Suchergebnisse

The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries' AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture.

The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries' AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture.

The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries' AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture. ; Kiekvienos asmens sveikatos priežiūros įstaigos (toliau – ASPĮ) tikslas suteikti saugias ir kokybiškas paslaugas pacientams, tačiau kartais teikiant sveikatos priežiūros (toliau – SP) paslaugas susiduriama su nepageidaujamais įvykiais (toliau – NĮ), kurių nepavyksta išvengti. NĮ gali pakenkti pacientui ir sukelti negrįžtamas sveikatos problemas, todėl pacientų sauga ir NĮ medicinoje išlieka globalinė problema visame pasaulyje. Pastaruoju metu mūsų šalyje ir pasaulyje gausėja tyrimų, įrodančių, kaip užtikrinti pacientų saugą (toliau – PS), kaip teikti kokybiškas paslaugas SP sektoriuje ir sumažinti NĮ skaičių. Europos Taryba 2009 m. pateikė rekomendacijas, kaip tobulinti PS, tačiau 2014 m. atlikto tyrimo rezultatai rodo, kad NĮ išlieka ASPĮ problema Europos Sąjungos (toliau – ES) šalyse.1 Kiek vėliau, 2017 m., nuspręsta, kad pateiktos rekomendacijos nacionaliniu lygiu nepakankamai įgyvendintos. Europos Komisija įvertino, kad vis dar yra trūkumų: bendradarbiavimo stoka tarp ES šalių, saugos kultūros įgyvendinimo, žinių ir įgūdžių analizuojant NĮ trūkumai. Straipsnyje analizuojama, kaip sekasi Lietuvoje įgyvendinti NĮ politiką, kodėl Lietuvoje ir ES šalyse patvirtintas privalomų registruoti nepageidaujamų įvykių sąrašas, tačiau šių įvykių registravimas vyksta vangiai, apie daugumą jų nepranešama, slepiamas jų realus skaičius ir dažnis, neanalizuojamos priežastys. Per praktinį didelės ligoninės pavyzdį atliekant atvejo studiją ir kokybinį tyrimą bandoma identifikuoti NĮ valdymo veiksnius, kurie yra barjeras veiksmingai vykdyti NĮ valdymo politiką SP įstaigose. Įžvelgiamos prielaidos sėkmingam NĮ valdymui: NĮ pranešimų sistemos elektronizavimas, kokybės standartų sukūrimas ir jų kontrolė, strateginė, tęstinė ir nuolatinė SP įstaigos administracijos lyderystė bei viso personalo įtraukimas jį motyvuojant, pritaikyti padalinio reikmėms mokymai, organizacinės kultūros laikantis konfidencialumo ir mokymosi iš klaidų palaikymas. Taip pat pastebėti ir trūkumai: žinių ir įgūdžių stoka, baimės būti nubaustam ir pažemintam įveikimas, grįžtamojo ryšio trūkumas, nacionalinės NĮ IT sistemos nebuvimas. Tai riboja NĮ valdymo proceso efektyvumą ir nacionaliniu, ir įstaigos mastu. Sėkmingas NĮ valdymo pasirinkimas tiesiogiai priklauso ir nuo vidinės tinkamos ASPĮ politikos, veiklos ir lyderystės. Nuosekliai ir ilgalaikėje perspektyvoje remiantis europinėmis rekomendacijomis planuojamos, organizuojamos ir kontroliuojamos priemonės stebint ir vertinant jų rezultatus padeda pasiekti tikslus. Dar kartą patvirtinta, kad, norint išvengti NĮ ateityje, būtina juos registruoti ir nuolat analizuoti. Todėl ES šalių NĮ valdymo politikos pamatas – tinkamo NĮ valdymo modelio, priklausomai nuo sistemos brandos, pasirinkimas; valdymo modelis apima pranešimų sistemos diegimą ASPĮ, jų analizavimą ir prevencijos veiksmų sudarymą bei įgyvendinimą. Tai padeda dalytis patirtimi, nuolat analizuoti, mokytis iš klaidų ir formuoti naują požiūrį ir PS kultūrą.

The article analyses the formation, implementation and evaluation of rehabilitation policy in Lithuania and the United Kingdom through a comparative analysis and two empirical sociological qualitative studies. The following scientific problematic issues were raised: what is the situation in the field of rehabilitation policy formation, development and assessment in the historical perspective in Lithuania and the United Kingdom, what are the advantages and disadvantages of the implementation of rehabilitation policy in Lithuania and the UK, and what are the possibilities to change and improve the formation and implementation of rehabilitation policy. A comparative analysis of the principles of rehabilitation policy development, financing, legal regulation, advantages and disadvantages has been carried out, using scientific publications, reports, publications of foreign research papers, legal acts as well as qualitative researches of experts in Lithuania and the United Kingdom. Rehabilitation policies have been found to have similarities in the United Kingdom and Lithuania, but they are quite different as well. Lithuania developed its rehabilitation policy in a relatively short time in all areas of development amid a rapidly changing environment, with effective legal regulation, ambitious measures and limited resources. The United Kingdom's rehabilitation policy has a much longer history; it changed in many ways to adapt to the needs of patients and society. It is based on the approach to the patient as an individual having a particular disorder, and the rehabilitation system promotes an individual rehab program in which the patient is an active participant and can even contribute to the plan, select services they need, and control the rehabilitation budget assigned to them. The system of rehabilitation policy between Lithuania and the UK varies considerably. In the UK, the focus is on the improvement of rehabilitation policy, working with communities, introducing new technologies. However, in Lithuania rehabilitation policy is still evolving, looking for a model that would fit best, even though rehabilitation in Lithuania lacks funding. In both countries, the systematic work of politicians, communication with various organizations, interest groups, contributes to successful rehabilitation.

