CC BY
6
HYGIENIC AND LIVING CONDITIONS IN HOSPITALS - A FACTOR
OF QUALITY OF TREATMENT
Shopov Dimitar Georgiev
MD, PhD, Chief AssiMant Prof. Department of Social Medicine and Public Health Medical University - Plovdiv,
Bulgaria
Mihaylova Vanina Kratfeva
PhD, Assoc. Prof. Department of Preventive Medicine, Faculty of Public Health, Sofia; Chief AssiMant Department of Healthcare Management, Faculty of Public Health, Medical University,
Plovdiv, Bulgaria
Stoeva Teodora Radeva
Senior health care University Hospital "Sv. George " - Plovdiv Bulgaria
ABSTRACT
The health-insurance syflem in the Republic of Bulgaria positions the medical inflitutions 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 largefl hospital in Southern Bulgaria through the eyes of former patients. To this end an anonymous survey was conveyed among the patients, including queflions in this area. The flructure 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 diagnoflic 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 conflantly 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 eflablishment 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 cuflomer 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 adminiflration 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 firfl one - outlining the flructural approach. It includes the preliminary conditions for producing a high-quality project - material means, hospital flructure - premises, medical and technical equipment, finances, adminiflrative flructures, personnel and teams.
- The second one - outlining the procedural approach whereby the level of technical competence of the flaff, 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 fludy 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 MultiProfile Hospital for Active Treatment „St. George" - Plovdiv. Logical units are the respondents. The queflionnaire was carried out within the period from 1 October 2015 to 31 December 2015. The development of the queflionnaires complies with the main requirements of the method:
- A clearly formulated objective of the fludy 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 queflionnaire. On the day of discharge from hospital the patients were given a queflionnaire and an envelope for the latter to be sealed in. After completion and sealing of the queflionnaire, the envelopes were given to the secretary of the clinic. The participation was voluntary.
During the Satirical 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 illuflration of the processes and phenomena observed and for certain dependencies and regularities.
During the computer processing of the collected database the Satirical package SPSS version 19 and Microsoft Excel have been used.
In the gender aspect the women were predominant. The age flructure marks a considerable balance with a slight predominance of the respondents over 64. The highefl per cent belongs to the patients with secondary education, followed by those with higher
Chart 1 graphically presents the method of admittance of the patients to the clinics of the university hospital. The highefl 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 diagnoflic and treatment process. A positive answer has been communicated by 77.8% of
Patient's characteriflics
The direct individual anonymous queflionnaire was carried out among 419 patients treated in the clinics of the University Multi-Profile Hospital for Active Treatment «St. George» -Plovdiv. The characteriflics of the respondents comprises:
- Sex
- Age flructure
- Education
Table 1
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
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, consifling of conflant hygienic rounds, increased microbiological control and responsibility of the senior medical specialifls for the execution of the disinfection plan and hygienization of their units.
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%
How did you decide to come to this hospital ?
53,70%
f-T 41,53%
■
2,86
2,86% 0 1 91%
□ Recommended by GP
□ Personal choice
□ Sent from another hospital
□ Recommended by another patient
□ No answer
Chart 2
Are you satisfied with the hygienic and living conditions of the clinics ?
18,62%
3,58%
0
77,80%
□ yes □ no □ partially □ No answer
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
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
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
that the additional food was brought in because of the fact that the hospital kitchen prepares dishes under a flrictly determined book of recipes and in this connection the food does not have the guflatory qualities inherent to the home-made food (salt, spices, etc.), and its quantity cannot satisfy the habits eflablished in the domeflic environment.
Table 2
Has anyone explained to you what diet you need to keep ? Yes 91,89%
No 8,11%
Do you think that the condition presuppose a trouble-free stay of disabled people ?
1,43%
□ Yes - all conditions for disabled people are available
□ Yes but not enough
□ No response
The patients' satisfaction with the quality of the medical presented on chart 4. 89.26% categorically respond that if services as a complex of different elements has been graphically necessary, they would come back to this hospital for treatment.
Chart 4
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%
Would you come back to this hospital for treatment ?
□ yes □ no □ I have not thought about that □ No answer
Conclusion:
The reforms taking place in the health care sector and the changes in the legislation led to the regiflration of the medical inflitutions 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 inflitution for his treatment. The underfinanced syflem of work under clinical paths impedes even more the diagnoflic 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 mofl cases they are admitted to hospital at the recommendation of their general practitioner rendering outpatients' medical service. Along with the diagnoflic 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 inflitution is also important.
Bibliography:
1. Borisov, V. Management of the quality of healthcare. Zdrav. menidzhment, 2002, № 2, 53-55
2. Stoeva, T. et al. Management and economic indicators in hospital care / T. Stoeva, D. Batashki, Y. Barganova-Zaharieva. // Meditsinski meridiani, 5, 2014, N 2, 42-46
3. Donchev, I. et al Contentedness of patients from medical care. A comparative analysis between a bulgarian and german hospital / I. Donchev, I. Batashki, D. Shopov, R. Stefanov. // Zdrav. ikonom. i menidzhment, 7, 2007, N 2, 3-12
4. Chaneva, G.: Patient satisfaction with the quality of nursing care in hospital. Bulg. med. zhurnal, 2, 2008, N 1, 61-64
5. Ganova-Iolovska, M. et al Patient satisfaction with hospital care - a comparative and methodological analysis / M. Ganova-Iolovska, N. Danova, T. Ivanova, J. Golemanova. // Sots. med., 18, 2010, N 4, 17-21
6. Nikolova, R. Patient satisfaction. Med. menidzh. i zdr. politika. MP, 33, 2002, N 3, 3-10
7. Petkov, V Satisfaction with the quality of health care in Bulgaria after the introduction of mandatory health care insurance in Bulgaria. Zdrav. menidzhment, 4, 2004, N 4, 28-30
8. Petrova, Zl Patient satisfaction from the healthcare quality - part of the delivered health services quality / Zl. Petrova, V. Mladenova. // Zdrav. menidzhment, 3, 2003, No 3, 11-14
9. Stoeva, T. et al Patient satisfaction - a pledge of quality in health in&itutions / T. Stoeva, D. Batashki, D. Shopov, Y. Barganova-Zaharieva. // Seflr. delo. MP, 46, 2014, N 2,15-18
10. Vekov, T The patients and medical doctors' satisfaction with the health care reform and recomendations for its management. Med. menidzh. i zdr. politika. MP, 39, 2008, N 2,19-26
