Sağlık sektöründe hekim performansının değerlendirilmesi
Sağlık sektöründe en önemli insan kaynaklarından birisi olan hekimler çoğu zaman tek başlarına çalışarak sağlık ile ilgili pek çok sonucun sorumluluğunu üstlenmektedirler. Çalışmalarını son derece karmaşık bir ortamda sürdüren hekimler gün geçtikçe takımlar ve sistemler içerisine daha fazla dahil olmaktadırlar. Son on yıl içerisinde hekimlerin sağlık sistemi ile entegrasyonu ve başta hasta bakımı olmak üzere sağlık hizmetlerinde kalite artışına vermiş oldukları katkının artışı hekim performansının ölçümüne olan ilgiyi artırmıştır. Hekim performansının ölçümü ile ilgili yaklaşımların ağırlıklı olarak klinik performans ölçümüne odaklandıkları görülmektedir. Bu çalışmada hekim performansı ölçümü konusundaki yaklaşımlar; klinik ve davranışlar performans ölçümü yaklaşımları ile objektif ve subjektif performans ölçümü yaklaşımları olmak üzere sınıflandırılarak incelenmiştir. Bu çerçevede gelecekte hekim performansının ölçümü konusunda çok boyutlu yaklaşımların ön plana çıkacağı düşünülmektedir.
Assessment of physician performance in health sector
Physicians, who are the most important human resources in health sector, act alone most of the time and they undertake the responsibility for health care outcomes. Physicians work in complex environments and they fall into teams and systems increasingly day by day. Physicians involvement in health care system and the increase in their contribution to quality of health care services including patient care in the last ten years has increased the emphasis on the measurement of physician performance. It was seen that physician performance assessment approaches have mainly focused on the measurement of clinical performance. In this study, approaches in physician performance assessment are classified as clinical/ behavioural approaches and objective/ subjective measurement approaches. In this framework, it has been expected that multi dimensional physician performance assessment methods would become more popular in the future.
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- ADAIR, J.G., (1984), The Hawthorne Effect : A Reconsideration of The
Methodological Artifact, Journal of Applied Psychology, 69(2), 334-
345
- BARROWS, H.S., (1993), An Overview of The Uses of Standardized
Patients for Teaching and Evaluating Clinical Skills, Academic Medicine,
68(6), 443-451
- BARUTÇUGİL, İ., (2002), Performans Yönetimi, Kariyer Yayıncılık İletişim
Ltd. Şti
- BERGUER, R., (1999), Surgery and Ergonomics, Archieves of Surgery,
134(9), 1011-1016
- BERTAKIS, K.D., HELM, L.J., CALLAHAN, E. J., AZARI, R. and ROBBINS, J.,
(1995), The Influence of Gender on Physician Practice Style, Medical
Care, 33(4), 407-416
- DILLNER, L., (1995), Manchester Tackles Failure Rate Of Asian Students,
BMJ (British Journal of Medicine), 310:209
- DONABEDIAN, A., (2000), Evaluating Physician Competence, Bulletin of
The World Health Organization, 78(6), 857-860
- DUBINSKY, I., JENNINGS, K., GREENGARTEN, M., and BRANS, A., (2010),
360-Degree Physician Performance Assessment, Healthcare Quarterly,
13(2), 71-76
- ELÇİN, M., ODABAŞI, O. ve SAYEK, İ., (2005), Yapılandırılmış Objektif Klinik
Sınavlar, Hacettepe Tıp Dergisi, Editöryal 36:1-2
- ELÇİN, M., ODABAŞI, O., TURAN, S., SİNCAN, M., ve BAŞUSTA, N.B., (2010),
Tıp Eğitiminde İletişim Becerilerinin Standart Hastalar ve Yapılandırılmış
Değerlendirmelerle Geliştirilmesi, Hacettepe Tıp Dergisi, 41 (4), 219-
230
- ERGİN, G., (2009), Çalışanların Ücretlendirilmesi: Sağlık Kurumlarında
Çalışanların Ücret Sistemini Değerlendirmelerine İlişkin Bir Araştırma,
Doktora Tezi, Hacettepe Üniversitesi, Sağlık Kurumları Yönetimi, A.B.D.,
Ankara
- ESPTEIN, R.M. and HUNDERT, E.M., (2002), Defining and Assessment
Professional Competence, Journal of American Medical Association,
287(2), 226-235
- EVANS, R., ELWYN, G. and EDWARDS, A., (2004), Review of Instruments
for Peer Assessment of Physicians, BMJ (British Journal of Medicine),
328, 1-5
- FARMER, E.A., BEARD, J.D., DAUPHINEE, W.D., LADUCA, T. and MANN, K.V.,
(2002), Assessing The Performance of Doctors In Teams and Systems,
Medical Education, 36: 942-948
- GORDON, R., (2012), The Vanishing Physician Scientist: A Critical Review
and Analysis, Accountability In Research, 19, 89-113
- Hacettepe Üniversitesi 2011-2012 Öğretim Yılı İyi Hekimlik
Uygulamaları Kılavuzu, www.tip.hacettepe.edu.tr/ekler/pdf/rehber12
- pdf
- HALL, J.A., PALMER, H., ORAV, E.J., HARGRAVES, J.L., WRIGHT, E.A. and
LOUIS T.A., (1990), Performance Quality, Gender and Professional Role,
