Scientific journal
European Journal of Natural History
ISSN 2073-4972

Improving quality of public medical care

Pavlov V.V. 1 Nikolskaya O.G. 2 Suslin S.A. 1
1 Institute of post-graduate training of Samara state medical university
2 Municipal medical institution city hospital № 10
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The article provides basic principles of management in health care according total quality management (TQM).

State program of Russian Federation «Development of health care» during 2012–2020 includes the principle of total management according to quality (TQM) – «improvement in quality».

Principles of managing an organization of a certain process are especially urgent in health care. A specific result, an impact over a person’s health, correct orientation of a doctor’s work improve life quality among the population (E.I. Dubynina, A.A. Kalininskaya, F.A. Sulkina, 2009, V.M. Levanov, 2012, V.O. Schepin, A.F. Molchanova, A.A. Kaliniskaya, E.Y. Shkatova, 2011).

A number of various recommendations, methodical guides, instructions of conducting a patient, treatment forms, medical-economic criterions, standards require a definite universal implementation. In our opinion, their variability is a positive phenomenon. But one should consider that, in order to orient himself in this flow of information and facilitate it correctly, he needs knowledge of basic laws of management (Y.M. Komarov, 2011).

The first principle is direction towards a consumer, in our case – towards a patient, considering his present and future demands. A problem arises before treatment institution – it needs know health characteristics of its potential customers thoroughly. Nowadays, it is impossible to carry out prevention work and medical-social care in an open society without any public organizations. This aspect is also considered in studying self-audit.

In practice analysis of keeping passport of hospitals, filling ambulatory cards and medical reports according to existing standards and plans of medical observation allows one to forecast volumes of medical care and control existing flows of patients. The main objective of this direction is to train population to follow a healthy lifestyle.

The next absolute principle is forming an objective of a medical institution. Without a leading part of a manager, head doctor, administration development of managing quality of medical health is impossible. A manager must create and support an inner environment in which all employees should be involved into the management system. In order to establish it, one should carry out professional instructions considering his knowledge of the process of providing medical care within an institution in accordance with practical purpose of a project.

According to the existing standards of records management, with logical control and practical experience, managers should develop professional instructions, regulations, collective pacts, statutes. It is necessary to clear actions of each administrator from unnecessary functions, as well as of each doctor or nurse. Today this work takes place in four treatment institutions of municipal region of Samara.

Further we study the principle of complete involvement of all levels of institution employees into the process of improving quality of medical care. To do it, workers of our department have prepared lectures according to modern principles of management.

The most important principles in managing quality of treating process are system and process approaches. All the activity of an institution is studied as a whole, as an open system in which process of achieving results and the result itself are studied. The developed indicators of quality should become a basis of models of a final result. Moreover, for 15 years organizers of medical care of our region are familiar with this principle of evaluating their own work.

The next principle of TQM is making management decisions that are based on facts. It means that only analysis of premises and possession of statistic information in dynamic mode allows one to achieve a set goal.

A correct maintenance of records, reflection of basic indexes of a medical institution activity in it is a basis of making a management decision. A special attention is paid to this division in our department.

A result of following and executing principles of TQM will be an improvement in quality of organizing medical care. It is testified by international practice and experience that has been collected in a number of regional healthcare institutions.

During several recent years a work of involving medical institutions into the system of self-evaluation and organization of medical care has been carried out at the territory of Samara region in collaboration with Povolzhskiy quality club. About ten clinics, hospitals have participated in self-audit, and leaders were rewarded with the Prize of Quality. Systematizing record management, correct filling of medical documentation, stages and algorithms of the TQM concept have disciplined operation of these organizations.

Besides, an experience shows that going through a complete circle of contest is localized at a limited time period and requires significant expenses of staff. It is often considered as a one-time measure. These conditions does not allow one to maintain a wide range of institutions in field of improving management of medical care organization quality by attracting them to contests.

A solution of this situation is simple. In is necessary to start introducing methods of consequent small steps (method of Kaizen) that is possible to organize within any institution. It implies carrying out systematic hard work on realizing contents of the described TQM principles on mastering terms in the area of managing quality, forming actives that are aimed to implement the principle of consequent improvement, realizing the necessity of changes and readiness to accept them.

After some initial stage of work, one should plan to take the next step in introducing the model «Self-evaluation of an institution activity» that will allow him to form some kind of a picture of his activity and compare it to certain standards, see his weak points and continue a conscious formation of his strategy.

The work was submitted to International Scientific Conference «Innovative medical technologies», France (Paris), March, 15-22, 2013, сame to the editorial office on 29.04.2013.