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HEALTH AND WELLNESS 2/2013
WELLNESS AND ENVIRONMENT
CHAPTER I
1
MedicalUniversity of Silesia in Katowice
Faculty of Public Health
Department of Epidemiology
Śląski Uniwersytet Medyczny w Katowicach
Wydział Zdrowia Publicznego
Zakład Epidemiologii
2
MedicalUniversity of Silesia in Katowice
Faculty of Public Health
Department of SurgeryPropaedeutic and EmergencyMedicine
Śląski Uniwersytet Medyczny w Katowicach
Wydział Zdrowia Publicznego
Katedra i Zakład Propedeutyki Chirurgii i Medycyny Ratunkowej
3
MedicalUniversity of Silesia in Katowice
Student at the Faculty of Medicine
Śląski Uniwersytet Medyczny w Katowicach
Studentka Wydziału Lekarskiego
TERESA BILEWICZ-WYROZUMSKA1, DARIUSZ MYRCIK2,
MONIKA BILEWICZ3,
Quality in health care
Jakość w opiece zdrowotnej
The first definitions of quality come from the ancient times. The notion of quality related to excellence was introduced into philosophy by Plato. In the definition
suggested by Plato, quality was compared to beauty and its evaluation was left to the
user. Presently, many authors defining quality describe it in the aspect of fulfilling
or exceeding client’s expectations, fairly often including costs. Quality as a dynamic
process is perceived mainly in Japanese culture, and more and more often in the
sector of health protection. The United States is considered to be the leader in studies on quality improvement in healthcare service. In 1951 in the United States, Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) was appointed,
and after a few years it also involved other health care institutions. According to
JCAHO, quality is a level of a service delivered to a patient according to a present
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knowledge, it raises a probability of healthcare desired result and reduces a probability of unwanted effects. The interest in quality in healthcare in European countries
appeared in the 80s. Presently, each developed country has got at least one organization which deals with accreditation of health care institutions. In Poland, in 1994,
The Minister of Health appointed the Centre of Quality Monitoring in Healthcare
(CMJ) with the head office in Krakow, which issued in 1998 the Program of Hospital Accreditation [11]. Presently, the process of hospital and outpatient clinic accreditation is one of the elements of marketing strategy in the health sector. Cooperation
of the CMJ workers with the representatives of scientific institutions, governmental
organizations, medical governments, societies of hospital managers resulted in making up a set of standards. Accreditation standards are constantly verified, improved
and adjusted to present state. The healthcare reform in Poland, introduction of
health insurance funds, reorganization of healthcare, the changed form of medical
institutions functioning, conversion from the central administration system into
marketing management model have led not only to structural but also to social
changes [5]. Initially, the measure of quality included a condition of utility rooms,
equipment, devices and patient’s satisfaction, while for the last few years the number of various measures has been constantly growing.
At all the levels of healthcare, regardless of the type and size of healthcare subject, the medical service includes three actors: the leader, quite often a business
person, the employee and the patient. Each of these persons influences the quality
of the service in a special manner. Therefore, the relations happening between them
are becoming more meaningful. The quality of those relations decides whether the
actors taking part in this process are comfortable in their roles. For a leader the word
„success” has irrevocably a magnetic power, predicts recognition, joy of winning
and quite often an increase of income. An organization can also be a leader. In aspiring to reach the international recognition by an organization, a person who has a
leading position plays the key role in this organization. Looking for a model of a
perfect spearhead, one can notice that some people are successful easily, sometimes
in different fields, while for others, the same challenges are too difficult [1].
This is the reason why biographies of famous leaders have become so successful
in contemporary world and focus much interest and often undergo detailed analysis.
