Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Honorary Doctor of the Pirogov Center, Honored Doctor of the Russian Federation
Born in 1965, in Ryazan.
In 1989 he graduated from the Ryazan Medical Institute named after Academician I.P. Pavlova (diploma with honors), after which he studied in internship, and then in clinical residency at the Department of General Surgery of the Ryazan Medical Institute named after academician I.P. Pavlova.
From 1992 to 2002 - surgeon, and then deputy chief physician for surgery at the Ryazan Regional Clinical Hospital.
2002 - doctoral student at the Research Institute of Public Health and Healthcare Management of the Moscow Medical Academy named after. THEM. Sechenov.
2003 - Head of the Department for Long-Term Development and Planning of the State Institution “National Medical and Surgical Center named after N.I. Pirogov Ministry of Health Russian Federation».
2004 - Head of the Health Department of the Ryazan Region.
From 2004 to 2005 - Director of the Clinical Diagnostic Complex No. 1, Director of the Administrative Department of the Federal State Institution "National Medical and Surgical Center named after N.I. Pirogov Federal Agency for Health and Social Development."
From 2006 to the present - General Director of the federal state budgetary institution "National Medical and Surgical Center named after N.I. Pirogov" of the Ministry of Health of the Russian Federation.
2005 - defense of a dissertation for the degree of Doctor of Medical Sciences in two specialties “Healthcare Organization” and “Surgery”.
2007 - awarded the academic title of professor.
2011 - elected head of the Department of Public Health and Healthcare of the Institute for Advanced Training of Physicians of the Federal State Budgetary Institution "National Medical Clinical Center named after. N.I. Pirogov" of the Russian Ministry of Health.
2010 - Decree of the President of the Russian Federation dated September 4, 2010 No. 1096 “On awarding state awards Russian Federation" for its great contribution to the development of healthcare, medical science and many years of conscientious work was awarded the honorary title "Honored Doctor of the Russian Federation.
2016 - Decree of the President of the Russian Federation dated June 28, 2016 N 302 “On awarding state awards of the Russian Federation” for services in the field of healthcare and many years of conscientious work awarded the order Honor.
2016 - By decision of the Federation Council of the Federal Assembly of the Russian Federation, in connection with high achievements in activity and great contribution to the development of domestic healthcare, he was awarded a Certificate of Honor of the Federation Council.
Full member Russian Academy natural sciences, is the author and co-author of more than 200 scientific and educational and methodological works, dedicated current problems medicine, implementation innovative technologies into clinical practice, issues of informatization and healthcare organization. Scientific supervisor and consultant of two doctoral and six candidate dissertation studies.
METHODOLOGY FOR ORGANIZING PATIENT SURVEYS TO ASSESS SATISFACTION WITH THE QUALITY OF MEDICAL SERVICE
Karpov O.E., Makhnev DA UD K: 616-082-052(079.5)
National Medical and Surgical Center named after. N.I. Pirogov
The quality management system in a medical organization, in addition to working to improve medical care, must necessarily extend to the service component of the process. An effective tool for studying the satisfaction of consumers of medical services is formal surveys. The basic principles for developing questionnaires and questionnaires, approaches to processing results, and features of organizing surveys in a medical institution are proposed.
Key words: satisfaction assessment; survey; survey; quality of medical care.
METHOD OF PATIENTS INTERROGATIONS ORGANIZATION FOR ESTIMATION OF SATISFACTION BY THE MEDICAL SERVICE QUALITY
Karpov O.E., Makhnev D.A.
The control system of quality in medical organization besides work for perfection of medical aid, should necessarily be involved in the service component. Effective tool for studying satisfaction of the medical services consumers-formalized interrogations. Here are offered the basic principles of development of the questionnaire and polling sheets, approaches to processing results, feature of organization of interrogations in medical establishment.
Keywords: satisfaction estimation; interrogations; questionnaire; medical services quality.
Relevance
According to the fundamentals of marketing [1], quality in the eyes of consumers is divided into perceived and real (technical). Real quality is the material, actual content of a service, work, product. Perceived quality is a set of subjective characteristics such as impression, comfort and others. Interestingly, these two dimensions of quality are perceived differently by consumers over time. Technical quality is assessed only after the actual receipt of the service (product), and sometimes after a significant period of time; the perceived quality begins to be assessed by the consumer from the moment he receives the first information about the service (“the theater begins with a hanger”). Thus, the process of consumer assessment of the level of satisfaction with the quality of a service begins with the perceived quality and, already against its background, develops (supplemented, adjusted) by technical quality.
Traditionally, in the work of medical institutions, maximum attention is explicitly paid to the real (technical) component of quality - clinical medicine itself, the process and results of treatment
To what forms the concept of “quality of medical care”.
