Result to assess management capability of maternity hospitals / Шинэ санаа Шинэ нээлт

Background@#Healthcare organizations are successfully implementing quality management system by forming legal entity, administration’s structure, arrangement and developing healthcare organization’s structure, arrangement, functional standard, clinical guideline, rule and employee’s moral principles. Implementation of accreditation system into healthcare organizations is proof of accepted standard application. However, the results of healthcare paradigm shift outcome is insufficient. Also researchers, citizens and policy makers commented that quality and access of healthcare service began to worsen compared with previous degree of development. Management capability index presents management assessment by score, assesses outcome of organizational functions and give chance to measure capability of management.@*Methods@#This study was performed at the Amgalan Maternity Hospital, Urguu Maternity Hospital and Khuree Maternity Hospital. The study involved 480 employees of above-mentioned hospitals. The study used 9 chapter and 90 criteria that was used in over 30 Mongolian Governmental Organizations for capability assessment to determine management capability index of Maternity Hospitals, using Cross-Sectional study method. In the study, a questionnaire with 90 questions including organization management capability 9 chapters which are organizational goal and task, leadership skill in organization, worthwhile structure and arrangement, organization’s motivation and leverage, organization’s relationship and collaboration, organizational culture, resource utilization, knowledge and innovation, organizational productivity, quality and performance was used. Organizations capability index was estimated by assessment of each questions in scores 1 to 5.@*Results@#Total 480 employees consisting of 220 employees working at Urguu Maternity Hospital, 125 employees of Khuree Maternity Hospital and 135 employees of Amgalan Maternity Hospital filled the questionnaire. 46 administration officials, 75 doctors, 208 nurses and obstetricians, 105 caregivers and service assistants and 46 economic employees involved it. Organizational management capability was 71.8, 73.6 and 93 respectively Urguu Maternity Hospital, Khuree Maternity Hospital and Amgalan Maternity Hospital. It is obvious that there has necessity to improve organizational knowledge, innovation, resource utilization, behavior, culture and activate their organization. In result of studying doctors, nurses, obstetricians and other employee’s work task management, there has relatively little difference of management capability index with 0-3.9% between Urguu Maternity Hospital and Khuree Maternity Hospital while management capability index of Amgalan Maternity Hospital had difference with 14.7-20.1%. In the work task questionnaire analysis, no difference was noted but administrative officials and service assistants gave high assessment for organizational management. Regression analysis was used to assess the relationship between management capability assessment of doctors, nurses, obstetricians and other employee of Maternity Hospitals and the result was p<0.001 and r=0.89. It represented the presence of strong association between those.@*Conclusions@#Management capabilities of Urguu and Khuree Maternity Hospitals which don’t implement the quality management system have difference from Amgalan Maternity Hospital’s management capability. All participants of Amgalan Maternity Hospital implementing quality management system gave same assessment for their organizational management capability index regarding of differences of work tasks.

Postpartum readmission rate / Монголын Анагаах Ухаан

Background@#Postpartum readmission rate has been increasing after both caesarean and vaginal delivery. Postpartum diseases, in some cases with infection and anemia, result in hospital readmission. Also it raises the issue associated with maternal hospital’s healthcare quality. There has lack of study focusing on postpartum readmission. So we will study postpartum readmission rate. @*Material and Methods@#112 patients who readmitted in Amgalan maternity hospital in Ulaanbaatar were involved in this study. We used patient’s medical history to determine risk factors resulted in hospital readmission after caesarean and vaginal therapy. @*Results@#The mean age of women delivered by cesarean was 30.2±7.32 and vaginal delivery’s was 28.3±7.21. 34.8 percent of women who readmitted after vaginal delivery had 1-3 readmission days and 56.5 percent was 4-6 days and 8.7 percent was 7-10 days. Readmission day for women delivered by caesarean was 1-3 days in 21.2 percent of these, 4-6 days in 56.1 percent and 7-10 days in 19.7 percent. The mean readmission day of women delivered by vaginal delivery was 4.73±1.61 (mean±SD) and the mean of women delivered by caesarean delivery was 5.54±2.34 (mean±SD). In each category, there had 24.2-28.3 percent cases with lochia. Women who had caesarian delivery were infected their scar with 24(36.3) cases. Renal urinary system infection had in 12(26.0) women delivered by vaginal delivery. @*Conclusion@#58.9 percent of total readmissions cases were caesarean and 41.1 percent was vaginal delivery. Lochia and renal urinary infection had influence in readmission after vaginal delivery. Also both lochia and infected wound impacted on postpartum readmission after caesarian delivery.