Some empirical studies are trying to find the answer to a question; what are the
personal features that help some people make good decisions quickly and achieve
success ? Is effective management a matter of innate talent or skills ? Many authors
claim that a leader searching for excellence should have a passion for his work,
improve his own results, possess a very good communication skills, be able to build
positive relations and create well cooperating teams. Undoubtedly, the ability to
make decisions supported by optimism and belief in victory should be balanced with
the ability to calculate risk. Taking this into consideration, managers constantly
analyze the indexes for accurate decisions. They search for information about the
best methods and tools which can help to manage more effectively [13].
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Teresa Bilewicz-Wyrozumska, Dariusz Myrcik, Monika Bilewicz
Quality in health care
The influence that a leader can have on the organization depends on many factors. The desired personal features of effective managers include analytic abilities,
logical thinking, creativity, ability to evaluate a situation, mental resistance, being
receptive to new ideas, self-esteem [8,24]. A contemporary manager is expected to
be able to create visions, concepts of activities adjusted to a type of healthcare subject, its size and function in the environment. Ability to deal with contradictions
quite often decides about manager’s success. The level of competence of people
managing healthcare institutions clearly focuses on the level of provided service.
Thus, being a manager requires various skills [12].
Apart from the knowledge of foreign languages and using a computer, a manager
should be able to persuade, understand and analyze information. A test for manager’s skills is an ability to implement strategies influencing the level of healthcare
and condition of public health, and consistent and competent decisions related to
financing, allocation of resources, predicting the effects of the decisions and also
the ability to invest and plan services and implement new technologies. In the era of
constant changes due to fast technological progress, increasing costs, growing number of chronic diseases, the ability to define effectiveness parameters (measurement
indices) and formulating standards for an organization is of great importance. The
ability to manage personnel and cooperate with them effectively has gained an exceptional significance [21,24]. Presently, we observe an international society of
specialists creating a new quality of service in the field of healthcare, the quality
which can be managed in many ways, can be controlled, whose deviations and effectiveness can be measured. Transfer of techniques and devices of quality improvement, such as PDSA model (plan, do, study, act), six sigma, lean management
[3,10] is implemented more and more bravely into the sector of healthcare services.
A habit of noting down ideas, evaluating them after some time and implementing
those that are considered to be good ones seem be useful. Searching for solutions to
the problems can include searching for analogy, looking at the problem from another
perspective, reducing complex problems to the sizes that can facilitate their solution,
reading professional literature, being with people searching for new ideas and stimulating creative thinking. The interest and ideas can be also developed by asking
questions. Mutual “stimulation” in discussion on various problems can make us find
more ideas and potential possibilities of their implementation. In the rational and
analytic society basing choices on facts and evidences, there is a big group of wellknow and admired people, business people and thinkers, who ascribe their good
choices and victories in the pursuit of success to an intuition. Carl Jung was one of
the first to describe intuitive personalities and he admitted that extravert intuition is
extremely important both in economy and in culture. Presently, the world of science
has started to abandon old superstitions on intuition, more often a question about a
potential that we have and how it can be developed is asked. Getting to know oneself is like discovering an own guiding system, it means discovering new possibilities [25].
.
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Tab.I Rudiments of emotional intelligence according to D. Goleman
Self-awarness
Emotional awareness:
ability to recognize and
understand own emotions and to see their
influence on work
effectiveness, interpersonal relations, etc.
Accurate
self-evaluation
sound evaluation of
own advantages and
disadvantages
Self-confidence
silne poczucie własnej
wartości.
