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The easy access to data from electronic patient records has made using this type of data in pay-for-performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this for several reasons. Not all data can be used to derive good quality indicators and quality indicators can't reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.Dostop do podatkov iz elektronskih zapisov o bolnikih je enostaven, zato se ti podatki vedno pogosteje uporabljajo kot podlaga za plačilo zdravnikov družinske medicine po uspešnosti. Ti po vsej Evropi temu iz več razlogov vedno odločneje nasprotujejo. Za vrednotenje kakovosti na osnovi kazalnikov ni mogoče uporabiti vseh podatkov, kazalniki kakovosti pa ne morejo odražati širokega obsega primarne oskrbe. Posebno težko je meriti lastnosti, kot sta oskrba, osredotočena na posameznika, in dolgotrajna oskrba. Registracija in upravljanje potrebnih podatkov namreč zdravstveno osebje časovno precej obremenijo. Vendar pa so kazalniki kakovosti lahko zelo koristni kot izhodišča za razprave o kakovosti v primarni zdravstveni oskrbi z namenom, da bi zasnovali, spodbudili in podprli izboljšanje kakovosti dela. Zato je Evropska skupina za kakovost in varnost pacientov v družinski medicini (EQuiP) objavila izjavo o merjenju kakovosti v primarni oskrbi. Leta 2018 jo je potrdilo tudi Evropsko združenje zdravnikov družinske medicine.

A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management.We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators.Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices.First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.Pilotni projekt na področju družinske medicine v Sloveniji je leta 2011 uvedel novo metodo dela v družinski medicini, pri čemer je nov član tima postala diplomirana medicinska sestra, prav tako pa se je uvedel nadzor kakovosti s pomočjo kazalnikov kakovosti. Namen tega članka je bil oceniti kakovost vodenja bolnikov s sladkorno boleznijo in hipertenzijo.V analizo smo vključili vse ambulante družinske medicine, ki so sodelovale v projektu konec decembra 2015. Iz avtomatične baze poročil smo izluščili in analizirali naslednje podatke: spol in specializacijo zdravnika, status zdravnika (javni uslužbenec, koncesionar), trajanje sodelovanja v projektu, regijo, v kateri je ambulanta, število prebivalcev na območju, ki ga pokriva ambulanta, računalniško hišo, ki nudi program, in raven izbranih kazalnikov kakovosti.Od 584 ambulant družinske medicine jih je imelo 568 (97,3%) popolne podatke in so bile vključene v analizo. Najvišja vrednost kazalnikov kakovosti je bila opazovana pri kazalnikih kakovosti pogojev (register diabetikov), najnižja pa pri kazalnikih procesa in izida. Vrednosti izbranih kazalnikov kakovosti so bile neodvisno povezane s trajanjem sodelovanja v projektu, nekaterimi regijami Slovenije in nekaterimi računalniškimi hišami, ki nudijo elektronsko podporo.Prva analiza podatkov kazalnikov kakovosti za diabetes in arterijsko hipertenzijo je pokazala na probleme, ki trenutno onemogočajo doseganje višje kakovosti obravnave bolnikov na primarni ravni zdravstvenega varstva.

A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices.A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared.The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort.The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.Referenčne ambulante predstavljajo novo organizacijsko obliko dela na primarni ravni. V njihovem timu sodeluje diplomirana medicinska sestra s podiplomskimi znanji, ki skrbi za register kroničnih bolnikov in bolnike aktivno vabi na redne kontrole. Samostojno opravlja nekatere postopke, kot je npr. pregled nog, in po protokolu dela sodeluje pri drugih postopkih oskrbe. Kakovost obravnave bolnikov s sladkorno boleznijo tipa 2 (SB2) je opredeljena z izbranimi procesnimi in izidnimi kazalniki kakovosti. Standardi kakovosti so postavljeni na 80% za procesne in na 50% za izidne kazalnike kakovosti. Večina raziskav potrjuje, da razširitev tima in prevzem nekaterih nalog v oskrbi sladkornih bolnikov s strani diplomirane medicinske sestre ne poslabša kakovosti oskrbe ali pa jo izboljša, če jo primerjamo z oskrbo, ki jo vodi le zdravnik družinske medicine. V raziskavi smo želeli ugotoviti kakovost vodenja sladkornih bolnikov pred uvedbo referenčnih ambulant in po njej.Izvedena je bila kohortna retrospektivna raziskava. Podatki so bili zbrani iz zdravstvenih kartotek bolnikov s SB2 iz treh ambulant družinske medicine. Primerjani so bili kazalniki kakovosti, med njimi meritve HbA1c, izveden je bil letni laboratorij (z določitvijo lipidov v plazmi, ocenjene glomerularne filtracije oz. kreatinina in urinske analize), opravljene so bile meritve krvnega tlaka, pregled nog in napotitev na pregled očesnega ozadja; ter ugotovljena je bila vrednost HbA1c pred uvedbo referenčnih ambulant in po njej.V vzorec je bilo vključenih 132 bolnikov, pri katerih je oskrba SB2 potekala izključno na primarni ravni. Proces oskrbe se je značilno izboljšal po uvedbi referenčnih ambulant. Najbolj sta v izboljšanju kakovosti izstopala rednost pregleda nog in rednost testiranja HbA1c, čeprav pa nista dosegla priporočenega standarda kakovosti 80%. Kljub doseženemu standardu kakovosti izidnega kazalnika 50% v tej kohorti ni bilo dokazano statistično pomembno izboljšanje glikemije (p0,1).Pred uvedbo referenčnih ambulant je bilo vodenje sladkornih bolnikov daleč od priporočenega. Vključitev diplomirane medicinske sestre v tim izboljša postopke kakovostne oskrbe. Priporočeni standardi za kazalnike kakovosti so dosegljivi. Boljšo urejenost glikemije in druge kakovostne izide oskrbe bolnikov bo treba še dokazati.

Celovito obvladovanje kakovosti je ključnega pomena za nenehno izboljševanje vseh dejavnikov delovnih procesov organizacij. Organizacije v javnem sektorju imajo na voljo številna orodja za celovito obvladovanje kakovosti, večina pa uporablja skupni ocenjevalni okvir za organizacije v javnem sektorju – model CAF. V diplomskem delu je predstavljena študija modela CAF in njegovega vpliva na spremembo kakovosti delovanja upravnih enot. Z deskriptivno metodo sem predstavil širše področje kakovosti v organizacijah. Z metodo komparacije in s pomočjo anketnega vprašalnika sem primerjal spremembo kazalnikov kakovosti upravnih enot, ki so bile v različnih obdobjih uporabe modela CAF, in tako prikazal njegov vpliv na spremembo kakovosti delovanja upravnih enot. Rezultati analize so potrdili, da njegova uporaba pripomore k ohranjanju dobrih rezultatov pri posameznih kazalnikih kakovosti. S komparativno metodo in s pomočjo anketnega vprašalnika sem raziskoval tudi, kako je stopnja koristnosti uporabe modela CAF, ki so jo upravne enote izrazile, povezana z dejanskim stanjem kazalnikov kakovosti. Predvideval sem, da bodo tiste upravne enote, ki so izrazile boljšo stopnjo koristnosti, dosegale tudi boljše rezultate. Rezultati so pokazali, da ni povezave med izraženo stopnjo koristnosti in dejanskimi rezultati kazalnikov kakovosti. Total quality management is crucial for the constant improvement of all factors that affect work processes of organizations. Organisations in public sector can choose between many quality models and tools for the purpose of total quality management, but the majority of them use the common assessment framework for organizations in the public sector (model CAF). The object of this thesis is a study of model CAF and it´s effect on the change of operational quality of administrative units. With the use of the descriptive method, I presented a broader field of quality in organizations. With the use of the comparative method and the help of a questionary, I compared the change of quality indicators of administrative units that were in different time periods of usage of the model CAF and so shown it´s effect on the change of operational quality of administrative units. The results of the analysis confirmed that its use contributes to maintaining good results at individual quality indicators. With the use of the comparative method and the help of a questionary I have also researched, how is the degree of usefulness of usage of the model, that was expressed by the administrative units connected with the actual condition of quality indicators. I assumed, that the administrative units that expressed a better degree of usefulness will also achieve better results. The results have shown no connection with the expressed degree and the actual results of quality indicators.

