GOVERNMENT

OF
MEXICO

TECHNICAL GUIDE
MANAGEMENT MODEL
MEDICAL UNIT
directory

Lic. Germán Martínez Cázares

Managing Director

Dr. Victor Hugo Borja Aburto

Director of Medical Benefits

Dr. Ana Carolina Sepúlveda Vildósola

Education, Research and Health Policy Unit

Dr. Mario Madrazo Navarro

Health Policy Coordinator

Dr. Raúl Peña Viveros

Health Services Management Improvement Division

Index
Index........................................................................................................................................3
Introduction.............................................................................................................................5
Medical Unit Directive Management Model...........................................................................6
• Quality management system.........................................................................................7
• Performance Management System...............................................................................7
• Human Resources Management System......................................................................7
• Financial Resources System.........................................................................................8
• Facilities Management and Security System................................................................8
• Infection Prevention and Control System.....................................................................9
• Medication Management and Use System...................................................................9
Medical unit management.....................................................................................................10
Administration to achieve objectives and with a risk approach........................................11
Strategic Management and Operational Management.......................................................11
Integrated Management Model..............................................................................................14
Management Model of the Medical Unit..............................................................................16
1. Strategic Planning.......................................................................................................17
2. Organization and Management...................................................................................19
3. Control........................................................................................................................20
4. Analysis and decision making....................................................................................21
5. Continuous Improvement...........................................................................................22
6. Organizational development.......................................................................................23
Integration of the concept of directive management and other components of the quality
and safety model................................................................................................................24
Institutional Model for Competitiveness...............................................................................26
1. Users...........................................................................................................................27
2. Leadership..................................................................................................................27
3. Planning......................................................................................................................27
4. Processes.....................................................................................................................27
5. Human talent..............................................................................................................27
 6. Innovation, knowledge and information.....................................................................28
7. Social responsability...................................................................................................28
Model of the General Health Council for Health Care with Quality and Safety..................29
Medical unit address..............................................................................................................29
Directive documents..............................................................................................................31
Bibliography..........................................................................................................................32
Introduction
The medical units of the Mexican Social Security Institute have as their main
function the provision of health services that the entitled population requires,
generating the operational health structure to fulfill the objectives of the Institute
such as contributing to the universalization of access to health, strengthen income,
increase productivity, improve the health care model and improve economic and
social benefits. The provision of medical care is one of the most important functions
carried out by the Institute with the aim of improving the quality of life and
contributing to the development of entitled families, hence the importance of medical
units operating with the greatest efficiency and effectiveness possible. .

To this end, the Medical Benefits Directorate has worked throughout its history to
establish the methods and guidelines necessary for adequate management. Having
in the last 6 years greater strength in the standardization and implementation of
these directive actions. The Coordination of Health Policies through the Division of
Improvement of the Management of Health Services, has generated the essential
tools and advice for a gradual and sustained development of the improvement in the
managerial actions of the personnel related to this great responsibility. Among these
standards is the alignment of the different concepts and work models that are served
in medical units. This document has the purpose of facilitating the understanding of
the Management Model of a medical unit and the definition of concepts for the
adequate implementation and execution of management management in the
operation.

Its content is not unique or exclusive and the reader must even go to increase the
theoretical information on the matter and associate it with the most current
techniques, concepts and skills in the administration of public health services and in
the field of private initiative and international as references of success and attend to
what can be transferable to the business model. local managerial work.
Medical Unit Directive Management Model
2
A system is understood as the set of mutually related or interacting elements . “A
system is a series of elements that form an activity, a procedure or a plan of
procedures that seek a common goal or goals, through the manipulation of data,
energy or matter. For adequate and updated administrative practice, the systems
used will determine this” 3 .
To better understand the importance of the medical unit as a “living” organization, it
is necessary to think in terms of the need for constant change to offer the best
possible health services and given its constant evolution, it must have a philosophy
(mission and vision) and work in a coordinated manner, uniting isolated elements to
achieve common goals (objectives). The concept of a system as an instrument of
union between the processes that make up the medical unit allows for a
comprehensive vision as a whole that facilitates the operations of the programs
carried out in the processes. The system is considered as the organizational
structure, procedures, processes and resources necessary to implement the
Management Model.
The managers of the medical units keep in mind that the exercise of administration
is in itself a methodology that requires knowledge and the development of skills,
which must be applicable to human relations and their activities, so the systems
become a means for action and measurement of results, being the best way to
preserve the objectives as the end of the provision of health services.
The operation unit (Hospital or Family Medicine Unit) is taken as a large system,
which is governed by the strategic plan, the quality and safety plan, tactical and
operational plans for process improvement. On the other hand, the Hospital or
Family Medicine Unit must be considered as an organization of interrelated parts
operating in different and coordinated ways in order to meet strategic and specific
objectives, which adopts a structure determined by its interaction with its
environment. 4

