Olga Siskou

Informal payments for maternity health services in public hospitals in Greece.

BACKGROUND Private health expenditure for consuming maternity health services has been identified as an issue within public hospitals. AIM To estimate level of private health expenditure, in the form of informal payments, for maternal services in public hospitals in Greece. METHODS The study population consisted of 160 women who had recently given birth in three provincial general hospitals and one general hospital in Athens. A three-part questionnaire was developed in order to collect financial information regarding the use of public obstetrics services in Greece. RESULTS The mean age of respondents was 29.5 (±5.6) years. There was a high rate of informal payments with 74.4% of women involved in informal transactions. Mean total private payments were €1549 (±992), representing 7.9% of the mean annual per capita income in Greece. Mean informal payment was €848 (±714). For 56.3% of the respondents, it was at the obstetricians request, on top of formal payment of €701 (±1351). Total informal payments were higher for women who gave birth in Athens (p<0.001), for Greek women compared to non Greek (p<0.001) and for deliveries that were conducted by womens personal obstetrician (p=0.001). CONCLUSION There is a large black economy in the field of obstetric services, as 74.4% of women who used public maternity services had to pay under-the-table payments corresponding approximately to the net salary of an intern physician. There is a need for the state to adopt innovative strategies and mechanisms in order to reduce informal payments for obstetric services in the public sector.

Conflict management in public hospitals: the Cyprus case

BACKGROUND Conflict among health-care personnel has been identified as an issue within health-care settings around the world. AIM To investigate the existence and management of conflict among health-care personnel in public hospitals in Cyprus; to assess the factors leading to conflict among staff members; to evaluate the consequences of conflict arising; and to consider the management strategies. METHODS A self-administered questionnaire was completed by a random sample of 1037 health-care professionals in all (seven) state-run hospitals in Cyprus in 2008. RESULTS Mean age of respondents was 41 years, and 75% were female. Sixty-four per cent of respondents reported that they had never been informed about conflict management strategies, with physicians being the least informed as the relative percentage was 79.8% (χ(2) = 33, P < 0.001). Sixty per cent of health-care professionals reported conflict at work with other health-care personnel one to five times per week, and 37% of the respondents stated that they devote 90 min (mean value) from work during their shift in conflict resolution, meaning that managing conflicts may absorb 19% of working time daily. The majority of respondents agreed that organizational problems and communication gaps were the main issues creating conflict. Avoidance and collaboration were the preferable strategies for conflict resolution, used by 36.6% and 37.5% of the respondents, respectively. CONCLUSION   Better communication, fair management practices and clear job descriptions and expectations may be needed in order to facilitate change and reverse the negative atmosphere that exists. Further education in conflict management for physicians, nurses and their managers may also be needed.

Public health services knowledge and utilization among immigrants in Greece: a cross-sectional study

BackgroundDuring the 90s, Greece has been transformed to a host country for immigrants mostly from the Balkans and Eastern European Countries, who currently constitute approximately 9% of the total population. Despite the increasing number of the immigrants, little is known about their health status and their accessibility to healthcare services. This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece.MethodsA pilot cross-sectional study was conducted from January to April 2012 in Athens, Greece. The study population consisted of 191 immigrants who were living in Greece for less than 10 years. We developed a questionnaire that included information about sociodemographic characteristics, health status, public health services knowledge and utilization and difficulties in health services access. Statistical analysis included Pearson’s ×2 test, ×2 test for trend, Student’s t-test, analysis of variance and Pearson’s correlation coefficient.ResultsOnly 20.4% of the participants reported that they had a good/very good degree of knowledge about public health services in Greece. A considerable percentage (62.3%) of the participants needed at least once to use health services but they could not afford it, during the last year, while 49.7% used public health services in the last 12 months in Greece. Among the most important problems were long waiting times in hospitals, difficulties in communication with health professionals and high cost of health care. Increased ability to speak Greek was associated with increased health services knowledge (p<0.001). Increased family monthly income was also associated with less difficulties in accessing health services (p<0.001).ConclusionsThe empowerment and facilitation of health care access for immigrants in Greece is necessary. Depending on the needs of the migrant population, simple measures such as comprehensive information regarding the available health services and the terms for accessibility is an important step towards enabling better access to needed services.

Conflict management and job satisfaction in paediatric hospitals in Greece

AIM To assess the major causes of conflict and to identify choices of strategy in handling conflicts. BACKGROUND Conflict is inherent to hospitals as in all complex organizations, and health personnel deal with internal and external conflicts daily. METHODS The sample consisted of 286 participants. A five-part questionnaire, specific for conflicts in hospitals, was administered to health personnel. RESULTS Of the participants 37% were physicians and 63% were nurses and nursing assistants. As far as choice of strategy in conflict management is concerned, avoidance was found to be the most frequent mode chosen while accommodation was the least frequent mode. Organizational problems were the main issue creating conflicts since 52% of nurses and 45% of physicians agreed that receiving direction from more than one manager may lead to conflicts (P=0.02). Educational differences and communication gaps were reported as another cause of conflicts, with nurses supporting this statement more than the other groups (P=0.006). CONCLUSION To become effective in conflict management nurses and physicians must understand causes and strategies in handling conflicts. IMPLICATIONS FOR NURSING MANAGEMENT Major changes are needed regarding human resource management, work incentives and dynamics of teamwork in order to improve working conditions in Greek public hospitals.

The cost of home care for patients with malignant neoplasms.

A microeconomic study evaluated the health sector cost of home care in Greece for patients with malignant neoplasms. A cost-identification analysis was performed from the home care services perspective. According to the results of the study, the cost varies among the main categories of malignant neoplasms because of a fluctuation in the cost of drugs, whereas the main cost-driver factor is the cost of laboratory tests. In comparison with the corresponding cost of in-hospital care, the cost of home care for patients with malignant neoplasms is significantly lower, which also is confirmed by the results of other international studies.

Living with breast cancer: Patients’ journey within the Greek National Health System

Abstract Background: Process mapping (a patient-centred method) and recording the medical, nursing and administrative staff’s views involved in the provision of care help us understand patients’ experience regarding the constraints, delays and bottlenecks of healthcare service processes and identify areas of improvement. Patients and Methods: Time information and data were collected through time and motion study with regard to the path patients with breast cancer follow in two public hospitals (sample of 86 patients) and a semi-structured questionnaire was administered to medical, nursing and administrative staff (sample of 14 employees). Results: The amount of time required in total for the prescription process was increased up to seve7 times compared to the beneficial amount of time, and the longest delays in patients’ waiting time were observed with regard to the process of chemotherapy (more than 2 hours and 40 minutes, in some cases). About 92.3% of the staff of the two hospitals prioritized the malfunctioning of theCcentralIinformationSsystem as the most important factor and more than 75% of the study participants mentioned that several administrative and technical aspects have a negative and significant effect on the time required to prescribe the necessary medicines for the treatment of patients. Conclusions: The lack of understanding of the hospital’s processes and spatial infrastructure by most patients, the lack of an electronic patient record system and central information system are highlighted as the main issues that contribute decisively to the increase in the non-beneficial time that patients with breast cances have to spend nowadays in hospitals of the NHS in Greece.