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The state of the system for ensuring the quality of medical care in the healthcare industry

It is necessary that the conditions, and not the governing ones, force people to work. Ryutaro Hashimoto

One of the most important tasks of health care, formulated in the Concept for the Development of Health Care and Medical Science in the Russian Federation and the State Guarantee Program for providing Russian citizens with free medical care, is to provide high-quality and affordable medical care to the population, taking into account insufficient financing of the industry and territorial organizational and economic features of the Far East.

Having adopted the triad of A. Donabedian, medical workers had to develop approaches to the sequential evaluation of the three components of the ILC: resources, diagnostic and treatment technologies and results. Since the 90s, in the development of the principles of management of ILCs enshrined in the Law “On Medical Insurance of Citizens in the Russian Federation”, the creation of a system for assessing the conditions for the provision of medical services in the form of licensed accreditation bodies has begun in the Far East of Russia. However, as is often the case in recent years in the native country, the concept of licensing and accreditation was not thought out and an appropriate regulatory framework was formed. In fact, despite the steps taken to reform the federal ministry, there is still no efficiently functioning and clearly defined state vertical of this most important component of the industry, which impedes the formation of state control over the quality of medical care.

It should be noted that in world practice the roots of the history of managing the production of quality products go back to the beginning of the twentieth century, when Frederick Winslow Taylor conducted his first research. In the following years, quite a lot of attempts were made to continue this research, to develop original models of quality management. Unfortunately, in a special field in which quality control can be successfully applied using statistical methods, i.e. in the healthcare industry, service quality management processes lag far behind industrial enterprises. There are fewer specifications, technical conditions, but certain management problems constantly arise, technical failures occur less often, but errors occur that result in a loss of staff time, a decrease in the patient’s health level, etc., leading to their dissatisfaction. Most often there are two types of errors:

• as a result of which patients suffer;

• as a result of which the operating mode of the “conveyor” for the production of medical services (MPI) is violated.


Analyzing the processes occurring in the field of standardization of “quality assurance tools” for medical services in the Far East of Russia, we can come to the disappointing conclusions that until recently they had the character of close interaction between a swan, a cancer and a pike - every head of itself creates what it considers necessary, and as it sees fit. Unfortunately, a unified approach to the provision of ILCs has not yet been formed either in Russia or at the international level. It should be noted that in European healthcare practice the term “quality assurance means" is used in many cases in relation to a method used by individuals, a group of individuals, an organization or an industry. In English-language texts, it is most often used in the narrow sense with respect to a set of simple methods of "continuous quality improvement" (OQI - Organizationwide quality improvement or TQM - Total quality management tools).

In a broader sense, it includes many other methods, mechanisms, programs or systems for ensuring safety and quality. Some of them are diagnostic methods that help in making decisions, some are intended only for practical actions and transformations, while others include methods for assessing the level of technology support and the results of practical interventions.

All employees of the public health authorities of the Far East should have a clear understanding of the ILC and access to information on quality management methods for the production of medical services not only in Russia but also abroad, use fairly simple methods of costing when assessing the appropriateness of using certain medical technologies .

The development of the concept of quality management in relation to the healthcare industry is a phased and lengthy process that requires a thorough review of the formed stereotypes of the quality of production of medical services and approaches to reforming the system of medical care for the population. The most difficult task is to bring together in the form of a common strategy at the regional and local levels the interests of the key parties in the process of production of medical services: medical workers, healthcare facilities, patients and payers. It should be borne in mind that each of these groups has its own idea of ​​quality and pursues the associated expectations.
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The state of the system for ensuring the quality of medical care in the healthcare industry

