Isihloko: Ukuphathwa Kwekhwalithi Ezibhedlela: Ukuqinisekisa Ubuhle Ekunakekelweni Kweziguli
Esimweni esiyinkimbinkimbi nesiguquguqukayo sezokunakekelwa kwempilo zanamuhla, ukugcina amazinga aphezulu okuphathwa kwekhwalithi ezibhedlela akuyona nje into eza kuqala kodwa kuyisidingo. Ukuphathwa kwekhwalithi kuhlanganisa uhla lwezifundo kanye nemikhuba eyenzelwe ukuthuthukisa ukunakekelwa kweziguli, ukuthuthukisa ukuphepha, nokuqinisekisa ukulethwa kwezempilo okuphumelelayo. Le ndlela ephelele ihlose ukunciphisa amaphutha, ukuthuthukisa imiphumela yeziguli, kanye nokukhuthaza isiko lokuthuthuka okuqhubekayo ezikhungweni zezempilo.
Ukubaluleka Kokuphathwa Kwekhwalithi Ezibhedlela
Ukuphathwa kwekhwalithi ezibhedlela kubalulekile ngezizathu eziningi. Okokuqala nokubaluleke kakhulu, kuthinta ngqo ukuphepha kweziguli kanye nemiphumela. Ngokusebenzisa izinhlelo zokuphathwa kwekhwalithi eziqinile, izibhedlela zinganciphisa ukwanda kwamaphutha ezokwelapha kanye nezehlakalo ezimbi, okuholela ekwanelisekeni kweziguli kanye nokwethenjwa okungcono. Ngokusho kwe-Institute of Medicine, amaphutha ezokwelapha ayimbangela ehamba phambili yokulimala nokufa, kugcizelela isidingo esibalulekile sokulawulwa kwekhwalithi okuqinile.
Esinye isici esibalulekile sokuphathwa kwekhwalithi ukuhambisana nezindinganiso zomthetho. Izinhlangano ezilawulayo ezifana ne-Joint Commission, i-Centers for Medicare & Medicaid Services (CMS), kanye neminyango ehlukahlukene yezempilo kazwelonke zibeka izindinganiso okumele izibhedlela zihlangabezane nazo ukuze zihlale zigunyaziwe futhi zithole uxhaso. Lezi zindinganiso zihlanganisa ububanzi bokunakekelwa, kusukela ezinqubweni zezokwelapha kuya emikhubeni yokuphatha, futhi ukunamathela kuzo kuwuphawu lwesibhedlela esiphethwe kahle.
Ngaphezu kwalokho, ukuphathwa kwekhwalithi kubalulekile ekuzinzeni kwezezimali. Abahlinzeki bezokunakekelwa kwempilo basebenza endaweni yokuncintisana lapho ukuxhaswa ngezimali kanye nokubuyiselwa kwemali kuhlotshaniswa kakhulu nezilinganiso zokusebenza. Izibhedlela ezibonisa ukunakekelwa kwekhwalithi ephezulu zingaheha iziguli eziningi, zifinyelele imiphumela engcono yezempilo, futhi zithole ukubuyiselwa kwemali okuphezulu ezinkampanini zomshuwalense kanye nezinhlelo zikahulumeni.
Izingxenye Eziyinhloko Zokuphathwa Kwekhwalithi Ezibhedlela
1. Ubuholi Nokuphatha: Ukuphathwa kwekhwalithi okuphumelelayo kuqala ngobuholi obuqinile. Abaphathi bezibhedlela namalungu ebhodi kumele babeke phambili ikhwalithi nokuphepha kweziguli ekuhleleni kwabo amasu kanye nezinqubo zokwenza izinqumo. Abaholi kufanele bakhuthaze isiko lenhlangano elihlonipha ukucaca, ukuzibophezela, kanye nokuthuthuka okuqhubekayo. Kumele futhi baqinisekise ukuthi izinsiza ezanele zabelwa izinhlelo zekhwalithi nokuqeqeshwa kwabasebenzi.
