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https://doi.org/10.32689/2617-2224-2020-2(22)-202-214
Samofalov Dmytro Alexandrovich,
Doctoral Candidate of the Humanitarian and Socio-Political Studies Department of the Odessa Regional Institute for Public Administration of the National Academy for Public Administration under the President of Ukraine, PhD, Deputy Director of the Southern Trans-regional Department of the National Health Service of Ukraine. 65000, Odessa, Str. Rope, 83 Offices. 504, tel.: (050) 631-01-86, dr.samofalov@gmail.com, https//orcid.org/0000-0001-7850-5365 Самофалов Дмитро Олександрович, докторант кафедри гуматтарних та сощально-полтичних наук Одеського регюнального гнституту державного управлтня Нащональног академп державного управлтня при Президентовг Украти, кандидат медичних наук, Заступник директора Швденного мгжрегюнального департаменту Нащональног служби здоров'я Украти. 65000, м. Одеса, вул. Канатна, 83, оф. 504, тел.: (050)631-01-86, dr.samofalov@gmail.com, https//orcid.org/0000-0001-7850-5365
Самофалов Дмитрий Александрович,
докторант кафедры гуманитарных та социально политических наук Одесского регионального института государственного управления при Президенте Украины, кандидат медицинских наук, Заместитель директора Южного межрегионального департамента Национальной службы здоровья Украины 65000, г. Одесса, ул. Канатная, 83, оф. 504, тел.: (050)631-01-86, dr.samofalov@gmail.com, https//orcid.org/0000-0001-7850-5365
CONTEMPORARY FOREIGN PRACTICE OF COMMUNICATIVE ACTIVITIES IN HEALTHCARE
Abstract. The article analyzes the foreign sources and outlines, the approaches to communication activities and communication policy development in the public healthcare administration.
A review of the literature reveals that the issues of communicative activity of the public administration are now widely considered, as a form of interaction
between the subjects and the objects of the government, which is the cornerstone of a democratic society. The same tendency is observed in the healthcare, but healthcare communications are related to a wider range of problems, as they serve as social communications that affect all the areas of the society.
The article deals with the communication activities between the healthcare administrative bodies, subjects and objects, public associations, media, and more. However, it is also noted that in many countries, for many years, there has been a lack of a standardized policy on the communication activities.
Communication approaches are characterized, which differ significantly in the developed countries with high affluence from the countries with low economic performance. It is well established that a large number of organizations in the United States are involved in the development of the policies and guidelines for communication activities, while in low-income countries such activities are often developed with the international assistance of the NGOs and foreign donors. However, it is determined that in the health sector there is no perfect scheme of interaction between all the actors of the communication process in healthcare, so each country builds its own paths in the light of the socio-cultural traditions.
Keywords: public administration, health care, public health, communication activities, communication technologies, health care communications, public health communications.
СУЧАСНА ЗАРУБ1ЖНА ПРАКТИКА КОМУШКАТИВНО1 Д1ЯЛЬНОСТ1 В СФЕР1 ОХОРОНИ ЗДОРОВ'Я
Анотащя. Наведено аналiз зарубiжних джерел та на ochobí отриманих даних видшеш шдходи до комушкативно!" дiяльностi та розробки комушка-тивно! полггики в публiчному адмшютруванш охорони здоров'я.
При оглядi лиератури виявлено, що в сьогоденш дуже широко розгля-даються питання щодо комушкативно!" дiяльностi публiчного управлшня, як форми взаемодп суб'екпв i об'екпв управлшня, що виступае нарiжним каменем демократичного сустльства. Така сама тенденщя вiдмiчаеться i в охорош здоров'я, але комушкаци в охорош здоров'я ввдносятся до ширшого спектру проблем, адже виступае у якост сощальних комушкацш, як впли-вають на усi областi суспiльства.
В стати розглянута комушкативна дiяльнiсть мiж адмшютративними органами охорони здоров'я, суб'ектами та об'ектами управлшня, громадськи-ми асощащями, засоами масово'1' iнформацiï тощо. Однак також зазначено, що в багатьох крашах впродовж вже багатьох роюв зберiгаеться вiдсутнiсть едино! унормовано! полiтики щодо комунiкативноï дiяльностi.
Охарактеризовано шдходи в комушкативнш дiяльностi, яю значною мiрою вiдрiзняються в розвинених крашах з високим достатком вщ краш якi мають низькi економiчнi показники. Так визначено, що в Сполучених штатах Америки велика кшьюсть оргашзацш займаеться розробкою полгги-ки та настанов комушкацшно'1' дiяльностi, в той час як в крашах з низьким статком така дiяльнiсть часто розроблена за допомогою мiжнародноï допо-
моги Недержавних громадських оргашзацш та зарубiжних донорiв. Однак визначено, що в сферi охорони здоров'я вщсутня вдеальна схема взаемодп bcíx акторiв комушкативного процесу в охоронi здоров'я, тому кожна кра'на вибудовуе власнi шляхи з огляду на сощокультурш традицп.
