某院科主任查房质量评价与应用

目的从科主任查房中发现问题,强化医疗质量管理。方法聘请本院资深专家对科主任查房的形式、内容和质量的优点及存在的问题进行全面点评、打分。结果科主任查房质量上新台阶,有较大进步,但依然存在部分问题。结论加强宏观管理,把科主任临床查房工作纳入到科主任年度目标考核管理,建立科主任查房长效督导机制,持续提高医疗质量。     

The preliminary impact of Maryland's medical director and attending physician regulations

OBJECTIVES: To identify the impact of the regulations implemented in Maryland in 2001, related to nursing home attending physicians and medical directors, and nursing home quality assurance requirements, on Maryland nursing homes, administrators, and physicians. DESIGN: Two surveys were mailed to all nursing home administrators in Maryland, one for their completion and one to give to their medical directors to complete. These surveys were to be returned by mail to the authors. SETTING: All nursing homes in all jurisdictions in Maryland. PARTICIPANTS: Two-fifths of administrators and medical directors in Maryland nursing homes completed and returned the survey. MEASUREMENTS: Results were tabulated for each question of each survey, and were calculated as percentages of the total responses. Additionally, individual comments were reviewed. RESULTS: A relatively large sample of administrators and medical directors in Maryland responded. Most respondents were positive or at least neutral about the impact of these regulations on them and their organizations. Many administrators agreed that there had been improvements in medical director participation and performance. There were significant advances in medical director compensation. There were relatively few negative comments about the impact. CONCLUSION: Requirements for physician and medical director accountability appear to have had a positive impact on medical director performance and relationships with nursing home administrators. Additional study is warranted to measure the impact of that performance on patient care outcomes and facility performance.     

The National Institute for Program Director Development: a school for program directors

BACKGROUND: The role of residency program director is unique in medicine and medical education. Most program directors learn the job through trial and error, with a fortunate few benefiting from the wisdom and experience of their predecessors and mentors. In 1994, the Association of Family Practice Residency Directors (AFPRD) made the development of training and support resources for program directors a top priority. METHODS: With the support of the strategic plan of the AFPRD, the focus on excellence in residency education by the ABFP, and a survey documenting need, the National Institute for Program Director Development (NIPDD) was formed, with its sentinel product, a school for family practice residency directors. RESULTS: A fellowship-format 9-month training program was constructed using a multidimensional educational model. To date, there have been more than 300 participants. The curriculum emphasizes leadership development, resource allocation, a thorough familiarity with regulations and standards, educational options, and personnel management skills. A follow-up survey in 1999 documented an increase in program director tenure and an overall positive impact on family practice residency programs. CONCLUSIONS: Enhanced preparation for the job of residency program director results in a positive impact on both the director and the program.     

当好医疗副院长应具备的六种意识

医疗副院长必须具备六种意识：（１）找准副院长的“为政坐标”增强角色意识;（２）以副为乐,树立院长的核心地位意识;（２）放弃自我,提高配合意识;（４）忍辱负重,强化大局意识;（５）防止越位,要有自觉的到位意识;（６）积极主动,要有谋事、揽事意识。     

What administrators look for in their directors of pharmacy

A questionnaire was sent to 160 hospital administrators in Southern California. The questionnaire sought to determine whether directors of pharmacy are good managers, how much time directors spend on administrative tasks, and which managerial skills are most valuable for a director of pharmacy to possess. The results of that questionnaire and a series of recommendations are presented.     

医院院长职业化和专业化建设现状及推进策略

本文采用自填式问卷调查和典型调查相结合的方式对17个公立医院改革国家级联系试点城市的全部二、三级公立医院（其中北京市和上海市为市级公立医院）正副院长、正副书记进行了问卷调查。研究得出医院院长职业化和专业化建设的现状和问题是：院长多为医学专业背景;多数人不愿放弃临床专业;“医而优则仕”的选拔方式;管理者职能与所有者权力混淆;对院长的绩效考核和激励刚起步;院长职业化培训有提高的空间;院长职业化人才市场尚未形成。通过对现状和问题的分析,得出院长职业化建设推进策略为：促进院长的管理专业化建设;改革干部人事制度,建立院长的公开选拔机制;完善院长的绩效考核体系和激励约束机制;制定院长职业化的相关法律法规。     

Developing Future Nursing Home Medical Directors: A Curriculum for Geriatric Medicine Fellows

