Flexible nursing staff planning when patient demands are uncertain

Determination of appropriate nursing staff levels to provide quality service and maintain economic efficiency is a difficult problem for health care administrators to solve. The objective of this paper then is to prevent a mathematical model for determining the number of staff among full time and part time staff as well as overtime when patient demands are uncertain. The demand level is considered as a distribution on a daily basis. The model intends to integrate an entire week as a whole so that the number of staff is found on a weekly basis. Based on this model, the nursing workforce can accommodate patient needs efficiently and economically while remaining flexible in an uncertain demand environment.     

北京市社区医务人员需要量预测方法的探索研究

社区医务人员数量预测存在着未考虑人员工作量和卫生服务需求、预测方法不得当等问题。本研究比较了多种人员需要量预测方法,探索人员需求指标法在社区医务人员需要量预测中的应用,并提出该方法适用于北京市社区医务人员数量配置,拥有广阔的应用前景。     

Challenges of a negative work load and implications on morale,productivity and quality of service delivered in NHS laboratories in England

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them.This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England.Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery.There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.     

卫生人力资源配置方法探讨

卫生人力资源是卫生资源的核心，是发展卫生事业的决定性资源。为探索新形势下我国卫生人力在各级医疗卫生机构优化配置的途径与方法，提高卫生人力资源配置效率，最大限度地调动卫生工作者的积极性，本文对国内外卫生人力资源配置方法进行了回顾与评述。卫生人力资源配置方法包括健康需要法、健康需求法、服务目标法、人力人口比值法、医院规划模式法、灰色模型法、微观集成法、任务分析法等。     

急诊科建设思路与措施

探讨了急诊科建设的结构与布局、人员编制、执业范围、急诊科人员素质培养等急诊 科建设模式问题,并提出急诊科适应新形势的建设措施。     

Medical staffing in Ontario neonatal intensive care units.

Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.     

Determining the Optimal Physician Mix in Health Maintenance Organizations

Described is a simulation model for forecasting the appropriate mix of physicians needed to meet health service demands of patients in managed health care organizations. The model can be used by executives of managed health care organizations to plan for physician staffing levels by specialty. Uncertainties such as changes in the population size served by the managed health care organization, new developments in health care delivery technologies and changing attitudes of the population regarding healthier lifestyles are considered in this model. Use of the model is illustrated in an example.     

Flexible nursing staff planning with adjustable patient demands

The objective of this paper is to present a mathematical model for flexible staff planning when patient demands are uncertain and adjustable. The demand level before adjustment is considered a distribution on a daily basis. The adjustment is done by increasing or decreasing the average and the standard deviation of the daily demand level, with the assumption that the total patient demands for a week are identical. The adjustment of patient demands can be achieved by cooperating with an inpatient admission system to control the patient mix and the variation of an admitted census. Then, the nursing workforce can accommodate patient needs efficiency and economically with quality assurance in an uncertain demand environment.     

边疆专科医院病案管理现状及改进措施

病案信息服务在医院管理中愈来愈凸显出重要地位与功能。针对目前西部边疆专科医院病案管理工作存在决策层对病案管理重视不够、病案管理岗位多由“非专业人员”担任、管理理念及技能滞后、病案基本设施陈旧、管理人员地位待遇偏低、对年轻人缺乏吸引力、人员流动性大等问题,建议优化并合理配置人员、多途径培养病案管理人员以提高整体综合素质及待遇,稳定病案管理队伍,加强病案管理基本设施的改善与投入,提升病案信息服务水平与专科医院信息化管理层次。     

A model to determine staff levels,cost, and productivity of hospital units

A methodology is presented with examples of the productivity, the staffing required, the resultant productivity, and costs that can be obtained for hospital units that are subject to random work demands such as laboratory, radiology, physical therapy, and nuclear medicine. The methodology assumes that the hospital has a labor productivity system that produces the RVUs or earned hours of work accomplished daily by shift. Factors considered are the distribution of the capabilities of the work force, the fatigue and delay allowances of the work standards, the quality of the work standards, the maximum amount of overtime that people will be asked to work, staffing policies such as constant or different staffing levels for each day of the week, and worker selection processes. Predicted results are compared with present practice, which indicates that substantial cost reductions can occur with the use of the methodology.     

区域卫生资源分布优化建模

目的:建立区域卫生资源分布优化模型,探讨优化机制,解决区域卫生资源在空间分布上的最优分配及最优利用问题.方法:以课题组卫生资源优化部署理论研究为基础,针对区域卫生资源分布的优化问题,采用运筹学方法,以卫生资源的有效服务半径为保障半径,以保障负荷为约束条件,按照"划区治疗,就近收治"原则,构建分布优化模型.结果:构建了区域卫生资源分布优化模型,获得区域卫生资源分布优化机制.结论:模型构建合理,解决了区域卫生资源分布的最优分配及最优利用问题.     

Patient load and medical staffing in adult dialysis units in the United Kingdom

A survey of medical staffing in 50 adult dialysis units in the United Kingdom in 1986 showed a wide range of patient to staff ratios or staffing score ratios. The total patient load (patients receiving haemodialysis in hospital and at home and those receiving continuous ambulatory peritoneal dialysis) varied from 12 to 270 per unit. Patients receiving acute haemodialysis or who had received a transplant were not included. The unit staffing score, on a weighted scale based on experience, varied from 6.0 to 40.5. Previous surveys have all been regionally or nationally based so criteria for assessing the adequacy of staffing in single units do not exist. This survey attempts to provide a guideline by describing the range of medical staffing compared with patient load in single dialysis units. No unit considered itself to be overstaffed, and several considered themselves to be greatly understaffed. Individual dialysis units should plead their own case in the light of their own circumstances and up to date information provided in nationwide staffing surveys such as this one.     