However, it should be noted that the development of methods and their effectiveness in clinical medicine can only be fully assessed by a professional, i.e. actually a doctor. The patient, as a rule, can only say: whether the treatment helped him or not, how quickly the effect occurred, how painless it was; sometimes - how much the treatment result affected the quality of life. Besides, absolute majority techniques used in modern
In modern medicine, they are standard, that is, the place where medical care is received (provided it is equally accessible) becomes unimportant for the consumer.
The second component (service) - perceived quality - is often underestimated. Accordingly, as a rule, it is missed. But it is the service component that the patient is able to evaluate independently. As a result, perceived quality accounts for at least half of the patient's impression of treatment. Convenience, accessibility, speed, comfort, “personality” of the relationship and other subjective indicators ultimately determine the patient’s choice of “where to be treated” and “what to tell friends about on occasion.” Moreover, the demands of patients are growing precisely in the service component due to consumer experience in household (non-medical) services.
In addition, one cannot neglect the fact that any somatic pathology inevitably affects psychological state patient, which exacerbates the importance of the subjective service component.
Thus, without diminishing the importance of developing the quality of clinical medicine itself, the importance of working in a medical organization to increase the level of quality perceived by patients (i.e. the level of the service component of the treatment process) is obvious.
Both components of quality are inextricably linked and equally important for the consumer. Maintenance high level business reputation and competitiveness of the organization is possible only with the simultaneous development of both components. Therefore, it is important to realize that quality management in a medical organization is work to improve the quality of medical care.
Qing service in general, and not just to improve medical care.
Required part This work involves monitoring the satisfaction of consumers of medical services.
Tools
The simplest and at the same time the most effective tool for studying consumer satisfaction is a survey formalized in the form of a questionnaire. Surveys are the most common way to obtain information. The source of information when conducting a survey is the respondent, i.e. a person whose opinion is sought during a survey.
There are two main types of survey methods - questionnaires and interviews.
A questionnaire survey presupposes a strictly fixed order, content and form of questions, and a clear indication of answer methods.
An interview is a conversation that involves direct contact between the researcher and the respondent, recorded by the interviewer himself. The most common is a formal interview, which is conducted according to questions included in the interview form.
One of the most important advantages surveys is that they allow you to find out the opinions of large populations of people in a fairly short time and obtain a variety of information.
Consumer satisfaction studies solve two important problems at once: information and communication. The information role is to obtain data about the needs, expectations and wishes of customers, as well as the extent to which these needs are being met. Obtaining and using this data allows you to build a competitive development strategy for the organization. The organization gets the opportunity not only to satisfy consumer demands, but also to predict and generate potential demand.
The second, no less important task is to play a communication role, signaling that the interests and needs of consumers are not only taken into account, but are also considered with due seriousness. The effect can be significantly increased by informing patients about the measures taken by the organization on their recommendations.
The research tool for the survey is a questionnaire or interview form. The basic principles of creating tools for questionnaires and interviews are the same.
Questionnaire development
In order to conduct research, it is necessary to logically structure the basic concepts contained in the definition of the subject of research. A logical analysis of these concepts presupposes an accurate, comprehensive explanation of their content and structure, and
on this basis - an understanding of the relationship between those elements and properties of the phenomenon being studied, the sequential analysis of which gives a holistic picture of the state of the subject of research. This procedure is the basis for creating a questionnaire.
Like any other research, a survey involves subsequent measurement of the phenomena of interest. All facts that are used to measure and serve as a numerical (quantitative) expression of what is being studied social phenomena and processes are called indicators.
The measurement tool in sociology is the scale. It consists of measurement indicators arranged in one order or another.
When developing a questionnaire, the following main types of scales can be used: nominal, rank (ordinal) and interval.
The nominal scale is used in cases where we are dealing with a list of objective characteristics characterizing respondents: gender (male, female); profession (list of professions), etc.
The rank (ordinal) scale is used to measure those properties and characteristics of social phenomena for which it is difficult to find objective indicators. When using a scale of this type, the measurement is based on subjective indicators expressing the respondents’ attitude to any phenomenon. For example, when answering the question “How do you evaluate the work of the clinic as a whole,” you can use the following answer options: excellent, good, average, below average, bad.
The interval scale is used when measuring those properties and characteristics whose value can be expressed in numbers (for example, age, work experience, number of family members, etc.). Scale intervals may not be equal. So, when answering the question “Your age,” the scale with intervals will look like this: up to 20 years; 20-30 years; 30-40 years old; more than 50 years. When constructing a scale, it is important to ensure its validity, completeness and sensitivity.
The validity of a scale depends on the correct choice of indicator (i.e., the scale measures exactly the factor that needs to be measured).
The completeness of the scale assumes that it takes into account all possible answers to the question.
