PRESENTACIN.......................................................................................................................................

5
CAPTULO 1. LA GESTIN Y SUS DESAFOS................................................................................... 6
QU ES GESTIN?................................................................................................................................. 6
ADMINISTRACIN VERSUS GESTIN ......................................................................................................... 7
CMO EXPLICAR LAS ORGANIZACIONES? ................................................................................. 8
CUALES SON LOS DESAFOS EN LA GESTIN INSTITUCIONAL? ................................................................ 10
Principales desafos planteados por la Teora de las Organizaciones .............................................. 10
Nuevos desafos de la gestin............................................................................................................. 13
PARTICULARIDADES DE LA GESTIN EN SALUD...................................................................... 14
COMPONENTES DE UN SISTEMA DE SALUD ............................................................................................... 15
Modelo de gestin .............................................................................................................................. 16
Modelo de financiacin...................................................................................................................... 17
Modelo de Atencin............................................................................................................................ 18
NIVELES DE GESTIN EN SALUD .............................................................................................................. 18
SNTESIS .................................................................................................................................................. 19
BIBLIOGRAFA....................................................................................................................................... 22
SITIOS WEBS RECOMENDADOS ....................................................................................................... 22
EVALUACIN ......................................................................................................................................... 24
CAPTULO 2. MODELOS DE GESTIN ................................................................................................ 28
CONCEPTO DE MODELO DE GESTIN........................................................................................... 28
MODELO DE GESTIN Y PARADIGMA ADMINISTRATIVO ......................................................................... 30
COMPONENTES DEL MODELO DE GESTIN ............................................................................... 31
EL SER DE LA ORGANIZACIN ................................................................................................................ 32
Misin ................................................................................................................................................ 32
Visin ................................................................................................................................................. 34
Valores ............................................................................................................................................... 35
EL HACER DE LA ORGANIZACIN ............................................................................................................ 37
Prioridades......................................................................................................................................... 37
Funciones ........................................................................................................................................... 38
ACTIVIDADES .......................................................................................................................................... 39
EL ESTAR DE LA ORGANIZACIN ............................................................................................................ 41
ESTRUCTURAS ......................................................................................................................................... 41
Cultura e Incentivos ........................................................................................................................... 41
Ambiente externo................................................................................................................................ 42
PARTICULARIDADES DE LA GESTIN EN SALUD...................................................................... 43
MODELOS DE GESTIN EN LAS ORGANIZACIONES DE SALUD ................................................................... 43
LA TEORA DE LAS ORGANIZACIONES Y LOS SERVICIOS DE SALUD........................................................... 46
INCENTIVOS Y MOTIVACIN EN SERVICIOS DE SALUD .............................................................................. 47
SNTESIS .................................................................................................................................................. 49

BIBLIOGRAFA....................................................................................................................................... 52
SITIOS WEBS RECOMENDADOS ....................................................................................................... 52
Bibliografa On Line .......................................................................................................................... 52
Journals.............................................................................................................................................. 53
Sitios de gestin y administracin en salud ....................................................................................... 53
EVALUACIN ......................................................................................................................................... 54
CAPTULO 3. GESTIN Y CAMBIO................................................................................................... 57
EL CONCEPTO DE INNOVACIN...................................................................................................... 57
PROGRESO TCNICO VERSUS INNOVACIN TECNOLGICA ....................................................................... 57
INNOVACIN TECNOLGICA VERSUS INNOVACIN ORGANIZATIVA ......................................................... 58
Cambios en la administracin versus gestin innovadora................................................................. 59
Motores de la innovacin organizativa.............................................................................................. 59
GRANDES MODALIDADES DE CAMBIO DEL MODELO DE GESTIN.................................... 61
QU ES CAMBIAR EL MODELO DE GESTIN? ......................................................................................... 61
RECONVERSIN VERSUS REINGENIERA.................................................................................................. 61
QU ES RECONVERTIRSE? ...................................................................................................................... 63
DISEO DE ORGANIZACIONES......................................................................................................... 65
ESTRUCTURAS Y MODELOS DE ORGANIZACIN ...................................................................................... 66
CRECIMIENTO INSTITUCIONAL Y REDISEO DE ESTRUCTURAS................................................................. 67
Estructura simple ............................................................................................................................... 68
Burocracia mecnica ......................................................................................................................... 68
Forma divisionaria............................................................................................................................. 68
DISEO DEL MODELO DE GESTIN EN ORGANIZACIONES DE SALUD ....................................................... 69
REINGENIERIA ...................................................................................................................................... 70
ESTRUCTURA FORMAL VERSUS REAL....................................................................................................... 71
SNTESIS .................................................................................................................................................. 74
BIBLIOGRAFA....................................................................................................................................... 74
SITIOS WEBS RECOMENDADOS ....................................................................................................... 75
EVALUACIN ......................................................................................................................................... 76
CAPTULO 4. ESTRATEGIA................................................................................................................... 79
ETAPAS EN LA VIDA DE LA ORGANIZACIN .............................................................................. 79
SIGNIFICADO DE LA ESTRATEGIA ................................................................................................. 80
LA ESTRATEGIA EN LA ORGANIZACIN...................................................................................... 83
I. DEFINICIN DE LA MISIN .................................................................................................................... 85
CMO DEFINIR LA MISIN ....................................................................................................................... 85
II. CONVALIDAR LA MISIN ..................................................................................................................... 91
III. DESARROLLAR UN PLAN .................................................................................................................... 92
MATRIZ PRI ............................................................................................................................................ 93
Prestigio ............................................................................................................................................. 93
Influencia ........................................................................................................................................... 94
Recursos ............................................................................................................................................. 94
EVALUACIN DE DESEMPEO......................................................................................................... 96

