Polish Healthcare System Research Articles

Standards of Value Stream Mapping as a tool supporting logistics processes in the healthcare system in Poland

According to the World Health Organisation (WHO) a health system consists of many components like organizations, institutions, resources, and people whose primary purpose is to improve health. The system is complex and requires staff, funds, information, supplies, transport, communications and overall guidance and direction to function properly. These elements interact with each other and, as in the logistics system, there are uninterrupted physical, decision-making and information flows between its most important elements, which include: service providers, service recipients (patients), a payer (the National Health Fund), control and supervision institutions, the Ministry of Health. The Polish healthcare system is struggling with many problems, such as insufficient access to health services, inefficient system management, shortages of medical staff, or underfunding. The use of Value Stream Mapping (VSM) standards can significantly contribute to the improvement of logistics processes of the Polish healthcare system. The standards can be also used to improve the processes of treatment of other diseases, but also the functioning of healthcare units.The aim of the article is to present the possibility of applying Value Stream Mapping standards in the process of ischemic stroke treatment as the results of the project ‘Lean Management in Healthcare’, implemented by the consortium consisting of the Medical University of Warsaw, the Institute of Psychiatry and Neurology in Warsaw and the Polish Society of Health Economics, financed by the National Centre for Research and Development under contract no. IS-2/200/NCBR/2015.

Patient outcomes through interprofessional partnerships

This in-depth conversation explores the dynamics of collaboration between pharmacists and nurses, with a special emphasis on pharmaceutical care (PhC). The investigation commences by clarifying the notion of PhC, emphasizing its professional, patient-focused, and inter-professional aspects. The story takes place in the framework of the Polish healthcare system and highlights the critical role that pharmacists play—a position that was further highlighted by the COVID-19 pandemic. But obstacles that have been found—from doubt to organizational difficulties—showroom deficiencies in the cooperative decision-making process between pharmacists and nurses, calling for a paradigm change. Extending the reach internationally, the discussion is consistent with the World Health Organization's recognition of nursing's comprehensive care, both independent and cooperative. Research demonstrates how collaborative efforts, such interprofessional medication reviews, can improve patient outcomes, lower errors, and raise the standard of care overall. Aspects of education highlight the deficiencies in nursing programs and stress the significance of identifying and maximizing nurses' contributions to pharmaceutical care in order to enhance patient safety and healthcare quality. The discussion ends by emphasizing how important it is to break down barriers via innovative professional viewpoints, educational changes, and legislative modifications.

Family doctors as healthcare coordinators. Matrix of family doctors' competences for unlocking health workforce potential - the case of Poland

The article presents the results of the research on the competences of family doctors in the Polish healthcare system. According to the 2017 bill on primary health care (PHC) introducing integrated care to PHC, family physicians are obliged to coordinate the care delivered to their populations and to manage the PHC teams. First contracts on integrated care with the National Health Fund have been concluded in 2022. 
 The regulation evoked the necessity of redefining the role of family physicians in the healthcare system. Before that they were habitually deprived of chances to manage the care they provide. The author claims that their role should be perceived as managerial. It is crucial for patients and decision makers to understand family physicians' role in the system and properly manage the PHC workforce, especially when new professions and functions are being introduced to PHC. The regulation is not clear enough in regard to the definition of healthcare coordinator and leaves space to terminological inconsistency and, as a consequence, inadequate use of health workforce potential. The observations that led to designing the research were shared and consulted with the PHC community (focus group consisted of family doctors and PHC facilities’ staff members from lubuskie voivodeship). The research has been shared within academia (results of each stage of the research have been published and peer reviewed).
 The author has developed the matrix of family doctors’ competences to show the scope of competences they demonstrate. It is an ordered aggregation of competences classified according to the roles performed by family doctors in the healthcare system. It includes the indication of classified sources of formal requirements of those competences (in brief: sources of competences). One of the six roles presented in the matrix is a healthcare coordinator. Comparative text analyses have been performed to assess the relation between the range of family physicians’ and healthcare coordinators’ competences. 
 The results show that family physicians have a full set of competences, including managerial, to coordinate the care, which means that they are predisposed to play the role of healthcare coordinator. The author proposes a precise competence-based description of the role of family doctor as a healthcare coordinator. The author further suggests introducing a new function of healthcare coordinator’s assistant. 
 Since one of the sources of competences included in the matrix are WHO’s recommendations on competence clusters for coordinated care the results of this research may be found particularly interesting by international audiences. Especially when the shift towards integration of care is common for most of the healthcare systems and many of them are in preliminary stages of introducing the changes when comparing practice is of great value. 
 The research will be followed by qualitative study of family physicians’ experience in playing the role of healthcare coordinator. The aim of this study is to develop a framework for competence training for family physicians delivering coordinated care.