Long term care facilities are important sites of care for elderly adults. Despite a growing need and interest in medical direction in nursing homes, there have been limited educational opportunities in this area for geriatric medicine fellows. This article describes a novel medical director’s curriculum for first-year geriatric medicine fellows to prepare them for the role of nursing home medical director. This novel curriculum has been integrated into the Department of Geriatric Medicine’s Fellowship training program at the John A. Burns School of Medicine, University of Hawaii. The curriculum consists of seven seminars that have been integrated into the didactic sessions during the first year of fellowship. Core content areas include: (1) roles and responsibilities of the medical director, (2) infection control, (3) physician documentation, (4) federal regulations and state surveys, (5) quality improvement, (6) culture change in nursing homes, and (7) transitions in care. All topics were discussed using the framework described by the American Medical Directors Association’s position statement on the roles and responsibilities of the nursing home medical director. To our knowledge, this is the first curriculum in the medical literature that is designed to prepare geriatric medicine fellows for roles as medical directors in nursing homes.     

以院长质量查房为龙头带动质量体系认证与实施

我院启动ISO90 0 1:2 0 0 0质量管理体系认证 ,为规范医院最高管理者质量管理过程 ,并落实各管理职能部门和各医疗业务科室管理者的质量管理职能 ,建立以院长质量查房为龙头的质量管理。其主要做法是 :坚持每月院长查房制度 ;职能科室预查制度 ;科室接受查房和制定质量改进项目。这是为了全面了解科室业务及管理情况 ,进一步规范医疗行为 ,提高医疗质量 ;改进职能科室工作作风 ,提高为一线服务的意识和效率 ;对科主任和科室管理起到了强化作用 ;推动了医院质量体系认证与实施     

Smart Case Review: A Model For Successful Remote Medical Direction and Enhanced Nursing Home Quality Improvement

This article describes how medical directors can use a strategic approach [Smart Case Review (SCR)] to perform effective and efficient clinical case reviews and key medical director oversight functions simultaneously. SCR can be done either on-site or remotely, by using existing information in the medical record for a focused clinical discussion of patient symptoms and issues while simultaneously evaluating related clinical practices and facility processes and performance. Common problem-solving and cause identification methods apply to both patient- and process-related reviews. This approach supports effective and efficient medical direction and facility quality improvement. Unlike most current approaches to quality assurance and performance improvement, SCR begins by reviewing cases and then aggregates the findings, instead of vice versa. Although the electronic medical record (EMR) facilitates the process, it can be done without an EMR. Any medical director can potentially use this approach, and it is relevant to any long-term and postacute care facility. This method could potentially transform the approach to medical direction, evaluating quality and improving care, and the nursing home survey process.     

From pilot project to annual success: Creating an evidence-based leadership program for medical directors in long-term care

Engaging physicians in health care administration is critical. Within Canada, physician leadership programs have not been designed to meet the needs of medical directors in Long-Term Care (LTC). This article explains how a pilot program for medical directors in LTC was created to develop their leadership skills, and how it has now become an annual event. The program must evolve to enable medical directors to participate in system change and innovation within LTC.     

提高科主任查房质量的探索与实践

为提高诊治水平，促进医院业务技术建设，分析了我院科主任在业务查房中的缺陷及其原因。教育科主任提高对查房质量重要性的认识。针对不同年龄段科主任采取不同类型的理论学习和临床基本功的训练，夯实了提高查房质量的基础；采用了制定和执行严格的查房规章制度、规范查房模式、实施科主任查房全程监控和定期讲评等方法，从而保证了科主任查房质量的稳固提高。科主任查房质量是医疗质量管理极其重要的内容，可以提高医疗质量水平和服务水平，促进医院的可持续发展。     

Mission impossible? The definition and functions of the medical director

Seeks to throw light on both strategic and managerial aspects of the post of medical director. The medical director is a key executive member of the Trust Board, yet the role remains ill-defined. The existing published guidance gives some indication of what medical directors should be doing but gives limited information about "best practice" or how to cope with the demands being made on them. A survey of medical directors in 1994 revealed the diversity of the tasks that they can be called on to perform, often with inadequate managerial and secretarial support. The survey also indicated that problems have occurred as a result of the heavy workload and unexpected multiple facets of the role. Concludes that, to make the job somewhat easier, there should be a clear core job specification which is tailored to suit the individual circumstances. This should be combined with generous support and training, together with a suitable reward package.     

