Processes management in health services and team work. Methodological considerations


Processes management in health services and team work. Methodological considerations


Gestión por procesos en los servicios de salud y el trabajo en equipo. Consideraciones metodológicas



Benita Mavel Beltrán González1, Teresa Vega Díaz2, Grace Sarduy Pérez3, Elsa María Santandreu Uriarte4

1 Villa Clara University of Medical Sciences. Cuba. E-mail:
2 "Santa Clara". University Teaching Polyclinic. Villa Clara. Cuba. E-mail:
3 "Juan B Contreras". University Teaching Polyclinic. Ranchuelo. Villa Clara. Cuba. E-mail:
4 "Juan B Contreras". University Teaching Polyclinic. Ranchuelo. Villa Clara. Cuba. E-mail:




To fulfill the medical care, teaching and researching functions, the horizontal integration of health services can be strengthened through process management. The intellectual capital accumulated in the individuals that make up the organization is a key active factor for the achievement of such purposes; It is the objective of the authors to analyze the implicit methodological aspects to develop skills related to behaviors and enhance teamwork, due to its impact on the commitment to achieve better results in medical care, teaching and researching, while at the same time it strengthens flexibility, change, innovation in health services and contributes to excellence in training processes.

MeSH: health services, health services research, practice management, medical, teaching care integration services, practice management.


Para dar cumplimiento a las funciones docente, asistencial e investigativa, la integración horizontal de los servicios de salud puede ser fortalecida mediante la gestión por procesos. El capital intelectual acumulado en los individuos que integran la organización es un factor activo clave para el logro de tales propósitos; es objetivo de los autores analizar los aspectos metodológicos implícitos para desarrollar capacidades relacionadas con los comportamientos y potenciar el trabajo en equipo, por su incidencia en el compromiso del logro de mejores resultados en la atención médica, la docencia y la investigación, a la vez que fortalece la flexibilidad, el cambio, la innovación en los servicios de salud y contribuye a la excelencia en los procesos formativos.

DeSC: servicios de salud, investigación en servicios de salud, administración de la práctica médica, servicios de integración docente asistencial, gestión de la práctica profesional.



The organization, efficiency and quality of the services constitute essential components in the institutional performance and make possible the fulfillment of the medical care, teaching and researching functions of the professionals that participate in the teaching-learning process in different places, and the satisfaction of the needs of users in the health system.1-3

The horizontal integration of health services can be strengthened through process-based management that makes it possible to conceive how to work through systems that cross departmental service and functional borders, by showing the internal relationships of users and providers.4-6

The management concept refers to the action of carrying out procedures that make it possible to carry out an operation in general, according to Stoner:2 "... it is the process of planning, organizing, directing and controlling the efforts of the members of the organization and to apply the other resources of it to reach the established goals".

The intellectual resources accumulated in the individuals that make up the organization is a key active factor for the achievement of such purposes and these resources will only be deployed when all its members develop their natural talent, aligning their interests with those of the organization; for this it is fundamental to develop a teamwork that allows facing the contingencies and the demands posed by the changing environment that interacts with it, which requires an attitude of commitment and the intelligence of all its personnel.2,7

When considering process management refers to the coordination of external and internal relations in the organization of health services, it is the union among all subsystems to achieve the fulfillment of the mission.2,8

Sometimes there is a lack of effective integration among the different functional and structural areas represented by each of the members of the organization; hence the importance of considering methodological aspects when managing processes to avoid or solve this problem that affects either the undergraduate or postgraduate training processes. The first thing that should be analyzed is what is happening in the development of the processes, what organizational factors and the interrelation among those involved are associated; the information obtained will facilitate the actions to be developed.

When managing processes it is necessary to make changes in the behavior of the members of the organization, including: merging thinking with action for improvement; admit that it is not about working more, but about working in a different way; be committed to results in medical care versus compliance; know that the orientation is external, towards the user of health services, and that in that management students, residents and teachers participate through the in-service training as a guiding principle, by developing teamwork to contribute to the achievement of excellence in health services.9

To achieve such purposes it is necessary to consider the following premises:

