samedicino momsaxurebis xarisxis kontrolis samsaxuris moqmedebis principebi da koncefciebi Tanamedrove moTxovnebis pirobebSi

nikoloz gegeSiZe, paata aladaSvili

tuberkulozisa da filtvis daavadebaTa erovnuli centri

1995 wlidan qarTul medicinaSi daiwyo reformirebis urTulesi procesebi, romlebic dRemde grZeldeba. samkurnalo da sadiagnozo muSaoba gadavida Tvisobrivad gansxvavebul principebze, rac gamoixateba u.y. dafinansebis tipis cvlilebiT da mkurnalobis programirebuli sqemebis SemoRebiT. aRniSnuli procesi mWidrod iqna dakavSirebuli qveynis ekonomikur-politikur gardaq-mnebTan, samedicino politikis cvlilebasTan da miuaxlovda msoflio standar-tebis dones.

programebis farglebSi Seqmnili standartebiT mkurnalobas gaaCnia rogorc dadebiTi, ise uaryofiTi mxareebi, magram Cveni naSromis mizans maTi avkargianobis Sefaseba ar warmoadgens.

winamdebare naSromis mizania, Tanamedrove moTxovnebis pirobebSi wina planze warmoaCinos samedicino momsaxurebis xarisxis kontrolis samsaxuri, romlis upirveles mizans warmoadgens qveynis mosaxleobis uzrunvelyofa usafrTxo da maRalxarisxiani gamokvlevebiT da mkurnalobiT. aqve unda aRiniSnos, rom xarisxis uzrunvelyofa isedac aris samedicino dawesebulebis valdebuleba, am samsaxurma ki misi SenarCuneba da mudmivi kontroli unda ganaxorcielos.

msoflios yvela ganviTarebul qveyanaSi am mimarTebiT Seqmnilia da mudmivad ixveweba samuSao principebi, samoqmedo debulebebi da praqtikuli Cvevebi.

xarisxi yovelTvis ar niSnavs umaRles xarisxs, es aris saTanado, Tanac misaRebi xarisxi. XX s.-is 40-50-ian wlebSi ekonomikis profesorma edvards demingma Camoayaliba ,,xarisxis strategiuli dagegmarebis 14 postulati~ da Caatara leqciebis kursi iaponiis industriis 100-mde bosTan_Sedegs albaT, yvela vxedavT.

xarisxis garantiisTvis kontrolis saWiroeba jer kidev platonis mier aris SemCneuli, mas ekuTvnis gamoTqma: ,, eqimebi mudmivad presis qveS unda iyvnen~ .

ra aris xarisxi zogadad?

_es aris procesi, romelic akmayofilebs momxmarebels,

ra aris samedicino daxmarebis xarisxi?

_es aris teqnologiebis adeqvaturoba dasaxuli miznis misaRwevad da miRebuli samedicino-ekonomikuri standartis gansaxorcieleblad.

ra aris xarisxis kontroli?

_ igi aCvenebs ara imas, Tu ramdenad kargebi varT, aramed imas, Tu ramdenad cudebi varT, raTa SevaCeroT cudi movlenebi.

ai, ra unda akmayofilebdes xarisxis gansazRvras:

1. sazomi Skala (mag.: xarisxi);

2. Semadgeneli elementebi (mag.: jandacvis samsaxurebi);

3. individis da zogadad, xalxis keTildReobisTvisgamoyenebuli Tanxis raodenoba;

4. mizanze orientireba(mag.:sasurveli janmrTelobis miRweva);

5. Sedareba qselSi arsebul uxarisxo an arakontrolirebad xarisxian MmaCveneblebTan

6. procesis da Sedegebis urTierTkavSiri;

7. calkeuli da mTeli sazogadoebisTvis sasurveloba;

8. prioritetebi da faseuloba;

9. aucilebloba an saWiroeba;

ai, ra unda akmayofilebdes xarisxis kontrolis gansazRvras:

1. mizani (ris Sesrulebas vcdilobT, misi prioritetuloba da TiTieuli muSakis misia

2. Secdomebis minimumamde dayvana;

3. darwmuneba xarisxis gaumjobesebaSi;

4. programuli muSaoba;

5. gageba imisa, rom yovelTvis da yvelasTvis umaRlesi xarisxi ar miiRweva;

6. Tanxebis, resursebis da drois racionaluri xarjva;

7. religiuri aspeqtebis da kulturuli arealis(garemocva, tradiciebi aRqma da gaTvaliswineba;

8. xarisxis programis eTikuroba;

9. xelmisawvdomoba da usafrTxoeba;

