The diploma thesis is focused on the legal hospital health care regulation in the Czech Republic. The main efford is to provide a sufficient review of the up-to-date situation in this field. It examines hospitals by a theoretical standpoint and also its key problems concerning actual situation of the czech health care and lack of finance as the main significance. The top part of thesis focuses on actual legal hospital health care regulation and proposes ways of improvement. Following part assesses proposals of improvement of the hospital care quality. Final chapter presents possible ways of optimal solutions of hospital care as well as health care at all.

Magistro baigiamajame darbe išanalizuoti LR egzistuojančių viešų ir privačių sveikatos priežiūros įstaigų veiklos skirtumai bei jų sąveiką. Ištirti tokie viešųjų ir privačių sveikatos priežiūros sektorių aspektai: sveikatos priežiūros sektoriai patys savaime, šių įstaigų institucinis išsidėstymas, teisinis reglamentavimas, finansavimas, konkurencingumas, prieinamumas pacientui. Pirmojoje darbo dalyje yra aptarta Lietuvos nacionalinės sveikatos sistema, kaip turinti vienyti viešąsias ir privačiąsias sveikatos priežiūros įstaigas, aptarta jos bendroji charakteristika. Antrojoje dalyje išsamiai išnagrinėtos, suklasifikuotos sveikatos priežiūros įstaigos, aptarta jų priklausomybė viena nuo kitos. Trečiojoje darbo dalyje kaip atskiros grupės išskirtos privačios ir viešosios sveikatos priežiūros: aptarta jų sąveika, pagrindiniai skirtumai, pamatiniai teisinio reglamentavimo ypatumai. Paskutinė ketvirta lyginamoji darbo dalis leido surasti tuos taškus, per kuriuos viešasis sveikatos priežiūros sektorius galėtų bendradarbiauti su privačiu. Palyginta šių sektorių finansavimo bazė, surasta papildoma alternatyva papildomojo sveikatos draudimo pavidalu. Kadangi sveiktos priežiūros sektoriuje centrinė figūra vis tik turi būti pacientas, pateiktas ir jo požiūris į privatų ir viešąjį sveikatos priežiūros sektorius, šių sektorių vertinimas. / The distinction and interface of health care institutions of Lithuania Republic are analyzed in this final master’s work Such public ant private health care institutions aspects are analyzed: health care institutions by themselves, deployment of these institutions, their legal regulation, sponsorship, competitive ability, accessibility for the patients. The first part of the work is concerned about national health care system of Lithuania, which must unify public and private health care institutions. The common characteristics of this system are discussed. The second part thoroughly reveals and classifies health care institutions; knock about their dependence on each other. In the third part as separate groups are divided private and public health care institutions: their interaction, main differences and basic legal regulation principles are discussed. The last fourth comparative part enabled to find those points, which could help for private health care sector to collaborate with public one. The comparison of financial basis of those sectors, allowed to found an additional assurance alternative. Since the patient is the central figure in a health care sector, his attitude towards the private and public health care institutions, and those sectors valuation is represented.

Aim of the study. To explore and evaluate the frequency of stress and psychological violence experienced at work by nurses working at Kaunas district health care institutions, and to evaluate factors that cause stress and psychological violence. Methods. Information has been gathered using anonymous questionnaires distributed among 152 nurses working at health care institutions in Kaunas district. Statistical evaluation of the obtained data was performed using SPSS 12.0/w software package. Results. We found that 73.7% of nurses experienced stress. A statistically reliable relationship was detected between critical situations at home, workload, and stress (p<0.01). 11.2% of nurses felt absolutely unsafe and 41.4% - unsafe about retaining their work position in the future. 12.5% of nurses experienced psychological violence at work. Psychological violence towards nurses most frequently resulted from backbiting and rumours, lack of information affecting job quality and performance, and reminding about mistakes made at work. A statistically reliable relationship was found between negative experience at work and poor health estimation. Nurses who were ignored and isolated at work (p<0.05, OR 2.76 CI (1.07;7.10)), experienced (p<0.01, OR 3.71 CI(1.44; 9.52)), humiliation, and mockery (p<0.0001, OR 5.07 CI (2.07;12.41)) had a higher probability of evaluating their health as poor. 33.6% of nurses experienced patients’ and their relatives’ threats, and 2% of nurses experienced... [to full text]

