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.

The result of the changes of the work-related stress of physicians and nurses with the critical ill patient units / Монголын эм зүй, эм судлал

Background@#The career and work of medical workers are considered to be the occupation of the highly responsible job of the worldwide. @*Goal@#To identify the percentage of the work-related stress, the burnout, and the symptoms of work-related stress of the physicians and nurses who is working at the critical and intensive care units of UB hospitals. @*Materials and methodology@#The survey was done by quantitative methods and cross sectional design. The study data was collected using the validated questionnaire for the work related stress. The results of the study were analyzed by the Microsoft Excel and SPSS 20 program. @*Results@#The response rate was 97.3% The study found that 78.7% of respondents reported having regular stress; and 89.4% of all participants in the survey had a personal burnout, 90.4% had work-related burnout and 94.5% had a high level of client-related burnout.</br> Physical symptoms include the insomnia 76.7%; psychological symptoms - the headaches 65%; behavioral symptoms as like forgetfulness and annoyance 53.3%; cognitive symptoms as like an increase in sick days or absenteeism by 40% for all physicians and nurses.

Current Status of Public-Private Partnership in Mongolian Health Sector / Шинэ санаа Шинэ нээлт

State that the private sector partnership is a general concept that encompasses formal legal relationships between government entities and the private sector to use private sector resources and expertise to ensure delivery of public services and property. This is because public services to improve the capacity for sustainable use of private sector skills and modernization of technology andfinancial resources, capacity building and increased capacity necessary to wait for the budget cost ofthe current economic situation of our country. Public-private partnership noted that the assessment made by international organizations to take place very effectively in our country. Therefore, the evaluation of the current public-private partnership in the health sector in order toimprove these conditions and to improve the quality and accessibility of care and identify ways of involvement in the implementation of a basis for the work of the study. The purpose of the study is to assess the state of public-private partnership conditions in the Mongolian health sector.We conducted overall 20 focus group interviews with 180 participants, including doctors and health care professionals. 17 out of 20 were from Ulaanbaatar and 3 were out of 20. From them, six interviews in the Aimag’s and district’s Complex Hospital represented for the secondary health care organizations, 8 interviews in the Family Clinic represented for primary health care organizations.3 interviews in the third health care organizations. Also 3 interviews in the private health care organizations.Is not known the advantages of public and private medical practitioners and medical specialists partners and do not have experience in working partner. But running has partnered with medical doctors, specialists increased support service types currently provided as a partnership between the hospital and doctor finds that your experience is improving and increasing the quality of service.For flip side is that partners can expand partnership working poor accountability. Future doctors and medical experts believe is necessary to strengthen the increasing awareness of the Partnership through the provision of secondary education, advocacy and policy.Doctors and medical experts believe that public-private partnerships Mongolian international health industry groups have developed expanding significantly. It believes that the lack of knowledge about the partnership, due to be implemented in a realistic policy document.

The comparative study of the Mongolian Health professional’s liability insurance system with some foreign countries / Шинэ санаа Шинэ нээлт

Risk management practice and decision making are paramount for doctors to improving patient outcomes and managing the total cost of risk in our evolving healthcare landscape. In Mongolia there are no legal regulations about health professional’s liability insurance. The aim of the study is to provide relative information about the legal environment, systems and financing of liability insurancefor health professionals in selected foreign countries and Mongolia and to look at what policies and regulations could be applied to Mongolia.We carried out a policy study focused on health professionals’ liability insurance in four selectedcountries. We investigated health professionals’ liability insurance situation in Mongolia in the year of 2012-2014 byReviewing and analyzing the data related to health professionals liability insurance voluntary from the top six insurance companies’ by size and interviewing managerial level staff at these companies Studying court decisions related to health professionals’ errors to see how many health professionals could be prevented from court hearing Studying patients’ complaints against health professionals as filed with the Ministry of Health andSports to see how much risks are facing by health professionals.There are two main legal systems we discovered regarding resolution of health professionals’accountability for patient complaints: Court sentencing. Examples include Mongolia and the United States. Reimbursing the loss. Examples include Switzerland, Finland, New Zealand, Canada, Australia, England, and the Russian Federation. There are two insurance types for health professional’s liability: А. Compulsory B. Voluntary1 In USA, Canada and England, the liability insurance system for health care providers developed late in 19th and earlier in 20th century. Today, both private and nonprofit insurance entities in these countries insure health professionals and members of the health professionals’ association. England has rich experience of health professional’s liability insurance and the system is too large. Data fromthe England legal system shows that one case may take up to 4 years to receive a final decision. In order to determine health professionals’ fault with regard to claims, a health professionals’ liability damage assessor is needed who is well experienced and trained in healthcare law. Mostly not more than 30 percent of the claims are reimbursed. In Canada, statistical trends show claims against health professionals continue to increase. As a result, doctors prescribe additional laboratory tests and other additional investigations which increase health sector costs. In Russia in 2010 the health professional’s liability insurance law is approved and the implementationwill start January 2017. In Mongolia in 2012-2014, there were registered 373 complaints and errors against health professionals and 162 clients applied court complaints. During this period, 27 health professionals received court sentences. Health professionals liability insurance premium is calculated 0.8-3.5 percent of the insurance valuation. In 2012-2014 total 4377 health professionals insured voluntarily against professional liability.In most developed countries health professionals are protected from sentence to court. Averagecomplaints against health professionals have continued to increase steadily similarly in other countries.Therefore health professional’s professional risk is increasing. It shows that it is very important to improve the legal environment of the liability insurance system for Mongolian health professionals. of coronary atherosclerosis.

CORRELATION OF AIR POLUTION AND PRETERM BIRTH RATE / Шинэ санаа Шинэ нээлт

Over the last decade a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. For preterm births the evidence as yet is insufficient to their infer causality. Our study goal was to study the associations between air pollution exposures during pregnancy and preterm birth for a 6 years period (January 2008 through December 31, 2013) in Ulaanbaatar, Mongolia. We used a logistic regression adjusting for gestational age, parental education level, parity and infant age. The preterm birth varied with maternal age, maternal education level, maternal pregnancy order and season after adjusting covariates. Young maternal age, maternal less education level, early and older birth order, spring season, not married status and higher number of pregnancy order t are risk factors for low birth weight. The correlation of preterm birth and air pollution was observed in the second and the third trimester of pregnancy. The preterm birth rates were associated with the average of combined air pollutants concentrations such us PM10, NO2 and SO2 in the preceding 6 weeks.