What is an independent assessment of the quality of services provided by medical organizations?
Since June 2014, together with the Federal Law "On the Foundations of Public Control in the Russian Federation", provisions on an independent examination (assessment) of the quality of medical services have been introduced.
According to him, an independent assessment of the quality of the provision of medical services is one of the forms of public control, which is carried out so that the citizens of our country have information about the quality of service in medical organizations, as well as to improve this quality.
It's important to know! An independent assessment of the quality of medical services is NOT CONDUCTED in order to control the quality and safety of medical activities and the quality of medical care!
Who conducts an independent assessment of the quality of services provided by medical organizations?
Subjects of public control. Public control (in accordance with the aforementioned Federal Law No. 212) is the observation of the activities of state authorities, local governments, state and municipal organizations in order to verify, analyze and publicly evaluate their work.
In the case of an independent assessment of the quality of the provision of medical services on the territory of the Khabarovsk Territory, this function is entrusted to the public council under the state executive body in the health sector (Public Council under the Ministry of Health of the Khabarovsk Territory). Representatives of public associations and the medical association of the Khabarovsk Territory are involved in the work of the public council.
Which organizations are being evaluated?
Mandatory - medical organizations participating in the implementation of the territorial program of state guarantees of free provision of medical care to citizens in the Khabarovsk Territory, regardless of their departmental affiliation and form of ownership.
How is an independent assessment of the quality of services provided by medical organizations organized?
Every year, before February 1, the Ministry of Health of the Khabarovsk Territory sends to the Public Council under the Ministry of Health of Russia and to the relevant public councils at the regional level information about medical organizations participating in the implementation of the territorial program of state guarantees of free provision of medical care to citizens in the Khabarovsk Territory. Further, the public councils approve the list of organizations for assessment for the current year.
An interactive questionnaire for assessing the quality of services in a unified format is posted on the website of the Ministry of Health of the Khabarovsk Territory and on the websites of medical organizations. At the request of citizens, the same questionnaire in paper format is provided to them directly during a visit to a medical institution.
The results of the questionnaire are sent to public councils, whose members analyze the results and submit them to the Ministry of Health of the Khabarovsk Territory, along with proposals to improve the quality of work of each organization.
The Ministry of Health of the region is considering the results and proposals, developing measures to improve the activities of medical organizations and posting information on the results of an independent assessment for the current year on its website.
Detailed information on the organization and conduct of an independent assessment is set out in the provisions of Article 79.1 of the Federal Law No. 323 and in the Methodological Recommendations approved by Order of the Ministry of Health of the Russian Federation No. 240 dated May 14, 2015.
What are the criteria for an independent assessment?
- openness and accessibility of information about a medical organization (completeness, relevance and clarity of information about the organization on its official website, etc.);
- the comfort of the conditions and the availability of medical services (the proportion of patients who managed to get a coupon during the first visit to a medical organization, the availability of an appointment by phone, the Internet, etc.);
- the waiting time for the provision of medical services (the average waiting time for a diagnostic test from the moment of receiving a referral, the proportion of patients who see a doctor at the time indicated in the coupon, etc.);
- benevolence, politeness, competence of medical workers (the proportion of patients who speak positively about contacts with the staff of a medical organization, etc.);
- satisfaction with the services provided (the proportion of patients willing to recommend a medical organization).
How often can an independent assessment be carried out?
Not more often than once a year and not less than once every three years.
What information does a healthcare organization need to provide for an independent assessment?
In accordance with paragraph 14 of Article 79 of Federal Law No. 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation", medical organizations must provide conditions for an independent assessment of the quality of services, provide citizens with all information in an accessible form - on information boards and on their own official website. The volume of this information is approved by Order of the Ministry of Health of Russia dated December 30, 2014 No. 956n.
Where can I see the results of an independent assessment?
- On the official website for posting information about state (municipal) institutions (bus.gov.ru).
- On the official website of the Ministry of Health of the Khabarovsk Territory, in the "Public Control" section (zdrav.medkhv.ru).
Dear residents of the Khabarovsk Territory!
We invite you to evaluate the work of medical organizations in which you received medical care. To do this, go to the main page of the official website of the Ministry of Health of the Khabarovsk Territory (or the Ministry of Health of the Russian Federation) click the banner"Independent assessment of the quality of services provided by medical organizations. Participate in voting" for further transition to the appropriate section and the choice of a medical organization.
In the summer of 2014, a new Art. 79.1 "Independent assessment of the quality of services provided by medical organizations" (entered into force on October 21, 2014). With regard to autonomous health care institutions, such an assessment should be organized by their founders, doing it at least once every three years, and when it is carried out, it is necessary to use indicators characterizing the general assessment criteria established by the Ministry of Health. Let's analyze what such indicators are.
To general criteria Health Fundamentals Act relates:
- openness and availability of information about a medical organization;
- the comfort of the conditions for the provision of services and the availability of their receipt;
- waiting time for the provision of medical services;
- benevolence, politeness, competence of employees of a medical organization;
- satisfaction with the services provided.
