Organizational and environmental factors in hospital alliance membership and contract management: a resource-dependence perspective

Using a resource-dependence perspective, we analyze the association between organizational and environmental characteristics and the likelihood that non-profit hospitals will enter into one of two forms of interorganizational relationship (IOR): hospital alliance membership or contract management (n = 1,661). The former is representative of high autonomy IORs, while the latter is representative of low autonomy IORs. Results of logistic regression analysis indicate that hospitals with greater resources and more favorable payer mix are more likely to join alliances, an IOR form which minimizes loss of autonomy. In addition, facilities operating in less favorable environments are more likely to be contract managed and less likely to be alliance members.     

Effects of contract management on hospital performance.

The performance of contract-managed (CM) hospitals is compared to that of a set of internally managed hospitals matched on a variety of hospital and market area characteristics. The performance of the study hospitals was similar to that of the matches in the years before the onset of contract management. Among 12 performance indicators, only occupancy rates differed significantly in the two samples in the years before contract management. Occupancy rates were lower on average in the hospitals which later became contract managed. During the 3 years following the onset of contract management, the CM hospitals showed no improvement in productive efficiency but did show changes in the way services were priced. The ratio of gross patient revenue to total expense increased significantly in the CM hospitals relative to their matches. This increase also appears to be associated with an increase in net profits in the CM hospitals relative to their matches.     

使命、契约、法治：创新公立医院管理模式的思考

一、问题的提出卫生部等五部委《关于公立医院改革试点的指导意见》（以下简称《意见》）对公立医院管理体制改革,主要从明确各级政府举办公立医院的职责、探索管办分开的有效形式和改革公立医院的法人治理机制三方面提出了原则性要求。笔者以为,作为对全国公立医院管理体制改革具有指导意义的文件,《意见》从定位到路径,抑或从目标到举措都缺乏前瞻性、系统性和科学性。其实对公立医院管理体制改革的目标,陈竺部长讲得十分明确,     

某医院采用合同能源管理进行节能减排的经济效益评价

目的:从医院角度评价某医院采用合同能源管理进行节能减排的经济效益.方法:比较医院采用合同能源管理前后在能源消耗上的支出.结果:医院采用合同能源管理后,每年节省约55万元的直接能源消耗费用.结论:合同能源管理是降低医院能源费用的一个有效途径.     

创建爱婴医院的一种管理模式

对综合性医院创建爱婴医院的管理模式进行了探讨。即改革产科制度,实行开放式管理、责任制护理,建立出院后的随访网络。     

Adapting a strategic management model to hospital operating strategies. A model development and justification

Industrial organizations have employed the process of strategic management in their attempts to cope effectively with global competitive pressures, while attempting to build and maintain competitive advantage. With health-care organizations presently trying to cope with an increasingly turbulent environment created by the uncertainty as to pending legislation and anticipated reform, the need for such organizational strategic planning is apparent. Presents and discusses a methodology for adapting a business-oriented model of strategic planning to health care.     

Trends in contract management: the hidden evolution in hospital organization

Contract management is an arrangement whereby the day-to-day operation of the hospital is contracted to an outside organization. In the past two decades there has been dramatic growth in the number of hospitals opting for contract management, yet surprisingly little attention has been paid to this phenomenon. Using national data, we report trends and demonstrate that adoption of contracts results in decreases in service offerings more often than increases. Since contract-managed hospitals tend to be located in rural areas, this raises concerns regarding access to care. On the other hand, contract management may allow distressed hospitals to survive.     

美国医院的应急管理模式

美国21世纪发生的恐怖活动、自然灾害、传染病疫情使人们认识到建立一种全新医院应急管理模式的迫切性.政府对医院应急管理的组织领导,指挥和协调、应急准备、应急培训、应急演练、物资管理、通讯和信息传递都提出了明确的要求.美国的大多数医院都采用医院应急管理规划的模式来推动应急管理工作,主要包括:设置专人负责医院的应急管理工作;建立医院应急管理委员会;制定应对突发事件的综合预案;进行脆弱性分析;制定应对突发事件的专项预案;进行必要的应急准备.加强与外部机构的协调和寻求专业支持;开展应急培训和演练;定期进行回顾与评估.专门用于医院应对各类突发事件的医院突发事件指挥系统在美国的医院中被普遍采用.     

