Análisis del rol de la gestión administrativa y financiera en la cancelación de cirugías
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Fecha
2025
Autores
Angarita García, Johannys Andrea
Sierra Amador, María Isabel
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Ediciones Universidad Simón Bolívar
Facultad de Administración y Negocios
Facultad de Administración y Negocios
Resumen
La cancelación de cirugías programadas en instituciones prestadoras de servicios
de salud (IPS) representa una problemática multifactorial con efectos negativos
sobre la calidad del servicio, la satisfacción del paciente y la sostenibilidad financiera
de las organizaciones. Esta investigación tuvo como objetivo analizar el impacto de
la gestión administrativa y financiera en las cancelaciones quirúrgicas, en este
ejercicio de investigación fue posible identificar causas que logran ser atribuidas al
paciente, al personal de salud y, especialmente, en mayor proporción a fallas
institucionales de tipo administrativas, La metodología empleada incluyó revisión
documental, análisis de indicadores institucionales (P.2.15) y contrastación con
estudios nacionales e internacionales.
Los hallazgos evidencian que más del 30 % de las cancelaciones obedecen a fallos
administrativos (errores en autorizaciones, ausencia de insumos o fallas en la
gestión contractual) y que estas situaciones generan pérdidas mensuales
superiores a Ciento Cincuenta Millones de Pesos ($150.000.000) en instituciones
con alto volumen quirúrgico, además de glosas que superan el 50 % en facturación
presentada, realizar el abordaje de esta temática resulta de gran importancia toda
vez que es indispensable desde el ámbito de seguridad del paciente crear un
aprendizaje en los diferentes actores del sistema que eviten que estas prácticas se
conviertan en repetitivas en el entendido que se busca la disminución del riesgo que
se crea al paciente.
Como propuesta de mejora, se plantea la adopción de metodologías de gestión
como el ciclo DMAIC y auditorías integradas, orientadas a reducir cancelaciones
atribuibles a la institución, fortalecer los procesos contractuales en las empresas y
optimizar el flujo financiero, los métodos señalados permiten no solo diseñar
fortalezas en los procesos de las instituciones que permitan la disminución
significativa de cancelaciones quirúrgicas injustificadas y que por consiguiente se
constituyen en motivos recurrentes de glosas, sino que además al mejorar estas
acciones se genera un impacto positivo en el robustecimiento de los proceso y
mejoramiento del flujo de recursos.
Las acciones de mejora planteadas en el presente trabajo de investigación permiten
desde cada área de desempeño que intervienen en los procesos institucionales
establecer fases de estructuración y planteamiento de estrategias de seguimiento
que permitan monitorear de forma constante los registros en las Instituciones, una
vez se lleve a cabo la retroalimentación efectiva de las acciones de mejora desde la
gestión administrativa y las auditoría presentadas, esto con el propósito de
identificar lo reflejado en los datos de acuerdo al porcentaje de cancelación de
procedimientos, estas cifras permiten identificar las acciones de repetición de
causas y lograr determinar si en el interior de las instituciones se da adherencia a
las acciones establecidas.
Para las instituciones prestadoras de salud, asumir esta problemática con
responsabilidad implica reconocerla como un indicador de desempeño que debe ser
monitoreado, analizado y optimizado.
En conclusión, la cancelación quirúrgica trasciende el ámbito asistencial y
representa un reto estratégico para la gestión administrativa y financiera, reto que
debe ser asumido atendiendo las necesidades reales del Sistema de Salud
Colombiano, estudiando en detalle las barreras presentadas y que requieren de
acciones correctivas costo-efectivas para garantizar la sostenibilidad y la calidad del
servicio quirúrgico en las instituciones de Salud.