10. kontrolis meTodebis sajarooba da gamWvirvaloba;

11. miRebuli Sedegebis analizi;

12. Semdgomi samoqmedo gegmis dasaxva Sedegebis gasaumjobeseblad;

ZiriTad koncefciebTan(principebTan) erTad xarisxis Seqmna-SenarCunebisa da kontrolis mimdinareobisas gasaTvaliswinebelia saerTo debulebebi da maT Sesasruleblad saWiro unar-Cvevebis Camoyalibebuli sistema.

aRniSnuli debulebebi pasuxs scemen TviT xarisxs, mis kontrols da aseve maTi urTierTkavSiris gansazRvrebebs. debulebebze aTeulobiT welia muSaoben msoflios ganviTarebul qveynebSi, rogorc samenejmento, ise klinicisturi midgomiT. ra Tqma unda, debulebebi ar aris Sabloni an dogma, es igive principebia, romelTa gaTvaliswinebiTac yvela konkretuli dawesebuleba qmnis sakuTar samuSao programas.

rogorc ukve aRiniSna, xarisxis Seqmna-SenarCuneba-kontrolis uzrunvelsa-yofad saWiroa samoqmedo programis arseboba, xolo mis Seqmnamde aucilebelia SemsrulebelTa gundis Camoyalibeba. am debulebis ZiriTadi procesis sqematuri gamosaxva mocemulia #1 danarTSi(sqema martivia da, albaT, komentirebas ar saWiroebs).

ZiriTadi moTxovna xarisxis Seqmna-SenarCuneba-kontrolis procesSi aris misi uwyvetoba-sistematuroba, romlis mTavari devizi gaxlavT is, rom es ar aris umaRlesi xarisxi, aramed es aris saTanado da misaRebi xarisxi, amasTan, am xarisxiT momxmarebeli kmayofilia(sulerTia, vin aris igi_pacienti, eqimi, Tu dawesebuleba).

uwyvetobis SenarCunebas xels uwyobs:

1. resursebis racionaluri, (ekonomiuri) xarjva, Tanxebis akumulireba da reinvesticia;

2. mecnieruli midgomebis gamoyeneba (arsebuli faqtebis analizis principi);

3. diskusiuri procesi(sayovelTaobis da gamWvirvalobis principi);

4. integracia sxvadasxva samsaxurebTan(maT Soris barierebis dangrevis principi);

5. gundis disciplina, profesiuli codna da gamocdileba(permanentuli swavleba-gadamzadebis principi);

6. ar unda viyoT TviTkmayofili;

7. ar unda gvqondes samuSaos SiSi;

ra gziT miiRweva es procesi?

1. moTxovnilebebi da SesaZleblobebi SesabamisobaSi unda iyvnen;

2. samoqmedo gegmaSi CasarTavi procesebi unda iyos gaazrebuli(sruli codnis saWiroebis principi);

3. aucileblad unda iyos cikluri(uwyveti);

4. aucilebelia mudmivi saTanado xarisxi (ara umaRlesi);

xarisxis Seqmna-SenarCuneba-kontrolis uwyvetobis principis sqematuri gamo-saxuleba mocemulia #2 danarTSi. sqemis aRqmisas advilad davrwmundebiT imaSi, rom erTi romelime rgolis amovardniT sasurveli Sedegi ar miiRweva.

am procesis mimdinareobaSi SesaZlebelia, sxva problemebic warmoCindes, rac ZiriTadad gamoixateba raime movlenis an situaciis saTanadod verSefasebiT_esenia:

1. bunebrivoba da diferencireba;

2. xarisxis klinikuri fesvebi;

3. profesionalizmi(an araprofesionalizmi);

4. arasakmarisi faqtebi;

5. servisis sxva elementebi;

aseve problemebs qmnian:

1. arsayovelTaoba;

2. araintegrireba(disharmonia);

3. resursebis Seufasebloba an gadafaseba;

4. saWiro drois da/an informaciis uqonloba an simcire;

5. arasakmarisi finansireba da teqnikuri uzrunvelyofa;

6. momxmareblis (pacienti, eqimi, dawesebuleba) indiferentu-loba;

7. saerTo undobloba;

problemebis gaTvaliswinebis da daZlevis Semdeg xarisxis Seqmna-SenarCu-neba-kontrolis procesSi mTavari principia, miRebuli Sedegebis swori analizi da saboloo gadawyvetilebis miReba.

rac Seexeba analizs, aq mTavari pirobaa sazomis amorCeva, romlis indikatoric unda akmayofilebdes Semdeg kriteriumebs:

