2022年八年級(jí)建立健全醫(yī)院立體化績(jī)效考核評(píng)價(jià)體系

1、n 掌握NE5000E/80E/40E產(chǎn)品的體系構(gòu)造n 掌握NE5000E/80E/40E的單板構(gòu)成n 掌握NE5000E/80E/40E換板操作n 了解NE5000E/80E/40E升級(jí)操作建立健全醫(yī)院立體化績(jī)效考核評(píng)價(jià)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(chǎng)競(jìng)爭(zhēng)不斷加劇的今天，醫(yī)院如何改變?cè)械倪\(yùn)行管理模式，適應(yīng)新形勢(shì)的變化，提高醫(yī)院的核心競(jìng)爭(zhēng)力，是醫(yī)院管理者不可回避的重要問(wèn)題。我國(guó)醫(yī)院的開(kāi)展經(jīng)歷了從設(shè)備競(jìng)爭(zhēng)技術(shù)競(jìng)爭(zhēng)效勞競(jìng)爭(zhēng)戰(zhàn)略競(jìng)爭(zhēng)的過(guò)程，目前

2、正向文化競(jìng)爭(zhēng)開(kāi)展。競(jìng)爭(zhēng)就要有目標(biāo)，目標(biāo)是醫(yī)院開(kāi)展的方向，在當(dāng)前醫(yī)療市場(chǎng)的競(jìng)爭(zhēng)中，實(shí)施目標(biāo)管理是醫(yī)療機(jī)構(gòu)保持競(jìng)爭(zhēng)實(shí)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(biāo)管理事先有比擬明確的目標(biāo)作為標(biāo)準(zhǔn)和動(dòng)力，人們隨時(shí)進(jìn)展自我管理，并努力完成既定的工作目標(biāo)。目標(biāo)管理輔以績(jī)效考核的手段，可以催促人們?cè)趯?shí)現(xiàn)目標(biāo)過(guò)程中，及時(shí)調(diào)整方向進(jìn)展資源整合，最終到達(dá)組織利益的實(shí)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(guān)背景資料：2. Background近十年來(lái)，隨著國(guó)務(wù)院及其他政府部門(mén)相關(guān)醫(yī)療政策的出臺(tái)，以及中國(guó)參加WTO 后醫(yī)療市場(chǎng)的逐步對(duì)外放開(kāi)，國(guó)內(nèi)的醫(yī)療行業(yè)狀況發(fā)生了巨大的變化。民營(yíng)醫(yī)院大量崛起，其中有些甚至收購(gòu)了多家公

7、立醫(yī)院；外資醫(yī)院或機(jī)構(gòu)正在大舉入侵，其憑借獨(dú)特的技術(shù)和效勞優(yōu)勢(shì)占得了不小的市場(chǎng)份額；隨處可見(jiàn)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(kāi)展帶來(lái)了一定的沖擊。國(guó)家醫(yī)改方案遲遲不能出臺(tái)，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(guó)醫(yī)療市場(chǎng)的總體改革方案，醫(yī)療體制改革舉步維艱，公立醫(yī)院開(kāi)展前景不明朗。無(wú)錫市針對(duì)國(guó)際國(guó)內(nèi)形勢(shì)變化，在沒(méi)有任何經(jīng)歷可借鑒的情況下，在國(guó)內(nèi)率先進(jìn)展了“政事分開(kāi)，管辦別離運(yùn)行機(jī)制的改革。衛(wèi)生局作為行政執(zhí)法部門(mén)對(duì)公立醫(yī)院的經(jīng)營(yíng)行為進(jìn)展監(jiān)管；由衛(wèi)生局別離出來(lái)的醫(yī)院管理中心以下簡(jiǎn)稱醫(yī)管中心成為政府“辦醫(yī)院和“管資產(chǎn)的責(zé)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(guò)優(yōu)化配置資源，提高醫(yī)療質(zhì)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(zhì)醫(yī)療產(chǎn)品?！肮苜Y產(chǎn)就是要確保國(guó)有資產(chǎn)保值和效益最大化。在醫(yī)管中心成立后，將前幾年進(jìn)展的以經(jīng)濟(jì)指標(biāo)考核為主的 “托管制改革進(jìn)一步深化為注重對(duì)社會(huì)效益和工作業(yè)績(jī)綜合考核的“醫(yī)療效勞、資產(chǎn)經(jīng)營(yíng)委托管理法人代表任期目標(biāo)責(zé)任制改革，把解決醫(yī)院建立和運(yùn)行目標(biāo)作為重點(diǎn)，探索所有權(quán)和經(jīng)營(yíng)權(quán)別離的模式，到達(dá)既盡顯公益性特征、又增強(qiáng)醫(yī)院活力的目的。職能上下放醫(yī)院經(jīng)營(yíng)管理、人事用工和經(jīng)濟(jì)分配權(quán)，激發(fā)醫(yī)院活力。醫(yī)院那么是?？平?、人才培養(yǎng)、醫(yī)療效勞與經(jīng)營(yíng)的主體。面對(duì)醫(yī)管中心下達(dá)的涉及醫(yī)院管理、醫(yī)院信息、醫(yī)療平安、醫(yī)療效勞、經(jīng)濟(jì)運(yùn)作、醫(yī)