医院治理结构改革与医院管理职业化

通过对当前两种医院治理结构的六个要素比较，认为这两种改革模式的主要问题在于不能很好地解决委托人(或董事会)人员来源和委托人的所有权约束和激励以及代理人的约束和激励等两个问题。并据此提出政策建议，认为解决委托人与经营者的约束和激励问题是医院治理中非常关键的一环，国资委应在医院经营中培育一个专业化、职业化的委托人和代理人阶层。     

A methodology model for quality management in a general hospital

A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts.     

浅谈医院后勤经营管理模式

医院后勤由供给福利型管理转向经营管理,是医院适应市场经济、保证改革发展方向的必由之路。计划经济体制下滞后的医院后勤封闭式供给福利服务模式,已经严重制约了医院的改革与发展。在后勤服务社会化的市场竞争中,医院后勤经营管理模式可根据我国目前的基本国情、生产力发展水平、全社会生产社会化的程度和医院后勤工作状况,采取社会化经营、企业化管理的多种实现形式。①院内社会化：实行全面经济承包;成立经济实体;成立经营（企业）实体。②过渡社会化：社会逐步接办后勤部分服务项目;实施“准社会化工程”;创建涉医的集约化、集团化公司;建立生产经营联合体。③社会化：让社会服务行业基本承办医院后勤服务项目。     

医院管理中知识共享模型的构建

文章针对医院管理中知识的特点和知识管理的现状,论述了知识共享的重要性,在理论上构建了知识共享的概念模型,完善了医院管理中知识共享问题的研究,为提高其服务的质量和效率提供了有益的参考.     

医院感染持续质量管理模式研究

医院感染持续性质得管理是在全面质量管理基础上,对医疗工作进行医院感染过程管理和要素管理,保持不间断地医院感染监控,以提高医院感染控制述了地续质量管理的实质及意义、主要方法及管理模式,对医院感染持续质量的关键问题,即要素提取、采集、医院感染危险因素分析、医院感染预测、报警教学模型以及医院感染管理信息系统软件设计与编程进行了讨论。     

A multistage model of hospital bed requirements.

This article presents a model for projecting future hospital bed requirements, based on clinical judgment and basic probability theory. Clinical judgment is used to define various categories of care, including a category for patients who are inappropriately hospitalized, for a large teaching hospital with a heavy indigent and psychiatric workload. Survey results and discharge abstract data are then used to calculate expected discharges and patient days for each clinical category. These expected discharges and patient days are converted into estimated bed requirements using a simple deterministic equation. Results of this multistage model are compared with the results obtained from exercising the simple deterministic equation alone. Because the multistage model removes patients from the hospital if they are deemed inappropriately placed, this model results in the projection of 5.1 percent fewer hospital beds than the simple deterministic equation alone.     

A social systems model of hospital utilization.

A social systems model for the health services system serving the state of New Mexico is presented. Utilization of short-term general hospitals is viewed as a function of sociodemographic characteristics of the population and of the supply of health manpower and facilities available to that population. The model includes a network specifying the causal relationships hypothesized as existing among a set of social, demographic, and economic variables known to be related to the supply of health manpower and facilities and to their utilization. Inclusion of feedback into the model as well as lagged values of physician supply variables permits examination of the dynamic behavior of the social system over time. A method for deriving the reduced form of the structural model is presented along with the reduced-form equations. These equations provide valuable information for policy decisions regarding the likely consequences of changes in the structure of the population and in the supply of health manpower and facilities. The structural and reduced-form equations have been used to predict the consequences for one New Mexico county of state and federal policies that would affect the organization and delivery of health services.     

零缺陷管理模式在医院管理中的应用——新医改背景下的医院管理新模式

本院从2005年开始至今,对医院管理采用零缺陷管理模式,通过诊疗流程大讨论活动,建立“零缺陷”管理流程型组织,新开发并运用“零缺陷”信息化管理平台等举措,大力提升医院整体管理水平,明显改善了医患关系与干群关系,符合新医改的精神。