HOSPITAL CHOICE IN LITHUANIA: PATIENTS’ATTITUDE

The article presents the research that reveals the complexity of the patient hospital choice process and, in the context of the research data, enables the evaluation of the patient hospital choice factors influencing their decision. The problem of hospital choice is topical both in Lithuania and other EU and world countries. It is a complex process that requires the evaluation of the poly-functionality of the choice factors: the character of the patient disease and their state of health, the characteristics of the hospital, the interactive relationship between the hospital staff, the patient’s relatives, and Internet access. The research sample consisted of 477 participants aged between 18 and 89, treated in various hospitals throughout the country. Based on the results of the research presented in the article, one can argue that the factors having the greatest impact on patients’ choice of hospital include the advice of friends and significant others, personal experience, and the advice of their family doctor. The main prerequisites for choosing a hospital named by the patient respondents were the qualification of the medical staff, the quality of health care, communication between doctors and patients, the geographical location of the hospital, and its accessibility.KEYWORDS: hospital choice, evaluation of the state of health, patient characteristics, hospital characteristics.DOI: http://dx.doi.org/10.15181/tbb.v82i1.196

TINKAMA SVEIKATOS PRIEŽIŪRA: NAKTINIS MEDIKŲ DARBAS

he article aims to reveal the medics’ approach to night shift work in multiprofile hospitals of Lithuania. The night shift medics’ work and it singularity was analysed in several related and summarized aspects: approach to night shift work as a phenomenon (1), the impact of night shift  on the physiological needs, health and family (2), the  interface of night shift work with the environment and work organization (3). The differences of approaches of doctors and nurses to night shift work were disclosed in the article.KEY WORDS: healthcare quality, medics’ night shift work, hospitals, safety environment.DOI: http://dx.doi.org/10.15181/tbb.v72i3.116

KOKYBIŠKA IR TINKAMA SVEIKATOS PRIEŽIŪRA: PACIENTŲ NUOMONĖ IR VERTINIMAS

Straipsnyje nagrinėjamas pacientų sveikatos priežiūros tinkamumas ir kokybė, jų pasitenkinimas sveikatos priežiūra ir lūkesčių išsipildymas didelėje daugiaprofilinėje universitetinėje ligoninėje. Pateikiama individualių, institucinių ir sociodemografinių charakteristikų įtaka pacientų sveikatos priežiūros vertinimui bei jų elgsenai. Tyrimas vykdytas 2004–2015 m. anketinės apklausos metodu. Jis atskleidė, kad absoliuti dauguma (93,8 proc.) pacientų sveikatos priežiūra buvo patenkinti ir jos rezultatai atitiko ar viršijo daugumos (83,8 proc.) jų lūkesčius. Tyrimo rezultatų pagrindu suformuluotos motyvuotos išvados.PAGRINDINIAI ŽODŽIAI: Pacientų pasitenkinimas sveikatos priežiūra, sveikatos priežiūros vertinimas, tinkama sveikatos priežiūra, sveikatos priežiūros kokybė

Changes in the quality and appropriateness of healthcare during the COVID-19 quarantine: patients opinion and evaluation (case study)

Sveikatos priežiūros kokybė karantino metu, įvertinta įvairiais aspektais, gali skirtis nuo buvusios iki epideminio laikotarpio. Karantino metu keičiasi ir pacientų, ir medikų elgsena. Darbo tikslas – įvertinti pacientų nuomonę dėl sveikatos priežiūros kokybės, jos skirtumų ir pokyčių COVID-19 karantino metu. Atliekant tyrimą, analizuotos skirtingų šalių autorių mokslinės publikacijos, apklausti pacientai, įvairiais laikotarpiais gydęsi Klaipėdos universitetinėje ligoninėje. Atskleista pacientų nuomonė įvairiais sveikatos priežiūros ir jos kokybės vertinimo aspektais. Įvertinus sveikatos priežiūros kokybę iki epideminio laikotarpio ir karantino metu, esminių skirtumų ir pokyčių pacientams nenustatyta. Raktažodžiai: sveikatos priežiūros kokybė, COVID-19 karantinas, pacientų nuomonė.The quality of health care during quarantine may be differ from the pre – epidemic period in terms of various aspects – the behaviors of patients and physicians changes during quarantine. The aim of the study – to assess patients’ opinion on the quality of health care, its’ differences and changes during Covid-19 quarantine. Material and methods. From January 2019 to June 2020 the survey has been performed. The study included 35 884 in patients. Information was collected using a special questionnaire, prepared by the author and co-authors, which consisted of 28 closed-ended and one open – ended question. The study data were analyzed and compared in two periods – before the beginning of the Covid-19 pandemic (2019-01-01 – 2019-12-31) and during the quarantine period (2020-03-15 – 2020- 06-15). Three groups of patients were studied: patients who had been treated befor the onset of the Covid-19 pandemic (1), during Covid-19 quarantine (2), and Covid-19 infected and suspected infected patients (3). Analysis of statistical data was done using the software SPSS version 23. Results. The quality of health care was rated as very good and good 90,4% patients of first group, 93,6% patients of second group, and 94,4% patients of third group. Conclusions. In the analysis of various aspects of patients health care quality and results, no differences were observed between the studied groups. The vast majority of patients would re-choose the hospital and recommend if to their relatives and a acquintances. Key words: health care quality, Covid-19 quarantine, patient opinion

