Impact of the quality of management on the general improvement of the healthcare system

1. Introduction

Patient security and satisfaction depends largely on the availability of adequate numbers of properly trained and motivated personnel working within an appropriate scope of duties [1, 2]. Poland has one of the lowest ratios of practicing physicians and nurses per 1,000 population among European countries. The identified shortages and unfavorable age structure of practicing doctors [3] and nurses [4] causes a concern for the stability of the healthcare system.

High levels of physician satisfaction is associated with a lower likelihood of medical errors and suboptimal patient care [5]. Research reported a positive relationship between levels of patients’ and physicians’ satisfactions [6], as well as an association between low levels of physician satisfaction and poor patients’ compliance with medical treatments [5, 6].

Nursing care is crucial for the quality of medical services and patient safety. The international project RN4CAST confirmed associations between organizational structure of hospital care and nurse recruitment, retention and patient health outcome [8, 9, 10]. According to the results of this project, 11–56% nurses in European countries are dissatisfied with their jobs [10]. Nurse staffing cuts in healthcare units adversely affect patient health outcomes [8]. Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care and poor or failing safety grades [9].

Currently healthcare quality and patient safety are not regularly assessed in Poland. Hospital accreditation is encouraged by financial incentives (based on contracts with the National Health Fund) nonetheless only 210 hospitals and 31 primary care units have received accreditation by the Centre for Quality Monitoring in Health Care [11]. Recently, the Ministry of Health has prepared the “Act on quality in healthcare and patient safety’ [12]. Based on this document the establishment of a dedicated “Agency for the Quality of Health Care and Patient Safety in Health Care” is planned. To get a broader perspectives regarding the impact of the quality of management on the healthcare system, we decided to conduct research based on opinions of healthcare stakeholders.

2. Objective

The main aim of this research was to collect health decision-makers and practitioners opinions concerning importance of quality of management to improve the healthcare system.

3. Methods

We invited for interviews eight stakeholders (4 women and 4 men), from different healthcare levels: 1. central (Ministry of Health, Nursing Consultant) 2. regional: self-governments, hospital manager and 3. healthcare providers including in-patient care and out-patient facilitates. The interview protocol consisted of five key questions, focusing on the impact of quality of management on the improvement of the healthcare system. The study was conducted in March, 2018. Approval of Bioethical Committee was not required.

4. Results

The first question focused on the impact of management quality on the improvement of the healthcare system. Using 4 point Likert scale, 5 respondents evaluated this impact as important and 3 as very important. Nobody identified the impact is weak or limited.

The second question aimed to determine healthcare aspects, on which management quality has the greatest impact. Respondents successively defined: quality and security of healthcare services, patient satisfaction, satisfaction of healthcare personnel, staff motivation and commitment to the work, better financial situation of healthcare units. They also pointed on: better organization of health services delivery. Respondents who have daily contact with the patients focused on matching health services to patients’ needs.

When asked about their own personal experiences on how the quality of management can influence healthcare system, respondents presented varied answers, including: accreditation process (6 respondents); restructuration process and adaptation to the demographic needs of the local community, modernization of the healthcare units (6 respondents); implementation of new tools in human resources management (4 respondents); implementation of health promotion programs for patients (3 respondents); implementation of telemedicine techniques and cooperation with academic institutions (3 respondents).

The next question focused on the conditions, required to improve management quality. Most of the answers concentrated on competences of managerial personnel. Respondents representing the central level stressed strategies related to “creation of a professional corps of healthcare managers, increased their autonomy (independent from of self-government policy and political authorities) and implementation of certification and continuous education of healthcare managers, and development of the career path for this group”. While, direct care doctors and nurses paid attention to the necessity of regular staff meetings and exchange of information between managers and employees. Respondents stressed the need of adequate employment of medical staff, ensuring adequate financial resources and implementing modern/innovative technologies and medical equipment.

The last question addressed conditions, necessary to ensure that management quality results in improvement of the healthcare system. The answers could be divided into two groups: the management/governance side and the medical staff side (Table 1).

Employment of the adequate number of medical staff is the main challenge for the Polish healthcare system. The shortages and unfavorable age structure of practicing doctors and nurses are the main challenges for the healthcare system. Underemployment causes over-stress, burnout, excessive workload and negatively affects patient care. Adequate funding and proper fund allocation are indispensable. Highly skilled and constantly trained managers are necessary to meet the requirements of the complex tasks of the current healthcare sector.