All indicators are divided into two large groups - they characterize services provided in outpatient and inpatient settings. Moreover, although this is not directly stated in the order under consideration, information on one part of the indicators can be obtained by the operator for the assessment by collecting administrative data and by the method of observation (for example, visiting the website of an autonomous institution), and on the other part, which concerns the opinion service recipients, the operator will have to conduct consumer surveys.
Outpatient service quality indicators
The quality of outpatient services should be assessed according to five blocks of indicators. Let's consider them in more detail.Openness and availability of information about a medical organization
1.1.The rating indicator on the official website for posting information about state and municipal institutions (bus.gov.ru). According to the federal legislation on non-profit organizations, autonomous institutions (like any other state or municipal institutions) are obliged to provide the Federal Treasury with a certain list of information (information about constituent documents, a plan of financial and economic activities, state or municipal assignments, etc.). In turn, the procedure for forming the specified rating is posted on the bus.gov.ru website in the "Independent Quality Assessment System" section. For this indicator, you can get from 0 to 1 point. The final rating is formed on the basis of five parameters that relate to the information contained in Indicators of structured information about the institution, and have their own weights. Namely, the publication rate on the bus.gov.ru website:
- general information - has a weighting factor of 0.1. It includes the information established in sect. 1 Indicators of structured information about the institution;
- information about a state or municipal task - a weighting factor of 0.1. This information is determined p. 26, 27 and 31 Indicators of structured information about the institution;
- data on the volume of services established in the state or municipal assignment - a weighting coefficient of 0.2. They are listed in p. 29 Indicators of structured information about the institution;
- data on the quality of services established in the state or municipal assignment - a weight coefficient of 0.2. They are defined in p. 28 Indicators of structured information about the institution;
- information on plans of financial and economic activities - the weight coefficient is the highest, 0.4. This information is listed in sect. 3 and 4 Indicators of structured information about the institution.
Note that the assessment by the indicator of openness and accessibility of information can be difficult and subjective in cases where certain information about the institution is posted, but is incomplete (the question arises whether to put 1 point or 0 here).
- 1.2.Completeness, relevance and clarity of information about a medical organization posted on its official website. The information that can be posted on the site covers four positions:
- general information (for example, the address of the institution, its telephone number, the name of the head);
- information about medical activities (for example, a list of medical services provided by the institution, the time of their provision);
- information about medical workers (in particular, information about which categories the doctors of the institution have);
- other information (state or municipal task of the institution, the plan of its financial and economic activities, etc.).
Then the scores for each position are multiplied by their own weighting coefficient: the coefficient 0.2 is applied to the indicator "General information", 0.5 to the item "Information about medical activity", the indicator "Information about medical workers" is multiplied by 0.2, and position "Other information" - by 0.1. As you can see, the second position is of greatest importance in assessing the completeness, relevance and comprehensibility of information about an organization.
The points obtained for each position are added to form the total score. It ranges from 0 (if a zero is received for each item in the evaluation) to 1 (if a one is set for all items). For example, if the institution's website contains only general information and information about medical activities, the total score will be 0.7.
1.3.Availability and availability of feedback methods with consumers of services on the official website of a medical organization. The total number of points for this indicator is from 0 to 2. If the institution's website has a form for submitting an electronic appeal to the institution, 1 point is assigned, if through the website a consumer can fill out and send to the institution a questionnaire to assess the quality of services in a medical organization - more 1 point. In the absence of the specified opportunities on the site, the institution receives 0 points.
1.4.The proportion of service consumers who are satisfied with the quality and completeness of information about the operation of a medical institution and the procedure for providing medical services that is available on its premises. This indicator is measured as a percentage. If the share of consumers is less than 70%, 0 points are given, from 70% inclusive, but less than 75% - 1 point, from 75% inclusive, but less than 80% - 2 points, from 80% inclusive, but less than 85% - 3 points, from 85% inclusive, but less than 90% - 4 points. The institution will receive the highest score for this indicator (5 points) if the share of consumers satisfied with the information about the organization's work is equal to or exceeds 90%.
1.5.The share of consumers of services satisfied with the quality and completeness of information about the work of a medical institution and the procedure for providing medical services, which is available on its official website. This indicator is assessed similarly to the previous one. Note that the practical adequacy of this indicator may be questionable if the specified share of all consumers of services is determined, because a significant part of them (especially the elderly) may never visit the institution's website due to lack of opportunities or interest. Therefore, it is more correct to determine this proportion of the number of those consumers of services who visited the site.
2.1.The share of consumers of services who made an appointment with a doctor (received a coupon indicating the time of appointment and the full name of the doctor) when they first applied to a medical organization. Here, the assessment is carried out in the same way as for indicator 1.4 (see above).
