Management Of Medical Institutions Research Articles

Healthcare institution efficiency: Meta-analysis and case study

The article analyses the factors that influence the efficiency of a medical institution. The VOSviewer bibliometric analysis allowed to identify four main clusters that determine the dominant areas of scientific research related to the topic of the medical institution efficiency. The largest cluster was the one describing the relationships between factors that directly determine the healthcare facility efficiency (decision-making, use of information technologies (artificial intelligence, blockchain, Internet of Things, etc.), effectiveness of solving medical problems of patients, etc.) The second largest cluster combines research areas related to the organisation, management, standardisation, audit, professional development, quality and productivity in healthcare facilities. The third and fourth clusters are related to the service and resource components in ensuring the efficiency of a medical institution, respectively. The article presents various approaches to classifying performance indicators of a medical institution: by type of performance, by form, by costs, by measurement of results, by scope of work, by stages. The national approaches to the medical industry development in the UK, Ukraine and Germany are analysed. The mechanisms for decentralising the management of medical institutions, increasing their autonomy, productivity and quality of medical services are described on the example of Ukraine. Using the pattern of a typical medical institution in a small city of Ukraine, the mechanisms for increasing efficiency are analysed: in terms of staffing, patient care, financing, corporate culture, patient-centeredness, and control over financial flows separately for each level of medical care. Priority steps to improve the infrastructure support of the subject of analysis, possible measures to improve the quality of medical services, the preferred resources for financing the planned measures, the implementation period and the expected results of proposed measures are identified. From the theoretical point of view, this article deepens knowledge about the nature of the medical institution efficiency. From a practical point of view, recommendations and ways to improve the medical institution efficiency make it possible to form a roadmap for promising changes. Their implementation will increase the primary healthcare facility efficiency and ensure a vivid rise in the medical provision efficiency at the secondary level in the short and medium term.

Level of awareness managers of medical institutions and health care bodies of Lviv Oblast regarding the theoretical foundations of non-infectious diseases (according to the results of a sociological study)

Introduction. Since the implementation of ″Epidemiological transition concept″ (Abdel R. Omran, 1971), the predominance of non-communicative diseases (NCDs) among the population of European Union member states turned to reality that has been a heavy burden for the population, in the context of both individual and public health, as well as on life expectancy, economic and defense resources of countries. It is noteworthy that NCDs are strongly dependant on the behavior of each particular person, outlining its lifestyle due to existing risk factors. Taking into consideration total growth of NCDs in Ukraine since 1991 (the period of independence) by nNCDs = +1.5 times and their influence on the decreased count of country`s population (NNCDs = 80.3 ± 0.9 % of the total number of dead), the purpose of present investigation was to elucidate the level of awareness of Lviv Region heath care chief executives in the context of existing predominance of NCDs and its consequences. Materials and methods. General, applied, analytical-descriptive, monographic/single, medium-term, continuous sociological investigation was conducted using the elaborated “Questionnaire for studying the state of doctor`s awareness regarding the presence of non-communicative diseases in Ukraine” among post graduate students of specialization cycles and thematic improvement in the specialty “Organization and management in health care” of the Department of Public Health of the Faculty of Post Graduate Education of Danylo Halytskyi Lviv National Medical University in 2022 (∑ participants n = 327/Р = 100%) of total count of Lviv region health care chief executive officers (∑n = 392). The survey, compilation and processing of the available sociological material was carried out by the author with the research methods based on the principles of systematicity and corresponding to the Passport of the specialty 14.02.03 Social medicine. Results. It was established that М = 80.4 ± 0.3 % (n = 263) of respondents understand the essence of the concept of “Non-communicative diseases”; М = 40.1 ± 0.2 % (n = 131) of the respondents disclosed the content of the epidemiological transition from infectious to chronic diseases, which radically changed the structure of mortality by causes. The obtained results indicate that М = 98.2 ± 0.3 % (n = 321) of the respondents associated NCDs group with diseases of the circulatory system [I00-I99], while neoplasms [С00-D48] and mental and behavioral disorders [F01-F99] were attributed respectively to М = 85.0 ± 0.3 % (n = 278) of respondents and М = 75.2 ± 0.3 % (n = 246) of respondents; diabetes [E10-E14] was associated with M = 85.0 ± 0.3 % (n = 278) of respondents, while chronic diseases of the lower respiratory tract [J40-J47] were counted by M = 63.6 ± 0.2 % (n = 208) of the total number of participants (n = 327). Conclusion. The results testify low level of knowledge on the theoretical background of NCDs among the chief executives of health care institutions and bodies of Lviv region. This requires the implementation into learning curriculums of the existing departments of health care management and of clinical directions, in both pre- and post-graduate levels electives/cycles concerning the epidemiological transition concept on the predominance of non-communicative diseases (NCDs) and on its impact on current health care management to minimize negative consequences.

