Situational diagnostic

and
SWOT
Intensive care unit
Traumatology and Orthopedics Hospital
 Traumatology and Orthopedics Hospital

The main objective of management is “the performance of its function is to ensure that
nursing professionals reach the highest level of competence and commitment to ensure
personalized care for users.” In every work environment there must be strategic planning,
which is the foundation on which all the plans of an organization are built, which can be long
and short term. It is a broad plan that includes the future use of different resources in an
integrated pattern. and that establishes a sequence of required actions and chronological
programs for each one in order to achieve the stipulated objectives.
For this discipline, it is of utmost importance to prepare a situational diagnosis using
the strengths, weaknesses, opportunities and threats (SWOT) matrix in which areas of
opportunity will be detected and intervention actions will be formulated in the face of certain
conflicts and uncertainty that affect in this case to the intensive care service.
Addressing the needs in which an entire multidisciplinary team participates will help in
the improvement of intensive care at the traumatology and orthopedics hospital of Puebla
since the strategic plan will contribute to strengthening the work performance of the service,
therefore it is necessary to find the internal and external factors that are present in the
workplace and set goals or objectives that lead to improvement and quality for the service
provided.
Therefore, the importance of establishing a strategic diagnosis that allows identifying
opportunities for improvement in the service through lines of action that include training,
monitoring and evaluation programs in the medium and long term to improve the professional
development of the personnel of the Intensive Care Unit of the Traumatology and Orthopedics
Hospital.
 Content

Unit Description...................................................................................................................................................... 4
Infrastructure.......................................................................................................................................................... 5
Epidemiological Data.............................................................................................................................................. 7
Installed capacity.................................................................................................................................................. 12
Services Portfolio.................................................................................................................................................. 12
User Population.................................................................................................................................................... 13
Reference Units.................................................................................................................................................... 15
Performance and productivity data Processes and Subprocesses.......................................................................17
Human Resources................................................................................................................................................ 21
Material Resource................................................................................................................................................ 22
equipment............................................................................................................................................................. 23
Strategic Analysis (SWOT)................................................................................................................................... 25
Processes Noun Management.......................................................................................................................... 25
Processes Noun Human Resources................................................................................................................. 25
Processes Noun Material Resources................................................................................................................ 26
Processes Noun Nursing Care.......................................................................................................................... 27
Strategic diagnosis with prioritization.................................................................................................................... 29
 Unit Description
On November 19, 1988, the Traumatology and Orthopedics Hospital (HTyO) was
inaugurated by the President of the Republic Lic. Miguel de la Madrid Hurtado as governor of
the state of Puebla Lic. Mariano Piña Olaya, the general director of the Mexican Social
Security Institute Lic. Ricardo García Sainz, and delegation head of Medical services Dr.
Manuel Tovia Arrioja, coordinator of the nursing department at the Enfra Delegation level. Ma
del Carmen Ramírez García. The first director was Dr. Coronado Olea Benjamín and the
head nurse was Socorro Cuevas Reyes.
The creation of the HTyO was due to the need to provide care to a growing number of
accident victims and injuries as a result of crime, accidents and violent acts. Before that date,
services of this type were provided at the San Alejandro hospital until June 15, 1999, the
hospital suffered severe damage during the earthquake, for which reason it was necessary to
transfer patients and staff to the specialty hospital.
The traumatology and orthopedics hospital was reopened on November 18, 2000 by
Lic. Melquiades Morales Flores Governor of the State of Puebla and Lic. Mario Marín Torres
Municipal President of Puebla and in 2004 Dr. Carlos Francisco Morales Flores director of the
hospital, explained that it was granted the classification of High Specialty Medical Unit due to
the complexity of the services offered, the medical equipment with cutting-edge technology,
the training human resources for postgraduate health and conducting health research, which
is why it was designated the headquarters of the orthopedics and traumatology residency.
The new establishment was located in what had been the hospital of the National Railways of
Mexico dating back to 1968, whose location was immediate to important road arteries
Avenida Defensores de la República and 4 Poniente.
 Infrastructure
It is considered one of the three most important high-specialty hospitals in the country,
it provides high-quality surgical medical services required by traumatic and orthopedic
pathologies since it has pediatrics, geriatrics, donation, pain clinic and palliative care
programs, clubfoot clinic, interventional radiology and burn unit, intensive care unit, care is
also provided for patients with spinal and hip injuries, plastic surgeries, neurosurgeries, hip
and maxillofacial surgery, among others, are also performed.
Currently, the Traumatology and Orthopedics Hospital provides services to the states
of Puebla, Tlaxcala and Oaxaca, with a staff of 123 specialist doctors and 291 nurses, who
during 2019 performed seven thousand 924 surgeries, which despite the quarantine operates
normally. in its outpatient consultation services, emergency care, first-time and scheduled or
subsequent appointments, granting 253 specialty consultations daily, 153 emergency
consultations. In addition, it occupies fourth place nationally in the procurement of organs and
tissues, only that so far this year 20 donations have been made, 17 of them multi-organ and
three in cardiac arrest, of which: 30 kidneys were obtained , 24 corneas, 11 livers, three
hearts and a musculoskeletal tissue.

