主动适应当地医疗市场 逐步增强医院竞争能力

1 抓住机遇,恒心发展,增强实力 我院在十几年的改革中由于受整编的影响,一直在动荡不安中艰难地生存,发展非常缓慢,曾失掉过三次发展机遇。直到1993年军区医院工作会议之后,我们才抓住了发展机遇。针对医院的“先天不足”,经过认真思考和反复论证,首先提出了医院建设分“三步走”和“四个一”的奋斗目标。第一年打基础,以引进设备为龙头,带动专科技术发展;第二年上台阶,以营区改造为突破口,改善工休环境;第三年“硬件”、“软件”同步发展。这使医院的整体功能具有一支过硬的技术队伍,有一套先进的医疗设备,有一批较高水平的科技成     

关于认真实践"三个代表"推进医院快速发展的思考

江总书记“三个代表”思想是建党、建国经验的集萃 ,也是卫生事业、医院发展的动力、源泉、根本。认真实践“三个代表”是推进医院快速发展的必由之路 ,必须扎实做好四方面工作 :一是按照“三个代表”要求加强医院党、政领导班子建设 ;二是加大思想解放力度 ,强化经济管理增强经济实力 ;三是加大科技兴院力度 ,增强技术竞争力 ;四是加大医院文化建设力度 ,不断提高优质服务水平。领导班子过硬 ,决策正确 ;经济宽裕 ,能抗风浪 ;人才汇集 ,占领科技高地 ;服务一流 ,尽善尽美 ,医院发展必定提速     

求实开拓铸辉煌——解放军371医院领导班子强院兴医记事

解放军371医院创建于1947年,现位于河南省新乡市中心,是济南军区所属的一所集预防、医疗、教学、科研于一体的综合性驻军医院和河南医科大学的教学医院。展开床位500余张,设备总价值由1992年初的360万元增加到目前的2200余万元,综合实力明显增强,已跻身于军内外同级医院先进之列,连续两年被济南军区表彰为“优质服务先进单位”,并被河南省命名为“文明医院”。     

以“新优廉”促医院发展

以“新优廉”促医院发展翟三江，李连荣，王增林，杜恩起近年来，我院从一个技术、设备均较落后的医院一跃成为具有较高水平和较强实力的以治疗肿瘤为重点的省级综合性教学医院，其主要原因是我院在改革中坚持求“新”、求“优”、求“廉”的经营思想，抓住机遇，力求医院...     

实行产权制度改革 创建股份合作制医院

实行产权制度改革创建股份合作制医院成都第一骨科医院（６１００３１）曾志勤我院在上级的领导下，坚持以建设有中国特色的社会主义理论和党的基本路线为指导，以“抓住机遇、深化改革、扩大开放、促进发展”为契机，为使医院能在社会主义市场经济的大环境下增强生存和发...     

试论科主任在创建“无红包医院”活动中的作用

在创建“无红包医院”工作中科主任应发挥五个作用:激励作用、教育作用、协调作用、引导作用、评价作用.应注意三点:一是要提高科主任对创建“无红包医院”的认识,增强其主动性、调动其积极性;二是要抓好科主任的作风养成,强化其自律意识,使科主任真正成为廉洁行医、拒收“红包”的示范群体;三是要建立评估体系,做好考评工作,强化对科主任的责任评估,系统构建创建“无红包医院”的工作机制.     

适应市场经济 促进医院发展

广东省兴宁市人民医院地处粤东山区,是一所拥有518张病床,800余名职工的综合医院,是全市的医疗、预防、保健、康复、教学和科研中心。在市场经济大潮中,我院始终以邓小平理论和党的十五大精神为指针,认清形势,把握方向,深化改革,主动适应市场经济的挑战和考验,通过几年的努力拼搏,增强了医院的综合实力,拓宽了服务范围,提高了医疗服务水平和市场竞争能力,有力地促进了医院的发展。1994年以来,先后被广东省卫生厅评为“二级甲等医院”、“爱婴医院”和“百家文明医院”,并连续3次被广东省委、省政府授予“文明单位”称号,被梅州市委、市政府、兴宁市委、市政府授予“文明单位”,“文明医院”称号。我们的主要做法是:     

