Quality Management as a Tool for Improving the Performance of Healthcare Organizations at Different Levels

Introduction: Healthcare organizations are faced with numerous problems, including a chronic lack of financial resources. Aim: To determine the difference in familiarity with the standards related to the quality management system between the primary, secondary and tertiary levels of health care, to determine the difference in the implementation of the quality system; determine the connection between the implementation of the quality system and the satisfaction of service users – patient. Materials and methods: Statistical processing of all data from the survey questionnaire was performed in the SPSS 17.0 package (SPSS Inc.). The level of statistical significance was set at 0.05, and all confidence intervals are given at the 95% level. The normality of the distributions was checked by ShapiroWilk tests when the samples were smaller than n=30, and by the Kolmogorov-Smirnov test for larger samples. Given that in most cases they indicated statistically significant deviations from normal distributions, the median and interquartile ranges were used as measures of central tendency and dispersion. Mutual comparisons of all three levels of health activity were analyzed with the Mann-Whitney U test, with Bonferroni’s correction of the level of statistical significance. The survey questionnaire was sent to the addresses of a total of 110 BiH health institutions at the primary, secondary and tertiary levels of health care. In the period June/July 2024, a total of 86 completed survey questionnaires were collected, which represents 76,18 % of all respondents. Conclusion: Research on a sample of primary, secondary and tertiary healthcare institutions in Bosnia and Herzegovina showed that the knowledge and application of the quality management system is still insufficient and points to the need to raise awareness of the importance of the application of the quality management system. Clinical hospital centers, as expected, given the application of the highest standard of medicine and the highest level of provision of health services, showed: greater knowledge of the importance of the quality management system and representation of quality assurance requirements of the ISO standard. The research also found that healthcare institutions that use international standards of quality management systems perform systematic monitoring of patient satisfaction with services provided statistically significantly more often (χ2 = 5.134; ss = 1; P = 0.032; contingency coefficient = 0.237). 47.1% of them carried out systematic monitoring of patients, compared to 20.3% of institutions that did not implement international norms of the quality management system.