Management In Health, MIH (National School of Public Health, Management, Romania)
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Occupational Stress Management
Get PDF: The problem of occupational stress has been extensively studied mainly due to the negative effects it has on the organization and employees. Some organizations have programs designed to help physical and mental health workers to prevent problems due to stress and to help "make do" with work-related stress. Stress management is an important part of maintaining good physical and emotional health and healthy relationships with others. This article presents some strategies to prevent and reduce stress both at the organizational level as well as individually. With rare exceptions, Romanian stress Management programs have not known a great success, the reasons behind this being related to mentality. The occupational stress problem in Romania is still an open question, waiting to be solved. Key words: occupational stress, stress managemen
Study of the Variations in the Use of Hospital Services, Based on the Case Mix, in 2008 in Romania
Get PDFThe healthcare system copes with economic challenges worldwide, so the healthcare reform is a topic more important than ever for social policies. What do we get for our money? Is a question that raises more and more. It has been shown that more healthcare services does not necessarily mean a better health. Many countries focus of medical practice variations or health disparities. The collection of case mix data starting with 2003 in Romania made possible several studies concerning practice variations in Romania. The present article shows how these data can be used to provide accurate comparisons in geographic profile concerning the volume of services, territorial disparities and to hypothesize about the possible causes of practice variations. Key words: Hospitals, medical practice variations, territorial disparities, case mi
Clinical and Therapeutic Management of Acute Stress Disorder
Get PDFAcute stress is an anxiety disorder due to an exposure to a traumatic or stressful event which implies a specific reaction. Clinical features are variable, depending on: type of personality, coping mechanisms, socioeconomic or professional factors, co-morbidities. Therapeutic management involves pharmacotherapy (antidepressants are the most common), psychotherapy or an association between both in selected cases. Keywords: acute stress, anxiety, pharmacotherapy, psychotherap
Infiintarea unui spital privat in Romania
No full textIn Romania, health legislation encourages the foundation of private medical units. This article discusses the reasons why it is benefic to open such hospitals, especially in the conditions where the Romanians are faced with the problem of the diminution of the number of public hospitals, and consequently of the number of beds. The article also presents the legal conditions to follow in order to open such an institution and makes a short review of the most important aspect to consider out when discussing the subject of planning a new hospital. Because the private hospital not only serves the population, but also it is an institution that has to provide financial profits, it is very important to take into account aspects related to the location, the characteristics of the population to be served, the financial investment and so on. Anyway, if planned carefully and according to the law, the private health units can influence the quality of the medical act and the satisfaction of the population, by the stimulation of the competition.In Romania, legislatia incurajeaza infiintarea unitatilor medicale private. Acest articol prezinta motivele beneficiilor infiintarii unor spitale private, in special in conditiile in care Romania se confrunta cu o diminuare a numarului de spitale publice si, consecutiv, a numarului de paturi de spital. Articolul descrie, de asemenea, conditiile legale ce trebuie respectate pentru infiintarea unei asemenea institutii si o scurta revizie a celor mai importante aspecte punctate de literatura stiintifica in termeni de planificare a unui nou spital. Deoarece spitalul privat nu doar serveste populatia, dar, de asemenea, reprezinta o institutie care trebuie sa produca beneficii financiare, este foarte important sa fie luate in considerare aspecte privind locatia, caracteristicile populatiei deservite, investitiile financiare necesare etc. Printr-o planificare atenta si in concordanta cu prevederile legale, unitatile medicale private nou infiintate pot influenta calitatea actului medical si satisfactia populatiei, ca urmare a cresterii competitiei
