The contribution of to the development and evaluation of the quality of nursing services and to the optimization of the use of financial, material and human resources

Doctoral Dissertation uoadl:3217378 55 Read counter

Unit:
Department of Nursing
Library of the School of Health Sciences
Deposit date:
2022-05-17
Year:
2022
Author:
Konstantakopoulou Olympia
Dissertation committee:
Καϊτελίδου Δάφνη, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Χρυσούλα Λεμονίδου, Ομότιμη Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Θεόδωρος Μαριόλης, Αναπληρωτής Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Αθηνά Καλοκαιρινού, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Παναγιώτα Σουρτζή, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Χαράλαμπος Οικονόμου, Καθηγητής Τμήμα Κοινωνιολογίας, Πάντειο Πανεπιστήμιο Κοινωνικών Και Πολιτικών Επιστήμων
Όλγα Σίσκου, Επίκουρη Καθηγήτρια, Τμήμα Τουρισμού, Πανεπιστήμιο Πειραιώς
Original Title:
Η συμβολή διοικητικών εργαλείων στην ανάπτυξη και την αξιολόγηση της ποιότητας των νοσηλευτικών υπηρεσιών και στη βελτιστοποίηση της χρήσης των οικονομικών, υλικών και ανθρωπίνων πόρων
Languages:
Greek
Translated title:
The contribution of to the development and evaluation of the quality of nursing services and to the optimization of the use of financial, material and human resources
Summary:
Background: The way in which healthcare managers, decision-making and health policy-making executives evaluate the quality of health care services provided, both at the secondary and primary care level of the provision of care, includes mainly indicators related to the organization and operation of health units, with an emphasis on components such as efficiency, adequacy of infrastructure / material resources and human resources, their degree of utilization and human resources productivity Increasingly, the assessment of the quality of health services’ dimensions regarding responsiveness of care and people / patient-centered care), such as is reflected and evaluated by exploring PHC patients' experiences is directly related to the evaluation of the performance of health units and the optimization of the use of financial, material and human resources, as shown by the widely used models for the evaluation of the performance of health systems and units and the results of related studies. For this reason, the evaluation of these dimensions is a powerful administrative and strategic tool for PHC units’ managers as well as the decision-makers and health policy-makers towards the improvement of the quality of the provided health services.
Methods: A mixed methods approach was applied. In particular, the methodology of developing and validating the tools included the establishment of the theoretical background, a qualitative study(development of the tools items and establishment of the face validity, using two patient focus groups), a quantitative study (pilot testing and establishment of the structural validity and estimation of the internal consistency of the tools - 733 Primary Health Care services’ users/patients) and a cross-sectional study on a full-scale (2,620 recipients of ToMYs’ PHC health services). Exploratory and confirmatory factor analysis was performed to check for structural validity of the tools, while Cronbach’s alpha coefficients were estimated to check for reliability. Also, correlation analyses were conducted on a bivariate and multivariate level (a=0.05).
Results: Confirmatory factor analysis confirmed almost perfectly the presumed theoretical model and the following six factors were identified through the tools: (a) accessibility (three items, e.g. opening hours), (b) continuity and coordination of care (three items, e.g. doctor asks for medical history), (c) comprehensiveness of care (three items, e.g. doctor provides advices for healthy life), (d) quality of medical care (four items, e.g. sufficient examination time), (e) facility (four items, e.g. comfortable waiting room) and (f) quality of care provided by nurses and other health professionals (four items, e.g. polite nurses). With regard to the full-scale cross-sectional study, Study population included 2620 participants (response rate=58.3%) who visited 63 local health units (ToMYs) from January to March 2019. Mean age of the participants was 53.1 years (standard deviation=15.1, median=54, minimum=19, maximum=96); 14% from 19 to 35, 27.9% from 36 to 49, 31.9% from 50 to 64 and 26.2% more than 65 years old. Twelve point two percent of the participants visited the local health units (ToMYs) for their children, while 87.8% visited for their problem. Sixty five point three percent of the participants were female, while 31.2% had higher education, 22.6% finished high school and 14.6% had after high school education. The majority of the participants was Greeks (94.0%) and insured (91.4%) and self-estimated their health status as moderate to excellent (92.4%). Almost half of the participants had a chronic disease (45.4%) and only 4.7% were disabled. Sixty-eight point five percent visited this facility at least one time over the last 6 months and 31.5% visited this facility for first time. Most of the participants (94%) have already registered for family physician before visited this facility. In this visit, most of the participants (85.1%) had a contact with a GP, while 36.6% had a contact with a nurse, 13.6% had a contact with a health visitor, 12.4% had a contact with a pediatrician and 12.4% had