Scientific Basis for Managing the Activities of a Base Hospital in the Area of Responsibility

The dissertation is devoted to the scientific substantiation of managing the activities of a base military hospital (Military Hospital 427, Voronezh) functioning in the Southern area of responsibility. The research was conducted in the conditions of reforming military healthcare, the introduction of medical insurance, and the development of paid medical services. The work developed principles and methods for optimizing hospital management based on the introduction of computer technologies, including local computer networks and automated workplaces. The author conducted an analysis of hospitalized morbidity among military personnel serving on conscription and under contract, as well as reserve officers and warrant officers, and assessed the interrelationship between morbidity, activity results, and resource provisioning of the hospital. An integrated indicator of the health status of the served contingent, prognostic models for managing medical care, and algorithms for rationalizing the organization of medical care delivery were developed. The scientific novelty consists in the first systematic approach to optimizing the management of a military hospital using computer technologies, the determination of the optimal need for personnel, equipment, and financial resources. The results have been implemented in the practice of Military Hospital 427 and other medical institutions.

In the context of ongoing reform of military healthcare, increasing requirements for the quality of medical care, the introduction of modern medical technologies, and medical insurance, one of the problems of military healthcare is the enhancement of requirements for the timeliness of managerial decision-making in the organization and provision of medical care to military personnel and members of their families under inpatient conditions in the Southern area of responsibility. For military personnel in the Southern area of responsibility and members of their families, the resolution of the listed tasks is even more urgent in connection with the need for prompt provision of all types of medical care. This, in turn, requires the introduction of modern information technologies for processing a large volume of diverse clinical-statistical and socio-economic information, which must be purposefully collected, processed, analyzed, and acted upon in the shortest possible time to arrive at optimal operational managerial decisions, both at the level of the corresponding structural unit and across the Southern area of responsibility as a whole.

In modern conditions, many administrators of medical institutions of the hospital type use computer technologies in solving individual operational tasks, in particular, for calculating employee salaries, billing insurance medical companies for rendered medical services, compiling annual reports, and so on, which is of a fragmented nature and does not resolve the problem of operational management of a hospital institution as a whole. In the opinion of leading specialists in the field of healthcare organization (Lisitsyn Yu.P. 1993; Shchepin O.P., 1991; 1994; 1996; 2003; Starodubov V.I. 1997, et al.), the mere availability of modern computing equipment does not by itself resolve the problem of optimizing the management of a military medical institution, since its resolution requires the use of comprehensive and systematic analysis of hospital activities, taking into account their capacity, structure, equipment, the needs of military personnel in corresponding types and volumes of medical care, the satisfaction of those needs, and much more, which, in turn, requires the development of corresponding algorithms, technologies of economic-mathematical approaches, the development of intra-institutional computer networks, the use of information programs, and so forth.

However, the absence of corresponding information and standardized programs across the area of responsibility as a whole complicates current and prospective (strategic) planning of activities of a multidisciplinary hospital in modern conditions.

The above stated determined the relevance of the topic and served as the basis for carrying out the research.

The study was included in the plan of NRI of the Research Institute of Public Health of the Russian Academy of Medical Sciences and in the plan of NRI of Voronezh State Medical Academy named after N.N. Burdenko (state registration number 01.99.007719).

The objective of the research: based on new information technologies, to develop recommendations for optimizing the activities of a base hospital in order to enhance the timeliness of its management and the effectiveness of medical care for military personnel and members of their families in the area of responsibility.

Based on the objective of the research, the following tasks were set:

1. To develop a comprehensive socio-hygienic program for assessing the activities of a base hospital in the area of responsibility and the effectiveness of its management.

2. To conduct an analysis of the interrelationship between the hospitalized morbidity of military personnel serving on conscription, serving under contract, and members of their families with the results of activities and resource provisioning of a base hospital, in order to manage resources with the aim of their optimization.

3. To assess the condition and prospects for the use of information technologies for enhancing the effectiveness of management of a base hospital in the area of responsibility.

4. To develop scientifically grounded recommendations for optimizing the activities of a base hospital in order to enhance the timeliness and effectiveness of medical care for military personnel and members of their families in the area of responsibility.

In the research, methodological approaches developed at the National Research Institute of Public Health of RAMS and at the Department of Public Health and Healthcare of Voronezh State Medical Academy named after N.N. Burdenko were used, modified by the authors in accordance with the set objectives and tasks. Various sources of information were used with subsequent mathematical processing on a personal computer of the Pentium IV class using the Access 2000 DBMS, the Excel 2000 spreadsheet processor, and the statistical software packages Statistica 5.1 and StatgraphicsPlus for Windows 3.0.