The article analyses the formation, implementation and evaluation of rehabilitation policy in Lithuania and the United Kingdom through a comparative analysis and two empirical sociological qualitative studies. The following scientific problematic issues were raised: what is the situation in the field of rehabilitation policy formation, development and assessment in the historical perspective in Lithuania and the United Kingdom, what are the advantages and disadvantages of the implementation of rehabilitation policy in Lithuania and the UK, and what are the possibilities to change and improve the formation and implementation of rehabilitation policy. A comparative analysis of the principles of rehabilitation policy development, financing, legal regulation, advantages and disadvantages has been carried out, using scientific publications, reports, publications of foreign research papers, legal acts as well as qualitative researches of experts in Lithuania and the United Kingdom. Rehabilitation policies have been found to have similarities in the United Kingdom and Lithuania, but they are quite different as well. Lithuania developed its rehabilitation policy in a relatively short time in all areas of development amid a rapidly changing environment, with effective legal regulation, ambitious measures and limited resources. The United Kingdom's rehabilitation policy has a much longer history; it changed in many ways to adapt to the needs of patients and society. It is based on the approach to the patient as an individual having a particular disorder, and the rehabilitation system promotes an individual rehab program in which the patient is an active participant and can even contribute to the plan, select services they need, and control the rehabilitation budget assigned to them. The system of rehabilitation policy between Lithuania and the UK varies considerably. In the UK, the focus is on the improvement of rehabilitation policy, working with communities, introducing new technologies. However, in Lithuania rehabilitation policy is still evolving, looking for a model that would fit best, even though rehabilitation in Lithuania lacks funding. In both countries, the systematic work of politicians, communication with various organizations, interest groups, contributes to successful rehabilitation.

Public participation as an approach to health policy decision making refers to a democratic component of "institutional design of partnership governance". The practice of policy formation inevitably triggers networks of external stakeholders and tends to change into a flexible organisational structure which recognises the value added of the knowledge that networks generate. Seeking to depolarize new trends of spontaneous policy networking with an existing hierarchical institutional structure, and find out the renewed role of democratic representatives, the practice of network recognition at the ministerial level needs to be explored. Research seeks to evaluate whether the policy making environment at Ministry of Health is adopted to integrate the network paradigm and to explore the level of stakeholder participation. The research is drawn on the cases of participatory decision-making groups, consensus-building groups that operated during 2007 and 2010 at the Ministry of Health of Lithuania. The research methodology engages a social network analysis for participation measurement and semi-structural interview for participation practice evaluation. The network analysis and network visualisation were processed by UCINET software. The total research data set covers temporary institutional arrangements and makes a network of 1005nodes with 1764 relationships that represent individual participation facts. Participatory groups were employed more than twice as less frequently in 2010 than in 2007. The social network analysis of the members that participate in problem solution processes lets us measure the prevalence and the boundaries of participatory policy practice. Empirical studies of the evolution of the network characteristics of the groups exhibit a stable practice of using interrelation with stakeholders in the policy network. A decision making group as a temporary organisational structure is employed with the diverse purpose: to manage stakeholder input, to burst consultation, to align proper decision, to diminishing confrontation. The equilibrium between dominant policy actors with high interest representation abilities and the stakes that are not expressed and conceptualized make a second challenge that needs to be solved by designing the organisational framework. ; Straipsnis nagrinėja Sveikatos apsaugos ministerijoje buriamų darbo grupių, kaip horizontalios organizacinės struktūros, veikimo praktiką, siekiant nustatyti kokia apimtimi suinteresuotosios pusės yra įtraukiamos į politikos formavimą. Tyrimas apėmė darbo grupių dinamiką, pasirenkant dviejų kalendorinių metų laikotarpį (2007 m. ir 2010 m.). Tyrimo metu buvo taikoma mišri metodų derinimo metodologija, kai kokybinis tyrimas derinamas su kiekybiniu tyrimu. Darbo grupių dalyvių sudėties analizei atlikti buvo pasitelktas statistinės analizės bei socialinių tinklų analizės metodai, tinklo mazgais laikant oficialiose darbo grupėse dalyvavusiuosius narius. Siekiant ištirti darbo grupių būrimo tikslus, paskirtį ir pridedamąją vertę politikos formavimui buvo atliki pusiau struktūrizuoti interviu su valstybės tarnybos atstovais. Buvo nustatyta, kad išoriniai suinteresuotieji yra įtraukiami į darbo grupes Sveikatos apsaugos ministerijoje, tačiau jiems suteikiama periferinė vieta tinklo struktūroje, tuo tarpu dominuoja valstybės tarnybos atstovai. Taip pat nustatyti darbo grupių, kaip organizacinės struktūros veikimo tikslai, kuriuos respondentai įvardijo kaip: konsultacijos, problemų sprendimas, kompromiso ieškojimas, įrodymų ir pagrindimų ieškojimas, informacijos skaida, politinės atsakomybės pasidalinimas ir vietą organizacinėje struktūroje.