运用服务质量差距分析模型提高医院医疗服务质量

医疗服务质量管理是医院管理的核心内容，提高医疗服务质量也正是医院管理年活动的主题。医疗服务质量是患者预期服务质量与实际感知服务质量之差，而服务质量管理的关键是进行服务质量差距的管理。服务质量差距分析模型是一种简单有效的工具，它分析导致提供服务失败最可能出现的5种差距，帮助医院管理者发现服务质量问题的根源，努力消除那些存在的差距，提高医院医疗服务质量。     

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。     

二级医院医患关系现状及对策研究

通过对某二级医院患者的问卷调查，总结了患者对医患关系、基本医疗服务现状以及医疗服务质量要素的看法，分析了患者的观念变化，感知医疗服务差距，从构建新型和谐的医患关系、强化政府职责、完善医疗卫生法律体系、提高医疗服务水平等四方面论述了改善医患关系的对策。     

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。     

公立医院门诊患者生活满意度影响因素研究

目的研究医疗服务满意度、患者医疗质量感知和患者信任对上海市门诊患者生活满意度的影响程度,为提高患者生活满意度提供参考。方法在文献研究基础上,通过问卷调查收集实证数据,运用有序Probit模型对影响因素进行分析。结果医疗服务满意度、患者医疗质量感知及患者信任对患者生活满意度的影响程度在不同级别公立医院有所差别。结论改进我国医疗卫生服务质量,增强患者医疗服务满意度和信任度能够提高患者生活满意度,对促进我国医疗卫生事业的发展具有十分重要的意义。     

远程医疗患者满意度影响因素的Meta分析

目的：系统评价影响远程医疗患者满意度的主要因素。方法：基于“结构-过程-结果”理论,对远程医疗患者满意度影响因素相关研究文献进行Meta分析。结果：纳入12项相关研究,共计4 981例样本;Meta分析结果显示,结构维度的感知系统质量和资费感知、过程维度的感知易用性和感知交互性、结果维度的感知服务质量、感知有用性和感知价值是影响远程医疗患者满意度的主要因素。结论：当前证据表明,远程医疗服务的结构、过程、结果质量均能影响患者满意度,建议采取措施提升远程医疗的结构、过程、结果质量,进一步提高患者对远程医疗的满意度。     

某三甲医院住院患者对医院服务质量的感知评价调查

目的：通过调查患者对医院服务质量期望与实际感知之间的差距,从患者感知角度,有针对性采取措施,提升医院服务质量。方法：设计SERVQUAL量表对某医院364名患者进行医院服务质量期望与感知情况问卷调查。结果：感知均值均显著低于期望均值,IPA分析显示,可靠性、有效性维度处于高期望高感知区域,经济性和响应性维度处于高期望低感知区域,有形性维度处于低期望高感知区域,人性化和信任感维度处于低期望低感知区域。结论：该医院住院患者感知到的服务质量较期望服务质量还有一定差距,可靠性和有形性方面需继续保持,经济性和响应性方面可以作为宣传点吸引患者;人性化和信任感方面应该作为发展医院特色的契机,有形性方面是医院在今后的工作中需要重点发展的内容。     

基于BYOD技术及SERVQUAL理论构建医疗服务质量评价体系

目的探索在基于BYOD信息化技术及SERVQUAL理论下设计最优医疗服务质量评价体系。方法基于SERVQUAL理论,以服务周期为轴,从患者感知体验的角度,对每项医疗服务进行量化;通过BYOD及移动医疗的方式,为患者和医疗团队之间搭建一个服务桥梁,将传统手工方式切换为以信息设备支撑的网络评价模式。结果借助BYOD技术及SERVQUAL理论,建立一套准确的服务质量评价系统,医护人员可以通过该系统与患者适时、有效地沟通;全方位对医院进行分析,持续改进医疗服务质量。结论结合BYOD信息化技术及SERVQUAL理论,可提高医疗服务质量及患者满意度;提升医护人员素质、更新服务理念和模式;优化医院管理,提升医疗服务信息化管理水平。     

运用差距模型提高医疗服务质量

目前,我国许多医院已经开始引入ISO9002等质量体系来努力提高医疗服务质量管理水平.但医疗服务的过程性、不可贮存性、无形性等特点决定了医疗服务质量管理的特殊性和复杂性,另外,临床诊疗的效果也与患者积极配合分不开,需要患者调整自己心理状态和改变生活习惯等努力,这些因素使医疗服务质量管理比其他服务行业更加复杂.本文探讨利用服务质量差距模型来提高医疗服务质量.     