Health care management development in Lithuania: changes, trends, critical approach, international context

Darbo tikslas: įvertinti sveikatos priežiūros vadybos raidą ir esminius pokyčius Lietuvos sveikatos apsaugos sistemoje ir jos organizacijose. Analizuota įvairių šalių mokslinės publikacijos sveikatos priežiūros vadybos klausimais, statistiniai duomenys, teisės aktai. Visa tai sisteminta ir vertinta. Darbe atskleisti profesionalios sveikatos priežiūros vadybos ir bendrosios vadybos esminiai skirtumai bei parodytas sveikatos priežiūros vadybos sudėtingumas. Pateikta sveikatos priežiūros sistemos ir jos organizacijų vadybos bei vadybos mokslo raida, atskleisti esminiai jos vystymosi trikdžiai. Daroma išvada, kad nepaisant įvairių trikdžių ir neigiamų momentų, sveikatos priežiūros vadyba šalyje vystėsi ir tobulėjo, dėl to gerėjo ir pati sveikatos priežiūra.The aim of the study – the assessment of healthcare management development and the main changes in the healthcare system and its organizations in Lithuania. Methods. The analysis, structuring and comparison of scientific publications, statistical date and legislation. Results. The study revealed the main differences between the professional and the general management and showed the complexity of healthcare management. Given the evolution of healthcare management and health care management science, the barriers of their development. Conclusion. Some of the biggest barriers of health care management in Lithuania are centralization, lack of professionalism, the growing burocracy, inadequacy of resources and defective its allocation methodology, permanent reforms, instability and unpredictability of the healthcare system and organizations, non separation of functions of payers for healthcare services (sickness funds) and their suppliers (healthcare organizations). Country’s health care management and health care services as its outcome has evolved and improved, and is in touch with the developed Europe and World countries. The elimination and avoidance of healthcare management barriers do not require additional resources and easily accessible with the adjustment of legislation

Health care (hospital) choice and quality: literature overview and case (Lithuania) study

Darbo tikslas: išanalizuoti ir įvertinti paciento sveikatos priežiūros (ligoninės) pasirinkimo galimybę, šiam procesui įtakos turinčius veiksnius bei jų sąsajas su kokybe ekonomiškai išsivysčiusiose šalyse ir Lietuvoje. Analizuota įvairių šalių mokslinės publikacijos, nagrinėjančios sveikatos priežiūros įstaigų (ligoninių) pasirinkimą, teisės aktai, statistiniai duomenys, pacientų apklausos anketos. Medžiaga sisteminta ir vertinta. Darbe pateikta pacientų pasirinkimo koncepcija, atskleistas šio proceso sudėtingumas ir jį apsprendžiantys ar paveikūs veiksniai. Pateikta trumpa pacientų pasirinkimo Lietuvoje ir ligoninėje analizė. Daroma išvada, kad ligoninės pasirinkimas yra sudėtingas procesas, sąlygojamas įvairių veiksnių, organizacijos bei paciento charakteristikų, teigiamai veikiantis sveikatos priežiūros kokybę.The aim of the study – to analyze and estimate the possibility of health care (hospital) choice, factors affecting this process and their relationship with quality in economically developed countries and in Lithuania. The object of the study and methods. The object of the study - process of the hospital choice. Methods – systematic analysis of scientific literature, interpretation and extrapolation of tendencies, statistical data analysis, theoretical generalization. A comparative analysis of patients questionnaires was performed, 175374 patients who were hospitalized in Klaipeda university hospital 2013-2017 years were interviewed (response rate 79,9%). Statistical data analysis was done using programme SP SS 20.0.1 for Windows. Results. It has been established that the theory of choice of health care is constantly changing, its application and results depend on the country’s structure of health care system, society and many other variables. The choice of patients health care has a positive impact on health care quality in hospitals, although it is a controversial statement. Both patient and hospital characteristics play an important role in choosing the hospitals. Patients in Lithuania have the right to choose a hospital and doctors since 1991. When examining the opinion of patients in the Klaipeda university hospitals, if was found that 80,5 proc. of then choose the hospital themselves, the rest were delivered to the hospital on an urgent basis, so they did not have a free choice. The absolute majority of patients were satisfied the health care in the hospital and will be chosen if in the future. Conclusions. The hospital’s choice is a complex process, a combination of patient hospital characteristics and behavior interaction in the context of a constantly changing environment. One of the factors contributing to health care quality improvement is the choice of the hospital which determines the patient’s active participation in the health care process and satisfaction. The patients personal characteristics and behavior influenced by experience, knowledge and information, greatly influence the choice of the hospital. Hospital’s characteristics – their structure, technologies, management, activity, quality and outcomes comparison of individual hospitals and exclusion of advantages – the main determinant of patient choice. The choice of hospital in Lithuania is a real possibility. A multidisciplinary, university, equipped with modern technologies, promoting high – quality hospital services – a subject of choice of patients, reflecting their needs and expectations, providing satisfaction with health care