A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care

OBJECTIVE: To examine the trends in processes of diabetes care and in participant outcomes after an intervention in two remote regions of Australia. DESIGN: Follow-up study over 3 years. SETTING: Seven health centres in the Tiwi Islands and the Katherine West region of the Northern Territory. PARTICIPANTS: 137 Aboriginal people with type 2 diabetes. INTERVENTION: Implementation of a multifaceted trial, including transfer of purchasing and planning responsibility to local health boards, the development and dissemination of clinical guidelines supported by electronic registers, recall and reminder systems and associated staff training, and audit and feedback. MAIN OUTCOME MEASURES: Trends in the proportion of Aboriginal people receiving services in accordance with clinical guidelines and in the proportion for whom specified levels of blood pressure and glycosylated haemoglobin (HbA(1c)) were achieved; health staff perceptions of barriers to effective service delivery. RESULTS: An initial improvement in overall service levels from 40% to 49% was not fully sustained over the 3-year period. The overall proportion of services delivered varied from 22% to 64% between communities and over time. The proportion of participants whose most recent HbA(1c) level was less than 7% improved from 19% to 32%, but there was little change in blood pressure control. Perceived barriers to service delivery included discontinuities in staffing, lack of work-practice support and patients' acceptance of services. CONCLUSIONS: Multifaceted interventions can improve quality of care in this environment, but achieving sustainable, high-quality care in a range of services and local conditions presents particular challenges. Developing and testing strategies for consistent and sustained improvement should be a priority for service providers and researchers.     

Joint venture acquisition of expensive medical technology by Oahu hospitals. Planning, operations and impact of lithotripsy and magnetic resonance imaging

Expensive diagnostic and treatment services and equipment are naturally suited to large, populous medical market areas, with sufficient forecasted service demand to justify the large investment in capital, construction and staffing. Only major tertiary or secondary medical centers with shared resources can justify the first-generation investment in the multimillion-dollar purchases of magnetic resonance imaging (MRI), megavoltage linear accelerators, or lithotripters. The regional referral system in most nations accommodates the outlying population in the less developed rural sectors.     

我院图书馆为患者服务的实践研究

欧美发达国家患者图书馆历史悠久,成为医疗服务中不可缺少的一部分。而在我国,患者图书馆事业还未兴起。介绍了广东省人民医院图书馆通过让图书馆员与患者接触,到病区现场提供服务,并发放医院图书馆对患者服务需求问卷等多种方式为患者提供相关服务。指出医院图书馆为患者服务具有很大的需求市场,但全面开展患者服务条件尚不成熟。     

关注患者需求 创建满意医院

在系统分析患者的多方面需求的基础上,针对不同需求,制定相应服务对策：针对安全需求,加强安全管理;针对生理的需求,提高技术水平;针对经济的需求,控制医疗费用;针对社会的需求,实施人文关怀;针对环境的需求,加大投入力度。同时注重营造服务文化,树立良好形象;强化质量管理,提高服务质量;关注员工成长,提升员工素质。     

基层医务人员对成人高等教育需求情况的研究

目的 调查基层卫生技术人员基本情况、继续医学教育现状和对成人高等教育需求,明确医学成人教育培养目标,加快成人教育教学管理模式改革,提升基层卫生人才培养质量。方法 对2019年参加某市基层卫生培训的全市12个县市区,106家乡镇卫生院和50个社区卫生服务中心的1 233名(23期)卫生技术人员进行问卷调查和访谈。结果 目前基层医务人员基础学历相对较低,有成人高等教育需求,集中在20～50岁年龄段,护理、医技专业对成人高等教育较临床专业需求量大。但是随着国家对基层卫生的重视,临床本科及以上学历卫生技术人员数量日益增多,对研究生学历的需求也日益增加。结论 基层卫生人力资源规模和质量提升要求不断提高,在成人高等教育中一定要做好为基层人才进一步深造的充分准备,同时要将人文教育纳入教育过程中,稳定基层卫生队伍。     

浅谈医学生的合作精神培养

现代医学工作者正面临着在竞争中生存,在合作中发展的现实,而医学生作为未来的医学工作者,培养和提高他们的合作精神,是世界卫生组织的呼唤,是未来医学事业的要求,是成才的需要。培养医学生的合作精神主要是要通过营造合作环境及教学中创设合作氛围、开展科研活动和开展社区服务活动等有效途径来完成。     

社区卫生服务中心从业人员的工作满意度及其影响因素研究

目的了解社区卫生服务中心从业人员的工作满意度现状及其主要影响因素,为社区卫生服务管理提供参考依据。方法以信度和效度均较高的问卷为基础版本设计调查问卷,对杨浦区某社区卫生服务中心全体从业人员进行工作满意度自填式问卷调查。计数资料采用χ2检验,相关影响因素分析采用Logistic回归分析模型。结果社区卫生服务中心从业人员的总体工作满意度一般;大专学历、临床一线、年龄在30～39岁并且工作年限在5～9年的人员、年龄在40～49岁并且工作年限在10～19年的人员满意度较低;不同的工作满意度维度存在个体差异。工作本身、组织管理、社会支持是影响工作满意度的主要因素。结论社区卫生服务中心从业人员工作满意度有待提高;社区卫生服务管理者应建立合理公平的分配制度,建立尊重成就的激励机制,形成有效的组织文化。