基于患者感知的医疗卫生服务质量评价模型分析

在医患矛盾成为社会所关注的一个焦点问题的今天．医疗卫生服务质量成为医院管理中最重要的研究领域之一。当前，我国卫生主管机构对于卫生医疗服务质量的评价还没有统一的模型，各级各类医院在各自的考核体系中都涉及到医疗质量，但是，基本都是以诊断治疗结果为评价指标，没有很好地突出以病人为中心的理念。借鉴顾客感知服务质量管理的理念．研究基于患者感知服务质量的卫生医疗服务质量评价模型的内容指标，勾勒以病人为中心的卫生医疗服务质量的粗略模型，是改善医患关系、建立和谐就医环境非常重要的环节。     

基于熵权改良TOPSIS法对某三甲医院医疗服务质量综合评价北大核心CSCD

目的对江苏某三级医院2010-2014年医疗服务质量工作进行综合评价,了解其医疗服务质量情况,为医院管理提供科学依据。方法应用熵权法和改良TOPSIS法结合对医院服务质量进行综合评价。结果江苏某三级医院近5年医疗服务质量总体呈上升趋势,医疗服务质量提升幅度明显。结论熵权改良TOPSIS法综合评价在医疗服务质量工作中具有灵活性和广泛性,评价结果真实可信,对评价医院医疗服务质量,提升服务效率具有一定的导向作用。     

基于熵权改良TOPSIS法对某三甲医院医疗服务质量综合评价

目的对江苏某三级医院2010-2014年医疗服务质量工作进行综合评价,了解其医疗服务质量情况,为医院管理提供科学依据。方法应用熵权法和改良TOPSIS法结合对医院服务质量进行综合评价。结果江苏某三级医院近5年医疗服务质量总体呈上升趋势,医疗服务质量提升幅度明显。结论熵权改良TOPSIS法综合评价在医疗服务质量工作中具有灵活性和广泛性,评价结果真实可信,对评价医院医疗服务质量,提升服务效率具有一定的导向作用。     

基于患者感知价值的医院服务质量评价:以河南省某三级甲等医院为例

目的从患者感知价值视角,对医院医疗服务质量进行评价和研究。方法设计改良服务质量(SERVQUAL)量表进行调查问卷,通过河南省某三级甲等医院门诊和住院患者的综合评价,得出其对医疗服务质量的评分分值。结果患者对医疗服务质量各条目的差距评分均为负值,患者感知的医疗服务质量排位最靠前的维度为可靠性,排位最末的维度为反应性,表明该医院患者对医疗服务质量的感知未能达到自身期望水平,医院方应进一步缩小差距。结论 SERVQUAL模型能够用于评价医院医疗服务质量,并有利于改进其薄弱环节。     

以患者为中心的卫生医疗服务质量评价模型分析

在医患矛盾成为社会所关注的一个焦点问题的今天，卫生医疗服务质量成为医院管理中最重要的研究领域之一。当前，我国卫生主管机构对于卫生医疗服务质量的评价还没有统一的模型，各级各类医院在各自的考核体系中都涉及到医疗质量，但是，基本都是以诊断治疗结果为评价指标，没有很好地突出以患者为中心的理念。本文试图借鉴顾客感知服务质量管理的理念，探索基于患者感知服务质量的卫生医疗服务质量评价模型的内容指标，勾勒出以患者为中心的卫生医疗服务质量的粗略模型。     

急诊患者满意度模糊综合评价

目的：探索影响医院急诊患者满意度的因素，为医院科学管理提供客观依据。方法：对某医院2003-2005年急诊患者或家属1564名进行问卷调查，进行模糊综合评价分析。结果：3年急诊患者满意率分别为90．16％、91．71％、92．56％，模糊评价总评分为J=0．7648、0．8961、0．9577，2005年诊疗环境与总体医疗服务质量模糊控制量占前两位（C=0．4843，0．2037）。结论：大多数急诊患者感到满意，且逐年提高，但诊疗环境与总体医疗服务质量有待进一步提高。     

论医疗服务质量在医院管理中的作用

以提高医疗服务质量来获得和保持良好的社会和经济效益，已成为医院发展的根本方向。本文从医疗服务质量的重要性、提高医疗服务质量对医院服务成本的影响及如何提高现代医院的医疗服务质量进行了阐述。     

基于过程视角的医疗服务质量评价实证研究

目的:基于过程的视角调查患者对就医3阶段服务质量的评价,识别影响评价的主要因素,以明确医疗服务质量改进的方向和重点,为相关医院提高医疗服务质量提供参考.方法:抽取130位杭州临安市公立医院就诊的患者进行问卷调查,应用描述性统计与回归分析对数据进行分析处理.结果:挂号、诊断与治疗3阶段总体评价得分分别为3.60,3.37和3.53,而各阶段影响患者评价服务质量的最主要因素分别是前台挂号人员的态度和医生技能.结论:各阶段患者总体评价尚可,但影响患者评价服务质量的因素并不相同.     

