International liber cogito multidisciplinary science congress

CHANGE OF PUBLIC HOSPITAL STRUCTURE ON CHANGE OF HOSPITALS: PATIENT VIEWS¹

Handan ERTAŞ

Assoc.Prof. Selçuk University, Faculty of Health Sciences, Department of Health Management,[e-mail]

Musa ÖZATA

Prof.Dr.,Ahi Evran University, Faculty of Economics and Administrative Sciences, [e-mail],

Fatma ÇİFTÇİ KIRAÇ

Research Assist., Selçuk University, Faculty of Health Sciences, Department of Health Management, [e-mail]

Purpose of the Study: In the survey, the satisfaction of the patients receiving services from Public Hospitals Institution in Konya province was measured. Materials and Methods: 300 patients participated in the survey from Konya province, Beyhekim State Hospital, Numune Hospital and Faruk Sükan Maternal and Child Diseases Hospital affiliated to the Public Hospitals Association. 300 patients participating in the study were evaluated by the questionnaire system. Patients participating in the study were selected by simple (random) sampling method. Findings: Patients who participated in the survey reported that their satisfaction with the services they received from the hospitals changed slightly in favor of 35.3%. Patients expressed that 47.7% of the public hospital unions implemented in the last one to two years in the health care system were found to be necessary and partially correct and that the Ministry of Health was good at 41.7% in terms of patients transferring the management of state hospitals to local public hospitals. Conclusion: Practices that have been misled by public hospital associations are seen as positive by the patients and patients are satisfied with the services provided

Key Words:

Public Hospital Unions, Hospital, Change, Health Transformation Program

Change in the healthcare sector can be defined as long-term goals to improve treatment, diagnosis, education, transportation, prevention, research and quality, safety, productivity and costs, aiming at introducing or improving a new concept, idea, service, process or product (Omachonu ve Einspruch, 2010:5). Rapid technological changes in the field of health, increasing cost pressures, matrix organizational structure, increase in the number of health institutions, service duplications, intensification of competition, changing patient-doctor relations, consumer awareness, consumer dissatisfaction are constantly improving and changing health institutions (Tengilimoğlu, 2000:188). However, in some cases, only one or a few areas of change are inadequate, and there is a need for fundamental change so that healthcare institutions can keep pace with globalization processes and follow changing world order. For this purpose, the Ministry of Health has implemented the Health Transformation Program (HTP) in 2003 for effective, equitable, accessible and quality health care. With the "Restructuring", the second step of the HTP, in November 2011, with the Decree Law No. 663 on the Organization and Duties of the Ministry of Health and Affiliated Institutions with Turkey Public Hospitals Authority began operations in 2012 (Sağlık Bakanlığı,2014:5).Public hospitals institution established to provide (Sağlık Bakanlığı,2017:35);

• 
  Second and third level health services in accordance with the ministry, policies and targets,
  
• 
  Opening of hospitals and similar health institutions,
  
• 
  Continuation of activities, all kinds of preventive diagnosis, treatment and rehabilitative health services.
  

In the study, the evaluation of the Public Hospital Associations from the point of view of the patients and the satisfaction level of the patients with this process were investigated.

Material Method

300 patients participated in the survey from Konya province, Beyhekim State Hospital, Numune Hospital and Faruk Sükan Maternal and Child Diseases Hospital affiliated to the Public Hospitals Association.Quantitative research design was used in the research. Patients who participating in the study were selected by simple (random) sampling method.The questionnaire used in the research was created by Bostan and a reliability analysis was conducted to determine the reliability of the questionnaires and the Cronbach Alpha value was 0.84.

Findings

Table 1. Demographic Data of Patients Involved in the Survey

Hospitals	n	%	Job	n	%
Beyhekim	101	33,7	Unemployed	76	25,
Numune	106	35,3	Housewife	88	29,3
Faruk Sükan	93	31,0	Worker	44	14,7
Gender	n	%	Civil Servant	37	12,3
Male	132	44,0	Artisan	15	5,0
Female	168	56,0	Self-employment	25	8,3
Education Status	n	%	Retired	15	5,0
Primary School	107	35,7
High School	89	29,7
Undergraduate	104	34,7
Total	300	100	Total	300	100

According to Table 1, 101 (33,7%) patients from Beyhekim State hospital, 106 (35,3%) from Numune Hospital and 93 (35,3%) patients from Faruk Sükan participated in the study. 44% of the patients were male and 56% were females. 35,7% of the patients are primary school graduates and 29,7% are high school graduates. 29,3% of the patients participating in the survey are housewives, 5% are workers and retirees.

Table 2. Changes in State Hospitals Through the Application of Public Hospital Unions

	Changed in the negative direction		Unchanged		Little has changed in a positive direction		Positively changed
	N	%	N	%	N	%	N	%
The attitudes and behaviors of the physicians towards the patient the last one to two-year practices	21	7,0	115	38,5	95	31,5	69	23,0
The attitudes and behaviors of hospital employees towards patients the last one to two-year practices	36	12,0	95	31,5	96	32,0	73	24,5
The success of treatment diseases of patients the last one to two-year practices	28	9,3	73	24,3	130	43,3	69	23,0
The reputation of hospitals in the community the last one to two-year practices	27	9,0	102	34,0	93	31,0	78	26,0
The reputation of physicians and health professionals in the community the last one to two-year practices	24	8,0	93	31,0	107	35,7	76	25,3
Degree of satisfaction with the services you receive from the hospitals the last one to two-year practices	24	8,0	74	24,7	106	35,3	96	32,0

Patients who participated in the study according to Table 2 stated that the attitudes and behaviors of the physicians towards the patients change positively with 54,5% and the attitudes and behaviors of the hospital employees changed slightly with positive %32.Patients who participating in the study, stated that the reputation of the hospitals in the society has not changed by 34% and the degree of satisfaction with the services patients receive from the hospitals the last one to two-year practices has changed slightly with positive 35,3%.