Assessment of the Financial Stability of the Diagnostic-consultative Centres in Varna

The Diagnostic-Consultative centres' management teams can benefit from applying financial analysis methods. One of these methods is the calculation of Altman's Z-score. This analysis can be vital in guiding management decisions to improve financial stability and thus contribute to high-quality medical services. Our study aims to assess the financial stability of the diagnostic-consultative centres in Varna based on the calculation of their Altman Z-score. The study design includes all nine Diagnostic-Consultative centres (DCC) in Varna- 6 of which are municipally owned, two are privately owned, and one is state-owned. The study period is 2018-2021, and for each year of the period and each of the medical institutions, based on information from their financial reports, Altman Z-score was calculated. For one of the DCCs, with private ownership of the capital, the necessary information to calculate the indicator is missing, so it is excluded from the study. The results show that the DCCs with a Z-score lower than 1.8 for 2018 are five, four for 2019, and three for 2020 and 2021. For six of the eight analysed healthcare centres, the indicator's value increased over the period, and the financial situation improved and stabilised. The average value of the indicator for the whole group of medical institutions increases from 0.25 in 2018 to 2.84 in 2021. The indicators used in calculating the Z-score are critical in determining the financial health of medical institutions, so the dynamic of the Z-score is an essential indicator that the management of medical institutions should monitor.

의료기관의 경영관리를 위한 대학의 회계교육에 관한 연구

With the rapid development of the medical industry, competition in the medical market is gradually intensifying. However, due to the negative perception of business performance management of medical institutions and the lack of professional manpower, business performance management of medical institutions is insufficient. Research on business performance management of medical institutions is insufficient, and research on business performance management personnel of medical institutions is even more insufficient in the future. Accordingly, this study was conducted to understand the relationship between the characteristics of accounting education, learning flow, and learning outcome of college students majoring in hospital management, who will become key talents in business performance management of medical institutions in the future.
 As a result of the study, it was found that there was a significant influence relationship between the characteristics of the educational environment, learning flow, and learning outcome of university accounting education. All three detailed factors for the characteristics of the educational environment (school educational environment, professor's teaching technique, and computer accounting software) were found to have a significant positive effect on learning outcome through learning flow. Through the results of this study, it will seek ways to improve students' studies and be used as basic data for establishing effective educational techniques for accounting education.