Darbo tikslas: Ištirti personalo valdymą Kauno miesto pirminės asmens sveikatos įstaigose. Tyrimo metodika: Tyrimo metu apklausti Kauno miesto pirminės asmens sveikatos priežiūros įstaigų (PASPĮ): viešųjų ir privačių vadovai. Tyrimas buvo atliekamas dviem etapais. Pirmame etape atliktas kokybinis tyrimas. Apklausti 4 atsitiktinai pasirinktų įstaigų (2 viešųjų ir 2 privačių) vadovai. Tyrimas buvo atliekamas interviu metodu, pateikiant iš anksto apgalvotus klausimus. Kokybinio tyrimo tikslas – išsiaiškinti kokios yra personalo valdymo funkcijos PASPĮ. Antrame etape atliktas kiekybinis tyrimas. Iš viso buvo išplatintos 43 anketos visose Kauno miesto pirminės asmens sveikatos priežiūros įstaigose Atgal sugrįžo 41 anketa: 7 iš 9 viešųjų ir 34 iš 34 privačių pirminę asmens sveikatos priežiūrą teikiančių įstaigų. Tai sudaro 95,3% nuo visų išplatintų anketų. Į 35 anketas atsakė patys įstaigų vadovai, o į 6 įstaigų administratoriai. Uždaviniai: 1. Ištirti pirminės asmens sveikatos įstaigos vadovų kompetenciją personalo valdymo srityje. 2. Ištirti ir palyginti kaip atliekamos personalo valdymo funkcijos viešosiose ir privačiose pirminės asmens sveikatos įstaigose. 3. Nustatyti esmines personalo valdymo tendencijas ateityje įstaigų vadovų požiūriu. Rezultatai: Personalo vadovas yra visose 7 viešosiose PASPĮ, o tuo tarpu iš 34 privačių PASPĮ personalo vadovą turi tik 5,9 proc. Savo kompetenciją personalo valdyme aukščiau įvertino viešųjų PASPĮ vadovai. Išvados: 1. Savo kompetenciją... [toliau žr. visą tekstą] / Aim of work: to analyze the management of personnel at Kaunas city primary health care institutions. Methodology of the work: during the research, the heads of both public and private Kaunas city primary personal health care institutions (PPHCI) were polled. The research was made in two stages. In the first stage the qualitative research was made. 4 heads of accidentally chosen institution (2 public and 2 private) were polled. The research was made in the form of interview, given the questions considered in advance. The aim of qualitative research is to find out what are the functions of personnel management at PPHCI. In the second stage a quantitative research is made. There were 43 questionnaires distributed in all Kaunas city primary personal health care institutions. 41 questionnaires were returned: 7 from 9 from public and 34 from 34 from private institutions, providing primary personal health care. It makes 95,3% of all questionnaires that were distributed. 35 questionnaires were answered by the heads of these institutions and 6 by their administrators. Tasks: 1. To analyze the expertise of the heads of primary personal health care institutions in the field of personnel management. 2. To analyze and to compare how the personnel management functions are carried out in public and private primary personal health care institutions. 3. To find out fundamental future tendencies of personnel management from a viewpoint of the heads. Conclusions: 1. The respondents in... [to full text]

Darbe analizuojamas auditas ir jo ypatybės sveikatos priežiūros institucijose. Pagrindinė analizė yra atliekama nagrinėjant SPI auditą atliekančių institucijų veiklą šioje srityje. Visų pirma pirmame darbo skyriuje yra pristatomos pagrindinės audito definicijos, audito bruožai, analizuojama kodėl pastaruoju metu išsaugo audito svarba. Taip pat nagrinėjamos pagrindinės audito klasifikacijos. Aptariami pagrindiniai audito procedūros etapai. Darbe taip pat skiriamas dėmesys pagrindinių audito kriterijų analizei, kalbama apie 3 E koncepciją, daugiausia dėmesio skiriant vienam svarbiausių bei problematiškiausių kriterijų – efektyvumui, tam tikslui pristatomas Didžiosios Britanijos Nacionalinės audito organizacijos parengtas efektyvumo įrankių komplektas. Toliau antrame darbo skyriuje yra kalbama apie auditą Lietuvos sveikatos priežiūros institucijose. Paskutinė tiriamoji dalis yra skirta susipažinimui su atlikto tyrimo duomenimis. Darbas užbaigiamas išvadų bei rekomendacijų suformulavimu. Pagrindinė bendra problema Lietuvoje yra, kad vis dar dažnai painiojamos kontrolės ir audito sąvokos painiojamos ir kyla nesusipratimų tuomet, kai įstatymu apibrėžtos veikos pagal audito apibrėžimą, turėtų būti priskirtos auditui, o realybėje atliekamas ne auditas o tik vykdoma kontrolė arba atvirkščiai- veikla kuri įvardijama kaip kontrolė, iš tiesų prilygsta auditui. Taip pat aktuali problema su kuria susiduria SPI auditą atliekančios institucijos yra žmogiškųjų išteklių trūkumas, kuris... [toliau žr. visą tekstą] / The importance of audit grows in every sector, this can be said and about health care sector. Every person wants to get an accessible and good quality health care service. Health care institutions audit is one of the implements which helps to review accessibility and a quality of health care services and also or these services satisfies customers needs. Also audit in health care institutions helps to know how institutions use finances. The main purpose of this