The medical unit management system (Figure 1) is the set of medical-

administrative elements that interact with each other to achieve the objectives
set to provide health services in a safe, effective, patient-centered, timely
manner. efficient and equitable to the entitled population that demands
attention at the IMSS . The system is made up of different systems and
subsystems that regulate the operation of substantive and support processes that in
turn allow the implementation of strategic programs and projects.

Objectives of the medical unit management system

• Provide safe and quality health services.
• Achieve productivity efficiency.
• Prevent, reduce and address risks.
• Improve performance.
• Make a sustainable organization.

The system is made up of at least the following specific systems:

• Quality management system

A quality management system is the activities carried out by the medical unit in its
human resources, documents, procedures and structure, with a focus on achieving
quality services and ensuring satisfaction and the results desired by the
organization. It is also considered as a “tool that allows planning, executing and
controlling the activities necessary for the development of the mission, through the
provision of services with high quality standards, which are measured through
customer satisfaction indicators. users.” 5,6

• Performance Management System

It allows evaluating the individual and collective qualitative or quantitative
performance of the medical unit, generating the necessary implications to provide
feedback to the staff in achieving the planned objectives and goals. For the adoption
of this system, performance is understood as the fulfillment of the obligations
inherent to the profession, position or trade. While evaluation will be understood as
estimation, appreciation, calculation of the value of something, estimation of
knowledge, skills and performance. The system includes the use of dashboards and
indicators, as well as the management of information generated by information
systems.

• Human Resources Management System

The human resources management system allows adequate administration and
control of human resources, working with an approach that is aimed at developing
and maintaining the good performance of human talent, its development to
guarantee better results in its work, permanence in the organization, creation of a
good work environment through the exercise of institutional values and an adequate
organizational climate. This system creates important strategic alliances for
development with internal and external organizations related to human talent and
work.

• Knowledge Management System

This vital system for the medical unit is formed by considering the “organization as a
large network that unites people, information and communications technology.
Knowledge management seeks to maximize organizational learning with a view to
6
increasing its global competitiveness” . We can also consider it as the “Personnel
Competencies and Education System”.

• Financial Resources System

It is the organizational system that deals with the proper administration of financial
resources, control and management of budget items, analysis of results and
decision making related to the proper use of financial resources.

• Facilities Management and Security System

The purpose of this system is to provide medical care in safe facilities, with optimal
functionality, supporting everything necessary for it to operate on a regular and
contingent basis. It must integrate at least aspects of unit protection, correct
management of dangerous materials, substances and waste, cleaning, order and
classification of objects, preventive and corrective maintenance, safety against
dangers related to fire, floods, smoke and earthquakes. Correct management of
equipment and use of biomedical technology, correct operation of priority beneficiary
care services, as well as preparation and management of external and natural
emergencies.

• Infection Prevention and Control System

The purpose of this system is to minimize risks to avoid harm to the patient,
implement specific actions with a multidisciplinary approach to reduce the risk of
infection in patients, staff and visitors. The integration of the system includes
planning, implementation, staff training, supervision, corrective actions, preparation
of the report, the operation of the corresponding committee and the implementation
of the program guidelines of the Mexican Social Security Institute related to this
system. (See Model of the General Health Council for Health Care with Quality and
Safety).

• Medication Management and Use System

In the general system, there is a specific system for the safe management and use
of medications that is implemented in accordance with the legislation. It is made up
of the phases: selection and acquisition, storage, prescription,
 distribution, dispensing, preparation, administration and control. The goal is to
provide safe therapeutics. ( See Model of the General Health Council for Health Care with
Quality and Safety ).