К ВОПРОСУ О ПОДГОТОВКЕ СТАНДАРТОВ ОПЕРАЦИОННЫХ ПРОЦЕДУР В АСПЕКТАХ ОБЕСПЕЧЕНИЯ БЕЗОПАСНОСТИ МЕДИЦИНСКОЙ ПОМОЩИ

Among the key performance indicators of the health care system, the priority is to ensure the 
 quality and safety of medical care. State regulation of these aspects of medical activity is certainly necessary, 
 however, the regulations adopted at this level define the principles and foundations, which, in order to ensure 
 their rigorous implementation, in most cases are subject to substantive detailing and development in local acts.
 In practice, the creation of comprehensive standards for each specific treatment and diagnostic process 
 and operation is the prerogative and duty of the management of medical institutions. With the adoption in 2021 
 of sanitary and epidemiological requirements for the prevention of infectious diseases, the obligation to stand ardize operational processes is enshrined in law. At the same time, due to the lack of an approved development 
 procedure and the form of standard operating procedures, the search for an optimal approach to the implementation of this quality management tool continues.
 The authors believe that the implementation of the development of standards of operating procedures 
 should be carried out on the basis of the regulations for interaction within the framework of diagnostic and 
 treatment processes, in turn, formed in accordance with the current state regulations in the direction of medical 
 care. According to the authors, the effectiveness of standards of operating procedures in terms of ensuring the 
 quality and safety of medical care and the introduction of the principle of lean operation into the work of a 
 medical organization, among other things, largely depends on the regulation of the training processes for performers, control and evaluation system for the performance of standards of operating procedures.
 The paper presents a possible approach to the process of developing a standard of operating procedures 
 as the basis of a quality management system for medical care

Отношение врачей к применению телемедицины в детской стоматологии

Currently, favorable conditions are being created in the Russian Federation for the development and effective use of telemedicine in healthcare. Options for the use of information and communication technologies in pediatric dentistry are: telemedicine consultations, consultations, distance education of medical workers, medical education and preventive activities among the child population. The aim of the research as part of the dissertation work, the research was aimed at studying the attitude of dentists to the use of telemedicine technologies in pediatric dentistry. Materials and methods. The process of studying the attitude and readiness of pediatric dentists to use telemedicine technologies was aimed at identifying individual (micro) and conceptual (meso- and macro) factors affecting the use of medicine in pediatric dentistry. The study included a semi-formal interview and questionnaire. Results. As a result of the research on the sections: Telemonitoring – remote monitoring of patients, including outpatient management of patients; storage and transmission of medical data; interactive telemedicine, it was found that doctors in Tver and the Tver region have both positive and negative beliefs and opinions that can promote or hinder their use of telemedicine in their professional practice. Conclusions. Research with the participation of pediatric dentists will help both developers and managers of medical institutions to understand the limitations and advantages of technologies from the point of view of practicing pediatric dentists, will allow predicting its development. The results of this study will contribute to solving the problems of implementing telemedicine services, contribute to the rational development of telemedicine platforms in pediatric dentistry in Tver and the Tver region.

Experience of domestic and foreign healthcare by appointment of specialists without medical education to the head positions of medical institutions (literature review)

Following the special attention of foreign colleagues to appoint doctors as hospital managers, the issue 
 of appointing specialists without medical education to the management of medical institutions in Russia is increasingly being looked at and discussed. 
 The purpose of the study is to analyze historical and modern literary sources that highlight the experience of domestic and foreign healthcare by appointing specialists without medical education to the head positions of treatment and preventive medical institutions.
 The analysis of literary sources from 1940 to 2021 was carried out in electronic scientific libraries: Scopus, Web of Science, MedLine, eLibrary, CyberLeninka, Central scientific medical library and the Russian State Library by keywords: manager, physician, physician leadership, hospital CEO
 The article presents historical data on the formation in Russia since the beginning of the 18th century of the first medical institutions for the needs of the army and navy and the appointment of doctors to senior positions in them. From 1755 to 1908, the management of military hospitals was temporarily transferred to specialists without medical education, which led to numerous conflicts and a decrease in the efficiency of hospitals. Currently, in a number of foreign countries, in order to improve the quality of medical care, the issue of transferring managerial functions to doctors in hospitals is being actively discussed.
 The main reasons for the discussion about the expediency of appointing specialists to senior positions in medical institutions without medical education are: shorter terms of their training; health care activities in market conditions; the need for modern managers to possess leadership, managerial, economic and legal competencies.
 Conclusion. The work experience of domestic and foreign health care indicates the expediency of appointing doctors with leadership qualities and special training in the field of healthcare institutions and public health to senior positions in medical institutions. This contributes to the formation of a corporate culture in medical teams and improving the quality of medical care for the population.

