This paper examines the process of improving a diabetes disease program in a Promoting Health Institution (IPS, the Spanish acronym), in order to achieve a better adherence from the physician to the clinical guidelines, and from the patient to the program, through the application of the methodologies Chronic Care Model (CCM), Clinical Decision Support Systems (CDSS), and Lean Six Sigma.

This study analyzed a program in an uncomplicated diabetic population of one IPS, which has introduced a growth in diabetes prevalence over the last 3 years. Semi-structured interviews were carried out with the program managers, and secondary data were collected in order to identify the main causes of adherence process failure, through SIPOC, DMAIC, identification of potential failure modes, critical requirements analysis for quality, and necessary resources for timely and focused patient care.

It was found three main factors affecting adherence to the program. Therefore, several solutions were proposed based on: a) system capacity enhancement through care cells by patient profile. The above with the aim of improving the opportunity and the physician's resolution, using Jackson networks model (b) methods and processes enhancement by involving patients as partners in self-care; and (c) control mechanisms improvement through program adherence tools, in order to facilitate monitoring to the indicators of patient diabetes control as well as make better decisions.

The improvement proposals pointed to guarantee a better adherence control. It was also important to verify the practical validity of analyzing a health scenario, through sector-specific tools, and industrial engineering tools; which allow to solve issues of adherence lack to health programs.

Keywords

Lean Six Sigma, Chronic Care Model (CCM), Clinical Decision Support Systems (CDSS), Processes Enhancement, Health Programs.