strong feeling of selfesteem
Self-regulation
Social conscience
Self-control:
Empathy:
ability to control ability to feel emonegative emo- tions of other people,
tions and imunderstand their point
pulses
of view and be eager
to deal with their
Be reliable:
consistent honest problems
and integral
Ogranization
attitude
awarness:
ability to see organizaDiligence
ability to control tion dynamics, build
own conduct and decision nets and to be
to fulfill the
familiar with inner
duties
policy
Adaptation
Ancillary approach:
ability to notice and
skills:
ability to adjust satisfy client’s needs
to new situations
and overcome
obstacles
Successoriented attitude:
aspiration to
complete the
inner criteria of
a good job
Initiative:
readiness to
make use opportunities
Social skills
Visionary leadership:
ability to take leadership and to inspire
others with convincing
visions
Being influential:
ability to use various
persuasive techniques
Developing other
people’s skills:
eagerness to increase
other people’s potential through feedback
and guidance
Communication
skills:
ability to listen to and
transfer suggestive
messages adjusted to
the receiver’s ability
Cathalizing changes:
ability to generate new
ideas and to show
people new paths to
explore
Preventing conflicts:
ability to resolve arguments and find
solutions
Creating interpersonal bonds:
abitity to build and
maintain bonds with
many people
Team work skills:
promoting cooperation
and building teams
Source: Goleman D.. Przywództwo, które przynosi efekty. „Harvard Business Review Polska”
2004, No 12 p.41 [8]
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Teresa Bilewicz-Wyrozumska, Dariusz Myrcik, Monika Bilewicz
Quality in health care
The points of contacts with clients and points of influence should be perceived
and analyzed as a chain of events. Although many points of influence remain out of
sight, in some way behind the scenes, they are really essential for the client’s service
and they decide about the quality of service. Searching for mistakes, errors lead to
changes and implementing solutions preventing similar problems. The rule of constant improvement leads to the enhancement of the effects in all the aspects. The
candidates for medical and nursing positions, apart from formal requirements, such
as a licence to perform a profession, certificates of practical skills, should also possess some social skills. Presently, those skills are stressed to be more and more
important in building bonds and creating client’s loyalty. The patients establishing
contact with a receptionist expect her/him to possess adequate competences, ability
to solve their problems quickly, and also to be sympathetic. A doctor can set accurate diagnoses, a nurse can give injection very skillfully, however, if they are not
sympathetic, empathic, have not the ability to provide a conversation, it creates a
problem from the client-oriented point of view. This problem is also noticed by
personnel managers because it is a fundamental factor in building accurate relations
with patients and company’s image [23]. The process of quality education should be
dedicated to all the participants, clients, employees, manages and shareholders.
Managing human resources in the program of quality improvement plays a strategic
role. During discussion on quality improvement in healthcare, a problem of patient’s
safety is often raised [7]. Issues of safety in medical services have become the topics of many international meetings and conferences. A need of coordination in technologies applied in medicine, in quality of medical and pharmaceutical products,
safety standards are stressed very often. Reaching for experiences from the army,
aviation or navy can enable creating better system security devices (patterns) for the
environment in which medical service is provided. In pursuit of eliminating medical
errors, it is necessary to create a system of undesired events reporting. There are
some activities taken in Poland to implement similar initiatives. Undoubtedly, analysis and drawing conclusions from mistakes should enable creating an education
platform which will be the basis for correcting procedures improving safety of services provided on the organization and technical level or avoiding undesired effects
of drugs or medical substances. Detailed analyses should cover the reasons of patient’s death and the process of monitoring medical devices and products. The system of quality in the sphere of patient’s safety should include many levels and areas;
from meeting the legal requirements and conditions through increasing accuracy of
patient’s identification, better communication between personnel, medical personnel
and patients. Decreasing the risk of hospital infections, decreasing a number of
complications, it also means decreasing costs. Improving safety of medicine administration, providing full information about medicines taken by a patient at each stage
of treatment including elderly patients and those with memory disorders, and eliminating drug interactions and side effects, make the elements of the strategy improving safety of therapy and service quality. The improvement of medical services can
be achieved more easily when the patient is actively involved in the treatment and
education process, when the risk factors can be identified, patient’s condition thoroughly monitored and all the changes respectively dealt with [7]. The healthcare
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services should deliver the feeling of safety both in a service provider and a client.
