临床科室护士长绩效考核体系的构建

目的探索全面、客观考核临床科室护士长绩效的有效工具,以科学评价护士长管理水平、公平衡量护士长管理绩效。方法结合医院管理年要求和卫生部《医院管理评价指南（试行）》、湖北省医院管理评审和护理专项管理的要求,利用关键业绩指标法和平衡计分卡法,形成临床科室护士长年度考核和月度考核标准,月度考核以行政管理、质量管理、护理服务质量与安全管理、护士培训和护理教学管理5个方面为考核内容;年度考核从科室绩效、科室护理质量管理与护理安全、科室服务质量、护理科研与教学4个维度考核。结果应用临床科室护士长绩效考核体系后,医院综合护理质量达标率由2006年96.0%上升至2009年99.4%,护理差错由3起降至1起,护理投诉由10起降至3起,患者对护理服务满意度由95.6%提升至98.4%,科室护理培训落实率由89.0%上升至97.0%。结论护士长绩效考核调动了护士长管理的积极性,增强了护士的质量管理意识和医疗安全意识,有利于医院持续、健康、稳定的发展。     

查检表在非内分泌专科护士胰岛素笔注射培训中的应用

目的探讨信息化查检表在非内分泌专科护士胰岛素笔规范注射培训中的应用效果。方法设计胰岛素笔注射查检表,对接入信息化护理系统;由各科室护士长对照查检表负责所在科室护士的基线调研及规范注射的培训落实;3个月后,护理部质量管理委员会便利抽取88名护士集中进行培训后考核调研。结果护士胰岛素笔规范注射的总不合格率由7.86%降至3.50%。结论胰岛素笔注射查检表降低非内分泌专科护士胰岛素笔规范注射的不合格率,推动全院胰岛素笔注射的同质化护理行为。     

开展“优质护理服务示范病房”的实践与体会

绩效考核中的“量化”,特指明确绩效考核指标的标准,具体职位的绩效考核用一种具体的标准来衡量,达到明确、可以用外在的标准计量的目的. 基础护理是临床护理工作的重要组成部分,也是衡量医院护理质量的重要标志.为认真落实“以病人为中心”的服务宗旨,充分调动护理人员的工作积极性和主动性,使护理人员在晋级、奖惩方面有据可依,最大限度的挖掘每一个护士的潜能,提高护士的整体素质和科室的优质护理服务质量,制定了运用量化法对临床科室的护理人员绩效进行考核,     

绩效考核量化管理在优质护理服务中的应用

绩效考核中的“量化”,特指明确绩效考核指标的标准,具体职位的绩效考核用一种具体的标准来衡量,达到明确、可以用外在的标准计置的目的. 基础护理是临床护理工作的重要组成部分,也是衡量医院护理质量的重要标志.为认真落实“以病人为中心”的服务宗旨,充分调动护理人员的工作积极性和主动性,使护理人员在晋级、奖惩方面有据可依,最大限度的挖掘每一个护士的潜能,提高护士的整体素质和科室的优质护理服务质量,制定了运用量化法对临床科室的护理人员绩效进行考核. 我科于2010年9月开始实施优质化护理,取得了满意效果,现介绍方法如下：     

平衡记分卡在科室护士年终考核中的应用

目的探讨科学有效的科室护士年终考核方法。方法建立患者满意、护理质量与能力、个人学习与发展、财务指标4个维度量化考核指标。年终统计护士个人分数并排序,以此完成护士年终考核。结果患者满意度从2007年92.3%提高至94.5%,实施前后比较,差异有统计学意义(P<0.01);科室护理差错、质量检查不合格、护理记录缺陷、护理责任事故的发生分别从2007年13、20、25、1起降至2009年5、11、10、0起;实施后科室护士主持院内大讲课人数显著高于实施前(P<0.01),发表论文、参加竞赛、三基考试合格人数有所上升。结论平衡记分卡的四维评价体系明确了全体护士的工作目标,调动了护士工作的主观能动性,增强了日常护理工作的竞争意识和责任意识,提高了患者满意度和护士的业务水平。     