Introduction: A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management. Methods: We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators. Results: Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices. Conclusion: First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level. Uvod: Pilotni projekt na področju družinske medicine v Sloveniji je leta 2011 uvedel novo metodo dela v družinski medicini, pri čemer je nov član tima postala diplomirana medicinska sestra, prav tako pa se je uvedel nadzor kakovosti s pomočjo kazalnikov kakovosti. Namen tega članka je bil oceniti kakovost vodenja bolnikov s sladkorno boleznijo in hipertenzijo. Metode: V analizo smo vključili vse ambulante družinske medicine, ki so sodelovale v projektu konec decembra 2015. Iz avtomatične baze poročil smo izluščili in analizirali naslednje podatke: spol in specializacijo zdravnika, status zdravnika (javni uslužbenec, koncesionar), trajanje sodelovanja v projektu, regijo, v kateri je ambulanta, število prebivalcev na območju, ki ga pokriva ambulanta, računalniško hišo, ki nudi program, in raven izbranih kazalnikov kakovosti. Rezultati: Od 584 ambulant družinske medicine jih je imelo 568 (97,3%) popolne podatke in so bile vključene v analizo. Najvišja vrednost kazalnikov kakovosti je bila opazovana pri kazalnikih kakovosti pogojev (register diabetikov), najnižja pa pri kazalnikih procesa in izida. Vrednosti izbranih kazalnikov kakovosti so bile neodvisno povezane s trajanjem sodelovanja v projektu, nekaterimi regijami Slovenije in nekaterimi računalniškimi hišami, ki nudijo elektronsko podporo. Zaključek: Prva analiza podatkov kazalnikov kakovosti za diabetes in arterijsko hipertenzijo je pokazala na probleme, ki trenutno onemogočajo doseganje višje kakovosti obravnave bolnikov na primarni ravni zdravstvenega varstva.

Magistrsko delo obravnava razvoj kazalnikov kakovosti v zdravstveni negi pljučne kirurgije. V delu smo z različnimi orodji managementa kakovosti prikazali sistem za razvoj kazalnikov kakovosti, s katerimi lahko spremljamo uspešnost in učinkovitost procesa zdravstvene nege pacienta pri operaciji pljuč. V empiričnem delu smo s SIPOC metodo in procesnim modelom opisali klinično pot pacienta pri operaciji pljuč. Popis procesa zdravstvene nege pacienta pri operaciji pljuč smo analizirali z analizo možnih napak in njihovih posledic – FMEA metoda. S pomočjo strokovne literature ter strokovnega zdravstvenega delavca smo identificirali možne napake, katere se v procesu zdravstvene nege lahko pojavijo. Z analizo anketnega vprašalnika smo za vsako napako z izračunanim povprečjem pridobili tri faktorje. Prvi faktor je verjetnost nastopa napake, drugi je teža napake in zadnji verjetnost odkritja napake. Zmnožek teh nam poda skupno tveganje potencialnih napak oziroma indeks pomembnosti napake (IP). S Pareto diagramom smo pridobili pet potencialnih napak, katere skupaj predstavljajo 21,82 % vseh indeksov pomembnosti. Kar pomeni, da pojav teh petih napak predstavlja najvišje tveganje pri izvajanju kakovostne zdravstvene nege pacienta pri operaciji pljuč. Za vsako izmed petih napak z najvišjim indeksom pomembnosti smo izpeljali naslednje kazalnike kakovosti: • Število alergijskih reakcij na zdravila / 200 pljučnih operacij • Številno napak pri izpolnjevanju dokumentacije / 200 pljučnih operacij • Številno nepopolnih premedikacij zaradi nedosledno izpolnjenega temperaturnega lista / 200 pljučnih operacij • Število nedoslednih diagnoz, katerih posledica ja nepopolna anamneza pacienta / 200 operacij • Število pacientov s pnevmotoraksom zaradi lastne odstranitve drenaže / 200 pljučnih operacij Poudariti moramo, da je za zdravstvene ustanove pomembno, da kakovost svojih storitev neprestano spremljajo in izboljšujejo. Predlagamo, da torakalne klinike stalno spremljajo kazalnike kakovosti, pridobljene v tem delu. V primeru spremembe procesa nege predlagamo, da kazalnike kakovosti prenovijo po sistemu, ki je prikazan v tej nalogi. Ob enem pa je prikazan sistem za razvoj kazalnikov kakovosti, primeren tudi za vse ostale procese, ki se odvijajo v zdravstveni negi. The Master's Thesis examines the development of quality indicators in healthcare of pulmonary surgery. In our work, we have demonstrated a system for the development of quality indicators using various quality management tools to monitor the effectiveness and efficiency of the patient's healthcare process in the lung operation. In the empirical part, the patient's clinical pathway for lung surgery was described with the SIPOC method and process model. The patient's healthcare process in lung surgery was analysed with FMEA method (Failure mode and effects analysis), where we identified all the possible failures, based on professional literature and the practice of a professional healthcare worker. For calculating Risk Priority Number (RPN), we calculated Mean for all three factors: Severity (of the event), Probability (of the event occurring) and Detection (Probability that the event would not be detected before the user was aware of it). Based on Pareto analysis we obtained five potential failures, which they together represent 21.82% of all RPNs. That means that occurrence of this five failures represents the highest risk in quality healthcare for patients. The quality indicators we developed for each of this five failures with the highest RPN are: • Number of allergic reactions to medicines / 200 pulmonary operations • Number of errors in documentation fulfilment / 200 pulmonary operations • Number of incomplete premedications due to incompletely filled temperature chart / 200 pulmonary operations • Number of inconsistent diagnoses, which is the consequence of incomplete patient history / 200 pulmonary operations • Number of patients with pneumothorax due to their own removal of drainage / 200 pulmonary operations It should be emphasized that it is important for healthcare institutions to constantly monitor and improve the quality of their services. We suggest that thoracic clinics constantly monitor the quality indicators obtained in this Thesis. In case of any changes in the process, we suggest that the clinic reclassifies quality indicators according to the system shown in this Thesis. We think that the system for developing quality indicators in this Thesis is also suitable for all the other processes in health care.

