医院文化建设面临的困境及对策

医院文化,严格地讲是一种系统的医院管理,在市场经济条件下,为了赢得市场竞争和社会认同的需要,迫使医院要通过构建共同的价值观念、理想、追求来加强对医务人员的管理,增强其素质;通过培养自己独特的思维方式和行为准则,用精湛的技术质量和优质服务来展示医院独特的个性,树立自己的形象,进而得到社会的承认,是一种全面提高人员素质和医院管理水平的探索与实践.随着卫生体制改革的逐步深化,医院面临的内外环境发生了一系列深刻的变化,医院发展遇到了前所未有的挑战,一些医院管理者对医院文化建设的态度冷漠和认知贫乏,文化建设实践中的庸俗与乏力,职工的价值观和信念取向朦胧而迷茫,这都给医院文化建设带来了新的矛盾与困惑.加快医院管理方式和经营理念的转型,引发医院文化从观念到内容的变革,已经成为医院文化建设急需解决的重大课题.     

关于医院文化建设的思考

本文从医院文化的概念、建设具有鲜明个性的医院文化、自觉加强医院文化建设几方面探讨了医院文化的内涵、特点及建设问题。     

试论医院医疗环境的营造

为探讨医院医疗环境在医院管理中的作用，本阐述了医院硬环境和软环境的内涵和表现。为医院医疗环境在医院管理中发挥作用提供经验。     

新形势下医院建设和发展的思考

目前 ,医院生存与发展面临着一些新情况、新问题 ,必须内强素质 ,外树形象 ,加强医院自身建设。在实际工作中要处理好环境与氛围、服务与宗旨、质量与医院生命、管理与医院制度、人才与医院发展后劲、改革与医院发展等关系。     

企业医院走向社会的实践--对港口医院从港务局分离的调查与思考

介绍了港口医院转为镇江市二院大港分院的运行情况。     

改进医院资产负债表的设想

医院资产负债表静态地反映了医院在某一特定日期全部资产负债和净资产的情况,它为研究医院的财务状况建立了基础框架.目前所使用的医院资产负债表能在很大程度上满足医院及其利益相关者对有关会计信息数量和质量的要求,但如果对该表作一些改进,将能获得更有用的信息.     

医院兼并的动机探讨

医院的兼并产权有偿转让为基本标志 ,是一种市场竞争中优胜劣汰的行为。从微观上讲 ,有利于优势医院迅速集中资产 ,实现资产一体化 ,达到最佳规模 ,表现为服务项目增加和服务范围的横向扩大和纵向延伸 ,从而有利于医院长远发展及在市场竞争中占据有利的位置。从宏观上讲 ,有利于实现卫生资源的优化配置 ,盘活存量。医院兼并将取消被兼并医院的法人资格 ,这种取消方式不是以被兼并医院破产为代价 ,故这种行为相比而言对社会产生的震荡是较小的。医院兼并并不是盲目地求大求全 ,主要是出于以下几个方面的动机 :一、医院发展动机在市场经济中 ,…     

当前军队医院的建设与管理

为探讨军事斗争准备任务繁重,医疗保险改革新形势下军队医院建设与管理,本阐述了（1）强化军事职能,带动医院发展;（2）调整建设思路,谋求医院发展,（3）坚持科技创新,巩固专科优势。（4）积极参与医改,改革中求发展。     

八、九十年代美国医院转变概况及借鉴

着重分析了80、90年代美国医院转变的形式、特征、驱动力及其他方面的一些信息，从中得出几点建议，作为我国今后医院转变及分类管理的借鉴。     

Comparing patient reports about hospital care across a Canadian-US border.

