Scientific Grounds for Optimizing Interpersonal Interaction of Medical Personnel as a Property of Quality of Medical Care

The dissertation is dedicated to the scientific grounds for optimizing interpersonal interaction of medical personnel as a property of quality of medical care. The research is conducted on the example of secondary prevention of the most important non-infectious diseases and is aimed at developing a comprehensive methodology for a medical-social study of the readiness of medical and nursing personnel for interpersonal interaction. The research compares the readiness of medical personnel of departmental and municipal healthcare institutions for conducting preventive measures by professional, medical-social parameters, as well as by parameters of "personal qualities" and "self-development".

Relevance of the research. Under conditions of the unfavorable dynamics of public health indicators of the Russian Federation population, the increase in the structure of mortality of non-infectious character, it is necessary to activate the prevention of the most important non-epidemic diseases, in which a significant role should be played by the interaction of medical and nursing personnel. It is generally recognized that preventive work from the medical, social, and economic perspectives is more effective compared to therapeutic practice. The state comprehensive program "Prevention" conducted until 1990, aimed at improving medical and social prevention of the most widespread chronic non-infectious diseases (CND), for a number of reasons (political, social, economic) remained unrealized to the end. However, the preventive orientation was and remains a priority principle of domestic and world healthcare, reflected in fundamental documents of Russia and the WHO. To revitalize preventive work and improve its quality in new socio-economic conditions, in the opinion of a number of authors (Cherepanova I.S., 1995; Vishnyakov N.I., 1995; Komarov Yu.M., 1995; Denisov I.N., 1996; Kuzmenko M.M., 1996; Kuchenko V.I., 1996; Lindenbraten A.L., 1998; Volodin N.N., 2003; Polyakov I.V., 2003; Medik V.A., Yuryev V.K., 2003), this is possible only through the maximum realization of the potential of the healthcare human resource, improving the quality of interaction between physicians and mid-level medical workers in the implementation of preventive measures. At the same time, to date, works on the study of the interaction of medical and nursing personnel on issues of prevention of the most important non-infectious diseases are virtually absent. Existing studies are not comprehensive in nature, do not provide criteria for assessing interaction, and do not allow quantitative measurement of its quality. This situation requires the development of scientifically grounded approaches to assessing the readiness of medical and nursing personnel for interaction in conducting preventive measures and optimizing this interaction. Research objective: on the basis of a comprehensive medical-social study of the readiness of medical personnel for interpersonal interaction on issues of secondary prevention of the most important non-infectious diseases, to develop proposals for its optimization. In order to achieve the stated goal, the following tasks were set: 1. To develop a methodology for a comprehensive medical-social study of interpersonal interaction of medical personnel as a property of quality of medical care (on the example of secondary prevention of the most important non-infectious diseases). 2. To provide a comparative assessment of the readiness of physicians of municipal and departmental hospitals for conducting work on prevention of non-infectious diseases. 3. To present a comparative assessment of the readiness of nursing personnel for conducting work on prevention of non-infectious diseases. 4. To analyze the quality of the result of preventive work of medical and nursing personnel taking into account the state of the factor of interpersonal interaction. 5. To develop a complex of proposals for optimizing the management of interpersonal interaction of medical personnel as a property of quality of medical care. Scientific novelty of the research consists in the fact that for the first time: • a comprehensive methodology of medical-social study of interpersonal interaction of medical personnel as a property of quality of medical care was developed; • a comparative analysis of the readiness of medical personnel of departmental and municipal healthcare institutions for conducting work on prevention of non-infectious diseases was carried out; • a comparative characterization of the readiness of physicians and midwives for conducting preventive work by professional, medical-social parameters, and by parameters of "personal qualities" and "self-development" was presented; • an expert assessment of the quality of the result of secondary prevention of the most important non-infectious diseases was conducted; • a quantitative assessment of the level of coincidence of readiness of medical and nursing personnel for interpersonal interaction in conducting preventive work was provided; • the role of the factor of interpersonal interaction of nursing and medical personnel in ensuring the quality of preventive work was established, and components were identified with the greatest level of deviations. The scientific and practical significance of the work is determined by the results of the research, which made it possible to present to government bodies, administrations, and practical healthcare institutions objective, scientifically grounded information on the state of secondary prevention of the most important non-infectious diseases in municipal and departmental healthcare institutions. A complex of proposals for optimizing the management of interpersonal interaction of medical personnel as a property of quality of medical care was developed. The data obtained as a result of the research made it possible to determine the methodological foundations for searching for ways to optimize the management of the process of interaction between medical and nursing personnel. Based on the results of the research, a model of optimizing the process of interaction between medical and nursing personnel on issues of ensuring the quality of prevention of non-infectious diseases was developed. Practical recommendations can be accepted as typical for implementation in other therapeutic and preventive institutions and regions of the Russian Federation. The results of the conducted research, as well as prepared methodological documents, were introduced into the practical activities of the Committee on Population Health Protection of the Administration of Novgorod Oblast, the Road Clinical Hospital of St. Saratov, the Research Institute of General Pathology and Pathological Physiology of the Russian Academy of Medical Sciences, and into the teaching process at the Department of Public Health, Healthcare, and Occupational Hygiene of the Institute of Medical Education of Novgorod State University named after Yaroslav the Wise. The data obtained in the course of the research on methodological approaches to assessing the success of interaction between nursing and medical personnel on issues of ensuring the quality of prevention of non-infectious diseases, as well as ways to optimize it in intra-organizational conditions, were included in informational letters for healthcare organizers of the Committee on Population Health Protection of the Administration of Novgorod Oblast: "On the State of Quality of Secondary Prevention of the Most Important Non-Infectious Diseases" and "On Approaches to Optimizing the Interaction of Nursing and Medical Personnel on Issues of Secondary Prevention of the Most Important Non-Infectious Diseases" (appendices 10-11). Basic provisions to be defended. 1. It is advisable to include indicators of interpersonal interaction of medical personnel in the set of quality indicators for the implementation of secondary prevention of the most important non-infectious diseases, which can be determined quantitatively using the proposed methodology. 2. The basis for managing the level of interpersonal interaction should be information on the initial socio-psychological readiness of medical personnel, which should be used for its optimization and targeted correction. Personal contribution of the author to the conducted research. The author independently conducted an analytical review of domestic and foreign literature on the studied problem, compiled the research program, developed statistical accounting forms, and conducted a sociological survey of medical personnel (personal participation - 100%). The program for mathematical-statistical processing of the material and the processing itself were conducted with the participation of the author (share of personal participation - 80%). Intermediate results of the research were systematically checked by the scientific supervisor. Analysis, interpretation, presentation of obtained data, formulation of conclusions, and practical recommendations were mainly performed by the author personally (share of personal participation - 95%). Public presentation of the work. Materials of the dissertation were reported and discussed at International Conferences "Health and Education — XXI Century" (Moscow, 1999, 2001, 2002), a republican seminar "New Technologies in Obstetrics and Gynecology" (Ivanovo, 1999), the 2nd All-Russian Congress of Midwives (Moscow, 2000), a jubilee scientific-practical conference dedicated to the 10th anniversary of the Department of Public Health, Healthcare, and Occupational Hygiene of the Institute of Medical Education of Novgorod State University named after Yaroslav the Wise (Veliky Novgorod, 2003). Five scientific works were published on the topic of the dissertation.