卓越绩效模式在我院的实践应用

笔者介绍了某三甲医院对医院的SWOT分析选择医院管理模式、对医疗服务过程管理的改进及以社会效益为特点的经营结果,总结了实践卓越绩效模式的体会,并比较了卓越绩效模式与ISO9000及JCI的区别,分析了我国医疗卫生领域实行卓越绩效模式管理的意义。     

卓越绩效模式在我国医院管理中的应用现状

为了解卓越绩效模式在国内医院管理中的应用现状,为后续研究和实践提供参考,本研究检索中国知网和万方数据库相关文献并进行分析,发现34篇文献发表于《中国医院》等18种期刊。其中,以2018年发表论文最多,达到9篇。研究最多的主题是过程管理,其次是绩效、战略和资源。综合分析文献,本研究认为卓越绩效模式在国内医院中应用的研究处于刚刚起步阶段,过程管理是当前的研究热点,高产作者尚未突出显现,需加强国外研究成果的借鉴。     

基于卓越绩效模式下的医院过程管理探析简

卓越绩效模式是现代全面质量管理（TQM）的实施框架和评价准则,它适用于追求卓越的各类组织。针对我国医院导入卓越绩效模式时所遇到的过程管理方面的问题,通过对GB/T19580-2012《卓越绩效评价准则》中“过程管理”类条款的阐释和举例,具体论述了医院导入卓越绩效模式时过程管理各个阶段的应对策略,以帮助医院深入理解过程管理的条款要求。     

卓越绩效模式在公立中医院绩效考核中的应用

绩效考核是推动医院高质量健康发展的助推器,如何通过绩效考核,实现城区老牌中医院的振兴发展是管理者需要思考的重要课题。本文阐述了北京中医药大学附属护国寺中医医院作为三甲中医专科医院把卓越绩效管理模式导入医院绩效管理,将卓越绩效模式与平衡记分卡融合运用,构建基于医院发展战略的绩效考核体系,实施系统的绩效管理策略,提升医疗质量和管理成效的实践。分析卓越绩效模式在医院实践应用中的有效性,并提出相应建议,以期为提升公立中医院的科学管理水平提供参考。     

卓越绩效模式在提升医院护理管理品质中的应用研究

目的分析、总结卓越绩效模式与平衡积分卡在护理管理中的融合应用。方法护理部门通过应用平衡积分卡围绕财务、顾客、内部流程、学习与成长四个层面将部门发展与医院战略相结合,并将战略指标落实为可操作的衡量指标和目标值,保证战略的有效执行。结果卓越绩效是个开放的管理模式,采用卓越绩效模式进行护理管理后,护理队伍管理理念发生变化,一方面护理质量、患者满意度等得到了大幅提升,另一方面员工的效益得到了提升,充分调动了工作积极性。实施后患者满意度第三方测评提升了5.2%,投诉率下降了23.1%,优质护理服务质量提升了2.3%,护理人员流失率下降33.3%。结论卓越绩效的导入和全面实施能够提升医院护理管理品质。     

探索适宜医疗卫生行业的EAP模式

医疗卫生行业因其工作性质所致,非常需要高效实用的压力管理手段来提高员工的身心健康水平和工作绩效。EAP即员工援助计划,作为现代组织压力管理的有效工具,在卫生行业的应用研究还鲜有报道。通过实证研究,找到一种适合于医疗卫生行业的EAP服务模式,对实现员工和组织双赢的目的大有益处。     

以病人为中心 以医疗质量为基础的医院综合绩效考评体系研究

绩效（Performance）是指组织及员工完成工作目标的程度和效果,绩效管理（Performance Management）最早由美国管理学家于20世纪70年代提出,其完善的框架、科学的业务流程和持续改进的良性循环体系深受企业界喜爱。在世界500强企业中被广泛应用,90年代传入中国,近年绩效管理开始在国内医疗卫生行业尝试。     

科研绩效考核体系的建立与应用

绩效考核是实现最优组织绩效全过程中的一个重要环节.科研绩效考核体系的建立与应用,能够更好地调动科研人员的积极性,有效改进科研质量,有利于科研工作的长远发展.朝阳医院结合本单位实际情况创建了一套绩效考核体系,经过实施取得了初步成效,并总结不足.采用SMART原则分析评价其指标的科学合理性.对国内医疗卫生领域的绩效管理模式进行了有益的探索.     