Fig. 1. Components of the Medical Unit Management System . It is made up of at

least 8 strategic systems that organize the actions necessary for proper
administration of the organization. Conceptually, this organization of the system
allows us to better understand the interaction between the different systems.

Source: Health Policy Coordination. Health Services Management Improvement

Division (DMGSS). IMSS.

Medical unit management

Administration is the social science that aims to study organizations and medical
units must be conceptualized as such, so the purpose of their administration is to
execute the planning, organization, direction and control of human resources,
materials, financial, technological and knowledge resources aimed at obtaining the
maximum benefit for the users of the system, thus complying with the mission and
vision of the IMSS. The strategic levels of the medical unit (Director, Deputy
Directors, Coordinators and Head of

Nurses) and Delegations (Head of Medical Benefits Services), as well as the

operational management levels (heads of service), have the obligation to correctly
exercise administration in health services. The work of this group of managers
focuses on the principle that management basically consists of your ability to
manage complex systems.

Administration to achieve objectives and with a risk approach

One of the fundamental principles of the IMSS medical units is to provide the service
with the greatest possible care, also taking into account all factors in the
environment that are related to risks of any type, including financial risks. Risk
management is defined as a structured approach to manage uncertainty related to a
threat to the quality, safety and efficiency of the system, activating a series of
activities that include risk assessment, strategies for its prevention and attention.
and mitigation if it has occurred, all through the use of management methods and
tools.

The Unit Management Model considers for its implementation a permanent vision of
risk, identifying, prioritizing and analyzing these for their prevention and timely
attention. The result of the analysis of risks and priority problems is translated into
part of the strategic diagnosis that is used for the development of the Strategic Plan
of the medical unit and this analysis also forms the so-called Quality and Patient
Safety Plan, which is a document that prioritizes the actions to address all risk
factors.
8
The Certification Model for Medical Units proposes a proactive approach which
consists of anticipating damage based on the identified risks by putting safety
barriers first and a reactive approach when acting after the presentation of a
problem, learning from the error and placing safety barriers. Risk is generally
conceptualized as the possibility of some event occurring that will have a negative
impact on the objectives, processes or services of the medical unit (Standard 1000-001-
003).

Strategic Management and Operational Management

The complexity of the medical unit forces us to differentiate the management activity
at two large levels, the strategic management that is the responsibility of the
highest authorities of the governing body headed by the director of the medical unit
and the operational management circumscribed in process management. , in
charge of the intermediate levels of direction and control of the heads of service.

Strategic management is the formulation, implementation and evaluation of

strategies (decisions) of different scopes that allow medical units to achieve their
objectives. It is the process that determines strategic objectives, developing policies
and tactical plans to achieve these objectives through processes, programs or
projects, conveniently managing the resources allocated for institutional programs or
strategies. Strategic management, therefore, combines the activities of various
functional areas of an organization to achieve organizational objectives. It is the
highest level of managerial activity in the medical unit . 9,10,11

Operational management is also what is carried out by middle management

managers, such as service heads, within their processes, with the aim of increasing
the capacity to achieve the purposes of their specific objectives. In operational
management, a continuous analysis of the services in their operation is carried out,
taking into account what the service offers and the needs of the beneficiaries. The
analysis of the results of the processes continuously evaluates the functionality of
the procedures that govern their functionality and allows the correction of
irregularities in adherence to the expected standards, which is carried out through
evaluation and supervision.

Service heads or directors in medical units without middle managers are responsible
for the correct use of public resources in their area of competence, creating
controllable and efficient services. Efficient operational management increases
results and value to the user. On the other hand, a good operation manager reduces
service production costs, is attentive to risk reduction, has a permanent vision for
continuous improvement and identifies the requirements and aspirations of the
entitled population.

Operational management is supported by the so-called process management or

Business Process Management (BPM) is a form of organization where the user's
vision prevails over the organization's activities. The processes thus defined have a
person responsible for them to achieve the planned standards of improvement
(operational plans) and success provides a vision towards efficiency and adaptation
to the needs of users. The processes are generally regulated by procedures that are
defined as the specific way of carrying out activities by management and operational
personnel.

The Unit Management Model Medical from the point of view ofhis
operational administration, attends to the improvement planning in processesand
subprocesses, programs and projects. The processes in turn HE classify in
nouns and support. Comprehensive Health Care is located in the context of health
and disease processes that are also subject to continuous improvement planning to
achieve the proposed objectives.

