Public quality management of health care services

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Candidate of Economic Sciences, Associate Professor

Department of Public Management and Administration Sumy National Agrarian University

Public quality management of health care services

Brychko A.M.

Анотація

ПУБЛІЧНЕ УПРАВЛІННЯ ЯКІСТЮ МЕДИЧНИХ ПОСЛУГ СФЕРИ ОХОРОНИ ЗДОРОВ'Я

Результати теоретичного аналізу статті показали, що проблема якості послуг є актуальною для багатьох країн протягом тривалого часу, тому її управлінню присвячена велика кількість наукових і практичних досліджень.

Організація контролю якості повинна враховувати наступні етапи роботи: 1) розробка та впровадження відповідних стандартів якості послуг та критеріїв якості; 2) вимір фактичних показників якості та порівняння їх із показниками, прийнятими у встановлених стандартах та критеріях; 3) розробка та впровадження необхідних коригувальних заходів, якщо досягнуті результати суттєво відрізняються від встановлених стандартів.

Сучасний стан охорони здоров'я в Україні визначається як передумова розвитку медичної галузі. Визнається, що нинішня демографічна ситуація в Україні супроводжується швидким погіршенням стану здоров'я населення, скороченням кількості людей працездатного віку через передчасну смерть, що гальмує розвиток людського капіталу, що є ключовий фактор економічного зростання.

Реформа галузі та запровадження загаль- необов'язкового медичного страхування є подальшими каталізаторами збільшення потужності українського ринку медичних послуг. В Україні ринок медичних послуг все ще формується, а конкуренція для пацієнтів все ще знаходиться на первинному рівні. Розмір цього ринку незрівнянно менший, ніж ринок проміжних послуг. В Україні сьогодні попит на якісні медичні послуги, кращий рівень обслуговування зростає, зростає попит на прозорі та високі зарплати для лікарів, а самі заклади охорони здоров'я вкрай потребують досвідчених управлінців. Це вимагає запровадження ефективної системи управління охороною здоров'я на національному рівні.

Традиційно для управління розвитком сфери охорони здоров'я інформаційні потоки оформляються за критерієм джерел формування інформації. Відповідно до принципів та стандартів управління прийнято включати інформацію про середовище, в якому працює та розвивається медична сфера. Для створення інформаційного простору для галузі охорони здоров'я важливим кроком є визначення змісту початкових інформаційних потоків, який повинен надавати всім зацікавленим сторонам необхідну інформацію про галузь для прийняття якісних управлінських рішень в медичній сфері.

Ключові слова: медичні послуги, якість, управління, сфера охорони здоров'я, публічне управління.

Abstract

The results of the theoretical analysis of the article showed that the problem of service quality has been relevant for many countries for a long time, so a large amount of scientific and practical research is devoted to its management.

The organization of quality control should take into account the following stages of work: 1) development and implementation of appropriate service quality standards and quality criteria; 2) measurement of actual quality indicators and their comparison with the indicators adopted in the established standards and criteria; 3) development and implementation of the necessary corrective measures, if the achieved results differ significantly from the established standards.

The current state of health care in Ukraine is defined as a prerequisite for the development of the medical industry. It is acknowledged that the current demographic situation in Ukraine is accompanied by a rapid deterioration in the health of the population, a reduction in the number of people of working age due to premature death, which slows down human capital development, which is a key factor in economic growth.

The reform of the industry and the introduction of compulsory health insurance are further catalysts for increasing the capacity of the Ukrainian medical services market. In Ukraine, the market for medical services is still emerging, and competition for patients is still at the primary level. The size of this market is incomparably smaller than the market for intermediate services. In Ukraine today, the demand for quality medical services, better service is growing, there is a growing demand for transparent and high salaries for doctors, and health care facilities themselves are in dire need of experienced managers. This requires an effective health management system at the national level.

Traditionally, to manage the development of health care, information flows are designed according to the criteria of sources of information. In accordance with the principles and standards of management, it is customary to include information about the environment in which the medical field operates and develops. To create an information space for the health sector, an important step is to determine the content of the initial information flows, which should provide all stakeholders with the necessary information about the industry to make quality management decisions in the medical field.

Key words: medical services, quality, management, health care, public administration.

Formulation of the problem in general. Ukraine's integration into the European Community will contribute to social reforms, in particular in the field of health care. This is due to the conflict between the current level of medical services and the market conditions of these services. Of course, the country's medical sphere needs to be supported, given the current standard of living of the Ukrainian population. However, in the event of insufficient budget funding, such a system will not be able to fully fulfill its role and will be forced to seek additional resources, the main source of which will be health insurance. As medical institutions provide medical services, the success of them, as well as free market entities that specialize in providing all services, is evidenced by the quality of service. The lack of a system of proper quality medical care hinders the full development of the entire health care system.