基于卓越绩效教育准则的我国医学研究生教育质量管理体系探讨

源于美国企业界的卓越绩效教育准则,是提高质量管理的理论与方法。该理论已经被世界各国的许多行业所接受,也同样被用于高等教育行业的质量管理,称之为卓越绩效教育准则。本文针对医学研究生教育的特点,结合卓越绩效教育准则（ education criteria for performance ex-cellence,ECPE）的理论,构建了医学研究生教育质量管理体系,并就完善ECPE模式下医学研究生教育质量管理体系提出了几点思考。     

乡镇卫生院的绩效管理探析

<正>绩效管理是乡镇卫生院发展过程中遇到的一个十分重要的课题。绩效管理水平的提升,不仅能促进乡镇卫生院的建设发展,还能调动乡镇卫生院工作人员的工作积极性,提高服务质量,提升乡镇卫生院的核心竞争力和综合实力。1乡镇卫生院绩效管理模式目前国内医疗卫生机构绩效管理的主要模式主要有以下四种:第一种:奖金福利型:奖金福利型绩效管理模式,简单说,就是在基本工资的基础上增加奖金和福利来体现对绩效的奖罚的绩效管理模式。这种管理模式较为传统,但是管理效果一般,难以在奖金和福利上体现个人在工作中的差异。第二种:承包责任制:这是一种仿效包产到户的土地承包责任制的绩效管理模式。     

An Application of Business Process Method to the Clinical Efficiency of Hospital

The concept of Total Quality Management (TQM) has come to be applied in healthcare over the last few years. The process management category in the Baldrige Health Care Criteria for Performance Excellence model is designed to evaluate the quality of medical services. However, a systematic approach for implementation support is necessary to achieve excellence in the healthcare business process. The Architecture of Integrated Information Systems (ARIS) is a business process architecture developed by IDS Scheer AG and has been applied in a variety of industrial application. It starts with a business strategy to identify the core and support processes, and encompasses the whole life-cycle range, from business process design to information system deployment, which is compatible with the concept of healthcare performance excellence criteria. In this research, we apply the basic ARIS framework to optimize the clinical processes of an emergency department in a mid-size hospital with 300 clinical beds while considering the characteristics of the healthcare organization. Implementation of the case is described, and 16 months of clinical data are then collected, which are used to study the performance and feasibility of the method. The experience gleaned in this case study can be used a reference for mid-size hospitals with similar business models.     

Disparities in Health Information Quality Across the Rural–Urban Continuum: Where is Coded Data More Reliable?

The growing application of evidence-based medicine practices across US healthcare has created greater dependence on information resources, especially related to quality and consistency of data. The manipulation of data through coding and classification of patient information presents a critical process where the quality of information, as well as perceived quality of care, could potentially suffer. Where recent regulatory standards, such as HIPAA, create additional requirements for consistency in coding of health information, it becomes apparent that meaningful health outcomes assessment is, in part, an indicator of data quality as well as clinical quality. In a national survey of 16,000+ accredited health information managers we found most respondents reported that significant coding errors existed in 5% or less of the records in their institutions. Within specific organizations, however, coding errors existed in six to ten percent of their records, and at times exceeded 20%. Regional variation in reported coding error and inconsistency ranged widely, occurring across organizations as well as population concentrations. Metropolitan-based organizations tended to have somewhat worse reported overall coding accuracy, compared to suburban and rural areas. At a national level there will need to be some degree of coding and classification uniformity across population areas, if healthcare professionals are expected to rely on comparative evidence benchmarks to fully assess medical outcomes data. Related impacts on comparative cost and clinical performance assessment are discussed.     

A Theory for Classification of Health Care Organizations in the New Economy

Most of the available studies into information technology (IT) have been limited to investigating specific issues, such as how IT can support decision makers distributing the information throughout health care organization, or how technology impacts organizational performance. In this study, for use in the planning of information system development projects, a theoretical model for the classification of health care organizations is proposed. We try to reflect the development in the contemporary digital economy by theoretically classifying health care organizations into three types, namely traditional, developing, and flexible. We describe traditional health care organizations as organizations with a centralized system for management and control. In developing health care organizations, IT is spread over the horizontal dimension and is used for coordinating the different parties throughout the organization. Finally, flexible health care organizations are those which work actively with the design of new health care organizational structure while they are designing the information system.     

老年综合评估的临床应用进展

由于老年患者特殊的病理、生理特点,其医疗照护一直是社会和医务界关注的重点。大多数老年患者存在躯体功能、心理、社会等多方面的医疗需求,全面了解老年患者的健康状况是满足其医疗照护需求、为其提供最佳诊疗方案的关键。老年综合评估（CGA）是近年来在国内外广泛应用的从医疗、躯体功能、认知心理及社会、环境因素等多角度检测评估老年人健康功能水平的一种诊疗方式,既包含对老年患者的整体评估又包括相应的针对性干预措施,倡导多学科合作,充分体现整体健康功能的现代医学理念。CGA在临床上的早期应用和干预,在一定程度上能够延缓老年人机体功能衰退、缩短住院时间、降低入院率及病死率,为老年人的健康管理和医疗照护提供重要参考信息。本文对CGA的临床应用进展进行综述,总结了CGA在不同诊疗场所及疾病中的评估内容、应用方法、适用范围及使用限制,以协助医务人员在临床中应用CGA。     

Establishing health care performance standards in an era of consumerism

As the US health care system begins to reengineer itself to address the need for quality improvement, it also is being actively reshaped by the expectations of consumers. The confluence of these forces requires a new approach to setting health care performance standards. The National Quality Forum (NQF) has been established as a private, not-for-profit, open membership, public benefit corporation for the purposes of developing consensus about standardized health care performance measures, reporting mechanisms, and a national strategy for health care quality improvement. The NQF has broad representation from all segments of the health care industry and provides an equitable way of addressing the disparate priorities of health care's many stakeholders. Agreement and implementation of standardized health care performance measures and achievement of quality improvement in the emerging era of consumerism will be facilitated by (1) establishing national goals for health care quality; (2) embracing public policy that recognizes the complementary roles of quality improvement, cost control, and improved access; (3) giving greater priority to measuring and reporting the performance of those aspects of the health care system that directly affect consumers; (4) focusing on creating a health care culture of excellence; and (5) promoting the active collaboration of all stakeholders.     