9、德醫(yī)風(fēng)六個(gè)方面內(nèi)容，八大類17項(xiàng)數(shù)百條共1000分的考核標(biāo)準(zhǔn)，醫(yī)院該如何確立一個(gè)符合自身開(kāi)展需求的總體目標(biāo)，并能按方案有步驟地加以實(shí)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(wú)錫市第四人民醫(yī)院是一所集醫(yī)療、教學(xué)、科研、預(yù)防、保健為一體的衛(wèi)生部首批三級(jí)綜合性醫(yī)院，是無(wú)錫市腫瘤醫(yī)院和蘇州大學(xué)附屬第四醫(yī)院；也是蘇州大學(xué)生命科學(xué)學(xué)院臨床腫瘤和分子生物研究所、無(wú)錫市腫瘤防治研究所所在地；無(wú)錫市心胸外科治療中心和無(wú)錫市麻醉科質(zhì)量控制中心均設(shè)在我院。醫(yī)院技術(shù)力量雄厚，?？铺厣黠@。以腫瘤診斷治療為重點(diǎn)，其他學(xué)科協(xié)調(diào)開(kāi)展。醫(yī)院開(kāi)放床位1050張，腫瘤床位占總開(kāi)放床位的50%以上。醫(yī)護(hù)員工1250名，其中醫(yī)師430名，護(hù)士458名；擁有高級(jí)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(mén)、急診量60

21、萬(wàn)人次，出院病人2.8萬(wàn)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(jīng)過(guò)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(jìn)一步提高腫瘤診治水平，完善綜合醫(yī)學(xué)救治能力，滿足廣闊病員日益增長(zhǎng)的診治需求，在挽救病人生命與改善病人生活質(zhì)量方面作出不懈地努力，成為名副其實(shí)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(wù)。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(guó)有公立醫(yī)院，如何適應(yīng)醫(yī)療體制未變，但運(yùn)行機(jī)制卻發(fā)生改變的形勢(shì)，全面完成醫(yī)管中心下達(dá)的目標(biāo)任務(wù)；如何面對(duì)社會(huì)對(duì)醫(yī)療效勞過(guò)高需求與員工自身素質(zhì)參差不齊的考驗(yàn)；如何在市場(chǎng)經(jīng)濟(jì)的大潮中，面對(duì)醫(yī)療市場(chǎng)開(kāi)放后外資醫(yī)院的競(jìng)相涌入，面對(duì)國(guó)內(nèi)民營(yíng)醫(yī)院的蓬勃開(kāi)展，面對(duì)公立醫(yī)院之間的劇烈競(jìng)爭(zhēng)，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(jī)遇并存。作為醫(yī)院管理者，不僅要自己明確醫(yī)院開(kāi)展方向，更要讓員工明確奮斗目標(biāo)與前進(jìn)航向，尋求一種職工共同參與、自我管理的方式，同舟共濟(jì)，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(jī)效管理文獻(xiàn)回憶：Review of the literature on performance management:績(jī)效考核是醫(yī)院管理的一個(gè)重要手段和方法，是對(duì)管理目標(biāo)實(shí)現(xiàn)和評(píng)價(jià)的客觀、公正的表達(dá)。目標(biāo)管理于20世紀(jì)50年代中期出現(xiàn)，是以泰羅的科學(xué)管理和行為科學(xué)理論為根底形成的一套管理制度，可以調(diào)動(dòng)人們親自參加工作目標(biāo)制定的積極性。持續(xù)改良與提高管理水平需要制訂科學(xué)合理、注重實(shí)績(jī)的考評(píng)體系，才能進(jìn)展全面、客觀、公正、公平的評(píng)價(jià)，這是落