OBJECTIVE: To compare patient reports about hospital care between western New York State and southern Ontario using a random intercept model. METHOD: Cross-sectional survey of 3923 patients who received medical or surgical care between August and October 2004 at 28 hospitals (14 hospitals per jurisdiction). Thirty-five questions were combined to calculate eight indicators with scores ranging from 0 to 100 (best care experience). For each indicator, a model was built where the region (western New York vs. southern Ontario) was included as a fixed effect with hospital as random within region. A number of patient characteristics were also included as fixed effects. RESULTS: The effect of the region was statistically significant (P < 0.05) only for the models predicting the 'continuity and transition', 'involvement of family' and 'physical comfort' indicator scores. The differences were 10.66, 4.05 and -3.23 points, respectively. In all three models, the random intercepts were not statistically significant, indicating that the differences above did not vary by hospitals. The model predicting 'overall impression' scores, however, showed a random intercept statistically significant (P = 0.026). The individual-level explained proportion of variance ranged from 5.68 to 11.22%, and the hospital-within-region-level explained proportion of variance ranged from 2.19 to 52.28%. CONCLUSION: The difference observed on the 'continuity and transition' indicator might be the only one somewhat meaningful, and might be explained by health maintenance organization reimbursements' mechanisms and hospital quality improvement initiatives available in western New York, as well as by the fact that occupancy rates in western New York border the 60% compared with the 95% in southern Ontario.     

Cost inefficiency and hospital health outcomes

This study explores the association between cost inefficiency and health outcomes in a national sample of acute-care hospitals in the US over the period 1999-2001, with health outcomes being measured by both mortality and complications rates. The empirical analysis examines health outcomes as a function of cost inefficiency and other determinants of outcomes, using stochastic frontier analysis to obtain hospital cost inefficiency scores. The results showed no systematic pattern of association between cost inefficiency and hospital health outcomes; the basic results were unchanged regardless of whether cost inefficiency was measured with or without using instrumental variables. The analysis also indicated, however, that the association between cost inefficiency and health outcomes may vary substantially across geographical regions. The study highlights the importance of distinguishing between 'good' costs that reflect the efficient use of resources and 'bad' costs that stem from waste and other forms of inefficiency. In particular, the study's results suggest that hospital programs focused on reducing cost inefficiency are unlikely to be associated with worsened hospital-level mortality or complications rates, while, on the other hand, across-the-board reductions in cost could well have adverse consequences on health outcomes by reducing efficient as well as inefficient costs.     

Comparison of health care professionals' and surveyors' opinions on problems and obstacles in implementing quality management system in Thailand: A national survey.

OBJECTIVE: To explore problems and obstacles of hospitals in Thailand implementing quality management systems according to the hospital accreditation (HA) standards. DESIGN: Questionnaire survey. SETTING: Thirty-nine hospitals in all 13 regions of Thailand. PARTICIPANTS: A total of 728 health care professionals and 41 surveyors of the national accreditation program. MAIN OUTCOME MEASURES: Health care professionals' and surveyors' opinions on problems and obstacles in 24 items representing Thailand HA standards. RESULTS: The response rates were 94.9 and 73.2% in health care professionals and surveyors, respectively. More than 90% of both groups thought that there had been problems in the items such as 'quality improvement (QI) activities' and 'integration and utilization of information'. The items considered by health care professionals as major obstacles included 'adequacy of staff' (34.6%) and 'integration and utilization of information' (26.6%), for example. For surveyors, 'integration and utilization of information' was ranked highest as presenting a major obstacle (43.9%), followed by 'discharge and referral process' (31.7%) and 'medical recording process' (29.3%). The rank orders for the 24 items as problems and major obstacles were similar in both groups (Spearman's rank correlation 0.436, P = 0.033 and 0.583, P = 0.003, respectively). Surveyors had a higher degree of concern and paid more attention to care-related items than health care professionals. CONCLUSIONS: Health care professionals have been facing many problems with multidisciplinary process-related issues of the accreditation standard, whereas surveyors might have had some difficulties in conveying the core QI concepts to them. The findings might be explained by the effects of health care reform on the underlying accreditation principles. One of the strategies to respond to the situation was presented.     

Reporting comparative results from hospital patient surveys.

