Independent assessment of the quality of services provided by organizations. Evaluation of the quality of medical care. Outpatient service quality indicators

A native of Italy, who was destined to glorify French music - such is the fate of Jean-Baptiste Lully. The founder of French lyrical tragedy, he played a key role in the formation of the Royal Academy of Music - the future Grand Opera House.

Giovanni Battista Lulli (that was the name of the future composer at birth) is a native of Florence. His father was a miller, but the origin did not prevent the boy from becoming interested in art. In childhood, he showed versatile abilities - he danced, played comic scenes. A certain Franciscan monk instructed him in the art of music, and Giovanni Batista learned to play the guitar and violin perfectly. Luck smiled at him at the age of fourteen: the Duke of Guise drew attention to the talented young musician and took him into his retinue. In France, the musician, now called in the French manner - Jean-Baptiste Lully - became the page of the Princess de Montpensier, the king's sister. His duties included helping her practice her Italian, as well as entertaining her with musical instruments. At the same time, Lully filled in the gaps in his musical education - he took singing and composition lessons, mastered the harpsichord, improved his violin playing.

The next stage of his career was the work in the orchestra "Twenty-Four Violins of the King". But Lully conquered his contemporaries not only by playing the violin, he also danced beautifully - so much so that in 1653 the young king wished Lully to perform with him in the ballet Night, staged at court. Acquaintance with the monarch, which took place under such circumstances, allowed him to enlist the support of the king.

Lully was appointed court composer of instrumental music. His duty in this capacity was to create music for the ballets that were staged at court. As we have already seen in the example of "Night", the king himself performed in these productions, and the courtiers did not lag behind His Majesty. Lully himself also danced in performances. The ballets of that era were different from modern ones - along with dancing, they included singing. Initially, Lully was engaged only in the instrumental part, but over time he became responsible for the vocal component as well. He created many ballets - "The Seasons", "Flora", "Fine Arts", "Country Wedding" and others.

At the time when Lully created his ballets, the career of Jean-Baptiste Molière was developing very successfully. Having made his debut in the French capital in 1658, after five years the playwright received a substantial pension from the king, moreover, the monarch ordered him a play where he himself could act as a dancer. This is how the ballet comedy "Reluctant Marriage" was born, ridiculing scholarship and philosophy (the elderly protagonist intends to marry a young girl, but, doubting his decision, seeks advice from educated people - however, none of them can give an intelligible answer to his question ). The music was written by Lully, and Pierre Beauchamp worked on the production along with Molière and Lully. Starting with "Reluctant Marriage", the collaboration with Moliere turned out to be very fruitful: Georges Danden, The Princess of Elis and other comedies were created. The most famous joint work of the playwright and composer was the comedy "The Tradesman in the Nobility".

Being an Italian by birth, Lully was skeptical about the idea of creating a French opera - in his opinion, the French language was not suitable for this primordially Italian genre. But when the first French opera, Pomona by Robert Cambert, was staged, it was approved by the king himself, which made Lully pay attention to this genre. True, the works that he created were not called operas, but lyrical tragedies, and the first in their series was the tragedy Cadmus and Hermione, written to the libretto by Philip Cinema. Later, "Theseus", "Atis", "Bellerophon", "Phaeton" and others were written. Lully's lyrical tragedies consisted of five acts, each of which opened with an extended aria of one of the main characters, and in the further development of the action, recitative scenes alternated with short arias. Lully attached great importance to recitatives, and when creating them, he was guided by the manner of recitation inherent in the tragic actors of that time (in particular, the famous actress Marie Chammele). Each act ended with a divertissement and a choral scene. The French lyrical tragedy, at the origins of which stood Lully, differed from the Italian opera - dancing played no less important role in it than singing. Overtures also differed from the Italian models, they were built on the principle of "slow-quick-slow". The singers in these performances performed without masks, another innovation was the introduction of oboes and trumpets into the orchestra.

