KAMU HASTANELERİ BİRLİĞİ YAPILANMASININ SAĞLIK HİZMETİ SUNUM SÜREÇLERİNE ETKİSİNİN YÖNETİCİ VE ÇALIŞAN AÇISINDAN DEĞERLENDİRİLMESİ

Sedat BOSTAN; Gökhan AĞAÇ

Makale detayları

KAMU HASTANELERİ BİRLİĞİ YAPILANMASININ SAĞLIK HİZMETİ SUNUM SÜREÇLERİNE ETKİSİNİN YÖNETİCİ VE ÇALIŞAN AÇISINDAN DEĞERLENDİRİLMESİ

Yazarlar:

Sedat BOSTAN | Gökhan AĞAÇ

Yayıncı:

Sakarya University

Ana Başlıklar:

Sosyoloji & antropoloji

Dergi:

The Journal of Business Science 2019 Vol.7 Issue 1, pp.151-174

Belge Tipi:

Makale

Yayın Tarihi:

4/2019

Belge Dili:

Türkçe

Document ID (Org No.):

2000479462

Sıklık:

Üç Yıllık

eISSN:

2148-0737

Özet:

 


Amaç: Bu çalışma, sağlıkta dönüşüm programının çatı uygulaması olan kamu hastane birlik yapılanmasının hastane hizmetleri üzerindeki değişim etkisini yönetici ve çalışan görüşleri üzerinden mukayeseli araştırmak olup 2017 yılında sistemde yapılan değişikliği bu veriler üzerinden tartışmaktır. 

Yöntem: Araştırmada verilerin toplanmasında dörtlü Likert yapıda bir anket formu kullanılmıştır. Bostan ve arkadaşları (2012) tarafından sağlıkta dönüşüm programının hastane hizmetleri üzerindeki değişim etkisini ölçmek üzere geliştirdikleri ölçek bu çalışmaya uyarlanarak kullanılmıştır. Üç kamu hastaneleri birliği yapılanmasına bağlı yedi hastaneden 325 yönetici ve sağlık çalışanı katılımıyla veriler toplanmıştır. Ölçeğin güvenirlik ve geçerliliği test edildikten sonra veriler tanımlayıcı istatistiksel yöntemler ile bağımsız örneklerde t testi kullanılarak analiz edilmiştir.

Bulgular: Uygulama sonuçlarına göre, sağlık yöneticileri ve sağlık çalışanları kamu hastane birlikleri uygulamasıyla kamu hastanelerinde meydana gelen yönetsel alandaki değişimin olumlu yönde (2,75/2,73) gerçekleştiğini, ortaya çıkan sayısal değişimlerin artış yönünde (2,52/2,53) olduğunu, genel olarak hizmet bileşenlerinin öneminin (3,09/2,86) artığını ifade etmişlerdir. Ayrıca, hem sağlık yöneticileri hem de sağlık çalışanlarına göre kamu hastanelerindeki sağlık çalışanı açısından değişimin olmadığını (2,31/2,28) ve kamu hastaneleri hakkında kamuoyundan duyduğu görüşlerin olumlu (2,81/2,72) olduğu görülmüştür.

Sonuç: Araştırma bulgularına göre; kamu hastane birlikleri uygulamasının sağlık çalışanı ve hastane yöneticilerinin ifadelerine göre, önemli ölçüde benimsendiği, olumlu yönde değişimin sağlandığı, hasta memnuniyetinde artış olduğu, etkin ve yerinden yönetimin öne çıktığı anlaşılmıştır. Bununla birlikte, sağlık çalışanlarının dönüşümden yeterli pay alamadıkları söylenebilir.


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In this study, the effect of the structuring with the Decree Law No. 663 on healthcare delivery processes and service delivery stakeholders in public hospitals was investigated. Within the scope of a scientific research project, it has been tried to determine how health administrators and workers evaluate the change in hospital service processes.

The purpose of this study is to measure the impact of public hospital union structure starting in 2011 and ending in August 2017 on the direction and the effect of the change in the presentation process of public hospital services. In the next three sections of the study, the structure of public hospital association was discussed within the scope of the transformation of health project. Then the studies related to the subject were reviewed. The fourth section was designated to the methodology. In the fifth section, the opinions of the health administrators and workers were collected, the findings were analysed and compared across this two groups. In the sixth and last section, a discussion of the findings, conclusions and suggestions were provided

The quantitative research method was undertaken in this study. A four-point Likert-type survey was used to collect the data. The questionnaire, which was developed by Bostan et al. (2012) to measure the effect of the transformation of health services, was adapted to this study accordingly. Then participants were asked to fill out this questionnaire. The questionnaire forms were distributed to the administrators and workers in the hospital. A total of 370 surveys were received. After the unusable surveys due to missing values and random responses were sorted out, 325 usable questionnaires including 80 from health administrators and 245 from health workers were used for the analysis.