Services that the unit has

It has 112 census beds.

● 98 adult beds

● 14 pediatric beds

Non-censable beds 39

● 12 recovery beds for post-surgical patients.

● 2 crash

● 7 first contact

● 12 adult emergency observation

 ● 6 Intensive Care unit

Due to the current pandemic, a respiratory triage was adapted with 6 beds, this area is
waiting for transfer to the Manuel Ávila Camacho High Specialty Hospital or the General
Hospital of Zone Number 20.

● In the medical and surgical area, the specialties it has are: 2 spine and diaphysis
specialties, Pediatrics, Burn Unit, Neurosurgery, Plastic Surgery, Maxillofacial Surgery,
General Surgery.

● Specialty clinics: 6 traumatology and orthopedics, 1 plastic surgery, 1 neurosurgery, 1

pre-anesthetic assessment, 1 plastic surgery, 1 spine and diaphysis

● For diagnostic and treatment complementation there are: Rehabilitation therapies,

echocardiograph, holters, electrocardiograph, ultrasound, tomography and the X-ray
room with mobile equipment and C-arm, recently acquired.
There are 11 Specialty Clinics

● 6 Traumatology and orthopedics

● 1 Neurosurgery

● 1 Preanesthetic Assessment

● 2 Plastic and Reconstructive Surgery

● 1 Column and Diaphysis

 Epidemiological Data
Deaths from external causes are considered those that result from an injury and cause
death. In Mexico 2019, 83,882 deaths from external causes were recorded, of which 3,174
occurred in Puebla. Of the total deaths due to external causes, 39.97% (33,524) were caused
by an alleged accident, with 43.71% (36,661) being caused by an alleged homicide, and
6,376 deaths (7.6%) were accidental and violent.
The rate of registered deaths due to external causes per 100,000 inhabitants in the
period is 66.3, the states with the highest rates were Colima 129.9, Baja California 123.4 and
Chihuahua with 121.6. Puebla has a rate of 47.8.
Of the total accidents (33,524), the largest proportion corresponds to transportation
accidents, with 15,156 cases (45.2%), with a rate of 22.2 in Puebla.
Of the total deaths due to presumed accidents, 7,730 (23%) correspond to women and
25,758 (76.9%) to men, with adults aged 65 or older being the most affected, followed by
adults aged 25 to 34 and those from 15 to 24 years old.
 Source: National Institute of Statistics and Geography ( INEGI) 2020, deaths registered
in Puebla.
 The following causes of death were recorded at the Traumatology and Orthopedics
hospital:
10 Main Causes of Hospital Admission

No. Cause of hospital admission No. of patients

Progressiv
e
1 Intracranial trauma 8 patients

2 intracranial hemorrhage 6 patients

3 Subarachnoid hemorrhage 4 patients

4 Chest trauma 1 patient

5 Chest fracture 2 patients

6 3rd burns degree 1 patient

7 Spinal cord injury 3 patients
8 fractured poly 2 patients

9 Brain death 1 patient

10 Septic shock and pneumonia 2 patients

Source: Operational Medical Information System (SIMO), November 2021.

