The Role of Sociological Methods in Information Support for the Management of Healthcare and Preventive Institutions

The dissertation is devoted to the development and pilot testing of a program for the study of public opinion in healthcare and preventive institutions with the aim of providing information support for the management of the activities of such organizations. The research is based on a comprehensive approach combining sociological methods — the surveying of patients and medical practitioners — with analytical and statistical methods for evaluating the effectiveness of managerial decisions. The object of the research was the clinics of MONIKI named after M.F. Vladimirsky, where work was conducted to study the opinions of producers and consumers of medical services regarding the organization of work and the quality of rendered medical care. On the basis of the results obtained, managerial decisions were developed and implemented for the optimization of the institution's activities, and their economic effectiveness was evaluated.

In the contemporary context, public health remains a paramount national issue, and the improvement of citizens' health constitutes the principal criterion for the effectiveness of reforms being implemented. At the same time, the primary objective of healthcare is to ensure constitutional guarantees regarding the provision of qualified medical care to every citizen of the Russian Federation.

Socioeconomic transformations occurring in the country should contribute to the creation of a more rational and efficient model of the healthcare delivery system, ensuring the improvement of the quality of medical services and the most complete satisfaction of the demand for them despite financial constraints, which depends to a large extent on effective management at various hierarchical levels (V.Z. Kucherenko, A.Y. Lindenbraten, Yu.P. Lisitsyn, V.K. Ovcharov, V.B. Filatov, A.V. Reshetnikov, V.I. Starodubov, A.M. Taranov, Yu.L. Shevchenko, O.P. Shchepin, V.O. Shchepin, and others).

At the same time, the improvement of management is impossible without adequate information support, which makes it possible to implement feedback within the system in order to understand and evaluate actual achievements or failures. One of the principal instruments of feedback in healthcare is the study of public opinion of various subjects of the system, who assess in different ways the quality of medical care, the nature of its provision, and the implementation of new organizational decisions in the healthcare sector.

Such a comprehensive analysis enables managers at various levels to analyze the consequences of the implementation of particular managerial decisions and to timely introduce necessary corrective measures.

Given that the quality of medical care, the nature of its provision, and the implementation of new organizational decisions in the healthcare sector are subjectively assessed in different ways by consumers of medical services, medical practitioners, and managers at various levels of management, the elaboration of these questions within each of the named groups is necessary when forming optimal pathways for the provision of medical care.

It is well known that official statistics indicators often do not allow for the adequate identification of the social effect from measures conducted at various levels of healthcare management. This contributed to a significant increase in the 1990s in the number of sociological research on the most diverse problems of medicine in general and healthcare in particular, which in turn made it possible to investigate urgent problems of healthcare, placing at the forefront a holistic perception of medical-social systems and social processes, the identification of social mechanisms and consequences of the transformation process. Moreover, the aforementioned is done with due regard to the specifics of the contemporary state of Russian society and makes it possible to take into account and understand the real patterns of public development in Russia (A.V. Reshetnikov, 2001, 2002).

At present, sociological methods of study have become sufficiently widely used in scientific research on the organization of healthcare. They acquire particular significance for the management of the activities of healthcare institutions, which constitute the primary link in the implementation of reforms in healthcare.

Managerial decisions adopted at the level of leaders of healthcare and preventive organizations with the aim of optimizing their functioning require adequate forms and methods of obtaining operational information. The conduct of sociological research enables healthcare institution leaders to receive such information, to implement operational feedback with the population and medical practitioners, to develop and introduce targeted managerial decisions into practice, and to evaluate their effectiveness.

A certain experience has already been accumulated in this area. An analysis of available literary sources testifies to a sufficient number of publications containing information on conducted sociological, including marketing, research pertaining to the evaluation of the organization and quality of rendered medical care in various types of healthcare and preventive institutions (S.Yu. Bakhanov et al., 2001; V.A. Serebrennikov, 2001; A.V. Reshetnikov, 2001, 2002; I.S. Kitsul et al., 2002; E.O. Parfenov, 2003; N.G. Petrova et al., 2003; S.V. Shishkin et al., 2003, and others). However, only in individual scientific works is a comparative analysis of results obtained over a specific period of time, including after the adoption of corresponding managerial decisions, as well as an evaluation of their effectiveness, conducted.

In this connection, the development of a program for the study of public opinion at the level of healthcare and preventive organizations, contributing to the optimization of the management of their activities, represents under contemporary conditions scientific and practical interest and determines the relevance of the present research.