32、實(shí)管理的基點(diǎn)。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(jī)效管理已在興旺國(guó)家，特別是國(guó)際成功企業(yè)中被廣泛采用，美國(guó)及歐洲一些國(guó)家的醫(yī)院，在各個(gè)層次都成功實(shí)施了績(jī)效管理。醫(yī)院在某些方面類似于企業(yè)，醫(yī)院管理、經(jīng)營(yíng)的許多理念，方式均始于企業(yè)或由企業(yè)演化而來(lái)。不同的是企業(yè)講利潤(rùn)最大化，追求的是經(jīng)濟(jì)效益；而醫(yī)院首先講救死扶傷，并只能在追求社會(huì)效益的前提下，講本錢(qián)核算。醫(yī)院在進(jìn)展績(jī)效評(píng)估與績(jī)效管理時(shí)，應(yīng)采取揚(yáng)棄的態(tài)度

35、，充分借鑒企業(yè)的做法與經(jīng)歷，并注重結(jié)合本行業(yè)的實(shí)際，實(shí)事求是地進(jìn)展績(jī)效評(píng)估與績(jī)效管理。如何將更科學(xué)的考核體系和良性競(jìng)爭(zhēng)的動(dòng)態(tài)機(jī)制融入到醫(yī)院評(píng)價(jià)比擬之中，科室單元內(nèi)部又如何以科學(xué)公正的績(jī)效指標(biāo)評(píng)價(jià)每位人才的價(jià)值和奉獻(xiàn)，目前缺少一套成熟而又實(shí)用的評(píng)價(jià)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(guān)衛(wèi)生組織績(jī)效測(cè)量的研究正在開(kāi)展，績(jī)效測(cè)量標(biāo)準(zhǔn)的研究是鑒于衛(wèi)生保健機(jī)構(gòu)沒(méi)有一個(gè)標(biāo)準(zhǔn)的績(jī)效測(cè)量系統(tǒng)，美國(guó)俄亥俄州大學(xué)的一項(xiàng)研究(1)在回憶有關(guān)醫(yī)療組織績(jī)效文獻(xiàn)的根底上，提出了衛(wèi)生保健機(jī)構(gòu)績(jī)效測(cè)量的總體框架。該框架中的績(jī)效測(cè)量包括內(nèi)部與外部評(píng)價(jià)兩個(gè)方

40、面，每個(gè)方面都有本錢(qián)財(cái)務(wù)績(jī)效及質(zhì)量績(jī)效兩個(gè)評(píng)價(jià)維度; 績(jī)效測(cè)量系統(tǒng)的研究，任何單獨(dú)的財(cái)務(wù)方面或經(jīng)營(yíng)方面的測(cè)量系統(tǒng)都不能使管理者在復(fù)雜競(jìng)爭(zhēng)的市場(chǎng)環(huán)境中成功地對(duì)績(jī)效進(jìn)展管理。因此，人們逐漸開(kāi)場(chǎng)采用多重指標(biāo)來(lái)衡量績(jī)效，其中有些是“硬指標(biāo)，包括各種經(jīng)濟(jì)和非經(jīng)濟(jì)尺度；有些是“軟指標(biāo)，包括質(zhì)量、員工態(tài)度及其類似的標(biāo)準(zhǔn)。現(xiàn)有文獻(xiàn)說(shuō)明對(duì)績(jī)效測(cè)量系統(tǒng)的研究熱點(diǎn)除系統(tǒng)開(kāi)發(fā)及系統(tǒng)所提供信息的利用以外，還有關(guān)于績(jī)效測(cè)量系統(tǒng)對(duì)組織作用及影響的研究和績(jī)效管理模式的研究。在英國(guó)，新的績(jī)效管理模式往往包括非財(cái)務(wù)措施，它代表了一種以戰(zhàn)略為導(dǎo)向的績(jī)效管理趨勢(shì)。在法國(guó)公司，在“Tableau de Bord績(jī)效管理模式里，將戰(zhàn)略分