This is the reason why monitoring complaints of medical devices and products,
analyzing the causes of devices break downs have gained great importance. The
safety of treatment process is connected with the concepts of undesired event and
medical error. However, it must be stressed that the culture of work organization,
communication and cooperation with other units plays a very important role in
providing safety to a patient and personnel. Therefore, the analyses of patients’
complaints and incidents during their hospital stay should be used by the managerial
staff as information about weak points requiring repair. Until recently, the patient’s
rights have been discussed in the context of complaints and claims for unpleasant
experience. Presently, this problem is analyzed from the perspective of building a
new level of service in healthcare. The role of the Council of Patient’s Rights (Ombudsman) is very important in this process, with a special prestige given by the act
on patient’s rights and the Council of Patient’s Rights [25]. Safety as a basic human
need requires different points of view from the perspective of the three main actors.
Due to a risk of causing harm and legal regulations related to it, doctor/manager or
employer makes a contract with an insurance agency and buys a special civil liability policy. Due to variety of needs and expectations, insurance market evolves and
will evolve to meet them. One of the examples is a new product ensuring a legal
protection of doctors, being a part of complex doctor’s insurance, increasing the
access to legal help, even for 24 hours per day [4]. This is a proposition of insurance
market in the healthcare sector which can ,through further development and better
adjustment to client’s needs, relieve stress connected with managing. The legal requirements and rules of patient’s and personnel safety, make a manager become
more effective in risk management, in operating information system, medical and
epidemiologic procedures, storing and making medical documentation available,
protecting property, media, obeying rules included in fire prevention regulations,
etc.
Active observation of directives, complying with the recommended requirements
referring to the variety of tasks and problems, influences building of the system
which transfers the quality of services provided directly onto a higher level. The
activities including control (verification) of medical procedures and standards and
some techniques relating to patient’s safety are becoming more common. Trusting a
doctor or a healthcare unit is a basic condition to be successful. The cardiologist,
Dean Ornish, in his book “Love and Survival” shared his observations on changes
merging into the sector of medical services [18]. He believes that:
“The real epidemic in modern culture is not only physical heart disease but also
what we call spiritual heart disease: loneliness, isolation, alienation, and depression which appeared along with breaking social structures. These structures gave
us a feeling of community and relationship with other people. In my opinion this
situation is a source of weakness, cynicism and aggression in our society”
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Teresa Bilewicz-Wyrozumska, Dariusz Myrcik, Monika Bilewicz
Quality in health care
Bill Gates, at the end of the previous century, editing his book „Business, The
Speed of Thought” predicted that we should get ready for digital future because
information technology will be of strategic value for companies [6]. In the chapter
“No health care system is an island” describing the advantages of personal computer technology and the Internet, he announced that introducing digital system would
cause inestimable benefits in all the areas of patient’s medicare from the ambulance
service through hospital treatment, post-hospital care, long-term analyses and tendency study. Referring to the experts’ opinions, he estimated that about 20-30% of
American healthcare costs, being a billion per year, is consumed by so called “paper
work”. Moreover, he suggested that in hospitals it can reach as much as 40-50 percent, and a one-week stay of one patient in a hospital can generate as much as one
hundred pieces of paper documents. Today we know that computer technology improves not only emergency medical care and constant contacts between a doctor and
a patient but also enables improving medical care by monitoring and long-term
analyses of the symptoms, diseases and methods of treatment. The collected data
makes the patients care more advanced. When used in management it can contribute
to radical improvement of the access to medical services delivered by specialists.
These possibilities are offered not only by telemedicine but also by e-education, esignature, e-prescription, etc. The Internet makes it possible for the patients to be in
touch with a doctor both during the hospital stay and after leaving the hospital, when
they are still under the treatment. Creating nets of visual connections with specialist
(i.e teleradiology, teleoncology) will spare the patients, especially with advanced
diseases, a burden of being transported. The nets will also provide unification of
therapeutic procedures and will increase patient’s access to those procedures. The
patients from a high risk group will be able to control their health condition, to obtain information about their illness and recommendations referring to a lifestyle.
