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I do not know this from hearsay. As a military medic, I was always careful about which hospital to send a wounded person to. Depending on his needs. Because I didn’t care how my brothers would be helped.
Now I see the system from the other side – as a person working with the wounded after discharge. Those who should go to the stage of rehabilitation, recover, return to civilian life. But I worry more and more, every time I think about something else: will this fighter survive until next Saturday? Because instead of rehabilitation, people have to be saved from what is officially called “treatment”, but actually looks like abuse. More powerful and capable institutions are often not engaged in rehabilitation, but in correcting other people’s mistakes.
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Unreasonable prescription of antibiotics. Incorrect treatment regimens. Urinary tract infections due to careless handling of catheters. Osteomyelitis, bedsores that eat away at the skin like iron rust. Patients in hospital beds melt like ice cubes in the boiling water of the system. These are not exceptions. This is the norm. The norm of Ukrainian medicine.
Care that does not exist The patient suffers the most where care decides everything. And care is primarily nursing work. It is easiest to blame the nurses for everything. But this is only the surface. Because this professional community – one of the largest in the system – was almost untouched by the transformation.
In the Ukrainian system, a nurse is not a professional, but “cheap labor.” Without the right to make decisions, without a future, without development. A nurse in our country is not a ladder. This is not a profession. This is a dead end. This is the verdict. They are in the health care system like the only actor on stage who missed a rehearsal.
No matter how much one would like to reproach the community of those who spend more time with patients than doctors, that they are doing wrong and wrong, but they are not to blame. They are part of the system that determines how they should be, what they should do, what they should learn and how they should work.
Outdated education standards, lack of quality control, meager wages, mistrust that is increasingly mutual, lack of funding – all these factors converge at one point. And this point has a name, a face, a history. She is lying in a hospital bed, covered in bedsores.
How could it be Nurses should become independent market players. With the possibility of receiving payment for your services directly from the NSZU. As it has already happened, for example, in Poland: there they can receive payment directly from the state, run their own practice, hire staff, research, teach.
In Great Britain, it is a separate academic profession altogether. There, I have more than once seen in the signatures of my colleagues: PhD Nurse. A person who does not just look after – he researches, develops, teaches. It’s just a development in the right direction. Therefore, it happens the other way around than with us. Up to research in which you are the subject, not the object. So, you just need to not disturb. Build not limitations, but opportunities.
Who is responsible for quality The problem is wider than it seems. In Ukraine, there is still no clear answer to the question: what is the quality of medical care? Who measures it? Who controls? We play a game without rules. And while hospitals, patients, the state – everyone plays “in their own way”, no one can win. In this game, only one risks losing – the patient.
The issue of the quality of medical services is not a popular issue, because then you will have to admit a simple fact – the help is of poor quality. And if it is of poor quality, there should be consequences for the person who provided it.
Currently, two players are participating in the medical tango at the state level – the Ministry of Health and the National Health Service of Ukraine. This interaction cannot fail to captivate. One creates the music, the other pays for the orchestra. There has never been such synchronicity in plans and actions. This tandem is a pleasure to watch. Despite the political turbulence, the challenges of the pandemic and a full-scale war for survival, they managed not only to preserve the values of transformations of the health care system that were laid down by its authors, but also to scale them. To make the healthcare system sustainable, able to treat, rehabilitate, restore and return to a quality life.
However, in every dance, and even more so in the competition for survival, there is not enough of a third participant – the arbiter of this performance. An independent institution that would monitor the quality of medical services provided by all market players – hospitals, primary care centers, and outpatient clinics. This simple truth is so powerful that it is surprising how we have not noticed it until now.
In Great Britain it is solved simply. The Care Quality Commission operates there – an independent institution that monitors all clinics, hospitals, homes for the elderly. It has the right to check, evaluate, publish the results and even close establishments if they do not meet standards. Nothing like this exists in Ukraine.
Immediately I will warn you about the fact that NSZU is either already doing something similar or should do it. No, it doesn’t. It seemsbut not the same. NSZU only monitors the execution of contracts. But this is not the same as quality control. Moreover, NSZU cannot simultaneously pay and ask “What did you do with this money?”. Because then there is a temptation to give someone the next piece of cake, and to refuse someone.
Public administration works somewhat more complicated than the family system. Manual management and punishment for disloyalty is not evolution, but rollback. These are different models of behavior. Different philosophy. The stability of the state begins with a system of checks and balances sewn into legislation and with independent institutions. I wanted those who came to power in 2019 to read it.
After the war It is sad to understand: in a country that cannot solve the main issue – mobilization, it is hardly worth waiting for attention to written off and tattered bodies in the wards. Real attention – without pathos and PR.
If we do not take care of those returning from the front, we risk turning the country into a large gerontological hospital. The only question is whether there will be those who will pay for its existence.
Our state is a state of social promises. Some promise, others pay. We pay twice. First, to the healthcare system for simulating treatment. Then – to the pension fund for the disability that this simulation guarantees.
Hleb Bityukov
A column is a type of material that reflects exclusively the point of view of the author. It does not claim objectivity and comprehensive coverage of the topic in question. The point of view of the editors of “Economic Pravda” and “Ukrainian Pravda” may not coincide with the author’s point of view. The editors are not responsible for the reliability and interpretation of the given information and perform exclusively the role of a carrier.