Subjective assessment of occupational stress and mental health of nurses during the Covid-19 pandemic period

IntroductionHealth status, sickness absence, and nurses’ attrition have a direct impact on the quality of care provided and patients’ health outcomes. The Covid-19 pandemic exacerbated issues that existed within the Polish healthcare system prior to the pandemic, including staff shortages, low wages, and system inadequacies. The aim of this study was to investigate how nurses during the Covid-19 pandemic period rated the burdensomeness of job characteristics and their mental health status, as well as the correlations between factors directly caused by the Covid-19 pandemic and nurses’ subjective assessments of job characteristics and mental health.MethodThe cross-sectional study was conducted in January 2022, in Poland and involved 796 registered nurses working in hospitals.ResultsDespite the pandemic’s sweeping societal effects, this research finds limited alteration in nurses’ perceptions of job stress and self-assessed mental health. Factors such as contact with infected patients, quarantine, and isolation do not appear to substantially modify mental health perceptions among nurses. Intriguingly, nurses subjected to COVID-19 testing report heightened stress and compromised mental health.ConclusionThe interplay of diverse factors influencing the well-being of nurses is intricately complex. It is advisable to prudently execute interventions and strategies to address the pandemic, aiming to alleviate its potential adverse effects on the mental health of nurses.

System ochrony zdrowia w Polsce a turystyka

Health care system in Poland and tourism The aim of the study was to analyze the Polish health care system from the perspective of its use by outbound and inbound tourists. Health care facilities are part of the supporting facilities in tourism. This type of infrastructure primarily serves local residents, but also determines the proper organization of tourism at the destination. With regard to tourism, this infrastructure is used by people before their travels, mainly for preventive purposes, tourists staying in a particular destination, as well as those returning from trips (e.g., requiring further treatment). In connection with health prophylaxis preceding the trip, attention was paid to the activities of the Polish Society of Maritime, Tropical and Travel Medicine together with the National Network of Travel Medicine Centres. In addition to the data obtained from this association, information from the Central Statistical Office and the System and Implementation Analyzes Database, as well as data obtained from the National Health Fund, were used in the research procedure. However, despite the presence of increasingly available data, there is still much work to be done in developing knowledge about travel risks and preventive measures related to travel to another country.

Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare

Poland has a unique history of traditional Chinese medicine (TCM) dating back to the 17th century when Polish missionary Michael (Michał) Boym was a pioneer in the field. In the 20th century, his successor, Professor Zbigniew Garnuszewski, reintroduced acupuncture to medical practice in Poland. However, other methods of TCM and its holistic approach to patient care have not found their place in modern medicine in Poland. At present, the legal status of TCM in Poland remains unregulated, with TCM included in the broad spectrum of complementary and alternative medicine (CAM) practices. Few reports are available on the use of TCM methods among the Polish population. Integrative medicine combines conventional medicine with evidence-based CAM interventions and considers all aspects of a patient’s health, including physical, emotional, mental, social, and environmental factors. An integrative healthcare model that incorporates TCM modalities and lifestyle recommendations as well as a whole person approach may provide a more sustainable solution for the constantly underfinanced Polish healthcare system, which faces challenges of multimorbidity in an aging society and limited access to care. The coronavirus disease 2019 pandemic, war in Ukraine, and ongoing climate crisis have underscored the need to strengthen the resilience of the Polish healthcare system and search for new solutions. A model of care that blends the best of biomedicine and TCM healing approaches may be a better option for both patients and the healthcare system in Poland.Please cite this article as: Rybicka M, Zhao J, Piotrowicz K, Ptasnik S, Mitka K, Kocot-Kępska M, Hui KK. Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare. J Integr Med. 2023; 21(6): 509–517.