ОРГАНІЗАЦІЯ КОРПОРАТИВНОГО СТИЛЮ МЕДИЧНОГО ЗАКЛАДУ: ФУНКЦІЇ ТА СКЛАДОВІ

Today's realities require medical institutions to take more careful account of intangible factors that make up an irreplaceable component of cultural characteristics. Changes in the socio-economic conditions of economic activity have led to increased attention of the management of medical institutions to the need to form a corporate style that will provide additional competitive advantages. The purpose of the study is to identify the functions and elements of the corporate style of a medical institution and its subdivisions, to find out its impact on the collective consciousness and behavior of consumers of medical services and to establish requirements for its development. The methodological basis of the study is modern research on the formation of corporate style and its impact on the reputation and successful development of organizations. The main hypothesis of the study is the assumption that corporate style influences the level of recognition and authority of a medical institution. Summary of the main research material. It is proved that an authentic, working corporate style for a modern medical institution is a necessary element of its organizational culture. It is determined that the corporate style contributes to creating a positive image of a medical institution in the eyes of consumers; allows distinguishing a medical institution from other medical institutions with a similar range of services; strengthens the organizational spirit of medical staff; increases the effectiveness of advertising; and creates a favorable image of a medical institution. The originality and practical significance of the study lies in the fact that a comparative analysis of the elements of corporate style of city clinical hospitals in Dnipro, which are clearly implemented on the official pages on the Internet, was carried out. Conclusions and prospects for further research. The conducted research has made it possible to state that the considered medical institutions of the city of Dnipro do not pay the necessary attention to the formation of their own corporate style. Sporadic initiatives and events create the appearance of the existence of a corporate style of a medical institution, but do not ensure the existence of such a corporate style that would work to increase the recognition and authority of a medical institution

THEORETICAL APPROACHES TO THE MANAGEMENT OF THE STRATEGIC DEVELOPMENT OF MEDICAL TREATMENT INSTITUTIONS

Topicality. Reforming the modern health care system requires comprehensive strategic measures that will contribute to increasing the effectiveness of the management of the strategic development of medical institutions. The market of medical institutions is an important component in the structure of the market of medical services, evidence of this is the intensive development and expansion of not only medical, but also cosmetic services, improving their quality and level of service. Therefore, there is an urgent need to determine the essence of managing the strategic development of medical institutions.
 Aim and tasks. To determine the fundamental theoretical approaches to understanding the essence of managing the strategic development of medical institutions.
 Materials and methods. The material for the research was the results of fundamental scientific works in the medical field, as well as materials for their planning in medical institutions. The main achievements of foreign and domestic science in the medical field, strategic planning of its development and the application of the principles of strategic management of medical institutions became the theoretical and methodological basis of the research. The work uses the methods of structural and logical analysis of the research, which will allow to highlight, logically structure and establish connections between the implementation of a unified medical information system and the result of the work. Statistical methods, including retrospective and prospective analysis, were used to study the competitive advantages of drug treatment. A problem-oriented method was used for the scientific substantiation of strategic directions for solving management issues.
 Research results. The level and quality of the provision of medical services characterizes the sustainable development of the country, because other areas cannot develop fully if the health care system is at a low level. The formation and development of strategic management is a significant part of corporate management not only of a manufacturing enterprise, but also of health care institutions, and it acquires an especially important role in the conditions of reforming medicine, with the aim of further obtaining social, therapeutic, financial and economic competitive advantages in the medical market services Without effective medical care, citizens are not interested in solving secondary problems, because the issue of preserving and maintaining health always comes first. With the spread of market development priorities, the management of medical facilities is gaining importance.
 Conclusion. Management of the strategic development of medical institutions is aimed at introducing new medical technologies, increasing the level of professional training of medical personnel of medical institutions, and improving the quality of medical care using the latest technologies.

