IMPROVING PERFORMANCE OF PUBLIC SECTOR HOSPITALS: IMPACTS OF QUALİTY MANAGEMENT SYSTEMS APPLICATİONS IN TURKEY

Year 2005, Issue: 50, 1131 - 1157, 13.10.2010

Ali Öztürk

Abstract

Özel sektörden kamu sektörüne adabte edilmiş yönetim metodlarından biri olan kalite yönetimi, son yirmi yılı aşkın süredir sağlık hizmeti sunan kuruluşlar tarafından da uygulanagelen bir yönetim yaklaşımıdır. Türkiye`de ise 90`lı yılların ikinci yarısından itibaren birçok kamu hastanesi kalite ve performanslarını artırmak amacıyla kalite yönetim sistemleri yaklaşımını benimsemiştir. Bu çalışma, kalite yönetim sistemleri yaklasımını benimsemiş Sağlık Bakanlığına bağlı devlet hastanelerinin kalite ve performans değişimlerini karşılastırmalı olarak incelemektedir. İlk olarak gelişmiş ülkelerin sağlık hizmeti sunan organizasyonlarında kaliteyi geliştirmeye dönük faaliyetleri üzerinde durulmuştur. Uluslararası Standardizasyon Organizasyonu (ISO)'nun kuruluş ve faliyetlerine değinildikten sonra, sağlık sektöründe kalite ve performansı arttırmaya dönük faaliyetler üzerinde durulmuştur. Çalısmamız ISO sertifikası almış ve almamış olan devlet hastaneleri arasında çok ciddi bir performans farkı olmadığını, ancak özellikle sertifika sonrası daha çok hasta ve doktorun sertifika almış olan hastaneleri tercih ettiğini ortaya koymustur. Diğer yandan, hastane kalite ve performanslarını ana boyutlarıyla ölçmemizi sağlayacak yeni indikatörlerin geliştirilmesi ve kullanılması gereği vurgulanmıştır. Son olarak, ISO belgesi almış devlet hastanelerinin kalite yönetim sistemlerini uygulamadaki tecrübe ve birikimlerinin, Sağlıkta Dönüşüm Programı`nın uygulama aşamasında diğer sağlık hizmeti sunan kuruluşlar için bir yol haritası çizilmesine büyük katkı sağlayacağının altı çizilmiştir.

Keywords

IMPROVING, PERFORMANCE, PUBLIC

IMPROVING PERFORMANCE OF PUBLIC SECTOR HOSPITALS: IMPACTS OF QUALİTY MANAGEMENT SYSTEMS APPLICATİONS IN TURKEY

Abstract

One of the contemporary management methods adopted from the
private sector and widely advocated in health care organizations over
the past two decades is quality management approach. Many Turkish
government hospitals have also implemented ISO 9001 quality
management systems standards to improve their quality and
performance since the second half of 1990s. This study examines the
impacts of ISO 9001 certification efforts at Ministry of Health (MoH)
hospitals. It begins with an examination of quality improvement
experience in developed countries’ health care services, and
International Organization for Standardization (ISO). Following section
offers a brief discussion on recent Turkish health care reforms. Next, an
analysis of the impact of ISO 9001 quality management systems
certification on quality and performance of government hospitals is
offered by comparing the nine ISO certified and non-certified hospitals’
performances during the pre and post certification periods. Findings of
the study show that although there were no significant differences
between ISO certified and non-certified MoH hospitals in terms of their
performance and quality, ISO certified hospitals were able to attract
more patients and doctors than non-certified hospitals during the postcertification period. In the light of these mix results, it is also discussed
that there is a need for adequately designed outcome performance
indicators which can be employed to measure the core quality and
performance dimensions of hospitals. Finally, this study concludes that
valuable lessons can be drawn from quality management systems practices of MoH hospitals in conceptualizing a road map for many
other health care organizations during the implementation stage of the
Transformation in Health program.  

