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

Main ideas, concepts, and lessons

1) Welcome, role of the instructor, and program context

• The class is led by Dr. Carlos Romero, introduced as:
  • Teacher of the module and coordinator/director/guide for the program.
  • A medical surgeon with extensive postgraduate and leadership experience in health services quality and bioethics.
• The session takes place in a structured specialization program at the Catholic University of Córdoba, with a long-running history (including prior cohorts and courses).
• The goal of the synchronous class is not only knowledge transfer, but also:
  • Building relationships among participants (human connection as a foundation for professional cooperation).
  • Supporting progress toward the specialization in Health Services Auditing, centered on quality control and patient safety.

2) Self-introductions emphasize interdisciplinary teamwork and shared purpose

Participants introduce themselves by profession and experience, highlighting:

• Different healthcare roles (e.g., medical doctor, medical auditor, nurse, pharmacist).
• Different institutions and geographic locations across Argentina.
• A shared understanding that quality and auditing are interdisciplinary activities.

3) Core module content: “Audit of service providers” + proactive modern auditing

In this module, the instructor frames auditing as evolving:

• The historical view is acknowledged (e.g., auditing tied to billing correctness like debits/credits).
• The modern approach emphasizes a more proactive auditor:
  • Involvement in matters related to quality in health services and patient safety.
• The class specifically targets provider audits focusing on:
  • Outpatient care
  • Inpatient care

4) Differences and connections: quality certification vs quality accreditation

• Quality certification:
  • Typically confirms compliance for a specific scope/service/process.
  • (Discussed using an example from a participant’s ISO certification.)
• Quality accreditation:
  • Broader—covers the entire institution and what it does.

5) Foundational philosophy and policy guidelines for auditors

Key guiding principles included:

• The audit expresses a qualified, independent opinion.
• Independence is crucial:
  • No pressure, conflicts of interest, or deviation from ethical/professional responsibilities.
• Truth is central:
  • The auditor must base judgments on evidence and documentation.
  • If knowledge is missing, the auditor must seek expert support.

6) “Quality auditing” as a tool for continuous improvement (not an end in itself)

The instructor stresses that auditing for quality is a means to:

• Observe performance
• Draw conclusions
• Recommend improvements when needed

It evaluates whether healthcare activities are:

• Effective
• Efficient
• Efficacious

(With emphasis that these are distinct concepts.)

7) Definitions and structure of auditing quality work

Auditing is described as:

• A systematic process that is:
  • Documented
  • Based on objective evidence
  • Evaluates the degree to which audit criteria are met

Key elements:

• Audit criteria:
  • The reference standard against which evidence is compared (e.g., policies/procedures/requirements).
• Objective evidence:
  • Documentation/data supporting what is claimed.

8) Health Technology Assessment (HTA) and epidemiology as audit knowledge areas

The class extends auditing beyond paperwork by including complementary knowledge areas:

• Health Technology Assessment (HTA) (aligned with WHO concepts):
  • Systematically valuing technology properties/effects/impacts.
  • Must consider medical, social, ethical, and economic dimensions.
  • Produces information to support decision-making in health.
• Epidemiology:
  • Studies the occurrence and distribution of health-related events in populations.
  • Helps identify directions for improving patient quality and safety.

Epidemiology tools emphasized:

• Observation
• Comparison and understanding patterns
• Prediction based on collected data

A monitoring concept echoed from quality auditing:

• Observe → Understand → Manage → Readjust

With three temporal audit styles:

• Prospective monitoring:
  • Related to policies/projects/programs/goals (before or during planned implementation)
• Concurrent monitoring:
  • Tracks and controls what’s happening now
• Retrospective monitoring:
  • Evaluates what was done vs what should have been done (traditional after-the-fact audit)

9) Recommendations, reports, and accountability

• Auditors:
  • Don’t “decide” actions directly, but synthesize findings into:
    • Corrective actions (when something doesn’t meet rules/agreements)
    • Preventive actions (based on what might happen—anticipation)
• Every audit activity must end with an audit report presented to senior management.
• The report must include:
  • Formal identification details of the establishment and the auditor
  • A link to professional responsibility for what is written

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Methodology / instructions (detailed bullet points)

Practical assignments (3 tasks)

Participants were instructed to do three practical assignments based on materials shared on the platform and referenced during the class.