实施全程医疗质量管理强化质量监控机制

绍兴市第二医院地处全国历史文化名城的绍兴市区,在世纪之交,医院迎来了90周岁华诞。医院现已成为浙东地区一所医疗设施齐全、管理有方、技术力量雄厚的三级乙类医院。医院设正式病床542张,工作人员766人,年门诊量近50万人次,全年出院病人1.3万余人次,拥有各类资产1.9亿元。在旧貌换新颜的基础上,医院如何更上一层楼,院领导提出了“三个全面”的工作思路:即全面规划医院建设布局;全面实施医疗质量管理;全面进行科室成本核算。在近三年内医院凭借实力再投资1.3亿元,一座更大规模、新颖的智能现代化医院将矗立在市区繁华地段。 现将我院实施全程医疗质量管理方面的     

全面落实科学发展观 历实医院内涵基础——成都军区昆明总医院全面建设剪影

成都军区昆明总医院创建于战争年代，建院58年来，经过几代人的努力，医院由小到大，逐渐发展成为在西南战区综合实力较强的一所大型综合性军队医院。医院展开床位1900张，下辖两个医疗区（原57医院、69医院），总占地约33万余平方米，呈“一院三片”格局。医院投资近亿元、建筑面积2．6万余平方米的新门诊大楼于去年10月落成使用，规划面积6．5万平方米的新住院大楼也已于今年6月动工兴建。     

联合办医中护理管理模式接轨的实践与探讨

目的：通过联合办医使两所不同等级医院的护理人员能适应联合办医的护理管理模式的接轨．使“三基”理论知识操作技能等方面都得到全面提高．确保病人在就医期间享受到高品质的护理服务。方法：通过开展“三基”知识的培训、考核。改革用人制度及奖金分配制度．实行行政、业务统一管理方式。结果：护理人员的专业水平、整体素质及护理质量均明显提高，满足病人对护理工作的不断需求。结论：联合办医中新型的护理管理模式的有效接轨及队伍的及时重组和建设，增强了实力，使医院获得社会、经济效益双丰收。     

以人为本促进员工健康成长

"以人为本"是做好新时期医院员工管理工作的重要指导思想。目前医院对员工的管理存在约束多于关怀、忽略了员工职业生涯规划、外环境增加医务人员工作压力等。文章通过分析问题的原因,提出了"以人为本"改进医院员工管理的建议。     

Rubella serosurveys at three Aravind Eye Hospitals in Tamil Nadu, India

OBJECTIVE: To determine the susceptibility of female eye hospital staff to rubella infection and the potential risk for hospital-based rubella outbreaks. METHODS: A prospective cohort study on the seroprevalence of rubella IgG antibodies was conducted at three large eye hospitals in Coimbatore, Madurai and Tirunelveli, Tamil Nadu, India, where young children with eye abnormalities attributable to congenital rubella are treated. A total of 1000 female hospital employees aged 18-40 years agreed to participate and gave written informed consent. FINDINGS: The proportions of rubella-seronegative women were: 11.7% at Coimbatore, with a 95% confidence interval (CI) of 8.1-16.5; 15% at Madurai (95% CI = 12.3-18.1), and 20.8 at Tirunelveli (95% CI = 14.7-28.6). For the entire cohort the proportion seronegative was significantly higher among married women (21.5%) than among single women (14.0%) (P = 0.02). Rates of seronegativity were highest among physicians and lowest among housekeepers. All 150 seronegative women in the study sample accepted a dose of rubella vaccine. CONCLUSION: These are the first rubella serosurveys to have been reported from eye hospitals in any country. The relatively high rate of susceptibility indicated a risk of a rubella outbreak, and this was reduced by vaccinating all seronegative women. A policy has been established at all three hospitals for the provision of rubella vaccine to new employees. Other hospitals, especially eye hospitals and hospitals in countries without routine rubella immunization, should consider the rubella susceptibility of staff and the risk of hospital-based rubella outbreaks.     

