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P RODUCTIVE M ANAGEMENT AND THE M ANAGEMENT I NFORMATION S YSTEM -WinSIG-

P RODUCTIVE M ANAGEMENT AND THE M ANAGEMENT I NFORMATION S YSTEM -WinSIG-. Pan American Health Organization/ World Health Organization. INCREASE RESOURCES?. INCREASE EFFICIENCY?. MANAGEMENT. THE LACK OF RESOURCES ISSUE. OR. MOBILIZATION AND PRODUCTIVE OPTIMIZATION OF RESOURCES.

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P RODUCTIVE M ANAGEMENT AND THE M ANAGEMENT I NFORMATION S YSTEM -WinSIG-

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  1. PRODUCTIVE MANAGEMENT AND THE MANAGEMENT INFORMATION SYSTEM -WinSIG- Pan American Health Organization/ World Health Organization

  2. INCREASE RESOURCES? INCREASE EFFICIENCY? MANAGEMENT THE LACK OF RESOURCES ISSUE OR MOBILIZATION AND PRODUCTIVE OPTIMIZATION OF RESOURCES EXTERNAL INTERNAL

  3. QUALITY OF SERVICES? PRODUCTIVITY? FROM EFFICIENCY TO PRODUCTIVITY OR SOCIAL PRODUCTIVITY OPTIMAL PRODUCTIVITY OF RESOURCES FOR THE EFFICIENT QUALITY OF CARE

  4. R PRODUCTIVIDAD OBJETIVOS ACTIVIDADES RESULTADOS E P PRODUCTIVE MANAGEMENT E = EFFICIENCYP = PRODUCTIONR = RESOLUTION

  5. PRODUCTIVITY MANAGEMENT OBJECTIVE OF EQUITY R MANAGERIAL STYLE AVAILABLE RESOURCES PRODUCTIVIDAD OBJETIVOS ACTIVIDADES RESULTADOS P E SERVICE CULTURE MANAGEMENT SYSTEMS

  6. EFFICIENCY EQUITY EFFICACY EFFICIENCY SHOULD NOT BE AN END IN ITSELF, BUT A NECESSARY CONDITION TO ACHIEVE EFFICACY AND EQUITY OF SERVICES PRODUCTION SATISFACTION THE PRESENCE OR ABSENCE OF ANY OF THESE ITEMS IMPLIES THE PRESENCE OR ABSENCE OF ALL OTHER CRITERIA

  7. USER SATISFACTION Structure, systems, technology, management, etc USERS: Needs Problems PROVIDERS: Criteria Inputs RESOURCES NEW REQUIREMENTS HEALTH FACILITY AS A PRODUCTION SYSTEM INTERMEDIATE PRODUCTION CENTER: - Laboratory - Radiology - Pharmacy - Etc. FINAL PRODUCTION CENTERS: - In-patient services - Surgical services - Ob-gyn services - Pediatrics services - Outpatient services - Emergency services - Dental services - Etc. SERVICES (Discharges and Consultation) GENERAL PRODUCTION CENTER: - Director - Administration - Kitchen - Etc.

  8. PRODUCTIVITY OBJETIVS ACTIITIES RESULTS COSTS MANAGERIAL INFORMATION SYSTEM INTELLIGENCE WinSIG METHODOLOGY FOR STRATEGIC DECISION MAKING MANAGEMENT FOCUSED ON SOCIAL PRODUCTIVITY

  9. WHAT IS WinSIG • A METHODOLOGY AND AN INSTRUMENT FOR ANALYSIS AND DECISION MAKING • IT COVERS ADMINISTRATIVE AND CLINICAL PROCESSES • IT EMPHASIZES SOCIAL PRODUCTIVITY • COST IS A CENTRAL COMPONENT OF WINSIG

  10. REQUIREMENTSOF INSTITUTIONAL DEVELOPMENT REAL: POTENTIAL: COVERAGE PRODUCTION COVERAGE PRODUCTION RESOURCES RESOURCES COSTS COSTS OPTIMIZE PRODUCTIVE CAPACITY COVERAGE AND PRODUCTION OBJECTIVES STRUCTURE AND DISTRIBUTION OF RESOURCE PATTERNS ORGANIZATIONAL AND MANAGERIAL MODELS WinSIG AS A MANAGERIAL PROCESS:INSTITUTIONAL DIAGNOSIS AND DECISION MAKING WINSIG¿ ?

