Karpov Oleg Eduardovich family. General Director of the Pirogov Center
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. Pavlov (diploma with honors), after which he was trained 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 of the Research Institute of Public Health and Health Management of the Moscow Medical Academy. THEM. Sechenov.
2003 - Head of the Department of Prospective Development and Planning of the State Institution "National Medical and Surgical Center named after N.I. Pirogov of the Ministry of Health of the 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 of the 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 "Health Organization" and "Surgery".
2007 - the academic title of professor was awarded.
2011 - elected as the head of the Department of Public Health and Healthcare of the Institute for Advanced Training of Doctors of the Federal State Budgetary Institution “N.M. N.I. Pirogov" of the Ministry of Health of Russia.
2010 - Decree of the President of the Russian Federation of 04.09.2010 No. 1096 "On awarding state awards of the Russian Federation" for a 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 - By Decree of the President of the Russian Federation of June 28, 2016 N 302 "On awarding state awards of the Russian Federation", he was awarded the Order of Honor for services in the field of healthcare and many years of conscientious work.
2016 - By the decision of the Federation Council of the Federal Assembly of the Russian Federation, in connection with the high achievements in his activities and his great contribution to the development of domestic healthcare, he was awarded the Certificate of Honor of the Federation Council.
A full member of the Russian Academy of Natural Sciences, he is the author and co-author of more than 200 scientific and educational works on topical issues of medicine, the introduction of innovative technologies in clinical practice, issues of informatization and healthcare organization. Supervisor and consultant of two doctoral and six Ph.D. dissertations.
METHODOLOGY FOR ORGANIZING PATIENT SURVEYS TO ASSESS SATISFACTION WITH THE QUALITY OF MEDICAL SERVICE
Karpov O.E., Makhnev YES UD K: 616-082-052(079.5)
National Medical and Surgical Center. N.I. Pirogov
The quality management system in a medical organization, in addition to improving 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 formalized surveys. The basic principles for the development of questionnaires and questionnaires, approaches to the processing of results, features of the organization of surveys in a medical institution are proposed.
Key words: satisfaction assessment; survey; questioning; quality of medical care.
METHOD OF PATIENTS INTERROGATIONS ORGANIZATION FOR ESTIMATION OF SATISFACTION BY THE MEDICAL SERVICE QUALITY
Karpov O.E., Mahnev D.A.
The control system of quality in a medical organization besides work for the perfection of medical aid, should necessarily be involved in the service component. An effective tool for studying the 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 assessment; interrogations; questionnaire; medical services quality.
Relevance
According to the basics of marketing [1], quality in the eyes of consumers is divided into perceived and real (technical). Real quality is the material, actual content of the service, work, product. Perceived quality is a set of subjective characteristics, such as impression, comfort, and others. Interestingly, these two components of quality are perceived differently by consumers over time. Technical quality is assessed only after the actual receipt of the service (goods), and sometimes after a significant period of time; the perceived quality - begins to be assessed by the consumer from the moment the first information about the service is received (“the theater begins with a hanger”). Thus, the process of assessing the level of satisfaction with the quality of the service by the consumer begins with the perceived quality and, already against its background, develops (supplemented, corrected) by the 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. actual doctor. The patient, as a rule, can only say: did the treatment help him or not, how quickly the effect came, how painless; sometimes - how the result of treatment affected the quality of life. In addition, the vast majority of techniques used in modern
medical care are standard, that is, the place of obtaining medical care (provided that it is equally accessible) becomes irrelevant for the consumer.
The second component (service) - the 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, the perceived quality is at least half of the patient's impressions of the 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 exactingness of patients is growing precisely in the service component due to consumer experience in household (non-medical) service.
In addition, one cannot neglect the fact that any somatic pathology inevitably affects the psychological state of the patient, which exacerbates the importance of the subjective service component.
Thus, without belittling 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. Maintaining a high level of 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
Qing services in general, and not just to improve medical care.
A necessary part of this work is monitoring the satisfaction of consumers of medical services.
Instruments
The simplest and at the same time the most effective tool for studying customer satisfaction is a survey formalized in the form of a questionnaire. Polls are the most common way to obtain information. The source of information during the survey is the respondent, i.e. a person whose opinion is obtained in the course of a survey.
