2022年八年級建立健全醫(yī)院立體化績效考核評價體系

1、n 掌握NE5000E/80E/40E產品的體系構造n 掌握NE5000E/80E/40E的單板構成n 掌握NE5000E/80E/40E換板操作n 了解NE5000E/80E/40E升級操作建立健全醫(yī)院立體化績效考核評價體系On 3-Dimensioned Performance Assessment and Appraisal System1、 前言：1. Preface在醫(yī)療改革呼聲日益高漲和醫(yī)療市場競爭不斷加劇的今天，醫(yī)院如何改變原有的運行管理模式，適應新形勢的變化，提高醫(yī)院的核心競爭力，是醫(yī)院管理者不可回避的重要問題。我國醫(yī)院的開展經歷了從設備競爭技術競爭效勞競爭戰(zhàn)略競爭的過程，目前

2、正向文化競爭開展。競爭就要有目標，目標是醫(yī)院開展的方向，在當前醫(yī)療市場的競爭中，實施目標管理是醫(yī)療機構保持競爭實力的最常用方法之一，更是醫(yī)院管理的最常用手段之一。由于目標管理事先有比擬明確的目標作為標準和動力，人們隨時進展自我管理，并努力完成既定的工作目標。目標管理輔以績效考核的手段，可以催促人們在實現(xiàn)目標過程中，及時調整方向進展資源整合，最終到達組織利益的實現(xiàn)。How can hospital transform the current mode of operation and management? How can hospital adapt itself to the new sit

3、uation? How can hospital improve its central competitive strength? Those challenges have to be approached by hospital managers today especially when health care reform is earnestly called for by the medical market with intensive competition. The development of hospitals in China has experienced the

4、competition in equipment, technology, service and strategy respectively and now is getting into the cultural competition. Competition, of course, feels like an objective, which is the direction of a hospital. In the medical market competition, however, objective management is the most popular practi

5、ce for a medical agency to maintain its competitive strength as well as to manage a hospital. As objective management cries out for a definite objective in advance, which serves as a standard and impetus, people can conduct self management at any time and strive to reach their goal. With help of per

6、formance appraisal, however, objective management may enhance timely adjustment of the course during realization of the objective to integrate resources and eventually to obtain benefits. 2、 相關背景資料：2. Background近十年來，隨著國務院及其他政府部門相關醫(yī)療政策的出臺，以及中國參加WTO 后醫(yī)療市場的逐步對外放開，國內的醫(yī)療行業(yè)狀況發(fā)生了巨大的變化。民營醫(yī)院大量崛起，其中有些甚至收購了多家公

7、立醫(yī)院；外資醫(yī)院或機構正在大舉入侵，其憑借獨特的技術和效勞優(yōu)勢占得了不小的市場份額；隨處可見的私人診所和藥店也如雨后春筍般出現(xiàn)。這些都給公立醫(yī)院的生存與開展帶來了一定的沖擊。國家醫(yī)改方案遲遲不能出臺，雖然先后有十套方案相繼出爐，卻始終未能形成一套適合中國醫(yī)療市場的總體改革方案，醫(yī)療體制改革舉步維艱，公立醫(yī)院開展前景不明朗。無錫市針對國際國內形勢變化，在沒有任何經歷可借鑒的情況下，在國內率先進展了“政事分開，管辦別離運行機制的改革。衛(wèi)生局作為行政執(zhí)法部門對公立醫(yī)院的經營行為進展監(jiān)管；由衛(wèi)生局別離出來的醫(yī)院管理中心以下簡稱醫(yī)管中心成為政府“辦醫(yī)院和“管資產的責任主體，“辦醫(yī)院就是在法律法規(guī)及政策的