  11. WinSIG AS MANAGERIAL TOOL: • PROVIDES CRITICAL INFORMATION FOR DECISION-MAKING • COMPREHENSIVE VISION FOR SELECTIVE TARGETING STRATEGIES AND INTERVENTIONS IN CRITICAL AREAS OF PRODUCTIVE MANAGEMENT • PROGRAMMING AND BUDGETING • MECHANISM FOR COSTING • QUANTITATIVE INDICATORS FOR: • REGULATING, CONTRACTING, AND PRICING • MONITORING THE PROCESSES OF CHANGE • EVALUATING PERFORMANCE AND RESULTS • ACCOUNTABILITY PRACTICE

  12. ... WHAT IT IS AND WHAT IT DOES • WinSIGRESPONDS TO CURRENT APPROACHES AND EMERGING PRACTICES IN THE SRP IN REGARDS TO EFFICIENCY WITH QUALITY, ALLOCATION OF RESOURCES, PRODUCTIVITY, COST CONTAINMENT AND PAYMENT FOR SERVICES • EASY ANALYSIS OF RELEVANCE, EFFICIENCY AND QUALITY OF PRODUCTION FOR NEGOTIATION AND MONITORING OF MANAGEMENT AGREEMENTS AND COST BILLINGS: • PROCESSING THE MORBIDITY SEEN • SET UP OF TREATMENT PROTOCOLS • DEFINE DIAGNOSES RELATED GROUPS • COST OF SERVICES

  13. ANALYTICAL DECISION-MAKING TOOL FOR PRODUCTIVE MANAGEMENT SELECTIVELY RELATES INFORMATION ALREADY EXISTING TO PROVIDE A STRATEGIC VISION FOR MANAGEMENT OF HEALTH SYSTEMS HELPS TO GENERATE THE NEW INSTITUTIONAL AND MANAGERIAL CULTURE FOR THE SRP PRIORITIZES PRODUCTIVITY WITHIN THE CONTEXT OF EQUITY, EFFECTIVENESS, AND EFFICIENCY OF HEALTH SYSTEMS ... WHAT IT IS AND WHAT IT DOES

  14. PRODUCTIVE MANAGEMENT AS THE FOCUS OF MODERNIZATION • MODERN MANAGEMENT MUST HAVE AN OBJECTIVE, QUANTITATIVE FOCUS • MANAGEMENT CONTROL OF INPUTS, PROCESSES, PRODUCTS AND IMPACT IS ESSENTIAL • ACCOUNTABILITY IS A CENTRAL PART OF MODERNIZATION • DECENTRALIZATION OR DECONCENTRATION ARE ESSENTIAL CONDITIONS FOR EFFECTIVE ACCOUNTABILITY • ORGANIZATION, PROCEDURES, SERVICE SUPPLY AND PRODUCTS, MUST BE SUBJECT TO CRITICAL ANALYSIS

  15. PRODUCTIVE MANAGEMENT BASIC PRINCIPLES • WELL DEFINED, QUANTIFIABLE PRODUCTS • EVERY PRODUCT MUST BE COSTED • EFFICIENT AND QUALITY PRODUCTS • THE BUDGET / PROGRAM MUST INCLUDE ALTERNATIVE FORMS TO USE RESOURCES (COST/BENEFIT RELATIONSHIPS)

  16. PRODUCTIVITY: A CENTRAL ELEMENT OF MANAGEMENT MODERNIZATION EVERY PROCESS TO INCREASE PRODUCTIVITY REQUIRES THAT INEFFICIENCY BE OBJECTIVELY QUANTIFIED

  17. More important...CHARACTERIZE THE SITUATION • REGIONS, DISTRICTS, HOSPITALS/CLINICS • SERVICES, SPECIALTIES • SUPPORT SERVICES • USE OF PHYSICAL FACILITIES • HUMAN RESOURSE PRODUCTIVITY • MATERIAL INPUTS • ORGANIZATION

  18. HEALTH QUALITY PROCESS • STANDARDS • diagnosis • inputs • procedures • human resource • CLINICAL • PRACTICE • diagnosis • inputs • procedures • human resource DEVIATION CORRECTIVES