Lully's work is not limited to operas and ballets - he created trios, instrumental arias and other compositions, including spiritual ones. One of them - Te Deum - played a fatal role in the fate of the composer: while directing his performance, Lully accidentally injured his leg with a battuta (a cane that beat the rhythm at that time), and the wound caused a fatal illness. The composer died in 1687 before completing his last tragedy, Achilles and Polyxena (completed by Pascal Collas, a student of Lully).

Lully's operas enjoyed success until the middle of the 18th century. Later they left the stage, but interest in them revived in the 21st century.

16. French opera in the 17th century. Creativity J. B. Lully.

Aesthetics of French Classicism. French music, along with Italian, is one of the significant cultural phenomena of the 17th-18th centuries. The development of musical art was associated primarily with opera and chamber instrumental music.

French opera was strongly influenced by classicism (from Latin classicus - "exemplary") - the artistic style that developed in France in the 17th century; and above all - the classical theater. Playwrights Pierre Corneille and Jean Racine, showing the complex struggle of passions, sang the sense of duty in tragedies. The actors played in a special manner: they sang the words, often used gestures and facial expressions. This manner influenced the French style of singing: it differed from the Italian bel canto in its proximity to colloquial speech. The singers, like dramatic actors, clearly pronounced the words, resorted to whispers and sobs.

At the court of the "Sun King" Louis XIV, the opera occupied an important place. The Royal Academy of Music (the theater where opera performances took place) became one of the symbols of the luxury of the royal court and the power of the monarch.

Jean-Baptiste Lully(1632-1687) - An outstanding musician, composer, conductor, violinist, harpsichordist - he went through a life and creative path that was extremely original and in many respects characteristic of his time. In French music, a kind of opera seria appeared - a lyrical tragedy (fr. Tragedie lyrique). The creator of this genre was the composer Jean Baptiste Lully. Lully's operas, large five-act works, were notable for their luxurious staging, the splendor of scenery and costumes, as required by the court, which wanted bright spectacles and a holiday. These are dramas typical of the Baroque era with features of classicism. Here passions raged, heroic events took place. Artificial, refined beauty in music and scenery, characteristic of the Baroque, and classic poise, harmony of construction. This is a feature of Lully's operas.

Lully wrote operas based on subjects from ancient mythology and epic poems of the Renaissance. His best opera - "Armida" (1686) - was created based on the heroic poem of the Italian poet Torquato Tasso "The Liberated Jerusalem". According to the plot, the Queen of Damascus Armida bewitches with her charms the knight of the crusader Reno (Tasso has Rinaldo). However, Reno's associates remind him of military duty, and the knight leaves his beloved, and she destroys the kingdom in despair. The idea of the opera meets the requirements of classicism (a conflict of duty and feeling), but the love experiences of the characters are shown with such expressiveness and depth that they become the center of the action. The main thing in Lully's music is extended monologue arias, in which the themes of a song or dance character alternate with recitative, which flexibly and subtly conveys the feelings of the characters. The influence of the Baroque was manifested not only in the external luxury of the production, but in the increased attention to the love drama; it is the depth of feelings, and not following the duty that makes the characters interesting for the listener. The development of the national opera continued in the work of Lully's younger contemporary, Jean Philippe Rameau (1683-1764). He also wrote in the genre of lyrical tragedy. In the works of Rameau, the psychological characteristics of the characters deepened, the composer sought to overcome the external brilliance and pomposity of French opera. Having a background in chamber instrumental music, he strengthened the role of the orchestra. An important role was played by dance numbers, which were complete scenes.

Jean Baptiste was born in Florence on November 28, 1632. The son of a miller, Lully, as a child, was taken to France, which became his second home. Being at first in the service of one of the noble ladies of the capital, the boy attracted the attention of his brilliant musical abilities. After learning to play the violin and achieving amazing success, he got into the court orchestra. Lully came to the fore at court, first as an excellent violinist, then as a conductor, choreographer, and finally as a composer of ballet and later opera music.

In the 1650s, he took charge of all the musical institutions of the court service as "Musical Superintendent" and "Maestro of the Royal Family". In addition, he was secretary, confidant and adviser to Louis XIV, who granted him the nobility and assisted in acquiring a huge fortune. Possessing an extraordinary mind, strong will, organizational talent and ambition, Lully, on the one hand, was dependent on the royal power, on the other hand, he himself had a great influence on the musical life of not only Versailles, Paris, but throughout France.

