成本核算与绩效评价相结合:医院奖金分配方案的探讨

指出了目前医院奖金分配方案思路不清晰的问题,提出了医院奖金分配方案应当关注的几个重要指标:奖金贡献率、奖金换手率、奖金占利润的比例。在此基础上结合实际工作经验提出了医院制定奖金分配方案的基本思路,为我国医院收入分配制度改革提供了科学参考。     

对医院奖金分配模式的反思与探讨

首先对医院原有的奖金分配模式进行剖析,进而提出了在成本核算基础上进行绩效评价的奖金分配办法,建立相关的数学模型,并提出具体操作方法,希望为医院管理者提供一种新的奖金分配思路。     

医院奖金分配方案的探索

随着医院改革的不断深化和市场竞争机制的引入,单纯的结余提成的奖金分配方式已不适应医院发展的需要。目前,医院分配方案改革的呼声日益高涨。文章结合我院奖金分配方案改革的实践,对奖金分配方案的宗旨原则、方案设计以及效果和体会做一探讨。     

医院奖金分配方案的探索

随着医院改革的不断深化和市场竞争机制的引入,单纯的结余提成的奖金分配方式已不适应医院发展的需要.目前,医院分配方案改革的呼声日益高涨.文章结合我院奖金分配方案改革的实践,对奖金分配方案的宗旨原则.方案设计以及效果和体会做一探讨.     

浅谈几种医院内部分配机制的方法

近几年来，医院实行的成本核算。很多医院主要是解决科室奖金分配问题，而忽视了成本管理实质性。目前，医院在分配机制上大多采用收支核算，结余提奖的办法，而收支核算有多种方案，这就决定了科室奖金分配的差异性，现就某院内部分配谈几点看法：     

医院科室成本核算方法的探讨

为进一步深化医院改革,向完全成本核算过渡,实现医院最佳的经济效益与社会效益,必须准确、合理地把医院总目标分解到各科室,使其成为科室努力的方向,并与科室奖金分配直接挂钩,为各科室创造一个平等的竞争环境,以确保总量控制、结构调整目标的实际,为此我院制订了科室成本核算办法。 1 总则 (1) 在完善经济核算的基础上,制订各科室的工作数量和质量、医德要求及经济指标,做为科室的工作目标,并与医院签订合同。(2)对完成目标的科室,实行定额奖金分配     

从奖金分配问题看医院分配制度改革

医院分配制度改革是当前卫生改革的重要组成部分.科学、合理、公平地分配奖金是医院分配制度改革的核心内容之一,也是许多医院面临的现实问题.通过对医院奖金分配过程中的计提、分配等问题做的初步探讨,提出几种计算方法,并对当前分配制度的改革提出建议.     

医院二级奖金分配模式探讨：以H医院为例

随着医院改革的不断深化和市场竞争机制的引入,单纯以工作量以及结余提成的奖金分配方式已不适应医院发展的需要。文章分析了医院现行奖金分配模式,提出了基于多元绩效评价的二级奖金分配模式,并以H医院为例,介绍了该模式的操作流程。     

基于工作量的医院奖金分配改革实践与探讨

本文分析了“成本核算、结余提成”奖金分配方案存在的弊端,提出了以工作量为基础,侧重手工操作、治疗收入,激励急诊收住,鼓励疑难危重收治,对工作量采用阶梯核算的奖金分配新模式。通过某医院一年多的实践,探讨医院奖金分配制度改革相关问题。     

医院奖金分配模式和分配方法的研究与实践

我院自1996年1月即开始实行院科两级核算，并在全成本核算的基础上对奖金分配制度做了一定调整。这些改革措施的实施曾极大地促进了医护人员增收节支的积极性，提高了医院的经济效益，但随着时间的推移和医疗市场环境的变化，单纯的“成本核算，结余提成”的奖金分配办法日益暴露出其片面性，已经不能完全适应医院分配制度改革的新     

Correlation between candiduria and departmental antibiotic use

The incidence of candiduria is increasing in teaching hospitals. We examined the hypothesis that this trend was correlated with the amount of departmental antibiotic consumption. In the setting of a large teaching hospital in Israel, the correlation coefficient between departmental intravenous antibiotic consumption (expressed as daily defined dose (DDD)/1000 patient-days) and the incidence of candiduria per 1000 patient-days was 0.47 (P=0.03). For broad-spectrum antibiotics, the corresponding correlation coefficient was 0.66 (P=0.001). The strongest correlation with candiduria was shown for the use of meropenem (r=0.79, P<0.001) and ceftazidime (r=0.66, P=0.001). This is the first time that departmental habits of antibiotic use have been shown to be strongly correlated with the incidence of candiduria in hospitalized patients. These results add an important new dimension to the strategy of restricting broad-spectrum antibiotics.     

