基于社会治理视角的公立医院社会评价策略及研究框架构建

社会治理是基于对社会管理过程中权力格局分析与判断,在政府、市场、社会与公民基本关系明确定位的前提下倡导的新型公共管理模式.社会评价是基于社会治理理论的一种有效实现载体和手段,由于其对公众利益和责任表达、解决突出社会矛盾问题具针对性和优越性,已得到普遍促进和应用.在基于社会治理理论开展公立医院管理改革情景分析的基础上,阐述了国内外社会治理及社会评价理论、内涵与进展,以及对相关社会领域社会评价治理路径及实践探索进行梳理分析,提出了在医疗服务管理领域探讨和开发其公立医院社会评价策略及研究框架构建,为探索建立公立医院社会管理制度以及政策制定提供依据.     

基于社会治理视角的公立医院社会评价策略及研究框架构建

社会治理是基于对社会管理过程中权力格局分析与判断,在政府、市场、社会与公民基本关系明确定位的前提下倡导的新型公共管理模式.社会评价是基于社会治理理论的一种有效实现载体和手段,由于其对公众利益和责任表达、解决突出社会矛盾问题具针对性和优越性,已得到普遍促进和应用.在基于社会治理理论开展公立医院管理改革情景分析的基础上,阐述了国内外社会治理及社会评价理论、内涵与进展,以及对相关社会领域社会评价治理路径及实践探索进行梳理分析,提出了在医疗服务管理领域探讨和开发其公立医院社会评价策略及研究框架构建,为探索建立公立医院社会管理制度以及政策制定提供依据.     

交易成本理论在医院治理中的应用

首先回顾交易成本理论,并评述国内部分医院治理文献。然后,以清华大学杨燕绥教授提出的四圈型医疗服务治理机制的分析框架为基础,分析医疗卫生领域存在的“准利益集团”的特征,并将社会评价与监督的治理机制延伸,并提出共同治理模式与疏堵协同治理模式,以达到改善医院治理绩效和节约交易成本。     

杭州市医疗卫生领域社会评价及治理典型经验与启示

改革开放以来,杭州市不仅在政府管理革新方面取得巨大成就,而且在推进创新社会治理效果亦然显著。在医疗卫生领域逐步打造了具有杭州特色,兼顾自下而上的社会治理与自上而下的政府治理相结合的多元治理体系。着重介绍了百万市民评卫生-患者满意度第三方评价、"公述民评"电视问政活动、《我们圆桌会》栏目、医疗纠纷第三方调解等治理方式在改善医疗或健康服务质量、提升群众获得感等方面的典型经验与启示。建议各级政府及医疗机构强化多元社会治理体制机制,精准对接人民群众的健康需求,落实社会评价意见的收集、追踪、整改和闭环回路。     

基于社会治理视角的公立医院社会评价策略及研究框架构建

社会治理是基于对社会管理过程中权力格局分析与判断,在政府、市场、社会与公民基本关系明确定位的前提下倡导的新型公共管理模式.社会评价是基于社会治理理论的一种有效实现载体和手段,由于其对公众利益和责任表达、解决突出社会矛盾问题具针对性和优越性,已得到普遍促进和应用.在基于社会治理理论开展公立医院管理改革情景分析的基础上,阐述了国内外社会治理及社会评价理论、内涵与进展,以及对相关社会领域社会评价治理路径及实践探索进行梳理分析,提出了在医疗服务管理领域探讨和开发其公立医院社会评价策略及研究框架构建,为探索建立公立医院社会管理制度以及政策制定提供依据.

Abstract：

Social governance is a novel form of public administration made based on the analysis and judgment for the power pattern in the course of social administration, a model advocated in the premise of a clearly positioned relationship among the government, marketplace, society and citizens.Social evaluation is an effective carrier and means leveraging the social governance theory, which has found extensive and outstanding use in such issues as expression of public interests and responsibilities,and in tackling sharp social problems. The authors called into play the scenario analysis based on public hospital management reforms with the social governance theory. In addition, they explored social governance at home and abroad as well as the theories, meaning and progress of social evaluation, and analyzed the pathways and probes in social evaluation and governance in the fields in question. On such basis, the paper proposed to explore and develop the social evaluation strategies and study framework for public hospitals in terms of healthcare management, aiming at building the social governance system and policies for public hospitals.     