There are two main types of survey methods - questionnaire survey and interviewing.
A questionnaire survey involves a rigidly fixed order, content and form of questions, a clear indication of the methods of answer.
Interview - a conversation involving direct contact between the researcher and the respondent, recorded by the interviewer himself. The most common is the formalized interview, which is conducted in accordance with the questions included in the interview form.
One of the most important advantages of surveys is that they allow in a fairly short time to find out the opinion of large populations of people and receive a variety of information.
Consumer satisfaction research solves two important tasks at once: information and communication. The informational role is to obtain data about the needs, expectations and wishes of customers, as well as how these needs are met. Obtaining and using this data allows you to build a competitive strategy for the development of the organization. The organization gets the opportunity not only to satisfy the needs of consumers, but also to predict and form 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 also considered with due seriousness. The effect can be significantly increased by informing patients about the measures taken in the organization on their recommendations.
The research tool for the survey is a questionnaire or interview form. The basic principles for the formation of tools for questionnaires and interviews are the same.
Questionnaire development
In order to conduct a study, it is necessary to logically structure the basic concepts contained in the definition of the subject of study. The logical analysis of these concepts involves an accurate comprehensive explanation of their content and structure, and
on this basis - understanding the relationship of those elements and properties of the phenomenon under study, the sequential analysis of which gives a holistic view of the state of the subject of research. This procedure is the basis for the formation of the questionnaire.
Like any other study, the survey involves the subsequent measurement of phenomena of interest. All the facts that are used to measure and serve as a numerical (quantitative) expression of the studied social phenomena and processes are called indicators.
The measuring instrument in sociology is the scale. It consists of measurement indicators arranged in a particular sequence.
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 features that characterize the respondents: gender (male, female); profession (list of professions), etc.
The rank (ordinal) scale is used to measure those properties and signs of social phenomena for which it is difficult to find objective indicators. In the case of using this type of scale, the measurement is based on subjective indicators expressing the attitude of respondents to any phenomenon. For example, when answering the question “How do you rate the work of the clinic as a whole”, you can use the following answers: excellent, good, average, below average, bad.
The interval scale is used when measuring those properties and characteristics, the value of which can be expressed as a number (for example, age, length of service, 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; over 50 years. When designing a scale, it is important to ensure its validity, completeness, and sensitivity.
The validity of the scale depends on the correct choice of the 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 on their basis allow us to proceed to the development of tools (questionnaires).
Questions of the questionnaire are subdivided according to the content into open ones, when the respondents answer the question in
free form, closed, in which all answers are provided in advance, and semi-closed, in which both possibilities are combined.
Open-ended questions allow you to identify the dominant opinions: people talk about what worries them the most. But the processing of 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. The formulation of closed questions presupposes compliance with the basic requirement - to foresee possible answers 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 answers, you need to consider:
The least likely answers 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 selected);
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 job is interesting and well paid”), each feature must be presented as a separate answer option;
All answer options for one question should be on one page;
You cannot print the whole 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 intersperse questions of the same type and prompts with others that are contrasting in content (if the list of proposed options is too large, the respondents work with the last groups of judgments less carefully than with the first ones);
Provide for the opportunity to avoid answering a closed question (the answer “I find it difficult to answer” provides the respondent with sufficient freedom, which reduces the percentage of those who evade participation in the survey);
Private questions should be put first, and generalizing questions should be put at the end of the corresponding block, since the sequence of posing questions affects the answers of respondents (general assessments will affect private ones, since the respondent psychologically seeks 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 for others).
The usual sequence of semantic sections of the questionnaire:
An introduction stating: 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 be included 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, because, working with the questionnaire, people gradually get tired;
Demographic (“passport”) data is more 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);
Usually, the conclusion is expressed by gratitude for cooperation in conducting the survey.
Features of the organization of surveys in a medical institution
The organization of sociological research in a medical institution has a small number of features, however, these differences are fundamental.
A. The appearance of staff conducting the survey should not be associated with doctors. This is explained by the fact that an employee dressed in a white medical gown can cause the respondent (patient) the psychological effect of “flattering” and, as a result, receiving negative information from him becomes doubtful.
B. When organizing a survey, it is important to focus on the fact 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 particular relevance in medicine is dictated by the patient's psychological dependence on the doctor.