 The following table shows that the main causes of hospital admission to the
traumatology and orthopedics intensive care unit, in which 63% belong to head trauma,
followed by chest trauma with 10%.

Source: Operational Medical Information System (SIMO), November 2021.

 10 Main Causes of Hospital Death

No. Causes of death No. of

Progressiv deaths
e
1 Severe head trauma, contusion 18
2 Septic shock 7
3 Cranial hematomas 7
4 Multiple contusions, hypovolemic shock 3
5 Acute myocardial infarction 3
6 Multiple organ failure 2
7 Encephalopathy blunt trauma abdomen 1
8 Severe respiratory insufficiency 1
9 Neuroinfection 1
10 Cerebral stranding event 1
Source: July-November operational medical information system (SIMO) 2020
 Installed capacity

The Traumatology and Orthopedics Hospital has:

⮚ 112 census beds;

⮚ 98 adult beds

⮚ 14 pediatric beds

⮚ 39 Non-registerable beds;

⮚ 12 recovery beds for post-operative patients.

⮚ 2 crash

⮚ 7 first contact

⮚ 12 adult emergency observation

⮚ 6 Intensive Care Unit

Services Portfolio

It has outpatient and emergency care with the following specialties.

⮚ Traumatology and orthopedics

⮚ 2 Spine and Diaphysis Specialties

⮚ Pediatrics

⮚ Burn Unit
⮚ Neurosurgery

⮚ Plastic and Reconstructive Surgery

⮚ Surgery. Maxillofacial

⮚ General Surgery

⮚ Psychology

In them, 5,702 consultations were provided in November 2020.

Services Total queries

Specialty Medicine 4002
Emergency Medicine 1700
Total, Unit 5702
Anesthesiology 168
General Surgery 79
Maxillofacial Surgery 46
Plastic and Reconstructive
368
Surgery
Physical Medicine and
135
Rehabilitation
Internal Medicine 28
Neurosurgery 65
Traumatology and orthopedics 3113
First Contact Consultations 1700
Psychology 77
Source: Operational Medical Information System (SIMO), November 2021.
 User Population
In the Puebla delegation of the IMSS, until November there are:

IMSS RIGHT-HOLDING POPULATION 2020

Assigned 1963728
Source: Affiliated beneficiary population (PDA), Mexican Social Security Institute,
November 2021.

Total
Men 955223
Women 1008505
Grand Total 1963728
Source: Affiliated beneficiary population (PDA), Mexican Social Security Institute, November
2021.
 Reference Units