  19. REQUIREMENTS: • HEALTH CARE STANDARDS • MORBIDITY DATA (STRUCTURE) • PATIENT TREATMENT DATA • SYSTEM TO COMPARE STANDARD AND TREATMENT • A SYSTEM TO IMPROVE CLINICAL PRACTICE AND EXCELLENCY

  20. DIMENSIONS OF MANAGEMENT THAT FUNCTION WITH WinSIG • LOCAL MANAGEMENT • LOCAL HEALTH SYSTEM MANAGEMENT • NATIONAL HEALTH SYSTEM MANAGEMENT

  21. C H A N G E P R O C E S S INDICATORS INPUT/PROCESS/PRODUCTS/COSTS PROGRAM BUDGET MACRO INSTITUTIONAL ANALYSIS MICRO INSTITUTIONAL ANALYSIS MANAGEMENT AGREEMENTS DESCENTRALIZATION, DECONCENTRATION

  22. C H A N G E P R O C E S S • HEALTH SYSTEM CHANGE VISION: • PROBLEMS • SOLUTIONS • STRATEGIES NEGOTIATION CONSENSUS PARTICIPATION • LOCAL CHANGE VISION: • PROBLEMS • SOLUTIONS • CHANGE STRATEGIES

  23. NATIONAL MANAGEMENT REGULATION AND CONTROL COMPARATIVE ANALYSIS OF LOCAL AND REGIONAL ORGANIZATIONS MANAGEMENT MONITORS

  24. CRITICAL COMPONENTS AND LINKS IN THE PROGRAM BUDGET PROCESS HEALTH COVERAGE GOALS EFFICIENCY CRITERIA DIRECT HEALTH SERVICES FOR THE HC GOALS EFFICIENCY CRITERIA SUPPORT SERVICES EFFICIENCY CRITERIA RESOURCES COSTS

  25. INSTITUTIONAL ANALYSIS CHARTS INDICATORS TREND INDICATORS PROGRAM / BUDGET COSTS COMPARATIVE ANALYSIS PATIENTS COST MORBIDITY DATA BENCHMARKS DRG - PRESUMPTIVE DRG - REAL QUALITY CARE CONTROL BY RESULTS INDICATORS PROTOCOLS WinSIG PRODUCTS PREVIOUS VERSION NEW VERSION +

  26. WinSIG AND COST OF HEALTH SERVICES RELATIONSHIP: • COSTS ARE INDICATORS OF INSTITUTIONAL EFFICIENCY • COSTS ARE NOT IMPORTANT PER SE • CONTRIBUTE TO MANAGEMENT AND INSTITUTIONAL DEVELOPMENT • FACILITATE ESTABLISHING STANDARDS OF EFFICIENCY AND QUALITY • NEW PRACTICES FOR ALLOCATION OF RESOURCES WITH PRODUCTIVITY CRITERIA, COSTS CONTAINMENT AND RECUPERATION

  27. COSTING OPTIONS OFFERED BY WinSIG: • AVERAGE COSTS: FOR INSTITUTIONAL RATIONALIZATION • PRESUMPTIVE COSTS: FOR INTER-INSTITUTIONAL SERVICE PURCHASE RELATIONSHIPS • CURRENT COSTS OF SERVICES: • Per patient • Per procedure • Per input FOR INDIVIDUAL SERVICES PURCHASING RELATIONSHIPS

  28. PATIENTS COST COSTS OF PERSONNEL SERVICES COSTS OF PROCEDURES COSTS OF ESSENTIAL INPUTS MANAGEMENT COSTS • ADJUSTMENTS: • Depreciation • Mark up • other

  29. PROCEDURES COSTS MATERIALS COSTS INDIVIDUAL PATIENT COST MEDICAL RECORD: PATIENT TREATMENT DATA PERSONNEL COSTS OTHER ADMINIST. COSTS

  30. PROCEDURES WEIGEHTED AVERAGE DIRECT CARE BED DAY COST DIRECT ALLOCATION INPUTS PATIENTS COST BY COST STRUCTURE INPUTS PERSONNEL REAL COSTS MANAGEMENT COSTS DISTRIBUTION BY DIRECT COSTS