work is to analyse audit system and audit features in health care institutions. The main analysis is concentrated into institutions which performs audit in health care institutions. At first in this work is introduced the main definitions of audit, audit features, elements, types and audit importance in nowadays world. Also there are analysed the audit procedure stages. Moreover there are analysed 3E conceptions (economity, efficiency, effectiveness) – the main attention is paid to efficiency. In the second chapter main attention is paid to audit in Lithuanian health care institutions. The third chapter analyzes institutions which performs audit in health care institutions.: The last section of this research is conclusions and recommendations. The main conclusion is that in Lithuania there are still confounded control and audit conceptions and sometimes it is cause the problems. Talking about health care sector, the institutions which performs audit in health care institutions, lack oh human resources and can not... [to full text]

Made available in DSpace on 2016-06-02T19:51:47Z (GMT). No. of bitstreams: 1 3476.pdf: 1426306 bytes, checksum: 16ac1aa2521059b79533957793763438 (MD5) Previous issue date: 2011-02-16 / Universidade Federal de Sao Carlos / The brazilian s Public Health System is characterized, in general, by precarity from its procedure and its services. This situation can be observed in the high time of waiting by an appointment, in the lack of beds, in the lack of training and education of the professionals from the Healthy Sector. This setting results in accumulation of procedure s errors and, in consequence, in a fall in the Health services quality. This reality exists, in part, because of the deficiency in the public health care service s management system. Nowadays, there are efforts from the government and the health care institutions in order to implement Quality Management programs and a management s structured systematic. These efforts aim to promote the guarantee and the improvement of the health care services. This dissertation aims to carry out the adjustment of the management of a public Health Care institution of smallsized localized in the interior of Sao Paulo (Institution A) according to the NAO s (National Accreditation Organization) requirement for Full Accreditation level by means of an Action Research. Besides, it proposes an orientative systematic for implementation of the level Full Accreditation in health care institutions of the small or medium-sized. As a subsidy for the Action Research, a Case Research was carried out in six health care institutions. This thematic needs more studies and experiences. The professionals of Health Brazilian Sector don t understand the Accreditation s concepts. The Action Research to begin to the adjustment of Hospital School s management, but it didn t was concluded integrally due to the short time period. A systematic was proposed for Health Care Institutions of small or medium-sized to adjust the management according to the NAO s Full Accreditation level. / procedimentos e serviços, a qual pode ser expressa pela demora de atendimento aos usuários, pela falta de leitos e, ainda, pela falta de capacitação e treinamento de considerável parcela dos profissionais da saúde, resultando numa acumulação de erros em procedimentos e atividades e, conseqüentemente, na falta de qualidade. Essa realidade se deve, em parte, a deficiências na gestão do sistema público de prestação de serviços médico-hospitalares. Isso tem justificado esforços governamentais e das instituições hospitalares para implantação de programas de Gestão da Qualidade e de sistemáticas estruturadas de gestão, com o objetivo de promover a garantia e a melhoria dos serviços prestados. Esta dissertação tem por objetivo adequar, por meio da realização de uma pesquisa-ação, a gestão de uma Unidade de Serviços Médico-Hospitalares pública, de pequeno porte, do interior de São Paulo (Unidade A), aos requisitos de Acreditação Plena da ONA (Organização Nacional de Acreditação), além de propor uma sistemática orientativa para implantação desses requisitos de Acreditação Hospitalar em Unidade de Serviços Médico-Hospitalares de pequeno e médio porte. Como subsídio à pesquisa-ação, foi realizada uma pesquisa exploratória em seis Unidades. Foi possível observar que a temática encontra-se, nacionalmente, incipiente, necessitando de um maior número de pesquisas e de melhor compreensão dos profissionais do setor de Saúde quanto aos conceitos da Acreditação. A pesquisa-ação iniciou a adequação da gestão da Unidade A aos requisitos de Acreditação Plena da ONA, porém, em virtude do curto horizonte de tempo, não foi realizada integralmente. Foi proposta uma sistemática que orienta Unidades de Serviços Médico-Hospitalares de pequeno e médio porte a adequarem sua gestão aos requisitos da ONA para obtenção da Acreditação Plena.