As a performer, Lully became the founder of the French violin and conductor school. Rave reviews of several prominent contemporaries have been preserved about his playing. His performance was distinguished by ease, grace and at the same time an extremely clear, energetic rhythm, which he invariably adhered to when interpreting works of the most diverse emotional structure and texture.

But the greatest influence on the further development of the French school of performance was exerted by Lully as a conductor, moreover, in particular as an opera conductor. Here he knew no equal.

Actually, Lully's operatic work unfolded in the last fifteen years of his life - in the 70s and 80s. During this time he created fifteen operas. Theseus (1675), Hatys (1677), Perseus (1682), Roland (1685) and especially Armida (1686) are widely known among them.

Lully's opera arose under the influence of the classicist theater of the 17th century, was connected with it by the closest ties, and largely adopted its style and dramaturgy. It was a great ethical art of a heroic nature, the art of great passions, tragic conflicts. The very titles of the operas indicate that, with the exception of the conventionally Egyptian "Isis", they were written on subjects from ancient mythology and partly only from the medieval knight's epic. In this sense, they are consonant with the tragedies of Corneille and Racine or the painting of Poussin.

The librettist of most of Lully's operas was one of the prominent classicist playwrights - Philip Kino. In Kino, love passion, the desire for personal happiness come into conflict with the dictates of duty, and these latter take over. The plot is usually associated with war, with the defense of the fatherland, the exploits of generals ("Perseus"), with the single combat of the hero against the inexorable fate, with the conflict of evil spells and virtue ("Armida"), with the motives of retribution ("Theseus"), self-sacrifice ("Alceste "). The actors belong to opposing camps and themselves experience tragic clashes of feelings and thoughts.

The characters were drawn beautifully, effectively, but their images not only remained sketchy, but - especially in lyrical scenes - became sugary. The heroic went somewhere past; courtesy consumed her. It is no coincidence that Voltaire, in his pamphlet The Temple of Good Taste, through the mouth of Boileau, called Cinema a ladies' man!

Lully, as a composer, was strongly influenced by the classical theater of its best days. He probably saw the weaknesses of his librettist and, moreover, sought to overcome them to some extent with his music, strict and stately. Lully's opera, or "lyrical tragedy" as it was called, was a monumental, well-planned, but perfectly balanced composition of five acts, with a prologue, a final apotheosis, and the usual dramatic climax towards the end of the third act. Lully wanted to return to the events and passions, actions and characters of Cinema the vanishing grandeur. For this, he used, first of all, the means of pathetically uplifted, melodious recitation. Melodically developing its intonational structure, he created his own declamatory recitative, which formed the main musical content of his opera. "My recitative is made for conversations, I want it to be perfectly even!" Lully said so.

In this sense, the artistic and expressive relationship between music and poetic text in French opera has developed completely different from that of the Neapolitan masters. The composer sought to recreate the plastic movement of verse in music. One of the most perfect examples of his style is the fifth scene of the second act of the opera Armida.

The libretto of this famous lyrical tragedy is based on the plot of one of the episodes of Torquato Tasso's poem "Jerusalem Delivered". The action takes place in the East during the era of the Crusades.

Lully's opera consisted of more than just recitatives. There are also rounded ariose numbers in it, melodically related to those of that time, sensitive, flirtatious or written in energetic marching or cutesy-dance rhythms. The declamatory scenes of the monologues ended with arias.

Lully was strong in ensembles, especially in characteristic, entrusted to comic characters, which he succeeded very well. A significant place was occupied in the "lyrical tragedy" and choirs - pastoral, military, religious and ritual, fantastically fabulous and others. Their role, most often in crowd scenes, was predominantly decorative.

Lully was a brilliant master of the opera orchestra for his time, not only skillfully accompanying the singers, but also painting various poetic and pictorial pictures. The author of "Armida" modified, differentiated timbre colors in relation to theatrical stage effects and situations.

Particularly famous was Lully's superbly designed introductory "symphony" to the opera, which opened the action, and therefore received the name "French Overture".