The criteria to consider a process include 12 :

• The activity has a clear mission or purpose.
• The activity contains inputs and outputs, you can identify the
users, suppliers and final product.
• The activity can be stabilized by applying the
process management methodology (time, resources, costs).
• Responsibility for the process can be assigned to one person.

The Mexican Social Security Institute, through its Standard 1000-001-003

13
corresponding to the Competitiveness Model , establishes the definition of
processes: Support process: Facilitates substantive processes, their contribution to
the creation of value for users It is indirect; However, its importance in the
performance and achievement of the objectives of the medical unit is relevant.
Substantive processes: These are the processes related to the fulfillment of the
Institute's mission, whose results directly impact the users and the overall
performance of the Unit.

Parallel to these definitions for the adequacy of the functionality of the processes,
the definition of quality is considered as the “Inherent characteristics of a product or
service that meets the needs and expectations of users, as well as other interest
 13
groups.” A subprocess is identified as well-defined and grouped operating
activities in a process that can be differentiated within the whole. Its identification is
relevant to segment problems and prioritize them for specific improvements within
the same process.

The Management Model of the Medical Unit permanently maintains a focus on the
continuous improvement of its processes, both substantive and support, defining
continuous improvement as the “Systematic and permanent process that consists of
planning, implementing, verifying and improving to increase competitiveness. of the
unit.” 13
The manager will also generate a focus on continuous improvement in addition to
quality and risks, by making his medical unit highly competitive, an achievement
associated with the "capacity of the unit to achieve competitive advantages with
respect to the opportunities that arise in the environment." , offering a different value,
which directly impacts the service; It is the result of continuous improvement,
innovation, best practices, sustained increase in efficiency, value creation and
financial sustainability.” 13

Integrated Management Model

In the daily practice of managing a medical unit director, the integration of three
apparent management models often creates confusion: the Directive Management
Model, the Competitiveness Model and the General Health Care Council Model. in
Health with Quality and Safety. In reality, the managers of the medical unit must
consider that there is a single Management System, with its corresponding operating
systems and an Integrated Management Model, which is made up of the
components of the three aforementioned models. The three models handle
complementary and important approaches for a medical unit director. (Table 1)

Table 1. Comparative approaches of the three models that currently prevail in a Medical Unit of the
Mexican Social Security Institute and that are served as a whole that integrates the different
components necessary to achieve the mission and vision of the organization .
 Model Approach

Management model of the medical unit Optimal administration of health services

Institutional Model for Competitiveness Process improvement and innovation

Risk management and continuous

Model of the General Health Council for
improvement
health care with quality and safety
Source: Health Policy Coordination. Services Management Improvement Division
Health. 2016

Figure. 2 Visual representation of the three current models for the management of
the medical unit, a single model must be considered and thus expressed to
collaborators, in management documents and in the operation itself. The interaction
of the components of the models and the importance of the user as the axis of the
system's success is observed.
Source: Health Policy Coordination. Health Services Management Improvement
Division. IMSS. 2016

To better understand these three models, we proceed to their definition:

Management Model of the Medical Unit

The Management Model of the Medical Unit (Figure 3) can be defined as the
operational functional proposal that represents the articulation of the processes and
programs that lead to the achievement of the mission, vision and objectives. It is the
operational representation of the Management System where the elements of the
administrative process are highlighted. The Management Model represents the
components of the administrative medical action of the IMSS medical units and has
the purpose of the rational and efficient use of resources for the optimal provision of
the health service. It is a scheme or framework of reference for proper
administration. We can also consider the model as the theoretical scheme of the
medical unit management system.
This model is considered as a premise for the proper implementation and
implementation of the other two models, since the optimal operation of the
processes and the correct administration of resources, added to the efficiency of the
operating systems, facilitates the adoption of the components of the
Competitiveness, Quality and Safety Model.