Objective: We performed a study on almost 20,000 Slovene patients with arterial hypertension (AH) to evaluate age- and gender-dependent blood pressure control, differences in the rate of AH control in the period 2002-2008, and to validate a potential impact of selected quality indicators on blood pressure control. Methods: The study was conducted as a part of the "Quality of Healthcare in Slovenia" project, in agreement with the National Medical Ethics Committee of the Republic of Slovenia. Appropriate statistical analyses were performed and the results evaluated. Results: Arterial hypertension control was relatively high (55.8%, 95% CI: 55.1-56.5) in the period 2002-2008 and improved significantly during that period. Based on our statistical model, the improved AH control in year 2006 compared to 2002 is particularly due to lower initial blood pressure values before treatment. Uncontrolled AH was largely attributed to uncontrolled systolic blood pressure. We found positive association between AH control and the frequency of blood pressure control in less than six-month time intervals. Conclusions: According to our results, AH control in family practice in Slovenia is relatively high compared to other European countries, but the results refer only to patients visiting their family medicine physicians. Izhodišča: V študiji, ki je vključevala okrog 20.000 slovenskih bolnikov z arterijsko hipertenzijo (AH), smo ugotavljali nadzor krvnega tlaka v odvisnosti od spola in starosti, nadzor AH v obdobju 2002-2008 in ocenili možni vpliv izbranih kazalnikov kakovosti na nadzor krvnega tlaka. Metode: Študija je potekala v okviru projekta "Kakovost v zdravstvu Slovenije" z dovoljenjem Komisije Republike Slovenije za medicinsko etiko. Rezultate smo statistično analizirali in jih ovrednotili. Rezultati: Nadzor AH v obdobju 2002-2008 je bil sorazmerno dober (55,8%, 95% CI: 55.1-56.5) in se je v tem obdobju značilno povečal. Rezultat, da gre za boljši nadzor v letu 2006 v primerjavi z 2002, je na podlagi našega statističnega modela predvsem posledica nižjega krvnega tlaka pred začetkom zdravljenja. Nenadzorovana AH je bila predvsem posledica nezadostno nadzorovanega sistoličnega krvnega tlaka. Nadzor AH je bil boljši pri bolj pogosti kontroli krvnega tlaka v intervalih, manjših od šestih mesecev. Zaključki: Glede na rezultate naše študije je nadzor AH v ambulantah družinske medicine v Sloveniji sorazmerno dober v primerjavi z drugimi evropskimi državami, vendar moramo pri tem upoštevati, da podatki veljajo samo za bolnike, ki so obiskali svojega zdravnika - specialista družinske medicine.

Namen: Nacionalna validacija kazalnikov kakovosti v preventivi bolezni srca in ožilja v primarnem zdravstvu v Sloveniji in primerjava z mednarodno validiranimi kazalniki. Metode: V okviru mednarodne raziskave Epa cardio je bil razvit seznam kazalnikov kakovosti, ki so izvirali iz strokovnih smernic, priporo- čil in dobre klinične prakse. V vsaki sodelujoči državi so bili predlagani kazalniki predstavljeni skupini nacionalnih ekspertov, ki so jih glede na razumljivost, veljavnost in izvedljivost ocenili v dveh krogih s pomočjo metodologije Delphi. V Sloveniji je sodelovalo 14 ekspertov–zdravnikov družinske medicine s posebnim zanimanjem za bolezni srca in ožilja. Rezultati: Največ validiranih kazalnikov je pripadalo skupini zdravstvene oskrbe bolnikov z boleznijo srca in ožilja. Manjše število kazalnikov je bilo validiranih s področja primarne preventive, večinoma glede zapisa in nasveta v zvezi z življenjskim slogom. Zelo malo je bilo validiranih kazalnikov izida (vrednost dejavnikov tveganja). Noben kazalnik o vključenosti bolnika ali o novejših dejavnikih tveganja, npr. socioekonomske okoliščine, ni bil validiran. Zaključki: Slovenija je validirala več kazalnikov kot mednarodna skupina, posebej s področja primarne preventive. Eksperti niso dosegli konsenza glede kazalnikov bolnikove perspektive kljub paradigmi družinske medicine, da je bolnik v središču oskrbe. Validirane kazalnike je potrebno pred uporabo za sistematično sledenje kakovosti preizkusiti v praksi. Aim: National validation of quality indicators for cardiovascular prevention in primary care in Slovenia and comparison with a set of internationally validated indicators. Methods: A list of indicators derived from guidelines, recommendations and good clinical practice was developed internationally within a wider Epa-cardio study. In each participating country a panel of national experts were recruited to assess the indicators using a Delphi Technique methodology in two rounds for clarity, validity and feasibility. In Slovenia, 14 national experts, all general practitioners with special interestin cardiovascular diseases, were recruited. Results: Most of validatedindicators belonged to the health-care management of people with established cardiovascular disease. Fewer numbers of indicators were validatedfor primary prevention, mostly on life style recording and advice. Only very few indicators on outcome measures (level of risk factors) were validated. No indicators of patientsć involvement or new risk factors, such associoeconomic circumstances, got consensus. Conclusion: Slovenia validated more indicators than the international study, especially indicators of primaryprevention. The experts did not achieve consensus on indicators of patientsć perspective, despite the paradigm of family medicine that the patient is in the centre of care. Validated indicators can now be tested for systematic quality assessment of cardiovascular prevention in the country.

Centri za nadzor telefonije pri operaterjih in manjša podjetja, ki so posredniki telefonskega prometa, uporabljajo sisteme za spremljanje klicev v realnem času. Pozornost namenjajo kakovosti storitve, ki v veliki meri zavzema nadzor nad kakovostjo večjih vzorcev klicev po različnih omrežjih končnih operaterjev. Cilj diplomskega dela je bil implementirati izboljšavo za nadzor kakovosti VoIP telefonije, ki bi omogočala grafično predstavitev kazalnikov kakovosti klicev. Podani so rezultati raziskave obstoječih orodij na trgu ter definirane zahteve sistema. V diplomski nalogi je predstavljena rešitev z implementacijo sklada ELK za urejanje, statistično obdelavo in grafično predstavitev kazalnikov kakovosti klicev. Pri ovrednotenju rešitve je nakazana možnost nadgradnje s pošiljanjem filtriranih podatkov iz orodja Logstash preko izhoda neposredno na Zabbix strežnik. Podane so ugotovitve, ki izhajajo iz vnaprej postavljenih zahtev sistema. Control centres of telephony operators and other smaller companies that route telephone traffic have a system of regularly monitoring calls in real time. Dedicating a lot of attention to the quality of service, mostly monitoring and controlling quality of larger patterns of calls going to different destinations. The aim of the thesis was to implement improvements in the field of controlling quality of VoIP telephony, enabling visual representations of formal quality indicators of calls such as ASR, NER, ACD. Research was made of the existing tools on the market at the moment and summarized the requirements of the system. The thesis presents a solution of implementing ELK stack for editing data, making statistical analysis and visualization of quality indicators of calls. While evaluating this solution an upgrade is suggested for using Zabbix output of data filtered in Logstash to send them directly to Zabbix server. Findings are given resulting from pre-established system requirements.