Ключовi слова: публiчне адмiнiстрування, охорона здоров'я, громадське здоров'я, комушкативна дiяльнiсть, комушкативш технологи, комунiкацií в охорош здоров'я, комушкаци в громадському здоров'''.
СОВРЕМЕННАЯ ЗАРУБЕЖНАЯ ПРАКТИКА КОММУНИКАТИВНОЙ ДЕЯТЕЛЬНОСТИ В СФЕРЕ ЗДРАВООХРАНЕНИЯ
Аннотация. Представлен анализ зарубежных источников и на основании полученных данных выделены подходы к коммуникативной деятельности и разработке коммуникативной деятельности публичного управления, как формы взаимодействия субъектов и объектов управления, что выступает краеугольным камнем демократического общества. Такая же тенденция отмечается и в здравоохранении, однако коммуникации в здравоохранении выступают социальными коммуникациями, а следовательно влияют на все области общества.
В статье рассмотрена коммуникативная деятельность между административными органами здравоохранения, субъектами и объектами управления, общественных организаций, средств массовой информации. Однако также выявлено, что во многих странах в течении длительного времени отсутствует нормирование политики коммуникативной деятельности.
Охарактеризованы подходы к коммуникативной деятельности, которые в значительной степени отличаются в развитых странах с высоким достатком от стран с низкими экономическими показателями. Так отмечается, что в Соединенных Штатах Америки достаточно большое число организаций занимается разработкой политики и рекомендаций коммуникативной деятельности, в то время как в странах с низким достатком коммуникативная деятельность часто разрабатывается с участием международных негосударственных общественных организаций и зарубежных доноров. Тем не менее, отмечено, что в сфере здравоохранения отсутствует идеальная схема взаимодействия всех акторов коммуникативного процесса в сфере здравоохранения, поэтому каждая страна развивает собственные пути с учетом социокультурных традиций.
Ключевые слова: публичное администрирование, здравоохранение, общественное здоровье, комуникативная деятельность, коммуникативные технологии, коммуникации в здравоохранении, коммуникации в общественном здоровье.
Formulation of the problem. Nowa- tion activities occupy one of the deci-days, it is logical that the communica- sive places in public management and
public administration. It is through communication activities that you can reach agreement, build strengths, neutralize risks, keep in touch, and understand the public opinion. In many cases the success of the public management and successful administration will depend on the quality of the communication with all the parties involved. And in all the spheres the healthcare sector first and foremost requires a wide exchange of information between all the actors in the process. Because in the field of health the communication activities are aimed at discussing and interacting with the public on changes and reforms in the field of healthcare, the introduction of a healthy lifestyle, the elimination of the medical illiteracy, which has a direct impact on all the social policy.
The Ukrainian state will have to establish a clear and balanced policy on the communicative healthcare activities. When creating a communication activity, it is necessary to take into account the scientific and practical experience of the other countries that have already developed or are on the way to developing the communication activities.
Analysis of the recent publications on the subject. According to Yu. V. Zbyranyk [1; 2], nowadays dictates to us the need to combine the communication and the public administration as a form of interaction between the subjects and the objects of the governance, since the basis of democracy is to take into account the needs and positions of the object of the government. However, as N. M. Drahomyretska and co-authors should consider the communication activity as a dynamic system in
which the communication can be separated and predictions made, as well as indicating the importance for many EU countries of a communication plan that can lead to the development of the social dialogue [3]. According to M. A. Znamenska, most of the works dedicated to the communication activity deals exclusively with the development of the information and communication technologies, telemedicine, Internet information and more. Their place and role in providing information and communication to the public [4], however, this approach does not fully address the issue of communication as a systemic phenomenon.
Many authors point to the need for communication between the health care administrative authorities and the media, demonstrating openness and facilitating changes in healthcare management and administration and public involvement in the elimination of the medical illiteracy [1; 3; 5].
However, not all the countries consider communication as a system, which leads to the fact that 85 % of Japanese, 63 % of English and 73 % of American leaders see the poor level of communication as the main problem in achieving the effectiveness of the organization [6].
N. M. Drahomyretska notes that today many governments are considering communicative activity of the public administration entities, which makes it possible to solve the important problems of building relationships between many actors: the state and the society, the public administration bodies, the public authorities and the public, the objects of the administration with the state and among themselves [3].
E. A. Afonin believes that the communicative activity in the public administration as a whole is undergoing a radical rethinking and significant changes, in accordance with the challenges of the time [5].