Right healthcare and quality: patients’ opinion and evaluation

In this article the right healthcare and quality at the big multiprofile university hospital are analyzed in the context of patients’ satisfaction and realization their expectations. This paper analyzes impact of individual, institutional, and sociodemographic characteristics on healthcare evaluation and patients behavior. The survey was performed from 2004 to 2015 in Klaipėda University Hospital via questionnaires. The study was showed the majority (93.8%) of patients was satisfied of health care services and results of the largest part (83.8%) fallows their expectations. The conclusion are correspond the results of the study

Organizational climate in the hospital: opinion of staff groups (case study)

Nesaugios darbo vietos fenomenas yra sudėtinga, sunkiai apibrėžiama, turinti daug vardų samprata. Saugaus organizacinio (psichologinio) klimato kūrimas yra sudėtingas procesas, priklausantis nuo visų organizacijos darbuotojų. Darbo tikslas – įvertinti Klaipėdos universitetinės ligoninės organizacinį (psichologinį) klimatą ir įvairių grandžių vadovų poveikį jo formavimui darbuotojų požiūriu. Analizuotos įvairių šalių autorių mokslinės publikacijos, apklausti darbuotojai. Atskleista darbuotojų, vertinusių organizacinį (psichologinį) klimatą ligoninėje, nuomonė bei įvairių grandžių vadovų poveikis jį formuojant. Darbuotojų nuomone, organizacinis (psichologinis) klimatas ligoninėje yra pakankamai geras, įvertintas gerokai aukščiau vidutinio, o įvairių grandžių vadovų darbas ir veikla, kuriant normalų organizacinį (psichologinį) klimatą ligoninėje, iš esmės vertinama gerai. Raktažodžiai: organizacinis klimatas, nesaugi darbo vieta, mobingas.The phenomenon of unsafe workplace is a complex, difficult-to-define concept. Aim of the research: To evaluate the opinion of Klaipeda university hospital employees about the organizational (psychological) climate in the hospital and the influence of various managers in its formation. Research methodology. The research was performed in 2019- 2020 by applying quantitative (questionnaire survey) research method. Questionnaire survey was applied by questioning employees of four different groups: medics (doctors and nurses), executives, other employees, and mixed group of employees. Questionnaires were completed by 504 employees. Statistical data analysis war prepared by using SPSS 23,0 statistical analysis packet and tables were prepared by using Microsoft Excel 2016. Results. Assessing the opinion of health care workers, heads of different health care facilities and others workers, they assessed the psychological climate in the hospital similary – almost as good. The psychological (organizational) climate in the unit in which employees work themselves they rated slightly Better, than the hospital. Analyzing the influence of managers in creating and formation a normal psychological (organizational) climate in hospital, the employees assessed activity of head of hospital, heads of units, and senior nursing administrators as good. The influence of deputy’s of head of hospital and chief-nurses of hospital the employees assessed a slightly lower score. Conclusions. The organizational (psychological) climate and working atmosphere of the hospital and its departments are normal and good in the opinion of the staff. The contribution of managers of various levels in creating and formation a normal climate of organization the employees assessed generally as good. Keywords: organizational climate, unsafe work place, mobbing

Evidence-based management of health care organizations

Straipsnyje autorius pristato įrodymais pagrįsto sveikatos priežiūros organizacijų valdymo tyrimą. Remiantis teorine ir praktine medžiaga atskleidžiama tokio valdymo paradigma, specifiškumas. Tyrimas rodo įrodymais pagrįstų valdymo sprendimų sveikatos priežiūros organizacijose priėmimo sudėtingumą ir didelę atsakomybę dėl jų rezultatųThe author presents the investigation of evidence-based health care organizations management. Based on theoretical and practical material the management paradigm and specificity are disclosed. The study shows the complexity of evidence-based management decision-making of health care organizations and high degree of responsibility for the result