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18MEDICAL SCIENCES
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SUBSTANTIATION OF PROSPECTS AND STRATEGIES FOR CREATING A PROGRAM TO OPTIMIZE THE ORGANIZATION OF DENTAL CARE BASED ON A RESOURCE APPROACH
Chernavsky A.F.,
PhD, Deputy Chief Medical Officer, Dental Polyclinic No. 12, Associate Professor of the Department of Therapeutic Dentistry and Propaedeutics of Dental Diseases, Ural State Medical University, Yekaterinburg
Chernavsky M.A.
postgraduate student, State Autonomous Healthcare Institution of the Sverdlovsk region
"Dental Polyclinic No. 12 Yekaterinburg city" (GAU SO "SP No. 12")", Yekaterinburg, Russia
Abstract
Dental care is one of the most resource-intensive areas in healthcare in the provision of primary health care and belongs to the most expensive areas of the healthcare economy and, as practice has shown for many decades, the most prepared to work in market conditions. An analysis of the work of dental institutions shows that in the spheres of state and municipal health care, the share of entrepreneurial activity reaches 50% or more of the total amount of work. Therefore, there should be no ineffective dental units in the healthcare system. For the effective work of the dental service, it is necessary to use a resource approach [1, 2, 3, 5, 6].
Subject. assets, capabilities, organizational processes, information, knowledge controlled by the enterprise and allowing it to create and implement effective strategies.
The goal is to study the parameters and combination of necessary resources based on the goals, activities, strategy, business processes in the dental service.
Methodology. assessment of market prospects, external and internal threats; analysis of the strengths and weaknesses of the resource potential and assessment of its capabilities for a long period of operation; assessment of overall competitiveness.
Results. to substantiate strategic recommendations taking into account several possible perspectives, to analyze the situation of the dental service. Determining the priorities of internal and external development.
Conclusions. The resource approach involves the identification and specification of available resources, and additional research. At the same time, its implementation will strengthen the capabilities of the dental service of the region and integrate new information and knowledge, which will strengthen competitive advantages.
Keywords: resource approach, organizational and management center, organizational psychology.
Over the past decades, a system of dental care organization has been formed in the Sverdlovsk Region, including state, municipal, and private organizations. The study of available statistical reports and the analysis of the work of dental organizations showed the following. Using the example of the city of Yekaterinburg, it can be seen that the dental service of the private healthcare system takes over about 40% of all the services of the dental health insurance market and about 72% of the services provided at the expense of personal funds of citizens, VMI and other sources not related to the MHI. Of course, the competitiveness of dental organizations of various forms of ownership has a positive effect on the availability and quality of dental care for the population, especially in highly specialized and highly specialized types, but we must not lose sight of the safety and quality of dental services provided. The requirements of sanitary legislation and the regulatory framework must be strictly observed by all dental organizations. There should be a single organizational and methodological center and a unified approach to the provision of services within the framework of the MHI and at the expense of other sources of funding. A unified regulatory, organizational and methodological framework for the provision of dental care is the most
important resource for the development of dental services. Using the example of UIA "SP No. 12", we have proved the effectiveness of creating a unified database of regulatory and legal documentation for filling out and maintaining medical records by medical workers, creating unified approaches to providing dental care and forming uniform requirements for the implementation of sanitary legislation by all employees of the institution. The results of our research were published earlier [7, 8, 9, 10].
The personnel issue has always been an important resource for the development of the dental service. Large municipal dental organizations, in particular UIA "SP No. 12" and many large private clinics have been actively working with students of the Faculty of Dentistry of USMU since the third year. The active position of both managers and employees of specialized departments allows them to actively attract young specialists to independent work. But there are quite a lot of pitfalls and the solution of emerging problems is possible only with the involvement of external resources: the formation of the position of chief specialists in protecting the interests of dentists and dental organizations, the focus of the dental association's work not only on repre-
sentative, but also on organizational and methodological assistance for dental organizations of various forms of ownership, the involvement of the latter in active work to protect their interests in the preservation and development of personnel [11, 12, 13, 14].
On the basis of UIA "SP No. 12", we, with the involvement of students of the Faculty of Dentistry of USMU, conducted studies among 259 patients visiting a doctor, which showed the following results. The population attaches great importance to dental health: 89% of respondents noted the need for regular visits to the dentist. 2% refused to answer the questionnaire questions, 9% go to the dentist only for urgent indications. There were 85% of applications for the treatment and removal of teeth, of which only 16.9% of respondents applied for planned oral sanitation. Of the respondents, 98.6% noted the need for visits to the dentist for preventive purposes. When analyzing the answers, the following factors drew attention to themselves, which, according to the respondents, influenced the preservation of dental health and the frequency of visits to the dentist: the price-quality ratio when receiving dental services, nutrition culture, dental literacy. The data obtained indicate the insufficiency of the preventive orientation of the work of the dental service. With a positive trend in the development of dental organizations and an increase in quantitative and qualitative indicators in the provision of dental care, interaction with the media remains problematic. The focus of work with the media should be not only advertising their services and attracting funds, but also the most important thing is the prevention of dental diseases, the formation of the attitude behavior of patients and, indirectly, dentists responsible for maintaining their health, the formation of patient requests for quality and timely medical care. The lack of information resource provision generates dissatisfaction with the population's demand for dental services. Our passive position when working with the media generates a negative and consumer attitude on the part of both our patients and society, which is influenced by the media [15, 16, 17, 18, 19, 20].