Factor analysis was used to ensure the validity of the structure of items. Kaiser-Meyer-Olkin (KMO) test was performed to determine whether the number of samples was sufficient, and it was found as 0.916. Also, Barlett's sphericity test results were examined to determine whether the correlation between the items was significant and it was found significant at the level of 0.001 (Approx. Chi-Square: 7933.483/ df: 820/ sig: 0.000). To dimension the items,” Direct Oblimin “rotation was applied by the ”principal components” method. The explained variance constitutes 56% of the total. For the reliability analysis of the scale, Cronbach's Alpha coefficient was examined, and this value was found as 0.945. After the reliability and validity test, the data were analyzed by the frequency analysis and t-test. As descriptive statistics, frequencies, percentages, arithmetic means and standard deviations values were calculated.

The opinions of health workers and administrators on how the structure of public hospitals association with its autonomy and specialization have an impact on healthcare services are as follows.

Health workers think that public hospitals association application generally have a positive impact on the administrative change in public hospitals. The structure of public hospitals association brings the most positive changes in healthcare delivery processes and patient satisfaction. Public hospitals have an increase in the numerical results (2.52) due to the structure of public hospitals association. In particular, there is an increase in the number of managerial units, the number of medical devices and hardware and number of examination rooms. The general importance of healthcare components in public hospitals is positively changing (2.86) due to the structure of public hospitals association. In particular, the increase in the importance of patient rights and patient satisfaction is remarkable. There is no change in the importance of physician and health worker. 

Hospital administrators think that the administrative change in public hospitals is slightly positive due to the structure of public hospitals association. Particularly in terms of service delivery and treatment effectiveness, positive change comes forward. Personnel structure, personnel procurement method, medical device procurement method, health worker satisfaction and revolving fund budget did not change. According to the application of public hospitals association, the numerical results of public hospitals are partially increased. Particularly in the number of outpatient room, medical devices and equipment, there was a partial increase. Average number of hospitalization day, physicians, surgery and hospital revenue did not change. In particular, the importance of productivity, patient rights, patient satisfaction, patient, physical structure and regulations and costs are increased. According to the application of public hospitals association, there is some change with regards to the health workers in public hospitals. Particularly, health workers' workloads, work stresses and their need for knowledge and skill improvement are partly increased. The views of the public about public hospitals are mostly positive. Especially the opinions of patients are very positive. Due to the structure of public hospitals association, the change in public hospitals partially solved the problems in hospitals. Applications are necessary and mostly correct. The structure benefited most patients from internal stakeholders and then health administrators. Construction and repair companies benefitted the most from external stakeholders.

As a result, according to the first three-year results of the MoH, which is the roof implementation of the health transformation program, the implementation of public hospitals association in the form of autonomous holding type of public hospitals, it is seen that the implementation is adopted by health workers and by hospital managers and the first results of the implementation are positive. The positive results of the application are particularly important for patients and administrators. Achievement of discipline in working environments, financial advantages in acquisitions, improvement in physical conditions, improvements in medical devices, and increase in patient satisfaction, effective and decentralized management can be seen as significant gains. However, it can be said that health workers cannot say the same in terms of their own interests.

The opinions of current administrators and health workers does not describe a problem or failure at a level to support the modification of the system. As a result, it can be said that the change of public hospital management system is not supported by health administrators and workers.

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Makale detayları

KAMU HASTANELERİ BİRLİĞİ YAPILANMASININ SAĞLIK HİZMETİ SUNUM SÜREÇLERİNE ETKİSİNİN YÖNETİCİ VE ÇALIŞAN AÇISINDAN DEĞERLENDİRİLMESİ

Yazarlar: Sedat BOSTAN | Gökhan AĞAÇ

Yayıncı: Sakarya University

Ana Başlıklar: Sosyoloji & antropoloji

Dergi: The Journal of Business Science 2019 Vol.7 Issue 1, pp.151-174

Belge Tipi: Makale

Yayın Tarihi: 4/2019

Belge Dili: Türkçe

Document ID (Org No.): 2000479462

Sıklık: Üç Yıllık

eISSN: 2148-0737

Sayı

Yazarlar:

Sedat BOSTAN | Gökhan AĞAÇ

Yayıncı:

Sakarya University

Ana Başlıklar:

Sosyoloji & antropoloji

Dergi:

The Journal of Business Science 2019 Vol.7 Issue 1, pp.151-174

Belge Tipi:

Makale

Yayın Tarihi:

4/2019

Belge Dili:

Türkçe

Document ID (Org No.):

2000479462

Sıklık:

Üç Yıllık

eISSN:

2148-0737