Good practice in operation since: 2016 Good Practices in Social Security A covenant on service quality A case of the State Employees' Social Security and Social Services Institute State Employees' Social Security and Social Services Institute Mexico Published 2017 www.issa.int
2 Summary This innovative program was implemented to improve the quality of care provided by the State Employees Social Security and Social Services Institute (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado ISSSTE) with the aim of strengthening interpersonal relationships by promoting proper treatment within the organization. The hypothesis is that the absence of quality in work life can result in negative consequences for workers, including work and psychological stress, anxiety, depression or health problems. At the same time, this can have a negative impact on service delivery. The program is multidimensional: we train staff to tackle abuse-generating factors, we focus on the integral well-being of the staff, the development of individual, collective, technical and professional service skills, and we encourage teamwork, which all improves physical and emotional performance and efficiency. We consider that a happy employee is kind to others and, consequently, beneficiaries receive a good service, which fulfils the Institute s mission. The ISSSTE is an entity that meets the needs of beneficiaries with quality and humanitarianism through respect, inclusion, service vocation, commitment, integrity, justice, loyalty, honesty and transparency. The issue or challenge What was the issue or challenge addressed by your good practice? Please provide a short description. To improve the quality of care provided by the ISSSTE and to enhance interpersonal relationships by promoting proper treatment within the organization. Addressing the challenge What were the main objectives of the plan or strategy to resolve the issue or challenge? List and briefly describe the main elements of the plan or strategy, focusing especially on their innovative feature(s) and expected or intended effects. The challenge is to improve the quality of work life and increase user satisfaction. In order to listen the voices of the nearly 13 million beneficiaries and users of the Institute, the national system handling requests and proposals (Sistema Nacional de Atención de Peticiones y Planteamientos SINAPP) collects the opinions of users through various channels (telephone, email and social media, among others) in various instances of the Institute, the National Commission of Medical Arbitration (Comisión Nacional de Arbitraje Médico), the National Human Rights Commission (Comisión Nacional de Derechos Humanos), the Presidency of the Republic, etc. The review of opinions is used to analyze, assess and propose efforts to improve service to beneficiaries. If beneficiaries perceive that the service is ignoring their needs, this can lead to a complaint, a suggestion or a request for services, while the opposite case will lead to praise.
3 SINAPP national statistics provide quality indicators allowing us to secure knowledge of the scope and importance of requests from beneficiaries, providing feedback to the system in order to create a new culture of kind treatment. The 2015 analysis of SINAPP allowed us to determine that 35 per cent of opinions were due to complaints and 30 per cent of these were due to authoritarianism and poor treatment. For this reason, measures were taken to contribute to the permanent improvement of the delivery of services. To enhance the quality of care provided to the beneficiaries, the national program Deal for proper treatment (Trato para un buen trato) was developed and implemented. This program promotes new cultural patterns of good relationships between workers, and decent customer service to beneficiaries, promotes patients commitment to self-healthcare and responds with proper treatment. In this context, a set of Ten Commandments ( Decálogo ) was developed to improve quality and friendliness among all those belonging to the ISSSTE, and a pin with the program symbol was designed (see annex 1 in its original language in the attached document) to be worn on a daily basis. This has made it possible to improve the working environment and strengthen customer service, on the basis that users and citizens are the Institute s reason for existence. The Ten Commandments are as follows: 1. I inform. The right to know and the obligation to inform. 2. I greet. Denotes politeness, courtesy and good manners. 3. I smile. This establishes friendly contact with people. 4. I am kind. This creates a harmonious climate. 5. I am patient. This allows understanding, acceptance, toleration, and agreement and helps people deal with difficulties. 6. I listen. This is the root of fraternal relationships with everyone. 7. I am inclusive. This promotes a sense of belonging in people. 8. I cooperate. To be generous in order to help and join forces and wills. 9. I accept difference. To live and to live with differences is to humanize respect. 10. I say please and thank you. A sign of good manners, politeness and courtesy. To achieve this, the authorities and the union signed a national agreement, including measures focused on workers in order to improve the working environment and interpersonal relationships through presentations and workshops included in the course Caring for the Caregivers (Cuidando a los que cuidan). It deals with issues such as management of work and psychological stress, knowledge of the emotions of the sick person, humanization of care, respect for human rights and the dignity of people, among other issues. The training activities for managerial staff on the course Connect (Conecta) address issues of leadership, motivation, conflict management, creation of a culture of proper treatment, the importance of recognizing staff on a daily basis, and effective and assertive communication. They also promote leisure activities within units depending on staff interests. Measures for the beneficiaries include publicising the 21 benefits provided by the ISSSTE, as well as the promotion of self-care and the corresponding good customer service.