Diagnosis-intervention packet-based Pareto chart of the proportion of high-cost cases and the analysis of the structure of hospitalization expenses.

In order to prevent the occurrence of high-cost cases, it is necessary to know the proportion of high-rate cases and the hospitalization cost of patients. Through the analysis of the high-rate cases of various specialties in a first-class hospital in a province, the profit and loss situation of medical institutions under the diagnosis-intervention packets (DIP) payment reform was discussed to seek a more effective way of medical insurance payment reform. Data of 1955 inpatients who participated in DIP settlement in January 2022 were retrospectively selected. The Pareto chart was used to analyze the distribution trend of high-cost cases and the composition of hospitalization expenses in each specialty. The high-cost cases are the main reason for the loss of medical institutions at the time of DIP settlement. Neurology, respiratory medicine and other specialties are the focus of high-cost cases. The cost composition of inpatients with high-cost cases is in urgent need of optimization and adjustment. DIP payment method can control the use of medical insurance funds more effectively, which is the guarantee for the refined management of medical institutions.

Clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection.

To analyze the clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection, a total of 360 diffuse large B-cell lymphoma patients with disease recurrence or progression after first-line treatment were retrospectively selected from our hospital from January 2021 to July 2022. After standardized nursing, the overall infection rate of lymphoma patients was 2.50% (9/360), which was significantly lower than the overall infection rate of our hospital in 2021 (7.44%, 844/11342) (P < .05). The proportion of 3 kinds of pathogenic bacteria detected were G+ bacteria (33.5%), G- bacteria (53.3%), and fungi (13.2%). The pathogenic bacteria genus with the most G+ bacteria is Enterococcus, the pathogenic bacteria genus with the most G+ bacteria is Enterobacteriaceae, and the pathogenic bacteria with the most fungi is Candida albicans. Female infection rate was significantly higher than male (P < .05). There was no significant difference in nosocomial infection among different marital status/fertility status (P > .05). The nosocomial infection of patients with different hospitalization times was statistically significant (P < .05). The duration of hospitalization in the infected group was significantly higher than that in the non-infected group (P < .05). The clinical effect of standardized nursing for lymphoma patients is significant, and the influencing factors of nosocomial infection include patient gender, hospitalization frequency, and hospitalization duration.

Один из подходов решения противоречивых задач «мягкого моделирования» управления медицинским учреждением

The article is devoted to the problem of both classification of contradictory conditions in management problems in medical institutions and their solution using the method of committees. In previous studies, it was found that medical problems require the use of “soft modeling” methods, which is often reduced to solving systems of linear equations and inequalities due to its difficulty in formalizing. This is where restrictions of various kinds arise. The purpose of the work. The purpose of this work is to study the contradictions in solving the problems of management of medical institutions, as well as the possibility of eliminating them using the committee method, as well as the approach of building the most joint subsystems. Materials and methods. It is proposed to use the method of maximally joint subsystems modified for the design of the problem, due to the probability of the model, that is, when the state vector is considered to be some random vector (random variable). Here, a situation arises related to the uncertainty principle, which is well solved with the help of the p-committee. The considered methods show effectiveness, since the approximate solution of an incompatible system turns out to be quite close to the true one. However, the classification of contradictions reveals new problems related to the dimension and number of members of the minimum committee. The results of the study. In the course of formulating the types of contradictions, it becomes clear that the problem of the number of members of the committee is reduced to the already solved problem of building maximally joint subsystems. Which, on the one hand, fully justifies the approach considered by the authors, and on the other hand makes it quite simple in the conditions of modern digitalization, since solving systems of linear inequalities is not time-consuming for modern computer programs. Discussion and conclusion. The results obtained allow us to assert that the use of “soft modeling” in the management of medical institutions is simpler, since it is reduced to clear and simple systems of inequalities, albeit incompatible, but this problem is solved using the method of committees. Howe¬ver, it is worth noting that in the end the problem has simple solutions when using convex functions, and the question remains open, in the general case.

