals and managers from multiple disciplines that foster intersectoriality.

MeSH: research; assessment; health systems; health services.

RESUMEN

Mejorar los procesos de atención en los servicios sanitarios es una prioridad del Ministerio de Salud Pública en Cuba y la Investigación en Servicios y Sistemas de Salud. Las proyecciones en este campo pueden estar dirigidas a la descripción de problemas de salud y de los servicios, la evaluación de intervenciones en salud (promoción, prevención, curación y rehabilitación) y las enfocadas en determinar situaciones problemáticas surgidas en la aplicación de actividades sanitarias con el objetivo de analizar las causas posibles y encontrar soluciones. Las investigaciones en servicios y sistemas de salud facilitan la planificación, organización, evaluación y control de los servicios y aportan evidencias para la dirección científica del sistema de Salud, por lo que el objetivo del artículo es analizar los aspectos metodológicos y organizacionales de las Investigaciones en Servicios y Sistemas de Salud y posibilitar la participación de los profesionales y directivos de múltiples disciplinas que propician la intersectorialidad.

DeCS: investigación; evaluación; sistemas de salud; servicios de salud.

 

 

Submitted: 06/04/2023
Accepted: 12/05/2023

 

 

Research in Health Services and Systems (RHSS) focuses on the analysis of the decision-making process, planning, personnel management, operation, and use of health services, with the aim of finding solutions, overcoming insufficiencies and improve the quality of processes in health services and systems.(1,2) The need to prioritize and optimize the organization, quality and efficiency processes for the sustainability of current services, given the limitations imposed on Cuba to access markets with favorable conditions and the world economic crisis, requires RHSS that provide evidence for the scientific management of the health system and the proper use of resources to improve the health status of the people.(5)

The Cuban Ministry of Public Health, in its health research policy, established the Program for the organization, efficiency and quality of services, which constitutes an essential component for strengthening institutional performance. The development of strategies to carry out promotion, prevention, cure and rehabilitation actions, according to the health situation, where health needs interact on the one hand and the available resources on the other, point to the need to carry out ISSS to provide the information managers in decision-making, either to prevent deficiencies and errors or to ensure correct and safe health care for each patient.(3-8)

Statistics related to the Maternal and Child Care Program on the adolescent pregnancy rate, risk pregnancy, control of preconception reproductive risk, low birth weight, prematurity, early weaning, as well as mortality from chronic non-transmissible diseases, care for the elderly, the use of Natural and Traditional Medicine, are unresolved problems that require multidisciplinary, inter-institutional and intersectoral actions organized through RHSS that develop research projects and provide relevant information for decision-making.(4-7)

The management of care processes through the RHSS makes it possible to promote the participation of professionals and managers of the organization to determine the choice of alternatives systematically and objectively in decision-making that require a scientific foundation, hence its importance in determining efficacy, effectiveness of interventions and economic analyses, to achieve better health outcomes.(7, 8, 9)

Through the RHSS, different types of designs can be developed that enhance the management of care processes and not only the evaluation of the quality of care. Projections in this field can be aimed at describing health problems and services to plan interventions based on needs, analysis of the use of health resources, organization, and management of services; Also, another projection is focused on the evaluation of health interventions (promotion, prevention, diagnosis, treatment, and rehabilitation), the coverage of needs, quality, impact, accessibility, efficiency (cost evaluation) and effectiveness. Any decision that involves choosing between two or more options and that has an impact on health and the use of resources can be evaluated. The third way to determine problem-based situations that arise with the application of sanitary activities has as objective: to analyze the possible causes and to find solutions; For this, there must be a marked difference between what is observed in the services: the «is» and the «should be», where the reasons for the identified problem are not clearly observed and there is more than one possible response.(9)

Beltrán González(4), a research advisor in this field for 25 years, emphasizes its usefulness, by focusing on priority health care problems, although all stakeholders must participate, depending on the object of study (people, the family, the community, the leaders of the health services, decision-makers and researchers) in each of the stages and oriented towards action, that is, formulating solutions and facilitating the organization of systems for the development of intersectorality in care for health.

The management of health care through the RHSS is not a spontaneous process, it requires planning, organization, direction and control, with a view to being able to articulate the available resources to achieve the goals, the system approach is used as a theoretical method for the analysis of the problems observed in health services and systems, with its three components: structure, process and result.(9)

In the evaluation of the structure element, the human resources, equipment, and material means, premises, organizational rules, care regulations, programs, economic resources and others that guide and serve the care process will be analyzed. Performance appraisal pertains to process and assumes that up-to-date medical knowledge and available appropriate technology are applied in all phases of medical care. Among the methods to evaluate it are medical audit, concurrent observation and performance evaluation.(9) In the results component, according to the evaluation carried out, the indicators of morbidity, mortality, disability, satisfaction of internal and external users, satisfaction of service providers and the behavior of economic indicators (cost/utility, cost/ benefit).

