平衡计分卡在军队医院战略管理中指标设计与权重的确定

平衡计分卡作为一种新型的绩效管理工具正逐渐被我国医疗卫生行业所重视，一些先行者对平衡计分卡在医院战略管理中的应用进行了研究和实例分析，但对指标设计与权重确定方面的研究还涉及不深，笔者在文献检索和军队医院实地调研的基础上，对平衡计分卡四个维度的指标设计与权重进行了分析和研究，希望能为军队医院引入平衡计分卡后指标设计与权重确定等方面提供一些帮助。     

平衡计分卡在军队医院实施的可行性研究

平衡计分卡是企业中使用的一种新的战略管理工具,它超越了传统的仅从财务角度衡量企业绩效的测评方法,从财务、客户、内部运营和创新与学习4个方面全面考察企业战略实施情况。2003年以来,国内诸多医院管理研究者对平衡计分卡在医院战略管理中的应用进行了研究和实例分析〔1~4〕,指出了平衡计分卡对帮助医院持续性改善绩效,全面提高医务人员的工作积极性,实现医院愿景和战略目标有着重要的作用。军队医院作为一种特殊的社会组织,健康、和谐、可持续发展是军队医院发展的主题〔5,6〕。笔者探讨了平衡计分卡在军队医院战略管理方面的可行性,希…     

平衡计分卡在医院绩效管理10年应用效果评价

医院要生存、发展、壮大,充分激发和调动所有员工的劳动积极性和创造性,保证医院持续、快速、健康发展.为此,引进了企业化管理工具"平衡计分卡",在全院范围内实行绩效管理、绩效评价、绩效考核、绩效分配.达到提高效率、提高效益、提高执行力、提高医院综合实力和医疗服务质量的目的,使医院整体功能得到全面提升,并根据平衡计分卡在医院绩效管理10年的应用情况,对平衡计分卡在医院的长期应用进行了效果评价和分析.     

平衡计分卡理论与医疗流程管理研究

医院流程管理是指医院在医疗活动中为患者提供优质医疗服务和医务人员行为规范而进行的过程管理。笔者探讨了平衡计分卡在医院流程管理方面的应用性研究,希望能为促进医院流程管理提供一种新方法。     

平衡计分卡在台湾医院中的应用

平衡计分卡（balanced score card,BSC）概念的提出为现代组织的绩效衡量提供了一种新的方法和工具。一些医院及其管理者也逐步认识到BSC在医院日常管理、绩效考核、战略执行及人才培养等许多方面的作用,并在理论和实践上对医院推行BSC的可行性进行了探讨。但大陆地区医疗机构对于BSC的应用起步较晚,在BSC的制定及方案实施方面都处在探索过程中,很少有成功实施的报道及案例研究。台湾地区的部分医院较早引入了BSC,并取得了明显的效果。笔者试图对台湾地区医院开发和实施BSC的主要特点和经验进行系统总结与分析,为BSc在医院管理中的应用提供经验和指导。     

军队医院个人绩效评价指标体系设计探讨

目前,医院个人绩效评价指标体系并没有统一规范的模型,研究者大多把重点放在了科室绩效评价上。我院从2006年开始实施平衡计分卡绩效管理模式,从财务指标、客户服务指标、内部流程及创新与学习指标等四个层面对科室的组织绩效进行全面、综合考核,有力地促进了医院核心竞争力的生成,医院全面建设健康、快速发展。     

明确军队医院愿景构建科学战略地图

随着国家市场经济的成熟和卫生事业改革的深入，军队医院迎来了快速发展的新时期。在这个时期里。每所军队医院都有自己的发展战略，但大多数采取的是隐式战略管理模式。这种战略管理是通过医院各职能部门的活动以隐式演进，在传达至医务人员时，会因为职能科室人员的业务性质和思维理念而转化，使真正实施战略的一线医务人员不能全面了解或扭曲医院的发展战略。导致医院整体战略不能如期或高质量完成。这就要军队医院管理者在制定战略时，用一种科学的方法将战略描述出来，达到全院人员共识的效果。     