公立医院院长绩效评价的意义与作用

公立医院院长绩效评价是引导医院坚持正确的办医方向、增强公益性的重要手段,也是促进公立医院加强内部绩效管理的重要手段.上海申康医院发展中心从2006年起,对上海23家三级公立医院院长开展了绩效评价.文章着重介绍了院长绩效评价的重要意义以及对医院办院方向和运行行为的正向引导作用.     

科主任的素质以及做好工作的方法和职责

科主任的素质高低，直接影响着科室的建设和医院的发展。本探讨了科主任应具备的素质，科主任应处理好的关系；科主任应履行的岗位职责，为科室主任做好工作提供参考。     

Expanding adult day care successfully

Expanding adult day care services successfully by strengthening recruitment and retention, quality assurance, programming, scheduling and financial management requires strong program leadership. Since the vast majority of day care program directors are educated as registered nurses, social workers and recreation therapists, cultivation of effective leadership skills must be achieved through a combination of additional formal education in management, extensive seminar/workshop attendance, outside readings and on the job guidance and experience. The administrator, to whom the program director reports, should devote considerable time and effort toward the director's management development through instruction, counseling and support. Conflicts may arise in areas such as staff and overtime expenses, and marginally efficient equipment purchases, where the director's clinical background may overshadow an objective cost/benefit analysis. Learning to delegate responsibility for basic programming and clinical services to staff, thus developing their skills, is a significant area for director and program growth. A well-trained and motivated nurse's aide can be quite capable of leading discussion and activity groups, perhaps assisted by volunteers. Social work students, with supervision, do a fine job of cofacilitating caregiver support groups and with additional experience, intake assessments.     

Competencies for population-based clinical managers: A survey of managed care medical directors

Background: The evolution of American health care into integrated systems of delivery and finance requires a specialized set of population-based skills for physicians. The field of preventive medicine represents one source of this expertise. Specific competencies for the emerging area of managerial medicine have not been well delineated.Methods: Using concept documents from the Residency Review Committee for Preventive Medicine and the American Board of Preventive Medicine, a list of proposed competencies for managerial medicine was identified. Surveys were mailed to medical directors of all members of the American Association of Health Plans and to a random sample of diplomates of the American Board of Preventive Medicine. Respondents were asked to rate the importance of these competencies for a population-oriented clinician manager.Results: Areas rated highly by medical directors included health services research (including outcomes research), quality assurance and improvement, health risk assessment and reduction, programmatic skills, and clinical preventive skills. Responses from preventive medicine specialists were similar, but placed lower emphasis on these skills.Conclusion: Despite its limited response rate, this survey may be useful in the implementation of specialty training in managerial medicine. Residency training programs may choose to emphasize specific content areas that reflect the priorities expressed by physicians actively involved in management.     

The Role of the Medical Director in Ontario Long-Term Care Homes: Impact of COVID-19

ObjectivesThe pandemic has uncovered a broad lack of understanding of the role of the Medical Director in Canadian Long-Term Care (LTC) Homes. Our objectives were to identify the current demographics and practices of LTC Medical Directors, discover how the pandemic affected their practice habits, and inform the content of the Ontario Long-Term Care Clinicians Medical Director Course, to ensure that Medical Directors have the requisite knowledge of the responsibilities of their role.DesignEmail survey.Setting and ParticipantsMedical directors in Ontario long-term care homes.MethodsResponses to open-ended, close-ended, multiple-choice, and free-text questions.ResultsA total of 156 medical directors (approximately 24%) completed the survey. Ninety-four percent were family physicians. Approximately 40% of participants had been a medical director for fewer than 5 years, whereas more than 11% have been in the role for greater than 30 years. More than 60% spend fewer than 2 hours per week in their administrative role, with fewer than 23% completing formal evaluations of the attending clinicians. Greater than 75% are either satisfied or extremely satisfied in their medical director role, citing excellent engagement and collaboration with team members. Feelings of dissatisfaction were associated with pandemic stress, increased hours and responsibility, inadequate remuneration, lack of ability to make decisions and lack of acknowledgement that physicians add value to the interdisciplinary team.Conclusion and ImplicationsIt is clear that medical directors are in a unique position to impact the care of residents within LTC. It is imperative to engage medical directors as integral members of the LTC health care team. This can be achieved by acknowledging their medical expertise for improving outcomes, providing them with the authority for decision making, compensating them appropriately, and clearly defining the role. By making these changes, we can ensure that there is a higher likelihood to sustain effective medical leadership in LTC.