Medical Services – State and Relevance in Modern Society
Modern conditions for the development of healthcare worldwide place high demands on the professionalism of medical specialists and the quality of medical services.
Patient safety and health is defined as terminology by the World Health Organization (WHO) and is perceived as protecting the patient from unnecessary or potential harm associated with the provision of medical care (WHO, 1946). The content of this term is also reflected in the policies adopted on public health protection.
In recent years, the rising costs of healthcare worldwide have posed a major challenge to national health systems. Many organizations around the world recognize the complementarity of public health and environmental safety, focusing on their effective management with identification of different types of risks (Pauliková, Chovancová, & Blahová, 2022). Total health expenditure represents 7.1% of GDP compared to 9.9% for the EU. Direct payments from households account for 37.8% of health expenditure in 2019 – the highest share in the EU and approximately 2.5 times higher than total share for the EU. The key drivers of the high share of direct payments include services outside the scope of the health insurance package and co-payments for some of the services included in the package, especially medicines (EOHSP, 2021). The effective treatment of patients within the prescribed length of hospital stay assumes paramount importance in accordance with the imposed regulatory requirements (Tripathi and Siddiqui, 2018). The management of medical activities relies on various criteria related to the measurement of response time to patients, the degree of leanlyness and hygiene in the infrastructure of the hospital facility, the application of established standards and medical practices, and the consideration of the satisfaction of the patients treated as some of the important areas of measurement of the quality offered (Crisan, Covaliu, & Chis, 2021). Strategic health management is aimed at achieving better public health adapting to changes and influences of external and internal environmental conditions (United Nations, 2015).
In Bulgaria, despite the inconsistency of health reforms, there have been changes that increase competition between health care institutions and the care they provide to patients. Hospitals are developing in a competitive environment and are relying primarily on an increasing degree of positive impact from the services provided to patients. In this sense, according to Vladimirova (2021), the present traditional views of relationship marketing are perceived as the basis for planning measures towards increasing the strategic capital of the organization. Healthcare organizations are making efforts in their management strategy towards enforcing customer satisfaction in the direction of planning, execution and control of service processes aimed at service quality.
In the conditions in which the health care system operates in the Republic of Bulgaria, health care institutions plan and carry out their activities within a competitive market for the implementation of health care services. Both private and public medical institutions operate in the country. The type of ownership determines the types of ways of financial provision and determines the degree of dependence on the decisions taken. On a different principle are the conditions of mechanisms and approaches that ensure the quality of medical services offered (Pavlova, 2019).
Ensuring the safety and security of patient health requires cooperation and information exchange between institutions and especially with those in the healthcare sector, guaranteed by appropriate models for the protection of public health (Pavlova & Sidjimova, 2017).
The purpose of this study is to assess the impact of external and internal environmental factors, which are essential to forming the context of organizations providing medical services in the Republic of Bulgaria. Determining the degree of influence of these factors will help each medical facility determine the specific circumstances of the internal and external environment in which it operates. It will refine the individual circumstances of its activities that influence the purpose of the organization, its goals and sustainable development in accordance with the adopted development strategy in line with its mission and vision.
It should be pointed out that at the time of this study, the effects of the spread and consequences of COVID-19 have left their mark.
In addition to the effects on the health of citizens and the health system in the country under the current complex conditions, several economic sectors are being affected.
A decline in the expected level of the Bulgarian GDP and the lack of an adequate political stance on the unification and voting of the normative frameworks of the national budget for 2023 can be reported, reasons that require changes in the behavior of a number of businesses and public organizations, including in health facilities.
The fundamental changes in the health care system in the Republic of Bulgaria after 2000 are the basis for the formation of new social relations with changes in the structure and scope of the health care sector.
The QMS toolkit will be used to identify and analyse the key aspects of the company and those of the stakeholders in order to determine the strategic management of the medical institution.
The following methods were used in the development: expert method and PESTLE analysis (P-Political, E-Economic, S-Social, T-Technological, L-Legal and E-Environmental factors) with quantitative assessment of circumstances. The study was conducted in three multidisciplinary hospitals in the Republic of Bulgaria for the period 2019-2021.
The study can be useful in planning and developing modern quality management systems in different areas of health care, as it identifies the requirements including stakeholders who consume the created medical services, subject to the company's activities or affected by them.