Rolul masurarii mortalitatii evitabile in aprecierea starii de sanatate a populatiei
No full textMeasuring the health status of the population is difficult, since many aspects have to be considered. In present, the emphasis is on using tools that includes as many dimensions of health as is possible; also, calculating synthetic and comprehensive indicators covering many aspects of health has become a common practice. Avoidable mortality (with its two components: treatable and preventable causes) is useful in measuring the health status of the population, but also in planning and assessing the healthcare services. In Romania, the avoidable mortality is less studied and data existing at international level require deepening in researching this phenomenon, in order to identify potential weaknesses of the health system and healthcare impact of different policies. For Romania, the level (first place in the EU countries) and increasing trend of phenomenon (mainly for diseases that are treatable) should alert policy makers and politicians. Scientific evidence must accurately reflect reality and decision making process must be supported by a good understanding of the phenomenon.Starea de sanatate a populatiei este dificil de masurat, dat fiind multitudinea aspectelor ce trebuie considerate. Astazi se pune accentul pe folosirea unor instrumente care sa curpinda cat mai multe dimensiuni ale sanatatii, iar calcularea unor indicatori cat mai sintetici si comprehensivi, care sa includa cat mai multe aspecte ale sanatatii a devenit o practica curenta. Mortalitatea evitabila (cu cele doua componente ale sale: cauze tratabile si prevenibile) este, de asemenea, utila in aprecierea starii de sanatate a populatiei, precum si pentru planificarea si evaluarea performantei serviciilor medicale. In Romania, mortalitatea evitabila este putin studiata, iar datele existente la nivel international reclama aprofundarea cercetarii acestui fenomen, in vederea identificarii potentialelor puncte slabe ale sistemului de sanatate si a impactului diferitelor politici din domeniul sanitar. Pentru Romania, nivelul fenomenului (primul loc in randul tarilor din UE) si tendinta de crestere (in principal pentru afectiuni care sunt 100% tratabile) trebuie sa atentioneze decidentii si politicienii
O privire din exterior: jurnal de leadership. Partea a V-a: Sistemul de analiza. Crearea sinergiilor
No full textIn the complex world of healthcare reform, the concept and tools of systems thinking offers to leaders and organizations in their search for how to manage the impact of reform initiatives so their organization is best positioned for sustained superior performance. “System thinking” is a useful approach to reduce complex issues and challenges into simpler and more understandable terms. Regrettably, many organizational challenges leave leaders without a structured process to analyze and then create innovative solutions. In fact, when critically analyzed, most solutions to problems are merely reactions to the symptoms problems generate while the underlying causes are left unexplored. “System thinking” allows widening the opportunities and taking into account of a large spectrum of neccesary changes. When we talk about health system reform, things get more complex, and leadership must be manifested both at the entire system and each organization level. Leaders must know and develop complex skills to enable them to forecast the necessary fundamental changes, to apply long-term learning strategies, to monitor performance regarding all aspects and also to help them planning and selecting the best scenario in the given situation. In addition to these skills, a leader needs of the other elements already discussed in the previous articles; without these elements, a leader is a mere observer without the ability to look deeper into the phenomenon in its complexity. Leaders must look beyond the challenges and, in the same time, they have to identify the best solution for various problems. For simple solutions for various situations which healthcare managers are confronted with, it is neccesary that the organization to have leaders with multiple and complex skills.Keywords: system thinking, learning strategies, performance monitoring, scenario planning.Intr-o lume complexa cum este cea a sistemului sanitar, conceptul si instrumentele “sistemului de analiza” ofera liderilor si conducatorilor de organizatii idei despre modalitatea prin care organizatia lor sa beneficieze de reformarea sistemului si sa obtina rezultate optime. Sistemul de analiza este