La propuesta de rediseño del Servicio de Medicina Interna del Hospital de la Santa Cruz y San Pablo

Abstract

ObjectiveThe society which hospitals serve is currently undergoing demographic, technological and cultural changes. The Internal Medicine Service (IMS) of the Hospital de la Santa Creu i Sant Pau considers these changes to provide an opportunity for improvement. We present the proposals and methodology applied for the re-engineering of the IMS. MethodThe nominal group technique was used to identify and prioritize objectives and to select problems and interventions for implementation. Hospital staff of all levels, residents’ associations in the hospital’s vicinity, health authorities external to the hospital, patients and their families participated in these groups. The redesign was initiated in 1998 and continues to date. ResultsThe strong points of the IMS were considered to be its multidisciplinary training and adaptability to different situations and needs. The seven objectives selected identified the external and internal clients. Among the five main problems prioritized, three centered on improving process management and two on non-clinical skills training. Finally, 23 end points influencing daily clinical activity were selected. These end-points aim to improve the participation of all the team members in the objectives of the service/hospital and to help in resolving citizen’s problems. ConclusionsOur proposal for remodelling raises two important issues. The first reveals the importance of working with specific and participative methodology. The second identifies objectives, detects problems, proposes courses of action for improvement, and selects a number of end points, which should be incorporated in the redesign of our IMS. The proposed redesign continues to be open and to incorporate improvements.