8、框架下，通過優(yōu)化配置資源，提高醫(yī)療質量，提供滿足不同層次需求的代表市屬醫(yī)院水平的優(yōu)質醫(yī)療產品?！肮苜Y產就是要確保國有資產保值和效益最大化。在醫(yī)管中心成立后，將前幾年進展的以經濟指標考核為主的 “托管制改革進一步深化為注重對社會效益和工作業(yè)績綜合考核的“醫(yī)療效勞、資產經營委托管理法人代表任期目標責任制改革，把解決醫(yī)院建立和運行目標作為重點，探索所有權和經營權別離的模式，到達既盡顯公益性特征、又增強醫(yī)院活力的目的。職能上下放醫(yī)院經營管理、人事用工和經濟分配權，激發(fā)醫(yī)院活力。醫(yī)院那么是專科建立、人才培養(yǎng)、醫(yī)療效勞與經營的主體。面對醫(yī)管中心下達的涉及醫(yī)院管理、醫(yī)院信息、醫(yī)療平安、醫(yī)療效勞、經濟運作、醫(yī)

9、德醫(yī)風六個方面內容，八大類17項數(shù)百條共1000分的考核標準，醫(yī)院該如何確立一個符合自身開展需求的總體目標，并能按方案有步驟地加以實施，那么顯得尤為重要。As health care policies have been promulgated by the State Council and other governmental bodies and the medical market has been gradually unveiled to outside after China entered WTO in the past 10 years, a great change has

10、 happened to Chinese medical industry, where are rising a lot of private hospitals, some even acquisitioned a few public hospitals; meanwhile, many foreign-funded hospitals or agencies are rushing off their head into China and they have a much share of the market thanks to their unique superiority i

11、n both service and technology; and on the other hand, private clinics and drug stores have emerged here and there, which, in some degree, is troubling the survival and development of public hospitals. 10 national health-care-reform programs, although published in succession, fail to bring about a ge

12、neral scheme which is suitable for Chinese medical market. In this connection, the health care reform is still far from matured and, as a result, public hospital is still fighting its way to survive and develop. In view of the present situation at home and abroad, Wuxi City has pioneered to undertak

13、e the reform on hospital operations mechanism, i.e. “Separating government functions from public institutions and administration from business running without any experience to be referenced. As an enforcing body, the Bureau of Health of Wuxi City serves to supervise the business of public hospitals

14、; the Hospital Management Center (HMC) separated from the Bureau of Health is a responsible entity of the government to “run hospitals and “manage assets. “Running hospital calls for providing quality medical products on a municipal level which can meet demand from different walks of life by optimiz

15、ing arrangement of resources and further improving the quality of health care in compliance with laws, rules and regulations. “Managing assets, however, calls for maintaining state owned assets and maximizing their benefits. After HMC was established, “entrusting system reform, characteristic of eco

16、nomic index assessment put into practice years ago, has been furthered into the reform of “target responsibility system set for the office term of the legal representative entrusted to manage medical service and assets operation. This system focuses on comprehensive assessment which is made over the

17、 social benefits and business performance and attaches importance to reaching the goal of hospital operations, with a view to exploring a mode of separating ownership and management to realize public welfare and activate hospital. In terms of function, the power over hospital business management, hu

18、man resources recruit and financial allocation is distributed to lower levels to energize hospital, which serves to undertake faculty construction, talents training, medical services and operations. HMC has issued hundreds of assessment criteria amounting to 1000 marks composed of 17 items covering

19、eight types and six aspects, namely hospital management, hospital information, medical security, medial service, financial practice and medical ethics. In this connection, it is very important for a hospital to correctly establish a general goal which satisfies its own development and act on this go

20、al as planned step by step.我所在的無錫市第四人民醫(yī)院是一所集醫(yī)療、教學、科研、預防、保健為一體的衛(wèi)生部首批三級綜合性醫(yī)院，是無錫市腫瘤醫(yī)院和蘇州大學附屬第四醫(yī)院；也是蘇州大學生命科學學院臨床腫瘤和分子生物研究所、無錫市腫瘤防治研究所所在地；無錫市心胸外科治療中心和無錫市麻醉科質量控制中心均設在我院。醫(yī)院技術力量雄厚，?？铺厣黠@。以腫瘤診斷治療為重點，其他學科協(xié)調開展。醫(yī)院開放床位1050張，腫瘤床位占總開放床位的50%以上。醫(yī)護員工1250名，其中醫(yī)師430名，護士458名；擁有高級職稱138名，其中主任醫(yī)師、教授34名，副主任醫(yī)師、副教授94名。年門、急診量60

