Background: Several researchers had been previously done the health professional workload study,however, because of the lack of studies of the relationship between physicians’ volume and outcome, wedid not have enough evidence of the resource allocation, the surgery outcome and quality improvementin our country.Goal: The study was aimed to study general surgeon volume and surgery outcome.Materials and Methods: We randomly selected 1147 patients diagnosed with gallbladder disease whounderwent laparoscopic cholecystectomy (LC) and acute appendicitis from 2012-2013 at the First andThird Clinical hospital and Khovd province Regional Diagnostic and Treatment Center were included.Patient demographics and clinical information, such as drug cost, duration of surgery, and name ofsurgeons were derived from patient medical records. Surgeons’ information, such as age, gender,professional and academic degree, and work experience were derived from hospital human resourcedepartment and correlation analysis was performed to examine the association between surgeryduration, surgeon experience and drug cost.Results: Hospitals LC was done 51,3±32,8 minutes with 24900,70 tugriks, appendectomy was done52,7±31,4 minutes with 18361,00 tugriks of drug cost. The Third Clinical hospital surgeons operatedhigher costs (28631,34±16985,86tugriks) and shorter time (39,86±39,54 ìèí) of an appendectomy. Butthe First Clinical hospital surgeons incurred lower cost (8460,82±13231,40 tugriks) of appendectomy.However, there were no significant differences in operation time and drug average cost in appendectomyin terms of positive and weak correlation(r<0.5, p>0.05). Conclusion: General surgeon volume was notassociated with surgery outcome.

Introduction Managers in the service sector are under increasing pressure to demonstrate that their services are customerfocused and that continuous performance improvement is being delivered. Given the financial and resource constraints under which service organizations must manage it is essential that customer expectations are properly understood and measured and that, from the customers ’perspective, any gaps in service quality are identified. Goal • SERVQUAL instrument in order to ascertain any actual or perceived gaps between customer expectations and perceptions of the service offered. • To point out how management of service improvement can become more logical and integrated with respect to the prioritized service quality dimensions and their affections on increasing/decreasing service quality gaps. Model of Service Quality Gaps There are seven major gaps in the service quality concept and three of them important gaps, which are more associated with the external customers are Gap1, Gap5 and Gap6. Gap1: Customers’ expectations versus management perceptions Gap2: Management perceptions versus service specifications Gap3: Service specifications versus service delivery Gap4: Service delivery versus external communication Gap5: The discrepancy between customer expectations and their perceptions of the service delivered Gap6: The discrepancy between customer expectations and employees’ perceptions Gap7: The discrepancy between employee’s perceptions and management perceptions According to this model, five dimensions are stated as follows 1) Tangibles. Physical facilities, equipments and appearance of personnel. 2) Reliability. Ability to perform the promised service dependably and accurately. 3) Responsiveness. Willingness to help customers and provide prompt service. 4) Assurance (including competence, courtesy, credibility and security). Knowledge and courtesy of employees and their ability to inspire trust and confidence. 5) Empathy (including access, communication, understanding the customer). Caring and individualized attention that the firm provides to its customers. The SERVQUAL approach contains a questionnaire that evaluates five generic service dimensions or factors through 27 questions, evaluating both expectation and performance using a seven point Likert scale. This approach evaluates service quality by calculating difference (gap) between customer expectations and perceptions (service quality= P – E). ‘P’ denotes customer perception of service or performance and ‘E’ denotes expectations before a service encounter deliver the actual. If the answer is negative, then dissatisfaction occurs. This equation is usually called gap analysis, but as it was emphasized, this approach only measures gap 5.

Goal: The aim of the study was to identify economic burden from hypertention in Ulaanbaatar and develop some recommenadations. Material and Method: The top down approach was used to calculate direct costs of hypertension in five hospitals of the secondary and tertiary levels. To calculate cost of hypertension financial reports and cost centres data were used. A self-administered questionnaire was used to calculate indirect costs from the disease. Patients, admitted to six UB district and three tertiary level hospitals due to hypertension filled in the questionnaire. Data was analysed using SPSS 15 programme.Results: Some 114 patients were surveyed. The average cost of hypertension was 143914 ± 38189.5 (average bed days 8.7) and 264756 ± 40760.4¥ (average bed days 9.5) in the selected district and tertiary level hospitals respectively. The average cost for per out-patient visit was 4237 ± 2123.5¥ in the selected district hospitals and 3,162 ± 308.3¥ in the selected tertiary level hospitals. The indirect costs included transport cost to and from hospital, food, transport cost of relatives to visit them, cost of medications, and some other expenses related to their admission. Average indirect cost of an admission of patients with the hypertension was 253,395 and 212,717.44¥ in district and tertiary level hospitals respectively. Economic burden from temporary loss of working ablility due to hypertension was 177.1 millions tugrigs. National average wage was 300500¥ in 2009. Some 65.8% of respondents used antihypertension drugs at least once a day and average cost was 653.4¥ per patient per day. Annual and 10 years drug use estimates were 238491 and 2.3 million tugrigs per patient respectively (Inflation and price changes were not counted).Conclusion: Indirect and direct costs for admission were 1.1 billion (49.6%) and 939 million (42.5%) tugrigs respectively. Cost of hypertension in Ulaanbaatar was 2.2 billion tugrigs in 2009 and it is 1.1% of total health sector financing.

Background: The career and work of medical workers are considered to be the occupation of the highly responsible job of the worldwide. Goal: To identify the percentage of the work-related stress, the burnout, and the symptoms of work-related stress of the physicians and nurses who is working at the critical and intensive care units of UB hospitals. Materials and methodology: The survey was done by quantitative methods and cross sectional design. The study data was collected using the validated questionnaire for the work related stress. The results of the study were analyzed by the Microsoft Excel and SPSS 20 program. Results The response rate was 97.3% The study found that 78.7% of respondents reported having regular stress; and 89.4% of all participants in the survey had a personal burnout, 90.4% had work-related burnout and 94.5% had a high level of client-related burnout.
Physical symptoms include the insomnia 76.7%; psychological symptoms - the headaches 65%; behavioral symptoms as like forgetfulness and annoyance 53.3%; cognitive symptoms as like an increase in sick days or absenteeism by 40% for all physicians and nurses.