Improving the quality of health care remains problem of the day for world health systems. Recognized quality management tools are used in Ukraine. However, a series of studies indicate the need for their improvement.. The aim of this work was to determine the features of the application of international instruments for regulating the quality of medical care and to substantiate the conceptual directions of their improvement in Ukraine. Materials and methods of research used: systemic approach; comparative analysis; bibliosemantic; conceptual modeling; scientific literature sources, including systematic reviews from the PubMed database; domestic legal documents. Main results: unlike international practices, professional activity of doctors is not licensed in Ukraine. The economic activity of health care institutions and individuals-entrepreneurs engaged in medical practice is subject to licensing. Аccreditation standards have not been revised since 2013. Domestic adaptation of clinical guidelines has been suspended for several years. Certification of quality management systems is administratively related to accreditation. All quality management tools are strictly regulated by the Ministry of Health, without the involvement of local governments, public patient organizations and health professionals. Conceptual directions of improvement of tools of quality regulation are offered: adoption of the law on professional licensing of doctors; creation of an independent accreditation agency; updating the content of accreditation standards, supplementing them with patient safety standards in accordance with international criteria; creation of methodological support for accreditation and certification; training of accreditation inspectors; introduction of tracer methodology in order to verify compliance with accreditation standards; resumption of adaptation of international clinical guidelines at the health sector.
The aim: To determine the level of patients' satisfaction with the received dental care in regional dental clinic and to make proposals for improving the quality of dental care based on the survey results. Materials and methods: 221 copies of the questionnaires completed by the respondents; sociological method (questionnaire), medical-statistical, analysis and bibliosemantic methods were used. Results: Patients expressed high satisfaction with the quality of dental care according to the criteria of geographical accessibility (4.28 ± 0.05 points), the conditions in the doctor's office (4.63 ± 0.04 points), safety of dental interventions (4.54 ± 0.04 points) and their effectiveness (4.58 ± 0.04 points), the attitude of the doctor to the patient (4.75 ± 0.03 points), the clarity of information for the patient (4.52 ± 0.04 points). However, the satisfaction of patients with the cost of dental services was only 3.76 ± 0.05 points. Conclusions: Patients' satisfaction with the financial accessibility of dental care was found to be lower compared to satisfaction with other healthcare quality components. This information can be used to make management decisions on revising the coverage of the cost of dental services from the state budget and other sources of funding.
Abstract. Standards for quality management systems require support for the system resources: human, infrastructure, process environment, knowledge, competence, awareness, communication, documented information. Objective. To conduct a systematic analysis of resource management in certified quality management systems of dental institutions; suggest ways to improve it. Materials and Methods. Forms №№ 17, 20 of the state statistical reporting, internal documents of municipal non-profit enterprises: "Zhytomyr Regional Dental Medical Association"; Kharkiv Regional Council "Regional Dental Clinic"; "Chernihiv Regional Dental Clinic of the Chernihiv Regional Council" were used (a total of 37 units). Methods: medical and statistical; system approach; content and comparative analysis; graphic. Results. It has been established that the institutions are provided with highly qualified competent medical staff, but there are no dental hygienists among the positions and individuals of specialists, which overloads dentists with simpler preventive procedures. At the same time, preventive measures are important to prevent the development of caries, periodontitis and diseases of the oral mucosa. There is no widespread involvement of employees in freelance organizational structures, monitoring and internal audit of processes and quality management systems. Heads of institutions did not organize the development and implementation of local clinical protocols based on evidence data. Dental care technologies are regulated by industry standards developed in 2004 on the basis of professional consensus. Clinical pathway of the patient, as organizational regulations of dental care, are descriptive textual in nature, the direction of the patient's movement is not traced, as well as the sequence of interaction of structural units - participants in the treatment and diagnostic process. Clinical quality indicators are not implemented in institutions and are not subject to calculations and monitoring. This creates risks for the effectiveness of patient-centered dental care. External and internal interactions of institutions and their structural units are unclear; there is a shortage of medical equipment; modern digital technologies are used to a limited extent for internal and external communications. Conclusion. Opportunities for the implementation of quality management, laid down in the standard, in each dental institution in the real conditions of its operation are not fully used, which requires the attention of heads of institutions in problematic areas.
Êàòåãîð³ÿ ÿêîñò³ ó ñôåð³ îõîðîíè çäîðîâ'ÿ: òðàíñôîðìàö³ÿ ïîíÿòòÿ Ðåçþìå. Ìåòà äîñë³äaeåííÿ: âèçíà÷åííÿ çì³ñòó ïîíÿòòÿ ÿêîñò³ íà ñó÷àñíîìó åòàï³ ðîçâèòêó ñâ³òîâî¿, çîêðåìà, â³ò÷èçíÿíî¿ ñôåðè îõîðîíè çäîðîâ'ÿ; àíàë³ç ³ óçàãàëüíåííÿ ðåçóëüòàò³â íàóêîâèõ ³ ì³aeíàðîäíèõ äîñë³äaeåíü çà òåìîþ ó õðîíîëîã³÷íîìó àñïåêò³.
Цель исследования: усовершенствовать подходы к планированию деятельности учреждения здравоохранения в соответствии с требованиями международного стандарта «Quality management systems - EN ISO 9001: 2015 for healthcare». Задачи исследования: провести анализ требований международного стандарта «Quality management systems - EN ISO 9001: 2015 фор healthcare» и разработать подходы к методическому обеспечению процесса планирования. Материалы и методы. Проанализированы научные источники (4 ед.), стандарт (1 ед.), нормативно-правовые акты (2 ед.). Использовались системный подход, системный и контент-анализ, графический метод. Результаты. Установлено, что планирование деятельности учреждения здравоохранения, в соответствии с требованиями стандарта «Quality манаґемент systems - EN ISO 9001: 2015 for healthcare», заключаются в принятии стратегического решения по планированию системы управления качеством на основе процессного подхода. В дальнейшем следует определить политику и целевые показатели процессов в соответствии с характеристиками качества медицинской помощи: соответствие потребностям пациента, доступность, непрерывность, эффективность, результативность, беспристрастность, оказание на основе научно обоснованных знаний, ориентированность на пациента на основе персонифицированного подхода и осознанного согласия, привлечение пациента к планированию и выполнению медицинских мероприятий, безопасность. Далее определяются меры по достижению целей, распределению ответственности полномочий работников в процессах, где они есть соисполнителями, планированию ресурсного обеспечения, мониторингу, оценке, внутреннему аудиту процессов и системы управления качеством, улучшению качества. Текущее и оперативное планирование обеспечивается путем декомпозиции стратегических планов на тактические и оперативные. Выводы. Требования стандарта «Quality management systems - EN ISO 9001:2015 for healthcare» позволяют усовершенствовать подходы к планированию деятельности учреждения здравоохранения на системном уровне на основе процессного подхода.
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