util pentru a reduce si diviza notiunile complexe in unele mai simple si mai usor de inteles. Din pacate, insa, multe provocari organizationale pun leader-ul in pozitia de a nu avea un proces structurat de analiza si de creere a solutiilor inovatoare. De fapt, intr-un spirit critic, majoritatea raspunsurilor la diverse probleme reprezinta mai degraba solutii pentru simptome, in timp ce cauzele reale ale problemei sunt neexplorate. Sistemul de analiza permite largirea perspectivelor si posibilitatea cuprinderii unei largi palete de schimbari necesare.Cand vorbim despre reforma unui sistem de sanatate, lucrurile devin mult mai complexe, iar leadership-ul trebuie sa se manifeste atat la nivel de sistem, cat si la nivelul fiecarei organizatii.Leaderii trebuie sa cunoasca si sa isi dezvolte abilitati complexe care sa le permita previzionarea schimbarilor fundamentale necesare, aplicarea strategiilor de invatare pe termen lung, monitorizarea performantei in ceea ce priveste toate aspectele si, de asemenea, care sa ii ajute in planificarea si alegerea celui mai bun scenariu pentru situatia data. Pe langa aceste abilitati, leader-ul are nevoie de celelalte elemente discutate in articolele anterioare, fara de care, el este un simplu observator fara capacitatea de a privi in fenomenul in complexitatea sa. Liderii trebuie sa priveasca dincolo de provocare si sa identifice modalitati de rezolvare optima a diverselor probleme. Pentru solutii simple de rezolvare a situatiilor diverse cu care managerii din domeniul sanitar se confrunta, este nevoie de lideri cu abilitati multiple si complexe.Cuvinte cheie: sistem de analiza, sistem de gandire, strategii de invatare, monitorizarea performantei, planificarea scenariului
Nanomedicina - medicina viitorului
No full textNanotechnology field is one of the segments with the highest expectations and as the progress of new medical technologies is becoming more and more alert, the expected benefits did not delay to occur. Currently, nanomedicine is considered not only a possible and promising path to a diagnosis of certainty and to an early and effective treatment, but also a probable way for prevention of chronic diseases. Nanomedicine applications include a wide spectrum range of interventions in specialties such as: internal medicine; oncology; emergency medicine through new first aid methods in physical injuries / accidents, burns and exposure to radiation; surgery; cardiology and cardiovascular surgery through rapid intervention and rehabilitation methods; neurology and neuro-surgery through new neurographic methods, spinal regenerating methods and interventions of brain repair; gastroenterology and nutrition area, to improve nutrition and digestion; sexology; human reproduction area; geriatria / gerontology - biostasis and ageing control strategies; genetics – the human body growth and development processes; gene therapy, reconstruction and cell regeneration; other areas: recreation and leisure, cosmetic, regulatory and sociological issues on the future of the medical profession, the hospitals and pharmaceutical companies.Keywords: nanomedicine, nanotechnology applications in medicine, nanotechnology risk assessment, development potential.Pe masura ce ritmul de progres a noilor tehnologii din domeniul medical este din ce in ce mai alert, beneficiile scontate nu intarzie sa apara, iar domeniul nanotehnologiilor reprezinta unul dintre segmentele cu cele mai mari asteptari.In prezent, nanomedicina este considerata nu numai o posibila si promitatoare cale spre o diagnosticare de certitudine, precoce si un tratament eficace si eficient, dar si o cale probabila de preventie a acestor tipuri de boli. Spectrul aplicatiilor nanomedicinei cuprinde o gama larga de interventii in specialitati precum: medicina interna; oncologia; medicina de urgenta prin noi metode de prim ajutor in cazul traumatismelor fizice/accidentelor, arsurilor si expunerii la radiatii; chirurgia; cardiologia si chirurgia cardio-vasculara prin metode rapide de interventie si reabilitare; neurologia si neuro-chirurgia prin noi metode neurografice, de regenerare spinala si interventii reparatorii cerebrale; gastroenterologia si domeniul bolilor de nutritie vizand imbunatatirea nutritiei si digestiei; sexologia, sfera reproducerii umane; geriatria/gerontologia - strategii pentru biostasis si controlul fenomenului de imbatranire; genetica - procesele de crestere a organismului uman; terapie genica; reconstructie si regenerare celulara; alte domenii: recreere si petrecerea timpului liber; cosmetologie; aspecte de reglementare si probleme sociologice, viitorul profesiei medicale, al spitalelor si companiilor farmaceutice.Cuvinte cheie: nanomedicina, aplicatii ale nanotehnologiilor in medicina, evaluarea riscului nanotehnologiilor, potential de dezvoltare
