Metodología de integración de los sistemas de gestión de la calidad, seguridad y salud en el trabajo y ambiental como contribución al cumplimiento del sistema único de acreditación en salud nacional en una institución de alto nivel de complejidad en Bogotá

Abstract

Offering quality services that meet the requirements of users, that comply with current regulations, and that also do not affect the environment and take care of the health of its workers, has become a necessity for Health Service Provider Institutions ( IPS). In the health sector, there are different tools to strengthen the quality processes of organizations, as well as management systems, which allow, through a set of elements, to achieve the objectives of the organization, generating greater patient satisfaction, better results of clinical and institutional outcome, increased competitiveness, sustainability in the market, greater recognition, among other benefits (Alfonso, Díaz, & Gómez, 2017). In addition to management systems, the health sector has other tools to guarantee quality in the patient care process, including the Unified Health Accreditation System (SUA), which allows to demonstrate, evaluate and verify compliance higher levels of quality by the IPS. However, for many institutions, obtaining certification for the different systems has not been an easy task, even more so when each system is managed independently. For this reason, any strategy, method or technique that is used to achieve this end is very useful, hence the importance of the integration of management systems in the IPS is generated, which provides a support guide to document and implement it in accordance with the requirements and standards of the systems, allowing them to be fulfilled in a planned, effective and efficient manner and also to use the necessary resources in the integral execution, aimed at achieving their organizational objectives together.

Based on this slogan, it is proposed to formulate a proposal for the integration of the Quality Management systems (QMS), the Occupational Health and Safety Management System (SG-SST) and the Environmental Management System (EMS), in an institution that provides health services of a high level of complexity, which contributes to compliance with the national SUA standards, to face the Health Accreditation process with a higher level of understanding and security, organized under the high-level structure of the management systems and the PDCA cycle, as a way to close the gap between opportunity, accessibility and quality of service, allowing IPS to face quality improvement processes with a higher level of certainty, compression and security, which guarantees the achievement of effective and efficient internal processes of quality in the care and provision of health services (Velásquez & Niño 2017).

The integration of the systems provides a coherent achievement of the objectives, since joint objectives are established or planned, articulated and directed towards the fulfillment of the same purposes, defining the required resources, responsible and establishing the methodologies for the evaluation of the results, In the same way, it allows to have a risk-based approach, which increases the organization's ability to anticipate and react to internal and external risks and opportunities and improve the competitive advantages of the organization and its positioning in the environment, due to the fact that achieves compliance with service requirements, user, employee, supplier and other interested party satisfaction and continuous improvement (Escobar, 2019).

At the international and national level, there are no studies related to the integration of the SGC, SGA, SG-SST and SUA, however some studies are identified where the integration only of the management systems described is proposed, others where more specific systems are added such as Information Management, Risk Management, Knowledge Management and others where the integration of management systems with other quality models such as National or International Health Accreditation, Qualification, the European Foundation Quality Management (EFQM) and the Balance Scorecard (BSC).

Likewise, in the different studies there are common benefits of the integration of the QMS, SGA, SG-SST and other quality models of the health sector, such as the ease of developing an intelligent and complete effort that combines the aspects of the systems, the which allows maximizing the use of resources, reducing costs and generating competitive strategies that are easily accepted and sustainable over time, it also allows the documentation, staff training actions and audits to be managed in an integrated manner, as well as to measure the effectiveness of the Comprehensive Management (SGI) and its increase, through a set of indicators (Palma, 2016).

This integration proposal is developed through four phases: in the first phase, a review of the literature related to the integration of management systems in the health sector and its contribution to the national SUA is carried out; In the second phase, the diagnosis of the SGC, EMS and SG-SST of the institution under study is carried out, through the application of checklists to evaluate compliance with the requirements based on the NTC-ISO; In the third phase, the design of the integration methodology by requirements is carried out, taking into account the PDCA cycle, in which the analysis of the correspondence relationships and differences between the different management systems is carried out and subsequently the analysis of the relationship of SUA standards with SGI requirements; and finally, in the fourth phase, the integration methodology is validated by consulting experts.