发展城市社区卫生服务体系与改善卫生公平

公平是和谐社会的主要特征之一,也是医疗卫生领域分配的基本原则。中国的卫生公平排在世界倒数第四位,这是导致老百姓看病难、看病贵问题凸现的主要原因。卫生分配和利用的不公平导致基层卫生服务萎缩,城市社区卫生机构不能为城市居民提供优质高效的基本医疗服务和预防保健服务,加之国家医药保障机制不健全,政府责任不到位,使得供需矛盾日益加剧,居民对卫生服务可及性的差距拉大。发展社区卫生服务有利于优化卫生资源配置,提高居民对卫生服务的可及性,促进人人享有卫生保健权利的实现。根据目前我国大部分城市社区卫生服务运行不良的现状,认为社区卫生服务必须围绕科学发展、机制保障、构建整体、以人为本、关注弱势的核心,才能有效改善公平,使群众分享经济社会文明进步的卫生资源成果。     

Benchmarking Electronic Medical Records Initiatives in the US: a Conceptual Model

This article provides a conceptual model for benchmarking the use of clinical information systems within healthcare organizations. Additionally, it addresses the benefits of clinical information systems which include the reduction of errors, improvement in clinical decision-making and real time access to patient information. The literature suggests that clinical information systems provide financial benefits due to cost-savings from improved efficiency and reduction of errors. As a result, healthcare organizations should adopt such clinical information systems to improve quality of care and stay competitive in the marketplace. Our research clearly documents the increased adoption of electronic medical records in U.S. hospitals from 2005 to 2007. This is important because the electronic medical record provides an opportunity for integration of patient information and improvements in efficiency and quality of care across a wide range of patient populations. This was supported by recent federal initiatives such as the establishment of the Office of the National Coordinator of Health Information Technology (ONCHIT) to create an interoperable health information infrastructure. Potential barriers to the implementation of health information technology include cost, a lack of financial incentives for providers, and a need for interoperable systems. As a result, future government involvement and leadership may serve to accelerate widespread adoption of interoperable clinical information systems.     

以家庭医生为核心的社区卫生服务模式的构建与成效分析

在上海市新一轮社区综合改革背景下,马陆镇社区卫生服务中心通过竞聘重组家庭医生团队,建立家庭医生工作形式,明确家庭医生团队服务内容,开展家庭医生工作室建设,建立家庭医生团队为核心的内部管理机制等举措,构建以家庭医生为核心的社区卫生服务模式。从运行效果来看,模式构建后,常住人口及慢性病患者人群签约率、社区就诊率上升,基本医疗质量指标、基本公共卫生服务质量指标明显改善,社会评价指标、全科医生人力资源指标有所改善,科研能力有所提升。以家庭医生为核心的社区卫生服务模式的构建,对充分发挥家庭医生健康与费用“守门人”作用,建立有序就医格局,促进居民健康具有重要意义。     

基于卓越绩效管理模式下共用护理单元绩效分配方案的应用

目的 探讨基于卓越绩效管理模式下共用护理单元绩效分配方案的应用价值.方法 选择深圳市坪山区人民医院2014年3月至2017年3月神经外科、呼吸内科、消化内科共用护理单元护理人员23人,实施卓越绩效管理模式下绩效分配方案,比较实施前后护理人员满意度、患者满意度、护理人员流失率和护理人员出勤率.结果 实施后护理人员对工作强度与压力、个人与专业发展机会、工作能力被认可、与上级沟通、与同事关系及工作氛围、工作待遇与同工同酬方面满意率分别为91.3%、87.0%、95.7%、87.0%、91.3%、87.0%,明显高于实施前的43.5%、47.8%、52.2%、43.5%、56.5%、52.2%,差异均具有统计学意义(P<0.05);患者对护理服务态度满意率、对护理技术水平满意率、对健康知识的知晓率、对健康教育宣教满意率、对解决问题的满意率实施后分别为87.0%、95.0%、91.0%、95.0%、91.0%,均明显高于实施前的62.0%、68.0%、67.0%、63.0%、68.0%,差异均具有统计学意义(P<0.05);实施前护理人员流失率为17.4%,明显高于实施后的0,差异具有统计学意义(P<0.05);实施前护理人员日常出勤率为60.9%,明显低于实施后的100.0%,差异具有统计学意义(P<0.05).结论 卓越绩效管理模式下共用护理单元跨科收治患者,可有效整合医院床位资源,避免资源浪费,建立适合的共用护理单元绩效考核标准,可有效提高护理工作人员满意度,提高出勤率,避免人才流失.