Table 3 Extraction of relevant quotations
Themes | Illustrative quotations | Interviewee |
|---|---|---|
People-related factors | ||
Leadership | “At the strategic or functional level they define and develop and promote an idea and there is a disposition but after that they are failing with the implementation.” | Group 1, Macro – International Expert O.2._201503101730_MEX |
“There was once, in the past two administrations, during president Fox and president Calderon, very interesting quality assurance strategies for all public institutions. Again, mostly based on interpersonal quality and what the different institutions and the different facilities… what they achieved in terms of quality… depended a lot of the interest of particular clinical groups.” | Group 1, Macro - Evidence synthesis O.2._201502231200_MEX | |
“So in Mexico we have the problem that they don’t talk to each other, they don’t understand each other and there is no governance… so that the way how they solve the problem is rather voluntary than an organizational or systemic matter.” | Group 1, Macro - Evidence synthesis O.2._201502271200_MEX | |
Knowledge competence | “The research culture here in Mexico is unfortunately very low in comparison with the culture of other north American or European countries…” | Group 1, Macro – Society O.2._201503191830_MEX |
“We still don't have a clear consciousness of the importance of implementing quality assurance measures at the system level. Quality concerns are concerned mostly of few groups within institutions. So I think the big challenge, the first initial challenge would be to develop a better consciousness of the importance of continuous improvement. This is I think the main challenge.“ | Group 1, Macro - Evidence synthesis O.2._201502231200_MEX | |
“… sometimes we receive drugs of very good quality. But sometimes we receive very bad quality because procurement doesn’t focus on this… As long as a drug passed the requirements of the health regulation of COFEPRIS there is a market…” | Group 1, Macro - Evidence synthesis O.2._201502271200_MEX | |
Knowledge sharing | “The doctors don’t always accept to provide this information. Let’s think about health records. This is really a problem that the doctors use them correctly… the information that is collected is little reliable.” | Group 1, Macro – International Expert O.2._201503101730_MEX |
“The problem is that many don’t fill in the type of incident … they don’t provide the name of the product. Therefore we cannot make a match and process the complaint adequately…” | Group 1, Macro - Evidence synthesis O.2._201503120900_MEX | |
“… nobody notifies about adverse reactions in this country…” | Group 1, Macro - Evidence synthesis O.2._201503091215_MEX | |
Mutual learning & skills | “… they are still duplicating their efforts… but what is difficult to change is the burocratic territory of each institute and there is no incentive that could motivate them to focus on a common purpose… an therefore they make what they can but not always coordinated…” | Group 1, Macro – International Expert O.2._201503101730_MEX |
“I believe that we have to improve the quality … conceiving a better interrelation between COFEPRIS and other federal units of the secretariat of health.” | Group 1, Macro - Evidence synthesis O.2._201503091215_MEX | |
“Because we don’t have, neither the resources and very probably we don’t have the expertise needed to follow up and to organize this kind of interventions.” | Group 1, Macro – Society O.2._201503232000_MEX | |
Organization-related factors | ||
National processes or structures | “… apart of adverse events there is no intermediate information available. So there is a lot of information that we loose… as surgeon you are very limited with regards to access information…” | Group 1, Macro - Evidence synthesis O.2._201503091215_MEX |
“I believe the weakest area is the federal with COFEPRIS and the strongest area is the Consejo de Salubridad General by means of CENETEC which is step by step better involved in the evaluation of medical technologies in a broad sense.” | Group 1, Meso - Institution O.2._201503121800_MEX | |
“The problem is that no one makes a follow-up of the output of results. Recently the secretariat of health has started to establish an evaluation system of the performance of hospitals.” | Group 1, Macro – International Expert O.2._201502240930_MEX | |
Organizational processes or structures | “They provide us with some type of report, they inform us in general about number of prosthesis and patients… but we don’t receive more information.” | Group 1, Meso – Institution O.2._201502241600_MEX |
“Further many federal units have different organizational structures so that this makes the situation even worse… they are heterogeneous so that en some units they are well organized… but in others there doesn’t even exist such an organization to adapt specific programmes…” | Group 1, Meso – Hospital O.2._201503171700_MEX | |
“When you ask what is the number of intra hospital infections that we have in Mexico nobody can provide you with a general number… this is something that haven’t been established in Mexico.” | Group 1, Macro – International Expert O.2._201502240930_MEX | |
Management-related factors | ||