医院工作场所暴力的流行病学特征及危险因素分析

目的 探讨医院工作场所暴力的流行病学特征及危险因素。方法 抽样调查医院工作人员工作场所暴力发生情况,根据2002年5月10日世界卫生组织在题为《新的研究表明工作场所暴力威胁卫生服务》的公报中关于工作场所暴力的定义,采用频数分析和logistic回归等统计学方法对资料进行处理。结果 调查的4062名医院工作人员中1年内有2619人遭受过工作场所暴力,暴力的发生率为64.48％,其中心理暴力为49.12％,身体暴力为15.36％。男性更容易遭受多次暴力,且更容易遭受身体暴力;30～39岁年龄组医院工作人员是工作场所暴力的主要受害者,医生、护士。(含助理护士)是工作场所暴力的高危职业人群;白班是发生工作场所暴力事件的高峰时问,病房是多发地点。患者(或探视者)的要求未能得到满足、患者自认病情无好转和诊疗费用太高是工作场所暴力发生的主要危险因素。患者亲属和患者本人是主要的肇事者。结论 医院工作场所暴力问题严重,实施以医院为主导和改善医患关系的综合干预措施,尽量减少和避免工作场所暴力发生。     

Violence against physicians and nurses in a hospital: How does it happen? A mixed-methods study

Background

Violence against medical personnel is unexpected in hospitals which are devoted to healing, and yet, it is frequent and of concern in the health system. Little is known about the factors that lead to hospital violence, and even less is known about the interactions among these factors.The aim of the study was to identify and describe the perceptions of staff and patients regarding the factors that lead to violence on the part of patients and those accompanying them.

Methods

A mixed-methods study in a large, general, university tertiary hospital. A self-administered survey yielding 678 completed questionnaires, comprising 34% nurses and 66% physicians (93% response rate). Eighteen in-depth interviews were conducted separately with both victims and perpetrators of violent episodes, and four focus-groups (N = 20) were undertaken separately with physicians, staff nurses, head-nurses, and security personnel.

Results

Violence erupts as a result of interacting factors encompassing staff behavior, patient behavior, hospital setting, professional roles, and waiting times. Patients and staff reported similar perceptions and emotions regarding the episodes of violence in which they were involved. Of 4,047 statements elicited in the staff survey regarding the eruption of violence, 39% referred to staff behavior; 26 % to patient/visitor behavior; 17% to organizational conditions, and 10% to waiting times. In addition, 35% of the staff respondents reported that their own behavior contributed to the creation of the most severe violent episode in which they were involved, and 48% stated that staff behavior contributed to violent episodes. Half of the reasons stated by physicians and nurses for violence eruption were related to patient dissatisfaction with the quality of service, the degree of staff professionalism, or an unacceptable comment of a staff member. In addition, data from the focus groups pointed to lack of understanding of the hospital system on the part of patients, together with poor communication between patients and providers and expectations gaps.

Conclusions

Our various and triangulated data sources show that staff and patients share conditions of overload, pressure, fatigue, and frustration. Staff also expressed lack of coping tools to prevent violence. Self-conscious awareness regarding potential interacting factors can be used to develop interventions aimed at prevention of and better coping with hospital violence for both health systems' users and providers.

     

Tuberculosis treatment outcomes among hospital workers at a public teaching and national referral hospital in Kenya

Setting:

Kenyatta National Hospital (KNH), Nairobi, Ken-ya, a large referral and teaching hospital.

Objective:

1) To document tuberculosis (TB) case notification rates and trends; 2) to describe demographic, clinical and workplace characteristics and treatment outcomes; and 3) to examine associations between demographic and clinical characteristics, HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) treatment and anti-tuberculosis treatment outcomes among hospital workers with TB at KNH during the period 2006–2011.

Design:

A retrospective cohort study involving a review of medical records.

Results:

The TB case notification rate among hospital staff ranged between 413 and 901 per 100 000 staff members per year; 51% of all cases were extra-pulmonary TB; 74% of all cases were among medical, paramedical and support staff. The TB-HIV coinfection rate was 60%. Only 75% had a successful treatment outcome. Patients in the retreatment category, those with unknown HIV status and those who were support staff had a higher risk of poor treatment outcomes.

Conclusion:

The TB case rate among hospital workers was unacceptably high compared to that of the general population, and treatment outcomes were poor. Infection control in the hospital and management of staff with TB requires urgent attention.     