Medical Care, 28(6), 489-501
- HAYS, R.B., DAVIES H.A., BEARD, J.D., CALDON, L.J.M., FARMER, E.A.,
FINUCANE, P.M., MCCRORIE, P., NEWBLE, D.I., SCHUWIRTH, L.W.T. and
SIBBALD, G.R. (2002), Selecting Performance Assessment Methods for
Experienced Physicians, Papers from the 10th Cambridge Conference,
Medical Education, 36, 910-917
- KAIGAS, T., (2000), Assessment of The Performance of Practicing
Physicians In Canada, 5th International Medical Workforce
Conference, Sydney, 101-118
- KIM, C., MCEWAN, L.N., GERZOFF, R.B., MARRERO, D.G., MANGIONE, C.M.,
SELBY J.V. and HERMAN, W.H., (2005), Is Physician Gender Associated
With The Quality of Diabetes Care?, Diabetes Care, 28(7), 1594-1598
- KOPELOW, M.L., SCHANBL, G.K., HASSARD, T.H., TAMBLYN, R.M., KLASS,
D.J., BEAZLEY, G., HECHTER, F. and GROTT, M., (1992), Assessment of
Performance In The Office Setting With Standardized Patients, Academic
Medicine, 67(10), 19-21
- KUTANİS, R.Ö., TUNÇ, T. ve TUNÇ, M., (2011), Tıpta Uzmanlık Eğiticileri
ve Uzmanlık Öğrencileri Tıpta Uzmanlık Sınavını (TUS) Nasıl Algılıyor?,
Kuram ve Uygulamada Eğitim Bilimleri, 11(4), 1992-2004
- LOCKYER, J., (2003), Multisource Feedback In The Assessment of
Physician Competencies, The Journal of Continuing Education In The
Health Professions, 23, 4-12
- LOCKYER, J.M. and VIOLATO, C., (2004), An Examination of The
Appropriateness of Using A Common Peer Assessment Instrument To
Assess Physician Skills Across Specialties, Academic Medicine, 79(10),
5-8
- MARSON, D.C., HAWKINS L., MCINTURFF, B. and HARRELL, L.E., (1997),
Cognitive Models That Predict Physician Judgements of Capacity to
Consent In Mild Alzheimers Disease, Journal of American Geriatrics
Society, 45(4), 458-464
- MCMASTER, F.R. and HENG, B.H., (2007), Measuring Physician
Performance: A Review of The Literature, Health Technology
Assessment, No: 1003, 1-3
- MIDIK, Ö., ve KARTAL, M., (2010), Simülasyona Dayalı Tıp Eğitimi,
Marmara Medical Journal, 23(3), 389-399
- MILLER, G.E., (1990), The Assessment of Clinical Skills/Competence/
Performance, Academic Medicine, 65(9), 63-67
- MISCH, D.A., (2002), Evaluating Physicians Professionalism and
Humanism: The Case for Humanism Connoisseur, Academic Medicine,
77(6), 489-495
- MOLEMA, J.J.W., GROOTHUIS, S., BAARS, I.J., KLEINSCHIPHORST, M.,
LEERS, E.G.E., HASMAN, A. and MERODE, G.G., (2007), Health Care System
Design and Parttime Working Doctors, Health Care Management
Science, 10: 365-371
- MORGAN, L., (2012), Results-Based Financing for Health: Performance
Incentives in Global Health: Potential and Pitfalls, Feature, The World
Bank, 1-6
- NONNOMAKER, L., (2000), Women Physicians In Academic Medicine,
The New England Journal of Medicine, 342, 399-405
- OVEREEM, K.,WOLLERSHEIM, H.C., ARAH, O. A., CRUIJSBERG, J.K., GROL,
R. and LOMBARTS, K., (2012) Evaluation of Phsyicians Professional
Performance: An Interative Development and Validation Study of
Multisource Feedback Instruments, BMC Health Services, 12:80
- SAĞLIK BAKANLIĞI, Sağlıkta Yönetici ve Birim Performansı, T.C. Sağlık
Bakanlığı Performans Kalite Geliştirme Daire Başkanlığı, Şubat 2012
- SANAZARO, P.J. and WILLIAMSON, J.W., (1970), Physician Performance
and Its Effects on Patients A Classification Based on Reports by Internists,
Surgeons, Pediatricians and Obstetricians, Medical Care, 8(4), 299-308
- ŞAHİN, H., ve SAÇAKLIOĞLU, F., (1999), Evaluation Of Practitioners
Apropriate Drug Prescribing Behaviour On Written Simulated Cases In
Bornova Health District, 7. Annual Meeting of ESOP/Ankara (Özet
Kitabı, s.49)
- VALLEVAND, A.L.C., (2008), Realibility, Validity and Sources of Errors In
Assessing Physician Performance In An Objective Structured Clinical
Examination: A Generalizability Theory Analysis, Master Thesis,
University of Calgary
- WEISSMAN, J.S., HASNAIN-WYNIA, R., WEINICK, R.M., KANG, R., VOGELI, C.,
IEZZONI, L., and LANDRUM, M.B., (2012), Pay-for Performance Programs
To Reduce Radical/Ethnic Disparities : What Might Different Designs
Achieve?, Journal of Health Care for Poor and Underserved, 23, 144-
160
- WHO (WORLD HEALTH ORGANIZATION), (2011), Transformative Scale
Up Of Health Professional Education, www.who.int/hrh
- WOOLF, K., POTTS, H.W.W. and MCMANUS, I.C., (2011), Ethnicity and Academic
Performance In U.K. Trained Doctors and Medical Students: Systematic
Review and Meta-Analysis, BMJ (British Medical Journal), 342,
1-14
- YILMAZ, F.N., (2012), İletişim Becerileri İstasyonundan Elde Edilen Öz Değerlendirme
ve Puanlayıcı Değerlendirmelerinin Karşılaştırılması, Eğitim
ve Öğretim Araştırmaları Dergisi, 1(2):357-363.