Study of staff employee’s satisfaction / Монголын Анагаах Ухаан

Introduction@#Studies in many countries have found that the satisfaction of medical workers is closely linked to the quality and efficiency of medical services, as well as the satisfaction of patients. Satisfied employees will bring about satisfied clients. The satisfaction of employees remains a key factor linking the internal management and external management of an organisation. The World Health Organization (WHO) Global strategy on human resources on health workforce 2030 sets out the policy agenda to ensure a workforce that is ft for purpose to attain the targets of the Sustainable Development Goals (SDGs). Motivation of health care workers can initiate them to exert and maintain an efort towards organizational goals. Motivation depends up on many factors, and job satisfaction is one of the most important factors. Healthcare is a service industry where the overall service experience is important for customer satisfaction and quality of care (even if in different extents according to the professional at stake) and that the literature has been bringing about the pertinence of such a holistic approach, this research was conducted within this perspective. Likewise, it is also known that there is close correlation between the job satisfaction of health care staff and the total quality of health services. Different groups have reported differences between the job satisfaction of doctors and that of other health providers. Various satisfaction levels of health care workers, including general practitioners, nurses and midwives, have been reported previously. @*Materials and Methods@#This study was performed at the Amgalan Maternity Hospital, Urguu Maternity Hospital and Khuree Maternity Hospital The study involved 480 employees of above mentioned hospitals. The short form of the Minnesota Satisfaction Questionnaire, with 20 items, was used to examine satisfaction with professional life. The self-administered questionnaire was distributed to all people at their workplaces. Responses of 4 (satisfied) or 5 (very satisfied) were classified as ‘satisfied’, those of 1 (very dissatisfied) or 2 (dissatisfied) as ‘dissatisfied’.@*Results@#The study recruited total 480 employees consisting of 220 employees working at Urguu Maternity Hospital, 125 employees of Khuree Maternity Hospital and 135 employees of Amgalan Maternity Hospital. 46 administration officials, 75 doctors, 208 nurses and obstetricians, 105 caregivers and service assistants and 46 economic employees involved it. In table, 87.1% of total employees of maternity hospitals were female and 12.9% were male. While there had significantly difference for gender, occupation type and worked year in this sector and workplace between 3 maternity hospitals (p<.001), age and education level had no significantly difference between these 3 groups. The proportion of health care staff satisfied with their work was 80.7%. The chance to tell people what to do’ and ‘Being able to do things that do not go against my conscience’, and mostly dissatisfied with ‘The working conditions’ and ‘My pay and the amount of work I do’. There was no significant difference between satisfaction scores of health care staff according to age, gender, marital status, and experience of profession. When the 20 items constituting job satisfaction were examined specifically, the satisfaction score showed a difference related to profession. The midwives’ satisfaction score was significantly lower than that of the others. In table 4, to assess employee’s satisfaction of each maternal hospital: While the minimum satisfaction was assessed by employees of Urguu maternity hospital whether salary is equal for work performance, the maximum satisfaction was assessed by employees of Amgalan maternity hospital under scope of consistent workplace at 93.9 percent. @*Conclusion@#Maternity satisfy external and internal factors of employees are influenced. Maternity is different, depending on the satisfaction of other working areas of employment.

Immunohistochemical diagnostics in stomach cancer / Монголын Анагаах Ухаан

Although stomach cancer immunohistochemistry is similar tothe immunohistochemistry of other organ, it has great impact on diagnosis and treatment, such as its ability to reveal whether the cancer is primary or metastatic and which treatment model would be more effective in individual case. Lately, CK7, CK20 and CDX-2 immunohistochemical markers are commonly used in stomach cancers. Stomach cancer prognosis is different in each patient, depending on several factors, patients’ health status, cancer cell differentiation, and cancer cell growth. To evaluate these factors,immunohistochemic al analysis is more effective and for this purpose they use Ki-67, CD 34, BCL-2, p53, Cyclin D1, andHer- 2 markers.The evaluation of HER-2 expression should be carefully carried out, as following: 1. HER-2 expression should be evaluated on minimum 5 positive stained cells. The evaluation criteria aremicroscopic magnification and cytoplasmic membrane-stained pattern. 2. Other than the membrane-stained pattern must be excluded. HER2 gene evaluation (FISH) can confirm the HER2 IHCexpression. 3. Usage of FDA approved antibody (4B5) has the advantageof increased sensitivity. 4. The algorithm for the evaluation of HER-2 expression used for breast cancer has 50% possibility of false negativity if it is used for stomach cancer. Therefore, it is needed to beevaluated with another specific algorithm. Because HER-2 2+ and 3+ cases can improve outcome with usingTrastizumab treatment.