This leads to the development of new methods, practices and approaches at the level of the public communication.
However, M. A. Znamenska and co-authors argue that in the modern world there is no "ideal" scheme of interaction between the healthcare system, the population and individual groups of communication influence, so each country seeks its own scheme of the communication activities in accordance with experience, social and cultural diversity [7].
However, given the financial and quality imperatives facing healthcare, it is not surprising that the providers are at the forefront of developing new programs and tools to enhance the communication. According to J. Gordon and co-authors, the innovative providers have borrowed best practices from communication activities in other industries, such as aviation, which are also critically dependent on the effective communication [8]. It is important to note that not always the communicative activities produce the expected results. For example, J. Lecouturier and co-authors point out that the education program for stroke screening programs has the significant disadvantage of targeting a small number of people from a specific group, only those who have already suffered from a stroke, while being ignorant of directing the programs to broader demographic groups [9].
Formulation of the purposes (goal) of the article. Based on the analysis of the foreign sources to study and analyze the modern understanding of the communication activity and development of the communication policy in the public management and public administration of the healthcare of different countries of the world.
Outline of the main research material. The most widely publicized healthcare activities are in the United States, as many governmental and nongovernmental organizations are involved in communication, both within the management and administration of the health sector and with the public on health issues. These include the Office of Disease Prevention and Healthpro-motion, the Centers for Disease Control and Prevention of the USA, the Food and Drug Administration, the American Heart Association, the Federal Communications Commission of the USA, the International Association of National Public Health Institutes, and others.
The Government Office for Disease Prevention and Healthpromotion has developed the "Healthy People 2020" strategy [10], which also includes a communication strategy and awareness-raising on health issues. This communication activity is designed to take into account that approximately 11 million people in the United States have very low education and some are not even able to read. This communication strategy seeks to clarify for the residents and workers the most important issues related to the public health administration: covering their insurance plan, what are the requirements and cost sharing mechanisms, complaint
procedures and appeals decisions, the composition of the network of healthcare providers, referral to specialists, the use of emergency services, the price, quality and safety of the funded services provided by the funded plans by the employer. Many communication activity developments are focused on the interaction between the clinic and the patient [11], but there are almost no national or local concepts, usually internal standard operating protocols of the respective medical institution.
In the European countries good communication has been shown by health communication and media involvement, so programs for increasing the use of safety belts [12; 13] and reducing tobacco use [14; 15] have been very successful.
For example, in Sweden [16] the development of new concepts of the communicative activity has made it possible to study the management work in the health sector and its implications, putting the debate into a wider context of the institutional reform. Mostly the communicative activities are aimed at analyzing the critical incidents. Conflict resolution: "Convenience is a bad argument compared to medical safety".
In Bosnia and Herzegovina the communication activity has focused on the widespread use of modern PR in healthcare settings [17]. The healthcare providers should be proactive in communicating with their consumer. The proactive communication should be symmetrical in order to satisfy the interests of all the patients and the society. The communication activity is therefore based on identifying the internal and external consumers in all the healthcare settings. It were created
the position of a PR specialist, speaker and communicator who meets the patient first. The hospitals are constantly looking for and recruiting communication specialists and training already available ones in the stuff. The key objectives, communication channels, technologies and methods of the communication are constantly evaluated and defined.
In the United Kingdom and the United States a large layer of communication in the healthcare is focused on the risk communication. According to this concept, the risk communication can be defined as an open bilateral exchange of information and thoughts on harms and benefits, with the aim of improving the understanding of the risks and improving the decisions on the use of medicines [18; 19]. Therefore, the risk message should cover: the probability of risk occurrence, the importance of the described negative phenomenon, the impact of the event on the patient [20].
Good results in England have been shown by the media involvement in the national stroke strategy. The government communication activity through the media was aimed at raising the public awareness of the symptoms and the need for immediate action [21].
In Germany similar communication activities were expanded to include not only the media, but also billboards and posters, with short slogans, a simplified guide to stroke that was distributed at mass events, and through family medicine clinics among the patients. A compilation of interesting stories about strokes, slogans and interviews were spread in the local newspapers, television and radio.
Public health communication in Europe is responsible for a large proportion of the public health communication activities.
In Europe all the communication channels are widely used for the public health in communication activities: television, radio, newsletters, and proactive communication. In addition, today the largest sector of communication is the Internet. According to C. Turcu's statement, the Internet of things in the health sector can create real economic value and improve the patient experience. Thus, gaining maximum value requires an understanding of both the paradigm of the Internet of things and the technologies that make it possible to use the Internet of things in the healthcare. There are some benefits to collecting and processing patients' data, as well as monitoring the daily health of the people [22].