某三甲医院医疗服务质量患者感知要素调查

目的 以医用“SERVQUAL理论”为基础,根据医院实际重新设计了“SERVQUAL模型” （服务质量差距模型）各条目,对于“SERVQUAL模型”在医疗服务质量评价中的应用进行探讨.方法 以北京市某医院117名患者及48位医务人员为对象,采用问卷调查的方法,测算患者对医院服务质量的SQ值.结果 患者对医院服务质量的SQ值呈现了其在对医院医疗服务的感知与期望间有较大的差距,并通过医患之间的数据对比阐明医务人员所提供的服务质量与患者所感受的服务质量间同样存在差异.结论 “SERVQUAL模型”是一种从患者角度评价服务质量的方法,可以结合患者对于医疗服务的期望和实际感受,科学地了解患者对医疗服务的满意程度,并据此发现医疗服务中的薄弱环节.     

以科技为先导质量为核心不断深化医院管理年活动

卫生部推出“以病人为中心，以提高医疗服务质量为主题”的“医院管理年”活动，其核心是质量问题。只有努力练好内功．提高医疗质量，才能为人民群众提供优质的医服务。何谓质量？医疗服务的质量体现在医疗技术和医疗务的水平上．体现在能不断适应人民群众日益增长的医疗卫生需求上．体现在人民群众对医院有较高的信任度和满意度上。我院在医院管理中紧紧抓住以科技创新、提高质量打造核心竞争力、以医疗服务质量的流程管理为重点，确立战略管理目标，取得了良好效果。     

Quotable Quotes

Patient adherence is extremely important to achieve positive outcome. While quality of healthcare service has been studied as a determinant of patient satisfaction and loyalty, its impact on patient adherence has not been examined. The authors attempt to determine dimensions of quality and their impact on patient adherence in primary healthcare in India. Exploratory factor analysis resulted into seven factors. Factor scores were used for regression to identify the influence of dimensions of service quality on patient adherence. Quality of healthcare emerged as a determinant of patient adherence.     

A research of service outcomes in Taiwan: the role of patients' quality perceptions and wait time

Wait time is a continuing issue in healthcare services. U.S. studies reveal wait time is inversely related to healthcare service outcome as well as patient behavior and attitudes. However, Taiwan, despite being an important center for global healthcare services, has not been the subject of much research attention regarding wait time and its impact on patient perceptions and behavior. In the authors' exploratory study, patients in Taiwan completed a self-report questionnaire on how wait time and service quality characteristics relate to service outcome. Results indicate the influence of healthcare service quality and wait time on service outcome. Contributions, limitations, and research and managerial implications are discussed.     

居家养老在社区老年保健服务中的效果评价

目的研究居家养老对社区老年保健服务的效果,为社区老年保健的进一步发展提供科学的依据。方法采用健康相关生命质量测量量表(SF-36)调查接受个性化服务的100户老年人,分析其生命质量评分的变化;自拟调查问卷对随机抽取的362名60岁以上的社区老年人进行健康教育效果调查。结果接受居家养老服务后,老年人的生命质量评分得到明显提高,社区老年人对高血压、糖尿病的健康知识知晓率得到明显提高,且有35.00%及36.67%的老年人改变了自己的不健康饮食方式、行为习惯。结论社区居家养老服务能在社区老年保健中发挥非常积极的作用,有助于提高老年人的生活质量。     

河北省县级医疗保健机构产科质量评估分析

为加强县级医疗保健机构产科建设 ,提高产科质量 ,依据《河北省县 (区 )级医疗保健机构产科质量评估标准 (试行 )》,采取随机抽样方法 ,对县级医疗保健机构进行了评估。结果显示 ,被评估的医疗保健机构建立了孕产妇急救中心 ,加大了对产科建设的投入 ,建章立制 ,将爱婴医院的建设与提高产科质量相结合 ,县级医疗机构的管理水平及医护质量得到很大提高 ,对降低孕产妇、新生儿死亡率起到了积极的作用。对存在的质量及管理等问题提出对策和建议。     

我国贫困地区县域内健康扶贫工作进展与政策建议

通过健康扶贫政策梳理、定量分析卫生健康统计数据和典型案例分析,研究我国县域内健康扶贫工作的进展、成效及问题,提出后脱贫期县域内医疗卫生服务改革与发展的建议。整体上看,我国健康扶贫工作成效显著:医疗卫生机构"三个一"和医疗服务能力"三条线"目标基本实现;卫生技术人员配置基本达到"三个一"要求;贫困县床位和设备配置达到或接近全国平均水平;通过新建临床专科、开展新技术和新项目等,贫困县专科服务能力得到提升;此外,部分贫困地区积极探索县域内医疗卫生综合改革。今后,新脱贫地区面临的主要挑战是县域内卫生服务体系建设仍需加强,基层卫生人才队伍差距和财政投入与卫生改革协同不足三大主要问题。建议中央财政继续支持县域内卫生服务体系建设;以人才建设为抓手,提升县域内医疗服务能力;强化保障措施,推进县域内医疗卫生综合改革。     

