CONTENT OF THE ISSUE
What has changed for medical organization with the adoption of the new regulation on federal state control (supervision) quality and safety of medical activity
The article analyzes the Regulations on the Federal state control (supervision) of the quality and safety of medical activities, approved by the Decree of the Government of the Russian Federation № 1048 of June 29, 2021. The following is noted: The Regulation defines a broader list of issues that are now the subject of federal state control of the quality and safety of medical activities; The regulation ensures continuity with the Federal Law № 248-FZ of 31.07.2020 «On State Control (Supervision) and Municipal Control in the Russian Federation», on the one hand, and with the Requirements for the organization and Conduct of internal quality control and Safety of Medical Activities approved by the Decree of the Ministry of Health of the Russian Federation № 785n of 31.07.2020, on the other hand; for the first time, the risk profile of causing harm (damage) to the life and health of citizens is fixed for supervisory
authorities as the most important area of work in the field of state control of the quality and safety of medical activities.
Current issues of evidence-based management of state and municipal health care.
The topic of evidence-based management is relevant due to a significant increase of managerial innovations in medicine, healthcare commercialization, changes in approaches to the use of evidence sources in healthcare and high commercial, investment, social and reputational risks of poorly evidence-based decisions. The article deals with awareness and practical use of the evidence-based management approach among the executives of budgetary medical cites. The results of the first Russian study of evidence-based management among health care managers are presented, in particular, their awareness of the evidence-based approach, attitude to evidence-based management practice, and the sources of information used by them are studied.
The purpose of the study is to investigate the existing practice of applying evidence-based approaches in the management, awareness of the approach, it’s application in practice, drawing conclusions about the factors influencing managerial decisionmaking, and making recommendations for their improvement.
Materials and methods. The study of the management practice of heads of medical organizations was conducted using an online survey. The general part of the questionnaire included questions about the demography of respondents, their management experience, education, and the size of the organization. The special part assessed: respondents ‘ awareness of the approach; their attitude to the evidence-based management practice; sources of information when making decisions. Their opinion on the role of corporate culture in the formation of evidence-based management practice was clarified.
Results. Only 17% of managers use an evidence-based approach in practice, and only 5% use at least six sources of information for this purpose. The popularity rating of information sources is presented as follows: own experience 81%, consultations with external experts 60,3%, internal data of the organization 56,9%, scientific data 38%, the opinion of colleagues 36,2%. Most managers consider the use of data in practice to be the most difficult in making managerial decisions. Only 31% of healthcare managers regularly summarize their managerial experience. The majority of respondents, 75.8%, recognize the important role of corporate culture in forming the habit of making decisions on an evidence-based basis, but also assess the organization’s resources for making informed management decisions as insufficient. Only 20,7% of respondents rated the degree of the organization’s learning ability and its readiness for changes as high.
Conclusions. Further improvement of the practice of making managerial decisions on an evidence-based basis is possible due to the informatization of healthcare and the development of the corporate culture of municipal medical organizations. Evidence-based management practices should be integrated into the trajectory of continuing medical education of healthcare managers in order to improve the efficiency of the industry.
Independent assessment of the quality of medical care in a multidisciplinary hospital
The assessment of the quality of the conditions for the provision of medical services from the patient’s point of view is an integral part of the management process of medical organizations within the framework of the implementation of the concept of patientoriented healthcare.
The purpose of the study is to analyze the results of a patient survey as part of an independent assessment of the quality of medical care conditions in a round-the-clock hospital of a large multidisciplinary medical organization.
M a t e r i a l s a n d m e t h o d s . As part of the independent assessment, the inpatient patients were surveyed using questionnaires approved by the Ministry of Health of the Russian Federation. A mathematical analysis of the results of the survey was carried out according to five criteria for assessing the quality of medical care conditions.
R e s u l t s . The results of an independent quality assessment in the hospital allow us to assess the effectiveness of measures to ensure comfortable conditions for the patient’s stay and can be used in practical healthcare for organizing measures to eliminate defects and making strategically important decisions on the management of a medical organization.
F i n d i n g s . The survey of patients allows not only to fulfill the requirements of the Ministry of Health of the Russian Federation on participation in an independent quality assessment, but also to identify “pain points” in the organization of medical care processes. The opinion of patients helps to focus attention on problematic areas in the activities of the Ministry of Health, which are often not noticed by the medical staff, gives an understanding of the effectiveness of innovations and reforms.
Health care organizers about the possibility of using outsourcing in medical organizations.
I n t r o d u c t i o n . The ratio of the number of administrative and administrative and auxiliary personnel to the main staff, as well as the share of their remuneration in the total cost structure, is one of the criteria for the effective use of resources of medical organizations.
The use of the outsourcing mechanism allows us to solve a number of problems that arise when such a ratio is observed, without reducing the quality and availability of medical care.
T h e p u r p o s e o f t h e s t u d y is to study the opinion of health care organizers about the possibility of transferring certain areas of activity of a medical organization to outsourcing.
M a t e r i a l s a n d m e t h o d s . The following methods were used in the study: statistical, sociological and analytical.