Reducerea inechitatilor in sanatate: prioritate pentru politicile si masurile europene
No full textGoals: This study is intended to highlight the importance of health determinants and equity in healthcare in an international and European context, to provide an overview on health inequities and on how they correlate with the political decisions for the ethical allocation of resources in the healthcare system from Romania. Methodology: The distribution of health socio-economic determinants was assessed by using data from two studies conducted by the National Institute of Statistics. Data for 2009 processed by NSPHHM were used in order to analyze the indicators regarding the main aspects of hospital activity and admitted morbidities. Concerning the analysis of the main demographic aspects and the trend of health expenses at national and/or regional level, the utilized data came from NCOPIISH2 (for 2007), EUROSTAT (statistical database 2009) and from WHO’s National Health Account database. Absolute values were also used and rates for assessing inequalities and inequities in resource allocation in healthcare system (medical doctors, nurses, beds, high-tech medical equipment) were calculated per development regions. Outcomes: The demand of healthcare services exceeds the ability to finance them from public funds (state budgets for health and social security funds). The share of out-of-pocket payments made by households in the total healthcare expenses is considerable (over 20%) This situation exposes households to a catastrophic risk (over 40% of the overall costs of a household). In the same time, decision makers face difficulties in a better understanding of the consumption causes in the healthcare system in order to create the premises of a better allocation of available resources. Inequalities between development regions are induced by: inequalities in health status and structure of risk factors to which the population from a certain region is exposed; inequalities in the need for healthcare services; inequalities in the service offer; inequality in providing service continuity; inequalities in the capacity of local authorities (DHA, DHIH, town-halls and county councils) to make organizational changes.: Obiectiv: Studiul are ca scop evidentierea importantei determinantilor sanatatii si a echitatii in domeniul sanatatii in context international si european si sa ofere o privire de ansamblu asupra inechitatilor din domeniul sanatatii si a modului in care aceste evidente pot fi corelate cu deciziile politice privind o alocare etica a resurselor in sistemul de sanatate din Romania. Metodologie: Analiza distributiei determinantilor socio-economici ai sanatatii a fost realizata utilizand datele din doua studii realizate de Institutul National de Statistica. Analiza indicatorilor privind principalele aspecte ale activitatii spitalicesti si morbiditatii spitalizate a utilizat datele prelucrate de SNSPMS pentru anul 2009. In ceea ce priveste analiza principalelor aspecte demografice si evolutia cheltuielilor pentru sanatate, la nivel national si/sau regional, au fost utilizate datele de la CNOASIIDS (pentru anul 2007), EUROSTAT (baza statistica 2009) si baza nationala de date privind conturile de sanatate a OMS. De asemenea, au fost utilizate valori absolute si au fost calculate rate pentru analiza, inegalitatilor si inechitatilor in alocarea resurselor din sistemul de sanatate, pe regiuni de dezvoltare: medici, personal mediu, paturi, echipamente medicale de inalta tehnologie. Rezultate: Cererea de servicii de sanatate depaseste capacitatea de finantare a acestora din fonduri publice (bugete de stat pentru sanatate si fondurile de asigurari sociale de sanatate). Ponderea platilor directe (out-of-pocket payment) ale gospodariilor, din totalul cheltuielilor pentru sanatate, este considerabila (peste 20%). Aceasta situatie supune gospodariile la un risc catastrofic (peste 40% din total cheltuielile unei gospodarii). De asemenea, decidentii au dificultati in ceea ce priveste o buna intelegere a cauzelor consumului din sistemul de sanatate, care sa creeze premisele unei alocari mai bune a resurselor disponibile. Inegalitatile dintre regiunile de dezvoltare sunt induse de: inegalitati in starea de sanatate si structura factorilor de risc la care este expusa populatia dintr-o regiune; inegalitati in nevoia de servicii de sanatate; inegalitati in oferta de servicii de sanatate; inegalitati in asigurarea continuitatii serviciilor; si inegalitati in capacitatea autoritatilor locale (DSP, CAS, primarii si consilii judetene) de a face schimbari organizationale
