ГИГИЕНИЧЕСКИЕ И БЫТОВЫЕ УСЛОВИЯ В БОЛЬНИЦАХ: ФАКТОР КАЧЕСТВА ЛЕЧЕНИЯ

Шопов Д.Г.¹, Михайлова В.К.², Стоева Т.Р.³ 

¹Кафедра социальной медицины и общественного здравоохранения медицинского университета, Пловдив, Болгария, ²Отделение профилактической медицины, факультет общественного здравоохранения, София, Главный ассистент кафедры управления здравоохранением, факультет общественного здравоохранения, Медицинский университет, Пловдив, Болгария, ³Университетская Больница Св. Георгия, Пловдив Болгария

ГИГИЕНИЧЕСКИЕ И БЫТОВЫЕ УСЛОВИЯ В БОЛЬНИЦАХ: ФАКТОР КАЧЕСТВА ЛЕЧЕНИЯ

Аннотация

Система медицинского страхования в Республике Болгария помещает медицинские учреждения в конкурентоспособную среду. Право выбора пациента, где проходить лечение, определяет место каждой больницы на рынке медицинских услуг. Идея автора состоит в том, чтобы рассмотреть роль гигиенических и бытовых условий в клиниках крупнейшей больницы в южной Болгарии, обратившись к мнению бывших пациентов. С этой целью был проведен анонимный опрос среди пациентов. Ддя максимальной релевентности, группы респондентов были структурированы по полу, возрасту и уровню образования. Суммируя вышесказанное, мы можем указать на высокий процент положительных отзывов бывших пациентов о гигиенических и бытовых условиях в клиниках. Высокое качество диагностического и терапевтического процессов способствовало удовлетворению пациентов и их готовности, в случае необходимости, лечиться в той же самой больнице. Возрастающие запросы пациентов требуют соответствующих реакций от руководства клиник. 

Ключевые слова: качество, медицинские услуги, пациенты, гигиенические и бытовые условия.

Shopov D.G.¹, Mihaylova V.K.², Stoeva T.R.³

¹MD, PhD, Chief Assistant Prof. Department of Social Medicine and  Public Health Medical University, Plovdiv, Bulgaria, ²PhD, Assoc. Prof.  Department of Preventive Medicine, Faculty of Public Health, Sofia, Chief Assistant Department of Healthcare Management, Faculty of Public Health, Medical University, Plovdiv, Bulgaria, ³Senior health care University Hospital “Sv. George” – Plovdiv Bulgaria

HYGIENIC AND LIVING CONDITIONS IN HOSPITALS – A FACTOR OF QUALITY OF TREATMENT

Abstract

The health-insurance system in the Republic of Bulgaria positions the medical institutions in a competitive principle. The right of choice of the patient where to receive treatment determines the place of each hospital on the market of medical services. The author's idea is to review the role of the hygienic and living conditions in the clinics of the largest hospital in Southern Bulgaria through the eyes of former patients. To this end an anonymous survey was conveyed among the patients, including questions in this area. The structure of the respondents by sex, age and education was reviewed with a view to maximum objectivity. In summary we can indicate the high per cent of positive answers of former patients about the condition of the hygienic and living conditions in clinics. The high quality of the diagnostic and therapeutic process has been objectified in satisfaction and willingness of the people in case of need to be treated in the same hospital. The increasing requirements of the patients require adequate reactions on behalf of the managers.

Keywords: quality, medical services, patients, hygienic and living conditions.

Introduction.

The medical services are directly related to the willingness of each person to constantly increase the quality of his life in order to be of better use for himself, his relatives and the society.[1;2]

A significant place in the realization of quality in medical services occupies the inpatient treatment.

Each separate activity or a bundle of activities and services performed for the improvement of the patient's quality of life in hospitals is determined as a hospital product having a certain property significant for the consumer, the payer (the financing body) and the hospital itself (self-assessment). [3;4]

There is an expressed dependency on a complex number of factors – economic, social, political and cultural. Such factors determine to a certain extent the differences in the level of the hospital services offered.

At the same time the high-quality medical services are important for the establishment of an optimum marketing policy of the hospital. [5;7]

The concept of „quality“ is very popular in the specialized economical literature, where the concept of „consumer satisfaction“ is a model for quality of the services offered. Such a tendency motivates scholars from all over the world to direct their research activity towards detailed survey of the phenomena and processes evaluating the customer satisfaction with the health services offered.

The WHO concept of quality of the medical aid focuses on the patient and the increase in his quality of life after the medical (physician's) intervention. [8;9]

The combinations between the good and bad marks between them may serve for development of certain trends of the work of the hospital administration for improvement of the quality of the hospital product. [10]

The quality concept of Avedis Donabedyan is very popular and well-known in the scientific circles with its three directions.

• The first one – outlining the structural approach. It includes the preliminary conditions for producing a high-quality project – material means, hospital structure – premises, medical and technical equipment, finances, administrative structures, personnel and teams.
• The second one – outlining the procedural approach whereby the level of technical competence of the staff, the quality of interpersonal relations, the level and quality of the relationship physician – patient are decisive, i.e. what has to be performed for the immediate rendering of medical aid – diagnosis, therapy, rehabilitation.
• The third one – outlining the outcome and reflecting the efficiency of the medical aid for the patient.