2. Ukulinganisa Ukusebenza: Ukulinganisa ukusebenza kuyisici esiyisisekelo sokuphathwa kwekhwalithi. Izibhedlela zisebenzisa izindlela ezahlukene zokulinganisa ukuhlola ukulethwa kokunakekelwa, okuhlanganisa imiphumela yesiguli, amazinga okwamukelwa kabusha, amazinga okutheleleka, kanye namaphuzu okwaneliseka kwesiguli. La maphuzu edatha ahlinzeka ngesisekelo sobuningi bokuhlonza izindawo zokuthuthukiswa nokulandelela inqubekela phambili ngokuhamba kwesikhathi.
3. Imikhuba Esekelwe Ebufakazini: Ukusebenzisa imikhuba esekelwe ebufakazini kubalulekile ekuthuthukiseni ikhwalithi yokunakekelwa. Le mikhuba isekelwe ocwaningweni lwakamuva kanye neziqondiso zezokwelapha, okuqinisekisa ukuthi ukunakekelwa kweziguli kusekelwe ezindleleni ezifakazelwe ngokwesayensi. Izibhedlela kumele zihlale zivuselelwa ngezindinganiso zezokwelapha ezishintshayo futhi ziqhubeke nokuhlanganisa le mikhuba ezimisweni zazo zezokwelapha.
4. Ukuzibandakanya Kweziguli: Ukuphathwa kwekhwalithi kuhilela ukuzibandakanya ngenkuthalo neziguli ekunakekelweni kwazo. Lokhu kuhlanganisa ukufundisa iziguli ngezimo zazo, izinketho zokwelapha, nokukhuthaza ukuhlanganyela kwazo ezinqubweni zokwenza izinqumo. Impendulo yeziguli nayo ibaluleke kakhulu ekuboneni izindawo zokuthuthukisa nokuthuthukisa izindlela zokunakekelwa ezigxile esigulini.
5. Ukuthuthukiswa Kwenqubo: Izindlela zokuthuthukisa inqubo eziqhubekayo njengemijikelezo ye-Lean, Six Sigma, kanye ne-Plan-Do-Study-Act (PDSA) zisetshenziswa ukuthuthukisa ukusebenza kahle nokunciphisa imfucuza. Lezi zindlela zisiza ukwenza imisebenzi ibe lula, ukunciphisa izinqubo eziphindaphindayo, kanye nokuthuthukisa ukulethwa kwezempilo okuphelele.
6. Ukuqeqeshwa Nokuthuthukiswa Kwabasebenzi: Abasebenzi besibhedlela bayigugu labo elibaluleke kakhulu. Izinhlelo zemfundo nokuqeqeshwa okuqhubekayo zibalulekile kubasebenzi bezokwelapha kanye nabangebona abezokwelapha ukuqinisekisa ukuthi banolwazi lwakamuva ngemikhuba nobuchwepheshe bamuva. Abasebenzi abanekhono nabaqeqeshwe kahle banganciphisa kakhulu amaphutha futhi bathuthukise ikhwalithi yokunakekelwa kweziguli.
7. Ukusetshenziswa Kobuchwepheshe: Ubuchwepheshe budlala indima ebalulekile ekuphathweni kwekhwalithi yesimanje. Amarekhodi Ezempilo E-elekthronikhi (ama-EHR), Izinhlelo Zokusekela Izinqumo Zemitholampilo (ama-CDSS), kanye ne-Health Information Exchanges (ama-HIE) zenza kube lula ukuphathwa kwedatha okungcono, kunciphisa amaphutha abantu, futhi kwenze kube lula ukunakekelwa okuhlelekile. I-Telemedicine kanye namathuluzi okuqapha akude nawo andisa ukufinyelela ekunakekelweni futhi athuthukise imiphumela yesiguli.
8. Ukuphathwa Kwezingozi: Ukuhlonza nokunciphisa izingozi kubaluleke kakhulu ezibhedlela. Amasu okuphathwa kwezingozi ahilela ukuhlola izinsongo ezingaba khona ekuphepheni kweziguli, ukusebenzisa izindlela zokuvimbela, kanye nokuthuthukisa izinhlelo zesimo esiphuthumayo. Le ndlela yokuqapha iyasiza ekunciphiseni ukulimala kanye nokuthuthukisa ikhwalithi yokunakekelwa iyonke.