The sensitivity of the scale is important, first of all, for ranking scales, since it expresses the degree of differentiation of respondents’ assessments. The more positions, the more sensitive the scale. In practice, as a rule, scales with three or five positions are used.
Thus, the definition of indicators and the construction of scales based on them allow us to proceed to the development of tools (questionnaires).
The content of the survey questions is divided into open-ended, when respondents answer the question in
free form, closed, in which all answer options are provided in advance, and semi-closed, in which both possibilities are combined.
Open-ended questions reveal the dominant opinions: people talk about what worries them most. But processing the answers obtained in this way is a complex and time-consuming procedure, and the possibility of subjectivity in interpreting the results is not excluded.
Closed questions allow for a more rigorous interpretation of the answer. It becomes possible not only to find out the content of judgments, but also to measure the intensity of assessments. Asking closed questions presupposes compliance with the basic requirement - to provide for possible answer options as fully as possible. To do this, you can use a semi-closed question, which leaves enough space for the respondent’s own version.
When formulating answer options, you must consider:
The least likely answer options should go first (when answering a question, a person chooses the first positions more often than the subsequent ones);
Hints should be approximately equal in length (the longer the “hint”, the less likely it is to be chosen);
All answer options must be kept at the same level of specificity (the more abstract the hint is, the less likely it is to be chosen, because people think concretely);
You cannot combine several ideas in one answer option (“the work is interesting and well paid”), each characteristic must be presented as a separate answer option;
All answer options for one question must be on one page;
You cannot print the entire series of positive prompts in a row, followed by a series of negative ones, or vice versa (in this case, the opinion is imposed by the very sequence of the proposed options);
It is necessary to alternate questions and tips of the same type with others that are contrasting in content (if the list of proposed options is too large, respondents work less carefully with the last groups of judgments than with the first);
Provide for the possibility of avoiding answering a closed question (the answer “I find it difficult to answer” provides the respondent with sufficient freedom, which reduces the percentage of those evading participation in the survey);
Particular questions should be put first, and generalizing questions should be put at the end of the corresponding block, since the sequence of asking questions affects the respondents’ answers (general assessments will influence private ones, since the respondent psychologically strives to justify the overall assessment);
The semantic sections of the questionnaire should be approximately the same length (the dominance of one section will affect the quality of answers to others).
The usual sequence of semantic sections of the questionnaire:
Introduction, which states: who is conducting the survey and why, how the data will be used, a guarantee of anonymity of information (if required by the content of the questions), instructions for filling out the questionnaire;
Introductory questions perform two functions: to interest the respondent and make it as easy as possible for him to get involved in the work (therefore, there should not be difficult or disturbing questions at the beginning of the text);
The final questions on the content of the topic should be relatively easy, since people gradually get tired of working with the questionnaire;
Demographic (“passport”) data is often included in the final part of the questionnaire (this section is concise, does not require much effort and indicates the completion of the survey);
It usually concludes by expressing gratitude for your cooperation in conducting the survey.
Features of organizing surveys in a medical institution
Organization of sociological research in a medical institution has a small amount of features, however, these differences are fundamental.
A. Appearance employees conducting the survey should not be associated with doctors. This is explained by the fact that an employee dressed in a white medical coat can cause the psychological effect of “ingratiation” in the respondent (patient) and, as a result, receiving negative information from him becomes doubtful.
B. When organizing a survey, it is important to emphasize that the information reflected in the questionnaire is under the “special” personal control of the head of the institution. Such control is important in organizations of any kind of activity, however, as in the first paragraph of “features...”, its special relevance in medicine is dictated by the patient’s psychological dependence on the doctor.
C. Considering that any somatic pathology inevitably affects the psychological state of the patient, the emotional mood of patients to participate in the survey is somewhat worse than that of ordinary consumers. Consequently, the behavior of the employees organizing the survey should be especially friendly.
Processing and analysis of results
Each study has its own object - a set of people who are carriers of the problem being studied. The object of study, constituting its general population, can be very significant
by number. In this case, there is a need to form a sample population.
Sample population (sample) is a part of elements population, selected in accordance with a certain algorithm. The sample must be strictly representative, i.e. - according to the selected parameters, the composition of the sample population must correspond to the proportions of the general population (the sample population must be a micromodel of the general population). The size (volume) of the sample depends on the degree of homogeneity of the objects being studied, the margin of permissible error and the size of the general population.
After identifying an array of questionnaires for analysis, they need to be prepared for processing. Those that contain at least one of the listed shortcomings are excluded from the array of questionnaires for processing: the passport part of the questionnaire is not filled out; there are no answers to key questions; there are filling errors that cannot be corrected; knowingly unreliable data (forgery).
The remaining questionnaires go through a coding process, which consists of assigning a different code to each answer option in the questionnaire. Special attention is devoted to the processing of semi-closed and open questions (they undergo manual processing).
