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The quality on medical attention and its evaluation have evolved since 1960 when the medical audit through the evaluation of the medical chart, surgery supervision, productivity measure, quality guarantee, continuous updating and total quality started. However, there is a need for changes in the quality process towards new generations of development and continuous update; but for this we need an open disposition to change. For an efficient progress towards change, it is required an effective exercise of leadership that handles it, that creates a vision and strategies, that develops teamwork, encourages and supports. An effective leadership depends on the leader's qualities whether they are born or developed, to take a group of people to achieve planned objectives; to interact with his/her team members; about his/her exercise of power: with a proper balance between accomplish the goals and caring for people; about his/her skills: listen to his team members, identify their needs and encourage them to achieve their goals The leader must choose the most appropriate type of leadership in accordance to his/her skills, surroundings, the maturity of the team members, the updated situatio. [ABSTRACT FROM AUTHOR]

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Hospital evaluation is a fundamental process to identify medical units' objective compliance, to analyze efficiency of resource use and allocation, institutional values and mission alignment, patient safety and quality standards, contributions to research and medical education, and the degree of coordination among medical units and the health system as a whole. We propose an evaluation system for highly specialized regional hospitals through the monitoring of performance indicators. The following are established as base thematic elements in the construction of indicators: safe facilities and equipment, financial situation, human resources management, policy management, organizational climate, clinical activity, quality and patient safety, continuity of care, patients' and providers' rights and obligations, teaching, research, social responsibility, coordination mechanisms. Monitoring refers to the planned and systematic evaluation of valid and reliable indicators, aimed at identifying problems and opportunity areas. Moreover, evaluation is a powerful tool to strengthen decision-making and accountability in medical units.

Human beings have a natural resistance to think about their old age, both personally and professionally. Governments have targeted efforts to successfully prolong the life of the population, situation which already is a social and economic problem. “Old is a person with physical, intellectual and emotional limitations, who has a reduced autonomy and welfare, as a result of the years lived”. Not everyone ages at the same age; it will depend on health, habits, physical and intellectual activity, nutritional status, vices and attitude towards life. A physician may decide not to continue exercising medicine due to: health problems, because they do not want to, because they do not feel competent, because of the risk of having to deal with a complaint or a lawsuit, to have a new life project, or because they have no patients. The options available for a doctor at the time of retirement will depend on his/her age, health status, stage of the aging process: autonomy, dependency or old age; his/her physical and mental condition, professional development, economic situation and family environment. A doctor may remain independent, join another family or seek shelter in a retirement home.

In the present work, we present an analysis of ethics in the practice of medicine, as a fundamental element of the quality of medical care. We present a brief review of factors related to the development of ethics. In this paper we have shown different institutional and societal conditions for the definition and promotion of ethics. We present a conceptual analysis of the quality of medical care and how ethics interplays with the care given by medical practitioners and how that combination of quality medical care and adherence to ethical principles are used to solve health problems, with a high-degree of satisfaction to both patients and their families. Before entering into the conceptualization of each of the ethical principles of medical practice, the concepts of morality, ethics, bioethics, medical ethics, and ethical deontology are defined. We continue with the proposal of ten ethical principles of medical practice that include charity, fairness, autonomy, confidentiality, respect, dignity, solidarity, honesty, loyalty, and justice, and the concept of each of them, as well as the precepts that each principle contains.