2020 № 10 Possibilities of application of the toolkit for independent assessment of the quality of service providing conditions by medical organizations for analysis of effectiveness of system transformations at the ambulatory stage
Successful achievement of goals of the national projects «Healthcare» and «Demography» is impossible without the
active participation of subjects of the Russian Federation. At the same time, choice of optimal tools for assessing the transformations carried out on a regional scale is of particular importance. The aim of the study was to analyze the effectiveness of implementation of the Standard for the organization of outpatient care in the Tomsk region using tools for independent assessment of the quality of conditions for the provision of services by medical organizations. The results of the questionnaire survey of patients of medical organizations participating in the implementation of the project were analyzed before (2018, 896 patients from 18 medical organizations) and after (2019, 252 patients from 5 medical organizations) implementation of its main activities using the Questionnaire approved by the Ministry of Health of Russia. The informativeness of the questions of the questionnaire used to assess the effectiveness of a regional project depended on their nature. It is shown that the results of a questionnaire survey on issues affecting technical aspects of the process of receiving services (waiting times for an appointment with a doctor, research) should be interpreted comprehensively in combination with an assessment of technological indicators and data on the resource availability of the processes under study. Questions related to various aspects of patient satisfaction with the services received and the conditions for their provision showed positive dynamics in a number of parameters, indicating the effectiveness of the project implementation. The questions that concretize the object of satisfaction
or dissatisfaction, in comparison with the questions involving an integrated assessment of the institution, were of great
information content. The survey data obtained in the course of an independent assessment of the quality of the conditions for the provision of services in medical organizations can become an effective tool for an integrated assessment of the implementation of regional projects, allowing to determine the correctness of the selected directions of systemic transformations.
2021 № 1 Applying lean manufacturing technologies to optimize ambulance operations amid the spread of COVID‑19
The pandemic of new coronavirus infection COVID‑19 has become a serious challenge for the national health
systems, including Russia, setting ambitious goals aimed at preventing the spread of infection and maintaining the availability of medical care in environment of increasing pressure. The aim of the study was to develop, based on the principles of lean production, a set of measures to increase the availability of emergency medical services for patients diagnosed with or suspected of a new coronavirus infection COVID‑19 in the Tomsk Region. Standard tools of lean manufacturing are applied to the work process of the admission department of the respiratory center in RSBHI «Medical sanitary station № 2». As a result of implementation of target state map, which provides for the optimization of process of transferring a patient diagnosed or suspected of a new coronavirus infection COVID‑19 to admission department, a positive dynamics of local (5.4 times increase in the proportion of calls completed within 15 minutes after the patient was delivered to the admission department) and system (an increase of 1.3 times in the proportion of calls with the time the ambulance team reaches the patient within 20 minutes) indicators of the ambulance service was achieved. The study confirms the effectiveness of lean manufacturing tools for optimizing the work of ambulance and allows us to recommend them for use in a pandemic and other risks of emergency.
2019 № 9 Application of lean management in medical examination of children in Tomsk region
The object of the study is the process of preventive medical examination of children of the first year of life, which can be improved on the basis of the principles of lean production. As part of a joint project of the Ministry of health of Russia and Rosatom state Corporation “Lean clinic”, which is designed to improve the efficiency of medical organizations and the availability of their assistance by introducing elements of lean production in public health institutions on a systematic basis, in the Tomsk region on the basis of a pilot medical organization – children’s clinic – a project was implemented to introduce lean technologies in the process of preventive examination of children of the first year of life, in order to minimize the loss of time when receiving medical services by the patient. The main directions of optimization: improving the productivity of the process using the mapping method; increasing the productivity of a single workplace using the 5C technique; increasing the productivity of the movement of medical staff using the Spaghetti diagram. During the project, the logistics scheme of patients and staff movement was significantly improved, and a route map was developed, which was issued to the parents of patients in the registry of the medical organization. In addition, in order to assess the effectiveness of the developed measures before the project and after its implementation, a sociological survey was conducted among the parents of children undergoing pre¬ventive medical examination, which allowed to assess the level of their satisfaction with the assistance provided. As a result of the implementation of the project on the introduction of lean technologies, it was possible to achieve the goals, in particular, to reduce by almost 3.5 times the time spent by patients on the passage of a full cycle of preventive examination, to reduce to 2 number of visits to the clinic, as well as to increase comfort of staying in the institution of patients and their parents.