41、解為財(cái)務(wù)與非財(cái)務(wù)指標(biāo)，作為流行的一種作法(2)。美國(guó)最近的一項(xiàng)有關(guān)社區(qū)醫(yī)院的研究已涉及到開(kāi)發(fā)一個(gè)戰(zhàn)略操作管理模式3，該模式將遠(yuǎn)期設(shè)備和效勞選擇，中層決策支持以及考慮了構(gòu)造約束后的社區(qū)醫(yī)院績(jī)效聯(lián)系起來(lái)。該研究在使人們對(duì)戰(zhàn)略操作管理決策有了更進(jìn)一步理解的同時(shí)，確定了在操作決策過(guò)程中的一些因果關(guān)系及在醫(yī)院績(jī)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(jī)效的關(guān)鍵戰(zhàn)略決策。其中，“平衡計(jì)分卡作為績(jī)效管理的一種最新、最有效的管理模式，吸引了眾多的學(xué)者和管理實(shí)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(duì)于醫(yī)院績(jī)效評(píng)價(jià)研究，國(guó)外醫(yī)院績(jī)效評(píng)價(jià)研究也包括三個(gè)層面。一個(gè)是以醫(yī)院為對(duì)象進(jìn)展績(jī)效評(píng)價(jià)：一個(gè)是對(duì)中層管理人員進(jìn)展工作能力評(píng)價(jià)；最后就是員工的績(jī)效評(píng)價(jià)。Robin S、Turpin利用PAJ模式對(duì)醫(yī)院績(jī)效指標(biāo)設(shè)置合理性進(jìn)展了評(píng)估4；全面質(zhì)量管理(TQM)那么對(duì)醫(yī)院績(jī)效改良進(jìn)展了研究5。另有一些對(duì)中層管理人員工作和能力評(píng)價(jià)的研究，并嘗試開(kāi)發(fā)了綜

51、合性的能力與工作評(píng)價(jià)工具6，而員工評(píng)價(jià)目前比擬盛行的是同級(jí)評(píng)價(jià) 7。但從整體看，對(duì)個(gè)人的評(píng)價(jià)多為針對(duì)醫(yī)師類的，較為單一，對(duì)醫(yī)院內(nèi)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(guó)，經(jīng)濟(jì)領(lǐng)域根本上完成了由方案經(jīng)濟(jì)向市場(chǎng)經(jīng)濟(jì)的轉(zhuǎn)化，但社會(huì)事業(yè)領(lǐng)域改革相對(duì)滯后，現(xiàn)有的醫(yī)療衛(wèi)生體制是在方案經(jīng)濟(jì)理論下建立的。作為一種科學(xué)的管理體系，績(jī)效管理正在受到國(guó)內(nèi)各級(jí)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(gè)人三個(gè)層面來(lái)進(jìn)展探討。根據(jù)中文科技期刊數(shù)據(jù)庫(kù)檢索，自1989年-2021年2月，涉及醫(yī)院績(jī)效的相關(guān)文章共有567篇，有關(guān)“績(jī)效考核的文章共有129篇，符合“績(jī)效管理檢索主題詞要求的文章有122篇，而建立績(jī)效考核評(píng)價(jià)體系的文章僅26篇。早在1993年西安第四軍醫(yī)大學(xué)胡琳、于爽等制訂了“醫(yī)院綜合效益評(píng)價(jià)體系，指標(biāo)按投入、產(chǎn)出分成兩大類，包括人員、設(shè)