1. iyos advilad misaRebi da xelmisawvdomi;

2. iyos mniSvnelovani;

3. iyos vargisiani;

4. iyos profesiulad orientirebuli;

5. iyos mgrZnobiare Catarebuli cvlilebebis mimarT;

romelime maTganis gamokleba, azomvebs arasandos xdis da miRebuli Sedegis analizi ar iqneba srulyofili. indikatoris SerCeva damokidebulia imaze, Tu ras vzomavT_process, Tu Sedegs(zogjer orives). am SemTxvevaSi asarCevia naklebxarjiani da metad efeqtiani azomva(aqve ganixileba drois faqtoric). uxSiresad aizomeba procesi, drois garkveul momentSi ki_Sedegi(ufro globaluri gaTvlebisas).

kriteriumis arCevis da miRebuli Sedegebis Semdeg sasurvelia Ria diskusiis Catareba, zogadi da konkretuli analizi da sazomis cvlileba(an mis Sesacvlelad saWiro RonisZiebebis dagegmva).

cvlilebaTa gansaxorcielebeli principebi:

1. koncefciebis Secvla sistemis struqturuli SecvliT;

2. e.w. morgebis meqanizmi_procesis gamravaljeradeba erTdroulad;

3. arasaWiro saqmianobis minimizacia;

4. saqmianobis sinqronizacia;

5. iZulebiTi gadaadgilebis sistemebis gamoyeneba;

6. dadebiTi da uaryofiTi motivaciebis gamoyeneba;

7. saqmianobis etapebis erTmaneTTan daaxloeba;

8. sistemis cvlilebebSi maqsimaluri avtomatizacia;

9. mTeli sistemis Secvla_personalis da teqnikuri saSualebebis erTian sistemaSi moyvana;

10. specialistTa drois racionaluri gamoyeneba;

11. momsaxurebis procesis romelime etapis sistemidan gareT gatana Sualedur procesSi;

12. ufro saWiro, misaRebi da ufro gamoyenebuli sistemis gamoyeneba;

13. informaciis safuZvelze procesis mcireodeni Seyovneba da metad dakvirvebis Semdeg Catareba;

14. araefeqturi momsaxurebis gamorCeva, misi identificireba da xmarebidan amoReba;

15. xelmisawvdomobis sxvadsxva arxis paralelurad gamoyeneba(saWi-roebisas da ara yovelTvis);

16. moTxovnilebebis winaswar gansazRvra;

17. pacientis xelSewyoba_misi TviTganswavla, sakuTari SesaZleblobebis ukeT gamoyenebis mizniT;

18. personalis, pacientTa raodenobis da Semdgomi muSaobis progno-zireba;

19. SemTxvevaTa yoveldRiuri monitoringi;

yovelive zemoTCamoTvlili principebi Tu debulebebi aris zogadi, aseve zogadad SeiZleba Camoyalibdes moqmedebis sqema(ixileT #3 danarTi).

moqmedebis ama Tu im etapze SesaZlebelia, gamoyenebul iqnas:

1. 10-mde samoqmedo programa(SesaZlebelia, drois monakveTSi isini icvlebodnen);

2. literatura (faqtebze damyarebuli daskvnebi, gaidlainebi, meTo-duri saxelmZRvaneloebi da sxva);

3. sakuTari da sxvaTa warsuli gamocdileba;

4. sxvadasxva statistikuri angarisebi;

5. saCivrebis sistema;

programebSi aucileblad unda ganisazRvros zemoqmedebis riski da ukuqmedebis meqanizmebi, monawileTa kriteriumebi, maTi gaTviTcnobierebuloba samoqmedo programis elementebSi, monacemTa Segrovebis sizuste, finansuri, drois da sxva konkretuli programisTvis damaxasiaTebeli mravali faqtori.

amis gaTvaliswinebiT SesaZlebelia gamoyenebul iqnas Semdegi programebi:

1. TvalsaCinoebis(sainformacio);

2. incidentis identifikaciis;

3. medikamentis(an gamokvlevis) janmrTelobaze zegavle-nis(ziani, riski);

4. aparaturis moxmarebis(datvirTvis) an cveTis;

5. statistikuri da samonitoringo;

6. resursebis (medikamentebis samedicino daniSnulebis sagnebis, finansebis) xarjvis;

7. da sxva;

zogierTi programis ZiriTadi aspeqtebi ixileT #4 danarTSi.