It is important to note the development of the vaccination communication activity as an important component of the healthcare sector. Today, one of the strong trends is the openness and transparency of the "bad news", which improves vaccination coverage by attracting old and new media [23].
An important trend in Europe is globalization, which also touches on the issue of the communicative healthcare activity at both individual and country level. It should be noted here that NGOs are involved in the communicative activities at the level of states, communities, clinics, doctors and patients. For example, the "Angels Initiative" NGO, through training and communication, raises awareness of the signs of stroke, increasing the number of patients receiving treatment at the
stroke centers. The communication activities aimed at the doctors form an international network of stroke centers and medical institutions ready to assist with stroke [24].
Australia has developed a digital health strategy that incorporates communication activity as a cornerstone of a high quality healthcare system. According to this strategy, support is being provided for the clinics, more comprehensive management of the chronic diseases, development of new digital services to support the health of the young and young children, access to telemedicine services, especially in the rural and remote areas, every healthcare professional is able to communicate with other professionals and their patients through secure digital channels [25].
In his study, D. E. Detmer studied the transformation of the communicative activity into the Internet age. She points out that in Europe the discovery of the biological and communication technologies has the potential to improve the health of the people and populations. Improving access to health and illness information is characteristic of today. However, over time, care in hospitals will shift towards palliative care and end-of-life care, and the treatment and prevention will mostly be done on an outpatient basis, at home or in the workplace. Thus, today it is necessary to form communication activities in view of these changes [26].
It should be noted that the developing countries today also recognize the need and importance of the communication activities. Thus, Afghanistan, Zimbabwe, Ghana, Kenya, Malawi and other countries have developed a
national communication strategy that defines the communication activities of these countries on the critical health and public health issues. It should be noted that these documents have been developed with the assistance of NGOs and the donor assistance of organizations such as the World Health Organization (WHO), the World Bank (WB), the United Nations Children's Fund (UNICEF), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), [27-31].
In most cases, the communication activities are aimed at engaging and consulting with the public on HIV/ AIDS, vaccination and treatment.
For example, in Kenya the communication activity deals with tuberculosis, reproductive health, HIV/AIDS treatment, vaccination and more [28]. The communication activities aim to provide a clear and informed roadmap for the communication planning, implementation and monitoring of the coordinated programming, a mechanism for coordinating communication activities to approach community health strategies, raising awareness of the strategic community approach at all the levels, government and partner resources to provide the community health resources, strengthen the capacity for communication practitioners at all the levels, identifying, implementing, monitoring, evaluating, and managing the program, increasing access to healthcare for all the groups, and facilitating the transfer of knowledge and skills at the household and community levels [28].
Five communication strategies were used to achieve the above goals: Media Policy, Program and Public Consultation, Enhancing the Communication
Opportunities, Enhancing the Communication and Social Mobilization at All the Levels, Communicating Behaviour Change at the Community Level as Critical Levels of Medical Assistance, Mobilizing and Coordinating the Partners and Stakeholders, Knowledge Management and Documentation [28].
Conclusions and prospects for further research. The current foreign health practice demonstrates the use of a wide range of forms of communication activities, including: PR; informing; openness and transparency to the "bad news"; use of the social media; electronic communications and use of ICT; talks; communication (including business, face-to-face, social, etc.); networking and data processing; entering a checklist; transaction and message creation; risk communication management.
New types of communication are distinguished for our domestic practice, such as "proactive communication" and "fair communication culture". It is also about creating temporary structures that facilitate communication with the community, which is also absent in the national culture of the communication in the healthcare sector.
The analysis of the publications made it possible to distinguish the positions of the professional communicators in the field of healthcare, for example: PR specialist of a health institution; health managers; HR specialist; public health workers; medical communicator with the relatives of the patients.
It is possible to speak about difference of cultures of the communications of the foreign countries of the world and the domestic healthcare system.
It should also be noted that there is a great demand for communication and information in the society today, and if it is not satisfied with the state, the residents will receive information from alternative channels that is not always correct. In the end, in order to foster health-related communication, it is necessary to simultaneously understand the basic measures that need to be considered and implemented first at the state level, and then to improve the communication between the government agencies, the scientific community, the medical staff and the public. In addition, it is necessary to increase the social trust so that the citizens smoothly follow the recommendations of the public authorities and medical personnel aimed at both treating the diseases and preventing them.
In the healthcare sector there is no perfect synergy of interaction between the state, the healthcare facility, the population as a whole and the individual communication groups, so each country builds its own paths in the light of the socio-cultural traditions.
Further exploration will address the identification and prerequisites for the implementation of the foreign experience in organizing the communication activities in the field of healthcare in the domestic practice.
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