A departmental stress management plan

To reduce stress, most people and organizations need to improve their skills in recognizing and coping with stressors. Department plans like the one described provide a good method of understanding and learning to cope with specific stressors. Researchers analyzed the effects of a stress management plan for registered nurses in an acute care hospital. This plan, called stress inoculation, began with education on stress and coping skills. The nurses were then exposed to the real-life stressors and expected to use the newly learned coping skills. Later, the nurses were asked to evaluate the effectiveness of the coping skills. The results of the study showed that the nurses' stress was reduced through stress management and that coping skills were the key ingredient. Education was needed to teach the coping skills, but by itself, education showed no benefit. If supervisors and employees remain committed to the departmental stress management plan throughout the six phases, the likelihood of reducing stress, improving morale, and increasing productivity is high.     

科主任对实施整体护理态度的调查

目的 为了解科主任对实施整体护理的态度，向有关领导提供信息。方法 利用自己设计的问卷对某一教学医院在位正主任及护士长开展无记名的调查。结果 ２６％的科主任对整体护理了解，了解的途径从本院护士处听说的占７４％；８５％的科核心组从未研究过整体护理；５３％的科主任没有看过护理病历，而其中３９％的认为护理病历对医疗帮助不大；科主任中认为整体护理是职权范围内的占４７％，有必要开展的占９４％，对医疗起促进作用     

对建立医院分科成本核算制度的探讨

该系统地论述了医院分科成本核算的管理体制、成本核算的步骤、成本费用的控制和成本费用控制等，对医院建立科学的成本核算系统有较大的借鉴作用。     

Developing a departmental culture for reporting adverse incidents

A simple, reproducible model for reporting adverse events was developed in order to promote cultural awareness and acceptance of risk management within the authors' department. A departmental proforma was created and prospective reporting of adverse events was encouraged. In the six months prior to commencing this study only four adverse incidents were reported. Following the introduction of the proforma 64 critical incidents and near-misses were reported in the one-year period. In conclusion a simple model for reporting critical incidents and near-misses has been established. This has fostered a cultural change within the department and all members of staff feel more comfortable with reporting such incidents. The process is seen as educational and an important part of continuing professional and departmental development. Protocols and changes in organisational practice have been developed to reduce and prevent the occurrence of adverse events and offer patients continuous improvement in care.     

Reengineering along departmental product flowlines

This article describes how a medical records department responded to relocating, upgrading a departmental computer system, incorporating severity of illness abstracting, and implementing continuous quality improvement techniques by reengineering along department flowlines over a five-year period. Areas of the department that were restructured were storage and retrieval, record completion, and data collection and reporting functions.     

Building departmental influence in health care organizations

This article has outlined several steps to follow in assessing and building department influence at the top management levels of health care organizations. Identifying and contributing to resolving the organization's key areas of uncertainty are strategies that have improved the influence of many departments in recent years. Individual strategies, such as developing one's expertise and sharing that expertise with other departments and top management (an example of the "involvement" technique), also are being used daily by effective department managers. Decentralized management, which entails the assignment of greater responsibilities to middle managers, is increasingly popular in health care organizations. This trend will no doubt facilitate the building of departmental influence in organizational decision making. However, the steps outlined in this article can be implemented whether or not top management endorses a decentralized management style. In a critical sense, departmental influence is too important to be left to top management. It is up to department managers to exert their influence for the good of their employees, the organization as a whole, and their own careers.     

Comparison of the quality of patient data collected by hospital and departmental computer systems

The quality of patient data routinely collected in hospitals is rarely assessed, though by repute it may often be incomplete and inaccurate. To explore their completeness and accuracy, patient data separately collected by a hospital Patient Administration System (PAS) and by a departmental Clinical Information System (CIS) used by clinicians were compared. The results indicate that, although both systems appear to record reliably demographic and administrative data, PAS data are more complete than CIS data. Moreover clinicians and medical records staff seem to use classifications of diagnoses and procedures in profoundly different ways. More attention should be paid to the need to assess and improve data quality. The development of a shared database, used and validated by medical records staff and clinicians alike, may be the best way to achieve this.     

New graduate therapists in acute care hospitals: Priorities, problems and strategies for departmental action

This study presents findings from an action research study of occupational therapists working in one acute care university-affiliated hospital department to ascertain their views regarding new graduates (NG). The aim of the study was to inform decisions regarding the development of NG support strategies to enhance organisational effectiveness. Twenty-four department participants identified 56 issues they perceived were important for NG. These were in four areas: (i) retention of NG staff; (ii) NG function in clinical roles; (iii) NG function in the occupational therapy department; and (iv) whose problem was it (NG themselves or staff already in the department that NGs join). A delphi survey was then conducted with 27 participants to identify which of the 56 issues were priorities. Fifteen issues of importance were identified and examples of departmental strategies, which were developed in response to these priorities, are described. Recommendations for application of action research approach as a change strategy in occupational therapy departments and further suggestions for research are made.