Electronic records of patient’s treatment, ordered tests, consultations, applied therapies influence the improvement of the healthcare. Good system cooperation of various sectors in the healthcare system, such as emergency service, diagnostic departments, pharmacies, blood banks, transplantology, insurance can significantly modify
not only costs but also time of providing help. The module supporting therapeutic
decisions will inform, for example, about ensuing “conflict” or interaction with
another drug, danger of allergic reaction or before ordering another X-ray, it will
show the date of the previous one. It will also refer to the current treatment standards
of a disease. The platform for on-line communication, both for a patient and for a
specialist providing the treatment, opens new possibilities of service quality improvement, especially for general practitioners. In medical contacts with patients
emotional sphere seems to be very important, therefore it is worth focusing on how
to model it. How to influence senses to make a patient, in the era of client’s cult,
experience as many as possible positive feelings. Taking up the challenge, the information should reach a patient’s mind on a deeper level, it means, it should cause
a reaction where a contact will be remembered as a nice experience. Pursuing a
success on the global market, activities overcoming the sphere predicted for mass
marketing get a new meaning. Especially in the environment of medical subjects,
applying services oriented to “reading” patient’s feelings and expectations in the
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process of constant improvement of service quality should not be neglected. Competent reception of signals coming from a patient and used as feedback information
enables introducing changes and defining directions of further activities. Focusing
attention on client’s needs and proper reaction allow to build individual bonds and a
trademark. Only getting real identification with the client’s role, we can assume the
point of view which will support recognizing areas that need improvements in the
management system. Brain constantly codes sensual data, quite often without any
awareness. It can also store various types of information and get it transformed.
Outside world is perceived by the senses of sight, hearing, feeling, taste and smell.
The way the surrounding reality is perceived depends on a way of using senses.
Each person has his “favourite” canal (system) which he uses most often for receiving signals coming from the surrounding and uses it as a tool to create his own inner
experiences. Our senses are canals for entering information. The persons with the
dominating sight system “think” in pictures. Those who prefer hearing system, analyze sounds more thoroughly than images or feelings. Those people prefer to refer to
feelings, they belong to the group using kinesthetic system, as a leading system.
Each detail noticed by a human in the outside world through senses, can be used to
creating images, sounds and feelings, this is experiences [16]. Colour is an example
of visual submodality, temperature and pressure – kinesthetic submodality, and
sound – acoustic. A large group of mangers apply the knowledge and NLP techniques to develop communication skills, solving problems, creating teams and strategies, which increases the probability of achieving success in management. Visualization and using own imagination is a good tool to introduce changes. It is widely
known that a methodical interview and detailed physical examination can be sufficient to propose an accurate diagnosis. However, if a doctor examines a patient with
cold hands, he will quickly discover that the patient’s body defends itself against
unpleasant touch, stays tense and much information important for further medical
procedure may be misinterpreted. Especially, in the case of small patients, improper
temperature of the room and diagnostic tools causes discomfort, crying of the child,
which makes further examination impossible. Therefore, heat radiators are very
often installed in pediatric surgeries over the place where a patient is examined, or
special heaters which warm up the gel used for the ultrasound examination to the
temperature friendly for the body. These simple solutions in everyday medical practice make the environment more patient-friendly, a doctor can obtain necessary
information easier, does not disturb child’s sleep or has a nice contact with him/her.
The X-ray or ORL surgeries do not warm up metal tools as a common procedure in
Poland but it is a signal for new trends being the evidence of exceptional care of
patient’s comfort, making the surgery more attractive for a patient at the same time.