2.2.Average waiting time for a doctor's appointment from the moment of making an appointment (regarding the waiting times established by the territorial program of state guarantees of free provision of medical care to citizens). The total number of points for this indicator is from 0 to 5. If the average waiting period is equal to the period established by the territorial program, the institution is assigned 1 point, if less by one day - 2 points, less by two days - 3 points, less by three days - 4 points. If the average waiting period is less than half of the established period, the institution receives the highest mark - 5 points. The order in question does not say in which case the institution is awarded the lowest score (0 points), but it can be assumed that this happens when the average waiting period is longer than the period established in the territorial program.
2.3. Availability of appointment with a doctor. This indicator can be awarded from 0 to 4 points. If the institution provides consumers with the opportunity to make an appointment with a doctor by phone, via the Internet, at the institution's registry in person and by the attending physician at the appointment, for each of the four listed methods used in the institution, 1 point is assigned, and for non-use of one or another method - 0 points. For example, if an AU has the ability to make an appointment only at the reception in person and by phone, it receives 2 points for this indicator.
2.4.The share of consumers of services who are satisfied with the conditions of stay in a medical organization. It also applies the scoring algorithm developed for indicator 1.4 (see above).
2.5.The share of consumers of services with disabilities who are satisfied with the conditions of stay in a medical institution. In this case, measurements are taken as a percentage. With a share of less than 50%, 0 points are assigned, from 50% inclusive and less than 55% - 1 point, from 55% inclusive and less than 60% - 2 points, from 60% inclusive and less than 65% - 3 points, from 65% inclusive and less than 70% - 4 points. The institution receives the highest mark for this indicator (5 points) if the specified share is equal to or exceeds 70%.
Note that the concept of "disabilities" in federal legislation is deciphered only in relation to the field of education. In particular, a student with disabilities means an individual with disabilities in physical and (or) psychological development, confirmed by the psychological, medical and pedagogical commission and hindering the acquisition of education without creating special conditions... Thus, in practice, when assessing this indicator, there may be discrepancies between approaches to what kind of recipients of medical services should be taken as 100%.
The waiting time for the provision of medical services
Average waiting time for a diagnostic test from the moment of receiving a referral to it (in relation to the waiting times established by the territorial program of state guarantees of free provision of medical care to citizens) (indicator 3.1). It is calculated in the same way as the waiting time for a doctor's appointment from the time of appointment (indicator 2.2).
In turn, when evaluating the proportion of consumers of services received by the doctor at the time specified by appointment (indicator 3.2), as well as the proportion of consumers who completed the diagnostic test at the time specified by appointment (indicator 3.3), a calculation methodology similar to the assessment of indicator 1.4 is applied.
Benevolence, politeness and competence of employees of a medical organization
The scoring algorithm developed for Indicator 1.4 is also used to evaluate the share of consumers of services who positively assess the benevolence and politeness of employees of a medical organization (indicator 4.1) and their competence (indicator 4.2).
Note that the competence of health workers is assessed separately from their benevolence and politeness, since in practice these components of the quality of the work of the institution's specialists may not depend on each other.
Satisfaction with the services provided in a medical organization
Customer loyalty is assessed in the same way (as for indicator 1.4): share of service consumers who are satisfied with the services provided (indicator 5.1) and ready to recommend a medical organization for medical care (indicator 5.2).
Indicators of the quality of the provision of inpatient services
When assessing the quality of the provision of inpatient services, five blocks of indicators are also used. Some of them are the same as those established for outpatient services. In particular, indicators characterizing openness and availability of information about a medical organization , and methods of their calculation are similar to indicators 1.1 - 1.5 of the first section. And indicators reflecting benevolence, politeness and competence of health workers , are calculated in the same way as indicators 4.1 and 4.2 of the first section.The comfort of the conditions for the provision of medical services and the availability of their receipt
The assessment methodology used in relation to indicator 1.4 of the first section is also applied when examining two parameters: the proportion of consumers of services, satisfied with the conditions of stay in a medical organization , and nutrition in it .
At the same time, the share of service consumers who have during the stay in the hospital, there was no need to pay for the prescribed diagnostic tests at their own expense , is estimated in the following way. For a share of less than 90%, 0 points are assigned, from 90% inclusive and less than 95% - 1 point, from 95% inclusive and less than 100% - 2 points. The institution receives the highest mark for this indicator (3 points) if the specified share is 100%. Similarly, scores are given for the proportion of service consumers who have during the stay in the hospital, there was no need to pay for the prescribed medications at their own expense.
Another indicator is the proportion of consumers of services with disabilities who are satisfied with the conditions of stay in a medical organization, - assessed similarly to indicator 2.5 of the first section, which also applies to citizens with disabilities.
Waiting time in line when receiving medical services
Average waiting time at the admission department of a medical organization. It is measured in minutes. If the average waiting time is 2 hours or more, the institution receives 0 points; from 75 minutes inclusive, but less than 120 minutes - 1 point; from 1 hour inclusive, but less than 75 minutes - 2 points; if from 45 minutes inclusive, but less than 1 hour - 3 points; from 30 minutes inclusive, but less than 45 minutes - 4 points. The institution receives the highest score for this indicator (5 points) if the average waiting time is less than 30 minutes.