基于服务质量差距模型的医疗纠纷原因及对策研究

目的：通过分析苏州某三甲医院近两年医疗纠纷案例中医患双方的相关信息,探究医疗纠纷的产生原因,基于服务质量差距模型提出可行性的建议。方法：收集2020年来苏州某三甲综合医院109例医疗纠纷卷宗,描述性统计分析纠纷成因。结果：普外科是医疗纠纷最多的科室,为19.8%。医疗纠纷有59.63%归咎于医方,35.78%是患方因素。医方因素主要包括缺少沟通、服务态度不佳、操作不合规范和手术不完善;患方因素包括对医疗行为的不理解、误解、对医疗结果的期望过高。结论：为弥合医疗服务过程中存在的认知差距、质量标准差距、服务传递差距、承诺差距和患者感知服务质量差距,建议加强医患沟通,正确认知管理患者期望;重视医疗安全,完善医疗服务质量标准;提高医方专业性,促进服务传递;注重关系营销,改善服务承诺;强化健康科普,提高患者信息素养。     

Patient involvement in a professional body: reflections and commentary

PURPOSE: The purpose of this paper is to consider the issues which emerge when an autonomous, professional, member-led organisation attempts to demonstrate its accountability to patients through lay involvement in its standard-setting processes. DESIGN/METHODOLOGY/APPROACH: The paper reports a project, which is still in progress and could be described as action research. Data were collected through participant observation in a series of discussions and working groups. A limited literature search was carried out at the start of the initiative but found little which relates to lay involvement in professional bodies. FINDINGS: The paper finds that patient involvement in a professional body is unlikely by itself to be a useful mechanism for delivering greater professional accountability. RESEARCH LIMITATIONS/IMPLICATIONS: The paper is a single case study and can only suggest hypotheses for further research. PRACTICAL IMPLICATIONS: The paper shows that professional bodies of various types are increasingly being asked to demonstrate public involvement in their decision making. It is important to identify the most effective mechanisms for this and the limitations inherent in the structures of organisations, which are accountable primarily to their members. ORIGINALITY/VALUE: The paper shows that individual doctors are held to account through a number of mechanisms, but little attention has been given to how medical professional bodies can be made more accountable for the collective power they hold. Patient involvement is interpreted within a consumerist model, which focuses on the doctor-patient relationship and ignores the considerable strategic influence which medical royal colleges exercise within the health service.     

Holding health providers in developing countries accountable to consumers: a synthesis of relevant scholarship

Health care providers in low-income countries often treat consumers poorly. Many providers do not consider it their responsibility to listen carefully to consumer preferences, to facilitate access to care, to offer detailed information, or to treat patients with respect. A lack of provider accountability to health consumers may have adverse effects on the quality of health care they provide, and ultimately on health outcomes. This paper synthesizes relevant research on health provision in low-, middle- and high-income countries with the aim of identifying factors that shape health provider accountability to consumers, and discerning promising interventions to enhance responsiveness. Drawing on this scholarship, we develop a framework that classifies factors into two categories: those concerning the health system and those that pertain to social influences. Among the health systems factors that may shape provider accountability are oversight mechanisms, revenue sources, and the nature of competition in the health sector-all influences that may lead providers to be accountable to entities other than consumers, such as governments and donors. Among the social factors we explore are consumer power, especially information levels, and provider beliefs surrounding accountability. Evidence on factors and interventions shaping health provider accountability is thin. For this reason, it is not possible to draw firm conclusions on what works to enhance accountability. This being said, research does suggest four mechanisms that may improve provider responsiveness: 1. Creating official community participation mechanisms in the context of health service decentralization; 2. Enhancing the quality of health information that consumers receive; 3. Establishing community groups that empower consumers to take action; 4. Including non-governmental organizations in efforts to expand access to care. This synthesis reviews evidence on these and other interventions, and points to future research needs to build knowledge on how to enhance health provider accountability to consumers.     

Variations in efficiency and the relationship to quality of care in the veterans health system

There is widespread belief that the US health care system could realize significant improvements in efficiency, savings, and patient outcomes if care were provided in a more integrated and accountable way. We examined efficiency and its relationship to quality of care for medical centers run by the Veterans Health Administration of the Department of Veterans Affairs (VA), a national, vertically integrated health care system that is accountable for a large patient population. After devising a statistical model to indicate efficiency, we found that VA medical centers were highly efficient. We also found only modest variation in the level of efficiency and cost across VA medical centers, and a positive correlation overall between greater efficiency and higher inpatient quality. These findings for VA medical centers suggest that efforts to drive integration and accountability in other parts of the US health care system might have important payoffs in reducing variations in cost without sacrificing quality. Policy makers should focus on what aspects of certain VA medical centers allow them to provide better care at lower costs and consider policies that incentivize other providers, both within and outside the VA, to adopt these practices.     

Improving professional competence--the way ahead?

Globally, there has been considerable interest from the public, medical profession, and governments in ensuring that doctors are fit for practice. Appropriate accountability for the profession has become an important contemporary issue. With doubts emerging on the effectiveness of professionally led regulation, a variety of different mechanisms have been devised to ensure that patients receive appropriate and good quality care. This paper reviews regulation of the medical profession and indicates the way in which doctors in the UK are held accountable for their practice.     