Figure. 3 Directive Management Model. It is made up of 6 components. It is the

basis of the medical unit management system. The model is a complement to the
IMSS Competitiveness Model and has as its main purpose the achievement of
objectives through correct management of resources.
Source: Health Policy Coordination. Management Improvement Division
Health services. IMSS. 2019

1. Strategic Planning
This component refers to the obligation of the medical unit to carry out the necessary
diagnoses for an adequate determination of the needs of the entitled population in
their health and expectations, the diagnosis of the quality of the service provision,
the performance of the processes, degree efficiency and medical-economic aspects,
in addition to the strategic diagnosis of the environment and competitiveness. All this
and other strategic information is contained in the folders documents
included (Figure 4):

• Diagnosisof health
• Diagnosissituational
• Diagnosisof risks
• Strategic plan

Strategic planning begins with the diagnoses, analysis and conclusions of these
documents, which allows the preparation of the strategic plan document according to
the institutional guidelines. The strategic plan is the document that contains the key
information for the adequate definition of the organizational philosophy, mission
statement, vision, values and policies that must in turn be aligned with the official
information of the IMSS. This document also describes the strategic objectives,
strategies, goals and forms of control of the processes, programs and projects of
greatest relevance for the proper operation of the medical unit. It also defines
quality, safety policies and alignment with the National Development Plan, the
sectoral plan (Health Sector) and that of the IMSS itself; (PIIMSS).
The strategic plan is the single planning document of the medical unit with its tactical
plans and the axis for the Quality, Safety and Continuous Improvement Plan. This
document is, in turn, at the tactical level, the way to plan process improvement in
strategic management concepts, which is necessary for operational planning to
improve processes in services.

Figure. 4. The organization of the directive documents related to any of the models must
be carried out in folders that clearly indicate the content by component, which facilitates the
location of the information and the continuous use of strategic documents.

Source: Health Policy Coordination. Health Services Management Improvement

Division. IMSS. 2016
2. Organization and Management
This component includes the actions necessary so that the resources allocated to
the provision of health services are adequately organized in order to facilitate the
implementation of the improvement actions that were planned at the different levels
of management to achieve the objectives and improve the processes. in their
results.
The art of management and the exercise of the rest of the management skills play a
fundamental role in this component of the model, since it is the most relevant phase
for the service provider personnel to execute the expected improvement. Process
management is the exercise of leadership, communication, collaborative work and
recognition of achievement. (Figure 5)

Figure. 5. Scheme that explains the relevance of process management , which

is the engine for things to happen within the Directive Management Model. The cycle
of planning objectives and actions, organization and management of resources,
implementation, exercise of knowledge and skills of
managers to influence the culture of execution.

Source: Health Policy Coordination. Health Services Management Improvement Division.

IMSS. 2016

3. Control
The control component is made up of the evaluation of the process, the supervision
of the implementation of the actions, the control boards and the analysis of the
results of the supervision, as well as the continuous action of advice and support in
the feedback of the results of the actions. implementation to operational staff.
(Figure 6). Adequate control requires instruments that allow the comparison of
expected standards, guidelines or guidelines with what is observed. The most
relevant impact of this component is to correct the observed deviations in real time
to align the operation with the improvement planning.

Figure. 6. Route for the evaluation and supervision of processes.

 Set the standards Assess
Measure results
Analyze Results Supervision
expected results of Correct deviations
obtained
Procedures assessment
Operational Lines

Source: Health Policy Coordination. Health Services Management Improvement

Division. IMSS. 2019

To conveniently measure the most relevant aspects of the processes defined as

critical points, their problems and their causes, both in the diagnostic phase and in
measuring the achievement of improvement tasks, it is essential to start from the
establishment of the expected standards that are usually derived from procedures,
standards, strategies, etc. Use a
reliable measurement instrument, analyze the measurement results and determine
the necessary actions to correct what is not happening through adequate
supervision.

4. Analysis and decision making

Component where the results obtained throughout the development of the process
are based on its improvement, it is constituted by the information collection phase of
the systems, analysis of balanced control boards where the achievement of goals is
concentrated in the different types of results and the phase where analysis methods
are applied to obtain conclusions of the achievement in the improvement of the
selected processes to work on the solution of relevant problems.

Decision -making is made based on the analysis and has as its purpose the
continuity of improvement actions, the strengthening of tasks or the replacement of
strategies in the system. This component of the Management Model considers the
need to describe the behavior of the process, identifying the steps that add value to
the beneficiary, those that do not do so and become “waste” from an operational
approach, which is extremely valuable. for process improvement, elimination of
problems for
providing good service.