WITH the average waiting period for planned hospitalization from the moment of receiving a referral for it (regarding the waiting times established by the territorial program of state guarantees of free provision of medical care to citizens). This applies the scoring algorithm developed for indicator 2.2 of the first section.
The share of consumers of services hospitalized at the appointed time of planned hospitalization. The assessment of this share is made in the same way as the assessment of indicator 1.4 of the first section.
Satisfaction with the services provided in the medical organization
This block includes three indicators: the share of service consumers, satisfied with the services provided , ready to recommend a medical organization for receiving medical care , and satisfied with the actions of the personnel of the medical care organization ... All of them are calculated similarly to indicator 1.4 of the first section.
Note that the presence of the latter of the named indicators distinguishes the assessment of inpatient services from the assessment of outpatient services. In fact, it is a private, specifying parameter that characterizes the proportion of consumers who are satisfied with the services provided.
Thus, medical organizations will have to be assessed according to a large number of different parameters. If all the conditions are met and the maximum marks are obtained, outpatient care facilities can score 73 points, and inpatient care facilities get 75 points.
Federal Law of November 21, 2011 No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation".
See Federal Law No. 256-FZ dated July 21, 2014 "On Amendments to Certain Legislative Acts of the Russian Federation on the Issues of an Independent Assessment of the Quality of Services Rendered by Organizations in the Sphere of Culture, Social Services, Health and Education".
Modernization of the national health care system presupposes its availability, transparency, openness to the population, and improvement of the quality of services provided. To track the current state of the sphere, the practice of independent evaluation is being actively introduced. Public control enables citizens to determine the level of service, identify problems in clinics and hospitals.
So what is an independent assessment of the quality of service delivery by medical organizations? What regulatory documents is it established and regulated by? What are the procedures and rules for its implementation? Who is involved in the assessment and what are the assessment criteria? We will answer these questions in this article.
What is an independent quality assessment?
The process of independent quality assessment (IQA) is established at the state level by the Federal Law "On the Fundamentals of Health Protection of Citizens in the Russian Federation". Article 79.1. contains a short description of this type of control. The purpose of the NOC is to obtain information about the services provided, to check to improve the quality of the activities of medical organizations. Directly the examination of the ongoing medical activity and its level is not set by the law to carry out control. The criteria for evaluating an organization include:
- Availability of information about the institution;
- Comfort;
- Time in queues for any service;
- Polite attitude towards patients;
- Qualification of employees;
- Overall satisfaction with the service.
Thus, the purpose of the NOC is to inform citizens about the quality of the provision of medical services by the relevant organizations, as well as to improve the quality of the activities of such organizations. NOC is held in medical organizations participating in the implementation of the program of state guarantees for the provision of free medical care to citizens.
Legal regulation
The consolidation of the phenomenon itself is carried out in Federal Law No. 323, which was already mentioned earlier. In 2014, the Ministry of Health issued Order No. 787n, which approved indicators that characterize the criteria for assessing the activities of medical organizations. The document describes in detail each of the indicators and the algorithm for assessing it on a five-point scale. Certain provisions on NOCs contain an order of the Ministry of Health No. 269 dated April 28, 2016. Methodological instructions for carrying out are reflected in the Ministry's act No. 240 dated May 14, 2015. The submitted results are evaluated in accordance with the order of the Ministry No. 197 of the same year.
NOC procedure
A more complicated, but also affordable way is to fill out a printed form of the questionnaire and send it to the body or its council (department, committee), responsible at the level of the subject for conducting an independent assessment of the quality of the services provided. The easiest way to do this is within the medical organization itself. Since the activities of public control by citizens are confidential, the disclosure of personal data of the placeholder is excluded.
Evaluation criteria
The general assessment criteria established by the federal executive body responsible for the development and implementation of state policy and legal regulation in the field of healthcare are given in the Order of the Ministry of Health No. 787n, published on November 28, 2014. It is in the named normative act that the procedure for assessing each of the criteria presented in the table below is described in detail.
Table - Criteria for assessing the quality of medical services provided by legislation in 2014
| Criterion |
Main factors |
|---|---|
| Open access to information |
|
| Comfort, availability |
|
| Granting timeout |
|
| Competence |
|
| Satisfaction with the services provided |
|
All these criteria are given for monitoring on an outpatient basis. In general, they are almost identical for a hospital. On
Sitdikova L.B., Head of the Department of Civil Law Disciplines of the Moscow Institute of Economics, Management and Law.
The article analyzes the authors' modern approaches to the criteria for assessing the quality of medical services. Particular attention is paid to the issues of objective and subjective criteria, based on the general and specific characteristics of medical services and legal relations for their provision.
Key words: quality, medical service, objective quality criteria, subjective quality criteria.
