Some Particularities Regarding the Health Care System


Economy Transdisciplinarity Cognition

Vol. 18, Issue 2/2015


Some Particularities Regarding the Health Care System Andrei Octavian PARASCHIVESCU George Bacovia University, Bacau, ROMANIA [email protected]

Valentin RADU The Clinical Emergency Hospital, Sf. Spiridon, Iasi, ROMANIA Abstract: The objective of our study was an analysis of the size and features of quality in the healthcare system with the support, legislation, research results and comparative observation. Quality of healthcare is a dynamic concept with many dimensions relative to both the patient and the social, organizational and environmental context. In addition, medical services cover the entire population of a country and shall be based on compliance with laws and regulations in force relating to ensuring and maintaining public health. Keywords: quality of care, quality collaborative, total quality

Introduction Medical practice is conducted in an environment with specific, highly sensitive, dynamic and often unpredictable. “To work is expandable to a high performance health units must have the ability to accept change, to identify and seize the opportunities and avoid possible risks.” [16, 561] Some studies and our analysis have concluded that better collaboration across the bands / medical teams can improve patient health, decreased length of stay in hospital and costs. It is necessary to better define what is meant by cooperation / collaboration to develop and evaluate strategies for forming this collaboration and to assess the impact. The most elementary form of interdisciplinarity in the hospital is collaboration between physicians of the same specialty or specialties, across doctors and nurses between doctors and pharmacists, and patients between medical staff etc. 1. The quality of medical care. Definitions and dimensions Subject quality of health care is extremely controversial, with implications both at the economic, financial, technological and human resources level and organizational management. Over time more definitions of quality were formulated based on the dimensions that the authors had in mind. The father of the modern concept of quality Donabedian describes the quality of health care as “that treatment that is expected to maximize the size of the welfare of patients, taking into consideration the balance of gains and losses expected to occur in all stages of health care” [3]. After Donabedian (first highlighted the complex nature and quality of care) there were two components of quality of care: technical and interpersonal. Quality of care is a dynamic concept with many dimensions relative to both the patient and the social, organizational and environmental. There are many definitions in the literature for quality medical care:  Quality is “the degree to which health services for individuals and populations increase the likelihood of desired outcomes of care and are consistent with current knowledge professionally”. They described six dimensions of quality of care: care is safe, effective, patientcantered, while useful, efficient, and equitable. [8, 1]  Quality is characteristic of a product or service that determines the level of excellence.  According to the WHO, quality in health is to take place with each patient share diagnostic and therapeutic suitable that will ensure the best result in health conditions in accordance with the current state of medical science at the best cost for the same result with the least risk for iatrogenic great satisfaction in terms of procedures, outcome and human acts within the health care system (1987).  Quality is all features you expect from a product, a service or care. (Association des Hospitaux du Quebec). 33

Specific dimensions of service quality in health care facilities are increasingly discussed in recent years in literature (Luchian – 2004; Vladescu – 2004; Donabedian – 2005, Mazen – 2012). Many of the dimensions are show in Figure no.1 THE REQUIREMENTS OF THE PATIENTS ACCESIBILITY OF CARE DEFABRICATIE














Figure no. 1 The dimensions of the health care quality

Vectors values that contribute to quality assurance in healthcare are [7]:  Excellent medical practice;  Introduction of integrated techniques and procedures, modern, popular with patients;  Reducing or keeping costs under increased efficiency and productivity. 2. The Implication of Whole Staff. Excellence Employees at all levels represent the core of a health unit and their involvement enables their abilities to be harnessed to maximize the benefit of the organization. Applying this principle implies [18, 33-34]:  Taking responsibility for solving problems;  Active involvement in identifying opportunities for improvement;  Showcasing the skills, knowledge and experience in teams and working groups;  Focus on meeting customer needs; developing a creative spirit in defining future goals of the organization;  A better representation of the organization in the relationship with customers, local communities and society in general;  Obtaining satisfaction from the work carried out;  Develop a sense of pride to be part of the organization.


To establish the performance criteria can be considered and developed models of excellence criteria, and simple patterns such as, for example "spider web" (Radar chart, Figure no. 2).