Challenges in Job Seeking and the Integration of Ukrainian War Refugee Healthcare Workers Into the Polish Healthcare System: Facebook Content Analysis.

Objectives: The full-scale Russian invasion of Ukraine resulted in a refugee crisis. The terms of employment of Ukrainian Refugee background Medical Professionals (UKR-MPs) in the Polish healthcare system were liberalised. The aim of the study was to identify challenges in job seeking and the integration of Ukrainian war refugee healthcare workers into the Polish healthcare system. Methods: A qualitative, descriptive study based on content thematic analysis of Facebook content. We analyzed 1,700 posts published on two public Facebook groups intended for UKR-MPs. Results: The most common problems encountered by UKR-MPs were: 1) lack of easy-to-understand information about the list of documents necessary to apply for a work permit, 2) lack of feedback from those responsible for handling individual cases, and 3) long waiting time for the decision issued by the Ministry of Health. Conclusion: Despite the promptly implemented solutions enabling access to the job market by UKR-MPs, the refugees have encountered considerable administrative difficulties, as well as those arising from insufficient knowledge of the regulations on working as medical professionals in Poland under the EU law.

I Choose Health. It is OncoLogical!—Informative and Educational Campaign Dedicated to the High School Students in Poland

Cancer is the second most common cause of death in Poland and the number of new cases is expected to increase by 28% over the next 10 years. Despite modifications and expenditure growth in the Polish health care system, oncological treatment outcomes are lower comparing to the other European Union countries. Early preventative interventions are effective in reducing the total number of cancers and improving early detection. OnkoLogika is an educational campaign launched in 2016 by the Comprehensive Cancer Centre, aimed at improving cancer awareness. One hundred and twenty students from 25 high schools of the Lower Silesia region in Poland participated in the OnkoLogika program, which consisted of four-segment workshops containing pre-/post-tests, theoretical and practical parts within the project. The mean number of correct answers from the both tests improved after educational intervention (p < 0.001). Students’ knowledge increased, especially in relation to risk factors of breast cancer development (416.31% increase), HPV-related cancers (344.81% increase), risk factors and red flag signs of skin melanoma (120.31% and 99.05% increase respectively). Approx. 86% of participants were satisfied with the OnkoLogika with 14% of respondents being dissatisfied and 94% declared increased awareness about cancer prophylaxis. High schools students indicated insufficient time (250; 16.67%) and lack of details considering presented cancers (80; 5.33%) to be the major weaknesses of the program. Nevertheless, 94% of participants would recommend OnkoLogika to a friend. OnkoLogika promotes healthy lifestyle and helps acquire necessary knowledge about chosen cancers.

The Ukrainian refugee crisis: its ethical aspects and challenges for the Polish healthcare system – a descriptive review

Since the start of the Russian Invasion of Ukraine on 24.02.2022, millions of people (mostly women and children) have fled Ukraine. Majority of them fled to Poland and providing adequate medical care for the massive influx of refugees is a considerable challenge for the Polish healthcare system, already burdened by the COVID-19 pandemic and staff shortages. The purpose of this study was to identify: the potential health problems of the incoming population, the legal and ethical aspects of the refugee crisis and its implications on public health. Combining the current data with previous research on refugee crises reveals a set of issues that need to be addressed. Ensuring continuity of chronic disease treatment, mental health, the risk of spreading vaccinable preventable diseases, high rates of tuberculosis, HIV and the ongoing COVID-19 pandemic are among the main concerns. In the near future, answers will have to be found to the emerging ethical questions of equal, safe access to care, implications of the language barrier, immunisation coverage, medical staff shortages, and existing legal and ethical regulations. As the emergency responses are addressed, the hosting countries need to prepare long-term resolutions.

