医院管理思维范式的变革

医院管理思维范式是管理科学活动的整合与升华,范式变革的实质就是提出一套全新的发现问题和解决问题的方法。如何理解医院管理思维范式的意义建构,怎样正确把握医院管理思维范式变革的特点,医院管理者只有在研究问题和解决问题的过程中,注重自己的管理思维品质培养,才能建立科学、理性的思维方式,进而改变工作方式,更好地应对新时期医院发展所面临的各种挑战。     

文明医院:和谐医疗服务的理想范式

“文明医院”是人类医院范式的理想追求，是构建和谐医疗卫生服务的理性选择。在新时期创建“文明医院”，纠正当前医院一些“不文明”的现象，建立现代文明医院范式，凸显文明医院的时代特质，是医院管理变革的理想选择。     

意义体认视域下高等医学人文教育范式创新论略

高等医学人文教育范式是指人们对高等医学人文教育实践活动中发生的各种教育现象所持有的见解、思维方式以及思维框架的总称,是对高等医学人文教育进行哲学思考的理论反映。在教育目的、教育向度、教育层次等多方面的具体与历史的统一中高等医学人文教育至少呈现出理想范式、问题范式与规律范式这样三种本质性范式。而实现理想范式、问题范式与规律范式具体的、历史的辩证统一既是高等医学人文教育理论体系走向成熟与完善的重要方法论前提,也是创新高等医学人文教育范式并促进高等医学人文教育实现其自身历史使命的重要方法论保证。     

风险防范式护理在儿科护理管理中的应用效果分析

目的:观察风险防范式护理在儿科护理管理中的应用效果.方法:选取本院护理人员作为样本,将其分为观察组与对照组.对照组采用常规方法护理,观察组在常规护理基础上,将风险防范式护理应用到儿科护理管理中.结果:观察组护理风险发生几率3.23%、患儿家属护理满意度100%;观察组护理风险发生几率19.35%、患儿家属护理满意度80.65%.结论:将风险防范式护理应用到儿科护理管理中,能够有效降低护理风险发生的几率,提高患儿家属护理满意度.     

风险防范式护理在儿科护理管理中的应用

目的:观察风险防范式护理在儿科护理管理中的应用效果.方法:本研究于医院内部选取了2015年9月～2017年9月收治的64例患儿作为研究对象,采用整群随机抽样法将其分为护理组和对照组,对比两组患儿的护理风险事件发生率和护理满意度.结果:护理组护理风险风险事件的总发生率为3.13％,显著低于对照组的25％(P<0.05);护理组患儿家属的护理满意度为93.75％,明显高于对照组的71.86％(P<0.05).结论:风险防范式护理在儿科护理管理中具有较好的临床护理效果,有利于改善患儿的临床症状,提高患儿家属护理满意度,宜广泛应用于临床护理中.     

探讨风险防范式护理在儿童医院护理管理中的应用效果

目的探讨风险防范式护理在儿童医院护理管理中的应用效果。方法选取该院2011年6月—2012年6月收治的患儿90例,对其进行随机分组,分别为观察组与对照组,每组各45例患儿。对照组给予常规护理,观察组给予风险防范式护理。观察两组患儿的护理情况、家属满意度情况,并进行对比。结果通过采取不同方式的护理后,观察组护理质量明显优于对照组,并发症相对较少,患儿家长的情绪较为稳定,同时患儿家属护理满意率也显著高于对照组,两组对比差异较大,均具有统计学意义（P〈0.05）。结论在儿童医院中,针对患儿采用风险防范式护理模式进行护理,不仅能够有效降低护理人员在工作中的风险事件发生率,还可有效提高护理质量与护理满意度,在临床护理管理中起到非常重要的作用,可广泛推广应用。     

新时代背景下卫生事业管理专业范式优化的驱动因素、内容诉求和支持路径——基于公共服务视角的反思

卫生事业重点关切公民健康，眷注民生福祉，新时代背景下该领域人才培养更是党和国家践行“健康中国”战略和回应“人民日益增长的健康需要”的动力支撑。为了保障和深化卫生事业管理专业的存续性和可为空间，基于卫生事业“公共服务”的精神内核，可以从公共管理理论演进的价值引导、服务性国家意志的积极催化、公共卫生服务合作供给的现实期待以及卫生事业管理专业的发展掣肘四种境况审视专业范式优化的驱动因素，从专业界限、培养目标、课程体系和就业导向四项要素系统思考专业范式优化的内容诉求，从高校、学界、政府以及社会四个主体积极探寻专业范式优化的支持路径。     

马克思主义卫生政治经济学理论框架与学科体系研究

理论的科学性体现为逻辑自洽和强现实解释力。新时代卫生改革发展呼唤更具解释力和指导性的卫生经济理论。文章通过回顾经济学发展历程,提出建立马克思主义卫生政治经济学、推进学科范式革命的必要性,系统论述了卫生政治经济学作为一门新学科的研究对象、理论框架、研究领域、研究方法等,并提出学科建设的总体思路。     

风险防范式护理对儿科护理不良事件发生率的影响分析

目的:研究风险防范式护理对儿科护理不良事件发生率的影响价值.方法:将126例儿科收治的患儿作为研究对象(2017年4月-2017年11月期间收治),随机分对照组、观察组,对照组予以传统护理,观察组在对照组基础上予以抗风险防范式护理.结果:观察组和对照组护理后比较,其不良事件发生率更低,P<0.05.结论:风险防范式护理对降低儿科护理不良事件发生率具有重要影响.     