医疗卫生领域基金会发展现状与困境——以北京市四家基金会为例

为吸引更多社会慈善资金流入医疗卫生领域,本文对北京市4家医疗基金会进行深入访谈,分析医疗基金会的发展现状与困境:(1)基金会运作主体劝募低效、信息公开质量差、机构间缺乏信息沟通、患者扶助不透明;(2)社会公众存在认知与行为偏差;(3)部分年检标准不适合医疗卫生领域。在分析以上问题及原因的基础上,建议基金会应提高透明度、增强募款能力、扭转公众捐赠偏向,相关政府部门应放宽医疗卫生领域基金会的年检标准,同时引导搭建具有医疗行业共性的信息化平台。     

基于健康需求演变的整合型医疗卫生服务体系优化

因我国医疗卫生领域不平衡、不充分的矛盾较为突出,健康服务供需不适配的困境亟待从体系设计上突破。构建整合型医疗卫生服务体系的分析框架,并基于现阶段居民健康需求在主体、内容、方式三个方面的全景式演变对现有体系的短板进行系统性回应。结合健康需求演变特征,提出体系优化策略:厘清服务链条,构建“点、线、面、体”相结合的内容整合路径;基于“主体-结构-功能”三重向度,打造横向多元主体治理模式;发挥治理要素驱动作用,加快服务方式纵深发展,为推进整合型医疗卫生服务体系优化提供内生动力与外在力量。     

医疗卫生领域安德森模型的发展、应用及启示

安德森模型自1968年创建以来,在倾向特征、促进资源和需要三个初始组成部分基础上,通过增加模型测量指标、调整结构、扩充路径关系、转变分析路径等方式历经5次修正和完善,实现了其作为理论模型的完整性及实证研究的可行性,最终获得了国际学术界的广泛认可。在欧美各国广泛应用于医疗卫生服务研究领域,作为分析影响个体就医选择、医疗花费、疾病筛查、药物使用等医疗卫生服务利用行为主要因素的理论模型。梳理并借鉴安德森模型的发展演变、国外应用研究进展,不但有助于我国医疗卫生服务领域的学术研究,亦对优化我国医疗卫生政策、国家卫生服务调查中问卷的指标设计具有现实指导意义。     

医院离退休干部参与社会治理现状

通过文献研究、问卷调查、专家访谈、现地调研等方法,分析医院离退休干部参与社会治理的现状及影响因素,探讨社区对离退休干部参与社会治理的需求,提出通过党建引领医院离退休干部参与社会治理的“1235”模式,并给出具体的操作路径,以期为推动医院离退休干部积极参与社会治理提供参考。     

公共卫生应急领域社会组织外部社会资本要素探讨

随着突发公共卫生事件频发，作为国家治理体系和能力的重要组成部分，如何强化公共卫生应急体系和能力建设已成为一个亟待解决的课题。社会组织作为协同治理的重要主体，其在我国公共卫生应急中的巨大优势尚未充分激活。文章从中观社会资本视角分析公共卫生应急领域社会组织外部社会资本要素，结合社会组织面临的实际困境探讨并提出促进其参与公共卫生应急的策略和建议。     

公立医院法人治理结构研究

建立具有中国特色的公立医院法人治理结构是现阶段我国医药卫生体制改革的目标之一。当前在医疗改革的背景下．要建立具有中国特色的公立医院法人治理结构,必须借鉴企业和国外医院管理的成功经验。通过对目前我国公立医院法人治理结构现状进行了分析,并就建立和完善这一体制作了有益的探讨。     