C. Given that any somatic pathology inevitably affects the psychological state of the patient, the emotional attitude of patients to participate in the survey is somewhat worse than that of ordinary consumers. Therefore, 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 under study. The object of study, constituting its general population, can be very significant.
by number. In this case, it becomes necessary to form a sample population.
A sampling set (sample) is a part of the elements of the general 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 should correspond to the proportions of the general population (the sample should be a micromodel of the general population). The number (size) of the sample depends on the degree of homogeneity of the studied objects, the margin of error and the size of the general population.
After determining the array of questionnaires for analysis, they must be prepared for processing. From the array of questionnaires for processing, those in which at least one of the listed shortcomings is found are excluded: the passport part is not filled in the questionnaire; missing answers to key questions; there are filling errors that cannot be corrected; deliberately not reliable data (forgery).
The remaining questionnaires go through a coding process, which consists in assigning a code to each answer option in the questionnaire. Particular attention is paid to the processing of semi-closed and open questions (they are processed manually).
The main methods of statistical processing of questionnaires: compilation of distribution series for each question and compilation of grouping tables.
The distribution series for a question is a series of numbers, each of which reflects the frequency of choosing the appropriate answer option for a particular question across the entire population of respondents. The data are indicated both in the number of people who indicated this answer option, and as a percentage of the total number of respondents.
Grouping tables contain the frequency of choice of answer options for a question, depending on the answers to another question. Grouping tables are important for determining the relationship between the answers to the substantive questions of the questionnaire and the characteristics of the respondents (distribution of answers by sex, 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 results of the survey 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 on the organization of the survey.
It is necessary to note the special value of the information obtained from respondents' answers to open-ended questions in the questionnaires. Statistical analysis of such sections is hampered by the heterogeneity of the data and the free presentation of the respondents' thoughts. The only possible way is to build ratings of unified formulations after "manual" processing
You are our patient, which means that you are the person for whom we work.
We would like you to be happy that you are contacting 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 really need to know your opinion on what to fix and what to strive for
Male Gender Female Often Frequency „ regularly visited very rarely
VMI attachment (including under an agreement with an organization) CHI attachment ^anal (budgetary) attachments 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 old 40-50 years old More than 50 years old
How do you rate the work of the clinic in general (circle)".
1 - excellent; 2 - good; 3 - medium; 4- below average; 5 - bad.
The level of professionalism of the clinic staff (circle):
Level of service organization (circle)."
1 - excellent; 2 - good; 3 - medium; 4- below average; 5 - bad.
When formulating comments and wishes, do not doubt whether the
Your comments, whether your wishes are valid - just tell us your opinion.
Remarks (which is bad)
Wishes (what would you like)
1.______________________________________________________________
2.______________________________________________________________
3.______________________________________________________________
We will try to take into account all your comments. We hope that you will be satisfied with both the professional level of specialists and the quality of service in the clinic.
Sincerely, Head of the Polyclinic 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 polyclinic
free-style comment operators. However, it is these sections of surveys that, as a rule, are of most interest to managers. This is the easiest way to get feedback from the consumer, paying attention to everything that is really important to him. This explains the special significance of information in response to questions with supposed negative assessments. Periodic reading of "live" comments of patients in the 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 ideas and priorities of the process of the organization's activities. On fig. 1 shows an example of a questionnaire for conducting a survey of patients in a polyclinic.
Conclusion
Properly designed surveys can provide the management of the organization with a constant stream of additional management information for analysis and decision making. The particular value of this information lies in the fact 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, as the consumer perceives the processes in his own way, sets priorities in his own way. But it is the opinion of the consumer that determines the assessment of the quality of service 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. Health Care Management Technology: A Guide for Vocational Education. - N. Novgorod: publishing house of the Nizhny Novgorod State Medical Academy, 2006. - S. 119-128.
3. Batleev G.L. Methods for obtaining and processing marketing information.
SPb.: Publishing house of SPb GUF, 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. - S. 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 of medical organizations (Practical guide). - M.: ETVOOK, 2009.-S. 121-160.
Contact Information
Makhnev D.A.
National Medical and Surgical Center. N.I. Pirogov 105203, Moscow, st. Lower Pervomayskaya, 70
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