Family Medical Unit Address

1 Calle 11 Sur 1305, Barrio De Santiago, 72410 Puebla, Pue.
Tlanalapan Manuel Ávila Camacho 625a, Col Ojo De Agua,
11 74042 San Martín Texmelucan De Labastida, Pue.
Calle 4 Nte 1001, Barrio De Jesús Tlatempa, 72760 San
12 Andrés Cholula, Pue.
11 Sur O, Constitución De 1917 5525, Bosques De Atoyac,
13 72459 Puebla, Pue.
14 Calle Vicente Guerrero 13, Vista Hermosa, Puebla, Pue
16 Calle 2 Sur 906 Tecamachalco, Col. Tecamachalco Center,
Calle Aldana S/N Xicotepec De Juárez, Col. Livestock,
17 Xicotepec
Avenida Primero De Mayo 238 Nuevo Necaxa, Col. Nuevo
18 Necaxa, Juan Galindo
Calle Corregidora 2 Huauchinango, Col. Huauchinango
19 Center, Huauchinango
Calle 9 Oriente 420 Heróica Puebla De Zaragoza, Col.
2 Center, Puebla
Avenida 14 Sur 3106 Heróica Puebla De Zaragoza, Col.
21 Anzures, Puebla,
Calle Del Ferrocarril S/N Teziutlán, Col. El Fresnillo,
22 Teziutlán,
Mexico-Oaxaca International Highway S/N Izúcar De
Matamoros, Col. Izucar De Matamoros Downtown, Izúcar De
24 Matamoros
Avenida De Los Pinos 15 Aire Libre (La Mina), Col.
25 Outdoors, Teziutlán,
Federal Highway Izucar De Matamorosatencingo Km. 18.5
26 Atencingo, Col. Atenzingo, Chietla,
Cuahutemoc Avenue 932 Ajalpan City, Col. Ajalpan,
27 Ajalpan,
Tehuacanteotitlán Highway Km. 32.5 Calipan, Col. Calipan,
28 Coxcatlán
Tehuacanteotitlán Highway Km. 55 San José Tilapa, Col.
29 San José Tilapa, Coxcatlán
Calle 5 De Febrero Oriente 206 Heróica Puebla De
3 Zaragoza, Col. San Felpe Hueyotlipan, Puebla,
Avenida Independencia Poniente 200 Tehuacán, Col. City
30 Center, Tehuacán,
Calle Victoria E Independencia S/N Chietla, Col. Chietla,
31 Chietla,
32 Calle Independencia 1 Lagunillas De Rayón (Alchichica),
 Col. Lagunillas Escape, Chietla
Avenida 5 Poniente 1 City of Rafael Lara Grajales, Col.
33 Rafael Lara Grajales, Rafael Lara Grajales,
Avenida Manuel Ávila Camacho 1102 Atlixco, Col. Atlixco
34 Center, Atlixco,
Avenida Ávila Camacho 1299 Ciudad De Libres, Col. Free
37 Center, Free,
Avenida Nicolas Bravo 1 Palmar De Bravo, Col. Palmar De
38 Bravo, Palmar De Bravo
39 Calle Canutillas S/N Zacatlán, Col. El Fresno, Zacatlán,
Avenida 14 Sur 3106 Heróica Puebla De Zaragoza, Col.
4 Anzures, Puebla
40 Calle 23 Poniente S/N Oriental, Col. Eastern, Eastern,
Boulevard Carlos B. Zetina S/N Huejotzingo, Col. Second,
41 Huejotzingo
42 Calle 2 Norte S/N Tepeaca, Col. San José, Tepeaca,
Calle 2 Norte S/N Ciudad Serdán, Col. From Guadalupe,
43 Chalchicomula De Sesma,
Avenida Sinaloa 26 Tlacotepec De Benito Juárez, Col.
44 Tlacotepec De Benito Juárez, Tlacotepec De Benito Juárez,
Avenida Sinaloa 26 Tlacotepec De Benito Juárez, Col.
46 Tlacotepec De Benito Juárez, Tlacotepec De Benito Juárez,
Calle Guillermo Prieto S/N San Miguel Xoxtla, Col. San
47 Miguel Xoxtla, San Miguel Xoxtla
Calle Rio Papaloteno S/N City of Tetela De Ocampo, Col.
49 Zoyatitla, Tetela De Ocampo
Calle Joaquin Osorio S/N Acatlán De Osorio, Col. La Palma,
50 Acatlán
Avenida De Las Torres Corner with Roble S/N Heróica
55 Puebla De Zaragoza, Col. Infonavit Amalucan, Puebla
Avenida De Las Torres Corner with Roble S/N Heróica
56 Puebla De Zaragoza, Col. Infonavit Amalucan, Puebla
Avenida Fidel Velázquez S/N Heróica Puebla De Zaragoza,
57 Col. Infonavit La Margarita, Puebla,
Benito Juarez Street No. 58 Colonia Centro, Col.
58 Tenampulco
6 Av 15 De Mayo S/N, Valle Dorado, 72070 Puebla, Pue
San Bartolo B Poniente Circuit S/N Heróica Puebla De
7 Zaragoza, Col. Infonavit San Bartolo, Puebla
Avenida Del Trabajo 57 Heróica Puebla De Zaragoza, Col.
8 Mayorazgo, Puebla,
Calle 31 Poniente 1418 Tehuacán, Col. Santa María
9 Coapan, Tehuacán,
 Performance and productivity data Processes and Subprocesses