a contact with a social worker. Only 1.5% visited a nurse or another health professional without visiting a doctor. The most frequent reasons for the visit were prescription of medications (38.1%), prescription of lab/diagnostic exams (22.7%), scheduled follow-up visit or medical check-up (27.4%), sickness (20.2%), and vaccination (9.1%). Most of the participants (86.3%) made an appointment for their visit and among them 58.5% waited less than a week and 31.7% waited from 1 week to 1 month. Also, 55.9% scheduled the appointment by phone at the reception and 36.9% by visiting the reception. More than half of the participants waited for <15 minutes for the consultation (67.9%), while 21.4% waited for 15-30 minutes and 9.7% waited for 31-60 minutes. The doctor referred 22.1% of the participants to another health service. In particular, the doctor referred 29.7% of the participants to a diagnostic center, 29.1% to another healthcare professional in this facility, 24.5% to another doctor outside the local health unit, 11% to a hospital and 7.1% to a health center. Most of the participants (88.5%) stated that the doctor offered adequate information/guidance for the referral. The doctor prescribed in the 78.9% of the participants. In particular, drug prescription was performed in 58.2% of the participants, prescription for diagnostic exams in 49.9% and prescription for consumables in 4.7%. Regarding participants’ experiences, we created six factors based on previous research, the literature review and the respective theory Cronbach's alpha coefficients for the questionnaire in total was 0.92, while Cronbach's alpha for the six factors ranged from 0.61 to 0.88 indicating acceptable to very good reliability. All mean values in items were greater than the mid-point of the scale (=3) indicating positive experience levels. Increased age was positively related to almost all scores of the sub-dimensions of patient experiences (except accessibility) (p <0.001). Women were more likely to state that they intended to recommend ToMY doctors (p = 0.004) and rated the quality of medical care (p = 0.002) and infrastructure higher than that of men (p = 0.001), patients with chronic diseases and the uninsured, had higher scores of positive experiences in dimensions such as continuity / coordination of care (p = 0.030) and accessibility (p = 0.012), respectively, and the low educational level of the participants was found to be associated with a higher score in terms of the recommendation of the ToMY (p = 0.045). Also, long waiting time between the day that the appointment was scheduled and the day of the visit to ToMY was associated with decreased scores of positive experiences (except for the continuity and coordination of care and the quality of nursing care) (p <0.001) while increased waiting time before the visit was associated with decreased score of positive patient experiences from the quality of nursing care (p <0.001). Finally, an increase in the number of visits to TοMY during the last 6 months was associated with an increase in the score of positive patient experiences from the comprehensiveness of care (p <0.001).
Conclusions: Primary Health Care (PHC) is an important pillar of any health system, as it is based on methods and technologies that are accessible to all individuals and their families within the community and at a cost that the community and the country can afford. The evaluation of patients' experiences seems to be an important tool that is directly related to the issues of quality and optimization of the use of financial, material and human resources for the health system and the services provided at the PHC level. This study emphasizes the importance of quality in terms of medical and nursing care for the patient, continuity of care and accessibility to PHC services and their relationship to patients' positive experiences at the level of PHC service delivery. Given these findings, health decision-makers and policymakers need to work to enhance patient-centered care, to formulate and implement strategic choices and proposals for the availability of relevant services and to link them to both the level of care itself (between PHC services) and between the different levels of care (between PHC services, hospital services and rehabilitation and long-term health care services), with the development and practical implementation of an integrated regulatory framework for the functional, administrative and scientific interconnection of health services at all levels of care in the light of improving the quality of health services provided, in continuing vocational training, in inter-disciplinarity, in the advanced nursing role and in maintaining patient management at the primary level, by avoiding frequent / unnecessary referrals to the hospital level. Also, health professionals, especially those working in PHC units, should work towards enhancing patient-centered care by empowering patients to actively participate, as reflected in their involvement in evaluating the services provided by evaluating their experiences.
Main subject category:
Health Sciences
Keywords:
Administrative tools, Development of nursing services, Quality of nursing services, Financial resources, Material resources, Human resources, Patient experiences, Value based healthcare
Index:
No
Number of index pages:
0
Contains images:
No
Number of references:
144
Number of pages:
282
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