21、萬人次，出院病人2.8萬人次。My employer, Wuxi Fourth Peoples Hospital (WFPH), is one of the first lot of grade 3 comprehensive hospitals certified by Ministry of Health of the Peoples Republic of China, which integrates health service, training, research, illness prevention and health care. It simultaneously ser

22、ves as Wuxi Cancer Hospital and Fourth Hospital Attached to Suzhou University. Meanwhile, this hospital also houses Clinical Cancer & Molecular Biology Research Institute attached to Suzhou University Life Science School, Wuxi Cancer Prevention and Treatment Research Institute, Wuxi Cardiothorac

23、ic Surgery Treatment Center and Wuxi Anesthesia Quality Control Center. Powerful in technology and characteristic of special faculty, this hospital focuses on cancer diagnosis and treatment with other faculties developed in balance. There are 1050 beds, of which those used for cancer faculty account

24、 for over 50%. The hospital is staffed with 1250 employees, 430 being physicians and 458 being nurses; 138 employees are of senior technician, 34 of them being chief physicians or professors and 94 being associate chief physicians or associate professors. 600,000 patient · times come for emerge

25、ncy or as outpatient in a year, of which there are 28,000 discharged patient · times. 經過三十年的建立，我院已成為一所區(qū)域性的腫瘤診治中心。進一步提高腫瘤診治水平，完善綜合醫(yī)學救治能力，滿足廣闊病員日益增長的診治需求，在挽救病人生命與改善病人生活質量方面作出不懈地努力，成為名副其實的蘇南地區(qū)具有影響力的腫瘤中心，是我們大家共同的愿景和重要的任務。After 30 years efforts, this hospital has come to be a cancer diagnosis and tr

26、eatment center in this region and we hope that we can be worthy of the famous cancer center in South Jiangsu by further improving cancer diagnosis and treatment, perfecting comprehensive medical treatment, satisfying patients increasing demand for diagnosis and treatment and sparing no efforts to sa

27、ve patients life and improve their living quality. 作為一家大型國有公立醫(yī)院，如何適應醫(yī)療體制未變，但運行機制卻發(fā)生改變的形勢，全面完成醫(yī)管中心下達的目標任務；如何面對社會對醫(yī)療效勞過高需求與員工自身素質參差不齊的考驗；如何在市場經濟的大潮中，面對醫(yī)療市場開放后外資醫(yī)院的競相涌入，面對國內民營醫(yī)院的蓬勃開展，面對公立醫(yī)院之間的劇烈競爭，保持旺盛的生命力等等。挑戰(zhàn)是全方位的，壓力也是前所未有的。但挑戰(zhàn)總是與機遇并存。作為醫(yī)院管理者，不僅要自己明確醫(yī)院開展方向，更要讓員工明確奮斗目標與前進航向，尋求一種職工共同參與、自我管理的方式，同舟共濟，那么是

28、所有醫(yī)院管理者所期盼的。How can we, as a large-sized state-owned public hospital, adapt to the new situation where the medical system is unchanged but the business operation is changed to complete tasks assigned by HMC? How can we approach the challenges when people have an over-demand for medical services but

29、the employees are irregular in quality? How can we maintain exuberant vitality when foreign-funded hospitals flooded in after the medical market was opened, vigorous development of private hospitals at home and acute competition between public hospitals in the market economy? Although there are all-

30、around and unprecedented challenges, they are accompanied by opportunities. A hospital manager shall not only specify the hospitals direction, but also lead the staff to specify their own. Of course, all managers look forward to having a method by which the staff are involved together and make self

31、management so that everyone has a clear mind that they are in the same boat. 3、績效管理文獻回憶：Review of the literature on performance management:績效考核是醫(yī)院管理的一個重要手段和方法，是對管理目標實現(xiàn)和評價的客觀、公正的表達。目標管理于20世紀50年代中期出現(xiàn)，是以泰羅的科學管理和行為科學理論為根底形成的一套管理制度，可以調動人們親自參加工作目標制定的積極性。持續(xù)改良與提高管理水平需要制訂科學合理、注重實績的考評體系，才能進展全面、客觀、公正、公平的評價，這是落