The influence of psychological characteristics on managers efficiency within medical institutions during the COVID-19 pandemic.

This article examines the theoretical and practical aspects of the activity of medical managers, the social and psychological climate within teams, and interpersonal relations. The goal of the study was to investigate the interpersonal interaction styles and intragroup relations between team members and managers, as well as to determine the impact of managers' psycho-emotional characteristics on their effectiveness during the COVID-19 pandemic. A total of 158 medical workers participated in the study, which was conducted in 2021 using a self-developed questionnaire. The expert evaluation method and standardized psychodiagnostic methods were used. We identified negative factors that affected the management of medical institutions during the pandemic, such as deficiencies in material and economic support, low levels of managerial competence, violation of collegiality and fairness principles during duties and rewards distribution, and deficiencies in manager recruitment. The most psychologically challenging aspects of managing or working in a medical facility during a pandemic include excessive emotional tension and stress, high levels of responsibility, lack of management experience and/or competence in crisis conditions, physical overload, work outside of working hours, and lack of adequate rest. A mini-personality profile of the effective manager of medical institutions in pandemic conditions was developed. One of the psychological regularities of a manager's performance identified is the presence of self-regulative skills in negative emotional states, pronounced activity and energy, mobility, and a strong desire for action.

The Effect of Emotional Labor on the Physical and Mental Health of Health Professionals: Emotional Exhaustion Has a Mediating Effect

(1) Background: Workers who perform emotional labor for an extended period are prone to emotional exhaustion; in particular, when the work exceeds the range of one's emotional resources, it will produce job burnout. This study investigated the effects of emotional labor and emotional exhaustion on the physical and mental health of health professionals. (2) Methods: This study was cross-sectional and the sampling criteria were health professionals from August 2020 to July 2021, including rehabilitators, nutritionists, clinical psychologists, radiologists, respiratory therapists, pharmacists, medical examiners and audiologists. A questionnaire was used to collect data on participants' emotional labor, emotional exhaustion, physical health and mental health. A total of 120 valid questionnaires were obtained. (3) Results: Significant positive correlations were found between emotional labor and emotional exhaustion, physical and mental health and anxiety. A hierarchical regression analysis found that the effect of emotional labor on physical and mental health increased the predictive power to 59.7% through emotional exhaustion, and emotional exhaustion had a mediating effect on the relationship between emotional labor and physical and mental health. (4) Conclusions: This study provides a reference for managers of medical institutions to care for employees' work stress and physical and mental health, which will help institutions build a friendly and healthy workplace.

Features of medical enterprise management in modern conditions

The article examines the problem of identifying characteristic differences in the implementation of management of medical enterprises in modern conditions. The terminological construct "modern conditions" in relation to the study of public management aspects in the field of health care covers the time period from 2015 to 2022. It has been confirmed that it was during this period that the domestic management system of medical enterprises underwent radical changes. It was established that the most characteristic differences in the implementation of the management of medical enterprises, compared to the previous period of sustainable development, were in the plane of strategic planning of the development of the medical industry; structural and functional restructuring of the network of medical institutions, as well as new approaches in the application of the economic mechanism of state management in the field of health care and digitization of management activities. It is argued that the start of the development of a new model of management of the national health care system is public recognition of the priority and necessity of implementing medical reform in Ukraine (2015). The implementation of the medical reform, which is recognized as the flagship of the development of Ukraine in the conditions of the European integration course, provided for the phasing of structural and functional changes in the management system. It has been proven that the course of the COVID-19 pandemic and the full-scale invasion of the Russian aggressor on the territory of Ukraine became challenges for the medical industry, which significantly slowed down the pace of its structural and functional restructuring. It was determined that the effectiveness of management of medical institutions in modern conditions is based on the principles of competitiveness and patient-orientation (quality, safety, availability of medical services). For this purpose, new management models of medical enterprises should be implemented on the basis of strategic planning; improve information and analytical support of management processes; increase the level of professionalization of medical personnel; implement international quality standards for the provision of medical services, etc.