Legal criteria of evaluation of quality of medical services
The article analyzes contemporary approaches to criteria of evaluation of quality of medical services; the special attention is drawn to the issues of objective and subjective criteria coming from general and specific characteristics of medical services and legal relations of rendering thereof.
Key words: quality, medical service, objective criteria of quality, subjective criteria of quality.
In modern conditions, the solution of the issue and the establishment of quality requirements in the contract for the provision of medical services are of particular importance for the legal regulation of medical activity. General regulatory requirements for quality are contained in Art. 309 of the Civil Code of the Russian Federation, which provides for the obligation of the parties to properly fulfill the obligation in accordance with its conditions and requirements of the law, other legal acts, and in the absence of such conditions and requirements - in accordance with the customs of business or other usually required requirements. Thus, the Civil Code of the Russian Federation does not impose any special requirements on the entities providing services, and this leads to ambiguity in determining the quality of services and the responsibility of the contractor for poorly rendered services. It should be admitted that scientists do not abandon the attempt to develop certain criteria for assessing the quality of services.
The definitions of the quality of the services provided in the economic literature are more focused on material services, the assessment of the properties of which largely coincides with the assessment of things and the results of work. If in a work contract it is necessary to achieve a materialized result, then for services the presence of a result, as a general rule, is an optional and optional condition for proper performance. Therefore, in contrast to assessing the quality of work, assessing the quality of services, including medical services, is a rather difficult task.
The normative definition of the concept of quality of service can be found in GOST 30335-95 / GOST R 50646-94, where the quality of service is understood as "a set of characteristics of a service that determine its ability to meet the established or anticipated needs of the consumer"<1>... Thus, the criteria for assessing the quality of a medical service should be various characteristics of a service that meet certain requirements.
<1>Resolution of the State Standard of the Russian Federation of March 12, 1996 N 164 "Interstate standard (GOST 30335-95 / GOST R 50646-94)." Services to the population. Terms and Definitions".
The concept of "medical care of adequate quality" is disclosed in the regulatory documents of the Federal Mandatory Medical Insurance Fund (hereinafter - FFOMS). So, for example, in the Methodological Recommendations developed by the FFOMS, the following definition is given: "Medical care of adequate quality (high-quality medical care) is medical care provided by a medical worker, excluding negative consequences:
- complicating the stabilization or increasing the risk of progression of the patient's disease, increasing the risk of a new pathological process;
- leading to the suboptimal use of the resources of the medical institution;
- causing dissatisfaction of the patient from his interaction with the medical institution "<2>.
It should be noted that FFOMS identifies a number of factors affecting the quality of medical services. Despite the fact that these factors reflect the quality in the CHI system, the main part is relevant for the entire system of medical services delivery.
The issues of the quality of the provision of medical services, the development of effective methods for its assessment are also considered by foreign scientists. Thus, Douglas J. Lanska, Arthur J. Hartz note that “traditionally, the quality of medical care was assessed in three general directions: structure, process and outcomes. , personnel (for example, its size, professional suitability and qualifications), as well as organizational characteristics (for example, methods of recovering expenses, a system for evaluating the work of doctors by other doctors.) competence in carrying out treatment methods, coordination of actions and continuity Outcome describes the result of the care provided in relation to the patient's health, including changes in his consciousness and behavior, patient satisfaction with medical and nursing services, biological changes in the disease, treatment complications, morbidity and mortality "<3>.
<3>Douglas J. Lanska, Arthur J. Hartz. Assessment of the quality of medical care // International Medical Journal. 1999. URL: http://medi.ru/img (date of access - 20.11.2009).
- the qualification of the doctor and his observance of the technology of diagnosis and treatment;
- the risk to the patient from medical intervention;
- availability of resources and optimal use of them;
- patient satisfaction<4>.
According to Y. Andreev, the quality of medical services depends primarily on the skill and professionalism of the executing doctor, medical personnel, on their conscientiousness and skill, on the availability of appropriate modern medical and technical means, on adequate scientifically grounded methods of counseling and treatment, on compliance by doctors and medical personnel of ethical standards, including an oath, "from the degree of consolidation of quality issues, measures of responsibility for non-compliance at the legislative and contractual level"<5>.
<5>Andreev Yu. Paid medical services. Legal regulation and judicial practice. M., 2007.S. 127.
The study of the issues of the quality of medical services shows that this is a complex indicator, which is made up of a number of individual factors. In turn, each of these factors is characterized by a whole complex of individual indicators. The highest level of service quality in general is possible only if it meets all the requirements of the factors under consideration.
