GUIDELINES FOR A IMPROVEMENT PROJECT

INTRODUCTION
The deployment of actions motivated by the implementation of the National Crusade for the Quality of Health Services
awakened in organizations, and in those who work in them, the desire to participate in the search for alternatives that
allow to improve the quality of the services provided.
The incorporation of indicators for measuring the quality of nursing services in the National Crusade for
The quality of healthcare services, for its part, has triggered the need to have the general guidelines that provide it
allow the operating and management staff of the institutions participating in this program to prepare their own
projects and continuous improvement programs, in order to correct the aspects that do not meet the quality standards
previously determined or to innovate those procedures that satisfactorily meet these standards.
To this end, the Interinstitutional Nursing Commission took on the commitment to once again call upon the representatives of
the different institutions of the Health Sector to collectively define these guidelines that aim to
provide nursing staff in medical units with the technical-administrative elements to structure
continuous improvement programs that also allow for the enhancement of service quality through the identification of areas
opportunity to timely take preventive or corrective actions that allow for the balance of cost-benefit and the
quality of services; contribute to ensuring users the best practices in the provision of services
nursing and developing the management capacity of the operational staff of nursing services
Thus, to develop the guidelines, what will be understood as Continuous Improvement for nursing was specified:
Process that allows managers and operational staff to take actions for change aimed at achieving that the
interventions, services or products of the nursing professional activity are consistent with quality standards.
This process consists of a series of stages and activities that complement each other. It is considered as a
new way of working in which all the workers that make up the organization become involved and committed in order to achieve the
satisfaction of users with the service received, and of service providers with the technical quality of the procedures
that they carry out.

Among the premises that support continuous improvement are the following:
For a health institution, continuously improving the quality of its services is part of its mission.
The knowledge of the expectations and needs of users of nursing services are the elements that
determine the design and operation of the services

Continuous improvement recognizes operational staff as the owners of the process, being experts in its execution and having the
elements of judgment to modify it and thus improve it.
Due to the dynamism of improvement projects, the work teams for this purpose are formed temporarily.
The methodology of analysis and decision-making for continuous improvement favors the achievement of consistent results in the short term.
deadline and without the use of additional resources.
The starting point for initiating continuous improvement programs or projects for nursing services will be the formulation of
quality policies that clearly define what is expected regarding qualitative characteristics and standards
quality of their interventions, products or services; a second step is the diagnosis to identify the level of
quality with which services are being provided, regarding the established standards, level that will be determined by the
results of the measurements of the nursing indicators incorporated in the National Crusade for Quality of the
Health Services, where systematic monitoring of these provides staff the opportunity to analyze each variable,
identify the cause of their non-compliance and propose different alternatives for its correction or in case of satisfactory results
the search for your innovation.
This document proposes the guidelines and methodology through which those responsible for quality matters...
Health institutions will be able to design, develop, and implement continuous improvement programs in services.
nursing.

GUIDELINES FOR DEVELOPING CONTINUOUS IMPROVEMENT OF NURSING SERVICES

1. DEVELOP THE DIAGNOSTIC PHASE
Carry out a qualitative-quantitative evaluation process to determine the level of quality by comparing the results.
obtained with the established standards
If the services satisfactorily meet the established standards:
Improve the standards or attributes of characterization or the way services should be provided.
Innovate work systems by incorporating user feedback
Obtain citizen approval
If the services do not satisfactorily meet the established standards:
Specify the situations that are below the defined minimum acceptable ranges.
Analyze the magnitude, significance, and vulnerability to classify the level of priority and findings of unforeseen situations.
Make decisions considering feasibility, impact, cost/benefit, and possible scenarios that may arise.
Define improvement projects that facilitate adjustments in response to the association of causes or elements that arise.
guarantee the continuity of quality controls and promote synergies.
Develop a work plan and the proposal for improvement and present them to the unit authorities, so that together
define and support the actions to be taken
2. INTEGRATE IMPROVEMENT TEAMS FOCUSED ON DEVELOPING THE SPECIFIC PROJECT
Identify those workers who, due to their personal characteristics, meet the required profile (deep knowledge of
theme, experience in regulatory and operational aspects, willingness to work in a team, and moral and technical authority to
decision making
Manage the involvement of specialists from other services when the project's objective involves other areas of
organization, to form an interprofessional team
Designate one of the participants as the group leader based on the proposal of the team members.
Work agenda form