Average Bed Days

Patient Days = 3360 patients

Occupancy Percentage=83%

Intensive Care Unit Bed Days=180

Patient days in ICU: 32%

General Stay Days=5.6

Intensive Care Unit=6.7

Deaths

Overall =9.6

Intensive Care Unit =5.2

Mortality rate

Overall=1.88

Intensive Care Unit=12.4

ICU Hospital Admission=18.8%

Quality indicators
 Hand Hygiene Compliance

Hand washing is the main measure to reduce intranosocomial infections. These infections
increase morbidity and mortality. The use of alcoholic solutions reduces the incidence of
nosocomial infection by 40%.

Decent nursing treatment.

Oral administration of medications

Evaluation of clinical records, therapeutic scheme and nursing interventions.

Prevention of falls in hospitalized patients.

Human Resources
Relevant Data

-The ICU has a full staff of nursing staff

-There are 6 floor managers distributed in different shifts
-66.7% of nursing floor managers have a bachelor's degree
-19% of the operational nursing staff have a bachelor's degree
-62.5% of the intensive care staff corresponds to nursing
-Experience of most nurses greater than 10 years
-The ICU service works 24 hours a day, 365 days a year
-18.75% of the Intensivist Specialist nursing staff attend continuous training in monographic
courses
-The nursing staff has the following qualities:
i) 90% of the ICU nursing staff is responsible.
ii) 80% of the nursing staff works as a team.
-The nursing staff is competitive
-Strengthen effective communication between operational colleagues.
-Unscheduled absenteeism causes conflicts due to overload
-Scheduled absenteeism is covered with general nurses who carry out leveling in the ICU
(vacations)
-Newly recruited staff have a low level of theoretical and practical knowledge, generating
deficiencies in patient care.
-There is resistance from some members of the operational staff to wear the uniform
correctly.

Material Resource
Relevant Data
The ICU has the necessary electro-medical devices in good working order for the care of
critically ill patients, such as:
Infusion pumps
monitors
pulse oximeters
Mechanical fans
-It has a fixed supply of consumer materials
-The instruments used in the service are: 4 healing kits with 2 tweezers, 4 suture kits with 3
tweezers.
-There is a supply of hospital clothing which is sufficient for the three shifts, although half is
given for the night shift since sponge baths are not performed.
-There are 6 functional and complete electric beds
-The provision of parenteral solutions is sufficient to supply the service
-There is a fixed supply of sufficient controlled and high-cost medications
-There is a complete inventory of furniture: 9 chairs, 3 desks, 2 shelves, 6 antibacterial
curtains, 6 high benches, 2 reclining chairs, 3 healing chairs, 6 May tables, 2 stainless steel
sinks and a nursing control
-There are 6 complete life support teams for patient care.
-existence of two computers to monitor patients from the nursing control which have not been
working for two months and a printer which does work.
-There is a computer equipment for use by the head nurse to request medications from
CADIT
- There are two typewriters in good condition that the medical department uses to make
notes.
-There are 6 file folders
-A refrigerator which is used for medicines to be kept in good condition, which is monitored
every two hours to ensure that the temperature is adequate.
-It has a fire extinguisher with hose for hydrants in case of fire.
-The service has two video surveillance cameras
-The provision of insufficient consumer material for the needs of the service:
Sterile pads, 20ml syringes, Disposable gloves, Adhesive cloth, Adult diapers
-There are test strips and a functional glucometer for the ICU service.
-The service does not have antiseptic solutions, which implies that the nursing staff in charge
of patient care has to move from the unit, putting care at risk.
- In units 3 and 4 of the intensive care service, the bed mattresses are broken and in poor
condition.
-Two chairs resting for patient mobilization are broken
-The service does have a file cart

