Dubitsky A.A. Shaydarova M. G.
Medical university Astana, Kazakhstan
CONTROL SYSTEM OF
QUALITY OF MEDICAL CARE IN THE REPUBLIC OF KAZAKHSTAN
Relevance of creation and introduction of the new
forms of government which guarantee maximum efficiency of activity of medical
institutions at the minimum expenses and high quality of rendering medical care
increases in modern economic conditions.
Improvement of quality of medical care and creation of
control systems by quality is one of the priority directions of development of
health systems around the world. In this regard, one of the most difficult
tasks is the problem of an assessment of quality of medical care.
Studying of the international
experience in area of improvement of quality of medical care showed that there
is no ready scheme which fully satisfies both parties. Therefore in all
countries there are own approaches applicable to health system to carrying out
an assessment of quality of medical care.
The qualitative system of
monitoring in sector of health care of the Republic of Kazakhstan is developed
with 1996. Within process of realization of system of the obligatory medical
insurance during the period with 1996 to 1998 the system of monitoring of
quality of medical services was developed.
This system provided various
sanctions and penalties concerning producers of medical services in case of bad
quality of their work. And though this system of penalties was abolished, the
analysis and an assessment of medical services continued to work. Thus the
special attention in them was paid to researches of level of satisfaction of
patients and questions of compliance of medical services to the established
medical standards.
Today quality management in health care is in
Kazakhstan under close attention of the President of the country. In January,
2012 in the annual Message to the people of Kazakhstan President Nursultan
Nazarbayev emphasized that one of the important directions of increase of level
of human potential are increase of availability and quality of rendering
medical services, healthy lifestyle advance. It is noted that the health system
qualitatively develops, and "now people choose those medical institutions
where the medical care" is better. This requirement for the right can be
carried to the medical organization which has passed accreditation on
compliance to standards.
The accreditation of the medical organizations
directed on ensuring quality and safety of medical services and for a long time
proved in the countries with the developed economy, it has the centenary period
of development.
So, the medical organization carries out a
self-assessment on compliance to standards, and then involves external
independent appraisers to receive more objective assessment, and also to reveal
so-called weaknesses in organization management which need to be minimized.
The accreditation purpose – ensuring continuous
improvement of quality of medical services provided to the population at the
expense of introduction in practice of the medical organizations of effective
administrative and medical technologies according to the international
approaches.
Expected results of participation of
the medical organizations in the program of accreditation are increase of
management efficiency, planning and the activity analysis, personnel
activization in the solution of problems of the organization, improvement of
structure of medical institutions (modernization of rooms and communications,
territory improvement), improvement of quality of medical documentation,
reduction of risks for patients when receiving medical care.
These aspects are included in
requirements of standards of accreditation, and first of all at a self-assessment
compliances or discrepancies to these requirements come to light. Accreditation
of the medical organizations is carried out by committee of control of medical
and pharmaceutical activity of Ministry of Health of the Republic of Kazakhstan
since 2009.
The committee has the territorial divisions which are
allocated with a certain independence in the regional centers of the country
and submit directly to Ministry of Health. The main function of committee and
its territorial divisions is identification of the problems connected with
quality of medical care, and acceptance of necessary measures for improvement
of quality of medical services.
Realization of the right of the patient to have equal
access to medical services and their appropriate quality is carried out by
placement by Ministry of Health of the state order in the accredited medical
organizations. Accreditation process – the beginning of consecutive movement to
the international quality standards of medical services.
According to point 2 of the article
14 "Accreditation in the field of Health Care" of the Code of the
Republic of Kazakhstan "About health of the people and health system"
accreditation has a voluntary nature and is carried out at the expense of means
of the accredited subject and other not forbidden means.
At the same time accreditations are
subject subjects of health care and subjects in the sphere of the address of
medicines, products of medical appointment and medical equipment for
recognition of compliance of rendered medical and pharmaceutical services to
the established requirements and standards.
The first standards of accreditation were developed in
2007 only for the medical organizations rendering highly specialized medical
care, in compliance with the international experience and were successfully
approved at three research institutes.
Since 2009 to the present Ministry of Health together
with the International bank of reconstruction and development carries out the
"Transfer of Technologies and Carrying Out Institutional Reform in Sector
of Health Care of the Republic of Kazakhstan" project.
Main objective of this project – quality ensuring
medical services and creation of competitive health care.
Now standards of accreditation consist of four
sections: "Management" (section A); "resource management"
(section B); "Management of safety" (section C); "Treatment and
care of the patient" (section D).
These four sections represent the main spheres of
activity of the organization of health care. Each of them plays an important role
in improvement of quality of medical care and the services provided by the
medical organization to patients.
Thus, standards of accreditation are focused on the
main indicators of work of the medical organizations and represent the
systematized list of the main requirements to the medical organization,
regulated by existing regulations of the Republic of Kazakhstan in the health
care sphere, and also the recommended WHO which member is also the Republic of
Kazakhstan. When carrying out accreditation of the medical organizations the
complex assessment is carried out (a self-assessment and external audit)
organization activity, beginning from questions of the general management,
resource management (the personnel, finance, material equipment, the room), management
of medicines, risks, etc.
And though quality of medical services in Kazakhstan
yet at rather high level, for the last period certain results in ensuring
quality of medical care were reached. Including the system of independent
medical examination, basic elements of accreditation in the field of health
care (rules in the field of accreditation were legislatively fixed, developed
standards of accreditation for the medical organizations, indicators of an
assessment of quality) are created, the service of internal audit of the
medical organizations for ensuring timely and high-quality providing medical
services and protection of the rights of patients is introduced.
The service of internal audit is created in all
medical organizations of our country since 2009 in pursuance of the order of
the Minister of Health "About the approval of rules on improvement of a
control system by quality of rendering medical care in the organizations of
health care of RK" of January 21, 2009.
The purpose of creation of this division in the
medical organizations – ensuring the rights of patients on receiving timely,
high-quality and safe medical care in necessary volume. Representatives of
service of internal audit are engaged in the solution of problems (addresses)
of patients on a place in process of their emergence and in optimum terms. In
cases of a dissatisfaction with quality of rendered medical services,
violations of the principles of ethics and a deontologiya, and also with
activity suggestions for improvement the patient can address to any of members
of service of internal audit information about which is placed in a visible
place in the medical organization.
Creation of institute of independent experts in the
country is also directed on realization of observance of the rights of patients
and medical workers. Now in Kazakhstan are created and successfully
associations of independent experts, associations of protection of the rights
of patients, the associations uniting people with various diseases (diabetic,
oncological, cardiological and others), professional non-governmental
organizations function. These institutes actively participate in the solution
of arising problems, sharply react to arising social problems.
On a site of Ministry of Health the register of the
independent experts accredited in accordance with the established procedure is
created. Independent experts can be involved when carrying out both external
examination, and internal as a part of service of internal audit.
Thus, in health care improvement of a control system
by quality the important part in which is assigned to accreditation with
application of the updated standards at the heart of which – the international
norms of safety and quality of medical services is carried out.