The analysis of various factors affecting the quality of medical service delivery allows us to combine them into two groups. The first group combines indicators characterizing a medical institution, its personnel, material and other resources. However, despite all their importance, these indicators should be used in a comprehensive assessment of the quality of medical services, and when assessing the quality of a specific medical service, they should be more informative than evaluative. Otherwise, the substitution of concepts is possible: instead of the quality of the service provided, the compliance with the established standards of the medical institution that should provide this service will be assessed. Due to this, indicators related to the second group of factors are the most important for resolving the issue of developing quality requirements and their establishment in the contract for the provision of medical services. These indicators include the characteristics of the medical service itself and the direct result of its provision. It should be noted that the assessment of the quality of the provision of medical services based on the second group of factors will contain both a subjective component (perception of the process of providing and the result of the service by the patient himself) and objective (the qualifications of a doctor and his observance of the technology of diagnosis and treatment, the result of the provided medical service. regarding the patient's health status, etc.).
The administrative regulations for monitoring compliance with quality standards of medical care, developed by the Ministry of Health and Social Development of the Russian Federation, provide for both monitoring compliance with medical care standards<6>and the use of indicators of the quality of medical care. At the same time, indicators of the quality of medical care are quantitative indicators reflecting the structure, process or result of medical care.<7>.
<6>The list of standards of medical care for patients with various diseases, as well as their content based on the current orders of the Ministry of Health and Social Development of the Russian Federation, is presented in the information databank of CJSC "Uniko-94" // SPS "ConsultantPlus". URL: http://base.consultant.ru (date of access - 20.11.2009).
<7>Order of the Ministry of Health and Social Development of the Russian Federation of December 31, 2006 N 905 "On Approval of the Administrative Regulations of the Federal Service for Surveillance in Healthcare and Social Development for the Execution of State Functions to Monitor Compliance with Quality Standards of Medical Care" // Rossiyskaya Gazeta. 2007.23 March. N 60.
Analysis of various approaches to the criteria for the quality of a medical service allows us to single out its five main constituent elements:
- information indicators of a medical service - obtaining available information about the patient's health in a form accessible to the patient, information about the results of the examination, the presence of the disease, its diagnosis and prognosis, treatment methods and associated risks, possible options for medical intervention, their consequences and the results of the treatment carried out<8>;
- qualification requirements for doctors - meeting the requirements for professional competence, the amount of knowledge, practical skills and abilities of doctors<9>;
- professional qualities of a doctor - a manifestation of competence in carrying out treatment methods, consistency of actions and continuity;
- the professionalism of the provision of medical services - the validity, adequacy of determining the scope of treatment, adherence to the technology of diagnosis and treatment, obtaining a positive (expected) result of the provided medical care in relation to the patient's health;
- quality indicators of the service delivery process itself - patient satisfaction with medical and nursing services.
In judicial practice, a positive result as a criterion for the quality of medical services has not yet received special recognition. Nevertheless, court decisions are already being met.
Thus, the magistrate's court considered a dispute between a citizen D., who is deaf, and an individual entrepreneur P., who undertook to restore D.'s hearing to a normal level within 10 days using an original method. However, unconventional treatment did not help: clinical examination of gr. D. before and after the treatment according to the original method showed that the hearing remained at the same level. D. demanded to return the amount paid for the service, since the promised result had not been achieved. The court recovered from the contractor the amount of payment for services with reference to the following circumstances:
- under the contract, P. assumed the obligation to achieve a certain effect (one of the terms of the contract included an indication of "the expected results of treatment, that is, restoration of hearing to normal");
- in accordance with paragraph 3 of Art. 4 of the Law of the Russian Federation "On Protection of Consumer Rights" if the contractor, when concluding the contract, was informed about the specific purposes of providing the service, then he is obliged to provide a service suitable for these purposes. Citizen D. informed entrepreneur P. that he needed to improve his hearing due to the special nature of his work;
- in accordance with the provisions of § 2 chap. 37 of the Civil Code of the Russian Federation on consumer contracts and Art. 10 of the Law of the Russian Federation "On Protection of Consumer Rights", the contractor is obliged to provide the consumer with sufficient and reliable information about the services, ensuring the possibility of their correct choice. In the judicial investigation it was established that the entrepreneur P. did not familiarize the customer with the medical documents describing the method of treatment, the drugs used, etc.
This reasoning allowed the court to apply the provision of paragraph 2 of Art. 732 of the Civil Code of the Russian Federation and Art. 12 of the Law of the Russian Federation "On Protection of Consumer Rights" that the customer has the right to demand termination of the concluded contract, as well as compensation for losses in cases where, due to incompleteness or inaccuracy of the information received from the contractor, an agreement was concluded on the performance of a service that does not have the properties that it had in mind the customer<10>.
<10>This example from judicial practice is contained in the work: M.V. Kratenko. Assessment of the quality of services (medical, real estate and tourism) in judicial practice. See: Services: problems of legal regulation and judicial practice: Sat. scientific-practical Art. M., 2007.S. 154 - 155.
If you analyze the case in question, you should pay attention to two sides of the issue. On the one hand, the court emphasized that the contractor undertook to achieve a certain result, for which he received payment, but did not fulfill it. On the other hand, the justification for the positive decision of the court was the motivation that the customer was not provided with all the necessary information about the service. In this case, the above legislative presumption does not protect the service recipient, since the quality of medical services, which requires taking into account many factors, was determined by only one of them - information support.