The purpose of the present article is to study the opinion of the patients with respect to the offered hygienic and living conditions in the hospital as an important factor for the quality of the health process.

Matherial and methods:

The subject of observation are clinics within University Multi-Profile Hospital for Active Treatment „St. George“ - Plovdiv. Logical units are the respondents. The questionnaire was carried out within the period from 1 October 2015 to 31 December 2015. The development of the questionnaires complies with the main requirements of the method:

• A clearly formulated objective of the study and doubtless dependence of its public and social significance;
• Maximum economy of time for the respondents;
• Complete anonymity and discretion.

Collection of primary information.

A variant of the sociological method has been used for the patients – a direct individual questionnaire. On the day of discharge from hospital the patients were given a questionnaire and an envelope for the latter to be sealed in. After completion and sealing of the questionnaire, the envelopes were given to the secretary of the clinic. The participation was voluntary.

During the statistical processing of the collected primary information a variational, alternative and non-parametric analysis have been used. The possibilities of the graphic analysis were used for illustration of the processes and phenomena observed and for certain dependencies and regularities.

During the computer processing of the collected database the statistical package SPSS version 19 and Microsoft Excel have been used.

Patient's characteristics

The direct individual anonymous questionnaire was carried out among 419 patients treated in the clinics of the University Multi-Profile Hospital for Active Treatment «St. George» - Plovdiv. The characteristics of the respondents comprises:

• Sex
• Age structure
• Education

Table 1

	Number of respondents	419
Sex	men %	45.82%
	women %	51.55%
	Without response	2.63%
Age	18-64	45.82%
	over 64	46.72%
	Without response	7.46%
Education	Primary education	12.89%
	Secondary education	50.60%
	Higher education	34.84%
	Without response	1.67%

  In the gender aspect the women were predominant. The age structure marks a considerable balance with a slight predominance of the respondents over 64. The highest per cent belongs to the patients with secondary education, followed by those with higher education (Table 1). Upon evaluation of the hygienic and living conditions offered, an important role plays both the educational level of the patients and their social environment. The number of retired people subjected to treatment prevails.  

Chart 1

Chart 1 graphically presents the method of admittance of the patients to the clinics of the university hospital. The highest per cent (53.7%) belongs to patients who have been admitted at the recommendation of their GP, followed by those who have been admitted at their choice (41.53%).

The good hygienic and living conditions in the clinics are of considerable importance for the diagnostic and treatment process. A positive answer has been communicated by 77.8% of the patients and 18.62% are partially satisfied with the hygiene in the clinics (Chart 2). There are no dissatisfied patients. This high index is due to the increased activity directed towards improvement of the hygiene, consisting of constant hygienic rounds, increased microbiological control and responsibility of the senior medical specialists for the execution of the disinfection plan and hygienization of their units.

 

Chart 2

 

Part  of the patients are admitted to the university hospital in a serious health condition with limited mobility and inability for independent hygienic service. The availability of conditions for such patients is essential. 61.58% of the respondents have answered that all necessary conditions for disabled persons were provided and 36.99% answer with yes, but they are not enough (Chart 3).

 

Chart 3

 

When admitted to the clinics for treatment, the patients receive comprehensive information on their dietary needs (Table 2). 91.89% of the respondents give a positive answer to that. The per cent of approval of the food offered is 48.45% and of disapproval – 42.72%, provided that in 62.29% of the cases the patients' relatives had to provide food for them. It is supposed that the additional food was brought in because of the fact that the hospital kitchen prepares dishes under a strictly determined book of recipes and in this connection the food does not have the gustatory qualities inherent to the home-made food (salt, spices, etc.), and its quantity cannot satisfy the habits established in the domestic environment.

 

Table 2

Has anyone explained to you what diet you need to keep ?	Yes	91,89%
	No	8,11%
Are you satisfied with the food offered by the hospital kitchen?	Yes	48,45%
	No	42,72%
	Without response	8,83%
Did you have to ask your relatives to bring you food?	Yes	62,29%
	No	37,71%

 

The patients' satisfaction with the quality of the medical services as a complex of different elements has been graphically presented on chart 4. 89.26% categorically respond that if necessary, they would come back to this hospital for treatment.

 

Chart 4

  Conclusion.

The reforms taking place in the health care sector and the changes in the legislation led to the registration of the medical institutions as business companies. With their positioning on the market of medical services the methods of funding of their activities have also changed. A competitive market was created where the patient has the right to choose a medical institution for his treatment. The underfinanced system of work under clinical paths impedes even more the diagnostic and treatment process. The different forms of ownership of the hospitals have also contributed to the quality of treatment and the movement of the patients flow. The patients' satisfaction with their treatment is complex. In most cases they are admitted to hospital at the recommendation of their general practitioner rendering outpatients' medical service. Along with the diagnostic and treatment process, an important role play the conditions in the clinics of the relevant hospital. The good hygienic and living conditions, the quality of the food according to the prescribed diet, the cleanness of the linen are decisive. The high per cent of positive answers of the respondents is an actual expression of the conditions created at University Multi-Profile Hospital for Active Treatment „St. George“ - Plovdiv. Of course, there is always more to be achieved and improved. The role of the management of the medical institution is also important.

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