Stalno izboljševanje modela kazalnikov kakovosti zdravstva s povratno informacijo sistema e-pritožb

Mohorič Kenda, Anka

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Title:	Stalno izboljševanje modela kazalnikov kakovosti zdravstva s povratno informacijo sistema e-pritožb
Authors:	ID Mohorič Kenda, Anka (Author) ID Leskovar, Robert (Mentor) More about this mentor... ID Pirnat, Rajko (Comentor)
Files:	DOK_Mohoric_Kenda_Anka_2018.pdf (4,49 MB) MD5: 9951109A5F4C33A6642EEA6BDB1FB764
Language:	Slovenian
Work type:	Doctoral dissertation
Organization:	FOV - Faculty of Organizational Sciences in Kranj
Abstract:	V raziskavi so obravnavani koncepti in izvedba stalnega izboljševanja modela kazalnikov kakovosti zdravstva s povratno informacijo sistema elektronskih pritožb. Podana sta pregled in primerjava pravnih ureditev obravnavanja pritožb pacientov v več evropskih državah. Podrobno je analizirana slovenska zakonodaja, ki je bila osnova za izdelavo modela procesa obravnavanja pritožb pacientov. Predstavljen je agregiran model kazalnikov kakovosti zdravstva. V raziskavi je zasnovan hierarhični model kazalnikov kakovosti zdravstva, ki ima štiri glavne agregatne kazalnike (kriterije): medicinski kazalniki, kazalniki zdravstvene nege, finančni kazalniki in kazalniki pritožb pacientov. Agregat, povezan s pritožbami pacientov, temelji na seznamu petnajstih pacientovih pravic, ki jih ureja Zakon o pacientovih pravicah (Uradni list RS, št. 15/08 in 55/17). Vsak kazalnik pritožb pacientov je sestavljen iz treh do dvanajstih elementarnih kazalnikov (kriterijev). Empirična raziskava z naključno izbranimi anketiranci (N = 1195) je pokazala pogostost skupin kršitev pacientovih pravic. Zajeli smo tudi mnenja anketirancev, ki se nanašajo na razloge, ki so jih kot paciente ali njihove svojce odvrnili od pritožbe. Obstaja pomembna statistična povezava med pogostostjo uporabe zdravstvenih storitev in uveljavljanjem pritožb. Pacienti, ki se pogosto pritožujejo, pogosteje zaznavajo kršitev. Ta skupina izraža nižjo stopnjo varnosti in večje nezadovoljstvo z odnosom in ravnanjem osebja v zdravstvenih ustanovah. Razvit je bil dogodkovno orientiran simulacijski model v jeziku GPSS, ki je strukturno zelo podoben dejanskemu obravnavanju pritožb pacientov. V simulacijskem modelu smo nastavili take vrednosti parametrov, da je število simuliranih obravnav zanemarljivo malo odstopalo od realnih, uradno objavljenih podatkov za leto 2016. Eksperimentiranje na simulacijskem modelu je bilo osredotočeno na spreminjanje trajanja časov izbranih aktivnosti, ki bi jih lahko zmanjšali z uvedbo informacijskega sistema. V okviru raziskave je bil razvit popolnoma nov informacijski sistem za elektronsko vlaganje zahtev za obravnavo kršitve pacientovih pravic. Vgrajene funkcije omogočajo podporo celotnega procesa obravnavanja pritožb, ki se zaključi z enim izmed zakonsko predpisanih stanj. Poročila, ki jih omogoča informacijski sistem, se lahko uporabijo za sprejemanje ukrepov za zmanjševanje odstopanj od želenega stanja. Povratna informacija o novem stanju (število pritožb po kategorijah, čas obravnavanja v različnih fazah pritožbenega postopka) predstavlja mehanizem za izboljšan nadzor in upravljanje kakovosti izvajanja zdravstvenih storitev. Informacijski sistem za elektronsko vlaganje zahtev za obravnavo kršitve pacientovih pravic smo testirali v izbrani zdravstveni organizaciji. Rezultati testiranja potrjujejo, da je razviti informacijski sistem usmerjen v izboljševanje kazalnikov kakovosti, povezanih s pritožbami pacientov. Model podatkov in programska rešitev omogočata spreminjanje strukture kazalnikov v primeru, da se pojavijo nove pravice pacientov ali se te ukinejo. Programska rešitev omogoča vzpostavitev novih kazalnikov oziroma opustitev pomanjkljivo definiranih obstoječih kazalnikov. Testni uporabniki so s svojimi predlogi vplivali na razvoj dodatnih funkcij. Informacijski sistem za elektronsko vlaganje zahtev za obravnavo kršitve pacientovih pravic je eden izmed najpomembnejših elementov za stalno izboljševanje modela kazalnikov kakovosti zdravstva s povratno informacijo. Njegova sprejetost v splošno uporabo je predpogoj, da v tem specifičnem delu modela kakovosti zdravstva vpeljemo merljive kriterije in racionalno strateško odločanje na nacionalnem nivoju.
Keywords:	Elektronske pritožbe pacientov, pravice pacientov, povratne informacije, izboljševanje kazalnikov kakovosti, simulacija sistema.
Place of publishing:	Maribor
Year of publishing:	2018
PID:	20.500.12556/DKUM-66447
COBISS.SI-ID:	8036883
NUK URN:	URN:SI:UM:DK:DOOKWJXJ
Publication date in DKUM:	23.07.2018
Views:	2070
Downloads:	247
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Categories:	FOV
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Licences