卫生列车医疗队手术组工作流程模式的研究

卫生列车医疗队是我军新型卫勤保障力量之一，其主要任务是在未来的应急作战中，负责从前方医院接受伤病员，通过卫生列车向战略后方医院后送，并保持后送途中的不间断治疗。手术组的工作任务主要是实施、完成紧急抢救性手术，挽救伤员的生命。为了充分利用手术组的资源，提高工作效率，我们应用工作流程理论与方法。对卫生列车医疗队手术组工作任务与流程进行了研究，使之规范化、标准化。     

ISO9002体系在介入诊疗管理中的应用

ISO是国际标准化组织(The International Organization for Standardization)的英文缩写。医院ISO国际质量管理是以质量管理为主导，以无缺陷管理为出发点，以优质、高效、低价及成本管理为前提，以患者满意为目标，以质量保证为医院发展战略，构建了21世纪医院管理的新模式。1999年我院在全国医院率先通过了ISO9002国际质量标准体系认证。现将ISO9002国际质量标准体系在我科介入诊疗管理中的应用介绍如下。     

强化科学管理意识提升医院建设水平

我院在实施科学管理中，充分利用“四轮驱动”平衡的原理和“五环联动”的整体效应，有力地推动了医院全面建设。2004年被军区评为“全面建设先进团单位”和“管理工作先进单位”，被中华医院管理学会评为“全国百姓放心示范医院”。同时，医院的医疗收入、收治量、手术量连创历史新高。     

超声背散射系数评价松质骨状况的可行性研究

目的研究超声背散射信号及其背散射系数（backscatter coefficient,BSC）评价松质骨状况的可行性。方法首先建立了一种蜂窝状的松质骨理论模型,然后将BSC与频率的理论关系和牛胫骨松质骨实验结果进行了比较;最后实验分析了BSC与松质骨表观密度的关系。结果松质骨中超声BSC随入射频率的增加而非线性的增加,理论模型和实验结果是一致的。随松质骨表观密度的增大,BSC增大。结论在用超声评价松质骨状况时,背散射信号具有重要作用,其BSC可用于评价松质骨状况。     

Detection by (18)F-FDG PET of unsuspected extensive bone marrow metastases in a case of basosquamous carcinoma of the cheek

Basosquamous carcinoma (BSC) is a rare type of malignancy with features of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with a potential for aggressive behaviour infiltration and destruction. First reported by MacCormac in 1910 in a series of rodent ulcers, this entity does have an increased risk of recurrence and metastases as well, which distinguish it from other forms of basal cell carcinoma. The overall incidence of basosquamous carcinoma ranges from 1.2% to 2.7%. An unusual case of basosquamous carcinoma (BSC) is presented where 18- fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) scan diagnosed unsuspected extensive metastatic disease in the bone marrow, which was further proven histopathologically. The patient was a 32 years old man with history of recently diagnosed basosquamous carcinoma of left cheek involving left lower eyelid and left eyeball. Contrast enhanced computed tomography(ceCT) of the head and neck demonstrated involvement of the left cheek skin by the malignancy along with erosion of zygomatic bone and phthisis bulbi of the left eye. The serum alkaline phosphatase was elevated (255units, normal range 50-150units). The patient was referred for (18)F-FDG PET, for disease status evaluation. The scan showed intense tracer uptake in the left zygomatic region, the site of known primary disease. Intense tracer uptake was noted in the multiple lesions of bone marrow of axial as well as appendicular skeleton. The scan appearance was highly suggestive of metastatic bone marrow involvement. A bone marrow biopsy was performed to confirm the scan findings. Guided by the (18)F-FDG PET scan findings, bone marrow biopsy was performed and metastatic basosquamous carcinoma was diagnosed. We believe this is the first reported case of basosquamous carcinoma where extensive metastatic bone marrow disease was diagnosed with the aid of (18)F-FDG PET. At first diagnosis, an advanced stage of BSC is often present. Due to its metastatic potential, extensive primary surgical resection of BSC, possibly completed by radiation or photodynamic adjuvant treatment is recommended. Given the aggressive nature of basosquamous carcinoma, whole body (18)F-FDG PET is very useful in diagnosing metastatic BSC. In conclusion, this is the first reported case of the use of (18)F-FDG PET study for diagnosing metastatic bone marrow disease in a patient with basosquamous carcinoma.     