Lully's ballet music has survived to this day in the theater and concert repertoire. And here his work was fundamental for French art. Lully's operatic ballet is by no means always a divertissement: it was often assigned not only a decorative, but also a dramatic task, artistically and prudently consistent with the course of the stage action. Hence the pastoral-idyllic dances (in "Alceste"), mourning (in "Psyche"), comic-characteristic (in "Isis") and others.

Before Lully, French ballet music already had its own tradition, at least a century old, but he introduced a new stream into it - "brisk and characteristic melodies", sharp rhythms, lively tempos of movement. At that time, this was a whole reform of ballet music. In general, there were much more instrumental numbers of "lyrical tragedy" than in Italian opera. Usually they were higher in music and more in harmony with the action taking place on the stage.

Shackled by the norms and conventions of court life, morals, aesthetics, Lully still remained "a great raznochintsy artist who recognized himself as equal to the most noble gentlemen." This earned him the hatred of the court nobility. He was not a stranger to free-thinking, although he wrote a lot of church music and largely reformed it. In addition to palace performances, he gave performances of his operas "in the city", that is, for the third estate of the capital, sometimes for free. With enthusiasm and perseverance, he raised talented people from the bottom to the high art, which he himself was. Recreating in music that system of feelings, the manner of expressing himself, even those types of people that often met at court, Lully in the comic episodes of his tragedies (for example, in Acis and Galatea) unexpectedly turned his eyes to the folk theater, its genres and intonations. And he succeeded in this, because from his pen came out not only operas and church hymns, but also drinking and street songs. His melodies were sung in the streets, "strummed" on the instruments. Many of his tunes, however, originated from street songs. His music, borrowed in part from the people, returned to him. It is no coincidence that Lully's younger contemporary, La Vieville, testifies that one love aria from the opera "Amadis" was sung by all the cooks of France.

Significant is Lully's collaboration with the brilliant creator of the French realistic comedy Molière, who often included ballet numbers in his performances. In addition to purely ballet music, the comic performances of costumed characters were accompanied by a singing-story. Monsieur de Poursonac, The Philistine in the Nobility, The Imaginary Sick Man were written and staged on stage as ballet comedies. For them, Lully - himself an excellent actor, who performed on stage more than once - wrote dance and vocal music.

Lully's influence on the further development of French opera was very great. He not only became its founder - he created a national school and brought up numerous students in the spirit of its traditions.

This publication will be of interest to students of professional retraining or advanced training courses in the specialty ""

The Ministry of Health has identified categories of medical organizations that can avoid the procedure for an independent assessment of the quality of services

Order of the Ministry of Health of the Russian Federation of April 28, 2018 N 197n "On approval of the list of types of medical organizations in accordance with the nomenclature of medical organizations in respect of which an independent assessment of the quality of the conditions for the provision of services by them is not carried out"

Registration N 51200

In accordance with paragraph 1 of part 4 of article 79.1 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, article 6724; 2014, N 30 , item 4257; 2017, N 50, item 7563) I order:

Approve the attached list of types of medical organizations in accordance with the nomenclature of medical organizations in respect of which an independent assessment of the quality of the conditions for the provision of services by them is not carried out.

Minister V.I. Skvortsova

APPROVED

by order of the Ministry

health care

Russian Federation

The list of types of medical organizations in accordance with the nomenclature of medical organizations in respect of which an independent assessment of the quality of the conditions for the provision of services by them is not carried out

1. Treatment and preventive medical organizations:

1.1. Specialized hospitals (including in the field of medical care), as well as specialized hospitals of the state and municipal health care systems:

psychiatric (hospital) specialized type;
psychiatric (hospital) of a specialized type with intensive supervision.

1.2. Children's home, including specialized.

1.3. Dairy cuisine.

1.4. Centers (including children's), as well as specialized centers of the state and municipal health care systems:

assisted reproductive technologies;
medical and social rehabilitation, including the department of permanent residence of the disabled and disabled children with severe forms of cerebral palsy, who do not move independently and do not serve themselves.

1.5. Medical organizations of emergency medical care and blood transfusion:

ambulance station;
blood transfusion station;
blood center.