32、實管理的基點。As an important way to manage hospitals, performance assessment can impartially and objectively embody realization of management by objectives. Born in mid-1950s, management by objectives is a set of management systems formed on the basis of the reasonable management and behavior science theo

33、ry founded by Frederick Winslow Taylor, which is expected to arouse peoples enthusiasm to involve personally in making the objective. In order to continuously renovate and improve management, it is necessary to establish a reasonable assessment system which focuses on actual performance. Only in thi

34、s way can appraisal be made fully, equally, objectively and impartially. This is the base point to realize such management. 績效管理已在興旺國家，特別是國際成功企業(yè)中被廣泛采用，美國及歐洲一些國家的醫(yī)院，在各個層次都成功實施了績效管理。醫(yī)院在某些方面類似于企業(yè)，醫(yī)院管理、經營的許多理念，方式均始于企業(yè)或由企業(yè)演化而來。不同的是企業(yè)講利潤最大化，追求的是經濟效益；而醫(yī)院首先講救死扶傷，并只能在追求社會效益的前提下，講本錢核算。醫(yī)院在進展績效評估與績效管理時，應采取揚棄的態(tài)度

35、，充分借鑒企業(yè)的做法與經歷，并注重結合本行業(yè)的實際，實事求是地進展績效評估與績效管理。如何將更科學的考核體系和良性競爭的動態(tài)機制融入到醫(yī)院評價比擬之中，科室單元內部又如何以科學公正的績效指標評價每位人才的價值和奉獻，目前缺少一套成熟而又實用的評價體系，這是目前各醫(yī)院管理者迫切需要研究與探討的重要課題。Performance management has been widely used in developed countries, particularly in those world famous enterprises. Hospitals in USA and some Europea

36、n countries also have successfully conducted performance management on various levels. In some aspects, a hospital is much similar to an enterprise and many ideas and methods in hospital management originate or are evolved from enterprise. Differently, enterprises seek for maximal profits and econom

37、ic benefits; hospitals, however, basically serve to heal the wounded and rescue the dying and take into account cost accounting only under the premise seeking for social results. A hospital shall handle performance appraisal and management by applying the applicable practice of an enterprise to its

38、own line according to the fact. Right now it still cries out for a mature and practicable assessment system to approach how to roll a more reasonable assessment system and a dynamic mechanism with virtuous competition into hospital appraisal and comparison and how to assess each talents performance

39、with help of reasonable and impartial performance index in different units of a department. This is the subject calling for an immediate solution offered by hospital managers. 有關衛(wèi)生組織績效測量的研究正在開展，績效測量標準的研究是鑒于衛(wèi)生保健機構沒有一個標準的績效測量系統(tǒng)，美國俄亥俄州大學的一項研究(1)在回憶有關醫(yī)療組織績效文獻的根底上，提出了衛(wèi)生保健機構績效測量的總體框架。該框架中的績效測量包括內部與外部評價兩個方

40、面，每個方面都有本錢財務績效及質量績效兩個評價維度; 績效測量系統(tǒng)的研究，任何單獨的財務方面或經營方面的測量系統(tǒng)都不能使管理者在復雜競爭的市場環(huán)境中成功地對績效進展管理。因此，人們逐漸開場采用多重指標來衡量績效，其中有些是“硬指標，包括各種經濟和非經濟尺度；有些是“軟指標，包括質量、員工態(tài)度及其類似的標準?，F(xiàn)有文獻說明對績效測量系統(tǒng)的研究熱點除系統(tǒng)開發(fā)及系統(tǒng)所提供信息的利用以外，還有關于績效測量系統(tǒng)對組織作用及影響的研究和績效管理模式的研究。在英國，新的績效管理模式往往包括非財務措施，它代表了一種以戰(zhàn)略為導向的績效管理趨勢。在法國公司，在“Tableau de Bord績效管理模式里，將戰(zhàn)略分