4 The implementation of the program National Health Care Campaign (Campaña Nacional de Atención a la Salud Canas) has also been planned, including health education modules addressing the most frequent illnesses. Another focal point is the national demographic transition that has directly influenced the transformation of the Institute s population. At present, 19 per cent of our beneficiary population are older adults, so care provided to this group was included to promote proper treatment and champion old age and aging. Improving care quality for older adults includes taking into account their rights, both as patients and as seniors. The basic premise of the program is proper treatment, conceived as a set of behaviours and values applied to relationships with others, such as respect, consideration, kindness, recognition, communication, support, satisfying needs, etc. It is designed to recognize people, units and/or offices that stand out for advancing the program and achieving its goals. The program s progress indicator is the number and percentage of trained managerial and operational workers, and the pattern of expressions of disagreement and praise in all services. Three years after the start of the program (as organizational changes occur in the long term), the quality of working life will be assessed based on the same standards as applied at the beginning of the program (achievement indicator). Targets to be achieved What were the quantitative and/or qualitative targets or key performance indicators that were set for the plan or strategy? Please describe briefly. To train 35 per cent of managerial and operational personnel in the first year of the program. To reduce complaints by 20 per cent and increase praise by 20 per cent over the previous year. Evaluating the results Has there been an evaluation of the good practice? Please provide data on the impact and outcomes of the good practice by comparing targets vs actual performance, before-and-after indicators, and/or other types of statistics or measurements. Progress has been uneven in the 35 regional and state offices, conditioned by the geographical and employment circumstances of each organization. To date, 11,192 managers and 31,869 workers in the operational area have been trained, totalling 44,061 people and representing 41 per cent of management and workers. Complaints fell by an average of 23 per cent, with a minimum of 8.96 per cent and a maximum of 36.33 per cent.
5 Praise increased by an average of 52.9 per cent, with a minimum of 5.17 per cent and a maximum of 157 per cent, all compared to the previous year. Lessons learned Based on the organization s experience, name up to three factors which you consider as indispensable to replicate this good practice. Name up to three risks that arose/could arise in implementing this good practice. Please explain these factors and/or risks briefly. 1. In order for the program to be successful, it is necessary to raise awareness among managerial staff and train them in the management process and the humanization of services. 2. It is necessary to schedule training according the characteristics of each workplace. 3. In order to achieve changes in attitude, the program must be permanent. 4. It is a good idea to build on knowledge, skills and abilities of the staff for the benefit of the program. Risks identified: 1. Resistance to change of both managerial and operational staff. 2. Care work limits staff training opportunities. 3. Limitations on financial resources to implement the program. This program has improved the perceptions of workers, as they feel valued and considered in their daily work, and of beneficiaries, as they perceive more quality and kindness in customer service. The conclusion is that this set of good practices will be very useful for other institutions in Mexico and abroad in exploring programs that help them to overcome similar challenges. The ISSSTE is ready to share and exchange its experiences.
DELEGACIÓN REGIONAL ZONA NORTE
ESTADO DE MÉXICO
ESTADO DE MÉXICO
ESTADO DE MEXICO
DELEGACIÓN ESTADO DE MEXICO
AGUASCALIENTES
HOSPITAL GENERAL TOLUCA, ESTADO DE MÉXICO
CMF VALLE DE ARAGÓN
CONJUNTO FUNERARIO TOLUCA
CLÍNICA HOSPITAL CHILPANCINGO
CMF TECPAN DE GALEANA, GUERRERO
CMF TLAPA, GUERRERO
CMFEQ ALTAMIRANO, GUERRERO
HOSPITAL GENERAL, ACAPULCO GUERRERO
HOSPITAL REGIONAL VALENTÍN GÓMEZ FARÍAS
HOSPITAL REGIONAL VALENTÍN GÓMEZ FARÍAS
HOSPITAL REGIONAL LEÓN, GUANAJUATO
HOSPITAL REGIONAL CÁRDENAS DE LA VEGA
HOSPITAL REGIONAL PRESIDENTE JUÁREZ, OAXACA
HOSPITAL REGIONAL VERACRUZ
JALISCO
NAYARIT
NUEVO LEÓN
PUEBLA
SAN LUIS POTOSÍ
TAMAULIPAS
TLAXCALA
VERACRUZ
YUCATÁN
ZACATECAS
CHIAPAS
DELEGACIÓN ESTATAL DURANGO
HOSPITAL GENERAL SANTIAGO RAMÓN Y CAJAL
CLÍNICA HOSPITAL GÓMEZ PALACIO DURANGO
CAMPECHE
COAHUILA
DELEGACIÓN REGIONAL X
BAJA CALIFORNIA
BAJA CALIFORNIA
BAJA CALIFORNIA
CHIHUAHUA
DELEGACIÓN REGIONAL ORIENTE