V diplomskem delu smo raziskovali način, kako se v mikro podjetju kar najbolje pripraviti za uvajanje in spremljanje kakovosti poslovanja. Za teoretsko podlago smo izbrali predmetno relevantno celovito upravljanje kakovosti oz. TQM (ang. Total Quality Mamagement). Namen obravnave kakovosti je prilagoditev obstoječe teorije TQM za uporabo v mikro podjetju ŠUŠTI, Tina Šušteršič, s. p. Poleg klasičnih metod obravnave, ki temeljijo na pozitivističnem pristopu, je posebnost raziskovalnega načina kombiniranje uporabljenih konceptov z razvojem vizije delovanja. V izhodiščih in predstavitvi uporabljene teorije smo osvetlili pomen usmeritve TQM v zadovoljstvo kupca in predstavili ostale pomembne elemente za spremljanje kakovosti poslovanja. V okviru uvajanja načel TQM v poslovanja smo na osnovi razvoja vizije delovanja predstavili koncepta ciljnega dobička in vpeljave kazalnikov kakovosti po metodi BSC (ang. Balanced Scorecard – slov. Model uravnoteženih kazalnikov). Opredelili smo tudi postopnost izgrajevanja spremljanja kakovosti, ki poteka hkrati z načrtovano rastjo poslovanja tako v kvalitativnem kot kvantitativnem smislu. V tem smislu smo utemeljili orodja in njihovo uporabo povezali z zadovoljstvom kupca. Posebna pozornost je vseskozi veljala pridobivanju in uporabi znanja in v tem okviru organizacijskega znanja. Temeljna ugotovitev, do katere smo prišli, je, da brez sodelovanja in voditeljstva ni kakovostnega delovanja in da mora tekmovanje na osnovi izključevanja zamenjati sodelovanje na osnovi vključevanja vseh deležnikov v poslu. V tem kontekstu določanje ciljnega dobička in ciljnih stroškov na osnovi konkurenčne cene omogoča razvoj kakovosti poslovanja. Motiv kakovostnega delovanja je zatorej povezovanje, sodelovanje in načrtovanje dosežkov kot alternativa nezdravemu tekmovanju, ki ga povzroča nebrzdana gonja za maksimizacijo profita. In the diploma thesis we researched the method how to prepare the best possible to introduce and follow the quality of conducting business. For a theoretical basis we chose subject relevant integral managing the quality i.e. TQM (Total Quality Management). The purpose of dealing with quality is to adapt the existing theory TQM for the usage in micro-company ŠUŠTI, Tina Šušteršič s.p. In addition to classic methods of dealing which are based on positivistic approach, the specialty of the research method is combining the used concepts with the development of the vision of the operations. In the starting-points and presentation of the used theory we enlightened the significance of the direction of TQM into the satisfaction of the buyer and presented the remaining important elements in order to follow the quality of conducting the business. Within the framework of introducing the principles of TQM into conducting the business we presented the concept of target profit and introduction of the indicators of the quality according to the method BSC (Balanced Scorecard), on the basis of the development of the vision of operations. We also defined the gradualness of building the monitoring of the quality which is occurring at the same time with the planned growth of conducting business in qualitative as well as in quantitative sense. In this respect we substantiated the tools and connected their usage with the satisfaction of the customer. A special attention was paid all the time to gaining and using the knowledge in this framework of the organizational knowledge. The basic ascertainment which we reached was that there is no qualitative operations without cooperation and leadership and that the competition on the basis of exclusion must be changed by the cooperation on the basis of inclusion of all the participants in the business. In this context the determining of the target profit and target costs on the basis of the competitive price enables the development of the quality of conducting business. The motive of the quality operations is, therefore, connecting, cooperation and planning the achievements as an alternative to unhealthy competition, caused by unrestrained pursuit in order to maximize profit.

Z izrazom nesamomorilno samopoškodovalno vedenje opišemo namerno povzročanje poškodb lastnega telesa na način, ki ni družbeno sprejemljiv in nima samomorilnega namena. Najpogostejše je v obdobju mladostništva. Posameznikom prinaša različne ugodnosti, načeloma pa služi kot način lajšanja notranjih napetosti. Večina mladostnikov, ki se samopoškodujejo, to storijo z namenom, da bi se pomirili, sprostili in ponovno zmogli nadzorovati svojo čustveno stisko. Prve zapise o samopoškodovalnem vedenju najdemo že v Stari zavezi, med tem ko v današnjih časih predstavlja pogost zdravstveni problem, s katerim se zdravstveni delavci vse pogosteje srečujejo na vseh nivojih zdravstvenega varstva. Kljub temu v slovenskem prostoru ni zaslediti sistematičnega spremljanja samopoškodovanja, med tem ko je bilo na podlagi tujih raziskav ugotovljeno, da zaposlenim v zdravstveni negi primanjkuje znanja o etiologiji motnje in njenem obvladovanju, kar lahko vodi v nerazumevanje in slabšo empatijo zaposlenih ter posledično negativno vpliva na celoten proces zdravljenja. Magistrsko delo je sestavljeno iz teoretičnega in empiričnega dela. V teoretičnem delu se seznanimo s psihopatologijo samopoškodovalnega vedenja in vlogo zdravstvene nege pri obravnavi pacientov s samopoškodovalnim vedenjem. Zajema tudi poglavja o kakovosti v zdravstvu, usmeritvah za razvoj kakovosti ter predstavi vlogo zaposlenih ob uvajanju sprememb. Zaradi pomanjkanja podatkov o samopoškodovalnem vedenju v bolnišničnem okolju smo najprej na podlagi internega kazalnika kakovosti ugotavljali pojavnost in način obravnave z vidika zdravstvene nege v Univerzitetni psihiatrični kliniki Ljubljana (UPK Ljubljana). V pomoč in usmerjanje zaposlenih, pacientov in njihovih svojcev smo izdelali zloženko »Samopoškodovanje in izdelava varnostnega načrta« ter na podlagi smernic Ministrstva za zdravje in nacionalnih načel kakovosti v delovni proces uvajali posamezne spremembe. Empirična raziskava je vključevala več faz. Za prvo fazo, imenovano identifikacija znanja, občutkov in odnosa zaposlenih v zdravstveni negi ob obravnavi pacientov s samopoškodovalnim vedenjem, smo opravili tri intervjuje. Na podlagi teh in ob pregledu raziskav, ki so bile izvedene v tujini, je bil izdelan vprašalnik, temu je sledila obširnejša raziskava. Podatke smo zbirali s kvantitativno tehniko, in sicer s samoocenjevalnim vprašalnikom zaprtega tipa. Anketiranje je potekalo v dveh delih, pred in po izobraževanju. Na podlagi izobraževanj smo želeli povečati senzibilnost zaposlenih, da prepoznajo samopoškodovalno vedenje kot simptom pacientove (najpogosteje mladostnikove) motnje in stiske ter ne le kot iskanje pozornosti ali način vplivanja na vedenja drugih. Želeli smo poučiti osebje zdravstvene nege o ustreznem ocenjevanju pacientove ogroženosti ob samopoškodovanju in s tem nudenju najustreznejše pomoči v trenutkih, ko jo najbolj potrebuje. Z raziskavo je bilo ugotovljeno sledeče: Več kot 50 % zaposlenih v zdravstveni negi, vključenih v prvi del raziskave meni, da ima premalo znanja o samopoškodovalnem vedenju. Pri tem je močno željo po izobraževanju izražalo več kot 75 % anketiranih. Ob izvajanju aktivnosti zdravstvene nege se največ zaposlenih sooča z občutkom nemoči. Odnos zaposlenih smo opredeljevali na podlagi vrednotenja SHAS lestvice (Self-Harm Antipathy Scale) ter ugotovili, da imajo zaposleni v zdravstveni negi v UPK Ljubljana pozitiven odnos do mladostnikov, ki se samopoškodujejo. V drugem delu raziskave, ki je potekala po izobraževanju, smo ugotovili, da se je na podlagi izobraževanja znanje zaposlenih izboljšalo. V nadaljevanju smo znanje zaposlenih v UPK Ljubljana primerjali z znanjem strokovnih delavcev iz izobraževalnega, socialno varstvenega, zdravstvenega in nevladnega sektorja v Sloveniji. Predvidevali smo, da je znanje zaposlenih v UPK Ljubljana boljše, kar smo potrdili na podlagi rezultatov testiranja hipotez. Vpliva izobraževanja na odnos zaposlenih do pacientov s samopoškodovalnim vedenjem nismo The phrase non-suicidal self-harming behavior describes the deliberate causing of injury to one's own body in a way that is not socially acceptable and does not have a suicidal purpose. It occurs most frequently during adolescence and brings various positive effects to the individual, principally serving as a means of relieving internal tension. The majority of adolescents who self-harm do so with the aim of calming themselves, relaxing and allowing them to regain control over their emotional distress. The first writings on self-harming behavior are found in the Old Testament and even today it is a common health issue that healthcare workers see ever more frequently at all levels of the healthcare system. Despite this, in Slovenia there is no systematic tracking of self-harming, although it has been determined on the basis of studies carried out abroad that healthcare employees lack knowledge of the etiology of the disorder and its control, which can lead to a lack of understanding and a lack of empathy by employees and consequently a negative effect on the entire treatment process. This master's thesis work is made up of theoretical and empirical work. The theoretical section deals with psychopathological self-harming behavior and the role of healthcare. It also includes a chapter on quality in healthcare and guidance for the development of quality, as well as on the role of employees in introducing changes. Due to a lack of data on self-harming behavior in a hospital environment, we first determined the appearance and means of treatment from the point of view of healthcare at the University Psychiatric Clinic Ljubljana (UPC Ljubljana) on the basis of an internal indicator of quality. In order to help and guide employees, patients and their relatives, we made a small flyer »Self-Harming and Making a Safety Plan« and introduced certain changes on the basis of guidelines by the Ministry of Health and of national principles of quality in the working process. Empirical studies are included at various phases. In the first phase, called the identification of knowledge, feelings and the relationship of healthcare employees during the treatment of patients with self-harming behaviors, we carried out three interviews. On the basis of these interviews and an examination of the studies carried out abroad, a survey questionnaire was made, followed by an extensive study. The data were collected using a quantitative technique, i.e. a self-evaluation questionnaire of a closed type. The survey was carried out in two parts, one before and one after education. On the basis of education, we wished to increase the sensibility of employees so that they would recognize the self-harming behavior as a symptom of patients' (primarily adolescents') disturbance and distress and not simply as attention seeking or as a way of influencing the behavior of others. Our aim was to teach healthcare personnel about the appropriate evaluation of a patient's vulnerability to self-harming and thus to help them offer the most suitable help at the times when it is most needed. This study determined the following: More than 50% of healthcare employees included in the first part of the study thought that they had too little knowledge of self-harming behavior. More than 75% of those surveyed expressed a strong desire for more education. While carrying out their work in healthcare, most employees face a feeling of powerlessness. The relationship between employees and patients was defined on the basis of an evaluation of the Self-Harm Antipathy Scale (SHAS) and we determined that healthcare employees at UPC Ljubljana have positive relations towards adolescents who self-harm. In the second part of the study, which followed the educational part, we determined that the knowledge of employees had strongly improved on the basis of the education. To follow up, we compared the knowledge of employees at UPC Ljubljana to the knowledge of employees in the educational, socia