”, — write: www.pravda.com.ua
I do not know this from hearsay. As a military medic, I was always careful about which hospital to send a wounded person to. Depending on his needs. Because I didn’t care how my brothers would be helped.
Now I see the system from the other side – as a person who works with the wounded after discharge and Those who should go to the stage of rehabilitation, recover, return to civilian life. But I worry more and more, every time I think about something else: will this fighter survive until next Saturday? Because instead of rehabilitation, people have to be saved from what is officially called “treatment”, but actually looks like abuse. More powerful and capable institutions are often not engaged in rehabilitation, but in correcting other people’s mistakes.
Advertising:
Unreasonable prescription of antibiotics. Incorrect treatment regimens. Urinary tract infections due to careless handling of catheters. Osteomyelitis, bedsores that eat away at the skin like iron rust. Patients in hospital beds melt like ice cubes in the boiling water of the system. These are not exceptions. This is the norm. The norm of Ukrainian medicine.
Care that does not exist The patient suffers the most where care decides everything. And care is primarily nursing work. It is easiest to blame the nurses for everything. But this is only the surface. Because this professional community – one of the largest in the system – was almost untouched by the transformation.
In the Ukrainian system, a nurse is not a professional, but “cheap labor.” Without the right to make decisions, without a future, without development. A nurse in our country is not a ladder. This is not a profession. This is a dead end. This is the verdict. They are in the health care system like the only actor on stage who missed a rehearsal.
No matter how much one would like to reproach the community of those who spend more time with patients than doctors, that they are doing wrong and wrong, but they are not to blame. They are part of the system that determines how they should be, what they should do, what they should learn and how they should work.
Outdated education standards, lack of quality control, meager wages, mistrust that is increasingly mutual, lack of funding – all these factors converge at one point. And this point has a name, a face, a history. She is lying in a hospital bed, covered in bedsores.
How could it be Nurses should become independent market players. With the possibility of receiving payment for your services directly from the NSZU. As it has already happened, for example, in Poland: there they can receive payment directly from the state, run their own practice, hire staff, research, teach.
In Great Britain, it is a separate academic profession altogether. There, I have more than once seen in the signatures of my colleagues: PhD Nurse. A person who does not just look after – he researches, develops, teaches. It’s just a development in the right direction. Therefore, it happens the other way around than with us. Up to research in which you are the subject, not the object. So, you just need to not disturb. Build not limitations, but opportunities.
Who is responsible for quality The problem is wider than it seems. In Ukraine, there is still no clear answer to the question: what is the quality of medical care? Who measures it? Who controls? We play a game without rules. And while hospitals, patients, the state – everyone plays “in their own way”, no one can win. In this game, only one risks losing – the patient.
The issue of the quality of medical services is not a popular issue, because then you will have to admit a simple fact – the help is of poor quality. And if it is of poor quality, there should be consequences for the person who provided it.
Currently, two players are participating in the medical tango at the state level – the Ministry of Health and the National Health Service of Ukraine. This interaction cannot fail to captivate. One creates the music, the other pays for the orchestra. There has never been such synchronicity in plans and actions. This tandem is a pleasure to watch. Despite the political turbulence, the challenges of the pandemic and a full-scale war for survival, they managed not only to preserve the values of transformations of the health care system that were laid down by its authors, but also to scale them. To make the healthcare system sustainable, able to treat, rehabilitate, restore and return to a quality life.
However, in every dance, and even more so in the competition for survival, there is not enough of a third participant – the arbiter of this performance. An independent institution that would monitor the quality of medical services provided by all market players – hospitals, primary care centers, and outpatient clinics. This simple truth is so powerful that it is surprising how we have not noticed it until now.
In Great Britain it is solved simply. The Care Quality Commission operates there – an independent institution that monitors all clinics, hospitals, homes for the elderly. It has the right to check, evaluate, publish the results and even close establishments if they do not meet standards. Nothing like this exists in Ukraine.
Immediately I will warn you about the fact that NSZU is either already doing something similar or should do it. No, it doesn’t. It seemsbut not the same. NSZU only monitors the execution of contracts. But this is not the same as quality control. Moreover, NSZU cannot simultaneously pay and ask “What did you do with this money?”. Because then there is a temptation to give someone the next piece of cake, and to refuse someone.
Public administration works somewhat more complicated than the family system. Manual management and punishment for disloyalty is not evolution, but rollback. These are different models of behavior. Different philosophy. The stability of the state begins with a system of checks and balances sewn into legislation and with independent institutions. I wanted those who came to power in 2019 to read it.
After the war It is sad to understand: in a country that cannot solve the main issue – mobilization, it is hardly worth waiting for attention to written off and tattered bodies in the wards. Real attention – without pathos and PR.
If we do not take care of those returning from the front, we risk turning the country into a large gerontological hospital. The only question is whether there will be those who will pay for its existence.
Our state is a state of social promises. Some promise, others pay. We pay twice. First, to the healthcare system for simulating treatment. Then – to the pension fund for the disability that this simulation guarantees.
Hleb Bityukov
A column is a type of material that reflects exclusively the point of view of the author. It does not claim objectivity and comprehensive coverage of the topic in question. The point of view of the editors of “Economic Pravda” and “Ukrainian Pravda” may not coincide with the author’s point of view. The editors are not responsible for the reliability and interpretation of the given information and perform exclusively the role of a carrier.