Externally-reported assessments of hospital quality are in increasing demand, as consumers, purchasers, providers, and public policy makers express growing interest in public disclosure of performance information. This article presents an analysis of a groundbreaking program in Massachusetts to measure and disseminate comparative quality information about patients' hospital experiences. The article emphasizes the reporting structure that was developed to address the project's dual goals of improving the quality of care delivered statewide while also advancing public accountability. Numerous trade-offs were encountered in developing reports that would satisfy a range of purchaser and provider constituencies. The final result was a reporting framework that emphasized preserving detail to ensure visibility for each participating hospital's strengths as well as its priority improvement areas. By avoiding oversimplification of the results, the measurement project helped to support a broad range of successful improvement activity statewide.     

Doctor and nurse perception of inter-professional co-operation in hospitals.

OBJECTIVE: To explore doctor and nurse perception of inter-professional co-operation in hospitals; discuss professional differences as reflections of cultural diversity in the perspective of quality improvement. DESIGN: Cross-sectional survey data from a stratified sample of 15 Norwegian hospitals, September 1998: 551 doctors and 2050 nurses at medical and surgical wards. Measures. Doctor and nurse evaluation of their inter-professional co-operation was mapped. Logistic regression models predicting their satisfaction were compared. RESULTS: Doctors were significantly more often than nurses satisfied with the inter-professional co-operation of the two groups. Satisfaction with inter-professional co-operation was predicted by a number of work situation variables. Some of them contribute differently to doctor and nurse satisfaction. CONCLUSIONS: Doctors and nurses not only evaluate their inter-professional co-operation differently, they also appear to define the concept in different ways. Hospital managers should include an understanding of this cultural diversity into the basis of their quality improvement efforts.     

A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States.

OBJECTIVE: Two recent Institute of Medicine reports highlight that the quality of healthcare in the US is less than what should be expected from the world's most extensive and expensive healthcare system. This may be especially true for critical access hospitals since these smaller rural-based hospitals often have fewer resources and less funding than larger urban hospitals. The purpose of this paper was to compare quality of hospital care provided in urban acute care hospitals to that provided in rural critical access hospitals. DESIGN: Cross-sectional study analyzing secondary Hospital Compare data. T-test statistics were computed on weighted data to ascertain if differences were statistically significant (P=0.01). SETTING: Centers for Medicare and Medicaid Services hospitals. PARTICIPANTS: US Acute Care and Critical Access hospitals. MAIN OUTCOME MEASURES: Differences between urban acute care hospitals and rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure and pneumonia. RESULTS: For 8 of the 12 hospital quality indicators the differences between urban acute care and rural critical access hospitals were statistically significant (P=0.01). In seven instances these differences favored urban hospitals. One indicator related to pneumonia favored rural hospitals CONCLUSIONS: Although this study focused on only three disease states, these are among the most common clinical conditions encountered in inpatient settings. The findings suggested that there may be differences in quality in rural critical access hospitals and urban acute care hospitals and support the need for future studies addressing disparities between urban acute care and rural critical access hospitals.     

医院等级评审与信息化建设

医院等级评审对信息化建设提出了更精细的要求,我院在评审的准备过程中,通过学习和领悟评审标准,结合我院信息化建设工作的实情,明确了医院信息化建设面对的挑战,并初步提出了改进信息系统的设计方法和思路。     

美国非营利和营利医院的定价策略

主要介绍了美国非营利性营利性医院的定价策略，并用经济学模型定性模拟了非竞争和竞争环境下各类医院的价格制定。     

公立医院院长职业化的现状与思考——以九江、株洲和武汉为例

目的以九江、株洲和武汉三市为例,分析我国公立医院院长职业化现状和问题。方莹定量和定性相结合,问卷调查44家医院160名院长,访谈10位卫生管理知情人,对院长的教育和专业情况、选拔方式和专职情况进行描述性分析。结果院长学历较高但以学医为主：绝大多数存在一肩多挑的现象,专职程度较差;半数以上院长由上级委派．公开招聘虽被看好但难以实施。结论我国公立医院院长职业化程度较低,应从卫生管理教育、选拔任用、绩效考核与和薪酬分配等方面加快改革。