The Functioning of the Polish Health Care System During the First Wave of the SARS-CoV-2 Pandemic in the Opinion of Primary Health Care Patients

The Functioning of the Polish Health Care System During the First Wave of the SARS-CoV-2 Pandemic in the Opinion of Primary Health Care Patients

"We are in this together" - Polish midwives' reflections on perinatal care for Ukrainian women after the outbreak of war.

February 24, 2022, the beginning of Russia's invasion of Ukraine, was also the beginning of an exceptional situation and a challenge for the Polish health care system, the health care workers and Polish citizens. This study aims to conduct a qualitative analysis of midwives' experiences of maternity care for Ukrainian women after the outbreak of war. Eight midwives with experience working with both Ukrainian patients and Ukrainian war refugees (who came to Poland after February 24, 2022) participated in a semi-structured interview. The interview data were transcribed and thematically analysed to identify the observations, challenges and medical personnel needs. The most frequently observed reactions in Ukrainian patients included crying, increased anxiety and irritability, fear, withdrawal, and constant information seeking about the current situation. Breastfeeding problems understood as a consequence of chronic stress were also observed and assisted by the midwives. All respondents pointed out the language barrier and their involvement, showing empathy and attentiveness to the patients' situation. No hospital introduced additional support for midwives. A high level of emotional burden on midwives was observed. The midwives were eager to help Ukrainian patients - they emphasized the more frequent need to make themselves available for them. However, the emotional involvement of the midwives is accompanied by the risk of traumatization and burnout, which are associated with exposure to the difficult experiences of patients. Implementation of training in trauma-informed care and supervision could support midwives in their work and prevent the consequences of long-term stress. Systemic solutions concerning translators' presence and hospital documents' translation are also essential.

Value-based medicine as an opportunity for the Polish health care system in a post-pandemic reality on the example of selected health programs

The article aims to present the concept of value-based medicine (VBM) in the Polish health care system. The author reviewed the literature on the subject and formulated a research problem and two research questions to solve it. The issue of considering is health programs of the National Health Fund based on value. The author used professional scientific databases: Taylor &amp; Francis online, PubMed, and Google Scholar to collect the bibliography. The literature on the subject covers mainly the years 2020–2022. First, the author presented the study’s theoretical framework by defining the EBM and VBM concepts, discussing the three main pillars of VBM, and highlighting its value limitations. Next, the author referred to the coronavirus pandemic and its impact on global health systems. The author characterized the current state of the health care system in Poland and listed its prospects for the post-pandemic future. Finally, the author presented three selected health programs based on the VBM model implemented in Polish healthcare: comprehensive coordinated care after myocardial infarction (KOS‑Zawał), POZ PLUS model, and comprehensive treatment of chronic wounds (KLRP-1 and KLRP-2). Of course, the discussed programs require further improvement and modification and may constitute the basis for developing other, new value-based programs. The value-based medicine model can complement the three branches of medicine — evidence-based, narrative, and integrative. Including these elements in the VBM model could benefit the entire health system, primarily medical staff and patients.

Digital transformation of healthcare and job roles changes

Changes in the healthcare system are triggered by, among other things, technological developments. As such, have a correlative effect on changes in the approach to task performance of healthcare professionals. One of the other reasons for changes affecting individuals among health care personnel is also the sense of transformation of the roles undertaken by them from classically accepted to being oriented by current needs and situations. This paper presents the results of a study related to such situation in the Polish healthcare system based on quantitative results of questionnaire survey distributed to staff at selected healthcare facilities countrywide.

Selected Medical and Legal Problems of a Surgeon’s Assistant as a New Speciality in the Polish Healthcare System

On 26 November 2021, a new speciality concerning surgical physician assistance (Polish: chirurgiczna asysta lekarza) was introduced in a regulation of the Polish Minister of Health. The term ‘surgeon’s assistant’ refers to an independent healthcare professional authorised to perform certain medical and surgical procedures under the supervision of a specialist surgeon. Undoubtedly, the successful introduction of this new speciality depends primarily on the appropriate training process. Then, it will be necessary to change the internal procedures existing at medical facilities, to ensure that the work of surgeon’s assistants is organised properly and enables their effective cooperation with other qualified practitioners. The introduction of a new speciality is a great challenge for hospitals, surgeons and society in general. It requires taking many additional legal and organisational measures by hospitals as well as at the national level.