Death-coping self-efficacy and its influencing factors among Chinese nurses: A cross-sectional study.

Nurses are the main caregivers of dying patients. Facing or dealing with death-related events is inevitable. Death-coping self-efficacy (DCS) is very important, as it can reduce the risk of nursing staff to adverse emotional distress, help them participate in end-of-life care and improve the quality of care of patients. Using the convenient sampling method, this study included a total of 572 nurses from a tertiary hospital in Hangzhou, China. The status and influencing factors of the DCS of nurses were explored using a general information questionnaire and DCS scale. The scores of each parameter, ranging from low to high, were in the order of coping with grief, preparation for death and hospice care. Factors influencing nurses' DCS included attendance in hospice care education courses within the previous year, experience of accompanying the family members of the deceased and attitude towards death. The overall self-efficacy of nurses in palliative care was at a medium level. Moreover, their self-efficacy in coping with grief and preparation for death should be strengthened. Managers of medical institutions can assess the death-coping ability of nurses, which helps provide corresponding support and training for nurses at an early stage. Nurses should receive guidance in grief adjustment and emotion regulation. Medical units should provide nurses with a platform for continuous training and education, use of death-related theoretical models and frameworks to guide nurses in dealing with death-related events, reduce nurses' negative mood and jointly promote their mental health.

A GENDER-ORIENTED APPROACH TO MANAGEMENT OF EMOTIONAL BURNOUT AMONG DOCTORS AND NURSES IN WARTIME

The study of emotional burnout syndrome manifestations in doctors and nurses is a topical issue, both among scientists, practical psychologists and among medical branch managers of different levels, especially in times of crisis conditions. The research of this phenomenon is actual all over the world: the detection of signs of emotional burnout varies from 20 to 75%; the number of scientific publications on this topic is constantly growing, so in 2010 104 works were published, and in 2021 already 952 works were published; the rapid growth of scientific research is observed. The war in Ukraine, which had not previously been on such a scale, affects everyone's life and physical and emotional well-being. In addition to physical exertion, medical workers have an excessive emotional burnout, as the authors' research shows - the burnout rate among general practitioners is 63,7%, and among nurses 70%. Therefore, it is necessary to investigate this phenomenon in stressful conditions, so that it is possible to develop recommendations and render psychological help to medical workers. The purpose of this article is to systematize the information on emotional burnout, to determine further ways of development and to establish dynamics of emotional burnout of medical workers before and during martial law. Relevance of our study is stipulated by that the control of this phenomenon manifestation allows to improve mental health and continuation of professional activity of the specialists and as consequence to improve medical services. Materials and methods: the analysis of the scientific literature on the international scientometric databases, questionnaire survey of general practitioners of CF CPMC. The authors have compared the models of emotional burnout and described the phases of this process. Attention was paid to factors causing and accelerating this process, and also characteristics of these factors were described, degrees of influence on acceleration of professional burnout process of separate factors were defined. The carried out research allowed to reveal problems at management of medical workers emotions, to define the factors causing violation of awareness and the control of displays of emotions, to find out a role of a medical institution management, methods of influence on the factors causing or strengthening process of emotional burnout. The results of the study of determination of negative manifestations of emotional reactions of medical workers in conditions of a military condition are reflected in practical recommendations for development of mechanisms of management of this condition. Practical value of the research is of recommendatory character for work of heads of a medical establishment.