The objective of the research is the scientific substantiation of the use of sociological methods for the purpose of obtaining information necessary for the adoption of managerial decisions aimed at the improvement of the activities of healthcare and preventive institutions.

The tasks of the research:

- to study and generalize literary sources on the given problem;

- to develop a program for the study of the opinions of producers and consumers of medical services regarding the organization of work and the degree of satisfaction with the quality of rendered medical care in healthcare institutions;

- to conduct a pilot test of the developed program in a base healthcare and preventive institution and to calculate the necessary amount of resources for its continuous use;

- to analyze the results obtained in the course of the implementation of the program;

- on the basis of the results obtained in the course of the implementation of the program, to develop proposals for the optimization of the activities of the base healthcare institution and to evaluate the effectiveness of implemented managerial decisions.

The clinics of MONIKI named after M.F. Vladimirsky were selected as the research base.

In accordance with the set tasks, a complex research methodology was employed, comprising the following methods: study and generalization of experience, sociological (questionnaire), analytical, statistical, comparative analysis method, and organizational experiment.

The object of the research was the opinions of producers and consumers of medical services regarding the organizational, medical, and economic aspects of the activities of a multidisciplinary healthcare and preventive institution.

The subject of the research — the use of sociological methods for obtaining information about the satisfaction of producers and consumers of medical services necessary for the purposes of managing the activities of MONIKI clinics named after M.F. Vladimirsky.

Scientific novelty. A program for the study of the opinions of producers and consumers of medical services regarding the organization of work and the degree of satisfaction with the quality of rendered medical care in a multidisciplinary healthcare institution was developed, incorporating the principle of staging in the conduct of sociological research, with subsequent detailing of the research program based on the analysis of results obtained in the course of preliminary surveys. In the course of the pilot testing of the developed program in a base healthcare and preventive institution, a comprehensive study of the opinions of patients and medical practitioners was conducted on a whole range of questions. On the basis of the results obtained in the course of the pilot testing of the program for the study of public opinion, proposals were developed and scientifically substantiated for the optimization of the management of the activities of the healthcare institution and for the use of sociological methods as an instrument of feedback for evaluating the effectiveness of adopted managerial decisions. Economic calculations of costs associated with the use of sociological methods of study in the analysis of the activities of the healthcare institution were conducted, and the economic efficiency of implemented managerial decisions was evaluated.

Practical significance

The information obtained in the course of the implementation of the program for the study of public opinion makes it possible to maintain constant operational feedback between patients, medical personnel, and healthcare institution leaders.

The results of the conducted research made it possible to scientifically substantiate new directions in the development of MONIKI clinics named after M.F. Vladimirsky, to develop and implement a whole complex of managerial decisions for the optimization of the management of the activities of a multidisciplinary regional healthcare institution on the basis of the use of sociological methods.

The research demonstrated the feasibility and economic expediency of using the program for the study of public opinion developed in MONIKI clinics in other healthcare and preventive institutions.

The results obtained are used in the system of postgraduate education at the Department of Social Medicine and Healthcare Organization, General Medical Practice of the Postgraduate Faculty of MONIKI.

Five works were published on the topic of the dissertation.

The results of the research were reported and discussed at:

- the scientific-practical conference "Public Health, Healthcare Policy and Technologies." State Scientific Center named after N.A. Semashko RAMN. Moscow, April 16-17, 2003;

- the scientific-practical conference "The Role of Healthcare in the Protection of Public Health," State Scientific Center of the Russian Academy of Medical Sciences, Moscow, April 22-23, 2004;

- at a meeting of the Medical Council of MONIKI, March 15, 2005;

- the scientific-practical conference "The Role of Healthcare in the Protection of Public Health," State Scientific Center of the Russian Academy of Medical Sciences, Moscow, April 19-20, 2005;

- the scientific conference of the Department of Economic Research in Healthcare of the State Scientific Center of the Russian Academy of Medical Sciences, Moscow, May 27, 2005;

- the interdepartmental conference of the State Scientific Center of the Russian Academy of Medical Sciences, Moscow, September 26, 2005.

The principal propositions to be defended:

- the results of the study of the opinions of consumers and producers of medical services in MONIKI clinics named after M.F. Vladimirsky;

- sociological research methods — an instrument of feedback for evaluating the effectiveness of adopted managerial decisions.