公立医院院长薪酬激励对医院绩效的影响

目的:本文研究院长薪酬激励对医院绩效的影响。方法:采用自然实验方法,选取了院长薪酬与医院绩效挂钩和不挂钩的两个城市,分析了两种模式对公立医院主要绩效指标的影响。结果:(1)在院长薪酬和医院绩效考核结果挂钩的激励机制下,院长薪酬的增长同医院收入增长正相关,但与均次费用和平均住院日没有显著关系;(2)在院长薪酬与医院绩效考核结果不挂钩的机制下,院长薪酬增量与医院绩效指标没有显著关系;(3)院长薪酬与医院绩效结果相挂钩的城市,公立医院门急诊和住院次均费用增加高于院长薪酬与医院绩效结果不挂钩的城市。结论:院长薪酬与绩效指标挂钩与否并没有显著影响医院绩效,说明非经济因素激励也非常重要。院长薪酬同医院绩效指标挂钩会促使医院向考核指标努力,可能忽略医院全面发展。     

国有大型专科医院的薪酬方案设计：中山大学肿瘤防治中心的理想薪酬方案

薪酬激励是激励机制中最常用也是最重要的激励手段.医院的薪酬体系要与医院的战略发展结合起来考虑,要设计有吸引力的薪酬制度,留住人才;通过薪酬制度的激励,引导员工朝医院预期的发展目标行动,达到医院与员工的双赢.中山大学肿瘤防治中心在广泛征求职工意见的基础上,设计出的理想薪酬方案.综合体现了多种因素如国家政策、职务、职称、工作质量等对职工薪酬的影响.     

我院人力资源管理的现状、问题与对策

人力资源管理是现代化医院管理的核心和重点。本文通过对我院人力资源管理的现状 进行分析，探讨了存在的问题，提出要树立正确的人力资源管理理念，建立科学合理的绩效管理和 薪酬分配体系，建立完善的员工培训制度和激励机制，以及做好员工的职业生涯规划等对策。     

公立医院高层次人才薪酬管理现状与思考

高层次人才是医院人才队伍的核心,他们对薪酬是否满意在一定程度上决定着工作的主动性和积极性.通过对新医改试点城市江苏省镇江市某附属医院高层次人才薪酬制度现状分析,指出高层次人才在薪酬制度上存在缺少引进后的有效激励机制和考评体系、对自有高层次人才重视不够、薪酬分配不合理等问题,提出应完善政府补偿政策、制定合理薪酬分配方案、创新“全面薪酬”管理模式、建立有效评价体系,不断完善公立医院高层次人才薪酬管理.     

基于EVA的民营医院绩效考核与薪酬分配制度设计

以湖北省黄石市爱康医院为例,将医疗技术服务的经济附加值(EVA)的概念和思想引入到医院日常的薪酬分配方案及其管理中,建立了一套基于EVA思想的适合该医院绩效考核和薪酬分配的激励机制,它在提高医院整体运营绩效、医疗服务质量和满意度等方面均取得了良好的效果.     

公立医院医务人员对职能部门管理人员绩效考核与绩效薪酬分配认知分析

目的分析上海市3所三级公立医院医务人员对所在医院职能部门管理人员绩效考核与绩效薪酬分配的认知。方法通过问卷调查,了解医务人员对所在医院职能部门管理人员绩效考核与绩效薪酬分配的认知。结果被调查的医务人员总体上认为所在医院职能部门管理人员绩效考核与绩效薪酬分配良好,但对绩效考核制度了解程度不高,对管理人员绩效考核过程的透明度和管理人员之间绩效薪酬水平差异性的恰当性评价不高。超过半数的被调查管理者认为未来职能部门管理人员的平均绩效薪酬应为医生平均绩效薪酬的0.9倍或1.0倍。结论公立医院应完善职能部门管理人员的绩效考核与绩效薪酬制度,职能部门管理人员绩效薪酬的平均水平不应显著低于医生的平均水平。     

基于岗位价值的公立医院绩效薪酬管理体系的设计与应用

科学的绩效薪酬体系对医院实施内部有效管理, 提高医务人员积极性, 推进公立医院高质量发展有重要意义。某三级甲等综合医院基于国家薪酬制度改革的要求, 自2016年开始进行绩效薪酬体系的设计与应用实践。该院构建了岗位评价指标体系对医院各岗位序列进行分层, 并确定了不同序列和层级的岗位价值系数;构建了包含岗位绩效薪酬、专项绩效薪酬和创新绩效薪酬的绩效薪酬项目体系;建立了涵盖薪酬标准制定, 绩效薪酬核算与分配, 以及绩效薪酬管理体系的动态调整的绩效薪酬管理体系。该绩效薪酬管理体系的应用实现了员工价值、岗位层级与医疗服务的匹配, 2016年至2020年员工对绩效薪酬的整体满意度均超过85%, 同时提高了医院的运行效率和质量, 驱动了技术发展与科研创新, 对医院高质量发展发挥了正向激励作用。     

军队医院员工薪酬管理体系的设计

目的针对军队医院人员构成复杂的特点,设计一套行之有效的绩效制度。方法按照新医改要求,针对军队医院的特殊性,结合属地特色,以医院员工薪酬设计为切入点,提出军队医院绩效的具体模式。结果薪酬可分为显性薪酬和隐性薪酬,显性薪酬主要为物质激励,设置为基本工资和绩效奖励的"双绩效"模式,实行总额预算和目标管理,通过全方位考核,分级分类核算。隐性薪酬主要为非物质激励。通过工作环境、发展机会、组织文化三个方面的改善,增加员工归属感,提高工作积极性。结论薪酬设计要遵守军地相关规定,符合医改要求;结合医院自身的战略目标和内外环境,做到制度"因地制宜",核算"信息化"和结果公开公平合理。     

京沪穗医院:高管危机

84.2％的医院薪酬制度不公平，81.7％的医院管理激励机制不到位80.8％的医生工资水平太低，78.6％的医院未能建立有效的绩效评估系统62％的医院承认留不住好的人才，67.2％的高管和医生沟通较差。     

公立医院分配激励机制的设计与优化

分配激励机制是从分配制度上激发员工的工作动机，调动员工的积极性和创造性，使员工努力去实现组织的目标。20世纪80年代医院引入卫生经济管理理念并开始实施成本核算与绩效薪酬制度以来，虽然在一定程度上提高了医院的效益，促进了医院的发展，但受多种因素及历史条件的限制，公立医院分配激励机制尚不完善，需要重新设计与优化。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.