Izinselele Ekusetshenzisweni Kokuphathwa Kwekhwalithi
Naphezu kwezinzuzo ezicacile, ukusebenzisa ukuphathwa kwekhwalithi ezibhedlela kuza nezinselele. Esinye sezithiyo eziyinhloko ukumelana noshintsho. Izindawo zokunakekelwa kwempilo zivame ukuba nemikhuba egxilile kanye nemicabango engaba nzima ukuyishintsha. Ukunqoba lokhu kumelana kudinga ukuxhumana okusebenzayo, imfundo, kanye nokuzibandakanya kuzo zonke izigaba zenhlangano.
Ukushoda kwezinsizakusebenza kuletha enye inselele enkulu. Izinhlelo zokuthuthukisa ikhwalithi zingadinga izinsizakusebenza eziningi, zidinga ukutshalwa kwezimali kwezobuchwepheshe, ukuqeqeshwa kanye nabasebenzi. Ukulinganiselwa kwesabelomali kungaphazamisa ukuqaliswa okugcwele kwezinhlelo zokuphatha ikhwalithi, okudinga ukubekwa phambili kwezinhlelo ngamasu.
Ukuphathwa kwedatha nakho kuyinkinga ebalulekile. Inani elikhulu ledatha eqoqwe esibhedlela lidinga ukuqoshwa, kuhlaziywe, futhi kusetshenziswe ngokunembile. Ukuqinisekisa ubuqotho bedatha nokuthuthukisa amakhono okuhlaziya aqinile kubalulekile ekwenzeni izinqumo ezinolwazi.
Izibonelo Nezindaba Zempumelelo
Izibhedlela eziningana emhlabeni wonke ziye zasebenzisa ngempumelelo izinhlelo zokuphatha ikhwalithi, okuholele ekuthuthukisweni okuphawulekayo ekunakekelweni kweziguli. Isibonelo, iVirginia Mason Medical Center eSeattle yamukele iToyota Production System (indlela yeLean) ukuze inciphise imfucuza futhi ithuthukise ukuhamba kweziguli. Le ndlela iholele ekunciphiseni okukhulu kwezikhathi zokulinda kweziguli, yathuthukisa ukwaneliseka kwabasebenzi, kanye nemiphumela yezokwelapha ethuthukisiwe.
Ngokufanayo, ukuzibophezela kweCleveland Clinic ekhwalithini nasekuphepheni kweziguli kuye kwayitholela ukuqashelwa njengesinye sezibhedlela eziphezulu emhlabeni jikelele. Ukugxila kwabo ekulinganiseni nasekubikeni ngokusobala izilinganiso zokusebenza kuye kwaqhuba imizamo yokuthuthukisa eqhubekayo eminyangweni eyahlukahlukene.
Isiphetho
Ukuphathwa kwekhwalithi ezibhedlela kuyingxenye ebalulekile yokunakekelwa kwempilo kwanamuhla. Kuhlanganisa ukuzibophezela kobuholi, ukulinganisa ukusebenza, imikhuba esekelwe ebufakazini, ukuzibandakanya kweziguli, ukuthuthukiswa kwenqubo, ukuthuthukiswa kwabasebenzi, ukusetshenziswa kobuchwepheshe, kanye nokuphathwa kwezingozi. Nakuba indlela yokufinyelela ubuhle ekuphathweni kwekhwalithi ingase ilethe izinselele, izinzuzo ngokuphepha kweziguli, ukuthobela imithetho, ukusimama kwezezimali, kanye nemiphumela yokunakekelwa kwempilo iyonke zijulile. Ngokukhuthaza isiko lokuthuthuka okuqhubekayo nokusebenzisa imikhuba emihle kakhulu, izibhedlela zingaqinisekisa ukuthi iziguli zazo zithola amazinga aphezulu okunakekelwa, zivula indlela yekusasa elinempilo kubo bonke.