The medical institution usually guarantees only the quality of the service that it is able to provide. At the same time, the patient, when contacting a medical institution, wants to receive medical services of the highest possible quality level. In this sense, already from the very beginning, the contract for the provision of medical services contains a conflict situation, in the event of which its resolution should be facilitated by the quality of medical service expected by the parties to the maximum prescribed in the contract. In this case, the patient's dissatisfaction with the quality of medical services acquires legal significance only if the terms of the contract are not fulfilled. Fulfillment of all the terms of the contract will mean that the service is provided with high quality, regardless of whether the patient was satisfied or not.
However, the possibility of prescribing all the features of quality indicators in the contract, especially when providing medical services that are complex in their content, is rather problematic. In addition, the consumer of medical services - the patient, as a rule, does not understand the intricacies of the diagnostic and treatment process, which does not allow him to conduct qualified negotiations with a medical organization.
It is proposed to solve this problem by introducing the concept of "purpose of using a service". Such a goal can be easily formulated by the consumer of a medical service and subordinates to itself a large number of professional requirements. In this case, when assessing the quality of a medical service, the patient proceeds from whether its goal has been achieved or not, ignoring the level of treatment and diagnostic technologies and their resource provision. Therefore, the purpose of the service should be formulated quite broadly, including, for example, not only "removal of the appendix" and "implementation of rehabilitation treatment", but also such parameters as "minimization of pain", "invisibility of traces of surgery on the skin", "comfortable stay in the hospital "," no postoperative complications "," the use of certain (specify) methods of treatment, rehabilitation ", etc.<11>".
<11>Alexandrova O.Yu. and others. The quality of medical care: legal assessment // GlavVrach. 2009. N 9.P. 63 - 72.
Certain assistance in assessing a disputable situation that has arisen between a patient and a medical institution can be provided by the classifier of the most common violations developed by the FFOMS, which may serve as a reason to go to court for protection. This classifier is presented in the FFOMS Order of October 11, 2002 N 48<12>... With regard to low-quality medical services, the Order highlights the following violations:
<12>FFOMS Order "On Approval of Methodological Recommendations" dated October 11, 2002 N 48 // ATP "ConsultantPlus". URL: http://base.consultant.ru (date of access - 25.12.2009).
a) late diagnosis and an unjustifiably prolonged diagnostic process, which led to a late start of pathogenetic therapy and, as a consequence, a belated recovery of the patient, which turned out to be associated with an extension of the patient's physical and mental suffering;
b) incorrect diagnosis of the disease, resulting in inadequate treatment, lengthening of treatment, the development of possible complications and, as a result, causing additional physical and mental suffering, death;
c) the wrong choice of the method of surgical intervention, the type of medical procedure or drug therapy, which resulted in an aggravation of the patient's condition, the development of complications, lengthening of the treatment period, possible disability, death;
d) errors in performing surgical operations, medical procedures and drug therapy, which led to an aggravation of the patient's condition, the development of complications, lengthening of the treatment period, possible disability, death;
e) late hospitalization, accompanied by an aggravation of the patient's or injured person's condition and entailing additional physical and mental suffering, death;
f) violation of the rules for transporting an injured or sick person, leading to the development of acute complications, critical health, death;
g) violation of continuity in treatment, expressed in non-receipt of information about medical and diagnostic measures performed at the previous stages of diagnosis and treatment, as a result of which the patient's health condition deteriorates;
h) unjustifiably early discharge of the patient from the hospital; premature termination of outpatient or inpatient treatment;
i) errors or negligence in the maintenance of medical records, leading to erroneous or late diagnosis, disruption of continuity in treatment, erroneous medical expert decision and, as a consequence, causing moral harm to the patient;
j) inadequate sanitary and hygienic conditions leading to a deterioration in the physical state of health, death;
k) rude, tactless, disrespectful, inhumane attitude of medical personnel towards a person who has applied to a medical institution for medical help; to a patient in a hospital in a helpless state; to a patient who is undergoing medical procedures in the order of treatment or rehabilitation.
It should be noted that the solution to the issues of poor-quality medical services, its assessment are the prerogative of experts. Only an individual examination by specialists of specific therapeutic and diagnostic measures, taking into account the characteristics of the patient's condition, the course of his disease and other factors that have taken place, can be the basis for identifying the shortcomings of the medical service. Therefore, the assessment of the actions of medical workers in the provision of medical services as high-quality or low-quality is the prerogative of experts.
From the point of view of civil legislation, the assessment of medical care by an expert is an assessment of the compliance of a service with the requirements for such services or the purposes of their usual use, and is the most important criterion for assessing the quality of medical services. This criterion is used quite widely, since there are simply no regulatory requirements regarding the quality of a number of types of medical services, and in most cases a detailed study of the terms of each contract is not carried out.