The analysis allows us to examine the global flow of work activities and their results
observed in the process evaluation cards or dashboard indicators, in addition to the
opinions or complaints of the user and service provider. In general, this component
is about providing explanations and solutions to issues such as the cost of operating
inefficient results, existing waste, impact on users and level of risk, etc. The purpose
of analysis is not only to have a lot of data but to make some type of improvement.
The use of statistical tools allows decisions to be made to raise the quality of the
process, increase efficiency, reduce unnecessary operating costs and promote a
safe and effective health service.

The Directive Management Model requires updated and reliable management of

results information organized in dashboards. The analysis of these results must be
subject to a scientific methodology such as the use of statistical tools and address
the available information in its entirety, including the results of the supervisions. to
the process to be able to draw conclusions and define the necessary changes,
seeking to achieve improvements in quality, performance, safety, risk reduction and
costs. (Figure 7).

Figure. 7 Route for analysis of results and decision making .

Purpose to improve:
Define critical points of
Balanced dashboards Service quality Process
lower performance
Process evaluation Use of performance Safety Risk
Problems and causes
analysis results methods reduction Lower costs
Impact of improvement
statistics
actions New alternatives

Source: Health Policy Coordination. DMGSS. IMSS. 2019

5. Continuous Improvement
The continuous improvement component is interpreted as a constant, a way of
thinking of all workers in the medical unit, it is the constant commitment to improve.
Its basis is the stabilization of processes for their improvement. Innovation,
teamwork and an entrepreneurial attitude is the essence of the attitude for
improvement. The result of this way of thinking is higher quality of service and
greater efficiency in the organization. Continuous improvement in the Management
Model requires constant identification and review of each substantive and support
process, evaluation with measurements of the results of each process, permanent
feedback and a commitment of the entire health team to achieve the objectives. and
correct what does not add value or is waste in the process. Continuous improvement
must be carried out as a proactive activity of the process leader and his work team
seeking: the opinion and empowerment of the service provider, transparency in the
process, generation of agreements, effective communication and sharing successes.
There are various principles of continuous improvement but in general the
Management Model aims to avoid errors, increase security, verify what has been
done, a change in organizational culture in a healthy work environment and assume
that improvement is unlimited in a scenario of order, cleanliness and discipline.

6. Organizational development
This last component of the Management Model refers to promoting the constant
growth and development of its trusted and operational workers in the medical unit,
considering that human capital is the most important thing to achieve adequate
functionality and process dynamics, generating the style that characterizes the
organization. This is achieved through an analysis of results and the environment,
redirecting strategies towards constant evolution and as demands warrant it.
Organizational development allows the medical unit to have the capacity or have the
necessary elements to be competitive and offer patient-centered, timely, safe,
efficient, effective, and quality services.
The implementation of this component, which is sometimes observed as a tool,
requires permanent learning, supported by continuous training of members of the
organization for the development of competencies. This is the responsibility of all
leaders in the governing body and not just the personnel and education area of the
medical unit.

The involvement and commitment of union representation and strategic alliances

with other educational and workforce development organizations are essential. Its
execution is based on behavioral sciences in organizations and the goal is to
increase individual and group effectiveness. In general, it is considered as
something planned aimed at changing values, culture, behaviors and structure which
seeks the change, growth and development necessary to be effective and
competitive. Organizational development has a method and cycle for an adequate
result. (Figure 8).
Figure. 8. Elements and sequence for organizational development.

Source: Health Policy Coordination. Health Services Management Improvement Division.

IMSS. 2019

The learning of the medical unit and the improvement of the culture driven towards
success requires the use of a method that consists of establishing a diagnosis of
needs for improvement in the behavior of human capital, the development of a plan
with the advice of expert consultants , the implementation of the improvement
intervention and the evaluation of results.

These actions may vary according to different authors, however, to facilitate the
standardization of institutional concepts, the general scheme is referred to in the
model. It is essential that these actions are always advised and led by a person in
charge and coordinate with the rest of the leaders the execution of the improvement
tasks, always seeking to achieve the purpose of behavioral change, which is usually
complicated and takes a long time to complete. implementation.

