3°COHORTE MÓDULO 2 SEMANA 1: clase asincrónica Dr. Carlos Romero

Main ideas, concepts, and lessons

Welcome and course purpose (Module 2, Week 1, asynchronous class)

Dr. Carlos Alberto Romero introduces Module 2: health service auditing, focusing on:

• Quality control
• Patient safety

He directs students to the platform’s accompanying materials:

• Reading material
• Practical work
• PowerPoint presentation, used as the basis for his explanation

Gratitude and program background

Romero expresses gratitude to:

• Catholic University of Cuyo for hosting the initiative since 2010
• Key supporters and organizers of earlier face-to-face programs, and for the transition to a virtual format

He highlights the program’s evolution:

• Postgraduate courses (two annual courses)
• Progression toward a career track for specialists in health service auditing
• Movement toward a virtual modality (“virtual race”) as a major step forward

Humanistic foundation of auditing

Romero references Dr. Ramón Carrillo’s humanist philosophy, emphasizing the “integral man” as the center of healthcare activity.

Auditors—especially those focused on quality control and patient safety—should promote care grounded in this humanistic conception.

Holistic view of health

He argues that even specialists and auditors must remember they are doctors first.

Healthcare specialization should serve better quality of life through holistic health, defined as:

Health = complete well-being of people

Auditing should support this holistic aim by improving quality and patient safety.

Health system organization (Argentina) and complexity

Romero explains that health systems reflect social conditions, and notes that charity has been present historically.

He contrasts:

• The public state sector vs.
• The private sector
  • (using Canada and the United States as reference models)

He then describes Argentina’s structure:

• Three health subsectors:
  1. Public sector
  2. Private sector
  3. Social works / social security subsector

Because of these three subsectors, the system is described as more complicated, requiring specific legislation.

Key Argentine legal and policy frameworks mentioned

• Law 18610 (Social Works Law)

  • Created INOS (National Institute of Social Works)
  • Related to the national nomenclature

• Laws 23660 and 23661 (both from 1988)

  • Context linked to Social Works Law and National Health Insurance
  • Romero notes they are in force

• PMO / PMOE

  • PMO: Mandatory Medical Program, later renamed/modified to PMOE due to economic emergency
  • Includes annexes with:
    • A catalog of benefits
    • Reference values for medicines
  • PMO/PMOE must be constantly updated and complied with by institutions under the Superintendency of Health Services

• Law 26529 (Patient Rights Law)

  • In force since 2009
  • Includes a dedicated section on:
    • Single medical record
    • Electronic single medical record
  • Includes informed consent, requiring patients to know:
    • What is planned
    • Proposed treatment
    • Risks
    • Benefits
    • Alternatives
  • Supports the ability to obtain a second opinion before consenting

Concept of quality (bioethics framing)

Romero adopts a quality definition associated with Diego Gracia Guillén:

• Quality has value
• In health, quality means search for excellence
• Excellence is an ideal—not always achieved, but guiding improvement
• Achieve excellence through ethics, understood as:
  • Good habits
  • Doing things right the first time

He connects this quality view to auditing: auditors must ensure compliance with quality and safety standards—not only billing/coding.

Auditing targets: beyond billing and codes

Romero emphasizes that auditors should ensure institutions meet:

• Quality assurance standards from the National Quality Assurance Program (Ministry of Public Health of the Nation)
• Safety measures from the World Health Organization (WHO)

Audits should evaluate both:

• The effector/provider side
• The other side (implying both how services are delivered and how they are organized/managed)

Audit methodology framework: Carrillo + Donabedian + Deming

Demand vs. supply focus

Linked to Carrillo’s thinking:

• Auditors should focus more on demand (what the patient needs) than on supply

Donabedian’s systemic triad (evaluation structure)

Used to structure assessment:

• Structure
  • Human resources
  • Technological resources
  • Physical resources
• Processes
  • Rules and procedural rules
  • Existence of protocols and whether they are complied with
• Results
  • Measure outcomes
  • Measure what auditors and institutions do
  • Applies to both implementers and service providers

Deming / “DEMI” quality circle (continuous improvement loop)

A continuous cycle:

1. Plan: audit activities must be planned
2. Do: execute according to the plan
3. Check: compare what was done vs. what was planned; identify gaps and needed changes
4. Act: implement corrective actions; repeat the cycle

He describes combining both guides as:

• Center: Donabedian triad (Structure, Processes, Results)
• Guiding loop: Plan–Do–Check–Act

Role of the auditor vs. institutional decision-making

Romero clarifies:

• Auditors do not make decisions
• Decisions belong to the institution’s senior management

Auditor responsibilities include:

• Analyze based on available resources and bibliography
• Produce a report including:
  • An opinion
  • Recommendations and suggested actions

Recommendations must align with:

• Current agreements
• Current nomenclatures
• Current laws

This requires understanding:

• Health economics
• Applicable legal/policy frameworks

Recommended action types:

• Corrective actions
• Preventive actions
• Improvement actions

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Instructions / assignments given in the video

Assignment 1: Movie-based written task (“A SCO movie”)

• Watch/read the assigned movie (referenced as “SCO movie” in subtitles).
• Write about:
  • What the movie is about
  • A brief comment and conclusion comparing what is shown in the movie with the Argentine health system

Assignment 2: Workplace self-evaluation + reporting (self-assessment material)

• Use the self-assessment material provided by the Ministry of Public Health of the Nation (available on the platform).
• At your workplace:
  • Evaluate by applying one of the four dimensions in the self-assessment material
  • Develop the practical work accordingly
• Then produce a report that:
  • Is descriptive
  • Includes what was found / discovered
  • Includes the recommendations, following the module’s auditing approach

Assignment 3: Identify subsector + apply Donabedian’s triad

• Considering the Argentine health system with its three subsectors:
  • Describe your workplace
  • Determine which subsector it fits within
• If possible, analyze alignment with Donabedian’s systemic triad:
  • Structure
  • Processes
  • Results

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Closing message / objective completion

Romero states the video’s purpose:

• A concise summary of the PowerPoint, reading material, and topic prompts for Module 2

He encourages success in:

• Completing the final project quickly
• Meeting attendance requirements and conditions to obtain the title of Specialist in Health Services Auditing, focusing on:
  • Quality control
  • Patient safety
  • The humanistic vision of the profession

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Speakers / sources featured (named)

Speaker

• Dr. Carlos Alberto Romero

Acknowledged individuals / supporters

• Dr. Albarracín (mentioned as involved with receiving/supporting the initiative)
• Dr. Sergio Elbarracín (named supporter/driving force for the program’s transition to virtual format)
• Accountant Gustavo Trabalini
• Dr. Cecilia Sarmiento (coordinator)
• Dr. Ricardo Herrero (general director of ITAES)

Referenced thinkers and models

• Dr. Ramón Carrillo (humanist philosophy of the health system)
• Diego Gracia Guillén (bioethics figure cited for the quality definition)
• Donabedian (systemic triad: Structure, Processes, Results)
• Deming / DEMI quality circle (Plan, Do, Check, Act)
• World Health Organization (WHO) (safety measures referenced)

Institutions / laws / policy sources

• Catholic University of Cuyo
• CONIAO (endorsing body mentioned in relation to face-to-face modality)
• Superintendency of Health Services (controls operation of social works and attached entities)
• Ministry of Public Health of the Nation
  • National Quality Assurance Program
  • Self-assessment material
• Law 18610
• INOS (National Institute of Social Works)
• National nomenclature (coded and valued services)
• Law 23660
• Law 23661
• PMO / PMOE
  • Mandatory Medical Program / Mandatory Emergency Medical Program
• Law 26529 (Patient Rights Law)