2018 № 2 Development and implementation of a standard for the organization of work of registries medical organizations: the project «Entrance group»
Regional project “Front-office” was set up and implemented in Tomsk oblast (Siberia, Russia). The aim of the project was launch a front-office of out-patients departments standard for improvement patients satisfaction in medical institutes. There are five directions in the project: providing affordable telephone service, front-office infrastructure, staff training, medical documents logistic, corporative style creation. Using of holistic project approach has led to significant improvement of availability and quality of health care in Tomsk oblast
2021 № 4 PROFESSIONAL BURNOUT OF NURSES: FEATURES OF GENERATIONS
Professional burnout among nurses is an urgent public health problem, which negatively affects the quality of medical care. A specialist’s belonging to a certain generation determines its own characteristics of the response to stress factors and the development of professional burnout.
Purpose of the study is to determine the main patterns of occurrence of professional burnout among nurses depending on the generation for development and implementation of targeted prevention methods.
Materials and methods. A one-stage comparative study was planned and conducted using a specially designed questionnaire, including a burnout questionnaire MBI (Maslach Burnout Inventory) and questions assessing professional performance and socioeconomic status to determine the factors of professional burnout. All nurses were stratified into three generational groups.
Results. The study involved 2486 nurses. It was found that respondents of all generations were prone to professional burnout, with a high and extremely high degree. At the same time, the third generation was most susceptible to the development of professional burnout, the first was the least. The main predictors of the development of professional burnout in the third generation were: lack of sleep and rest, low salary and large loan payments, excessive work load; in the first – the presence of chronic diseases. The second generation had a smaller percentage of respondents with an extremely high degree of professional burnout, because they were characterized by lower labor intensity, lack of sleep deficit and the highest salary.
Findings. Thus, prevention measures can be individual for each generation, with considering the differences in predictive and protective factors. While, it is necessary to focus on the youngest, third generation, reinforcing factors preventing the development of professional burnout.
2020 № 8 Satisfaction of patients as an indicator of the effectiveness of organizational models of providing medical care in the outpatient sector
The object of the study is patient satisfaction with the medical care provided as a potential tool for evaluating the effectiveness of organizational changes in the outpatient unit. The patient-oriented approach is becoming more and more widespread in the world and domestic health care, so it is also necessary to take into account the opinion of the recipients of medical care in order to evaluate the ongoing changes. The purpose of the study was to test the developed online patient satisfaction assessment service TesMed in the implementation of systemic organizational changes in the outpatient section of the Tomsk region (united in one document – the Standard for organizing outpatient care in the Tomsk region). Patients were able to use the smartphone functionality to identify the medical organization and put a rating on a five-point scale. If the patient scored less than five points, the app asked them to select a reason for dissatisfaction from the list. The data of 2898 forms were analyzed. By the time of the beginning of noticeable
changes for visitors of polyclinics (changing the format of the reception area, staff jobs, registry, formation of corporate culture), the share of visitors who rated the work of a medical organization by five points was 57.78%. After a month of project implementation, this parameter increased to 85.79% and did not fall below 72% until the end of 2019. The analysis of factors affecting negative ratings showed that the structure of reasons for their decline has not changed significantly. The study showed that the use of assessment methods used in the provision of medical care organizational models based on the opinion of patients, along with standard performance indicators, contributes to improving the effectiveness of interaction between medical organizations and patients.