  31. TRAINING: MANAGEMENT AND WinSIG DEVELOPMENT OF PRODUCTIVE MANAGEMENT IN THE HEALTH SECTOR • WEB-BASED VIRTUAL COURSE: • MANAGED BY THE VIRTUAL CAMPUS FOR PUBLIC HEALTH • EXPLAINS THE CONCEPTUAL AND METHODOLOGICAL FRAMEWORK • TEACHES HOW TO THE USE WinSIG PROGRAM • GUIDES THROUGH THE ANALYSIS AND USE OF INFORMATION • ON-SITE WORKSHOP: • THEORETICAL AND PRACTICAL ACTIVITY ADAPTED TO THE PROCESS • INTRODUCTION TO THE CONCEPTUAL AND METHODOLOGICAL FRAMEWORK • TEACHES HOW TO THE USE WinSIG PROGRAM • GUIDES THROUGH THE ANALYSIS AND USE OF INFORMATION • DISCUSSES IMPLEMENTATION STRATEGIES • ANALYSIS OF INDICATORS: INCORPORATED IN WinSIG • WinSIG PROGRAM AND MANUAL • WORKSHOP MANUAL WITH DIFFERENT ALTERNATIVES (ADAPTABLE TO THE PROCESS)

  32. AVAILABLE IN FIVE LANGUAGES

  33. BASIC FUNTIONS OF WinSIG Preserves the same structure and components of previous version: • CONFIGURATION • DATA • RESULTS • ANALYSIS • TOOLS

  34. MODULE 1:CONFIGURATION • Define and encode the characteristics of a facility or program based on variables used by WinSIG and its location within a health system • Flexible andadaptable to any type of health facility or program

  35. MODULE 2:DATA • Basic Matrix for monthly input • Basic Forms • Indicators • Morbidity • Procedures • Essential Inputs • Protocols • Costs: Procedures and Patients • DRGs

  36. DATA ENTRY INPATIENT SERVICES SUPPORTING SERVICES OUTPATIENT SERVICES INPUTS: (N) (N) MEDICE CIRUGIA GINECO (N) MEDICE ODONT. OPERATING R. ADMINISTRATION FARMACIA PERSONNEL: Salaries Benefits FINAL AND SUPPORTING SERVICES Bonus SUPPLIES Drugs X-Ray Films Insumos de Laboratorios Oxigeno Otros Productos Quimicos Material Medico Quirurgico Productos Alimenticios Insumos de Oficina EXPENDITURE ITEMS STRATEGICALLY CLASIFIED Productos Sanitarios y Aseo Repuestos y acces. de metal MANTENANCE OTHER CONTRACTS UTILITIES Transporte y Correo Electricidad y Agua, Etc. Telefono yComunicaciones PRODUCTION: DISCHARGES/VISITS INPATIENT DAYS BEDS OPERATIONS PRODUCTION OF FINAL AND SUPPORTING SERVICES PRESCRIPTIONS MEDICAMENTOS EXAMENES DE RADIOLOGIA PLACAS DE RAYOS X EXAMENES DE LABORATORIO ANALISIS DE LABORATORIO RACIONES MANPOWER HOURS PHYSICIAN NURSE AUXILIAR ENFERMERIA MANPOWER HOURS RECURSO NUCLEAR TECNICO(CALIFICADO) ADMINISTRATIVO OTRO PERSONAL AUXILIAR INSTITUTION: PERIOD: B A S I C D A T A M A T R I X

  37. MODULE 3:RESULTS • Managerial Charts • Historical Series • Management Indicators • Morbidity Attended • Billing Report • DRGS Report

  38. CHART 1. DATE: October 1991Production, Productivity and CostsInstitution: KARIBU GENERAL HOSPITAL COSTS SERVICES OccupancyRate Unit ofProduction Volume of Production ReplacementInterval Bed Turnover Bed Days ALOS Unit Service FINALS:MEDICINESURGERYGYN-OBSTETRICTSPEDIATRICS DISCHP-DAYDISCHP-DAY DISCHP-DAY DISCHP-DAY 294297919435085902012136825 2440241495527415704602939484 717303961359926033399688 100.3087.2071.3536.67 10.1318.083.416.07 4.36.36.810.6 11.66.06.85.0 2970402028202250 DISCHP-DAY 3004383 12149324 2475322 SUBTOTAL 77.31 7.68 7.2 8.1 12060 6259656435371269502 4273885 307660316971275479804514756631858257 VISITTREATM. OPERAT.TESTEXAMPRESC.MEAL-DSERVICE OUT-PATIENTCASUALTYSUBTOTAL TOTAL SUPPORT: OPERATING ROOMLABORATORYRADIOLOGYPHARMACYFOOD SERVICES MANAGEMENT 92133 6782482111603 78420742308020326121421729 109 39215894391075