TiTqmis yvela programisTvis aucilebelia etalonuri monacemebis mopoveba da miRebuli Sedegebis maTTan Sedareba.

programaTa muSaobis safinalo akordi miRebuli Sedegebis srulyofili analizia, da ara marto analizi, aramed gamovlenili arasasurveli faqtebis aRmosafxvreli RonisZiebebis da meqanizmebis damuSaveba, momzadeba da qmedeba.

ZiriTadad, xarisxis Seqmna-SenarCuneba-kontrolis samsaxuris mizania, mosax-leobis janmrTelobis SenarCuneba, pacientis, dawesebulebaTa samedicino per-sonalis da administraciis kmayofilebis miRweva, rasac igi axorcielebs mudmivi monitoringiT da sxvadasxva programebis uwyveti mimdinareobiT.

TaviTavad cxadia, yvela es moqmedeba(programa) aucileblad unda efuZnebodnen qveyanaSi momqmed kanonmdeblobas da samedicino politikas, eTikis normebs da samedicino deontologiis principebs.

rogorc dasawyisSi aRiniSna, winamdebare naSromis mizani iyo im ZiriTadi principebis da debulebebis gacnoba, romlebic gamoiyenebian xarisxis Seqmna-SenarCuneba-kontrolis samsaxurebis qmedebebSi, daTu saqarTvelos samedicino dawesebuelebebic analogiuri principebiT imuSaveben, momavalSi, imedia, Cveni jandacvis xarisxic iqneba Tu ara umaRlesi, saTanado da misaRebi mainc.

danarTi

TvalsaCinoebis programebi

I.

mizani: teritoriaze samsaxurebis da personalis ganTavsebis maCveneblebis TvalsaCino adgilze gamokvra(eqimis gvaris da Tanamdebobis CvenebiT);

Sedegebi:

1. daizogeba pacientis dro(igi droulad moxvdeba eqimTan);

2. ar daigvianebs gamokvleva da mkurnaloba;

3. pacienti kmayofilia;

II.

mizani: samedicino aparaturis adamianze moqmedebis meqanizmis aRweris

TvalsaCino adgilze gamokvra (aRwera mokled, popularul enaze);

Sedegebi:

1. pacienti acnobierebs gamokvlevis risks;

2. pacienti acnobierebs gamokvlevas;

3. pacienti kmayofilia;

III

mizani: dawesebulebaSi danergili kliniko-laboratoriuli gamokvlevebis da eqim-specialistTa konsultaciebis preiskurantis (dafinansebis wyaros CvenebiT) TvalsaCino adgilze gamokvra;

Sedegebi:

1. pacienti winaswar sazRvravs sakuTar danaxarjebs;

2. pacienti kmayofilia;

IV

mizani:

1. dawesebulebaSi mimdinare saqmianobis yovelkvartaluri(yovelTviuri)

angariSebis TvalsaCino adgilze gamokvra;

2. brZanebebis, gancxadebebis TvalsaCino adgilze gamokvra;

Sedegebi:

1. personali kmayofilia;

anketirebis programebi

medpersonalisTvis

mizani: gairkves personalis:

1. gacnobierebuloba dawesebulebis saqmianobaSi;

2. dasaqmebis saWiroeba;

3. misadageboba konkretul Tanamdebobaze;

4. azri dawesebulebis da konkretulad sakuTar muSaobaze;

5. azri samuSao adgilis zrunvelyofaze;

6. azri novaciebze;

Sedegebi:

1. momavali muSaobis principebis swori dagegmareba

da gansazRvra;

pacientebisTvis

mizani: gairkves pacientis:

1. gacnobierebuloba da ganswavluloba sakuTar daavadebaSi;

2. gacnobiereba dawesebulebis arsisa;

3. urTierToba medpersonalTan;

4. 4. azri

a. gamokvlevebze;

b. mkurnalobaze;

g. sxva servisul momsaxurebaze;

Sedegebi:

1. momavali muSaobis principebis swori dagegmareba

da gansazRvra;

problemebis identifikaciis programa

mizani:

1. gamovlenil iqnas zogadi da konkretuli problemebi;

2. ganisazRvros prioritetebi;

3. ganisazRvros misi aRmofxvris gzebi;

Sedegebi:

1. nebismieri arasasurveli incidentis aRmofxvra da

momavalSi Tavidan acileba;

Lliteratura

1. o. gerZmava sazogadoebrivi jandacva da menejmenti

2. jandacvis qarTul-Sveduri proeqti, saavadmyofoTa menejmenti SvedeTi balbo SHCAB (Tomas kelstriomi)

3. jandacvis saerTaSoriso organizaciis monacemebi, xarisxis kontrolis Sesaxeb

4. edvard demnusis postulatebi