2. Medical organizations of a special type:

2.1. Centers:

medical prevention;
disaster medicine;
medical mobilization reserves "Reserve";
medical information and analytical;
medical biophysical;
military medical expertise;

medical and social expertise;
medical statistics;
pathological and anatomical;
forensic medical examination.

2.3. Laboratories:

clinical diagnostic;
bacteriological, including the diagnosis of tuberculosis.

2.4. Medical detachment, including special purpose (military district, fleet).

3. Medical organizations for supervision in the field of consumer protection and human well-being:

3.1. Centers for Hygiene and Epidemiology.

3.2. Anti-plague center (station).

3.3. Disinfection center (station).

3.4. Center for hygienic education of the population.

3.5. Center for State Sanitary and Epidemiological Surveillance.

Recall that this procedure complies with the provisions of the federal law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation"

Independent assessment of the quality of services provided by medical organizations

It is a form of public control over the activities of medical organizations and provides for an assessment of the conditions for the provision of services by medical organizations according to the following general criteria:

openness and availability of information about the organization;
comfort conditions for the provision of medical services and the availability of their receipt;
waiting time for the provision of medical services;
friendliness, courtesy, competence of employees of a medical organization;
satisfaction with the medical services provided.

What is the purpose of conducting an independent assessment of the quality of services provided by medical organizations?

Providing citizens with information about the activities of medical organizations.

Improving the awareness of consumers of medical services about the activities of medical organizations.
Evaluation of individual performance indicators of medical organizations and the timely adoption of measures aimed at improving the efficiency or optimizing their activities.
Timely identification of negative factors affecting the quality of the organization of medical care, and their elimination.
Improving the quality of the organization of medical care.
Development of dialogue and cooperation between medical organizations and various structures of civil society.

What tasks are intended to be solved by an independent assessment of the quality of services provided by medical organizations?

Raising awareness of the population on the organization of medical care.
Obtaining information from citizens - recipients of medical services about the practice of providing these services by medical organizations.
Establishing the conformity of the presentation of information about the work of a medical organization on its official website on the Internet with indicators of completeness, relevance, convenience for visitors (patients) of medical organizations and other interested citizens.
Development of proposals to improve the quality of work of medical organizations.
Improving the quality of work of medical organizations.

What is being assessed?

Compliance of the information content and technological properties of the official websites of medical organizations on the Internet, assessment of the content and accessibility for perception of information and reference materials posted in the medical organization, with the requirements of the legislation of the Russian Federation.

Availability of the necessary infrastructure and conditions that characterize the external and internal improvement and comfort of visitors' stay, to the extent that satisfies public expectations, interests and needs of patients (visitors) of medical organizations, including persons with disabilities.
Compliance with the quality of the organization of the process of receiving patients (visitors), including the procedure for making an appointment with a doctor.
Evaluation of the overall satisfaction of patients (visitors) with the result of the provision of medical services by a medical organization.

Who can participate in an independent assessment of the quality of services provided by medical organizations?

Medical organizations.
Public (trustee, supervisory) councils of medical organizations.
Department of Health
Socially oriented non-profit organizations in the field of healthcare, patient, professional medical community.
Citizens are consumers of medical services.

One of the most important and fundamental areas of development in the country is the issue of health. Within the framework of this direction, the issue of providing the highest quality medical care to the population is resolved at the highest level, being, in fact, the most important state task. The only shortcoming of the Russian legislation can be considered the absence as such of the definition of "quality of medical care". This concept most often means the compliance of the medical care provided with established standards, Russian and international practice.

Specialists of the "Interregional Center for Expertise and Evaluation" assess the quality of medical services, including:

establishment of the fact of medical error;
assessment of the quality of medical care;
assessment of the choice of treatment methods;
examination of medical services
assessment of the rehabilitation, recovery;
resolving questions about the return of funds for poor-quality treatment.

The purpose of the trial is to identify violations that led to improper provision of medical care, resulting in partial or complete loss of health, deterioration in general well-being, exacerbation of chronic diseases, etc.