中国医保预算影响分析的研究范式

目的:探索中国医保预算影响分析研究范式,为规范研究框架和研究过程、提高研究结论的可靠性,提供理论和经验依据。方法:通过文献研究,了解医保预算影响分析研究的模型设计、关键要素、数据需求等理论方法及最新发展动态,结合中国国情,总结归纳适合中国的医保预算影响分析研究范式。结果:医保预算影响分析应包括模型设计、研究角度、市场情景、目标人群、研究时限、治疗成本、不确定性分析7大关键要素;此外,医保预算影响分析报告还应包括计算所用数据集、数据来源,并附计算软件与运算过程,以便于医保主管部门审查验证。结论:医保预算影响分析能够评价短期、特定情景内药物进入医保目录对医保基金的影响,与药物经济学配合使用服务于医保决策。     

Change remains — paradigm shifts in modern surgery

This article aims to describe underlying principles of paradigm shifts in clinical medicine by means of analysis of typical examples. Retrospectively, profound shifts of ruling paradigms can be shown in diverse fields such as outcome research, in the redefining of patients' and doctor's autonomies, in the challenges presented by consumer medicine and the free market economy. This has provoked controversy between doctors, patients and the community. The judgement on whether recent shifts in paradigms in medicine have improved the health care delivered today is by no means uncontroversial. Aiming to demonstrate how shifts of paradigms in medicine occur and what consequences can result from such shifts we reflect on the works of Thomas S. Kuhn, the eminent philosopher of science. An analysis of his theories lends important insight into the observed shifts in paradigms.     

Health inequities: evaluation of two paradigms

Social work practice in health is shaped by underlying paradigms.To effectively target health inequities, practitioners need to consider appropriate paradigms. In this exploration of how six health paradigms shape theory and practice, the two health paradigms that most attended to health inequalities are social determinants of health and political economy. The article undertakes a critical review of the social determinants of health paradigm and the political economy paradigm regarding how they might shape social work theory and practice targeting health inequities.     

The state of global research on social work and disability

Two paradigms are used to define disability. On the one hand, the biological paradigm, which attends to a person’s deficiencies and difficulties. And, on the other hand, the social, which does not treat disability as a pathology, but rather places the focus of interest on the deficient tools that society has to consider the capabilities of everyone. This article analyzes the scientific production on disability and social work, using bibliometric techniques and algorithms for the detection of communities, taking into account the current state of research worldwide. This analysis offers a holistic view of the characteristics of the work carried out in the world on this subject.     

Socioeconomic status and health: a discussion of two paradigms

Socioeconomic status and its impact on health are in the mainstream of public health thinking. This text discusses two paradigms utilized in assessing socioeconomic status in epidemiologic studies. One paradigm refers to prestige-based measurements and positive differentiation among social strata. This paradigm is characterized by classifications assessing social capital and the access to goods and services. The other paradigm refers to the classification of social deprivation and negative differentiation among social strata. The proposal of State-funded reposition to the mostly deprived social strata is acknowledged as characteristic of this paradigm. The contrast between these paradigms, and their potential interaction and debate are discussed. Fostering reflection on methodological strategies to assess socioeconomic status in epidemiologic studies can contribute to the promotion of health and social justice.     

Medical management: the scientific paradigm

Specialization, differentiation, as well as interdisciplinary integration are well-known phenomena in the development of sciences. The following paper proposes a scientific paradigm needed for the still young, but very current, discipline of medical management, which may be also a new perspective for health sciences.     

Organizational Adaptation in the VNA

The organizational history of the visiting nurse association (VNA) is reviewed from the perspective of paradigm change. A paradigm is a behavioral and structural model that comes to characterize a field because of its compatibility with environmental conditions. The concept is applied to interpreting adaptation among the VNA's. Four distinct paradigms are identified which comprise the overlapping but sequential course of VNA adaptation to changing circumstances. These paradigms are "public health nursing," "community nursing service.," "the home health agency," and the "home care enterprise." The emergence of each is examined with emphasis on the continuity and discontinuity of elements. Particular focus is given to the durability to date of the voluntary auspice and its future prospects in light of ongoing paradigmatic change is discussed.     

Organizational adaptation in the VNA: paradigm change in voluntary sector.

The organizational history of the visiting nurse association (VNA) is reviewed from the perspective of paradigm change. A paradigm is a behavioral and structural model that comes to characterize a field because of its compatibility with environmental conditions. The concept is applied to interpreting adaptation among the VNA's. Four distinct paradigms are identified which comprise the overlapping but sequential course of VNA adaptation to changing circumstances. These paradigms are "public health nursing," "community nursing service," "the home health agency," and the "home care enterprise." The emergence of each is examined with emphasis on the continuity and discontinuity of elements. Particular focus is given to the durability to date of the voluntary auspice and its future prospects in light of ongoing paradigmatic change is discussed.     

The fictionalist paradigm

The fictionalist paradigm is introduced, and differentiated from other paradigms, using the Lincoln & Guba template. Following an initial overview, the axioms of fictionalism are delineated by reference to standard metaphysical categories: the nature of reality, the relationship between knower and known, the possibility of generalization, the possibility of causal linkages, and the role of values in inquiry. Although a paradigm's ‘basic beliefs’ are arbitrary and can be assumed for any reason, in this paper the fictionalist axioms are supported with philosophical considerations, and the key differences between fictionalism, positivism, and constructivism are briefly explained. Paradigm characteristics are then derived, focusing particularly on the methodological consequences. Towards the end of the paper, various objections and misunderstandings are discussed.