V magistrskem delu smo predstavili pojem bolnišničnih okužb z MRSA in vse kar je z njim povezano, od njihovega ugotavljanja do preprečevanja in obvladovanja okužb v bolnišnicah ter sistem nadzora. Opredelili smo kakovost v zdravstveni negi povezano z bolnišničnimi okužbami in zakonodajo obvladovanja bolnišničnih okužb. Z raziskavo smo želeli ugotoviti koliko so zaposleni v eni izmed slovenskih bolnišnic seznanjeni z načini in protokoli za preprečevanje bolnišničnih okužb ter, ali jim preprečevanje bolnišničnih okužb predstavlja dodatno obremenitev tako psihično kot fizično. Metodologija raziskovanja. Uporabljena je bila kvantitativna metodologija raziskovanja. Kot instrument smo uporabili anketni vprašalnik. Raziskovalni vzorec je zajemal 60 zaposlenih (zdravstveni delavci) v eni izmed Splošnih bolnišnic v Sloveniji. Rezultate raziskave smo obdelali s pomočjo programov Microsoft Office Word 2010 in Microsoft Excel 2007 ter IBM SPSS Statistics 19. S pomočjo orodja programa SPSS smo uporabili metodo opisne statistike in sicer metodo analize frekvenc. Rezultati raziskave. Ugotovili smo, da bolnišnične okužbe z MRSA kot kazalnik kakovosti v bolnišnicah od leta 2010 do leta 2014 upadajo. Anketiranci so seznanjeni s protokoli za preprečevanje bolnišničnih okužb z MRSA kar je razvidno iz tega, da je 22% pritrdilo, da se izvajajo strokovni nadzori preprečevanja bolnišničnih okužb. 22,3% pozna navodila za preprečevanje prenosa MRSA. Pri negovanju pacientov okuženih z MRSA se 22,3% pravilno zaščiti. Za 9,1 % medicinskih sester, preprečevanje bolnišničnih okužb predstavlja dodatno delo oz. obremenitev. V vsakdanji praksi je 12,5% medicinskih sester, ki spremljajo merjenje in vrednotenje kakovosti v zdravstveni negi. Sklep. Bolnišnične okužbe so najpogostejše okužbe, ki se jih ni moč izogniti. Učinkovito preprečevanje okužb mora ostati del vsakdanjega dela vsakega zdravstvenega delavca. V okviru varnosti pacientov je higiena rok temeljni postopek preprečevanja prenosov bolnišničnih okužb z MRSA. Okužbe je možno zmanjšati in sicer z rednim nadzorom dela, z izobraževanjem zdravstvenega osebja in doslednim izvajanjem ukrepov za preprečevanje širjenja okužb. Uspešno obvladovanje bolnišničnih okužb je pomemben kazalec kakovosti dela v bolnišnicah in prispeva k zmanjšanju posledic. In this post-graduate thesis, we presented the concept of hospital-acquired infections with MRSA and everything associated with it, fromtheir detection to prevention and control of infections in hospitals and. surveillance systems. We also presented the quality of nursing care associated with nosocomial infections and the legislation forcontrol of nosocomial infections. We conducted a survey to determine how employees in one of the Slovenian hospitals are familiar with the methods and protocols for the prevention of nosocomial infections and whether preventing hospital-acquired infections represents an additional burden, both mentally and physically. Methodology.Quantitative research methodologywas used. Questionnaires were used as an instrument. The research sample consisted of 60 employees (health workers) in one of the general hospitals in Slovenia. The results of the survey were analysed using Microsoft Office Word 2010 and Microsoft Excel 2007 and IBM SPSS Statistics 19. The tools of the program SPSS were used for descriptive statistics, namely the method of analysis frequencies. Results. We found that hospital-acquired infections with MRSA as an indicator of quality in hospitals from 2010 to 2014 have declined. Respondents were familiar with the protocols for the prevention of nosocomial infections caused by MRSA which is evident from the fact that 22 % of the confirmedthat they are familiar with how to carry out professional controls to prevent hospital infections. 22,3 % are familiar with instructions on how to prevent the transmission of MRSA. In nurturing of patients infected with MRSA 22,3 % use the correct protection. For nurses, the prevention of nosocomial infections represents in 9,1 % of the additional work or load, while in 8,3 % sometimes. In everyday practice, there are 12,5 % of nurses who monitor the measurement and evaluation of quality in health care. Conclusion. Nosocomial infections are the most common infections that cannot be avoided. They can be reduced through regular supervision of work, education of health personnel and strict implementation of measures to prevent the spread of infections. Successful management of hospital-acquired infections is an important indicator of the quality of work in hospitals and contributes to reducing the consequences.