41、解為財務與非財務指標，作為流行的一種作法(2)。美國最近的一項有關社區(qū)醫(yī)院的研究已涉及到開發(fā)一個戰(zhàn)略操作管理模式3，該模式將遠期設備和效勞選擇，中層決策支持以及考慮了構造約束后的社區(qū)醫(yī)院績效聯(lián)系起來。該研究在使人們對戰(zhàn)略操作管理決策有了更進一步理解的同時，確定了在操作決策過程中的一些因果關系及在醫(yī)院績效方面的作用。該研究還找出了在變化著的醫(yī)療效勞環(huán)境中有助于提高社區(qū)醫(yī)院績效的關鍵戰(zhàn)略決策。其中，“平衡計分卡作為績效管理的一種最新、最有效的管理模式，吸引了眾多的學者和管理實踐者。Study on measuring performance of a health care organizatio

42、n is still on the way and study on performance measuring criterion is made in a view that there is no standard system to measure performance adopted by a health care organization. Review of the literature on performance in a medical body indicates that a study (1) made in University of Ohio has adva

43、nced a general framework to measure performance of a health service body. The performance measurement in this framework consists of internal evaluation and external evaluation, each having two evaluation dimensions, namely performance in cost/finance and that in quality; according to the study on pe

44、rformance measuring system, any single measuring system in neither finance nor operation can enable managers to successfully control performance in a complicated market falling in the acute competition. Therefore, multi-index starts service gradually to measure performance: some are “hard index, inc

45、luding various kinds of financial and non-financial measures and some are “soft index, including quality, attitude and the similar criteria. The existing literature shows that, besides application of information developed or provided by the system, the heated study on performance measuring system in

46、cludes study of action and effect of performance measuring system on an organization and study on performance management mode. In Britain, the new performance management mode always includes non-financial measures, which represents a trend of performance management oriented by strategy. Under the “T

47、ableau de Bord performance management mode in French companies, strategy is divided into financial index and non-financial index, which acts as a popular practice (2). A study on community hospital conducted in USA is related to development of a strategic operation & management mode3, which gets

48、 connected long-term equipment and service choice, middle-level decision support and community hospital performance which has taken structural confinement into consideration. While helping further understand decision over strategic operation management, the abovementioned study determines some cause

49、-effect relations and their action on hospital performance in the course of decision on operation. Furthermore, this study also finds out a key strategic decision helping improve performance of community hospital in the changing environment of medical service. Among them, the “balance score card is

50、the latest and most effective mode for performance management, which is attracting a number of scholars and management workers. 對于醫(yī)院績效評價研究，國外醫(yī)院績效評價研究也包括三個層面。一個是以醫(yī)院為對象進展績效評價：一個是對中層管理人員進展工作能力評價；最后就是員工的績效評價。Robin S、Turpin利用PAJ模式對醫(yī)院績效指標設置合理性進展了評估4；全面質量管理(TQM)那么對醫(yī)院績效改良進展了研究5。另有一些對中層管理人員工作和能力評價的研究，并嘗試開發(fā)了綜

51、合性的能力與工作評價工具6，而員工評價目前比擬盛行的是同級評價 7。但從整體看，對個人的評價多為針對醫(yī)師類的，較為單一，對醫(yī)院內多種成員組成的現(xiàn)狀考慮缺乏。Study on hospital performance appraisal abroad also consists of three levels: one is performance appraisal on hospital as a whole, one is ability appraisal on middle-level managers, and the other is performance appraisal o

52、n employees. Robin S. Turpin has employed the PAJ mode to appraise reasonability of hospital performance index4and Total Quality Management (TQM) to study improvement of hospital performance5. Meanwhile, he has also studied performance and ability of middle-level managers and developed an overall to

53、ol to appraise ability and performance6. For employee appraisal, however, peer appraisal is rather popular at the present7. On a whole basis, appraisal on individuals is mostly adopted by targeting physicians, which, however, takes into inadequate consideration a hospitals composition of members in

