Highlights. It is necessary to manage adverse events in order to maintain health and safety of patients and medical workers in the process of healthcare. One of the tools that can improve the system of managing such events is the Poka-Yoke technique.Aim. To theoretically justify and analyze the possibility of using lean manufacturing tools in the management of adverse events to ensure the quality and safety of healthcare.Methods. The analysis of domestic and foreign literature, regulatory and legal documentation for the period from 2015 to 2021 was carried out. The following keywords were used as search terms: “adverse events”, “medical error”, “risk management in healthcare organization”, “Poka-Yoke technology”, “adverse events management system”. The Russian Science Citation Index database, “Garant” reference system and Google Scholar search engine were used to find full text publications. The analysis of public reports of government officials on the issues of improving the safety of healthcare was carried out. The methods of system and logical analysis were used for the analysis. The article presents the experience of developing an adverse events management system at the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” (Kemerovo, Russia).Results. The analysis revealed a variety of approaches to management of adverse events. The authors believe that the “Poka-yoke” method, described in the set of national standards and technical specifications maintained by the Russian Federation “GOST R 56407-2015 Lean manufacturing. Basic methods and tools”, can be implemented in the process of managing adverse events. The main advantage of Poka-yoke method is the fact that it is prevention-based; thus, it is possible to introduce the concept of zero defects in healthcare process. The experience of the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” confirms the expediency of using this technique for the development of the adverse events management system.Conclusion. Implementation of the Poka-Yoke technique leads to the improvement in the adverse events management system.
Highlights. Telehealth remote monitoring for patients with arterial hypertension has been developed and implemented. A nurse coaching approach has been reported.Aim. To develop and implement the technology of remote dispensary observation of patients with arterial hypertension (AH) using telemedicine, in which the main performer is a clinic nurse.Methods. The research object is patients with AH who are under dispensary observation at the territorial polyclinic. The study included 183 patients aged 53±12.5 years, of which 64.5% were women. The duration of observation is from 30 to 90 days. The effectiveness was evaluated on the basis of the achievement of target values of blood pressure (BP), number of visits to the doctor for hypertension decompensation, patient compliance. The program used data processing technology applying telemedicine devices for automatic BP measurement.Results. In 75.5% of cases, there was a decrease in the average level of systolic and diastolic BP in comparison with the initial levels. A decrease in the maximum systolic BP and in the frequency of decompensation episodes of BP above 160 mm Hg was recorded in 15.8% of patients. Achievement of the target BP level was identified in 64.2% of patients, in 11.3% there was a positive dynamic in the clinical condition without achieving the target figures, in 24.5% of cases, no dynamics was found. The majority of patients (84.2%) preferred remote forms of counseling while maintaining a stable level of indicators. Among 15.8% of patients, the number of visits to a doctor decreased from 2.0 to 0.75 visits per month. High adherence to preventive measures was observed in 88.7% of cases; 100% of patients in the observation group confirmed the use of prescribed antihypertensive drugs.Conclusion. The original technology of remote dispensary observation of patients with AH using telemedicine devices enhances the continuity in “doctor-nurse-patient” interactions, which contributes to the improvement of medical efficiency by increasing the proportion of patients in the dispensary group who have reached the target level of BP and increase the patients' adherence to preventive measures. Telemedicine technologies reduce the number of scheduled and urgent patient visits to a polyclinic, which is relevant in the context of the shortage of medical personnel and the transition to remote consultation due to the restrictions caused by the epidemic threat [17].
Aim. To assess the effectiveness of QMS implemented by Research Institute for Complex Issues of Cardiovascular Diseases (NII KPSSZ) in 2020 and determine the impact of force majeure event (COVID-19 pandemic) on the achievement of the goals and objectives of the organization.Methods. 11 QMS processes of the NII KPSSZ in 2020 were analyzed according to 98 performance criteria. The following general scientific methods were used for the assessment of QMS: analysis, synthesis, structural and systems analysis.Results. The overall effectiveness of the QMS in 2020 was 83.5%, for the individual processes it varies from 57% to 100%. Achievement of target indicators in accordance with the criteria reflects the effectiveness of risk management in QMS processes. 27 criteria were added (9 of which were reformulated) as a result of the development of the system and the analysis of work experience in unusual circumstances for year 2021. At the end of 2021, QMS will be analyzed according to 117 criteria for the processes effectiveness.Conclusion. The presented experience of quality management system functioning in 2020 highlights the significant roles of monitoring of the main processes and performance indicators analysis of scientific and medical organization in the ongoing COVID-19 pandemic. Such analysis is a necessary for decision-making because it allows the organization to fulfill the obligations, maintain conditions for increasing stakeholder satisfaction, monitor risks and assess opportunities associated with the environment and objectives of the organization, and ensure compliance with the standard requirements, regulations and legislation.
Aim. To assess the correspondence between the results of the European Social Survey (ESS) “The Impact of Medical Activity Bureaucratization on Professional Values of Personnel” and the results of sociological surveys of personnel of medical organizations such as Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases (NII KPSSZ) and Federal State Budgetary Institution “Kuzbass Clinical Cardiology Dispensary named after academician L.S. Barbarash” (GBUZ “KKKD”).Methods. Comparative analysis of the results of ESS (3271 medical workers from 29 countries were questioned) and the results of sociological surveys of the medical personnel at NII KPSSZ (204 respondents in 2017) and at GBUZ “KKKD” (385 respondents in 2021) was carried out.Results. According to the survey data of employees of NII KPSSZ the dominant values are: professionalism and conscientious attitude to work, respectful attitude to colleagues and patients, strict compliance with law and regulatory requirements. Among the main values of GBUZ “KKKD” staff the following were named: discipline and order in fulfilling responsibilities, professionalism and conscientious attitude to work, and respectful attitude to patients.Conclusion. On the basis of the comparative analysis, the authors proved the validity of the conclusions and results of an international study devoted to the problem of the influence of bureaucratization of a medical organization on the structure of personnel values in medical organizations focused only on the treatment and diagnostic process. If an institution functions as a scientific and medical organization, then its employees tend to strive for professional self-development, innovative and creative thinking, which is not consistent with the conclusions of international researchers.
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