社会治理视角下和谐医患关系构建

社会治理模式是由政府、社会组织、社区能人、企事业单位等参与主体共同管理解决社会事务的多元化治理模式,强调参与主体多元性、合作性、和谐性,是新形势下重新构建和谐医患关系的最佳选择。从社会治理视角看,医患矛盾原因主要来自三方面。一是社会因素,包括卫生投入不足、医疗服务公平性下降、医疗纠纷处理机制不完善、媒体报道失实;二是医方因素,包括现代医学技术的限制、医疗卫生系统公益性淡化、医院管理模式滞后、医患沟通渠道不畅;三是患者因素,包括患者对健康的过高期望与医学常识相对缺乏的矛盾,及患者的维权意识、参与意识增强与法治意识淡漠之间的矛盾。要构建基于和谐医患关系的多元化社会治理模式,需要医方、患方、政府及社会共同参与,加强和完善维护群众权益机制,改善医患关系;医院要加强内涵建设,切实提高医院管理和服务水平;媒体要加强舆论引导;要建立多元化的医疗行为监管机制、医疗纠纷调解机制及医患权益保障机制。     

A proposed core model of the new public health for a healthier collectivity: how to sustain transdisciplinary and intersectoral partnerships

At present, there is no conceptual model by which public health could be represented as intersectoral governance collaborating with society and the state, and acting as a collective on the determinants of health. In this article, our interdisciplinary group, representing core competencies in public health, suggest two complementary conceptual models as frameworks for a diverse public concerned with public health and its core functions. The first conceptual ‘core model’ roots from the Ottawa Charter for Health Promotion. It represents the interrelationships of the three main poles united at the biopower level: the collectivity (entire population), the contemporary state and public health. In the second conceptual model, we present the various components in the meta-network of public health governance. We also present the roles of heterogeneous actors and how they can collaborate within a prominent process of capacity building and development of practice in public health. Thus, we emphasize the importance of intersectoral partnerships the contemporary state can make with public health without inducing any rupture with the social fabric. Our two complementary models can help actors from all sectors better understand the most frequent questions in public health governance (functions, roles, ingredients) and the challenges that intersectoral actors may very likely encounter in the implementation of these frameworks. The sustainability of well-balanced transdisciplinary and intersectoral partnerships contribute to a successful implementation of public health governance, and most importantly to a good health status for the collectivity.     

Healthy partnerships,healthy citizens? An international review of partnerships in health and social care and patient/user outcomes

As a result of changes in the governance of health and social care organizations across developed welfare states they are under increasing pressure to work in partnership with each other (at an organizational and inter-professional level) and with the private and voluntary sector. Drawing on a comparative literature review of the theoretical and empirical evidence from health and social care partnerships across developed welfare states, this paper aims to examine the policy drivers behind such changes and the effects the changes have had on the governance of health and social care, the results for service commissioners and practitioners, and particularly the results for patients and service users. It examines some of the evidence that suggests that patient/user involvement and outcomes may at best be unaffected, and at worst be negatively compromised by shifts towards increasing partnership working in health and social care. It will conclude by discussing what lessons can be drawn about service re-organization and user involvement in welfare organizations generally, and how best to protect the interests of vulnerable and disenfranchised groups of service users.     

‘Ingredients’ of a supportive web of caring relationships at the end of life: findings from a community research project in Austria

In accordance with the pluralisation of life plans in late modernity, the societal organisation of care at the end of life is diverse. Although the public discourse in western societies is dominated by questions about optimising specialised palliative care services, public health approaches, which take into account the social determinants and inequalities in end-of-life care, have gained in importance over the last decade. Conceptual aspects, dimensions of impact and benefit for the dying and their communities are well discussed in the public health end-of-life care research literature. Our research focuses on the preconditions of a supportive caring web in order to understand how communities can build on their social capital to deal with existential uncertainty. As part of a large-scale community research project, we carried out focus groups and interviews with community members. Through dispositive analysis, we generated a set of care-web ‘ingredients’, which constitute and foster a caring community. These ‘ingredients’ need to be cultivated through an ongoing process of co-creation. This requires: (i) a focus on relationships and social systems; (ii) the creation of reflective spaces; and (iii) the strengthening of social capital, and d) the addressing of inequalities in care.