R e s u l t s a n d d i s c u s s i o n . More than half of health care organizers believe that the introduction of outsourcing in a medical organization is necessary (66,1%). The study participants believe that it is possible to outsource such positions as cleaning of territories (94,4%), security of a medical organization (93,5%), laundry services (91,1%), maintenance of vehicles of a medical organization and maintenance of non-medical equipment and communications (87,1% each), etc. In their opinion, it is impossible to outsource such functions as planning and economic activities (69,4%), personnel records management (68,5%), procurement / contracts (58,1%), accounting (57,3%), legal support of the activities of a medical organization (37,9%), etc. Most often, the following functions have already been outsourced in medical organizations: laundry services (64,3%); maintenance of medical equipment (57,3%), motor transport of the Ministry of Defense (46,4%), non-medical equipment and communications (46,4%); cleaning of territories (35,7%).
C o n c l u s i o n . Outsourcing allows you to focus on the profile activities of a medical organization and improve the quality of services provided to the population. Before transferring certain functions of a medical organization to outsourcing, the head needs to analyze the practical experience of regions and other medical organizations, which will help to avoid the negative aspects of outsourcing, expand its scope and the range of functions transferred to outsourcing companies.
Elimination of preventable child mortality as a global task of the XXI century, including in the context of the COVID‑19 pandemic
Despite a sharp reduction (by almost 60 percent) over the past 30 years in the mortality of children and young people, including those under the age of five, the global burden of this problem, according to the UN, remains enormous. The paper provides information on the analysis of data from foreign scientific literature on the indicators of child mortality and its causes in foreign countries, including in the conditions of the COVID‑19 pandemic. It is during the pandemic that many countries experience interruptions in the provision of maternal and child health services, such as medical examinations, vaccination, prenatal and postpartum care due to lack of resources. Studies show that the overall risk of death from COVID‑19 in children is quite low. The causes of infant mortality are mainly factors associated with neonatal mortality: premature birth, low birth weight, complications during childbirth, neonatal sepsis, as well as infectious diseases, more often pneumonia, diarrhea and malaria, and insufficient vaccination. In order to prevent and reduce global child mortality, strategies are needed to provide adequate medical and social services to the population, as well as poverty eradication programs.
P u r p o s e o f t h e s t u d y : to review foreign scientific literature containing information on the analysis of child mortality rates and its causes in foreign countries, including in the conditions of the COVID‑19 pandemic.
M a t e r i a l s a n d m e t h o d s of research: bibliographic, information and analytical methods and methods of comparative analysis were used.
R e s u l t s . Studies have shown that only 122 countries were able to achieve the target of mortality of children under the age of five, designated in the “Sustainable Development Goals (SDGs) ” – 25 or less deaths per 1,000 live births by 2019. The death rate of young children is highest in areas where the poor, ethnic or religious minorities, indigenous peoples and people who are discriminated against live. Studies conducted in 2020 showed that the overall risk of death from COVID‑19 in children is quite low.
The COVID‑19 pandemic has led to serious disruptions in the work of health services, which threaten to negate efforts to eliminate child mortality.
F i n d i n g s . In order to prevent and reduce global child mortality, strategies are needed to provide adequate medical and social services to the population, programs to eradicate poverty, and provide access to obstetric and prenatal services. Many countries are experiencing disruptions in the provision of maternal and child health services, such as medical examinations, vaccination, prenatal and postnatal care due to a lack of resources during the pandemic. Due to failures in the health system during the COVID‑19 pandemic, additional deaths of children are possible as a result of potential disruption of health systems.
Borderline functional states of the men’s reproductive system: its influence on health and the quality of life.
Between the differing frequency of prevalence of sexual dysfunctions, there’s a particular interest in the borderline disorders of the male reproductive system, in which no obvious somatic and mental pathology can be found in the body. The reversibility of functional disorders unveils favorable prognostic prospects and presupposes the development of new approaches in the organization of observation and correction of minimal borderline functional states of the reproductive system.
P u r p o s e . To identify the frequency of borderline functional states of the reproductive system (BFSDS) among men over a five-year dynamics, their impact on the formation of health outcomes and quality of life.
M a t e r i a l s a n d m e t h o d s . The study was conducted at the Reproduction Center of the Clinical Diagnostic Center (Nizhny Novgorod) for five years. Two groups of men of reproductive age with BFSDS at the age from 20 to 60 years were tested. We used copy-pair method. The first group (DM) included men with sexual dysfunctions and similar sexual disharmony (BFSDS) who didn’t receive medical benefits. The second group (DM + treatment) consisted of men with BFSDS who received cognitive-behavioral therapy and medicine. All subjects assessed the state of the reproductive system, neurological and hormonal status, as well as the quality of life (according to the SF‑36 questionnaire). To compare the parameters of the quality of life, a control group was selected – healthy men of reproductive age.
R e s u l t s . The frequency of sexual dysfunctions in both groups is significantly increasing, but the frequency of their detection in men receiving treatment is 2,4 times lower than in the other group. An increase in neurological changes and hormonal disorders was recorded, the prevalence of which depends on the duration of observation and the availability of therapeutic measures. The study proved that the BFSDS have a significant impact on the quality of life of men, especially in the physical and psychological components of health. It was shown that the treatment allowed the patients to preserve the state of physical and, to a greater extent, psychological comfort during the five-year observation period.