Assessment of the Health Care System in Poland and Other OECD Countries Using the Hellwig Method.

The health care system is a key element in the functioning of any country. However, depending on the level of funding, the number of medical staff and their availability, there are significant discrepancies in the health care systems of different countries. This article presents a picture of the Polish health care system compared to the systems of other selected OECD countries. The comparison was made on the basis of selected indicators concerning financing, medical and nursing staff as well as patient satisfaction with the availability and quality of healthcare. The aim of this article is to analyze the Polish health care system and compare it with other selected OECD countries' health care systems. A literature review, secondary data analysis and statistical analyses were used as the research method. The ranking was prepared using Hellwig's linear ordering method. Ten indicators related to financing, medical and nursing staff, and residents' opinions on the availability and quality of medical services were selected for the analysis. The presented results clearly indicated that Norway, Germany and Switzerland have the best health care systems. The Polish system takes one of the last places in developed classification. The conducted analysis indicates the need to introduce changes to the health care system and the need to implement solutions from countries where health care systems have been indicated as the best.

How to ‘Discover the Beauty of Life’ in / against the Disease? Musicology in the Therapy for the Elderly with Oncological Illnesses

Abstract Cooperation between the Institute of Musicology of the University of Warsaw and ‘Jestem’ Foundation began in 2013. The Foundation aims to support adults (especially elderly people) with chronic or terminal illnesses. The so-called ‘hour on beauty’, the Foundation's innovation introduced as part of the schedule of activities for patients, takes the form of weekly meetings with interesting persons (journalists, actors, travellers, etc.), and in the last several years – also with students of musicology. Cooperation involves regular facultative classes at which teams of musicology students prepare educational-therapeutic projects subsequently implemented at the Foundation's seat as part of the ‘hour on beauty’. The paper presents the model of cooperation worked out over the years and examples of original projects implemented by musicology students. The diversity of topics has been discussed here along with effective methods of patient activation (such as task-oriented listening, joint singing, and improvisation using everyday objects). The Foundation's work fills a gap in the Polish health care system resulting from the National Health Fund (NFZ) only financing stationary and home-based hospices but not designating any resources for day-care hospices targeting those oncological patients who need not be permanently hospitalised. The Foundation strives to prevent their exclusion and to improve the quality of their lives as well as their well-being. The benefits of the cooperation are invaluable. There is no doubt that this project (innovative on the Polish scale) reveals a new and potentially surprising function of musicology in the contemporary world.

Health Care Systems on the Brink of Failure – The Impact of War on the Pattern of Emergency Health Care Visits by Ukrainian Refugees in Poland

Background/Introduction:One of the most severe outcomes of the Ukraine war has been the systematic destruction of communities resulting in mass migration of people to Poland. Millions of affected people have arrived in Poland as war refugees requiring medical attention from a fragile health care system overburdened by the COVID-19 pandemic. This study assesses ED utilization in Polish hospitals by Ukrainian refugees.Objectives:To assess the impact of Ukrainian refugees on ED utilization in Poland.Method/Description:Demographic data, chief presenting complaints, diagnosis, and the level of care needed were registered. Bivariate and multivariate logistic regression analysis were performed to yield odds ratios (OR) with a 95% confidence interval.Results/Outcomes:At the time of investigation, there were 4,000 Ukrainian refugees admitted to Polish hospitals, of which more than half were children. Results are forthcoming.Conclusion:Although COVID-19 pandemic highlighted the insufficiency of the Polish health care system, resulting in delayed treatment for many patients, the current mass migration from Ukraine emphasizes the lack of a proper organization for crisis management in Poland. Facing an unprecedented and historic challenge, the Polish health care system, operating at the limit of its capacity, is stretched beyond capacity resulting in excess mortality, which exceeded 200,000 deaths during the pandemic. The impact was directly due to the pandemic or the delay in treating other diseases such as cardiovascular diseases and cancer. Inconsistency in medical decision making, lack of proper recommendations from the authorities, and organizational insufficiency requires a renewed focus on adaptive capacity and long-term solutions that promote systems resiliency.