O scurta analiza a disparitatilor teritoriale in consumul de servicii spitalicesti destinate cazurilor acute, in Romania
No full textSummary: Purpose: to study the geographical disparities in the consumption of hospital services and their potential causes Methodology:The study presented in the article is a descriptive observation one, conducted for the year 2008. The analysis included all the cases discharged from continuous acute care hospitals in Romania, considered valid.There were studied the following hypotheses:the excess in consumption of hospital services (measured by the standardized ratio of the cases and of the hospitalization days, according to the age group) is associated with a lower standard of living and a greater number of bedsthe excess consumption of hospital services generates a reduction of the mortality in the general population in that geographic areas (measured by the standardized mortality report by age group).The association between these variables was tested for the 8 development regions (the Spearman correlation test) respectively for the patient's home county (the Pearson correlation test), using the statistical analysis software SPSS. Results:Although differences in the consumption of among the different development regions, respectively among the counties, are obvious, no association between the high volume of hospital services and mortality was found; therefore, it can be assumed that excessive consumption of services is not accompanied by an improving of the health status of patients as mortality reduction. The income influences poorly the volume and the outcome of the healthcare, but correlates with the number of hospital beds in counties with a higher income level. There is no correlation between the number of hospital beds and the volume of the consumed services. Although, at county level, the correlation between the number of cases and the hospitalization days are proven, there are development regions that surprises by the overall scarcity of cases, but excess hospital days. Conclusions There are variations in hospital care practice, which should be measured and analyzed in terms of causes, and should be prevented through monitoring the service needs, data reporting and the careful assessment of the structures and the resources.Scop: studierea disparitatilor geografice in consumul de servicii spitalicesti si a potentialelor cauze ale acestora. Metodologie: Studiul prezentat in articol este unul observational descriptiv, desfasurat pentru anul 2008. Au fost incluse in analiza toate cazurile externate din spitalele de acuti din Romania, considerate valide. Ipoteze de studiu:1. excesul de servicii spitalicesti consumate (masurate prin raportul standardizat al cazurilor si al zilelor de spitalizare in functie de grupa de varsta) se asociaza cu un nivel de trai mai scazut si cu un numar de paturi mai mare.2. excesul de servicii spitalicesti determina in zonele geografice respective o scadere a mortalitatii in populatia generala (masurata prin raportul standardizat al mortalitatii dupa grupa de varsta).Testarea asocierii a fost facuta la nivelul celor 8 regiuni de dezvoltare (test corelatie Spearman), respectiv judet de domiciliu al pacientului (test corelatie Pearson), cu programul de analiza statistica SPSS. Rezultate: Desi diferentele in consumul de servicii spitalicesti la nivelul regiunilor de dezvoltare, respectiv judetelor, sunt evidente, nu a fost gasita nici o asociere intre volumul mare de servicii spitalicesti si mortalitate; ca urmare, consumul excesiv nu este insotit de imbunatatirea starii de sanatate a pacientilor in sensul scaderii mortalitatii. Venitul influenteaza in mica masura volumul si rezultatul ingrijirii, dar se coreleaza cu numarul paturilor de spital din judetele cu un nivel mai mare al veniturilor. Nu exista o corelatie intre numarul paturilor de spital si volumul serviciilor consumate. Desi la nivel de judet exista corelatie dovedita intre numarul de cazuri si cel al zilelor de spitalizare, exista regiuni de dezvoltare care surprind global prin deficitul de cazuri dar exces de zile de spitalizare. ConcluziiExista variatii de practica in ingrijirile spitalicesti, care trebuiesc masurate si analizate din punct de vedere al cauzelor, si prevenite, prin monitorizarea nevoilor de servicii, raportarii datelor, precum si prin evaluarea atenta a structurilor si resurselor alocate