Model referenčnih ambulant družinske medicine prinaša spremembe v obravnavi pacientov na primarnem zdravstvenem nivoju, kar ima za posledico zmanjševanje ali odpravljanje dejavnikov tveganja za nastanek srčno-žilnih bolezni. V timu poleg zdravnika in srednje medicinske sestre sodeluje tudi diplomirana medicinska sestra, ki z znanjem, strokovnostjo in individualnim pristopom pomembno doprinese h kakovosti vodenja bolnikov z dejavniki tveganja. Namen magistrske naloge je bil raziskati zmanjšanje dejavnikov tveganja za nastanek srčno-žilnih bolezni med skupinami pacientov, ki so vključeni v obravnavo v referenčni ambulanti družinske medicine in splošni ambulanti. Uporabljena je bila presečna metoda zbiranja podatkov. Primarni podatki so bili zbrani iz predpisanih obrazcev, ki se izpolnjujejo ob presejalnih pregledih za srčno-žilno ogroženost in obdelani v statističnem programu SPSS. V okviru obdelave podatkov smo uporabili regresijo, analizo variance ANOVA, hi-kvadrat in t-test. V teoretičnem delu je bila uporabljena metoda analize literature. Viri literature so bili zbrani na podlagi znanstvene in strokovne literature. Pri kontrolni meritvi je imelo 41,6 % preiskovancev urejen krvni tlak, 45,5 % urejen holesterol ter 53,3 % urejen krvni sladkor. Vsi trije deleži so bili višji kot pri presejalnem pregledu. Delež kadilcev je znašal 23,7 %, kar je bilo prav tako manj kot pri presejalnem pregledu. Visoka srčno-žilna ogroženost (20–40 %) se je znižala pri kontrolni meritvi na 28,0 %, zelo visoka na 6,6 %. Dva- do štirikrat tedensko je bilo telesno aktivnih 54,3 % preiskovancev, petkrat tedensko pa 19,4 %, kar je predstavljalo višje deleže kot pri presejalnem pregledu. Rezultati kontrolne meritve kažejo pri preiskovancih, vodenih v referenčni ambulanti družinske medicine, na statistično značilno boljšo urejenost naslednjih dejavnikov tveganja: krvnega tlaka (x^2= 8,780 p=0,003) in holesterola (x^2= 4,781 p=0,029), ne pa tudi krvnega sladkorja. Pri gibalni aktivnosti je bil rezultat obraten, preiskovanci obravnavani v referenčnih ambulantah družinske medicine so navajali statistično značilno razliko v gibalni aktivnosti (x^2=15,304 p=0,002). Primerjava po spolu v referenčnih ambulantah družinske medicine je ponovno pokazala statistično značilno razliko v srčno-žilni ogroženosti v korist žensk (x^2=19,243: p

Teoretična izhodišča. Kakovost zdravstvene obravnave pomeni, da vsi, ki so vpeti v zdravstvo, strmijo k boljšim zdravstvenim izidom za paciente, večji uspešnosti delovanja sistema in k boljšemu razvoju strokovnjakov. Akreditacija je postopek, kjer zunanja institucija oceni, kako zdravstveni zavod izpolnjuje vnaprej pripravljene standarde kakovosti in varnosti. Namen diplomskega dela je predstaviti kakovost in sistem vodenja kakovosti v zdravstvu ter predstaviti razvoj in vzpostavitev sistema akreditacij bolnišnic v Sloveniji. V empiričnem delu smo raziskovali stališča zaposlenih o kakovosti v zdravstveni negi in seznanjenost z akreditacijo in namenom pridobitve le-te. Metodologija raziskovanja. Pri izdelavi teoretičnega dela smo uporabili deskriptivno metodo dela z analizo literature. Za izdelavo empiričnega dela je uporabljena kvantitativna metodologija raziskovanja. Anketni vprašalnik je vseboval 17 vprašanj zaprtega tipa in 2 vprašanji odprtega tipa ter 3 vprašanja polodprtega tipa. Raziskavo smo izvedli v eni izmed slovenskih splošnih bolnišnic v mesecu februarju 2015. Za izvedbo raziskave smo pridobili soglasje institucije. Rezultati. 97 % anketiranih meni, da izvajajo zdravstveno nego po sprejetih standardih, kar pomeni, da izvajajo kakovostno zdravstveno nego. 86 % anketiranih si želi več izobraževanj na temo kakovost v zdravstveni negi. 75 % anketiranih meni, da so dovolj seznanjeni s pomenom in potekom akreditacije v instituciji. Diskusija in zaključek. Zaposleni zagotavljajo kakovost tako, da imajo redne sestanke negovalnega tima, prav tako v veliki večini izvajajo zdravstveno nego po sprejetih standardih. Za zaposlene je zadovoljen bolnik najvišja vrednota, kar kaže, da se trudijo za kakovostno obravnavo vseh pacientov. Za kakovostno zdravstveno nego potrebujemo dovolj časa in ustrezno število zdravstvenega kadra. Zaposleni so zadovoljivo seznanjeni s samo akreditacijo in so tudi dobro seznanjeni s samim namenom pridobitve akreditacije. Akreditacija je tesno povezana s kakovostno zdravstveno obravnavo in je prinesla pozitivne učinke. Theoretische Ausgangspunkte. Im Rahmen der Behandlungsqualität streben alle Beteiligten am Gesundheitswesen nach den besseren Ergebnissen für die Patienten, dem effizienteren Funktionieren des Systems und der besseren Aus-, Weiter- und Fortbildung der Fachkräfte. In der Akkreditierung bewertet eine externe Stelle die Konformität einer Gesundheitseinrichtung mit den vorbestimmten Qualitäts- und Sicherheitsnormen. Zweck. Der Zweck dieser Diplomarbeit ist es, die Qualität und das Qualitätsmanagement im Gesundheitswesen darzulegen und die Entwicklung sowie die Einrichtung eines Akkreditierungssystems für Krankenhäuser in Slowenien zu präsentieren. Im empirischen Teil der Diplomarbeit wurde die Haltung der Beschäftigten im Gesundheitswesen gegenüber die Qualität der Gesundheitspflege untersucht. Des Weiteren wurde die Vertrautheit mit der Akkreditierung sowie dem Zweck ihres Erwerbs analysiert. Forschungsmethodologie. Im theoretischen Teil der Diplomarbeit wurde die deskriptive Arbeitsmethode mit der Literaturanalyse eingesetzt. Im empirischen Teil wurde die quantitative Forschungsmethode angewendet. Der verwendete Fragebogen wurde aus 17 geschlossenen, 2 offenen und 3 halboffenen Fragen zusammengesetzt. Die Studie wurde im Februar 2015 in einem Allgemeinkrankenhaus in Slowenien durchgeführt und wurde von der erwähnten Einrichtung genehmigt. Ergebnisse. 97 % der Befragten sind der Meinung, dass die Gesundheitspflege mit den anerkannten Normen übereinstimmt, das heißt, dass eine hochwertige Gesundheitspflege geleistet wird. 86 % der Befragten erhoffen mehr Bildung im Bereich Qualität der Gesundheitspflege. 75 % der Befragten sind der Ansicht, dass sie mit der Bedeutung der Akkreditierung und dem Verlauf eines Akkreditierungsverfahrens entsprechend vertraut sind. Schlussfolgerungen. Die Qualität der Gesundheitspflege wird mit den regelmäßigen Besprechungen zwischen den Mitgliedern des Pflegeteams gewährleistet. Außerdem erfolgt die Pflege im Einklang mit den anerkannten Normen. Ein zufriedener Patient stellt den höchsten Wert für die Mitarbeiter dar. Das bedeutet, dass sie sich um eine hochwertige Behandlung aller Patienten bemühen. Eine hochwertige Gesundheitspflege verlangt genug Zeit und ein entsprechendes Fachpersonal. Die Mitarbeiter sind mit der Akkreditierung und dem Zweck ihres Erwerbs ausreichend vertraut. Die Akkreditierung steht in enger Beziehung zur hochwertigen Behandlung und hatte im betreffenden Fall positive Auswirkungen.