equipment
Relevant Data
- It has a triangular design in accordance with the provisions of NOM-016-SSA3-2012.
-Adequate lighting of the service.
-The 6 units are functional and viable for patient care
-Washable walls to avoid nosocomial infections
-Non-slip floors for the safety of patient transfer and hospital staff
-It has 2 hot-cold mini Split equipment.
-Each unit has two oxygen nozzles and two air nozzles.
-Each unit has two oxygen nozzles and two air nozzles.
-The ICU area is in a good location since it has communication with the operating room,
emergency room, CEyE and laboratory
-The dimensions of each cubicle are 3.20 meters x 1.20 meters and do not correspond to
what is established by NOM-016-SSA3-2012, which is 9 m 2 per patient unit;
-Each cubicle is isolated and has a transparent door
-The circuit of the lower electrical current contacts of the units are not functional, the light
switch of unit 3 is broken and the mini Split does not cool
-It does not have an air extractor for the environment.
- There is a septic tank to leave dirty clothes, commodes, urinals and garbage
-service cleaning is only done once per shift
 Strategic Analysis (SWOT)

Processes Noun Management

Management Management
Internal analisis
Strengths Weaknesses
F1 Training and Supervision Program D1 Unscheduled absenteeism (4%).
F2 Nursing quality indicators D2 Insufficient operational supervision.
F3 Monitoring and evaluation instruments D3 Insufficient knowledge and training in the
F4 Appropriate distribution of the area management of the EJP.
F5 Schedule of basic services activities D4 Schedule of activities.
F6 Methodology for the preparation of D5 Prolonged length of stay of patients in
METS, Manuals, Guides, etc. ICU services.
D6 Lack of follow-up to the work program

External analysis
Opportunities Threats
O1 Existing Official Mexican Standards. A1 Change of focus and management
O2 Dissemination and continuous training of portfolio structure.
staff. A2 Inaccessibility and/or delay to internet
O3 Clinical nursing records. technology and medical equipment.
O4 Quality assessment in nursing. A3 Adverse events and sentinels.
O5 Technology adopted for nursing activities A4 Insufficient commitment of the unit's
(platforms, reports) governing body
O6 Work meetings with SJE A5 Insufficient knowledge in strategic
O7 Visits from the supervision team planning of personnel
O8 Monitoring and evaluation instruments executive
O9 Report delivery traffic lights

Processes Noun Human Resources

Human Resources
Internal analisis
Strengths Weaknesses
F1 Adequate Theoretical Template. D1 Poor implementation of the nursing
F2 Nursing staff rotation. process.
F3 Distribution of activities by category D2 Lack of trained personnel in priority
F4 Institutional regulations. programs.
F5 Induction into the position in a systematic D3 Lack of permanent stretcher staff on
and permanent manner weekends.
F6 Interaction of nursing management staff D4 A floor manager for two services (ICU -
that promotes an educated climate Emergency)
F7 Personnel with preparation of post- D5 Lack of General Nursing Assistant
technical courses and with career change D6 There are no nursing staff to cover
incidents
D7 Nursing staff who qualify as ICU
specialists sometimes do not receive their
corresponding payment
D8 Inadequate shift liaison and
individualized work (20%).
External analysis
Opportunities Threats
O1 Training program. A1 Leaves due to pandemic (COVID).
O2 Supervision program Quality indicators in A2 Constant changes in category, shift and
the nursing process. assignment.
O3 Supervisions by EJP and SJE. A3 Illnesses and deaths of personnel.
O4 Detection of training needs. A4 Resistance to activity and innovation
O5 Nursing staff recognition program. A5 Routine and thoughtless nursing activity
O6 Personnel development in the effective A6 There is no educational program for the
and human aspect accompanying family member, they show
O7 Expression of staff of their needs for little involvement with their patient's
recognition and support treatment
O8 Coordination with chief of staff to resolve
any D1 SJE problems that affect
management activities