The following methods were applied in the research: statistical, expert assessments, sociological, modeling, forecasting, organizational-expert, economic-mathematical, modeling, and forecasting methods.

The object of the research was the base Voronezh Military Hospital 427, which serves military personnel on conscription, under contract, as well as reserve officers and warrant officers and members of their families. The total number of contingents attached for medical service amounts to 107 thousand people, of which more than 50% are persons of senior age groups suffering from various diseases requiring special methods of diagnosis, treatment, and the use of complex medical technologies.

Material collection is carried out by various methods: sampling of data on the state of health, activities, and economic provision of the military hospital from annual reporting forms and explanatory notes (conjunctural review) for 1997–2004 years, followed by processing, calculation of extensive and intensive indicators, average values, assessment of the reliability of sample material and corresponding coefficients of pairwise and multiple correlation, integrated indicators; use of the sociological questionnaire method, organizational experiment for assessing the effectiveness of new organizational forms of medical care for military personnel (rehabilitative treatment in military units of patients who have had pneumonia, and determination of volumes for rendering high-technology medical care in the Southern area of responsibility).

The unit of observation was a structural unit of Military Hospital 427 equipped with a personal computer. For control comparison, hospital departments not equipped with computers were used.

The scientific novelty of the research lies in the fact that, in the conditions of reforming military healthcare, the introduction of medical insurance, and the development of paid medical services, for the first time:

- the principles and methods of optimizing the management of activities of a base military hospital in the area of responsibility based on the introduction of computers and the application of computer technologies have been developed;

- the effectiveness of computerization of a military hospital using local computer networks and technologies for improving the timeliness of management of the organization of medical care for patients who are military personnel and members of their families under inpatient conditions and enhancing its quality has been demonstrated.

- the optimal need of the inpatient facility for medical personnel, equipment, and financial resources has been determined;

- recommendations for the scientific substantiation of the activities of a base military hospital in the area of responsibility have been developed.

Scientific and practical significance of the work. The results of the work made it possible:

- to create a scientific database for current and prospective planning of the activities of Military Hospital 427 using computer technologies;

- to implement methods of operational management of Military Hospital 427 based on computer technologies in a rapidly changing operational environment:

- to ensure stable therapeutic and preventive activities of the military hospital in conditions of deficit budget financing and the introduction of medical insurance;

- to assess the effectiveness of the use of available hospital resources based on modern computer technologies;

- to lay the foundation for the optimization of management of activities of Military Hospital 427 through algorithms for optimal selection based on programming the state of the management object using computer technologies;

- to formulate and refine recommendations for the scientific substantiation of the optimization of management of a military hospital based on computer technologies.

The materials of the research have been implemented in the activities of Military Hospital 427 in the Southern area of responsibility, the 1472 Naval Hospital named after Academician N.I. Pirogov, as well as in the educational process at the Department of Public Health and Healthcare of Voronezh State Medical Academy named after N.N. Burdenko.

The main provisions of the dissertation were reported and discussed at the following conferences, seminars, and meetings: the Scientific and Practical Conference dedicated to the 70th Anniversary of the Voronezh Region "Actual Problems of Hospital Medicine" (Voronezh, 2004), the International Scientific and Practical Conference "Actual Problems of Hospital Medicine" (Sevastopol, 2004), the regional Scientific and Practical Conference "Actual Problems of Modern Clinical Medicine" (Podolsk, 2005), at the annual interdepartmental conferences of Voronezh State Medical Academy named after N.N. Burdenko; at the Department of Public Health and Healthcare of VGMU (2004, 2005).

Ten scientific works have been published on the topic of the dissertation.

The main provisions put forward for defense:

1. A systems approach to managing the activities of a military hospital, based on a deep analysis of the needs of military personnel and members of their families for inpatient care, makes it possible to develop measures for the optimal use of medical personnel, equipment, and financial resources in order to enhance the provision of inpatient medical care to military personnel and members of their families in modern conditions.

2. The computerization of a military hospital, the introduction of local computer networks and automated workplaces, accelerates decision-making and enhances the effectiveness and quality of medical care for patients under inpatient conditions.

3. The optimization of management of a military hospital in modern conditions is based on a comprehensive approach to solving the tasks facing it, which requires the development of corresponding algorithms, computer technologies, and programs.

4. The scientific substantiation of the activities of a military hospital reduces to the selection of an optimal variant of its management, which requires forecasting the state of health of military personnel, the activities of the inpatient facility, its resource provisioning, analysis of interrelationships, substantiation of priority directions of development with the aim of solving tasks related to improving medical care for military personnel and members of their families.