The analysis of citizens' appeals conducted in our institution, and the literature available for study on the characteristic features of court cases, and the judicial practice itself clearly demonstrates that 95% of complaints and appeals of patients and court cases are related to insufficient regulatory support for the work of a dentist, insufficient and incomplete elaboration of existing regulatory frameworks by both medical professionals and patients. "Free" interpretation of existing legal norms by both doctors and patients, insufficient legal protection of medical workers. Of the court cases we have studied against medical workers and organizations, only 8% are of an acquittal nature [21, 22, 23, 24].
The most important problem is the training of medical and non-medical personnel of dental organizations. Currently, an approach to creating a coherent, unified system of postgraduate training of young professionals is just being formed, everyone learns as best they can and as far as they have enough funds. Instead of receiving a systematic, versatile postgraduate educa-
tion, confirmed by scientific research, a specialist doctor receives disparate knowledge, which sometimes do not combine and cannot fit into the educational trajectory of a practical specialist. There is a separate conversation about the training of non-medical specialists. Administrators (registrars) of polyclinics are currently receiving a sufficiently systematic and high-quality education that allows them to successfully represent their institution for consumers of dental services. Other staff is completely deprived of the attention of the heads of dental organizations, and the successful work of the clinic depends on the competent work of the "auxiliary" staff. Of course, in this case, the corporate culture in the organization comes to the rescue, but it is still in its infancy in our region.
Scientific and practical activities in our region are the lot of enthusiasts. Unfortunately, the certification of specialists for the category is not mandatory. This does not at all stimulate doctors of practical healthcare to conduct research in practical healthcare and, as a result, there is no interest in independent study of scientific literature. As the work with students shows, already from the third year, students need to defend their practical work not only by passing an interview with a set of manipulations that they may have performed, but by a full-fledged course work confirming the student's personal participation in the organization of the doctor's work as an assistant and containing his conclusions about the work done under the guidance of a mentor. Similarly, the category should be defended by a presentation of the doctor about his work, skills, problems arising in the process of work. Only feedback from doctors of practical healthcare can show what resources are needed to solve emerging problems [25, 26, 27, 28, 29].
All of the above allowed us to offer a program for a resource-based approach to optimizing the organization of dental care.
I. Creation of a single organizational and management center of the dental service of the Sverdlovsk region for dental organizations of all forms of ownership.
A. Stage 1 - Completion of the creation of a unified database of patients, electronic medical records, regulatory and methodological and organizational documents, for all dental organizations - no monetary investments are required. Creation of a unified approach to the provision of dental care within the framework of the Territorial CHI Program (based on the RMIS) and at the expense of personal funds of citizens (Booking).
B. Stage 2 - a clear distinction between three types of volumes dental care: basic funds of compulsory medical insurance, high-tech - at the expense of funds and personal funds of citizens, cosmetic (aesthetic) - at the expense of personal funds of citizens.
C. stage 3 - Association of dental clinics in a single network, on the ground leaving, depending on the capacity of the institution or the chief medical officer (Deputy chief physician), or the head of a structural unit, possible to minimize administrative unit with redundant functions.
II. Personnel work and mentoring.
A. To develop and approve a unified regulatory framework for the conditions of training dental person-
nel from the 3rd year of training students in medical organizations of the Sverdlovsk region. The distribution of students should be carried out in all medical institutions of the region, with the provision of a workplace, places of residence and minimum wage.
B. The transfer of experience to a student is the main method of training staff inside the clinic, since no external training will be able to prepare a novice employee for professional activity for a particular medical institution, using general principles of mentoring and specific techniques, the use of which is associated with the traditions and characteristics of a particular medical organization. The general task of mentoring is to manage the process of student adaptation to work in practical healthcare and communication with patients and their representatives.
C. Creation of a system of conditions, resources and processes necessary for the implementation of mentoring programs in medical organizations, using developments in "lean technologies".
III. Working with the media offices of organizations.
A. Formation of distinct package of documents according to normative-legal support of information exchange, as within healthcare organizations, and the media.
B. Create a risk map for each health facility, when working with the media.
C. the Formation of a positive image of the medical organization
D. Communication and information interaction within the units (collective) a medical organization, aimed at the formation and adherence of the corporate culture.
E. formation of patients' requests for the preservation of their health and responsibility for the preservation of their health.
F. Protection of a medical organization from illegal actions of journalists.
IV. Regulatory and legal support for the work of the dental service.
A. Formation of a unified regulatory framework for the dental service. A single package of documents on the forms of medical documentation, IDS, contracts, orders and other things.
B. Creation of a system to protect medical workers from illegal actions of patients and external organizations.
C. Work with medical lawyers on the formation of legal literacy of medical workers in the provision of medical care.
V. Training of medical and non-medical workers, exchange of experience.
A. Conducting monthly videoconferences, meetings of all heads of dental departments with the report of one of the departments on work, new technologies, completed assignments.
B. Involvement of employees of specialized departments, graduate students, residents to conduct studies on the profile, familiarization with the directions of development of departments, institutes of UGMU, SOMK offer distance learning in specialized departments.
C. Reports of specialist doctors to specialized employees of departments applying for the assignment of a qualification category in videoconference mode (VKS), before passing the qualification exam.
D. Organization of a training scientific and practical center for medical workers.
VI. Scientific and practical activities.
A. Conducting applied research with the involvement of specialized and non-core scientific organizations.
B. Formation of horizontal and vertical scientific and practical ties with medical and scientific organizations of other regions.
Summing up, I would like to note that in the conditions of the impermanence of the external environment, a unified approach to the organization of a dental service with a certain set of resources and abilities provides the most stable basis for determining one's own identity and sustainability, a resource approach to the organization of a dental service provides the most serious basis for a strategy for its successful development in the region than the management of a dental service based only on its needs, which cannot be fully satisfied in a developing society.
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