Astma, kot najpogostejša kronična pljučna bolezen, zahteva kakovostno zdravstveno obravnavo bolnikov že na primarnem nivoju. Kronični bolnik je največkrat v stiku z izbranim osebnim zdravnikom, saj prihaja po redno terapijo, v primeru poslabšanja kronične bolezni in v primeru nove akutne bolezni. Na redne letne kontrole pri specialistu bolniki pogosto pozabijo ali pa le-te odlagajo, saj jih odvračajo dolge čakalne dobe, ki kljub naročanju nastajajo v čakalnicah specialističnih ambulant. Pomemben korak na poti k napredku in razvoj primarnega zdravstvenega varstva na slovenskih tleh je Ministrstvo za zdravje začrtalo v aprilu 2011 z uvedbo referenčnih ambulant. V ambulante družinske medicine se uvede nov član, diplomirana medicinska sestra, ki, kot strokovnjakinja na svojem področju, z znanjem in izkušnjami prevzema točno določene naloge in odgovornosti, ki so zapisane v protokolih obravnave posamezne kronične bolezni. Poleg razbremenitve izbranega osebnega zdravnika naj bi prispevala velik delež k boljši kakovosti življenja bolnikov s kronično boleznijo in razbremenitvi specialističnih ambulant. Diplomirana medicinska sestra skrbno vodi registre bolnikov s kronično boleznijo, skrbi za njihovo zdravstveno obravnavo po strokovnih protokolih in najnovejših kliničnih smernicah ter hkrati skrbi za nenehno poučevanje bolnikov. Dobro poučen bolnik s kronično boleznijo in redno obravnavo pri diplomirani medicinski sestri v referenčni ambulanti se lahko izogne poslabšanjem in pogostim obiskom v ambulanti izbranega osebnega zdravnika. V magistrskem delu je analiziran potek zdravstvene obravnave kroničnih bolnikov z astmo v referenčni ambulanti in opravljena je primerjava z obravnavo kroničnih bolnikov z astmo v primerjalni ambulanti, ki v procesu obravnave še ne sledi smernicam referenčne ambulante. Raziskavo smo opravili v Zdravstveni postaji Senovo, sodelovalo je 76 kroničnih bolnikov z astmo. Raziskava temelji na dveh predpostavljenih hipotezah. S prvo hipotezo smo raziskali statistično pomembno boljše kazalnike zdravstvene obravnave pri bolnikih, vodenih v referenčni ambulanti, v drugi hipotezi pa smo raziskali, ali imajo bolniki, vodeni v referenčni ambulanti, statistično pomembno več znanja o svoji bolezni, o pomenu rednega jemanja zdravil in pravilni tehniki jemanja zdravil v primerjavi z bolniki, ki se vodijo v primerjalni ambulanti. Kljub temu, da hipotez, ki smo si jih v raziskavi zastavili, nismo v celoti potrdili, smo prišli do zaključka, da je uvedba referenčnih ambulant prava pot k razvoju primarnega zdravstvenega nivoja, saj so rezultati vseeno pokazali, da je že po prvem letu delovanja diplomirane medicinske sestre v timu splošne ambulante opazna razlika. Asthma as the most common chronic lung disease requires quality medical treatment for patient at the primary level. Chronically patient is often in contact with general practitioner when they are coming for regular prescriptions, in the cases of aggravation of chronic diseases and in the appearance of new acute illness. Patients often forget to go to regular annually control to specialist of pulmology on the secondary level or they dispose of it because of long waiting time in spite of orders generated at the specialists clinics. An important step on the road to progress and development of primary health care on Slovenian territory, the Ministry of health have done in April 2011 with the introduction of reference clinics. In ambulance of family practitioner was introduced a new member, a register nurse who, as a specialist in its field, with expertise and knowledge, is taking over some defined tasks and responsibilities, which are noted in the protocol of treatment of specific chronic diseases. In addition to relieving of selected general practitioner is expected high share of better quality of life for patient with chronic disease and relieving of specialist' clinic. Register nurse carefully kept records of patient with chronic disease, taking care for their medical treatment under the protocols and the latest clinical guidelines whilst ensuring the constant health education of patients. Well-informed patient with chronically disease and regular annual visits at nurse in reference ambulance can avoid deterioration and frequent visits of the ambulance of selected family doctor. In our work we analyse some treatment of chronically ill patients in reference ambulance and after we compare treatment of chronically ill patients in the comparator ambulance which in the treatment process does not follow the guidelines of reference ambulance. The research was conducted in the Medical station Senovo, involving 76 patients with chronic asthma. The study is based on two predicted hypotheses. With the first hypothesis we studied statistically significantly important indicators of medical treatment in patient managed in a reference ambulance. In the second hypothesis, we investigated whether patients, guided by the reference ambulance, have significantly more knowledge about their disease, the importance of regular taking of medication and proper technique of taking of medication compared with patients who are kept in comparative ambulance. Although the hypotheses, we have investigated, we are not fully confirmed, we came to the conclusion, that the introduction of reference ambulances is the way to the development of primary health care. Results have shown that already after the first year of working of register nurse in the team of family practitioner in noticeable difference.