专职物价成本核算员在临床科室的试行与效果评价

目的探讨专职物价成本核算员在临床科室设置的可行性和有效性。方法由护理部和经管科室共同考核,选定6个科室作为试点,对选拔的6名专职物价成本核算员进行理论、临床培训及考核,培训合格后按照工作职责从事医嘱核对、物资请领、核对账本等工作。结果通过在试点科室试行专职物价成本核算员半年来,试点科室的各项护理指标合格率均在96%以上,护士工作满意度从实施前的88%上升至93%,住院患者满意率由93%上升到98%,出院患者意见征询满意率由90%提升到99%。结论在临床科室设立专职物价成本核算员是一种新的科室经济管理模式,使病区的物价收费更规范,物资管理有序,欠费管理有跟踪,利于加强病区物价收费管理、经济核算管理、护理管理和人事管理。     

学习与成长指标纳入护理绩效考核的管理实践

目的探讨将学习与成长指标纳入到医院护理绩效考核体系中对护士参与科研和继续教育的影响。方法采用历史对照设计,在原有考核护士工作数量、质量和中夜班补贴的护理绩效考核体系中加入有关护士学习成长相关指标和岗位系数等核算方式,每月绩效考核小组依据护士绩效得分情况分配绩效工资。选取4个科室运行该绩效考核体系1年后进行评价。结果实施后,护士发表论文、主持讲课、参加竞赛、参加继续学历教育、完成年度继续教育学分、申报省市级医学继续教育项目的比例显著高于实施前(P 0. 05,P 0. 01)。结论将学习与成长指标纳入护理绩效考核体系,能激发护士参与护理科研和继续教育的热情。     

护士长绩效考核的研究进展

对绩效结构理论的研究进展及其在绩效考核中的应用进行综述,提出当前我国护士长绩效考核的现状:考核制度的实施情况参差不齐,缺乏理论基础,考核方法、考核主体等有待进一步充实和完善,应在绩效结构理论指导下建立护士长绩效考核指标体系,并运用科学的考核方法进行实施,以进行有效的绩效管理。     

聘用制护士联络员的设立及实践

目的 探讨设立聘用制护士联络员的成效。方法自2007年起采取个人申请、护士长筛选、聘用制护士投票的方式选取聘用制护士联络员,明确工作职责,定期培训及考核。结果聘用制护士主动离职率由2007年的21.9％降至2010年的2.4％。结论推行科室聘用制护士联络员制,规范了聘用制护士管理,有利于护理人员基数的动态管理,避免了人...     

微信企业号在手术室护理管理中的应用

目的探讨微信企业号在手术室护理管理中的实践方法并评价其应用效果。方法申请微信企业号,设置通讯录,下设质量管理、感染控制、临床安全、教学科研、器械装备5个子部门;设置资讯平台及通知公告2个应用,资讯平台包括规章制度、科室文化、活动社区3个一级菜单和核心制度、岗位职责、操作规范、科训、科室简介、医院文化、优质护理、科室动态、科室带教、无瘤技术和手术室前沿资讯11个二级菜单,通知公告包括护理安全、器械管理、其他公告3个一级菜单。通过管理组讨论、不定期消息推送等促进手术室护士开展学习,以期提高护理质量,优化护理管理方法。结果微信企业号推广应用后,手术室护士规章制度知晓率由93.51%上升至98.70%,手术室护理工作质量评分由93.5分上升至98.8分。结论应用微信企业号能够促进手术室护士理论知识的学习,提高手术室护理工作质量,丰富手术室护理管理方法,是一种有效的护理管理手段。     