One of the most important and fundamental directions of development in the country is the issue of health care. Within the framework of this direction, the issue of providing the highest quality medical care to the population is resolved at the highest level, being, in fact, the most important state task. The only flaw in Russian legislation is the absence of a definition of “quality of medical care” as such. This concept most often means the compliance of the provided medical care with established standards, Russian and international practice.
The specialists of the "Interregional Center for Expertise and Evaluation" assess the quality of medical services, including:
- establishing the fact of a medical error;
- assessment of the quality of medical care;
- assessment of the choice of treatment method;
- examination of medical services
- assessment of the performed rehabilitation, recovery;
- resolving issues on the return of funds for poor-quality treatment.
The purpose of the trial is to identify violations that led to inappropriate provision of medical care, resulting in partial or complete loss of health, deterioration of general well-being, exacerbation of chronic diseases, etc.
Examination objectives:
- Assessment of the correctness of manipulations by a medical worker.
- Assessment of the professional level of a medical worker or a group of doctors who were directly involved in the diagnosis and treatment of the patient.
The price of the examination of the quality of medical care
Accounts
The procedure and methods for conducting an independent forensic examination of the quality of treatment
Examination of the quality of medical services is an important aspect in obtaining by individuals proper, qualified assistance from medical personnel in private medical centers, public health care institutions. The improper performance by a doctor of his immediate duties is the basis for bringing him to administrative, disciplinary, civil, and criminal liability.
A doctor, regardless of qualifications and category, must clearly understand and know his rights and obligations, as well as the rights of the patient. Have an idea that in the event of improper care, namely his professional duties, the patient has every right to conduct an independent medical medical error examination, to bring the health worker to justice within the framework of the current administrative, procedural and criminal legislation.
Examination of the quality of medical care carried out on the basis of the "Interregional Center for Expertise and Evaluation" is the most complex, responsible procedure requiring high qualifications and professionalism from experts. In the process of conducting and collecting data, it is very difficult for a specialist to identify the defect in the provision of medical care itself, as well as to establish how much this defect affected the outcome of the treatment of the disease. Thanks to the highest qualifications and many years of experience, the ICEO experts give a competent and detailed legal assessment of the situation that has arisen between the doctor and the patient, determine in the conclusion the degree of responsibility of the medical worker in relation to the patient, establish full or partial guilt, and also determine the degree of responsibility that should occur as the result.
Independent examination of the quality of medical care in Moscow and the Moscow region
- Examination of the quality of medical care provided in Moscow
address phone contacts independent center for the examination of the quality of medical services MCEO
Moscow districts VAO, CAO, CAO, SVAO, YuVAO, YuZAO, YuZAO, ZAO, SZAO
metro stations Elektrozavodskaya, Semenovskaya, Preobrazhenskaya Square,
Baumanskaya, Sokolniki, Airport, Dynamo, Sviblovo, Botanical Garden,
Aviamotornaya, Roman, Tula, University, Kiev, Oktyabrskoe Pole, Shchukinskaya - Independent forensic examination of the quality of medical care in the Moscow region, the city of the Moscow region Dolgoprudny, Mytishchi, Reutov, Lyubertsy, Vidnoe, Odintsovo, Krasnogorsk, Khimki
- Examination of the quality of treatment in Russia, representative offices in the regions of Sochi, Gelendzhik, Novorossiysk, Nevinnomyssk, Cherkessk, Vladikavkaz, Nalchik, Stavropol.
The possibility of conducting an examination of a medical error makes it possible to minimize the facts of negligence of medical personnel in the performance of their immediate (professional) duties, to exclude inappropriate assistance, the use of diagnostic, prevention, treatment and rehabilitation techniques uncharacteristic for a disease.
The tasks of the examination of the quality of medical services, solved by the experts of the ICEO:
to reveal the facts of violation in the provision of emergency, outpatient, inpatient medical care;
assess the timeliness of the assistance provided to the patient;
to establish how correctly the methods of treatment, rehabilitation, diagnostics, as well as prevention of current and chronic diseases were chosen;
to determine whether the result was achieved after the performed medical and diagnostic procedures.
Criteria for assessing the quality of medical care on which the ICEO specialists rely
The criteria used by the specialists of the "Interregional Center for Expertise and Evaluation" should be:
- Universal.
- Objective.
- Compliant with established standards (local and federal).
- Available for use.
- Specific.
Assistance in resolving issues related to the examination of the quality of medical care.
Improving the quality of medical care provided to the population is influenced by:
- opinions of consumers of medical services;
- results of research conducted by insurance companies and experts. It is these two indicators that often form the basis for conducting examination of the quality of medical care.
Thanks to the opportunity to conduct an independent examination of medical services, it will be easier for the patient to prove the medical errors made, to defend their rights and legitimate interests in court. This is especially important if the medical institution where the individual was observed did not take into account the fact of improper work of the medical staff and refused return money for poor quality treatment, including materially compensate for the incurred moral costs.
Loading ...