  39. CHART 2, DATE: October 1991PRODUCTIVITY COEFFICIENT OF SUPPORTING SERVICESINSTITUTION: KARIBU GENERALHOSPITAL OUTPATIENT SERVICES INPATIENT SERVICES SERVICESOPERATING R. OPERATIONOPERAT. PER DISCHARG/VISITLABORATORY TEST TEST PER DISCHARGE/VISIT TEST PER PATIENT DAYRADIOLOGY EXAMEXAM PER DISCHARGE/VISIT PHARMACY PRESCIP. PRESC. PER DISCHARGE/VISIT PRESC. PER PATIENT DAYFOOD SERV. MEALSMEALS PER PATIENT DAY TOTAL11603.00 302.00 0.026 5708.00 0.4922448.00 0.21117722.00 1.527 123.00 0.011 MEDICINE 294.002979.00 0.00 0.0004274.00 14.537 1.435 260.00 0.8841158.00 3.939 0.3893312.00 1.112 SURGERY 194.003508.00 203.00 1.0463358.00 17.309 0.957 163.00 0.840 885.00 4.562 0.2524135.00 1.179 GYN-OBST. 590.002012.00 229.00 0.3884892.00 8.292 2.431 118.00 0.200 524.00 0.888 0.2603689.00 1.833 PEDIATRCS 136.00 825.00 0.00 0.0002510.00 18.456 3.042 91.00 0.669 37.00 0.272 0.045 883.00 1.070 TOTAL 1214.00 9324.00 432.00 0.35615034.00 12.384 1.612 632.00 0.521 2604.00 2.145 0.27912019.00 1.289 O.P. CONST. 6782.00 302.00 0.045 2436.00 0.359 1235.00 0.18213199.00 1.946 0.00 0.00 EMERGENCY4821.00 0.00 0.0003272.00 0.6781213.00 0.2524523.00 0.938 123.00 0.026 PRIMARY PRODUCTION SECONDARY PRODUCTION

  40. CHART 3. DATE: October 1991PRODUCTIVITY AND COMPOSITION OF HUMAN RESOURCESINSTITUTION: KARIBU GENERALHOSPITAL OUTPATIENT SERVICES INPATIENT SERVICES SERVICES VISIT 6782 TOTAL6782 MEDICINE 2942979 PEDIATRICS 136 825 TOTAL 430 3804 PRIMARY PRODUCTION SECONDARY PRODUCTION DISCHARGE/VISITBED DAY HOURS PHYSICIANPHYICIAN HOURS PER PRIMARY PROD. UNIT PHYSICAN HOURS PER SECONDARY PROD. UNIT HOURS NURSENURSES HOURS PER PRIMARY PROD. UNIT NURSES HOURS PER SECONDARY PROD. UNIT 2255 1.000.30 2255 1.000.30 3381 1.0011.501.13 2058 1.0015.132.49 5439 1.0012.651.43 2260 1.100.33 2260 1.100.33 5210 1.5417.721.75 4342 2.1131.935.26 9552 1.7622.212.51 3940 1.920.583 3940 1.920.583 1984 0.596.75.67 1940 0.9414.262.35 3924 0.729.131.03 HOURS ASSISTANT NURSEASSIST. NURSE HOURS PER PRIMARY PROD UNITASSIST. NURSE HRS PER SECONDARY PROD UNIT 1648 0.800.24 1648 0.800.24 0 0.000.000.00 0 0.000.000.00 0 0.000.000.00 HOURS ADMINISTRATIVE PERSONNELADMIN HOURS PER PRIMARY PROD. UNIT ADMIN HOURS PER SECONDARY PROD. UNIT 35.79 61.32 43.99 1.46 1.46 INDICATOR: HOURS/PRODUCTION CHART 3A: FINAL SERVICESCHART 3B: SUPPORT SERVICES