医院等级评审工作认识及加强医疗管理工作的思考

医院评审是医院综合评价的国际惯例。通过评审可以实现医院战略转型、提升内涵质量。实践证明,我院开展评审后,医院管理、质量内涵、服务效率、文化和安全机制都得到了进一步加强。为进一步巩固评审成果,结合我院实际,我院将在学科人才、绩效考评、内涵建设、诊疗规范等重点工作上加大工作力度,推进医院建设再上台阶。     

Matched-Pair Comparison of Radioembolization Plus Best Supportive Care Versus Best Supportive Care Alone for Chemotherapy Refractory Liver-Dominant Colorectal Metastases

Purpose

This study was designed to evaluate overall survival after radioembolization or best supportive care (BSC) in patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer (mCRC).

Methods

This was a matched-pair comparison of patients who received radioembolization plus BSC or BSC alone for extensive liver disease. Twenty-nine patients who received radioembolization were retrospectively matched with a contemporary cohort of >500 patients who received BSC from 3 centers in Germany. Using clinical databases, patients were initially matched for prior treatments and tumor burden and then 29 patients were consecutively identified with two or more of four matching criteria: synchronous/metachronous metastases, tumor burden, increased ALP, and/or CEA >200?U/ml. Survival was calculated from date of progression before radioembolization or BSC by using Kaplan–Meier analysis.

Results

Of 29 patients in each study arm, 16 pairs (55.2%) matched for all four criteria, and 11 pairs (37.9%) matched three criteria. Patients in both groups had a similar performance status (Karnofsky index, median 80% [range, 60–100%]). Compared with BSC alone, radioembolization prolonged survival (median, 8.3 vs. 3.5?months; P?P?n?=?20, 69%), grade 1 abdominal pain/nausea (n?=?14, 48.3%), and grade 2 gastrointestinal ulceration (n?=?3, 10.3%). Three cases of grade 3 radiation-induced liver disease were symptomatically managed.

Conclusions

Radioembolization offers a promising addition to BSC in treatment-refractory patients for whom there are limited options. Survival was prolonged and adverse events were generally mild-to-moderate in nature and manageable.     

Inter-sonographer reproducibility of quantitative ultrasound outcomes and shear wave speed measured in the right lobe of the liver in adults with known or suspected non-alcoholic fatty liver disease

Objectives

To assess inter-sonographer reproducibility of ultrasound attenuation coefficient (AC), backscatter coefficient (BSC) and shear wave speed (SWS) in adults with known/suspected non-alcoholic fatty liver disease (NAFLD).

Methods

The institutional review board approved this HIPAA-compliant prospective study; informed consent was obtained. Participants with known/suspected NAFLD were recruited and underwent same-day liver examinations with a clinical scanner. Each participant was scanned by two of the six trained sonographers. Each sonographer performed multiple data acquisitions in the right liver lobe using a lateral intercostal approach. A data acquisition was a single operator button press that recorded a B-mode image, radio-frequency data, and the SWS value. AC and BSC were calculated from the radio-frequency data using the reference phantom method. SWS was calculated automatically using product software. Intraclass correlation coefficient (ICC) and within-subject coefficient of variation (wCV) were calculated for applicable metrics.

Results

Sixty-one participants were recruited. Inter-sonographer ICC was 0.86 (95% confidence interval: 0.77–0.92) for AC and 0.87 (0.78–0.92) for log-transformed BSC (logBSC?=?10log₁₀BSC) using one acquisition per sonographer. ICC was 0.88 (0.80–0.93) for both AC and logBSC averaging 5 acquisitions. ICC for SWS was 0.57 (0.29–0.74) using one acquisition per sonographer, and 0.84 (0.66–0.93) using 10 acquisitions. The wCV was ~7% for AC, and 19–43% for SWS, depending on number of acquisitions.