The main methods of statistical processing of questionnaires: compiling distribution series for each question and compiling grouping tables.
A distribution series for a question is a series of numbers, each of which reflects the frequency of choosing the corresponding answer option for a particular question across the entire population of respondents. The data is indicated as the number of people who indicated this option response, and as a percentage of the total number of respondents.
Grouping tables contain the frequencies of choice of answer options for a question depending on the answers to another question. Grouping tables are important for determining the relationship between answers to the substantive questions of the questionnaire and the characteristics of the respondents (distribution of answers by gender, age, status groups, etc.).
If possible, a graphical representation of the results of statistical processing is used, which greatly facilitates the analysis of information and makes the survey results more visual.
In any case, the information content of the data obtained during the survey depends on the thoughtfulness of the structure of the questionnaire and the organization of the survey.
It is necessary to note the particular value of the information obtained from respondents’ answers to open questions questionnaires Statistical analysis Such sections are complicated by the heterogeneity of the data and the free presentation of the thoughts of the respondents. The only possible way is to build ratings of unified formulations after “manual” processing
You are our patient, which means you are the person for whom we work.
We would really like you to be happy that you contact us for medical care.
This survey is anonymous, the purpose of the survey is to improve the quality of service and medical care in our clinic. We urgently need to know your opinion on what to fix and what to strive for.
male Gender female often Frequency „ regularly visited very rarely
VHI attachment (including under an agreement with an organization) Compulsory medical insurance attachment ^channel (budgetary) attachment for a fee (including under an agreement with an individual) employee (family member) up to 20 years old 20-30 years old Age „„ 30-40 years 40-50 years More than 50 years
How do you evaluate the work of the clinic as a whole (circle).”
1 - excellent; 2 - good; 3 - average; 4 - below average; 5 - bad.
Level of professionalism of the clinic staff (circle):
Level of service organization (circle)".
1 - excellent; 2 - good; 3 - average; 4 - below average; 5 - bad.
When formulating comments and wishes, do not doubt whether they are objective and ACCURATE
Your comments, whether your wishes are legal - just tell us your opinion.
Comments (what's bad)
Wishes (what would you like)
1.______________________________________________________________
2.______________________________________________________________
3.______________________________________________________________
We will try to take into account all your comments. We hope you will be satisfied as professional level specialists, and the quality of service in the clinic.
Sincerely, Head of the Clinic Questionnaire No.______ ________________________I.I. Ivanov
Federal State Institution “National Medical and Surgical Center named after N.I. Pirogov Roszdrav"
Rice. 1. An example of a questionnaire for conducting a survey of patients in a clinic
operators of comments written in a free style. However, it is precisely these sections of surveys that are usually most interesting to managers. This is the easiest way feedback with the consumer paying attention to everything that really matters to him. This explains the special significance of information in answers to questions with implied negative assessments. Periodically reading “live” comments from patients in questionnaires, especially in response to the questions “Your comments. What is wrong?" or “Your wishes. What would you like to change?” often forces the manager to re-evaluate the formed ideas and priorities of the organization’s process. In Fig. 1 shows an example of a questionnaire for conducting a survey of patients in a clinic.
Conclusion
Properly designed surveys can provide organizational leadership with a constant stream of additional management information for analysis and decision-making. The particular value of this information is that it makes it possible to evaluate the ongoing processes and results of the enterprise through the eyes of the consumer. Often this information does not coincide with the “official” information
about the state of affairs in the organization, since the consumer perceives processes in his own way and sets priorities in his own way. But it is the consumer’s opinion that determines the assessment of service quality and, as a result, the competitiveness of the organization.
Literature
1. Kotler F. Fundamentals of Marketing. - M.: Progress, 1992. - 734 p.
2. Guseva N.K. et al. Healthcare facility management technology: a guide for professional education. - N. Novgorod: publishing house of the Nizhny Novgorod State Medical Academy, 2006. - P. 119-128.
3. Batleev G.L. Methods for obtaining and processing marketing information.
St. Petersburg: Publishing house St. Petersburg State University of Physics, 1996. -14 p.
4. Petrova N.G., Vishnyakov N.I., Balokhina S.A., Teptina L.A. Fundamentals of marketing of medical services: Textbook. - M.: MEDpress-inform, 2008. - P. 77-88.
5. Ivanov V.V., Bogatchenko P.V. Medical management. - M.: Infra-M, 2009.-S. 32.
6. Butova V.G., Kovalsky V.L., Manasherov T.0. Entrepreneurial activity medical organizations ( Practical guide). - M.: ETVOOK, 2009.-P. 121-160.
Makhnev D.A.
National Medical and Surgical Center named after. N.I. Pirogova 105203, Moscow, st. Nizhnyaya Pervomaiskaya, 70
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