Coordination capacitaty Anticipative ability and rapid response Clarity of objectives and roles


Clarity of decision process

Information easy to find

0 1 2 3 4 5 6 7Collective planing

Tryind to simplify and improve Qality of results

Productivity sessions Fulfillment of objectives Collaborative atmosphere, motivation and involvement

Figure no. 2 “Spider’s web” of a team assessment [13, 185]

Some authors believe that while individual excellence decide the success or failure of the organization it is important and necessary an excellent system of teamwork. In the health care system teams are generally complex being made up of doctors, doctors + nurses, doctors - pharmacists. The quality standard fulfilment does not consist of or compliance with recommendations for executing a product or service. Quality management principles go beyond the quality of the process leading to “quality human spirit” [4], [10]. To achieve excellence collective organization must ensure conditions for the implementation of a set of methods that you will call EX- SITI [14, 27]:  Selection of employees;  Train them;  Time;  Tools. All this means quality culture, excellent management, excellent managers, excellent workers, excellent rating is given as a result of collaboration in the design, implementation, evaluation and continuous quality improvement. 3. Collaborative quality relationship - Total Quality Quality management proposes ways and means and determining performance management tailored to the activities of the medical service units. “Quality management does not refer to medical act; it refers to the services and support activities contributing to the medical act” [10, 17]. For a hospital, nursing home, outpatient specialty clinic, doctor etc., the quality of medical compliance is paramount. The concept of Total Quality Management (TQM) has not yet been fully developed within healthcare services. By “total quality” means today both quality and quality system. 35

Total quality management extends the concept of quality management, encompassing both participation and motivate all members of the organization. Three principles govern the concept of total quality:  Focus on customer  Continuous quality improvement  Team work. A new dimension of quality is developed in managerial practice of health care system that of collaborative quality or better collaborative management, which means more than participative management. The need for closer cooperation both internally (between positions) and externally (between partners) and new long-term relationships were deemed essential characteristics of modern quality management. In the health care system performing collaborative quality is based on “integration of all key success factors” [2, 300] (Figure no. 3).










Figure no. 3. Integration of key success factors (Adapted Boeri)

Providing medical "front line" in some countries is based essentially on professional models based on collaboration between nurses and family doctors [1, 137]. Collaborative quality is an objective quality management in all areas. The essential objectives of collaborative management are:  Building and maintaining an excellent reputation of quality products / services;  Solving all problems at one level and quality at all levels;  Personnel training so as to be able to participate in continuous quality improvement of products/ services. The secondary objectives are:  Definition of quality in terms of the customer;  The functioning of the system that measures performance. In recent years, the healthcare system has been described a new method - Method “Improving the quality collaborative” (QIC) whose implementation is investment of time, effort, and funding. QIC method brings together a group of participants (“collaborating”), persons or organizations engaged in studying / solve specific problems on health care quality, design and implementation of specific solutions, evaluation and continuous improvement and dissemination of results. The method has been described by Wilson et all (2006), Ovretveit et all (2002), Landon et all (2004). Another issue for collaborative quality of medical service is prescribing [6, 238]. The prescription is the culmination of a structured process, a forensic act of civil and criminal liability of the prescribing 36