The cancellation of scheduled surgeries in healthcare provider institutions (IPS) represents a multifactorial problem with negative effects on service quality, patient satisfaction, and the financial sustainability of organizations. This research aimed to analyze the impact of administrative and financial management on surgical cancellations. In this research exercise, it was possible to identify causes attributable to the patient, healthcare staff, and, in greater proportion, to institutional administrative failures. The methodology used included document review, analysis of institutional indicators (P.2.15), and comparison with national and international studies. Findings show that more than 30% of cancellations are due to administrative failures (authorization errors, lack of supplies, or failures in contract management), and that these situations generate monthly losses exceeding One Hundred Fifty Million Pesos ($150,000,000) in institutions with a high surgical volume, in addition to claims exceeding 50% of the invoicing submitted. Addressing this issue is of great importance, since it is essential from the perspective of patient safety to create learning opportunities for the different actors in the system to prevent these practices from becoming repetitive, with the aim of reducing risks for the patient. As an improvement proposal, the adoption of management methodologies such as the DMAIC cycle and integrated audits is suggested, aimed at reducing cancellations attributable to the institution, strengthening contractual processes within companies, and optimizing financial flow.These methods not only help design strengths in institutional processes to significantly reduce unjustified surgical cancellations, which consequently become recurring causes of billing claims, but also generate a positive impact on strengthening processes and improving resource flow. The improvement actions proposed in this research allow each performance area involved in institutional processes to establish structuring phases and monitoring strategies to constantly track institutional records. Once effective feedback of the improvement actions is carried out through administrative management and audits, it becomes possible to identify the data reflected in relation to the percentage of procedure cancellations. These figures make it possible to detect recurring causes and determine whether institutions are adhering to the established actions. For healthcare provider institutions, responsibly addressing this issue implies recognizing it as a performance indicator that must be monitored, analyzed, and optimized. In conclusion, surgical cancellations transcend the healthcare field and represent a strategic challenge for administrative and financial management. This challenge must be addressed by meeting the real needs of the Colombian Health System, studying in detail the barriers identified, and implementing cost-effective corrective actions to guarantee the sustainability and quality of surgical services in healthcare institutions
The cancellation of scheduled surgeries in healthcare provider institutions (IPS) represents a multifactorial problem with negative effects on service quality, patient satisfaction, and the financial sustainability of organizations. This research aimed to analyze the impact of administrative and financial management on surgical cancellations. In this research exercise, it was possible to identify causes attributable to the patient, healthcare staff, and, in greater proportion, to institutional administrative failures. The methodology used included document review, analysis of institutional indicators (P.2.15), and comparison with national and international studies. Findings show that more than 30% of cancellations are due to administrative failures (authorization errors, lack of supplies, or failures in contract management), and that these situations generate monthly losses exceeding One Hundred Fifty Million Pesos ($150,000,000) in institutions with a high surgical volume, in addition to claims exceeding 50% of the invoicing submitted. Addressing this issue is of great importance, since it is essential from the perspective of patient safety to create learning opportunities for the different actors in the system to prevent these practices from becoming repetitive, with the aim of reducing risks for the patient. As an improvement proposal, the adoption of management methodologies such as the DMAIC cycle and integrated audits is suggested, aimed at reducing cancellations attributable to the institution, strengthening contractual processes within companies, and optimizing financial flow.These methods not only help design strengths in institutional processes to significantly reduce unjustified surgical cancellations, which consequently become recurring causes of billing claims, but also generate a positive impact on strengthening processes and improving resource flow. The improvement actions proposed in this research allow each performance area involved in institutional processes to establish structuring phases and monitoring strategies to constantly track institutional records. Once effective feedback of the improvement actions is carried out through administrative management and audits, it becomes possible to identify the data reflected in relation to the percentage of procedure cancellations. These figures make it possible to detect recurring causes and determine whether institutions are adhering to the established actions. For healthcare provider institutions, responsibly addressing this issue implies recognizing it as a performance indicator that must be monitored, analyzed, and optimized. In conclusion, surgical cancellations transcend the healthcare field and represent a strategic challenge for administrative and financial management. This challenge must be addressed by meeting the real needs of the Colombian Health System, studying in detail the barriers identified, and implementing cost-effective corrective actions to guarantee the sustainability and quality of surgical services in healthcare institutions
Descripción
Palabras clave
Cancelación quirúrgica, Gestión administrativa, Eficiencia operativa, Sostenibilidad financiera, Servicios de salud