Strategy | “… programmes are established, they are effused like documents to be used but rarely there is a control if these programmes are realized… especially at the level of the secretariat of health… There is a deficiency beginning at the central legal level up to the state level where there are no adequate strategies to implement a program to improve quality.” | Group 1, Meso – Hospital O.2._201503171700_MEX |
“The healthcare systems remains in the 21st century or migrated back to the 20th century. What I want to say is that this system is focusing to cover crises, episodes, but does not attend patients.” | Group 1, Macro - Evidence synthesis O.2._201502271200_MEX | |
“…we are not using the information. We are collecting it and we are organizing it, we have the conditions to use it at very different levels, at the clinical level, at the top management level, but we are not using it. ” | Group 1, Macro - Evidence synthesis O.2._201502231200_MEX | |
Goal | “The problem is that we are affiliating people and little by little starting to guarantee regular access to comprehensive service. Unfortunately the overall quality of the services that are being provided is still very low especially at the ambulatory level. So, it is good, that we are expanding coverage, but we need to expand coverage with quality. If not, we are misspending the resources we have mobilized. ” | Group 1, Macro - Evidence synthesis O.2._201502231200_MEX |
“Recently a new epoc has started where we can say what are the palliative aspects that impacted … The famous collateral damages or additional expenses, or I had to keep the patient hospitalised longer because I could not operate him because the implant failed.” | Group 1, Meso – Hospital O.2._201503130830_MEX | |
“If you go to a hospital and you want to certify it and you ask them “Is there technical support for cardiotocography in the urgency unit”, the answer may be yes but no one would ever ask if they also know how to interpret the data.” | Group 1, Macro - Evidence synthesis O.2._201502261200_MEX | |
Measurement | “… the interesting thing is that there were no indicators for the number of prescriptions that are aligned with the clinical guidelines.” | Group 1, Macro - Evidence synthesis O.2._201503091215_MEX |
“And so, here most time the evaluations stop evaluating the existence of a product…” | Group 1, Macro - Evidence synthesis O.2._201502261200_MEX | |
“…The infrastructure is limited and this is a serious problem because there is interest … but also the money is an important limitation…” | Group 1, Macro - Evidence synthesis O.2._201502261115_MEX | |
Information technology-related factors | ||
Infrastructure | “… There are two problems that I can identify: One is the absence of basic information systems … our information is in general not systemised.” | Group 1, Macro – International Expert O.2._201503101730_MEX |
“Our registries are not complete, they are not reliable because not everything is registered. Therefore it is an idea of numbers… but a precise number requires a good registry with a very good systematisation…” | Group 1, Meso - Hospital O.2._201502251245_MEX | |
“…There might exist a lot of data in the different social security systems or within the same system but they are not in a single database” | Group 1, Macro - Evidence synthesis O.2._201502250830_MEX | |
Applications | “And one of the more serious problems is the information system. They are not based in patients, they are based in medical consultations, in hospitalization…” | Group 1, Macro - Evidence synthesis O.2._201502271200_MEX |
“In some institutes … they do have an electronic health record, but it is another deficiency that our country was not able so far to consolidate the electronic health records on national level…” | Group 1, Macro - Evidence synthesis O.2._201502261200_MEX | |
“… it is very difficult in the big hospitals and not all do have a health record, there are big hospitals that have health records but they don’t use it.” | Group 1, Macro - Society O.2._201503191830_MEX | |
Factors related to the role of knowledge from clinical procedures | ||
Relation of orthopaedic specialist and procurement | “… because the procurement process here in … is rather confidential, not all doctors participate, and sometimes it is very superficial so that it is only about affirmative or negative, but … often someone like a doctor doesn’t participate.” | Group 2, Micro - Social Security O.2._201502241300_MEX |
“They don’t take into consideration the surgeon to take decisions because often the administrators decides and they buy things that no one uses.” | Group 2, Micro – Ministry of Health O.2._201503121730_MEX | |
“… this decides the head of the department together obviously with the hospital director and … it is like a rather private situation…” | Group 2, Micro - Social Security O.2._201503121830_MEX | |
Knowledge informed decision-making | “…no because it is expected that they (COFEPRIS) have taken care of it, they have test it and everything is good and this is not true, many time not.” | Group 2, Micro - Social Security O.2._201503241330_MEX |
“… many times the decision-making is based on the material type and economical aspects or the cost of these implants.” | Group 2, Micro - Social Security O.2._201503181300_MEX | |
“No, I think it is very bad (information flow between micro and meso level) what is exchanged between us because we have requested a meeting between the people of the Seguro Popular and us to explain which material is good and adequate for the patients. But this has never taken place…” | Group 2, Micro – Ministry of Health O.2._201503131230_MEX | |