54、variety. 而在我國，經濟領域根本上完成了由方案經濟向市場經濟的轉化，但社會事業(yè)領域改革相對滯后，現(xiàn)有的醫(yī)療衛(wèi)生體制是在方案經濟理論下建立的。作為一種科學的管理體系，績效管理正在受到國內各級醫(yī)院管理者的重視，大多也是從醫(yī)院、科室及科室管理者、員工個人三個層面來進展探討。根據(jù)中文科技期刊數(shù)據(jù)庫檢索，自1989年-2021年2月，涉及醫(yī)院績效的相關文章共有567篇，有關“績效考核的文章共有129篇，符合“績效管理檢索主題詞要求的文章有122篇，而建立績效考核評價體系的文章僅26篇。早在1993年西安第四軍醫(yī)大學胡琳、于爽等制訂了“醫(yī)院綜合效益評價體系，指標按投入、產出分成兩大類，包括人員、設

55、備、物資、經費、社會效益和經濟效益6個方面8；1994年浙江省舟山市衛(wèi)生局莊漢國9對綜合性醫(yī)院的社會、經濟效益指標體系的設置及評價方法等問題作了探討，篩選出根本指標25項，作為評價指標體系。近年來隨著管理理論的深化和管理模式的探索，2001年，解放軍空軍總醫(yī)院陳明敏等提出了粗放型的醫(yī)療質量評價管理模式，主要指標為床日門診指數(shù)、床位利用指數(shù)、CD型率(總病例中復雜疑難危重病例所占比例)、人均醫(yī)療費、病員滿意度等 10；2001年，上海第二軍醫(yī)大學高岱峰、張鷺鷺等采用加權百分位次累加法建立評價模型，構建了“醫(yī)院綜合競爭力評價體系，指標體系分競爭力資產、競爭力過程、競爭力環(huán)境3個方面；2002年，復

56、旦大學胡善聯(lián)、李國紅等利用現(xiàn)場調查法和專家咨詢法，從業(yè)務水平、經營狀況和病人滿意度方面選出32個指標，建立醫(yī)院績效評價指標體系，并提出星級醫(yī)院評審的思想11。2005年?醫(yī)院管理評估指南?中將社會效益、工作效率、經濟運行狀況三個方面作為醫(yī)院績效評價的主要內容12。眾多文章都是從不同的角度對醫(yī)院績效進展評價，建立醫(yī)院績效評價指標體系時均有自己的側重點，而且在實際工作中也確實起到了促進醫(yī)院持續(xù)穩(wěn)定開展、提高醫(yī)院核心競爭力的作用。醫(yī)院績效評價體系是一個復雜的評價系統(tǒng)，目前國內采用的指標大多從業(yè)務、財務等方面分類考核，而專家咨詢法是篩選指標的方法。盡管企業(yè)領域績效管理的方法已開展得比擬成熟，但在國內醫(yī)

57、療衛(wèi)生領域中比擬通用和權威的績效考核指標還有待更深入的探索。而對于科室與個人的考核也有多篇研究報告。國內醫(yī)院在臨床科主任的績效評價方面也有局部嘗試，國內較具有代表性的有以下幾種評價方法：將平衡記分卡應用于績效評價；使用360度績效考核法考核臨床科主任；應用關鍵績效指標KPI的考核指標體系；運用目標管理的方法建立績效評估體系。In China, transition has been completed from planning economy to market economy, but reform on social institutions is still relatively la

58、gging behind, where the current health care system was born under the planning economy. As a reasonable system, performance management is having much attention from hospital managers on different levels in China, which is mostly discussed in three layers, i.e. hospital, faculty and its managers, and

59、 individual employees. My searching the database of technological periodicals written in Chinese indicates that there are 567 papers on hospital performance published from 1989 to February 2021, 129 relating to “performance assessment, 122 satisfying the key word of search for hospital performance and only 26 papers on establishment of performance assessment and appraisal system. As early as 1993, Hu Lin, Yu Shuang and etc. with Fourth Military Medical University based in