The Quality Of Medical Services In General Hospitals In Two Counties In Western Yunnan Based On SPO Theory Current Situation And Countermeasures Research

ObjectiveBased on SPO theory,this study investigates the current situation of medical service quality in general hospitals in two counties in western Yunnan from three aspects of medical service structural quality,process quality and outcome quality,explores the problems of hospitals in each dimension of medical service quality,analyzes the key factors affecting medical service quality in county general hospitals in western Yunnan,and proposes countermeasures for continuous improvement of medical service quality in county general hospitals in western Yunnan.MethodsTwo county-level general hospitals in western Yunnan were used for this study,and existing data collection,questionnaires and interviews were used to collect research data to derive the current status of medical service quality in county-level general hospitals in western Yunnan.The existing data were obtained from the annual hospital health statistics reports,and the data covered health staffing,medical facilities input,medical service provision,and service efficiency.The questionnaire survey and interviews included outpatients,inpatients and medical and nursing staff,and the survey covered patient satisfaction evaluation and medical and nursing staff job satisfaction evaluation.Results(1)Quality of medical service structure: lack of health technicians,unreasonable configuration of medical and nursing ratio and low education level.The number of physicians in the two hospitals did not reach 30% of the total number of hospitals,and the number of technicians only accounted for about 10%.The number of surgical beds in hospital X is not up to the standard,and the number of beds in intensive care medicine only accounts for about 2% of the actual number of open beds;the number of emergency department beds in hospital Y only accounts for 1.5% of the actual number of open beds and is decreasing year by year.indicators cannot meet the actual needs of medical institutions.(2)Quality of medical service process: the proportion of discharged patients with surgery in X and Y hospitals has not changed much,basically concentrated in about 30%.the number of day surgery cases in X hospital has been decreasing year by year,and Y hospital only officially started day surgery in 2021,and the number of cases carried out is only 48.the number of multidisciplinary consultation in X hospital does not exceed 30,and the number of multidisciplinary consultation outside hospital does not exceed 10,which is not optimistic.the number of multidisciplinary consultation in Y hospital is much higher than that in X hospital.The number of multidisciplinary consultations in hospital Y is much higher than that in hospital X.The number of patients transferred from hospitals X and Y is gradually increasing,but the number of patients transferred to higher-level medical institutions in hospital Y is increasing year by year,so the service capacity of the hospital needs to be continuously improved.the number of bed turnaround in hospital Y is increasing year by year,so the bed turnaround is faster,but the utilization rate is low and the beds are not fully utilized.the utilization rate of beds in hospital X is high,but the number of turnaround decreases year by year.the average number of hospital beds in hospitals X and Y is less than 8 days.The average hospitalization days of both X and Y hospitals do not exceed 8 days,and the average preoperative hospitalization days of elective surgery do not exceed 3 days.5.3 physician visits per day in 2020 for X hospital and4.2 for Y hospital are lower than the average of Yunnan Province.(3)Quality of health care outcomes: Hospital X and Y will have an admission and discharge diagnostic compliance rate and routine diagnostic report accuracy rate of 97% or higher in 2019-2021.Total patient inpatient mortality and surgical mortality rates increased slightly.The average per-patient medical cost and average per-patient drug cost of hospital discharges increased each year.Patient satisfaction:patient satisfaction in all dimensions was significantly and positively correlated with overall satisfaction(P<0.01).Among them,service efficiency had the highest correlation coefficient with overall satisfaction,which was 0.845.The differences in overall satisfaction of hospital environment,service efficiency,medical technology and medical costs in hospitals X and Y were statistically significant(P<0.05).Hospital X had the highest service attitude score with a score of 4.32;Hospital Y had the highest service attitude and personalized service scores with the same score of 4.18;both hospitals had the lowest service efficiency scores with 4.04 and 3.97,respectively.The differences in satisfaction scores of outpatients with different educational levels were statistically significant(P< 0.05),and the overall satisfaction scores of patients with elementary school and lower education and junior high school education were lower than those of college or bachelor’s degree patients.Job satisfaction of medical and nursing staff: the overall satisfaction score was 4.12.Workload satisfaction score was the lowest,at 3.68.Satisfaction of medical and nursing staff in each dimension was significantly and positively correlated with overall satisfaction(P<0.01).Work environment and doctor-patient relationship had the highest correlation coefficient with overall satisfaction,both at 0.830.The difference in satisfaction scores of medical and nursing staff by gender was statistically significant(P<0.05),and the overall satisfaction scores of female medical and nursing staff were lower than those of men.Compensation(75.3%-75.7%),safety of practice environment(51.5%-55.0%),and social trust and respect(34.7%-39.6%)were the three main factors affecting the satisfaction of health care workers in practice.Inadequate communication with patients(74.3% to 77.5%),high patient expectations(50.5% to 51.4%),and lack of patient trust in healthcare professionals(46.9% to54.5%)were the three main factors that healthcare professionals perceived as more influencing the doctor-patient relationship.Discussion(1)The structural quality of medical services has generally improved,but human resources,medical equipment,infrastructure,and information technology levels need to be improved.(2)The quality of medical service process has continued to improve in recent years,but there is still a large gap between the medical service capacity and work efficiency and the new expectations of the people.(3)The quality of medical service results has improved steadily,but medical safety still has hidden dangers to a certain extent,and there is still more room for improving medical costs and satisfaction.Countermeasures(1)policy-oriented,in-depth implementation of county-level general hospitals to improve quality and meet standards(2)Taking quality as the lifeline and continuously improving medical service capacity and efficiency;(3)Taking quality improvement as an opportunity to reasonably allocate medical facilities and equipment,vigorously promote the construction of information technology,and improve the environment for patients to seek medical treatment;(4)Take talents as the first resource,increase the number of health technicians and improve the comprehensive quality of personnel.Improve the welfare treatment of medical and nursing staff and improve the promotion mechanism;(5)Optimize the process of medical treatment and improve service efficiency;(6)Use humanistic services as a medium to build a harmonious doctor-patient relationship.