Integration of the concept of directive management and other components of

the quality and safety model.
Thinking holistically for the director of the medical unit is the best way to implement a
useful model for management practice. Figure 9 proposes a visual representation of
the previously mentioned elements and components related to quality and safety in
the attention of health services. As seen in the image, administrative work is
correlated with critical systems and basic patient safety actions, placing the essential
attributes expected for the user in the center and adding the issue of accountability
as a strategic component for feedback. of results. Nowadays the claim that models
strongly influence the thinking and acting of the members of the organization in a
favorable way not only under the principle of achieving objectives, but also giving the
organization a reason, the values and ideals that ultimately change. organizational
culture. The model proposes a change in culture and an influence on social
responsibility and the impact of the public health service on what is most relevant to
society. As a document annexed to this guide, a practical method of implementing
the model in the medical unit was created that easily leads the manager to an
understanding through the use of the concept of the management model. This
document describes in greater detail the measurable and verifiable elements of the
execution of this model.

Figure. 9. Visual representation of a practical way in the integration of the

Directive Management Model with some essential quality and safety
components such as critical systems, basic safety actions and strengthening
accountability with a central focus of user-centered care with quality and safe
services and the attributes expected in health services.

MANAGEMENT MODEL
MEDICAL UNIT
Source: Health Policy Coordination. Health Services Management Improvement
Division. IMSS. 2019

Institutional Model for Competitiveness

“It is the instrument to guide the medical, social or administrative units, which
constitutes the framework of reference to achieve the improvement and innovation of
the processes, with the purpose of transforming management management into
13
comprehensive and effective performance for the different groups of interest".
(Figure 9). It is an obligation of all medical and non-medical units of the Institute to
implement this instrument that is focused on the improvement and innovation of
processes. The principles of the model are:

• User focus.
• Strategic leadership
• Competitive results
• Committed staff
• Creativity and innovation
• Social commitment
Medical units, when implementing and maintaining the Institutional Model for
13
Competitiveness “MC”, adhere to the following criteria and sub-criteria :

1. Users
It includes the tools and instruments that the medical unit has developed to know in
depth and understand the specific needs of users and their expectations.

2. Leadership
The leaders align the strategic planning of the medical unit with the institutional
policies and programs and ensure compliance with the applicable regulations, to
promote the implementation of the “MC”, achieve competitiveness with a focus on
the user and the different interest groups.

3. Planning
The Governing Body implements the strategic planning of the unit, in alignment with
the National Development Plan, Institutional Program of the Institute

Mexican Social Security System (PIMSS) and determines strategies, objectives,

plans, programs, measurements, controls and improvements in the operation, as
well as the adjustments that are made to them as a result of the changes and
challenges that arise in the institutional environment and sectorial.

4. Processes
This criterion contains process management, aimed at achieving strategic objectives
and generating value, through continuous improvement, redesign and innovation, in
order to meet the needs and expectations of the employees. users, as well as
interest groups.

5. Human talent
It includes the implementation of processes and mechanisms to promote knowledge,
work development, skills, well-being and staff satisfaction; which promotes high-
performance teams that provide quality services and contribute to the development
of competitiveness, through compliance with the unit's strategic objectives.

6. Innovation, knowledge and information

The medical unit implements and manages actions that ensure the generation,
capture, permanent and systematic dissemination of information that results in
organizational knowledge to strengthen planning, decision making, continuous
improvement and innovation.

7. Social responsability
It is the reflection of the way in which the medical unit is committed and responsible
for the repercussions that its activities have on the community of influence and the
environment, contributing to achieving a culture of sustainable development.

Figure 9. Components of the Institutional Model for Competitiveness (CM)

Source: Standard 1000-001-003. Standard that establishes the provisions for the
implementation and maintenance of the Institutional Competitiveness Model
“MC”. Mexican Social Security Institute.

Model of the General Health Council for Health Care with

Quality and Safety

The General Health Council Model for Health Care with Quality and Safety considers
4 critical systems:

• Medication Management and Use System

• Infection Prevention and Control System
• Personnel Skills and Education System
• Facilities Management and Security System

For each of these systems, it is requested to implement the so-called “bases of the
model”, which are: identification, prioritization and analysis of risks and particular
problems of the entire organization with the focus on, at least, each of the critical
systems. Based on this analysis, risk and problem management is carried out to
achieve continuous improvement. In this way, the model encourages organizations
to develop a culture of quality and patient safety, in which they learn from errors and,
at the same time, avoid their occurrence as much as possible through the
implementation of safety barriers in a standardized manner. and systemic, seeing
the hospital as a “whole”.