  • Develop skills and avoid the syndrome of operational work, which occurs in those who think they can do better, paternalists and those who do not have qualities to train and strengthen their team; the teams do not appear spontaneously, they are usually shown as a "group", among their members it is necessary to cultivate trust, share interests, cooperation and effort to fulfill the medical care, teaching and researching functions in the health services; learn to listen, it is necessary that the belief system change and thaw what is considered valid to make the changes and give a new dynamic to the organization, in order to solve the identified problems. Among the reasons why people usually do not listen carefully are: the fear of being influenced by the other, feeling that when you speak you can exert more influence than when you listen; factors such as education, the scale of values and past experience act as a filter, generate prejudices about the meaning of what is intended to be transmitted and alter the interpretation.7,8
  • Identify the sources of stress in the members of the organization, these can be: not having defined the priorities in the work to be done, not properly managing the time, fears of not being qualified for the functions that must be fulfilled (medical care, teaching and researching), health problems or others that occupy attention; frequent interruptions that affect ending with the required quality what is started and the inadequate relationships among those involved; Resistance to proposed changes hinders team work and the development of the organization.7,8 Professionals should know that in the management of processes they will face problems, conflicts, and it is necessary to learn to solve these situations.
  • Negative beliefs should be replaced by the following basic beliefs that will influence behavior: believe in flexibility, in the need to resolve the conflict, in accepting that personal criteria may be wrong and other opinions should be heard, be convinced of that the solution to the identified problem can be found by respecting the ethical values of the profession, which are reflected in the performance of students and residents.7-10

The authors consider that it is a necessity in health services to prepare professionals to work as a team and develop their skills on technical or functional knowledge, skills for problem solving and decision making and interpersonal skills such as acceptance of risk, useful criticism, objectivity, listening, offering the benefit of the doubt and recognizing the interests and achievements of others.

Process management in health services and teamwork make it easier for structures to respond to strategies and develop capacities with great dynamics and without fear of the risk of complexity imposed by the forces of the environment, thus coordinating the team, information is shared, autonomy and self-control are strengthened in professionals. They will be able to manage their emotions, commit to the results in medical care, while strengthening flexibility, change, innovation in health services and contributing to excellence in training processes.


Declaration of interests

The authors declare no conflict of interest.



1. Garrido Latorre F, López Moreno S. Evaluación de los programas y servicios de salud en México. Salud Pública Méx [Internet]. 2011 [citado 20 Sep 2016];53 (supl 4):[aprox. 4 p.]. Disponible en:

2. Stoner J. Administración. 6ta ed. España: Editorial Prentice Hall; 1996.

3. González Capdevila O, Ballesteros Hernández M, González Alcántara SM, Hernández Moreno V. La política científica de la salud en Villa Clara: fundamentos, problemas y líneas de investigación. Medicentro [Internet]. 2017 [citado 20 Jul 2016];21(2):[aprox. 4 p.]. Disponible en: /1959

4. Pasarín MI, Berra S, González A, Segura Benedicto A, Tebé C, García Altés A. Evaluación de la atención primaria de salud. Gaceta Sanit [Internet]. 2013 [citado 20 Oct 2016];27(1):[aprox. 7 p.]. Disponible en:

5. Vargas González V, Valecillos J, Hernández C. Calidad en la prestación de servicios de salud: Parámetros de medición. Rev de Ciencias Sociales [Internet]. 2013 [citado 23 Sep 2016];19(4):[aprox. 9 p.]. Disponible en:

6. Forrellat Barrios M. Calidad en los servicios de salud: un reto ineludible. Rev Cubana Hematol Inmunol Hemoter [Internet]. 2014 [citado 10 Jul 2016];30(2): [aprox. 8 p.]. Disponible en:

7. Salas Perea RS, Salas Mainegra A. La educación en el trabajo y el individuo como principal recurso para el aprendizaje. EDUMECENTRO [Internet]. 2014 [citado 10 Nov 2016];6(1):[aprox. 5 p.]. Disponible en:

8. Segredo Pérez DM. Clima organizacional en la gestión del cambio para el desarrollo de la organización. Rev Cubana Salud Pública [Internet]. 2013 [citado 12 Nov 2016];39(2):[aprox. 9 p.]. Disponible en:

9. Fernández Sacasas JA. El principio rector de la educación médica cubana. Educ Med Super [Internet]. 2013 [citado 10 Jul 2017];27(2):[aprox. 10 p.]. Disponible en:

10. Herrera Kiengelher L, Zepeda Zaragoza J, Austria Corrales F, Vázquez Zárate VM. Validez y fiabilidad del cuestionario de cultura de calidad en servicios de salud en México. Rev Calidad Asistencial [Internet]. 2013 [citado 8 Oct 2016];28(5):[aprox. 4 p.]. Disponible en:



Submitted: November 28 2017.
Accepted: November 29 2017.



Benita Mavel Beltrán González. Villa Clara University of Medical Sciences. Cuba. E-mail:

Añadir comentario