Genel hastanelerde bir kapasite belirleme yöntemi

Abstract

ÖZET Çalışmanın amacı, temel kapasiteleri planlama evresinde belirlenen genel hastanelerin bölüm ve ünite düzeyinde alt kapasitelerinin belirlenmesi ve temel kapasite değişimlerinde, birbirleriyle ilişkili olarak değişimlerinin incelenmesidir. Tez kapsamı içerisinde temel kapasite olan toplam yatak sayılarının değişimini belirlemek üzere kullanıcı faktörleri ve hastanenin kullanım oranlarına bağımlı, zamana dayalı bir yaklaşım ele alınmaktadır. Temel kapasiteleri önceden belirlenmiş olan genel hasta nelerde kullanım sürecinde temel kapasite artışları süre gelmektedir. Bu artışın hızı geliştirilen bir 'temel kapasite modeli' ile saptanabilmektedir. Sağlık politikasındaki belirsizlikler, yatak adedi ve personelin uzmanlık alanlarına dağılımındaki dengesizlikler böyle bir çalışmanın gereğini ortaya çıkarmıştır. Konunun genişliği açısından, tez, genel hastanelerin sağlık bölümleriyle sınırlı tutulmuştur. Kapasite belirlenmesinde başlıca unsurlar; organizasyon sistemi, hizmet sistemi ve büyüklükler sistemleridir. Bu unsurlar genel hastanelerin, farklı bölüm ve ünitelerin de, kapasite saptanmasında etkili olan alt kapasite faktörlerini de farklı biçimlerde etkilemektedir. Genel has tanelerde, hasta bakım üniteleri ve polikliniklerde alt kapasiteler ünite ve uzman hekim sayısı ile belirlenebilmektedir. Ameliyathane bölümünde ameliyathane sayısı, teşhis ve tedavi ünitelerinde ise ünite ve personel sayı sı alt kapasite faktörü olarak tanımlanabilmektedir. Yardımcı sağlık hizmetleri bölümünde ise alan büyüklükleri kapasite belirleyicisi olmaktadır. Temel kapasiteleri farklı dört genel hastanenin istatistiksel verileriyle denetlenen bu çalışma, sonuçta:. Temel kapasite değişim ivmesinin saptanması ve buna bağlı alt kapasite belirlenmesi yoluyla dinamik ihtiyaç programlarının elde edilebilmesi,. Genel Hastanelerin büyüklüğü arttıkça 25-30 yataklı hasta bakım ünitelerinin artış süresinin hız kazanması,. Genel hastanelerde alt kapasite belirleme ve değişiminde ancak bölüm ve ünitelerin özelliklerine bağlı olarak farklı kapasite kriterleri ile sonuca ulaşılabileceği,. Tezin verileri ile temel ve alt kapasite belirleme ve değişimleri metodlarının kullanımı plancı, programcı ve tasarımcıya ilgili süreçlerde karar verme kolaylığı sağlayacak çerçevede olması, noktaları önem kazanmıştır. - vii -