A "smoke-free" hospital in Israel--a possible mission

BACKGROUND: A revised antismoking law in Israel (August 2001) called for a complete ban of smoking in hospitals. An evaluation of a hospital process and short-term outcome of implementing such policy may guideline its sustainability. METHODS: Two cross-sectional, random-sample surveys of employees 3 months before policy implementation, and 6-9 months post-implementation. The pre-implementation survey included 368 employees (90.4% response rate) and the post-implementation survey, 364 (92.8% response rate). RESULTS: The 'smoke-free' policy significantly reduced smoking in the unauthorized areas. Before implementation, 63% of staff reported frequently observing smoking in the hospital, compared to 40% 6 months post-policy implementation (P < 0.001). Significantly more smokers reported leaving their workplace to smoke (17% pre- vs. 62% post-implementation, P < 0.0001). Sixty-five percent of smokers, in both surveys, agreed that "a smoke-free policy is unfair to smokers". Fewer nonsmokers subscribed to this belief: 42% pre- and 34% post-implementation. Smoker prevalence remained unchanged (19%). CONCLUSIONS: Implementation of a "smoke-free" policy is an effective way to reduce smoking in the hospital environment. More effort is required, however, to help staff quit smoking altogether.     

The impact of evidence-based education on a perinatal capacity-building initiative in Macedonia

CONTEXT: The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A "train the teachers" approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje. OBJECTIVES: To describe the development, implementation and evaluation of the educational intervention. METHODS: A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR. RESULTS: A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%. CONCLUSIONS: The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the "train the teachers" approach, with concurrent strengthening of the infrastructure and organisational framework.     

The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical

ABSTRACT: BACKGROUND: Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. METHODS: This observational study was conducted from July 2004 through December 2010 at St. Luke's International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. RESULTS: The overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p=0.039). In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. CONCLUSION: In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.     

More power to the people

During the past 10 years, the trend has been to decentralize health services in developing countries. In Papua New Guinea changes in attitude take a long time. The principles of a widely available service were set out in the 1974-78 National Health Plan. The 1986-90 plan reaffirmed them. The decentralized health service in Papua New Guinea is based on the type of administration that had existed in the Health Department. At the 1980 meeting of provincial health officers, the Secretary for the Western Highlands Department reported that services were not improving because of the skilled manpower shortage. He found that the national staff feared for their own status and ignored decentralization. They believed that it was a "passing phase." They refused to make decision, forcing responsibility on the provincial governments. The Secretary suggested that discipline should be broadened to include people affected. Many provincial health officers (PHO) were overseas contract workers, while headquarters staff were citizens of Papua New Guinea. Certain arguments against decentralization used by officials of the Papua New Guinea Department of Health were similar to arguments put forth by the New York City Health Department staff when decentralization was decided on in the mid-1970s. In late 1982, the situation started to improve in Papua New Guinea. In the provinces, all health workers tended to see themselves as members of a single team. The former PHOs became Assistant Secretaries (Health) for the provincial departments. A course in community health was introduced at the University of Papua New Guinea. A diploma is now necessary for those who want senior provincial health positions. Improvements in health occurred from the decentralized primary health care (PHC) approach. Infant mortality decreased from 134/1000 live births in 1971 to 72/1000 in 1980; childhood mortality decreased from 79/1000 to 42/1000. Life expectancy at birth rose from 47.4 years to 49.6 years. Maternal mortality apparently remained high. The population had improved access to health services. The coverage of disease control programs improved when PHC was introduced. To give more responsibility and power to the people is the basic purpose of decentralization.     

创建二级甲等妇幼保健院的做法与体会

我院在创建二级甲等妇幼保健院的过程中（以下简称“二甲”），以创“二甲”为契机，巩固加强爱婴医院成果，狠抓医院管理，建章立制，强化内涵建设，注重医疗、保健服务质量的提高，充分发挥妇幼保健功能，完善科室建设和“硬件”设备，加强科研和“三基”培训。经过院领导班子和全院职工的共同努力，真抓实干、拼搏进取，使医院各项工作都迈上了新的台阶，妇幼保健工作有了长足的发展。