Processes Noun Material Resources

Material resources
Internal analisis
Strengths Weaknesses
F1 Timely supply of material resources. D1 Inadequate RPBI classification.
F2 Optimal technology in monitors, infusion D2 Equipment not functioning for monitoring
pumps, ventilators, endotracheal tube from the nursing center.
(closed circuit), X-ray equipment. D3 Insufficient beds in ICU (6).
F3 Adequate infrastructure per cubicle. D4 Lack of control, clothing, supplies,
F4 Provision of appropriate hospital clothing. medications.
F5 Timely detection and management of D5 Ant theft of medicine and materials by
input shortages staff.
F6 Preventive maintenance and furniture D6 Poor use of clothing on the night shift
D7 Waste in the use of inputs by the staff.
D8 Fixed matter pools are not authorized
External analysis
 Opportunities Threats
O1 Suppliers that provide equipment repair A1 Modifications to the basic material table.
(with warranty). A2 Change of tender.
O2 Clothes washing center that supplies A3 Population growth.
with opportunity. A4 Increase in the price of material
O3 CADIC. resources.
O4 Existence of supplies in central A5 Denied keys and insufficient authorized
warehouse according to CPMS increase budget
O5 Support from other hospital units at the A6 Damage to equipment
time of shortage A7 Warehouse shortage
O6 Comprehensive programs that provide A8 Lack of fixed clothing funds in services
the resource according to care needs in the
hospital unit.

Processes Noun Nursing Care

Nursing Care
Internal analisis
Strengths Weaknesses
F1 VENCER II System D1 Insufficient records of Nursing
F2 Systematization of records of nosocomial interventions (20%).
infections. D2 Newly hired staff with little experience in
F3 Standardized nursing process in clinical the area.
practice guides. D3 Disinterest and detachment of the worker
F4 Technical-administrative instruments for from the rules, instruction manuals and
evaluation and supervision. guides.
F5 Quality evaluation as a management tool D4 Lack of attendance of Nursing staff to
F6 Emergent plans as strategies for scheduled courses (18.7%).
improvement D5 Lack of knowledge and attachment to
F7 Openness to teaching by staff nursing care
D6 Failure to complete a clinical record in
accordance with the nursing process A5

External analysis
Opportunities Threats
O1 Training program. A1 Increase in chronic degenerative
O2 Professionalization-degrees. conditions.
O3 Update of courses and specialties. A2 About demand for care (increase in
O4 International patient safety goals. population).
O5 Evaluation of nursing care (indicators, A3 Culture of the population with an
safety, quality) inclination towards the curative aspect and
O6 Interaction with patients on aspects of not the preventive aspect
well-being and care provided by nursing A4 Disinterest and detachment of the worker
O7 Nursing Performance Recognition from the rules, manuals, instructions and
Program guides
O8 Unit Certification A5 Massive medical information (internet)
poorly understood by patients
A6 Lack of collaboration of the
multidisciplinary team in interaction with the
nursing process
 Strategic diagnosis with prioritization
Prioritization was carried out in order of importance, where a rating was given according to
what was valued, according to the following scale: 4 = highest rating and 1 = lowest rating.

No. Substantive Problem detected Impact Transcendence Viability Vulnerability Total

Process
D1 Inadequate RPBI
1 Materials 4 4 4 4 16
classification (50%)
Manageria D2 Insufficient
2 4 4 4 3 15
l operational supervision.
Nursing D1 Inadequate completion
3 of nursing clinical records. 4 4 4 3 15
Care
D5 Lack of permanent
Human
4 General Nursing Assistant 4 4 3 3 14
resource personnel in the service.
D4 One head for two
Human
5 services (ICU- 4 4 3 3 14
resource Emergency).
D3 Lack of permanent
Human
6 stretcher staff on 3 4 3 3 13
resource weekends.
D2 Monitoring equipment
7 Materials without optimal 3 3 3 3 12
functioning.
D7 Shortages and
8 Materials anomalies of material 3 3 3 3 12
inputs in the service.
D8 Inadequate shift liaison
Nursing
9 and individualized work 3 3 3 3 12
Care (20%).
D4 Lack of attendance of
Nursing
10 Nursing staff to scheduled 4 2 2 2 10
Care courses (18.7%).
Nursing D3 Lack of adherence to
11 procedure manuals. 4 2 2 2 10
Care
 Produced by:

I. Reyes López Viridiana Gabriela