physician and the pharmacist who delivers them. It is also a possible factor cost, errors and failures in continuity of care. Experience Swiss-based collaboration in quality circle of doctors and pharmacists in average outpatient and EMS and pharmacists to analyze drugs demonstrates that improving the quality of prescription involves strengthening the principles of ethical biomedical local partnerships, transparency and positive incentives in the interest of patients and in favour public health. Once trust built and the specific skills of each party recognized, medical services may target other objectives of quality of care, such as treatment compliance, empowerment of patients (patient empowerment), disease prevention and health promotion, integration of care (Integrated Care) use of information technologies (e-health) or coordinated management of chronic diseases (disease management). This (r) evolution must attain training health care professionals, medical research and pharmaceuticals, the community, the legal and socio-economic incentives for change. Management by quality in health systems is essential quality support collaborative and based on [2, 229], [17, 79]:  strategic and forward thinking;  human resources development (training, motivation training, recognition etc);  a visible management;  clear allocation of responsibilities;  emphasis on teamwork and involvement effectively;  culture of dialogue, communication, information, easy viewing;  collaborative creation and maintenance team spirit;  respect for rules;  focus on continuous quality improvement process;  reporting quality. Conclusions In healthcare, quality is variable and difficult to quantify can be regarded as the result of a comparison between the health service wanted / expected by the patient and the service received. Quality of health care is a dynamic concept with many dimensions relative to both the patient and the social, organizational and environmental. In addition, medical services cover the entire population of a country and shall be based on compliance with laws and regulations in force relating to ensuring and maintaining public health. Our study showed that in obtaining quality in health care system is based on different principles of industry, production and general services. Quality management must consider the specific dimensions of service quality in health care facilities: Other recent studies suggest that better cooperation as whole doctors and nurses can improve patient outcomes and decrease length of stay and costs. It is necessary to better define what is meant by collaboration, develop and evaluate strategies to prepare and assess the impact of this collaboration. The research results were based on literature studies and analysis / observation by the authors (first as a member of a board of a hospital emergency, and the second one as a doctor resident) medical system in the counties Iasi and Bacau. References [1] D’Amour, D., (2001) Collaboration entre les infirmières et les médicins de famille. Pourqoui et dans quelles conditions?, Rupture. Revue transdisciplinaire en santé, vol.8. no.1, p.136-145; [2] Boéri, D., (2006), Maîtriser la Qualité et le Management éthique, Editeur MAXIMA, Paris; [3] Donabedian, A., (2005), Evaluating the Quality of medical care. The Milbank Quaterly 83,(4), p.692; [4] Hacker, S.K., ş.a., (2002), O evaluare a abordării americane a calităţii, in the Journal Tribuna calită ii, nr.1, p. 10; [5]Landon, B.E, Wilson, I.B, McInnes,K, Landrum, M.B, Hirschhorn L, Marsden, P.V, et all. (2004), Effects of a quality improvement collaborative on the outcome of care of patients with HIV infection: the EQHIV study,.Ann. Intern. Med. , 140:887-960;


[ 6] Locca,J.F., Krähenbühl, J.M., Niquille, A., Figueiredo, Bugnon , O., (2009), Qualité de la prescription médicamenteuse: des progrès grâce à la collaboration médecins-pharmaciens, Rev Med Suisse, No 227, 2382-2387; [7] Luchian, M., (2005), Management sanitar, Apolonia, Iasi; [8] Mazen, J. El Sayed, (2012), Measuring Quality in Emergency Medical Services: A Review of Clinical Performance Indicators, Emergency Medicinal International, Hindawi Publishing Corporation, p. 30-37; [9] Mitchell, G.J, (2001), Self-care deficit nursing theory and the nurce practitioner’ s practice in primary care setting, Nursing Science Quaterly, 14 (1), p.29-33; [10] Opincaru, C., ş.a., (2004), Managementul calităţii serviciilor în unităţile sanitare, C.N.I. Coresi, Publishing House Bucharest; [11]Ovretveit, J., Bate, P., Cleary, P., Cretin, S., Gustafson, D., McInnes, K., et all. (2002), Quality collaboratives: lessons from research. Qual Saf Health Care, 11:345-51; [12] Paraschivescu, A.O., (2014), Calitatea:.istorie, cultură, educaţie, management, Tehnopress Publishing House, Iasi; [13] Paraschivescu, A.O., (2009, Managemenul excelenţei, Ştiin a Publishing House, Chisinau; [14] Paraschivescu, A.O., (2007), Excelenţa, in the Journal Tribuna Economică, no. 12, p. 27-30; [15] Perrier, A., (2005), Collaboration infirmières- médecins : un déterminant de la qualité des soins? Thérapeutique = Nurse-physician collaboration: a determinant of the quality of care, Revue medicale suisse, vol. 1, no42, pp. 2742-2745; [16] Sârbu, R, Zanfir,A., (2011), Necesitatea implementării unui sistem de management al calităţii în unităţile sanitare din România. O abordare din perspectiva pacientului, Amfiteatru economic, Vol.XIII, Special Issue no.5, p.561 -569; [17] Suciu, O., Oprean, C., (2007), Calitatea globală concurenţială, AGIR Publishing House, Bucharest; [18] î u, M., Oprean, C., Boroiu, A., (2011), Cercetarea experimentală aplicată în creşterea calităţii produselor şi serviciilor, AGIR Publishing House, Bucharest; [19]Vlădescu, C., (2004), Sănătate publică şi management sanitar, Cartea Universitară Publishing House, Bucharest.



Some Particularities Regarding the Health Care System

Economy Transdisciplinarity Cognition Vol. 18, Issue 2/2015 33-38 Some Particularities Regarding the Health Care System Andrei Octav...

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