It is recommended to carry out the evaluation of the services in the three dimensions and not only in one aspect, if the objective is to improve health results, the process and resources (structure) that contribute to achieving the effects must be understood, the information obtained It will enable effective management of health systems and services and constant improvement.(9)

In the management of care processes through RHSS, the differences between hospital care and Primary Health Care must be considered, either to assess quality or to intervene through technological innovation projects in promotion, prevention, cure, rehabilitation, or the development of organizational proposals. In the hospital context, it is important to verify compliance with the protocols established in the treatment of patients by professionals. Consultation with experts is easier than in PHC, where the magnitude of health problems, the incidence of factors in the social and physical environment requires dynamic monitoring and control systems that make it possible to truthfully investigate compliance with established programs and the behavior of the patient to carry out the indications and facilitate the management of the processes.(4, 8-10)

Research in Health Services and Systems facilitates the management of health care processes by providing the methodological and organizational requirements for the development of research that encourage the participation of professionals and managers, from multiple disciplines and provide evidence for management Health System Scientist.

 

BIBLIOGRAPHIC REFERENCES

1. Rojo Pérez N, Laria Menchaca S, Castell Florit Serrate P, Pérez Piñero J, Barroso Romero Z, Bayarre Vea H. «Investigaciones en Sistemas y Servicios de Salud en Cuba y su proyección hasta el 2015. Rev Cubana Salud Pública. [Internet]. 2010 [citado 04/10/2022];36(3):[aprox. 7 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662010000300004

2. Martínez Trujillo N. Capacidades individuales e institucionales para la investigación en sistemas y servicios de enfermería en Cuba. Rev Enferm Inst Mex Seguro Soc. [Internet]. 2017 [citado 01/03/2023];25(1):[aprox. 6 p.]. Disponible en: https://www.medigraphic.com/pdfs/enfermeriaimss/eim-2017/eim171k.pdf

3. Jara Navarro, MI. El uso de la investigación en la gerencia de los servicios de salud: el reto de comunicación entre dos comunidades. Revista Gerencia y Políticas de Salud. [Internet]. 2017 [citado 01/03/2023];16(32):[aprox. 4 p.]. enero-junio. Disponible en: http://www.scielo.org.co/pdf/rgps/v16n32/1657-7027-rgps-16-32-00005.pdf

4. Beltrán González BM, Torres Manreza O, Díaz Zarría L. Redes de equipos de investigación en salud para la gestión participativa de los profesionales. Medicentro Electrónica [Internet]. 2019 [citado 04/10/2022];23(1):[aprox. 5 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30432019000100007

5. Morales Ojeda R, Mas Bermejo P, Castell Florit Serrate P, Arocha Mariño C, Valdivia Onega NC, Druyet Castillo D, et al. Transformaciones en el sistema de salud en Cuba y estrategias actuales para su consolidación y sostenibilidad. Rev Panam Salud Pública. [Internet]. 2018 [citado 09/02/2023];42:[aprox. 9 p.]. Disponible en: https://www.scielosp.org/article/rpsp/2018.v42/e25/

6. Cuba. Ministerio de Ciencia, Tecnología y Medio Ambiente. Programas de Ciencia, Tecnología e Innovación. La Habana: CITMA; 2015.

7. Cuba. Ministerio de Salud Pública, Dirección Nacional de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud 2021. La Habana: MINSAP [Internet]. 2021. [citado 09/02/2023] Disponible en: https://temas.sld.cu/estadisticassalud/2022/10/18/anuario-estadistico-de-salud-2021/

8. Beltrán González BM, Vega Díaz T, Sarduy Pérez G, Santandreu Uriarte EM. Gestión por procesos en los servicios de salud y el trabajo en equipo: consideraciones metodológicas. EDUMECENTRO [Internet]. 2018 [citado 09/02/2023];10(1):[aprox. 4 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2077-28742018000100017

9. Astrain, ME. Introducción a la investigación en sistemas y Servicios de Salud. Trabajo confeccionado para el módulo la investigación en salud. Maestrías. ENSAP; 2002.

10. Granada Aguirre LF, Díaz España JA, Tenorio Cabezas M. Tendencias de la investigación en gerencia de servicios de salud: Aportes y ajustes metodológicos. Universidad Libre Seccional Cali. [Internet]. 2020 [citado 08/09/2022]:[aprox. 101 p.]. Disponible en: https://repository.unilibre.edu.co/bitstream/handle/10901/19236/Tendencias%20de%20la%20investigacion%20en%20la%20gerencia%20de%20servicios%20de%20salud.pdf?sequence=1

 

 

Declaration of interests

The authors declare no conflict of interest.

 

 

Contribution of the authors

Conceptualization: Belkys Lorenzo González and Benita Mavel Beltrán González
Data curation: Belkys Lorenzo González and Benita Mavel Beltrán González
Formal analysis: Benita Mavel Beltrán González and Belkys Lorenzo González
Research: Belkys Lorenzo González, Benita Mavel Beltrán González and Jesús Endo Milán
Methodology: Belkys Lorenzo González and Benita Mavel Beltrán González
Project administration: Belkys Lorenzo González, Benita Mavel Beltrán González and Juan José Pulido López
Writing, review and editing of the article: Belkys Lorenzo González, Mavel Beltrán González and Jesús Endo Milán

Copyright (c) 2023 EDUMECENTRO

Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.