Effects of decentralisation and health system reform on health workforce and quality‐of‐care in Indonesia, 1993–2007

The impact of decentralisation, socioeconomic changes and healthcare reforms in Indonesia on type and distribution of healthcare providers and quality‐of‐care has been unclear. We examined workforce trends for healthcare facilities from 1993 to 2007 using the Indonesian Family Life Surveys. Each included a sample of public and private healthcare facilities, used standardised interviews for numbers and composition of staffing, and quality‐of‐care vignettes. There was an increase in multiprovider facilities and shift in profile of solo providers—increasing proportions of midwives and drop in doctors in rural areas (including facilities with doctors) and nurses in urban areas. Quality‐of‐care scores were low, particularly for nurses as solo providers. Despite increased numbers of healthcare workers and growth of the private sector, outer Java‐Bali and rural areas continued to be disadvantaged in workforce capacity and quality‐of‐care. The results have implications for accreditation and in‐service training requirements, the legal status of nurses and private sector regulation. Copyright © 2014 John Wiley & Sons, Ltd.     

Meeting patient expectations: healthcare professionals and service re-engineering.

A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.     

Quality-based purchasing in health care

Quality-based purchasing is a growing trend that seeks to improve healthcare quality through the purchaser-provider relationship. This article provides a unifying conceptual framework, presents examples of the purchaser-provider relationship in countries at different income levels, and identifies important supporting mechanisms for quality-based purchasing. As countries become wealthier, a higher proportion of healthcare spending is channeled through pooled arrangements, allowing for greater involvement of purchasers in promoting the quality of service provision. Global and line item budgets are the most common type of provider payment system in low and middle-income countries. In these countries, improving public hospital performance through contracting and incentives is a key issue. In middle and high-income countries, there are several documented examples of governments contracting to private or non-governmental health care providers, resulting in higher perceived quality of care and lower delivery costs. Encouraging quality through employer purchasing arrangements has been promoted in several countries, particularly the United States. Community-based financing schemes are an increasingly common form of health financing in parts of sub-Saharan Africa and Asia, but these schemes still cover less than 10% of national populations in countries in which they are active. To date, there is little evidence of their impact on healthcare quality. The availability of information--concerning healthcare service provision and outcomes--determines the options for establishing and monitoring contract provisions and promoting quality. Regardless of the context, quality-based purchasing depends critically on informa-tion--reporting, monitoring, and providing useful information to healthcare consumers. In many low and middle-income countries, the lack of availability of information is the principal constraint on measuring performance, a critical component of quality-based purchasing.     

Seeking perfection in healthcare. A case study in adopting Toyota Production System methods

Virginia Mason Health System's vision to be the quality leader in healthcare means continually adopting new ways of thinking. One change has been shifting from believing defects are to be expected to believing zero defects in healthcare is not only possible, but also necessary. Generally, healthcare has advanced in technology and understanding of disease, but its business and management systems have changed little since the 1950s. Virginia Mason realized it needed a management method to help make real and measurable improvements in safety, quality, service and staff satisfaction.     

Testing not-so-obvious models of healthcare quality

PURPOSE: The purpose of this paper is to show that, although there has been some research to identify the dimensions on which healthcare quality and in-patient satisfaction should be measured, the confirmation of constructs and indicators that constitute an overall care quality and satisfaction remains unclear. The objective is to present several models of service quality and satisfaction in healthcare for discharged patients; and to test those models in a sample of discharged patients in public hospitals in the United Arab Emirates. DESIGN/METHODOLOGY/APPROACH: A detailed in-patient survey (using interviews) was used. Data were collected with questionnaires from adult discharges (n = 244) in public hospitals in the UAE. Several structures are proposed and tested. Confirmatory Factor Analysis (CFA) and LISREL SIMPLIS using maximum likelihood estimation were used to estimate and test the parameters of the hypothesized models derived deductively from the previous literature. FINDINGS: Several models (with one, two, three and four constructs) with different structures were tested using CFA. The final recommended model is based on three constructs--quality of care, process and administration, and information. The goodness-of-fit statistics supported the basic solution of the healthcare quality-satisfaction model. ORIGINALITY/VALUE: The model has been found to capture attributes that characterize healthcare quality in a developing country such as the UAE and could represent other modern healthcare systems. It can be used as a basis for evaluation in healthcare practices from discharges (in-patients) point of view. The study highlights the importance of patients' satisfaction with care as predictors of quality of care. The results also confirm the construct validity of the previously discussed healthcare quality scales.