License:	CC BY-ND 4.0, Creative Commons Attribution-NoDerivatives 4.0 International

Link:	http://creativecommons.org/licenses/by-nd/4.0/
Description:	Under the NoDerivatives Creative Commons license one can take a work released under this license and re-distribute it, but it cannot be shared with others in adapted form, and credit must be provided to the author.
Licensing start date:	26.06.2017

Secondary language

Language:	English
Title:	Continuous improvements of the quality indicators model of health care with feedback of e-complaints
Abstract:	This research deals with the concepts and implementation of continuous improvement of the quality indicators model via feedback from the electronic complaints handling system. It includes an overview and comparison of patient complaints handling regulations in several European countries. The legislation of the Republic of Slovenia, which served as the basis for the development of the patient complaints handling process model, was meticulously analysed. Also presented is the aggregated healthcare quality indicators model. In the research, a hierarchical healthcare quality indicators model was developed that is composed of four principal aggregate indicators (criteria): medical indicators, nursing indicators, financial indicators and patient complaints indicators. The aggregate indicator associated with patient complaints is based on a list of fifteen patient rights, which are regulated by the Patient Rights Act (OJ of the RS, No. 15/08 and 55/17). Every patient complaints indicator comprises three to twelve elementary indicators (criteria). An empirical study with random respondents (N=1195) was used to identify the frequency of patient rights violation categories. We have also included respondent opinions referring to reasons that have deterred patients and their family members from filing complaints. There is a statistically significant correlation between the frequency of healthcare service use and complaint filing. Patients that tend to file complaints more frequently are more likely to identify possible violations. This category is associated with a higher degree of safety and increased dissatisfaction with the attitude and actions of healthcare professionals in medical institutions. An event-oriented simulation model was developed in GPSS, which is in terms of structure highly similar to the actual patient complaints handling process. The simulation model was set up to include appropriate parameter values for the simulation to yield handling procedure numbers that insignificantly deviate from official real data published for 2016. Experimentation with the simulation model was focused on adjusting the selected activities' duration, which could be reduced with the introduction of an information system. An entirely new electronic incident reporting and patient rights violation handling information system was developed in the context of the research. The integrated functionalities support the comprehensive complaint handling process, which is concluded with a statutory state. The reports that can be generated by the information system may be used in the introduction of actions for reducing discrepancies from the desired state. Feedback on the new state (number of complaints by categories, handling time by complaint process phases) is the mechanism providing for the enhanced control and management of delivery quality of healthcare services. The electronic incident reporting and patient rights violations handling information system was tested at a selected medical institution. Test results indicate that the developed information system is geared towards improving quality indicators associated with patient complaints. The data model and software solution enable the adjusting of indicator structure in case of new patient rights introduction or their termination. The software solution makes possible defining new indicators or the omission of insufficiently defined existing indicators. Test users provided feedback contributing to the development of additional functionalities. The electronic incident reporting and patient rights violations handling information system is one of the most significant elements necessary for the continuous improvement of the healthcare quality indicators model via feedback. Its acceptance among the public is a prerequisite for the introduction of quantifiable criteria as well as rational and strategic decision-making on a national level into this specific healthcare quality model.
Keywords:	E-complaints, patient rights, feedback, improvement of quality indicators, system simulation.

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