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Title: PRILAGAJANJE NA SPREMEMBE V ZDRAVSTVENEM SISTEMU: Integracija pacientove perspektive pri oblikovanju strategij razvoja javnih zdravstvenih zavodov za obvladovanje sprememb ter vpliv družbenih dejavnikov na kakovost zdravstvene oskrbe Authors: ID Počrvina, Ljubinka (Author) ID Džajić Uršič, Erika (Mentor) More about this mentor... ID Lamut, Urša (Comentor) Files: 13496$$DR_Participacija_pacientov_PocrvinaL_avg2025.pdf (7,20 MB, This file will be accessible after 01.10.2026) MD5: 86CD4BEF98E7A9D7C043BB22A6BE1594   Language: Slovenian Work type: Doctoral dissertation Organization: FUDS - School of advanced social studies Abstract: Uvod: Namen disertacije je raziskati, kako lahko perspektiva pacientov postane sestavni del strateškega načrtovanja v javnih zdravstvenih zavodih, in sicer z namenom bolj učinkovitega odzivanja na spremembe v zdravstvu. Posebna pozornost je namenjena vplivu družbenih dejavnikov, kot so organizacijska kultura, zdravstvena pismenost, digitalna dostopnost ter odnos in zrelost vodstev zavodov do participacije pacientov. Disertacija analizira, kako strukturni dejavniki omogočajo ali omejujejo vključevanje pacientov kot enakovrednih partnerjev v oblikovanje zdravstvene politike. Posebna pozornost je namenjena vprašanju, ali zakonodajne reforme, zlasti Zakon o kakovosti v zdravstvu, predstavljajo dejanski premik v praksi ali ostajajo na ravni formalne, simbolne participacije. Namen raziskave je tudi oblikovanje priporočil za dolgoročno vključujočo in odzivno zdravstveno politiko, ki bo sposobna nasloviti potrebe prihodnjih modelov zdravljenja. Metode: Raziskava temelji na kvalitativni metodologiji in metodološki triangulaciji. Uporabljene so bile štiri glavne metode: analiza zakonodajnih in strateških dokumentov, polstrukturirani intervjuji s 26 deležniki, štiri fokusne skupine s 40 udeleženci ter diskurzivna analiza medijskih vsebin. Tematska, vsebinska in diskurzivna analiza so bile izvedene z namenom identifikacije vzorcev, ovir in priložnosti participacije pacientov v praksi. Rezultati: Ugotovitve kažejo, da vključevanje pacientov v Sloveniji pogosto ostaja na simbolni ravni. Zaznani so bili strukturni izzivi, kot so hierarhična kultura v zdravstvenih ustanovah, pomanjkanje sistemskih mehanizmov za participacijo, nizka zdravstvena pismenost ranljivih skupin ter neenak dostop do digitalnih rešitev. Zakon o kakovosti v zdravstvu (2024) predstavlja pomemben korak, vendar njegova implementacija še ne kaže sistemske spremembe. Primeri dobre prakse, kot so sodelovanje nevladnih organizacij in razvoj pilotnih programov skupnega odločanja, kažejo na potencial za dolgoročne učinke ob ustrezni institucionalni podpori. Zaključek: Raziskava potrjuje, da brez spremembe organizacijske kulture in odnosa do pacientov kot sogovornikov zakonodajne reforme ostajajo nezadostne. Uvedba modela skupnega odločanja (shared decision-making), vzpostavitev regijskih preventivnih centrov ter celovit pristop na mikro, mezo in makro ravni predstavljajo konkretne korake k prehodu iz simbolne v realno participacijo pacientov. Le takšen sistem, ki temelji na zaupanju, odprti komunikaciji in vrednotah vključevanja, omogoča dolgoročno vzdržnost in pravičnost zdravstvene oskrbe. Keywords: participacija pacientov, kakovost zdravstvene oskrbe, zdravstvene reforme, zdravstvena pismenost, organizacijska kultura, skupno odločanje, vključujoča politika. Year of publishing: 2025 PID: 20.500.12556/ReVIS-12341  Publication date in ReVIS: 02.10.2025 Views: 11 Downloads: 0 Metadata:    Cite this work Plain text BibTeX EndNote XML EndNote/Refer RIS ABNT ACM Ref AMA APA Chicago 17th Author-Date Harvard IEEE ISO 690 MLA Vancouver : Copy citation

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Language:	English
Title:	ADAPTATION TO CHANGE IN THE HEALTH SYSTEM: Integrating the patient's perspective in the design of strategies for the development of public health institutions to manage change and the influence of social factors on the quality of health care
Abstract:	Introduction: The purpose of this dissertation is to explore how the patient perspective can become an integral part of strategic planning in public healthcare institutions, in order to improve the responsiveness of the system to ongoing changes in healthcare. Particular attention is given to the influence of social factors such as organizational culture, health literacy, digital accessibility, and the attitudes and maturity of institutional leadership towards patient participation. The dissertation analyses how structural factors enable or hinder the inclusion of patients as equal partners in shaping health policy. Particular attention is given to whether legislative reforms, especially the Health Care Quality Act, represent a real shift in practice or remain at the level of formal, symbolic participation. The study also aims to develop recommendations for a long-term inclusive and responsive health policy capable of addressing the needs of future care models. Methods: The research is based on a qualitative methodology and methodological triangulation. Four main methods were used: analysis of legislative and strategic documents, semi-structured interviews with 26 stakeholders, four focus groups with 40 participants, and discourse analysis of media content. Thematic, content, and discourse analyses were conducted to identify patterns, barriers, and opportunities for meaningful patient participation in practice. Results: Findings indicate that patient involvement in Slovenia often remains at a symbolic level. Structural challenges were identified, including hierarchical institutional culture, lack of systemic mechanisms for participation, low health literacy among vulnerable groups, and unequal access to digital solutions. The Health Quality Act (2024) marks an important step, yet its implementation does not yet demonstrate systemic change. Good practice examples, such as cooperation with non-governmental organizations and the development of pilot programs for shared decision-making, reveal potential for long-term impact when supported by institutional commitment. Conclusion: The research confirms that without a shift in organizational culture and a redefinition of patients as interlocutors, legislative reforms remain insufficient. The implementation of the shared decision-making model, establishment of regional preventive centers, and a comprehensive approach at the micro, meso, and macro levels represent concrete steps toward a transition from symbolic to genuine patient participation. Only a system based on trust, open communication, and inclusive values can ensure sustainable and equitable healthcare delivery.
Keywords:	patient participation, healthcare quality, healthcare reforms, health literacy, organizational culture, shared decision-making, inclusive policy.

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