Keywords

IMPROVING, PERFORMANCE, PUBLIC

References

• Adinolfi, Paola ( 2003). “Total Quality Management in Public Health Care: a Study of Italian and Irish Hospitals,” Total Quality Management & Business Excellence. March 2003, vol. 14, Issue: 2, pp. 141-151.
• Aiken, Linda; Clarke, S.P., and Sloane, M. D. (2002). "Hospital Staffing, Organization, and Quality of Care: Cross-National Findings," in Nursing Outlook. 2002:50: 187-194.
• Al-Assaf, A. F. (2001) “Heath Care Quality: Past and Present”, Health Care Quality: An International Perspective. Ed. A.F. Al-Assaf. World Health Organization. India: New Delhi, pg. 1-13.
• Ferlie, Ewan B. and Stephen M. Shortell. “Improving the Quality of Health Care in the United Kingdom and the United States: A Framework for Change,” in Millbank Quarterly. 2001,Vol. 79, No.2, p.281-315.
• Goetsch, David L. and Stanly B. Davis (2002). Understanding and Implementing ISO 9000:2000, 2nd edition. Prentice Hall: Upper Saddle River, New Jersey.
• Harten, Williem H. van, Ton F. Casparie, Olaf A.M. Fisscher, “The evaluation of the introduction of a quality management system: A process-oriented case study in a large rehabilitation hospital”, Health Policy, 60 (2002), pp. 17-37.
• Kay, Tan and Lim Chai Soon (2000)."A detailed trends analysis of national quality awards world-wide," Total Quality Management. Vol. 11, No. 8, pp. 1065-1080.
• Klazinga, Niek ( 2000). "Re-engineering trust: the Adoptation and adaptation of four models for external quality assurance of health care services in Western European Health Care Systems", in International Journal for Quality in Health Care. Volume 12, Number 3, pp. 183-189.
• McKee, Martin and Judith Healy (2002). “Investing in Hospitals,” in Hospitals in a Changing Europe. Ed. By Martin McKee and Judith Healy. European Observatory on Health Care Systems Series. Open University Press; Philadelphia, USA.
• Ministry of Health, 2003 annual health statistics
• Nabitz, U.; Niek Klazinga, and Jan Walburg (2000). "The EFQM excellence model: European and Dutch experiences with the EFQM approach in health care," in International Journal for Quality in Health Care. Vol. 12, No. 3, pp. 191-201.
• Ovretveit, John (2003). "What are the best strategies for ensuring quality in hospitals?", WHO Regional Office for Europe's Health Evidence Network.
• Preker, Alexander S. (2001). “Global Development Challenges and Health Care Reform,” in World Hospital and Health Services, 2001; 37 (3); pp. 2-8, 40, 42.
• .Ruiz, Ulises and Jose Simon (2004). "Quality Management in health care: a 20-year journey," in International Journal of Health Care Quality Assurance. Volume, 17, No. 6. pp.323-333.
• Sarp, Nilgun, Afsun E. Esatoglu, and Yasemin Akbulut. “An Example of Health Sector Reforms in Turkey: Hospital Decentralization” in Journal of Ankara Medical School, Vol. 55, No. 1, 2002, pp. 9- 18.
• Savas, B.S., Omer Karahan, R. Omer Saka “Health Care Systems in Transition: Turkey”. In eds. Sarah Thompson and Elias Mossialos. Copenhagen, European Observatory on Health Care Systems, 4 (4) (2002)
• Shaw, Charles ( 2001). "External Assessment of Health Care," in British Medical Journal. April 2001, Vol.322. pp. 851-854.
• Van Peursem, K. A., M. J. Pratt, and S. R. Lawrence. “Health Management Performance: A review of measures and indicators” in Accounting, Auditing & Accountability Journal, Vol.8 No.5, 1995, pp. 34-70.
• World Bank (October, 2003). Memorandum of the President of the International Bank for Reconstruction and Development and the International Finance Corporation to the Executive Directors on a Country Assistance Strategy of the World Bank Group for the Republic of Turkey. Report No. 26756 TU
• World Bank (2003a.) Human Development Sector Unit: Europe and Central Asia Region. “Turkey: Reforming the Health Sector for Improved Access and Efficiency” (Two Volumes).Volume II: Background Papers. Report No. 24358-TU.
• World Bank (2003b.) Human Development Sector Unit: Europe and Central Asia Region. “Turkey: Reforming the Health Sector for Improved Access and Efficiency” (Two Volumes).Volume I: Main Report. Report No. 24358-TU.