1) Watch a documentary film - Film: “SITCO” - Task: - View it considering module concepts from the prior week’s discussion (health systems comparison, implications for access/quality).

2) Use the “Best Practices” manual and perform a self-assessment - Tool: Best Practices manual from the Ministry of Public Health of the Nation - Manual structure: - 4 dimensions - Task: - Select one dimension - Apply the relevant grid - Perform a self-assessment in the most accessible workplace setting - Base the assessment strictly on the grid’s content

3) Describe the workplace according to the Argentine health system - Task: - Describe the workplace/subsystem in the Argentine health system - Include how it operates and relevant: - legal framework - labor framework - other aspects requested in the prior-week material (aligned with the prior video content) - Output: - Write the description respecting the structure/model of an audit report.

Audit report methodology (structure and required components)

The instructor recommended writing practical work using an audit report model with core sections:

• Objectives of the audit
  • Explain overall purpose
  • Indicate whether it is:
    • periodic audit
    • follow-up of corrective actions
    • or another audit type
• Scope of the audit
  • Specify whether it addresses:
    • a single topic/service/process or multiple items
  • Justify the choice
• Third party / recipient / institution
  • Identify for whom the audit is being done
  • Include:
    • dates and places
    • audit criteria used
    • audited processes
    • standards/parameters for comparison
    • applicable norms/parameters
• Results
  • Present evidence found
  • Include:
    • positive results
    • opportunities for improvement
    • suggestions
    • supporting evidence for findings/conclusions
  • Provide a synthesis of the most relevant results and “lessons learned”
• Identification of the auditor and professional responsibility
  • Auditor identity included
  • Accountability emphasized: the report reflects what was observed and documented

Guidance for applying theory into practice

• The practical work is designed to connect theory from synchronous meetings with real professional practice.
• Emphasis included:
  • Focus more on demand than supply of service:
    • demand = the human being/patient
  • Measure patient satisfaction and patient/user opinion (citizen voice).
• Quality principles reinforced:
  • Quality is not luxury/complexity.
  • No “first-class” vs “second-class” patients—quality should be consistent at all care levels.
  • Quality is continuous improvement and must be measurable and organization-wide.

Platform submission and instructor feedback

• Participants were instructed to:
  • Publish completed practical work on the platform
  • The instructor will monitor submissions and provide feedback/grade (“refund”) through the same platform.

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Speakers or sources featured (identified at end)

Speakers / main participants

• Dr. Carlos Romero (instructor; coordinator/director/guide of the program)
• Dr. Cecilia (hosts/introduces; participates in greetings and wrap-up)
• Eli / “Eli” (presenter; provides institutional/program introduction before Dr. Romero begins)
• Dr. Maria Victoria (participant; medical auditor; high-cost drug evaluation department; lives in Ushuaia, Tierra del Fuego)
• Gustavo Torres (participant; nurse; nursing university professor)
• Lucia (participant; nurse; quality specialist; works in auditing at Italian Hospital of Buenos Aires)
• Hector (appears in conversation with greetings/acknowledgment; exact identity unclear beyond “Hector”)
• Andrea (participant; pharmacist; works in pharmaceutical supplies/Ministry of Health auditing-related areas; based in Tierra del Fuego/Ushuaia)
• Javier Faciano (participant; doctor; post-anesthesia recovery unit; works with auditing/ISO certification context)

Sources / referenced organizations and materials

• Catholic University of Córdoba
• CONAU / CONAOU (referenced regarding specialty accreditation approval)
• National Program for Quality Assurance of Medical Care (Ministry of Public Health of the Nation)
• Ministry of Public Health of the Nation (Best Practices manual / national program materials)
• ITAES (Technical Institute for Accreditation of Health Establishments; referenced via ITAES motto and roles)
• Argentine Society of Medical Auditing
• Joint Commission (accreditation mentioned in context of Italian Hospital)
• ISO (certification mentioned by a participant)
• WHO (World Health Organization) concept of Health Technology Assessment
• Ramón Carrillo (referenced as a historical health minister; health policy + social policy concepts)
• Galen (quoted by reference regarding “truth” as driving force)
• Avedis Donabedian (credited with quality assessment definition and monitoring concepts)
• Epidemiology (conceptual framework; not attributed to a single cited author)
• “SITCO” (documentary film assigned for the practical assignment)
• “Best Practices” manual (structured in 4 dimensions with evaluation grids)