Surgeon evaluation of suture and endo-mechanical products

BACKGROUND: Surgeons select medical instruments without comparative performance data. This analysis seeks to determine if suture and endo-mechanical products made by different vendors have equivalent performance profiles or are clearly distinguished by physicians on different dimensions. MATERIALS AND METHODS: A sample of 45 surgeons evaluated eight vendors of five categories of suture and endo-mechanical products: clip appliers, staplers, trocars, needles and sutures, and endoscopic specimen retrieval devices. Surgeons rated each vendor's products in each category on multiple performance dimensions at six animal laboratories at academic medical centers around the U.S. between April and September 2005. Performance dimensions included the product's clinical acceptability, ergonomics, functionality, overall performance, and relative rank-order preference. RESULTS: Physician evaluations of vendor performance vary widely. Vendors rated as clinically equivalent on a given product received different performance ratings by physicians. Ethicon's products (Somerville, NJ) were rated consistently high by physicians across product categories. This suggests the presence of some superior brand performance. Nevertheless, within some categories, there were alternative vendors (U.S. Surgical [Mansfield, MA], Applied Medical [Rancho Margarita, CA]) whose products are rated similar to the brand leader. This suggests there are often multiple vendors from which to choose. There was also evidence of idiosyncratic physician preference, especially due to the physician's gender, height, and glove size. CONCLUSIONS: Suture and endo-mechanical products made by different vendors do not have equivalent performance profiles. Specific brand seems to be the most important determinant of physician evaluations of the different vendors' products. These results suggest the value and importance of conducting head-to-head comparisons of multiple vendors of the same product.     

In vitro and in vivo evaluation of lyophilized bioprosthetic valve

Freeze-drying of biological tissues allows for dry storage and gamma ray sterilization, which may improve their use as a medical prosthesis. The objective of this study was to evaluate the rehydration characteristics and hydrodynamic performance of prosthetic valves before and after lyophilization. Two size 23 bovine pericardium aortic valve prostheses from different manufacturers were evaluated in a Shelhigh (Union, NJ, USA) pulse duplicator (80 ppm, 5 L/min) before and after lyophilization. Flow and transvalvular pressure gradient were registered in vitro and in vivo, and images of opening and closing of the prosthesis were obtained in the pulse duplicator in a digital camera. Rehydration was evaluated by comparison of dry valve weight with valve weight after 15 min, and 1, 24, 48, and 72 h in saline solution, inside the pulse duplicator. In vivo performance was assessed by surgical implantation in Santa Inês young male sheep in the pulmonary position after 30 min rehydration with 0.9% saline. Transvalvular pressure gradient and flow measurements were obtained immediately after implantation and 3 months after surgery when valves were explanted. Captured images showed a change in the profile opening and closing of valve prosthesis after lyophilization. The gradient measured (in vitro) in two valves was 17.08 ± 0.57 and 18.76 ± 0.70 mm Hg before lyophilization, and 34.24 ± 0.59 and 30.40 ± 0.97 mm Hg after lyophilization. Rehydration of both lyophilized valves was approximately 82%. Drying changed the profile of the opening and closing of valve prostheses, and increased on average by 83% the gradient in vitro tests. The result of the in vivo tests suggests maintaining pressure levels of the animal with the lyophilized prostheses within acceptable levels.     

基于卡方自动交互检测分析方法的病区单元护理绩效考核

目的探讨公平、公正、科学、便捷的病区单元护理绩效考核与分配方法。方法建立护理工作数量、质量、效率、业绩4个维度90个具体指标的病区单元护理绩效考核体系,从医院信息系统提取实际数据并完成绩效赋值计算,借助卡方自动交互检测分析方法每个月对全部病区单元护理绩效赋值进行分析,按显著性差异(P0.05)将病区单元归属到不同的绩效等级集群,从而完成对病区单元护理绩效的分类评价,实现护理绩效的动态考核与分配。结果应用新绩效考核方法后,护士及护士长对绩效考核满意度显著提高,护士长绩效考核工作效率显著提高(均P0.01)。结论借助医院信息系统及卡方自动交互检测分析,能准确、快速完成对病区单元护理绩效考核的分类评价,为护理绩效考核分配提供科学的决策依据,提高工作效率及护理人员的满意度。     

基于ICU亚专科岗位管理模式的护理服务绩效评价

目的探讨基于ICU亚专科岗位管理模式的护理服务绩效评价的实践效果。方法以35名ICU护士为研究对象,建立亚专科工作组,实施基于ICU亚专科岗位管理模式的护理服务绩效模式。结果实施1年后,护理各项综合指标成绩和护士岗位管理绩效管理满意度显著提升(均P0.01)。结论 ICU亚专科岗位管理有助于提高ICU护理综合质量和护士满意度。     

Variation of surgery clerkship grades in US medical schools

Background

Despite efforts at standardization, evaluation and reporting of clerkships remains highly variable. This study reviews the current spectrum of surgical clerkship grading.