I n c o n c l u s i o n , the authors emphasize the need for new approaches to the organization of observation and correction of the minor BFSDS.
Evaluation of the effectiveness of continuous support by midwives and douls in childbirth.
All the midwives around the word have been struggling in recent decades to reduce the level of unjustified interventions in the birth process. This study was aimed at determining how the continuous support of a private midwife or doula in childbirth will affect the level of caesarean delivery, epidural anesthesia, amniotomy, episiotomy, perineal traumas, labour stimulation with oxytocin and vacuum fetal extraction.
The concept of normal childbirth has changed fundamentally over the past 10 years – from stimulation and acceleration of the birth process to monitoring the normal course of labour. It is of great importance to determine labour satisfaction level, needs of women in labour, which are directly related to the understanding of the birth process by women and the provision of support during childbirth.
The Global Strategy for Women's, Children's and Adolescents' Health (2016–2030) is focused not only on childbirth survival, but also on the opportunity to fully realize the potential of life and health. A positive childbirth experience is very important for women, it is part of their personal and sociocultural expectations. Modern women want to give birth to a healthy baby in a safe and caring environment with continuous support during childbirth and postnatal period. They want to know how their childbirth is proceeding and control this process, making decisions together with healthcare professionals.
The main purpose of the study was to examine how continuous support during childbirth affects the following factors: vaginal delivery, cesarean delivery, amniotomy, epidural anesthesia, oxytocin stimulation, episiotomy, perineal ruptures, vacuum fetal extraction. We present a retrospective cohort observational population study of all the women who gave birth in the Russian Federation in the period from June 2015 to June 2019. All the patients of the main cohort received continuous support in childbirth from a private midwife or doula. The patients from the control group gave birth under standard conditions.
All the patients of the main cohort attended a course of lectures on childbirth and postnatal period. They learned all about labour stages, how it begins, proceeds and ends. The women studied relaxation techniques, including breathing techniques, massage, aromatherapy; various positions for greater comfort during childbirth. 95% of the women attended lectures with their partners. The partners were trained to provide emotional support, to give a massage and to practise breathing techniques.
There were 7,864,496 births in Russia in the period from June 2015 to June 2019. Of these, 30,0% of cesarean sections, 1,1% of vacuum fetal extractions, the perinatal mortality rate was 7,89%.
We have obtained the following results of our study: of 1082 women who received continuous support in childbirth, 165 gave birth by caesarean section (16%, OR0,4). The level of epidural anesthesia in childbirth was 26% (in the control group – 92%, OR0,3), labour stimulation with oxytocin – 12% (in the control group – 78%, OR0,3), episiotomy – 2% (in the control group – 21%, OR0,07), perineal traumas – 28% (in the control group – 74%, OR0,37), amniotomy – 26% (in the control group – 84%, OR0,3), vacuum fetal extraction – 0,5% (in the control group – 1%, OR1,6), perinatal mortality – 0 cases.
Continuous support in childbirth from a private midwife or doula reduces the level of cesarean section, the frequency of synthetic oxytocin use to stimulate labour, amnitomy, episiotomy, perineal traumas and vacuum fetal extraction and increases labour satisfaction level.
Legal and regulatory framework of the system for ensuring an accessible environment for people with disabilities and other low-mobility groups of the population on the example of an ophthalmological medical organization
The article analyzes the existing regulatory framework governing the formation of an accessible environment for people with disabilities and other low-mobility groups of the population. The experience of a republican-level clinic providing medical care in the field of “ophthalmology” when organizing visits to low-mobility groups of the adult population in the Republic of Tatarstan is presented. The forms of work of an ophthalmological medical organization to provide an accessible living environment for the specified category of patients are considered. The types of responsibility of officials and legal entities for violations in the field of providing an accessible environment for people with disabilities and low-mobility groups of the population are determined.
Review оf the Person-Centered Care Certification® of the Planetree International organization, USA
The article presents an overview of the Person-Centered Care Certification® program for healthcare organizations, developed by the non-profit organization Planetree International, as well as a description of the main certification criteria. A brief description and a history of the Planetree International company is also presented.
Labor rationing as one of the effective management tools of a medical organization.
Labor rationing is an important tool for managing the workforce of a medical organization, which is not limited to setting labor standards. Rationing has a number of potential opportunities, the competent implementation of which makes it possible to solve a number of urgent management tasks, including stimulating of employees.
The article discusses various aspects of the use of rationing in order to improve the efficiency of the medical organization.
Issues of registration of contractual relations in the provision of paid medical services.
The contract for the provision of paid medical services is the basis of legal and economic relations with the patient (consumer, customer). Against the background of the rapid pace of digitalization of all spheres of society, questions naturally arise about the permissible forms of contracts concluded, about their content, etc. The proposed material provides answers to some of the questions that arise in this regard.
Focus of the problem
Marketing in health care
Manager of health care consults
Questions and answers