55、備、物資、經(jīng)費(fèi)、社會(huì)效益和經(jīng)濟(jì)效益6個(gè)方面8；1994年浙江省舟山市衛(wèi)生局莊漢國(guó)9對(duì)綜合性醫(yī)院的社會(huì)、經(jīng)濟(jì)效益指標(biāo)體系的設(shè)置及評(píng)價(jià)方法等問(wèn)題作了探討，篩選出根本指標(biāo)25項(xiàng)，作為評(píng)價(jià)指標(biāo)體系。近年來(lái)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(zhì)量評(píng)價(jià)管理模式，主要指標(biāo)為床日門(mén)診指數(shù)、床位利用指數(shù)、CD型率(總病例中復(fù)雜疑難危重病例所占比例)、人均醫(yī)療費(fèi)、病員滿意度等 10；2001年，上海第二軍醫(yī)大學(xué)高岱峰、張鷺鷺等采用加權(quán)百分位次累加法建立評(píng)價(jià)模型，構(gòu)建了“醫(yī)院綜合競(jìng)爭(zhēng)力評(píng)價(jià)體系，指標(biāo)體系分競(jìng)爭(zhēng)力資產(chǎn)、競(jìng)爭(zhēng)力過(guò)程、競(jìng)爭(zhēng)力環(huán)境3個(gè)方面；2002年，復(fù)

56、旦大學(xué)胡善聯(lián)、李國(guó)紅等利用現(xiàn)場(chǎng)調(diào)查法和專家咨詢法，從業(yè)務(wù)水平、經(jīng)營(yíng)狀況和病人滿意度方面選出32個(gè)指標(biāo)，建立醫(yī)院績(jī)效評(píng)價(jià)指標(biāo)體系，并提出星級(jí)醫(yī)院評(píng)審的思想11。2005年?醫(yī)院管理評(píng)估指南?中將社會(huì)效益、工作效率、經(jīng)濟(jì)運(yùn)行狀況三個(gè)方面作為醫(yī)院績(jī)效評(píng)價(jià)的主要內(nèi)容12。眾多文章都是從不同的角度對(duì)醫(yī)院績(jī)效進(jìn)展評(píng)價(jià)，建立醫(yī)院績(jī)效評(píng)價(jià)指標(biāo)體系時(shí)均有自己的側(cè)重點(diǎn)，而且在實(shí)際工作中也確實(shí)起到了促進(jìn)醫(yī)院持續(xù)穩(wěn)定開(kāi)展、提高醫(yī)院核心競(jìng)爭(zhēng)力的作用。醫(yī)院績(jī)效評(píng)價(jià)體系是一個(gè)復(fù)雜的評(píng)價(jià)系統(tǒng)，目前國(guó)內(nèi)采用的指標(biāo)大多從業(yè)務(wù)、財(cái)務(wù)等方面分類考核，而專家咨詢法是篩選指標(biāo)的方法。盡管企業(yè)領(lǐng)域績(jī)效管理的方法已開(kāi)展得比擬成熟，但在國(guó)內(nèi)醫(yī)

57、療衛(wèi)生領(lǐng)域中比擬通用和權(quán)威的績(jī)效考核指標(biāo)還有待更深入的探索。而對(duì)于科室與個(gè)人的考核也有多篇研究報(bào)告。國(guó)內(nèi)醫(yī)院在臨床科主任的績(jī)效評(píng)價(jià)方面也有局部嘗試，國(guó)內(nèi)較具有代表性的有以下幾種評(píng)價(jià)方法：將平衡記分卡應(yīng)用于績(jī)效評(píng)價(jià)；使用360度績(jī)效考核法考核臨床科主任；應(yīng)用關(guān)鍵績(jī)效指標(biāo)KPI的考核指標(biāo)體系；運(yùn)用目標(biāo)管理的方法建立績(jī)效評(píng)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