Magistrsko delo je raziskovalna naloga, ki je potekala v treh primerljivih slovenskih bolnišnicah. Namenjena je vodilnim medicinskim sestram, ki lahko z učinkovitim vodenjem, z vseživljenjskim izobraževanjem, skrbstvenim in timskim delom izboljšajo medsebojne odnose zaposlenih, dvignejo motivacijo in dosežejo boljšo kakovost zdravstvenih storitev. Predstavljeni so vidiki vodenja ljudi, ki temeljijo na zaupanju, timskem delu, obojestranski komunikaciji, delegiranju nalog in vse večji soudeležbi zaposlenih pri sprejemanju odločitev organizacije v celoti. V zdravstveni negi je nujno potrebno, da imajo vodilne medicinske sestre za uspešno vodenje zdravstvene nege znanje s področja managementa in voditeljstva. K managementu kakovosti v zdravstvu je potrebno pristopiti na sistemski način, a vodilne medicinske sestre imajo nedvomno ključno vlogo v celovitem zdravstvenem sistemu, kar želimo raziskati na podlagi rezultatov in pripraviti smernice za dvig kakovosti zdravstvenih storitev. Raziskava je pokazala, da največ medicinskih sester pozna nevarni dogodek padec iz postelje, najmanj pa je takšnih, ki poznajo nevarni dogodek napačno poznavanje bolezenskih znakov in simptomov. Pri preprečevanju nevarnih dogodkov zelo malo vključujejo bolnika in njihove svojce, vendar so medicinske sestre prepričane, da bi o nevarnem dogodku obvestile neposrednega vodja. Ugotavljamo, da med glavnimi medicinskimi sestrami različnih oddelkov ni razlik, ki bi se odražale v kvaliteti dela. Na oddelkih, kjer so medicinske sestre večkrat pohvaljene od svojega neposrednega vodja ocenjujejo svoje delo kot bolj planirano, bolj timsko, bolj raznoliko, nudi jim več strokovnih izzivov, so bolj motivirane in sodelujejo pri sprejemanju odločitev. V vseh treh bolnišnicah imajo medicinske sestre enake možnosti za izobraževanja. Dodatna znanja bi želele pridobili z internimi in funkcionalnim izobraževanjem, nekaj je tudi takšnih, ki bi želele aktivno sodelovati v krožkih kakovosti, najmanj strinjanja pa medicinske sestre vidijo v uvajanju supervizije. Iz raziskave in Nacionalne ankete je razvidno, da so bolniki najbolj zadovoljni z zdravstveno nego, ki jo nudijo v Splošni Bolnišnici dr. Jožeta Potrča Ptuj, v primerjavi z drugima dvema bolnišnicama. Če želimo v bolnišnicah doseči kakovostno zdravstveno nego, mora sodelovanje med vodilno medicinsko sestro in zaposlenimi temeljiti na odprti komunikaciji, ki izhaja iz medsebojnega spoštovanja, delitve oblasti, informacij in virov ter medosebnega vrednotenja. Vse to pa lahko dosežemo, če bodo vse vodilne medicinske sestre uporabljale stil vodenja »tim«, ki označuje visoko zanimanje tako za delovne naloge, kot tudi za ljudi. This master's thesis is a research work, which has taken place in three comparable Slovene hospitals. It is intended for head nurses, who can with an efficient leadership, lifelong education, care and team work, improve mutual relations among employees, raise the motivation and achieve a better quality of health care services. Here are presented the views of leading people, based on trust, team work, two-way communication, delegation of tasks and increasing of sub-participation of employees at decision making for the whole organization. It is indispensible necessary that head nurses have knowledge from the area of management and leadership for a successful leading of the health care. We have to approach systematically to the quality management in the health care, but it is undoubtedly true that the head nurses have the key role in the whole health care system. That is the aim of our research which we want to achieve on the basis of the results. We want to draw up guidelines for the improvements in the quality of the health care services. Our research has demonstrated that the majority of nurses are familiar with the sentinel events: falling off a bed but less of them is familiar with the sentinel event: not knowing the symptoms and signs of the disease. Patients and their relatives are usually not included into the prevention of the sentinel events, but nurses are persuaded that they will inform their direct leader about them. There are no differences in the quality of work among head nurses of different departments. On the departments where nurses get compliments from their direct leaders, they evaluate their work as more planned, more team work, more diverse. Therefore they are more professional challenged more motivated and they are involved with the accepting of decisions. Nurses from all three hospitals have equal possibilities for additional education. With the internal and functional education they could get some additional knowledge and some of them would also like to actively participate in the quality circles. The least of nurses agree with the establishing of the supervision. The research of the National survey has shown that the most patients are satisfied with the health care in the General hospital dr. Jože Potrč Ptuj in comparison with the other two hospitals. There must be an open communication between the head nurse and employees, based on the mutual respect, division of authority, information and sources and interpersonal assessment, if we want to achieve a quality health care. All that can be achieved if the head nurses will use »team« management, which shows interests for working tasks and also for people.

V diplomskem delu smo obravnavali tri pomembne kazalnike kakovosti, in sicer MRSA, razjedo zaradi pritiska in padce bolnikov. Cilj je bil z anketo ugotoviti raven znanja medicinskih sester v Splošni bolnišnici Jesenice o preprečevanju in širjenju okužb z MRSA, o preprečevanju razjede zaradi pritiska in o padcih bolnikov. Zanimalo nas je tudi, ali medicinske sestre upoštevajo standarde kakovosti pri svojem delu. Ugotovili smo, da nekatere medicinske sestre v Splošni bolnišnici Jesenice ne upoštevajo standardov o preprečevanju in širjenju okužb z MRSA. Kljub temu da je večina medicinskih sester seznanjena s standardi o preprečevanju in širjenju okužb z MRSA, jih ne upoštevajo. Na drugo vprašanje, ali so medicinske sestre pozorne, da ima bolnik, ki je ogrožen za padec, primerne pripomočke, lahko odgovorimo pritrdilno, saj je iz odgovorov razvidno, da medicinske sestre upoštevajo vse varnostne ukrepe, ki pripomorejo k preprečevanju padcev. Tretje raziskovalno vprašanje je bilo, ali medicinske sestre poznajo preventivne ukrepe pri preprečevanju razjede zaradi pritiska. Medicinske sestre dobro poznajo preventivne ukrepe za preprečevanje razjede zaradi pritiska. Nekatere medicinske sestre pa niso dobro seznanjene, kateri so zunanji dejavniki, ki vplivajo na razjedo zaradi pritiska. Pri izdelavi diplomskega dela smo uporabili deskriptivno metodo s študijem slovenske in tuje literature. Za zbiranje podatkov in ugotavljanje, ali medicinske sestre v Splošni bolnici Jesenice upoštevajo standarde, ki so pomembni za preprečevanje in širjenje okužb z MRSA, ter standarde za preprečevanje padcev in razjede zaradi pritiska smo kot instrument raziskovanja uporabili anketo z vprašanji zaprtega in odprtega tipa. Obdelava podatkov je potekala v MS Excelu. Na podlagi rezultatov smo analizirali vse odgovore ter nekatere tudi grafično prikazali. Uporabili smo deskriptivno statistično metodo, rezultate pa predstavili v besedni in grafični obliki. In the diploma paper we have analyzed three important quality indicators, i.e. MRSA, pressure ulcers and falls of patients. The aim was to determine, through a survey, the level of nurses’ knowledge in Jesenice General Hospital on preventing and spreading of MRSA infections, on preventing pressure ulcers and on falls of patients. We also wanted to determine whether nurses take into account quality standards when performing their work. We have discovered that some nurses in Jesenice General Hospital do not take into account standards on preventing and spreading of MRSA infections. Despite the fact that the majority of nurses is acquainted with those standards, they fail to take them into account. The second question, whether nurses pay attention to the fact that the patient at risk of falling has appropriate devices, can be answered affirmatively, because the results show that nurses take into account all safety measures that contribute to avoiding the falls. The third question of the research was whether nurses are familiar with preventive measures concerning pressure ulcers. Nurses are well familiar with the preventive measures concerning pressure ulcers. But some nurses are not well acquainted with the fact which external factors affect pressure ulcers. When preparing this diploma paper we have used the descriptive method and the analysis of Slovene and foreign literature. To collect data and determine whether nurses in Jesenice General Hospital take into account standards, important for prevention and spreading of MRSA infections, and standards for prevention of falls and pressure ulcers, the open and closed type survey was used as a research instrument. MS Excel was used for data processing. On the basis of results we have analyzed all the answers and we have presented some of them graphically. We have used descriptive statistical method and presented the results in a verbal and graphical way.