Objectives of the examination:

Evaluation of the correctness of the manipulations of a medical worker.
Assessment of the professional level of a health worker or a group of doctors who were directly involved in the diagnosis, treatment of the patient.

The price of examination of the quality of medical care

Accounts

The procedure and methods for conducting an independent forensic examination of the quality of treatment

Examination of the quality of medical services is an important aspect in obtaining by individuals proper, qualified assistance from medical personnel in private medical centers, public healthcare institutions. Improper performance by a doctor of his immediate duties is the basis for bringing him to administrative, disciplinary, civil and criminal liability.

A doctor, regardless of qualifications and category, must clearly understand and know his rights and obligations, as well as the rights of the patient. Have an idea that in case of improper assistance, namely their professional duties, the patient has every right to conduct an independent medical examination of medical error, hold the health worker accountable under the current administrative, procedural and criminal legislation.

Examination of the quality of medical care, carried out on the basis of the "Interregional Center for Expertise and Evaluation", the most complex, responsible procedure requiring highly qualified and professional experts from experts. In the process of conducting and collecting data, it is very difficult for a specialist to identify the defect in the provision of medical care, as well as to establish how this defect affected the outcome of the treatment of the disease. Thanks to the highest qualifications and many years of experience, the ICSEO experts provide a competent and detailed legal assessment of the situation that has arisen between the doctor and the patient, determine in the conclusion the degree of responsibility of the medical worker in relation to the patient, establish full or partial guilt, and also determine the degree of responsibility that should come as result.

Independent examination of the quality of medical care in Moscow and the Moscow region

Examination of the quality of medical care provided in Moscow
address phone contacts independent center for examination of the quality of medical services ICEE
districts of Moscow Eastern Administrative Okrug, Central Administrative Okrug, SAO, SVAO, YuVAO, YuAO, YuZAO, ZAO, SZAO
metro stations Elektrozavodskaya, Semenovskaya, Preobrazhenskaya Ploshchad,
Baumanskaya, Sokolniki, Airport, Dynamo, Sviblovo, Botanical Garden,
Aviamotornaya, Romanskaya, Tulaskaya, University, Kyiv, Oktyabrskoye Pole, Shchukinskaya
Independent forensic examination of the quality of medical care in the Moscow region, the cities of the Moscow region Dolgoprudny, Mytishchi, Reutov, Lyubertsy, Vidnoye, Odintsovo, Krasnogorsk, Khimki
Examination of the quality of treatment in Russia, representative offices in the regions of Sochi, Gelendzhik, Novorossiysk, Nevinnomyssk, Cherkessk, Vladikavkaz, Nalchik, Stavropol.

The possibility of conducting an examination of a medical error makes it possible to minimize the facts of negligent attitude of medical personnel to the performance of their immediate (professional) duties, to exclude improper provision of assistance, the use of methods of diagnosis, prevention, treatment and rehabilitation uncharacteristic of the disease.

Tasks of examination of the quality of medical services, solved by the experts of the ICSEO:

identify facts of violations in the provision of emergency, outpatient, inpatient medical care;

assess the timeliness of the assistance provided to the patient;

to establish how correctly the methods of treatment, rehabilitation, diagnosis, as well as the prevention of current and chronic diseases were chosen;

determine whether the result was achieved after the treatment and diagnostic procedures.

Criteria for assessing the quality of medical care, on which ICSEO specialists rely

The criteria used by the specialists of the "Interregional Center for Expertise and Evaluation" should be:

Universal.
Objective.
Conforming to established standards (local and federal significance).
available for use.
specific.

Assistance in resolving issues related to the examination of the quality of medical care.

Improving the quality of medical care provided to the population is influenced by:

opinions of consumers of medical services;
results of studies conducted by insurance companies and experts. It is these two indicators that often form the basis of the examination of the quality of medical care.

Thanks to the opportunity to conduct an independent examination of medical services, it will be easier for the patient to prove the medical errors made, to defend their rights and legitimate interests in court. This is especially important if the medical institution where the individual was observed did not take into account the fact of improper work of the medical staff and refused to return money for poor-quality treatment, including material compensation for the moral costs incurred.