Gestin orientada a resultados .......................................................................................................... 96

Eficiencia, eficacia y efectividad en la organizacin ......................................................................... 97
Limitaciones del control de gestin.................................................................................................... 98
La evaluacin depende del tipo de organizacin ............................................................................... 99
Modelos de organizacin y modelos de evaluacin ......................................................................... 100
Anlisis de desempeo y reconversin institucional ........................................................................ 100
Algunas recomendaciones para los evaluadores ............................................................................. 102
BIBLIOGRAFA..................................................................................................................................... 104
SITIOS WEBS RECOMENDADOS ..................................................................................................... 104
Bibliografa On Line ........................................................................................................................ 104
Centro de investigacin y gestin en salud ...................................................................................... 104
Biblioteca de centros de salud ......................................................................................................... 105
Bases de datos sobre hospitales, utilizacin de servicios y resultados ............................................ 105
EVALUACIN ....................................................................................................................................... 105
UN MOTIVO PARA EL ORGULLO NACIONAL ............................................................................................ 105
EL HOSPITAL EN LA ENCRUCIJADA......................................................................................................... 105
CONSIGNAS ........................................................................................................................................... 106

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En Bibliomed hay una seccin sobre gerenciamiento en salud que permite acceder a un conjunto
de artculos breves en los que se abordan expeiencias concretas de gestin de organizaciones de
salud en diversos pases.
http://www.bibliomed.com/gestion/
Revista Via Salud. N 16- Segundo Trimestre del 2001
Manuel Camacho Montoya CON CIENCIA IPS. Una experiencia de produccin de salud en
el mercado libre El artculo describe el modelo de atencin implementado en una IPS (Institucin Prestadora de Salud) colombiana que mediante el acercamiento de los servicios de salud a la poblacin y un servicio personalizado, logr buenos resultados en cobertura de atencin,
reduccin
de
costos
y
satisfaccin
de
los
usuarios.

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Revista Via Salud. N 15 - Primer Trimestre del 2001

Pilar Arrzola. Una institucin con el dialogo en la piel: El caso del centro dermatolgico Federico Lleras Acosta. El artculo presenta el caso de la reconversin del Centro Dermatolgico Federico Lleras Acosta fue creado en 1934 por el Ministerio de Salud como laboratorio
central para investigaciones en Lepra. En su historia comparte aspectos con un gran nmero
de instituciones de salud, que con los aos desembocaron en una compleja crisis. As la inestabilidad administrativa y financiera, la prdida de compromiso por parte de sus funcionarios,
la falta de autonoma, la ausencia de una visin de empresa y de criterios administrativos de
eficiencia y calidad, fueron factores que llevaron al centro a una agudizacin de su problemtica, que toc fondo a principios de los noventa y, le llev a elegir una de tres posibilidades:
Desaparecer del sector salud
Convertirse en departamento de un hospital vecino
Transformarse en una organizacin slida e independiente

' "8
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BSCOLO, Ernesto & SANCHEZ DE LEN, Adolfo Reformas en el Sector Pblico de Salud: Es
necesario introducir condiciones de competencia para el desarrollo de un modelo de mercado interno?, en Gestin en Salud. Agosto. Disponible On line en:http://www.gestionensalud.com

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ra el gobierno, la industria, los consumidores y los proveedores de servicios de salud,

con el fin de reducir los errores mdicos. Adicionalmente, le pide al Congreso de los Estados Unidos que cree un centro nacional para la seguridad del paciente, y que se encargue del desarrollo de nuevas herramientas y sistemas necesarios para enfrentar los
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