Analysis of recent research and publications. The effective functioning of the health care sector allows to influence the quality of management decisions, including the provision of medical services. At the same time, there is a constant transformation of socially significant goals into their own, internal goals of the system, which leads to the fact that the system begins to work for itself and in the name of itself. Many researchers are currently studying the problems of the health care system within the framework of effective state management of the quality of medical services. Among them are N. Avramenko, N. Alekseev, Y. Belyaev, M. Bilinskaya, L. Bondareva, N. Borisov, S. Vovk, P. Gerasimov, I. Kovalev, N. Kryzina, D. Karamishev, V. Lehan, J. Radisha and others.

Unresolved parts of the common problem. However, the issue of clarifying the problems of public administration of electronic services in the field of health care, which affects the quality of medical services, is not disclosed in scientific sources, which indicates the relevance of the article and its practical significance.

The purpose of the article - scientific substantiation of applied bases of development of directions of improvement of public management of quality of medical services of sphere of health care through improvement of information maintenance of management of quality of medical services.

Presenting main material. The analysis of data conducted by the WHO Regional Office for Europe characterizes the current state of health of Ukrainian citizens with high morbidity and mortality, extremely low life expectancy, limited access to adequate medical care. Life expectancy in Ukraine is 5-9 years lower than in European countries. Analytical data allow us to conclude that only 65% of the total population in Ukraine is over 65 years [1]. The crisis in the health care system of our country is caused by the fact that this region is not able to adequately respond to the high morbidity of citizens, despite the fact that a significant part of the funds for health care is paid personally by people.

Ukraine ranks 33rd among other countries in terms of population. There are 41983.6 thousand people, which is equivalent to 0.57% of the total world population [2]. Official statistics show that between 1991 and 2020, Ukraine's population decreased from 51.944 million. up to 41,983 million people. Population decline is characterized by certain trends. The main factors of population decline are high mortality, low birth rate, aging population, low income, social insecurity and inefficient and poor quality health care. standard health care

The Ukrainian healthcare market occupies a significant part of the economic structure, despite the statutory principle of free medical care. There is a constant shortage of money in the Ukrainian healthcare system, which affects the shortage of medical staff, the workload of doctors, the availability of the necessary equipment, etc., which means that it affects the quality of medical services.

Strengthening the innovative potential of the health care system is an important condition for the development of the market for quality medical services. In Ukraine, the situation in the health sector with material and technical resources is becoming more complicated: outdated medical equipment and technologies. It should be noted that the domestic industry does not produce medical equipment that meets many world-class criteria, especially high-tech, so it is difficult to call medical services "quality". One of the ways to solve this problem, taking into account external experience, may be the development of medical equipment in companies of the Ukrainian industrial complex, as well as the use of new organizational forms and innovative technologies in health care facilities (eg optimization and restructuring). The Ukrainian market of medical devices is dominated by imported products. Both complete equipment and parts are imported to Ukraine. Humanitarian aid is physically 5% of the total structure of imports.

The further development of the market of quality medical services will be influenced by the reform of the state health care system: changes in the mechanisms of financing health care institutions, development of health insurance, introduction of a prescription system for selecting doctors, etc. As a result of the sectoral reform, direct public funding of most state and municipal health care facilities will be phased out from 2020, leading to the closure of some, especially in sparsely populated and rural areas. Some of the medical services included in the guaranteed package, which are approved by the state every year, remain free. The rest is paid by health insurance or patients (direct payments). In this case, the competitiveness of private institutions will increase, as budget medicine, on the basis of which a new health care facility will be established, will not be able to quickly switch to providing quality medical services.

Today, the private sector accounts for about 20% of the healthcare market. The growth rate of private health services is high: in 2012, private clinics accounted for only 1% of the Ukrainian healthcare market, in 2016 - 10%, as of 2021 - about 20%. However, the private sector of the Ukrainian healthcare market is insufficiently saturated compared to other countries (in developed private countries of medicine its share in the total volume of medical services is at least 50-60%), although the profitability of private institutions is about 25% [4].

Health care reform is expected to significantly change the way health facilities operate. An important aspect of this reform should be the transformation of public health facilities into self-sustaining entities based on autonomous financial activities. In other words, there is a market for medical services, where the business entities are medical institutions. Information should be the basis for making appropriate management decisions. The latter is very important for managers, regardless of their level of qualification.

Analysis of information needs, research of motivations in making managerial decisions, thematic information support of managers, information and analytical support of individual and group psychology are the objects of activity in the field of management and information support of business. Information systems must be designed on the basis of integrated quality management.

The design of information systems is based on the integrated interaction of the following components based on integrated quality management: employees; materials; technologies; methods. Therefore, the design of information systems should begin with the involvement of employees, potential users of the system. This concerns the ability to determine the set of information to be processed, as well as the formulation of requirements for ergonomics and system functionality. The requirements of the information system are taken as a basis, and on their basis the quantity of materials necessary for effective transfer of its work is defined. Materials can be both electronic and printed. Thus, the technology of data collection, processing and presentation of final results will be selected and tested. The chosen technology is based on existing data processing methods, which are aimed at ensuring the functioning of a high-quality health information system. When developing information systems for everyday use in the activities of health care facilities, attention should be paid to the compliance of project materials with the specifics of their activities. It will minimize different risk categories [6].