  41. CHART 4. DATE: October 1991OPERATION COST INSTITUTION: KARIBU GENERALHOSPITAL SUPPORTING SERVICES OUTPATIENT SER.. INPATIENT SERVICES EXPENSES % TOTAL GIN-OBST. EMERG. LABORAT. FARMACIA CIRUGIA RADIOLG. NUTRIC. MEDICINE PEDIAT. QUIROF. C.EXTER. ADMINIST. 341679513416347212359482320612617716166520611204110055023078327552671330361851020901 228025 29080 9881 4157611166178 30922823025875527586209362871000 2796421213216904287731163116250119 1612943384372129928465224 107932466328446501963722195917 18876013153501408670060481959 106056381335948170861726260488473500 1228544721219401204163583282622 95960294423206930449150232621483 44610417137225 102987161665912134147016 166944711065183289682910153452671044311851020901 PERSONNEL SERVICESDRUGSLABORATORY EXAMSOTROS PRODUCTOS QUIMICOSX RAY FILMSMEDICAL INSTRUMENTSPRODUCTOS ALIMENTICIOSMATERIAL DE OFICINAPRODUCTOS DE LIMPIEZAREPUESTOSEQUIPO MENOROTROS SUMINISTROSTRANSPORTES Y FLETESSERVICE CONTRACTSUTILITIESSERVICIOS PUBLICOS 80.133.151.11.84.542.963.79.05.282.36.54.08.013.24.43 168954 278947 363844 337479 174032 260846 173577 178775 155422 45389 268363 1858257 4263885 TOTAL DIRECT COST 43.58 7.91 6.54 8.53 3.96 6.12 4.07 4.19 3.65 1.06 6.29 PERCENTAGES 4.08 206085475663 105612 ADMINISTRATIONNUTRITIONPHARMACYRADIOLOGYLABORATORYEMERGENCY ROOM 260689144517207410554747349598759855592603421.72 281056161989350314579512998508959649596033922.55 137316316871 134434345921468139383452155653896889.14 119182275479 3427280451 1305102421046037214 126585 5701162596514.68 2014934819179021084924998538269164353715.09 21547712774745832325565293436355 71530216.82 128331307660 780 790 1215 5751 1245 630 TOTAL INDIRECT COST 134082 138096 120057 35062 207300 105612 TOTAL COSTS 4263885 291439 PERCENTAGES

  42. ... EXAMPLE PRODUCTION AND PRODUCTIVITY INDICATORS: • ICU transfers per discharge • Surgical operations per discharge • Physiology treatments per discharge • Clinical Lab. exams per discharge • X-Ray studies per discharge • Echographies per discharge • Electro-encephalograms per discharge • Discharges • Concentration index (discharges per 100 inhabitant) • Occupational rate • Average length of stay • Rotation index • Substitution interval • Bed allocation • Service supply structure • Intensive care services

  43. ... • Electro-cardiographs per discharge • Blood transfusions per discharge • Prescriptions per discharge • Meals per patient day • Kilos laundered per patient day • Physician hours per patient day • Nurse hours per patient day • Assistant nurse hours per patient day • Other personnel category hours per patient day • Total personnel hours per patient day • Physician hours per patient discharge • Nurse hours per patient discharge • Auxiliary nurse hours per discharge

  44. EXAMPLE OF COST INDICATORS: Total cost of cost center Discharge unit cost Total direct costs (and percentages) Total indirect costs by cost center (and percentages) Total cost of personal services (salaries and fringe benefits) Total costs of material supplies Total cost of drugs Total costs of medical and surgical supplies Cost structure of direct inputs

  45. Outpatient services Concentration index (Outpatient services per 100 population year) Structure of the supply of outpatient services Surgical operations per outpatient service Physiology treatments per outpatient service Clinical Lab. Exam per outpatient service X-Ray studies per outpatient service Echographies per outpatient service Prescription per outpatient service1 Physician hours per outpatient service Nurse hours per outpatient services Auxiliary nurse hours per outpatient service EXAMPLE OF AMBULATORY SERVICES INDICATORS:

  46. MODULE 4:ANALYSIS • Parameters • Programming-Budgeting • Control by Results • Productivity Evaluation • Institutional Efficiency • Estimated Cost of Care • DRGs Comparison

  47. MORBIDITY ATTENDED REPORT

  48. CONTROL BY RESULTS: COVERAGE

  49. CONTROL BY RESULTS: PRODUCTION

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