Foreign experience of anti-crisis management of medical institutions

The main components of the crisis management system of medical institutions were highlighted. Crisis situations will be understood as the inability of medical institutions to provide the population with medical services on time due to lack of various resources.&#x0D; As a result of catastrophes, natural disasters, armed conflicts, crisis situations arise when medical institutions are not able to fully provide the population with medical services, there is a lack of funding, human and material resources. Ukraine is no exception, as the armed conflict in the East in 2014 and Russia's full-scale invasion of Ukraine confirmed the lack of sufficient labor, logistical resources and financial support to provide quality medical care to the population. In such conditions, there is a need to develop tools, means of overcoming crisis situations in healthcare facilities.&#x0D; The aim of the article is to systematize the recommendations for Ukraine on the formation of a system of crisis management of healthcare facilities.&#x0D; Materials and methods of the research. The basis for the study were provided by private clinics for analysis documents of financial and economic reporting for the pre- and post-crisis periods, as well as scientific works of famous Ukrainian and foreign scientists. The research used methods of analysis, comparison, medical and statistical method and system.&#x0D; The result of the study was an analysis of the state of funding for healthcare facilities in Ukraine and a comparative analysis with the state of funding for such facilities in other developed countries such as Italy, Germany, Sweden, France.&#x0D; Conclusions. The main components of the system of anti-crisis management of medical institutions in crisis conditions are: effective leadership, which is provided by managers and management staff; human resources; equal access to basic medicines, vaccines and technologies of guaranteed quality, safety, efficiency; a functioning health information system has been established; financing of healthcare institutions and their financial protection in case of crisis; the process of providing quality, safe and efficient medical services with minimal expenditure of resources. In most European countries, the basic functions of healthcare management (prioritization, financing, service delivery, supply planning, quality control) are decentralized and carried out at the level of regional or local authorities, or regional health insurance funds or trusts

Ways of developing quality indicators in cancer care — opportunities, challenges and limitations for the Polish healthcare system

The aim of this article is to present possible ways of developing quality indicators in oncological care in the Polish healthcare system based on practice from other countries. The development of indicators in the healthcare systems presented in this paper is a process following several stages. Initially, at the planning stage, the clinical area to be assessed is selected and teams responsible for developing the indicators are organized. This is followed by the development stage in which the measurement team prioritizes and selects clinical indicators on the basis of documentation and knowledge gained from the scientific literature. After selecting the target clinical indicators, the specifications for each measure are operationalized, along with inclusion and exclusion criteria for the target population, and data sources are identified. In each of the foreign healthcare systems analyzed, determination of the final indicators was preceded by extensive clinical and social consultations. The use of clinical indicators to assess quality is an important approach in the process of assessing the quality of cancer care. Thanks to the introduction of quality indicators, participants in the healthcare system (regulators, clinicians, patients, managers of medical institutions) can obtain reliable information that is necessary for defining priorities, modifying methods of determining benefits, benchmarking, making informed choices, and improving the quality of oncological care.

Management of medical institutions on context of provision medical and preventive care in COVID-19 condition

The aim of the study management of medical institutions in the context of providing medical and preventive care in conditions of COVID-19 is an urgent research problem because it provides detection of management’s effective mechanism in times of crisis. It was to identify the management’s peculiarities of medical institutions in the context of providing medical and preventive care in conditions of COVID-19. The article uses a qualitative content analysis method, a method of comparison, and a method of analysis of countries’ cases in the context of rendering medical and preventive care in Ukraine, Spain, Italy, Germany, and the Czech Republic. The article identifies the main elements of the health system management mechanism during the pandemic, which includes coordinated work by stakeholders to ensure a coordinated response to the emergency. The mechanism includes the organizational, legal, and financial components of cooperation between agencies and ministries of national, regional level, involvement international organizations in the process of development of policy and tactics, management crisis’ strategies. Strategic documents of the national level are one of the main elements of the management’s system.