The results of the implementation of the information system obtained to improve the quality of medical services provided to patients allow:

carry out constant monitoring of the process of providing medical services;

control specific indicators, such as: the use of hospital beds, the number of outpatient visits, epidemiological data on the incidence of certain types of pathologies, mortality;

to improve working conditions in some structural units of the medical sphere, in particular in laboratories, pharmacies, operating rooms, etc.;

interconnect medical devices, including the transmission of radiological images and research;

effective and fast access to complete medical records of patients and better quality of documents and compliance with personal data protection;

the ability to obtain the results of examinations of patients by medical staff at any time and in any place;

ensure a high level of data security and confidentiality;

speed up the diagnosis and duration of the treatment process;

improve the quality of medical services.

The general advantages of the analyzed process are:

quick and easy access to information as a basis for decision management;

organization of information optimization in the system for its use, which allows you to make quick decisions;

access to a large amount of information allows to make decisions about investments in technical infrastructure and acquisition of fixed assets;

this allows you to develop long-term hospital strategies;

operational access to knowledge as a key resource today, which provides medical institutions with competitive advantages;

faster and more accurate selection of medical data, which affects the accuracy of diagnosis and organization of the entire treatment process, including improving the quality of medical services to patients;

to improve the organization and productivity, its comfort for employees;

limit unnecessary costs in order to provide comprehensive, highly qualified and effective treatment and create reasonable costs for medical services;

increase the efficiency of management of medical institutions.

The rational use of information media in our time directly affects the efficient operation of medical institutions, as well as the optimization of costs associated with their activities, which is reflected in sound management decisions.

Measures to inform the health sector are inevitable due to the rapid growth of technological development and the accumulation of a huge amount of information. Taking into account all the positive aspects of the implementation of the information system for both patients and health care, it is necessary to create its information management space, which takes place in several stages:

creation of the general information base of branches and medical divisions of the institution;

strengthening the proper security and protection of information resources;

technical support of information analysis.

Undoubtedly, the concept of e-health management with the support of technology, telemedicine and, finally, knowledge management plays a key role in ensuring the availability and quality of health services. Modern health management means that the sector needs to be restructured according to the basic criteria of rationality, efficiency, to ensure the necessary level of quality and accessibility of health care. This process would be impossible without the use of appropriate information tools to ensure the collection and dissemination of data using the latest communication technologies. The introduction of health information systems in Ukraine will help manage and ensure the effective collection and dissemination of data using the latest communication technologies.

When creating information systems, it is necessary to follow a certain methodology. The latter is the organization of the process of forming an information system. An important aspect is the proper management of this process, which ensures that the requirements of the information systems themselves.

An important point in this process is to understand the following aspects:

development of information systems is based on the experience of experts and developers to date, which takes into account the specifics of the functioning of health care facilities; certain types of information should be used to evaluate information systems taking into account the time of events;

potential users of the system increase the demand for results obtained through the implementation of the management function. Electronic management system not only improves the quality of information development, but also has a positive effect on productivity.

To achieve these results, you need to consider the following:

Electronic management system is the basis for managing information resources of medical institutions in the field of health care. The management process includes control, organization, planning and software.

In the past, e-government has had a positive impact, but it should be noted that this situation is acceptable given the simultaneous increase in quality and productivity. Adequate quality can be achieved by adhering to the accuracy of implementation at all stages of the methodology. This ensures an appropriate level of quality from design to implementation. Information systems are designed to computerize and restructure workflows to increase efficiency.

We focus on the need to continuously improve the quality of medical services. This need is always there and contributes to the development of medical and managerial staff. Physicians need to constantly improve their skills, as the knowledge gained will allow them not only to save lives, but also to fulfill their role in the medical institution and determine what depends on them in the process of providing medical services. Aware of their importance to both the hospital and the patient, health professionals are doing their best to continually improve their professional skills. All employees should be trained individually and jointly. The purpose of joint training is to form a cohesive team that could function as a whole. Patients themselves will have an effect when they receive quality medical care.

Conclusions. In modern conditions, one of the ways to ensure the sustainable development of the health care system is the development and implementation of irreversible and qualitative changes aimed at ensuring long-term success. To strengthen effective information support for its development and provide effective information support for development processes, it is proposed to define the information space, which should be understood as a set of information resources, databases, knowledge and methods to provide management decisions on design, implementation and control of projects. The main components of the information space of health management are information resources, tools of organizational communication and information infrastructure.

References

1. Енциклопедія: Старіння населення.

2. Основи законодавства України про охорону здоров'я. Закон України зі змінами від 30.03.2020. № 540-IX

3. Митник З. М. Здоров'я населення та діяльність системи охорони здоров'я України: реалії, проблеми та шляхи вирішення. Київ: 2019. 107 с.

4. Шафранський В. В. Європейська політика «Здоров'я-2020»: використання науково обґрунтованих стратегій для отримання позитивних результатів. Економіка і право охорони здоров'я. 2019. № 1. С.44-48.

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