新医改背景下护理绩效管理评价指标体系的构建

目的 探讨符合客观规律,能调动护士工作积极性的护理绩效管理评价指标体系.方法 采用查阅文献、访谈科主任及不同岗位层级护理人员、专家咨询等,依据关键业绩指标法为理论指导,遵循SMART原则,建立指标体系初始量表,采用Delphi法行2轮专家咨询,建立指标体系.结果 指标体系包括护理质量、护理数量、护理效果3项一级指标、8...     

护士长绩效评价指标权重分配研究

目的对构建的护士长绩效评价指标进行权重赋值,以评定各指标的重要性。方法对15名专家共进行2轮咨询,应用层次分析法进行权重系数的初始与归一化,确定指标的最终权重。结果专家的积极性系数在88%以上,权威系数为0.76;共形成4个一级指标,16个二级指标;4个一级指标中客户和内部流程维度所占比重较大,权重值均为0.33,财务、学习与成长维度次之,权重值均为0.17。结论评价护士长绩效时,应注重各评价指标的重要性,依据其权重值予以公平公正的考核。     

Evolution of the final fellowship examination

The Royal Australasian College of Surgeons Final Fellowship or exit examination, common to nine surgical specialties, has undergone substantial change since the beginning of formal assessment in 1934. These changes reflect the altered requirements of the different specialties and developments in examination techniques and technology. Although there is now some variation between specialties in the format of each segment of the examination, consistency remains with seven segments of the examination being common to all specialties – two written papers, two clinical segments and three vivas. Approval for Fellowship, indicating success in the examination, is the responsibility of the full Court of Examiners although guided by each Specialty Court. During the past decade the examination has become more structured and objective and all candidates experience similar assessment. Considerable work has been undertaken to ensure that the examination process is appropriate and fair. A review of examination outcomes 2001–2007 shows some variation between specialties. Although the basis for this is multifactorial, some differences between Specialty Courts of Examiners in the structure of the examination and the assessment process may be small contributory factors. With an increased emphasis on competence‐based assessment during training the form of this exit examination will continue to evolve.     

Correlating surgical clerkship evaluations with performance on the National Board of Medical Examiners examination

Background

Evaluation of medical students during the surgical clerkship is controversial. Performance is often based on subjective scoring, whereas objective knowledge is based on written examinations. Whether these measures correspond or are relevant to assess student performance is unknown. We hypothesized that student evaluations correlate with performance on the National Board Of Medical Examiners (NBME) examination.

Methods

Data were collected from the 2011–2012 academic year. Medical students underwent a ward evaluation using a seven-point Likert scale assessing six educational competencies. Students also undertook the NBME examination, where performance was recorded as a percentile score adjusted to national standards.

Results

A total of 129 medical students were studied. Scores on the NBME ranged from the 52nd to the 96th percentile with an average in the 75th percentile (±9). Clerkship scores ranged from 3.2–7.0 with a mean of 5.7 (±0.8). There was a strong positive association between higher NBME scores and higher clerkship evaluations shown by a Pearson correlation coefficient of 0.47 (P < 0.001). Students clustered with below average ward evaluations (3.0–4.0) were in the 69.5th percentile of NBME scores, whereas students clustered with above average ward evaluations (6.0–7.0) were in the 79.2th percentile (P < 0.001).

Conclusions

A strong positive relationship exists between subjective ward evaluations and NBME performance. These data may afford some confidence to surgical faculty and surgical resident ability to accurately evaluate medical students during clinical clerkships. Understanding factors in student performance may help in improving the surgical clerkship experience.