Conclusions

Hepatic AC, BSC and SWS measures on a clinical scanner have good inter-sonographer reproducibility in adults with known or suspected NAFLD. Multiple acquisitions are required for SWS but not AC or BSC to achieve good inter-sonographer reproducibility.

Key Points

? AC, BSC and SWS measurements are reproducible in adults with NAFLD. ? Inter-sonographer reproducibility of SWS measurement improves with more acquisitions being averaged. ? Multiple acquisitions are required for SWS but not AC or BSC.

     

带钩钢圈、电凝加钢圈栓塞静脉的实验研究

本实验采用带钩钢圈、电凝加钢圈两种方法对１６只犬３２条髂静脉进行栓塞。带钩钢圈组中（ｎ＝２０）有１４条靶血管闭塞，３条狭窄，另３条中钢圈移位于肺部。电凝加钢圈组（ｎ＝１２）全部闭塞。本文对两组的影像学、静脉压和病理学进行了讨论。作者认为电凝加钢圈是静脉栓塞的一种安全、有效的方法。     

Lessons from the organization of medical support during the Battle for Moscow

Covered and analyzed the state of medical support during the Battle for Moscow. The problems of organizing of medical support for troops during all stages of this war--defensive operations and counter-offensive strategic operations are considered. Analyzed errors and mistakes made in the course of medical support of combat operations of the fronts that participated in the battle for Moscow. The article traces the solutions of the problems encountered and assess the results of translating these decisions into practice. Particular attention is paid to problems of organization of work as a hospital base fronts and armies, and the medical units and divisional managers, as well as management of medical service, evacuate the wounded and sick, the dynamics of formation of the provision of specialized medical care and anti security forces.     

Skip policy: road to Force Health Protection 2010

The 2010 Force Health Protection Capstone concept envisions a single level of theater hospitalization and a greater reliance on the strategic movement of casualties from the theater. A significant Force Health Protection implication is 100% of the combat zone patients leaving theater will not have a second stay at an echelon/level IV hospital. In 2000, the Army began moving toward the Force Health Protection concept by using a skip policy for determining 2007 medical force structure requirements. Implementing the skip policy avoids (eliminates) the second echelon/level IV hospital length of stay for a percentage of combat zone patients leaving theater. The Army's decision to implement a skip policy exposed the complexities associated with determining deployable medical force structure requirements and the inherent inter-relatedness of the services medical mission.     

Addressing the shortage of radiologists

In a survey of 254 hospital radiology departments conducted last year, Dallas-based U.S. Radiology Partners (USRP), a radiology management firm, found that 45 percent of hospitals are understaffed in radiology. Fifty-six percent of hospital radiology department heads surveyed by USRP indicated that staffing shortages were diminishing the quality of care their departments are able to provide. Moreover, staffing shortages are occurring at a time when radiology volume generally is increasing. There are various underlying reasons why the supply of radiologists and other physicians is insufficient to meet demand in many areas, including institutional misdiagnosis, graduate medical education, patient preferences, the economy, restrictions on international medical graduates, practice patterns, patient and physician demographics and new technology. Given current physician supply and demand trends, a strategic radiology staffing plan is needed. Such a plan would include the following elements: retention, candidate parameters, contracts and incentives, sourcing, screening, interviewing, responsiveness and decisiveness.     

Advanced imaging programs: maximizing a multislice CT investment

Advanced image processing has moved from a luxury to a necessity in the practice of medicine. A hospital's adoption of sophisticated 3D imaging entails several important steps with many factors to consider in order to be successful. Like any new hospital program, 3D post-processing should be introduced through a strategic planning process that includes administrators, physicians, and technologists to design, implement, and market a program that is scalable-one that minimizes up front costs while providing top level service. This article outlines the steps for planning, implementation, and growth of an advanced imaging program.