3. DEVELOP IMPROVEMENT PROPOSALS

Start by analyzing the facts and data to isolate the root cause, using different tools for this purpose.
existing techniques
Prioritize the causes either by their level of competence or complexity, selecting those that can be resolved more easily.
ease with the intervention of the improvement team
Define improvement actions and specify the actions in a timely manner, through a work plan.
Present to the relevant authorities the work program for their approval and support for implementation beforehand.
feasibility analysis, impact and cost-benefit
4. IMPLEMENT THE IMPROVEMENT ACTIONS
Inform the unit personnel and specifically the staff involved in the services about the implementation of the actions.
programmed for improvement in order to strengthen their contribution
Train the project team members on the procedure to ensure compliance in the execution of the
procedures
Implement the improvement actions
Supervise the compliance with the scheduled actions
Measure the results until achieving standardization
5. MONITORING AND CONTROL
Take new measurements using the same instruments and the same sample size to verify and compare.
the changes graphing the results
Design a comparative table with the baseline measurements and the measurements obtained after implementing the actions.
improvement
Present the results to the authorities emphasizing the graphical demonstration of the changes.
Define the measures that will be taken in the future to maintain the standard or continue improving.
6. MONITORING OF RESULTS
Define a program for the systematic measurement of the behavior of each of the variables (according to the work program)
during a scheduled period and frequency
Have evidence of the control of the procedure
Identify user satisfaction with the actions taken
Document and publish the results
At the conclusion of the work program, acknowledge the team's efforts.

TECHNIQUES AND TOOLS FOR THE ANALYSIS OF OPPORTUNITY OR PROBLEM AREAS

The proper use of techniques to carry out the analysis of areas of opportunity or problems is essential for
propose solutions and make decisions based on objective data, making efficient use of resources. Even when
There are various techniques, the most common ones that can be used by work teams, without the need for a
specialized training includes among others: brainstorming, flowchart, Ishikawa diagram also known as
cause-effect and the control charts of which the description is made below:
BRAINSTORMING
It is one of the techniques with which the staff is most familiar, and it is well accepted because it encourages participation.
All members are allowed to express their ideas freely on a topic; the objective is to identify, analyze, and resolve.
problems in a short time and in an atmosphere of trust.
The rules that govern the process when implementing this technique include the willingness of management to listen to feedback.
that highlight unsatisfactory aspects of their management.
Preparation for the brainstorming session
Define the site where participants can feel comfortable
Have teaching aids such as flip charts to present ideas visibly to everyone, markers, blank sheets, and pencils.
Prepare the agenda and inform the participant before the meeting.
Log in on time
The team leader clearly presents the topic and objective of the session.
Everyone must participate with a spirit of collaboration, respect, and seriousness.
Ideas are presented one by one following the order in which people are located; if one doesn't have any idea, the
the person says 'pass'
Ideas should not be criticized, there are no "stupid" ideas, some ideas that seem far-fetched may be the key to
identify a solution
Note down all ideas, the greater the number, the more likely it is to identify quality ideas.
Do not look for blame when suggesting ideas related to the cause of problems
The session ends when everyone says 'pass' or the group feels satisfied with the number of ideas generated.
Once the contributions are completed, the evaluation is carried out, and the participants make comments for or against.
the exposed ideas. When it comes to a session to identify problems, two criteria can be used to evaluate the
one idea is the magnitude (frequency of occurrence) and the other is the transcendence (severity of the occurrence). On the contrary,
when the ideas refer to the solution, the criteria for evaluating it could be the feasibility of its application, the cost -
benefit and time to obtain the results.

FLOWCHART
The flowchart is essential for the analysis phase, providing a graphic idea of all the steps in a process.
to do, who is going to do it, when it is going to be done, where it is going to be done, and why it is going to be done) and show how each one is
interrelated; they help to develop and guide thinking between departments or functions to ensure that all the
parts of the process are included, identify duplicities or unnecessary activities.
This tool uses different symbols that represent the type of activity:

Start Operation Transfer

Delay Verification File

Correction

To apply this tool, the following activities must be carried out:

Process flow mapping, listing the component activities of it
Identify the type of operation performed in each activity
Identify the time used to develop each activity
Complete the analysis with the Pareto chart and the cause-effect diagram.

CAUSE-EFFECT DIAGRAM OR ISHIKAWA DIAGRAM

The cause-and-effect diagram is a brainstorming organized from the key elements that interact in the process that
analysis, one of the most frequent uses is to detect the different types of causes that influence a problem, to select them
main ones and prioritize them. It can also serve as a basis for the development of a work program aimed at the solution
of problems or to improve quality since the diagram shows all the causes that give rise to a problem or determine a
quality effect, it is possible to define objectives, assign activities and responsibilities as well as compliance dates. It is
It is possible that for each effect there are several important categories of causes. These categories can be summarized as: inputs,
methods, people, environment, equipment and measurement.
To develop the cause-effect diagram:
- Select the problem or quality characteristic that you want to analyze. This is inscribed in the box that represents the
fish head.
- Organize a brainstorming session about the causes that participants believe originate the problem or determine the characteristic
of analyzed quality.
Group the ideas into categories and subcategories when this becomes difficult; it is recommended to use the five Ms as a guide (measurement,
materials, methods, machinery, and labor
- Relate for each cause what happens while the main causes are released.
Use the fewest words possible.
Look for the causes that appear repeatedly
Obtain the group's consensus
Gather information to determine the relative frequencies of the different causes (ISHIKAWA DIAGRAM)

By seeing the ideas represented and related by the diagram, new ideas, categories, and relationships that modify may arise.
the original diagram and make it clearer. The criterion for deciding if a cause-effect diagram is well designed is the logic that
is established between the categories and the causes.

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