Service management: New Zealand's model of resource management

The health system in New Zealand, which in many respects is similar to that of the United Kingdom NHS, is currently undergoing massive change. In 1989 fourteen area health boards were formed, each board being accountable to the minister of health for achieving health goals and providing comprehensive health services for its defined population. This process has been assisted by the promulgation of a set of national health goals and a national health charter. Within area health boards the principle of general management is being implemented. Organisational structures are moving away from hospitals to services in a process which is being called service management which may be defined as the decentralisation of general management to the clinical workface. Similar in many respects to the resource management initiatives in the NHS it brings together medical, nursing and business management at the operational level with one person being accountable for the achievement of quality of care objectives within a budgetary framework. Budgetary restraints in excess of 10% have been achieved in the last 12 months partly through the service management process. Service management is seen to be a major paradigm shift in health services organisation and could be of international significance in its potential for achieving medical accountability for cost containment and quality assurance, and for coordinating care across agency and disciplinary boundaries.     

Fostering a Culture of Accountability Through a Performance Appraisal System

The current climate in Canadian healthcare requires that healthcare providers be more accountable to the government and other stakeholders. Using a well-structured performance appraisal system that is based on quantifiable objectives and standards, a high level of accountability can be achieved. The objective of this article is to demonstrate how a sound performance appraisal system can increase accountability and performance of healthcare organizations and their senior management.     

通过医保支付推进医疗质量管理的经验及启示

目的通过介绍典型国家及地区经验,阐述医保如何通过经济手段促进医疗服务质量提升,供我国大陆地区参考。方法采用文献分析法。采取主题词与分类号组合的检索方式,收集美国、英国及我国台湾地区有关医保与医疗服务质量的文献。结果美国实行基于价值支付的奖惩机制,包括医院服务价值购买计划、再入院扣费计划、医院获得性疾病扣费计划;英国实行提升基层医疗服务质量的激励机制;我国台湾地区实行结合医院评价体系的总额预付制。结论为促使我国大陆地区通过医保支付进一步推进医疗质量管理,建议建设卫生主管部门与医保部门有机融合的医疗质量考核系统,采用质量指标的多元计分方式,设计与质量联动的奖惩机制等。     

澳大利亚医疗服务质量管理的理念和做法

澳大利亚认为质量是组织绩效的组成部分，管理者对服务质量和安全应承担更大的责任。政府推行临床治理，加强改善质量和安全管理的研究机构，制定标准和评价指标。医院将质量和安全问题纳入机构日常和战略管理的计划并付诸实施。同时，政府和医疗机构重视病人和社区参与质量和安全管理。文章在探讨澳大利亚医疗服务质量理念、实践经验和质量评价指标的基础上，讨论澳大利亚经验对我国医疗服务管理的借鉴。     

The role of outputs and outcomes in purchaser accountability: reflecting on New Zealand experiences

Recent reforms in a number of countries' health systems have led to the separation of funder, purchaser and provider roles and the strengthening of funders' and purchasers' positions relative to providers. One of the aims of such reforms is to improve accountability. This paper reports on experiences in New Zealand where, in addition to improving the accountability of providers, purchaser accountability has also been a key policy issue. Attempts have been made in New Zealand to develop a funder-purchaser accountability framework based on a mix of outcomes, outputs and inputs. This paper discusses the roles that each might play in contracts and accountability relationships between funders and purchasers. The paper concludes that holding purchasers accountable for outcomes is likely to prove difficult and controversial, because of problems of attribution and because New Zealand funders in recent years have played an important role in determining the priority outputs and inputs which must be purchased. The paper suggests that accountability is more appropriate at the output and process level, in addition to holding purchasers accountable for the ways in which they make decisions and undertake contracting roles. Holding purchasers accountable for purchasing outputs and processes, however, requires greater commitment on the part of the funder to setting priorities more clearly; specifying the range and level of outputs to be purchased and the terms of access to those services; and funding services to this level. The international attention currently being paid to the development of practice guidelines and priority criteria also suggests that holding purchasers accountable for a form of inputs may become an increasingly common practice in future. From 1 July 1998, New Zealand will introduce a priority criteria system for determining access to elective surgery; accountability is thus becoming focused on inputs in the form of patient characteristics. This approach will greatly assist in promoting accountability.     

Doing accountability: a discourse analysis of research ethics committee letters

Research ethics committees (RECs) are charged with adjudicating the ethical status of research projects, and determining the conditions necessary for such projects to proceed. Both because of their position in the research process and because of the controversial nature of ethical judgements, RECs' views and decisions need to be accountable. In this paper we use techniques of discourse analysis to show how REC decision letters 'do' accountability. Using a sample of 260 letters from three datasets, we identify a range of discursive devices used in letters written by RECs. These include drawing attention to: the process behind the decision, including its collaborative nature; holding the applicants accountable, by implying that any decision made by the REC can be attributed to the performance of the applicants; referring to specialist expertise; and calling upon external authorities. These tactics 'do' accountability by showing that routines of ethical assessment have been enacted, by establishing the factuality of claims, and by managing questions of fault and blame attribution. They may, however, also risk undermining legitimacy by failing to acknowledge the inherent contestability of ethical decision making or the limited nature of the cultural authority accorded to RECs, and thus may appear as an illegitimate exercise of power.