  1. Prerequisites for the formation of a system for ensuring the quality of medical care in the context of reforming Russian healthcare at the turn of the XX-XXI centuries
    In 1997, the concept of the development of healthcare in Russia was released, where, to one degree or another, the solution to the problems of accessibility, safety, satisfaction, and optimality of medical care to the population was considered. Today in Russia there is a sufficient legislative basis for the implementation and improvement of the quality of medical care for the population, but there are still no criteria for evaluating activities
  2. Ensuring the quality of medical care in the work of the NSR service
    The quality of medical care (ILC) is a combination of its characteristics that meets the needs of citizens in the effective prevention and treatment of diseases, improving the quality of life and increasing its duration. A simpler and clearer definition of ILCs is when they do what they need, when they need it, and how they need it. Quality management of medical care is aimed at obtaining the maximum
  3. Quality of care indicators in some health services in the Far East
    To date, the quality management models of medical care used in practical health care are based on the so-called “professional model” (assessment of UKL, compliance of the treatment case with standards and protocols of patient care). This approach does not allow to identify the true causes of insufficient ILC and to introduce a system of continuous quality improvement. Other models
  4. Information problems of ensuring the quality of medical care to the population and system analysis
    What should doctors be interested in? Is this new information so significant that it is necessary to change the technology of medical care, introduce a new technological standard or abandon the old one, prescribe a different medicine for the patient, or receive training in developing a new treatment method for Stanley Tillingast? The development of market relations in the Russian economy, the liberalization of prices for goods and
  5. Causal relationships to ensure the quality and effectiveness of medical care. Regional features
    The Russian Far East is one of the regions that suffered the most from the economic crisis of the first half of the 1990s; the regional healthcare system has seriously weakened. There was a threat of violation of the universal accessibility of medical services, and the leadership of the subjects of the Russian Federation Far Eastern Federal District and market reformers clearly recognized it. When developing reforms, the task is to provide the population of the region
  6. On the way to the formation of common principles for the collection of information to ensure the quality and effectiveness of medical care
    At present, domestic health care is experiencing not only a financial crisis, but also an even more risky management crisis. Due to the poor quality of industry management, limited financial resources are spent extremely irrationally. The resource gap in healthcare has always been large. It will be no less acute in the 21st century. Before loan managers
  7. Unresolved problems of ensuring the quality of medical care to the population of the Russian Far East
    The “shoulders” of doctors and nurses bear a heavy burden of responsibility for the quality of medical services provided. Russian society still perceives medical workers as a certain category of people dressed in white clothes and having taken the Hippocratic oath, who should work for the good of that very society, denying itself the most necessary. For example, in obtaining a decent salary
  8. The current state of quality management of medical care for the population of the Far East
    Health care reform in the Far East of Russia: decentralization of management, expansion of the independence of health facilities, establishment of mandatory and voluntary health insurance systems, changing socio-economic conditions reinforce the urgency of the problem of managing the quality and effectiveness of medical care. The conceptual basis, strategic guidelines for such a policy can
  9. Ministry of Health and Social Development of the Russian Federation

    Department of Health Care and Resort Development

    Central Research Institute of Health Organization and Informatization. Resources and activities of healthcare institutions, 2009
    Key health indicators. Russian Federation. Network and personnel of medical organizations. Russian Federation. The distribution of medical organizations by subordination. Russian Federation. Medical staff. District physicians. District pediatricians. General practitioners. Doctors and paramedical ambulance personnel. Nursing staff.
  10. First aid for emergency conditions of the respiratory system
    The main signs of diseases of the respiratory system. A cough is a reflex protective act of the body. With the help of a cough, foreign bodies, sputum and other pathological elements are removed from the respiratory tract. Cough can be in the form of coughing, this is observed with tracheobronchitis, and paroxysmal cough, which is characteristic of whooping cough and bronchial asthma. Shortness of breath - difficulty
  11. Medical records and quality assurance
    Care should be taken to ensure that the medical records are complete, including a summary of what happened. Records should truly reflect events so that you can best reproduce them objectively. Record facts that you were an eyewitness without trying to analyze or interpret them. If it comes to health insurance, your lawyer may ask you to write a separate
  12. Pishchita A.N. Improving the legal support of medical activity in the context of healthcare reform in the Russian Federation, 2007
    Introduction Development of a theoretical and legal model for the development of legislation in the field of healthcare in Russia. Current problems of regulatory support of domestic health care. The basic principles of improving medical legislation in the context of healthcare reform in the Russian Federation. Identification of priority areas for improving medical legislation
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