Table 3. Personal Assessment of Health Transformation Project

	Negative		Mostly Negative		Mostly positive		Positive
	N	%	N	%	N	%	N	%
Opinions I have heard from the health workers about the practices of the hospitals over the last one or two years;	35	11,7	46	15,3	126	42,0	93	31,0
Opinions I have heard from patients about the practices of the hospitals over the last few years;	32	10,7	55	18,3	117	39,0	96	32,0
Opinions from professional associations and health unions about practices in hospitals over the last few years;	28	9,3	60	20,0	122	40,7	90	30,0
Opinions I hear from the community (friend, environment) about the Ministry of Health's transfer of the management of state hospitals to local Public Hospitals Associations;	29	9,7	32	10,7	148	49,3	91	30,3
Public hospital union practices in the last one to two years in the health system;	22	7,3	75	25,0	143	47,7	60	19,8
From the perspective of patients The Ministry of Health transfers the management of state hospitals to Public Hospitals Associations	31	10,3	64	21,3	125	41,7	80	26,7

According to Table 3, 42% patients who participated in the study were mostly positive opinions they have heard from the health workers about the practices of the hospitals over the last one or two years, 39% patients who participated in the study they have heard mostly positive opinions from patients about the practices of the hospitals. Patients who participated in the study found that the public hospital unions implemented in the last one to two years in the health system were found to be necessary and partially correct by 47,7%.

Table 4. Demographic data of those included in the survey with t test in independent groups among the changes in state hospitals through the practice of public hospital associations and variance analysis in independent groups

		N		F/t	P	Post Hoc Test
Gender	Male	132	2,65	2,59	0,010
	Female	168	2,88
Hospitas	Beyhekim	101	2,71	3,797	0,024	According to the Scheffe test result: there is a significant difference between the Numune and Faruk Sükan (p <0,05).
	Numune	106	2,68
	Faruk Sükan	93	2,96
	Total	300	2,78
Education Status	Primary School	107	2,90	6,828	0,001	According to Scheffe test result: there is a significant difference between university and primary school and high school (p <0,05).
	High School	89	2,89
	Undergraduate	104	2,55
	Total	300	2,78
Job	Unemployed	76	2,45	4,395	0,000	According to the Scheffe test result: there is a significant difference between the unemployed and housewives average (p <0.05).
	Housewife	88	3,02
	Worker	44	2,76
	Civil Servant	37	2,70
	Artisan	15	2,95
	Self-employment	25	2,81
	Retired	15	3,03
	Total	300	2,78

As seen in Table 4, t-test was performed between independent gender groups and the average change in public hospitals. According to the results of the analysis, a significant difference was found in the gender averages (p <0,05). There was a significant difference (p <0.05) between the hospital where the patients were included in the study and the change in the average of the public hospitals in the independent groups. The Scheffe test was conducted to determine which variables (hospitals) differed. According to the results, the patients receiving service from Faruk Sükan hospital found the change more positive than the Numune hospital. There was a significant difference between the educational status of the patients and the average of the change of public hospitals in the independent groups (p <0.05). According to this result, there is a significant difference between the university and primary school and high school (p <0,05). According to this result, the positive view towards change is decreasing as education level increases.

Discussion and Conclusion

According to the results of the research, the satisfaction of the patient services has changed slightly with a positive rate of 35,3%.This result is in line with the overall satisfaction rate of the TUİK from the Life Satisfaction Survey in 2015 with 72,3% and the patient satisfaction with the Public Hospital Association will increase in the survey conducted by Küçük and Şahin (2015). Participants who participated in the study expressed that the public hospital unions implemented in the last one to two years in the health system were found to be necessary and partially correct by 47,7%. In the light of this result HTP, which aims to make the health system more effective by improving the long-term financial sustainability with the purposeful management, efficiency, user and service server satisfaction, is the result that the patients who have been diagnosed with Public Hospital Association are perceived as a positive system by the patients. As a result, Public Hospital Association acting with the mission to provide health services with a focus on human-oriented patient and professional management based on employee satisfaction with applications that are implemented are seen as positive by patients.

References

Küçük, Yavuz Selim ve Şahin, Bayram (2015), “Kamu Hastane Birlikleri Uygulamasına İlişkin Sağlık Yöneticilerinin Görüşlerinin Değerlendirilmesi’’, Hacettepe Sağlık İdaresi Dergisi; 18(2): 103-121.

Sağlık Bakanlığı,Türkiye Kamu Hastaneler Kurumu, Stratejik Plan 2014-2018,2014:5.

Sağlık Bakanlığı, Türkiye Kamu Hastaneleri Kurumu 2017 Yılı Performans Programı,2017,s.11.

Omachonu,Vincent K and Einspruch Norman G (2010),”Innovation in Healthcare Delivery Systems: A Conceptual Framework’’,The Innovation Journal: The Public Sector Innovation Journal ;15(1):1-20.

Tengilimoğlu, Dilaver (2000),”Sağlık hizmetlerinde pazarlama karması elemanları ve özellikleri’’, Ankara Üniversitesi SBF Dergisi ;55-1:187-202.