When a health care facility implements the Council Model for Health Care with
Quality and Safety, it works on the critical processes that are related to the care of
patients and the staff who work within it. It is important that the organization
understands that the model has a system approach, which implies, as mentioned
above, seeing the hospital as a “whole”, where each of its parts is involved and
contributes to the results in the patient. Working with this approach requires the
involvement and participation of all areas and people that make up the organization.

Medical unit address

The director of the medical unit must fulfill his different responsibilities that are
indicated in the different regulatory documents of the Institute itself, among which
the following generally stand out 14, 15 :

• Coordinate the preparation of the situational diagnosis, health diagnosis,

work program and resource management
• Organize comprehensive and administrative medical care processes
 • Evaluate and direct medical care processes
• Coordinate and control specific work programs
• Carry out direct supervision of the service areas of the unit
• Evaluate results based on goals, objectives and the program
authorized.

• Implement, supervise and verify the application of authorized indicators for

the evaluation and measurement of performance, productivity, quality and

efficiency of medical-administrative processes and services

• Propose and monitor the execution of procedures
• Monitor compliance with current policies, institutional and national provisions
• Manage the needs of infrastructure, equipment, materials and other
resources essential for the operation
• Ensure that attention and solutions are provided to demands, complaints and
disagreements
• Monitor that the doctors of the operational services comply with their medical-
care and technical-administrative activities
• Coordinate the institutional and extra-institutional activities and agreements of
health personnel for the fulfillment of the programs
• Integrate and keep updated the regulatory, bibliographic and informational
collection of the medical unit to fulfill its functions.
• Communicate to the bodies dependent on the management, the objectives,
goals and assigned programs, as well as the mechanisms for their execution.
• Strengthen the quality and continuous improvement of healthcare processes
• Supervise the correct development of epidemiological surveillance programs
• Call and chair meetings with the Unit Governing Body
• Supervise that the information generated by the provision of services is
generated and sent in a timely manner, among other multiple responsibilities.

As can be seen, the work of the director of the medical unit is completely medical-
administrative and his actions must be carried out with knowledge, skills and
sufficient competencies to avoid risks, bad results or impact on institutional assets.
As a fundamental principle of order, it is found in having an adequate organization of
the directive documents and demonstrating by example from its physical
environment (order, cleanliness and organization) good managerial action.
The current means of information and computing systems allow the Director of the
medical unit to keep management information up to date in his or her office. updated
and organized in such a way that there is sufficient data, the appropriate order for its
quick location and, above all, its use for decision making. Below is a list of the
minimum requirements that a Director must have as tools and directive documents.

Directive documents

• Medical unit health diagnosis

• Situational diagnostic
• Strategic plan
• Quality and Patient Safety Plan (which must be part of the strategic plan)
• Plan in case of contingencies and disasters (Safe Medical Unit)
• Folders necessary for Unit certification
• Management folder containing: directories, contingency card, organizational
charts, schedules, management work plan, portfolio of services, installed
production capacity of the unit, typical day of production of services, demand
for services and user population, strategic censuses of users, vacation
periods of the governing body, among other documents)
• Unit strategic process maps
• Copy of the instruments used in the evaluation of programs and
strategic processes
• Sectoral, institutional regulations, health policies and programs of the
IMSS

• Control boards organized by processes, programs and projects. The

dashboards must be balanced and at least classified into: process
performance dashboard, service efficiency dashboard, finance dashboard,
human talent performance dashboard and social responsibility dashboard.
Control board for monitoring improvement commitments with different
instances

• Folders of the different committees integrated into the First or Second Level
Unit (for example, quality and safety, nosocomial infections subcommittee,
ethics, biosafety, clinical record, etc.)

• Folder with results and monitoring of audits, evaluations and supervisions of

delegational, external or central level entities
 • Folder with strategic analysis of results of processes, programs and projects
• Annual reports on performance, productivity and quality in the provision of
services
• Minutes of management meetings and follow-up of derived commitments
• Results of the management of dissatisfactions, complaints and quality of the
health services provided
• Minutes of extra-institutional and institutional agreements in the area
medical
• Copy of strategic information of the contracts that the unit has
medical for the provision of services

Bibliography

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