The surrounding world is full of various sounds, and a man through his constantly
active mind is contacting with this surrounding by listening and interpreting his
attitudes and opinions, feelings and self-identity. More and more companies realize
how important a sound is in creating their own trademark and they use this
knowledge effectively also in the area of healthcare. To make an appointment, a
patient can use a telephone registration. The contact with the healthcare institution
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Teresa Bilewicz-Wyrozumska, Dariusz Myrcik, Monika Bilewicz
Quality in health care
is made through a person who picks up a phone. Due to a type of contact, the evaluation will be created through sound perception. In the client-oriented institutions,
all telephone connections are monitored and analyzed systematically. One of the
quality measurement devices of this service is time which passes from the first telephone ring to the moment of conversation. In a very well managed institutions, more
than 90% phone calls are answered after the fourth sound signal. It is not an easy
task, but everyone who tried to get a connection with an institution, where after
listening to another announcement could not get in touch with a desired person and
receive the needed information, as a consequence, may consider such a subject not
very friendly. Therefore, company image specialists analyze the places where clients
establish a relationship with a company very carefully. In this type of contacts, it is
not only politeness, ability to communicate, a method of passing information, but
also diction, timbre of the person we are talking to, can make us regard this contact
as more or less pleasant. We know, that voice can get modified depending on an
emotional state and it can also carry some emotional load. The results it can cause
are very well recognized by actors, therapists, professional speakers. Some exercises
and voice training can give some effects and we can reach a desired aim. The voices
perceived as friendly, nice, full of affection can be a source of positive feeling associated with a company’s image. Presently, there is a possibility of generating digital
voices, for example, young, simple voice. Digital voices, including those used in
telephone switchboards or public transport, are perceived as impersonal, while a
patient looking for help is expecting to build more direct bonds. Modeling of emotions and moods can be also done by music [17]. Slow music makes people feel
well. It allows to introduce relaxation and has its established position in psychotherapy. Music tempo influences human perception of time flowing. Listening to slow
music makes patients feel that the waiting time is not so long. It must be also remembered that a patient can hear some undesired sounds coming from some medical
appliances. They can be perceived as some kind of danger approaching and make a
patient feel upset. Therefore, in some medical centres, relaxation music is sometimes used as a form acoustic barrier muffling unwanted sounds, for example,
sounds from dentist’s or gastroenterologist’s surgeries, which stimulate patients
imagination negatively, enhancing anxiety before the examination. Therefore, the
application of sound absorbing material or building vestibules to get rid of the unwanted acoustic effects should be considered at the stage of designing an area for
providing medical services. Practically, the use of those solutions can make a patient
feel that the service provided is on a higher level. Visual experiences also have a
very big influence on the evaluation of various situations. Light, color and shapes
trigger off visual images which most people trust and interpret the surrounding
phenomena through them. Image in sensual perception affects the central nervous
system and can recall memories. Depending on a colour and intensity various psychological effects can be stimulated, and certain associations can influence some
decisions. Interior designers use the knowledge of using colors to model moods of
the persons being inside the room. Additionally, lighting should be treated as the
element playing an important role in each space. The well matched lighting can
create the atmosphere of tranquility and peace, or on the contrary, it can change the
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colours of some objects. The advertisement specialists treat lighting strategically.
The knowledge of light and colour becomes a purposeful tool of fighting for a client.
In medical service, wrong illumination or wrongly adjusted colours can cause the
increase of unnecessary test orders and increase of costs. In one of the hospital
wards (pediatric cardiology), the room for neonates was painted violet and the blinds
had the same colour. While diagnosing heart defects in children, a cardiologist doing
the examination looking for the initial diagnosis, tried to establish whether a patient
has the symptoms of cyanosis or not. The patients in this room, more often were
suspected of the heart defect with the accompanying cyanosis . A similar situation
was observed in another ward where patients with problems of alimentary tract were
treated; medical personnel had an impression that the patients had symptoms of
yellow skin coloring, which resulted in a number of unnecessary tests. Intensity of
lighting should also be adjusted to the needs. The lights directed to a definite place,
with a possibility of changing its intensity, definitely improves the comfort of medical personnel’s work, can also improve a patient’s comfort or can eliminate a discomfort of compulsory neighborhood (especially at night). Installation of lighting
system connected with movement detectors, can also result in a considerable decrease of costs. Similar energy saving systems are already promoted and introduced
in some cities. It is suggested to decrease the intensity of street lighting by increasing the intensity of the stream of light when a man or a vehicle is approaching, afterwards the light decreases its intensity again. This type of solution can reduce costs
in the further perspective.