Le système de santé libanais connait une évolution chaotique de son secteur sanitaire, dans un univers en concurrence croissante. De plus, dans l’organisation de ce système, divers groupes d’acteurs évoluent et influencent directement ou indirectement les prises de décisions stratégiques dans les établissements de santé libanais. Voilà pourquoi, dans un contexte où évolue une pluralité d’acteurs qui sont interdépendants et poursuivent des objectifs divergents, la prise de decision stratégique semble un défi de taille. La présente étude vise donc à comprendre et à analyser les processus dynamiques des décideurs ayant une influence sur la prise de décision stratégique dans une organisation de santé, en contexte pluraliste, où diverses forces externes et internes exercent une influence sur ce processus décisionnel. Pour y arriver, la prise de décision stratégique est analysée selon une perspective de relations de pouvoir, en partant des acteurs de l’organisation de santé et du contexte dans lequel ils évoluent. Cette recherche propose un modèle conceptuel qui s’appuie sur les concepts généraux de l’analyse stratégique de Crozier et Friedberg (1977) jumelés au modèle de la poubelle « Garbage Can ». Les éléments proposés de ce cadre conceptuel sont pertinents pour expliquer l’interaction entre la liberté des acteurs et les relations de pouvoir qui en ressortent, la présence fortuite des courants menant à la prise de décision et l’environnement dans lequel baignent les acteurs et l’organisation, qui influencent de façon majeure l’élaboration de la prise de décision stratégique dans un établissement de santé pluraliste. Afin de répondre à l’objectif de cette recherche, nous nous sommes basés sur une revue de littérature sur la prise de décision stratégique en contexte hospitalier pluraliste. Ensuite, nous avons procédé à une démarche qualitative basée sur les entrevues semi-structurées et l’analyse documentaire, dans le cadre de deux hôpitaux libanais, représentatifs du bassin hospitalier libanais. Cette étude de cas a permis de retracer 4 cas traceurs à partir desquels les comportements stratégiques mobilisés par les acteurs concernés par le processus décisionnel ont été mis en évidence. Pour ne citer que quelques stratégies répertoriées, nous prenons l’exemple des stratégies d’adaptation à l’environnement, d’implication des acteurs externes ainsi que de collaboration et de négociation qui prennent en considération l’environnement turbulent dans lequel baignent ces établissements de santé. En outre, l’interprétation des résultats a mis l’accent sur les stratégies d’acteurs internes et externes qui ont mené à la formation d’une constellation de leadership élargie, composée d’acteurs stratégiques multiples en constante interaction. Ces jeux de pouvoir ont influencé le processus décisionnel et ont permis la rencontre des processus formels et « informels » de prise de décision, menant à une meilleure compréhension du cheminement décisionnel stratégique dans les établissements de santé pluralistes. En conclusion, des recommandations concrètes sont formulées à l’intention des décideurs en santé. De plus, la rencontre théorique développée pour la première fois dans cette thèse, apporte une contribution intéressante aux théories des organisations. Ultimement, la thèse ouvre la voie à des pistes de réflexion prometteuses sur la prise de décision stratégique, en contexte pluraliste. / The Lebanese health system is experiencing a chaotic evolution of its health sector, in a world of increasing competition. In addition, in the organization of this system, various groups of actors evolve and influence directly or indirectly the strategic decision-making of the Lebanese healthcare establishments. In a context in which evolves a plurality of actors who are interdependent and pursue divergent objectives, strategic decision-making seems a major challenge. Therefore, the present study aims to understand and analyze the dynamic processes of decisionmakers having an influence on strategic decision-making in a healthcare organization, in a pluralistic context, where various external and internal forces exert an influence on this strategic decision-making. To achieve this, strategic decision-making is analyzed from a power relation’s perspective, starting with the players in the health organization and the context in which they operate. This research proposes a conceptual model based on the general concepts of strategic analysis of Crozier and Friedberg (1977) combined with the garbage can model. The proposed elements of this conceptual framework are relevant for explaining the interaction between the freedom of actors and the power relations that emerge from it, the fortuitous presence of the currents leading to decision-making and the environment in which the actors are immersed which have a major influence on the development of strategic decision-making in a pluralistic healthcare establishment. To meet the objective of this research, we started with a literature review on strategic decisionmaking in a pluralistic context. Then, we used a qualitative approach based on semi-structured interviews and documentary analysis, within two Lebanese hospitals that are representative of the Lebanese hospital basin. This case study made it possible to trace 4 decisions from which the strategic behaviors mobilized by the actors were highlighted. To cite only a few listed strategies, we take the example of strategies of adapting to the environment, involving external actors as well as collaboration and negotiation that take into consideration the turbulent environment in which these establishments are surrounded. The results of this thesis show how the strategies developed by internal and external actors led to the formation of a broad constellation of leadership. This constellation is composed of multiple strategic actors who are in constant interaction, thus influencing the decision-making process through their power relations and strategic plays. Also, the results of this thesis highlight the 7 political decision-making process that takes place in a pluralistic health care organistion, leading to a better understanding of the strategic decision-making process in these establishments. In conclusion, concrete recommendations are made for decision-makers, to better manage health care organisations. In addition, the theoretical encounter developed for the first time in this thesis, makes an interesting contribution to the theories of organizations. Ultimately, the thesis opens the way to promising lines of reflection on strategic decision-making, in a pluralistic context.