SUMMARY A CAPACITY DETERMINATION METHOD IN GENERAL HOSPITALS Health problem gained importance with the social, cultural and economic development of the society, in order to be more productive and profitable for our century man Hea: geo po countries In developed world, a great part of the national resources with the knowledge and technology are used for health care. On the other hand, in developing countries, the health care organisation is being required to be remanipulated because of the insufficiency of tools and technology. Most of the health services in Turkey are carried on by the Ministry of Health and Social Aid. Other establish ments like as Social Insurance Association, private institutions, some other ministeries, public economic institutions and faculties of Medicine share these services. In our country, seventy per cent of the health institu tions contain less than hundred beds. In hospitals, the number of bed used is under the number planned and the average ratio of bed use is fifty-three per cent which is too much under world averages. This fact rises from the uncertainties in health politics, errors in planning decision and the unbalanced distribution of beds into speciality fields in medicine. Related with these problems, the aim of this study will be the determination of the sub-capacities in relation with the main capacity in general hospitals. Problem: The first chapter of the thesis offers the aims, boundaries and the definitions of the concepts concerning the problem. The aims of the thesis can be resumed as:. the determination of time intervals for a certain - viii -capacity increase in different size general hospitals. the determination of the capacity factors for different sections and unities. the exposition of mutual reactions of capacity changes in sections or units. When the health institutions are considered, `capacity changes` is a very large concept. So, the subtance of this study is limited by `the health services section in general hospitals` at the level of `sections and units`. Following the determination of the problem as stated above, the concepts concerning the problem are defined. These concepts are first `the general hospitals`, the physical face of the problem; `the organisation system`, the social one and the `capacity`. The general hospitals are the institutions offering all kind of he>alf-h sprvirps h o -in- and Out - patient S, in Studies related with the subject are mentionned at the and of this chapter and decided that there are still deficiencies in this field to be fulfilled. Space and Personnel Organisation Systems in General Hospitals : The spatial organisation system in general hospitals occurs as the health service department, the administra tion department and the technical service department. The health service department is organised as below:. nursing units. polyclinics (out-patient units). operating suites. diagnose units. cure units. auxiliary health units In general, the size and the distribution of beds into speciality fields and the morpohol'gies of the nursing units according to their main capacity are revised after laws and necessity programs. The interactions between the departments and units and their functional schemes are revealed for each unit. This part is concluded with the interdepartmental matrix. The personnel organisation system is one &f the most important factors in capacity researches. Specially, the - ix -number of health services personnel has an active role in the determination of the sub-capacities in some units. Also, the user's number, the activity-equipment and space interactions and the area need constitute the other factors in capacity studies. Determination of Main and Sub-Capacities in General Hospitals: The main capacity factor in general hositals is the number of beds which is determined in respect of the population of the environment. The using aim of the hospital, the health services system in the country, an the economic, social, cultural and physical conditions. The general hospitals are grouped according to their main capacity changing relatively with the number of beds forming a nursing unit. In each department of a general hospital, the capacity factors of the units can be different from each other. So, the object of this chapter becomes the investigation of the various capacity factors for the above mentioned units. Tables and graphs showing the distribution of beds and specialised personnel to clinics, for nursing units, are exposed. Then, the other capacity factors for various units as polyclinics, surgical suites, diagnose and care units are determined. The chapter is completed by the formation of the `capa city change and determination system` which can be explained in the following figure. CAPACITY CHANGE 2 ÇAPACI TY DE TERM! NAT ION ORGANISATION THE SERVICE QVEN SIZE (surface volime)- NUMBER OF PERSONNEL NUMBER OF USERS ACTIVITY GROUPS (type. number,sur tacel EQUIPMENT ltype,number,surtace) «USERS* REQUIREMENTS Figure Showing The Capacity Change and Determination - x -Each of the factors shown in the figure are defined as the element of the capacity change and determination system. Model: The model is presented in two steps; first being the main capacity model in which capacity changes relatively to time, the second, the sub-capacities model where capacities change according to the main capacity. The `main capacity model` attempts to find out the time interval in which a certain increase in number of beds occurs in general hospitals. This number must be about twenty-five and its multiples to form one or several nursing units. In the proposed model for the main capacity increase, the number of beds is the function of the number of out patients examined in one year, the average duration of staying, the bed use ratio and the percentage of in patients. The function is formulated as: Y a f (B, S, D, X) The function can be developed as: B (A) x S Y = D x 365 Where Y : is the number of beds at a certain time B : the number of out-patients in one year X : percentage of in-patients S : average duration of staying D : ratio of bed use Y values can be obtained, by the application of the variables to the formulae, in certain time intervals; then, the capacity increase occurs as below: Y = Y. - Y i o This model helps to foresee the augmentation in the total number of beds. On the other hand, the `sub-capacities model` is evaluat ed by the variables, the number of personnel, the service given and the size of the unit, each of them determined as the capacity factor in various sections. A table shows the sub-capacities model, the factors being the number of personnel and the number of units arising from the number of beds in nursing and polyclinic units; number of unit in surgical suites; number of personnel and unit in diagnose and cure sections; and area in auxiliary health units like the admittion section, the pharmacy, the blood bank, the first-aid and the autopsy-mortuary sections. - xi -Finally, the sub-capacity variables; personnel number, unit number and area changes are exposed on graphs related to main capacity changes. Case Study : The aim of the case study comes out to prove the capabi lity of aplication of the models. Four examples of general hospital in Istanbul are selected in order to try the proposed models. The application of the main capacity model consists of the revealing the time interval in which the capacity change reaches a certain number or multiple defining a nursing unit. The four cases having different main capacities, show different capacity increases. The results of the researches on the mentioned hospitals are given below: 100 beds hospital isaugmented 15 beds in 4 years. 360 beds hospital isaugmented 31 beds in 4 years.. 1050 beds hospital isaugmented 100 beds in 4 years.. 1250 beds hospital isaugmented 200 beds in 4 years. Briefly, the main capacity acceleration goes on with the size of the hospital. In the second part, the value changes in the same time interval for each hospital are determined and marked onto graphs in order to check the truth of the sub-capacities model. The graphs are organised according to sub-capaci ties factors, personnel number, unit number and area; and each of them is inspected for the related unit or department. Contrary to the personnel number change, the area and the unit numbers do not show visible change (increase or decrease) in short time intervals. Conclusion: The sixth and last part of thesis covers the conclusions, comparisons with similar studies results and discussions on the suitabilness to the purpose. The results of this study can resumed as below:. It seems to be possible to get dynamic necessity prog rams, with the determination of the time interval, while a certain number of units is added to the hospital.. When the size of the hospital is larger (hihger main capacity) the nursing unit increases (of 25-30 beds) occurs in a short time interval.. While the results are given as users' numbers or sizes into necessity programs, the thesis differs from them by being analised for each unit with the appropriate factor.. The thesis gives objective ideas about the capacity and sub-capacities changes. It is possible to estimate, and determine these changes and transmit them to the neces sity programs. - xii -