The sense of smell also influences our reactions. Some smells are generally perceived as unpleasant and that is why people avoid them, others can bring some nice
feelings or memories. The human desires to eliminate unpleasant smells and enhance nice experiences or a variety of tastes in the sphere of aromatic compositions,
it is very well reflected by the huge perfume market or a development of aromatherapy. Constant offer extension in order to satisfy client’s various needs and preferences should make the client feel to be really spoilt. However, if a doctor does not
know his client’s preferences, and a pharmacist does not enquire about his taste or
smell favourites, a patient will get a product which does not meet his expectations
despite a very rich offer. Therefore, the ability to establish contacts and to build
friendly relations with patients is of great importance. The people who deal with
management and quality by the method orientated to constant development of potential and structure and on activities in all aspects, spheres and results, which creates a
good image of the company its stable development, call it Total Quality Management (TQM) [22] These revolutionary changes in management were introduced by
W.E.Deming, thus he is considered to be the founder of the Total Quality Management philosophy. He described his approach in 14 theses. His theses are quoted in
various forms; with long or short commentary, or are presented in the form of slogans [2,28]. The theses versatility allows to implement them successfully into service companies, also medical service companies [9,19]. W.D. Deming defined the
attitude the companies and employees should adopt towards quality problems and
he also indicated those which can be employed in medical institutions. TQM is defi20
Teresa Bilewicz-Wyrozumska, Dariusz Myrcik, Monika Bilewicz
Quality in health care
nitely an interdisciplinary concept, it is only the perspective that may be different.
For many authors Total Quality Management is a philosophy or management system, for others a strategy. Due to this multidimensional approach, TQM definition
can be considered in many aspects; strategic, organizational, economic, marketing,
technical, social and systemic [27]. The aim of the system is an increase of internal
and external client’s satisfaction connected with the reduced resource consumption
[14]. It is worth observing and implementing various good solutions, even form the
disciplines not closely related to medicine, to improve the condition of medical
subjects and the quality of provided services.
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ABSTRACT
The interest in the quality in healthcare appeared in the 80s in the European
countries. Presently, a development of international specialists creating a new quality of service in the healthcare is being observed. The manager’s competence test
includes now the ability to implement strategies influencing a level of healt care and
coherent competence in decisions related to financing, resources allocation, predicting the effects of decisions, and also expertise in investments, service planning and
implementing new technologies. The management style is orientated to constant
improvement of potential and structure in all aspects and spheres, providing sustainable development of the organization consistent with TQM philosophy. Implementation of the tested solutions, even from fields distant from medicine, can improve the quality of medical service.
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Teresa Bilewicz-Wyrozumska, Dariusz Myrcik, Monika Bilewicz
Quality in health care
STRESZCZENIE
W krajach europejskich zainteresowanie jakością w ochronie zdrowia pojawiło
się w latach 80. Obecnie obserwujemy proces tworzenia międzynarodowej
społeczności specjalistów kształtujących nową jakość usług w sektorze opieki
zdrowotnej. Sprawdzianem sprawności menedżera staje się umiejętność wdrażania
strategii wpływających na poziom opieki zdrowotnej oraz spójność kompetencji w
podejmowaniu decyzji związanych z finansowaniem, alokacją zasobów,
przewidywaniem skutków podjętych decyzji ale także umiejętnością inwestowania,
projektowania usług i wdrażania nowych technologii. Sposób zarządzania
zorientowany na ustawiczne doskonalenie potencjału i struktury we wszystkich
aspektach i strefach, zapewniający trwały rozwój organizacji pozostaje spójny z
filozofią TQM. Implementacja sprawdzonych rozwiązań, nawet w z odległych od
medycyny dziedzin, może skutecznie poprawić jakość usług medycznych.
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