Trends in emigration of Polish health professionals. Where are we heading?

Abstract Background Migration of health professionals is one of the key challenges for many healthcare systems. In Poland this phenomenon is still under-researched. The aim of our study was to explore the estimated trends and directions of emigration among Polish health professionals. Methods The research was based on the data analysis of specifying the number of people who applied for the certification of their professional qualifications (the right to practice a profession) at five national registers maintained by chambers of health professionals: 1) doctors and dentists, 2) nurses and midwives, 3) physiotherapists; 4) pharmacists and 5) laboratory diagnosticians. The gathered data reported information which allows for an approximate determination of how many professionals are considering a decision to migrate from Poland. Additionally exploration of data from the European Commission Regulated Profession Database in the EU Single Market was performed. Results About 7-9% of Polish doctors and nurses have applied for certificates, which confirm their right to practice their profession in other European countries. The number of such certificates applied for by physiotherapists is also worrying. Emigration among pharmacists and laboratory diagnosticians is rather marginal. The biggest number of certificates, was issued to health professionals in the years 2004-2007, right after Poland joined the EU. In the period 2008-2015 the trend was not constant and it was related to the healthcare reform and changes in health professionals’ remuneration. Since 2016 the number of health workers applying for the certificates is by to a certain extent falling. The main destination of Polish emigrants were and are: United Kingdom, Germany, Sweden, Spain, Ireland, and EFTA countries (Norway, Switzerland). Conclusions Implementation of a mechanism for monitoring emigration is necessary, but systemic improvement of working conditions in Polish healthcare system is also needed. Key messages • The emigration, especially of young generations of medical staff, causes significant problems for the Polish healthcare system. • More in-depth research on migration of health professionals is necessary.

"To Be Treated as a Person and Not as a Disease Entity"-Expectations of People with Visual Impairments towards Primary Healthcare: Results of the Mixed-Method Survey in Poland.

Primary care is the core part of the Polish healthcare system. Improving its quality for vulnerable populations is among the principal goals of global and national health policies. Identifying patients’ needs is critical in this process. People who are blind or have low vision often demonstrate comorbidities and require more specific healthcare. The aim of this study was to explore the needs of Polish persons with visual impairments when they use primary care services. 219 respondents answered the “Patient value” questionnaire from the project Quality and Costs of Primary Care in Europe (QUALICOPC) and an open question regarding additional patients’ needs. Statistical and content analyses were used. The expectations of the study group regarding primary care appeared to be higher than those described in studies among other populations. Equity and accessibility were the most valued dimensions of care. Among particular aspects of care, those connected with psychosocial competencies and awareness of disability among medical staff appeared most frequently. Some personal characteristics were associated with preferences, including age, gender, longstanding conditions, quality of life, and disability-related variables. Our study indicates a need for multilevel interventions in legislation, economics, and medical staff training, with the people-centered approach as the option maximizing chances to meet diverse healthcare needs arising from particular disabilities.

Respect for illiterate or unconscious patient’s autonomy as a requirement for the legality of medical procedures in the polish healthcare system: a case report and review of the literature

According to the Polish law, each patient has the right to refuse to consent to a medical procedure, even if the refusal concerns a life-saving procedure. It may be difficult for a physician to accept this kind of decision. In each case, however, medical intervention requires patient’s consent. Its lack makes physician’s actions illegal. Such a situation becomes more complicated when the patient who is intellectually incompetent, unconscious or illiterate is unable to express a consent to a medical procedure. Then, the possibility and the need to document and prove the patient’s consent becomes crucial from the point of view of the legality of medical personnel’s conduct. In this article, two representative clinical cases are discussed in the context of the legal assessment of the physician’s conduct in the event of legal complications related to the process of consenting to medical treatment. The authors analyze ethical dilemmas and legal risks that doctors may face in the process of consenting to risky medical procedures by unconscious and illiterate patient.