医联体背景下基层医疗卫生机构发展需求模型构建

目的：构建基层医疗卫生机构发展需求模型。方法：对医疗机构工作人员、医联体负责人及卫健局相关负责人进行半结构化访谈,使用内容分析法,借鉴Leavitt组织变革理论构建基层医疗卫生机构发展需求模型,凝练出各类范畴,并进行频次统计。结果：组织结构发展、任务发展、技术发展和人员发展需求频次占比分别为57.2%、18.0%、12.7%和12.1%。组织结构发展需求包括人事政策、医保政策、基本公卫政策、首诊转诊机制、政府管理优化和医联体内管理优化;任务发展需求包括机构发展规划、辖区管理优化、业务整合、工作内容优化及机构内绩效管理;技术发展需求包括硬件设施建设、信息化建设、横纵向带动措施及专项服务能力提升;人员发展需求包括人员能力与职业精神提升。结论：基层医疗卫生机构存在组织结构、任务、技术和人员方面的多方位发展需求,相关政策和管理方式需定向完善以满足不同层次单位的需求。     

实施医疗质量审评加大监督管理力度

吉林不管不顾要对吉林省医疗机构医疗质量进行监督审评。认为实施医疗质量审评,加大监督管理力度应从以下几方面入手：（１）学好文件,抓好落实;（２）预防为主,强化规范;（３）监督评审,依据标准。     

Should we plan for contraction in health services? The Jamaican experience

Internationally a ‘standard scenario’ has been developedtreating the world economic recession since 1982 as the causeof declining health care and health in developing countries.Attempts to apply this scenario to Jamaica suggest that thedecline can be blamed equally on limitations of planning andmanagement. Existing planning procedures are associated withexpansion, and do not work well in situations of contraction;nor does the existing health service management system provideimpetus for contraction as it does for expansion. For planningand management under contraction, the required procedures mayinvolve greater privatization and decentralization. Part of the required impetus may come from external agencies,and part from emerging management groups within the health services.Both these sources present problems for developing countrieswhich remain to be solved. It is suggested that while the specificsof health care planning and management will differ from countryto country, the best prospect for improved management systemslies with a national merging of critical professional subgroups- health administrators at the local institutional level, andbroadly qualified epidemiologists and public health staff atthe national level.     

Are Michigan hospitals facing a shortage of trained personnel?

The 1990 MHA Health Personnel Shortage Survey requested information on 31 personnel positions to determine the extent of personnel shortages, the sources of replacement personnel, the positions for which it is most difficult to recruit applicants, and the positions for which it is most difficult to retain personnel. In addition, hospitals were asked about the impact of personnel shortages on hospital services, the strategies they had implemented to alleviate the problems caused by shortages, and their commitment to, and involvement in, training and educational programs to increase the availability of health care personnel in Michigan. A total of 77 Michigan hospitals and health care institutions responded to the survey. Analyses were performed on a sample of 69 community hospitals distributed similarly, with respect to hospital bed size category and geographic location, to the state total of 176 Michigan community hospitals. For more information, or for a copy of the complete 1990 MHA Health Personnel Shortage Survey report, contact the MHCI Health Policy Analysis Department.     

MATCH: a maternal and child health information network

The Maternal and Child Health Information Network--MATCH--was begun in 1984 as a demonstration project with support from the Division of Maternal and Child Health of the Health Resources and Services Administration, Public Health Service. The primary purpose of the project was the development of a system to manage data related to prenatal, child health, family planning, and genetic services that are delivered with State support in clinics in the State of Ohio. The design of MATCH enables the same data base to be used at both the State and local levels. Because it allows all participants, central and district, to manipulate the raw data, it is called an end-user--as opposed to a batch retrieval--system. Data recorded on individual forms during each client's visit to local service clinics are collected and entered into a microcomputer whose software package is a commercial data base. The clinic can then use the data for its purposes: program planning, management, evaluation, client referrals, appointment followup, quality control, and billing. The same data are also uploaded by central office staff to the State's DEC mainframe from data-filled disks mailed in by the clinics. Personnel who staff local projects can access their own data on the mainframe computer to generate reports for local use and send and receive messages electronically. That is, the system is "interactive."(ABSTRACT TRUNCATED AT 250 WORDS)     

Role Divergence and Complexity in Gerontological Home Care

This study documents high levels of role complexity and functional overlap in the field of home health care. Personnel perform a wide range of "professional/organizational" and "community/ familial" service functions though the emphasis is on the delivery of a battery of pseudo family-like tasks. The importance of a familial orientation does not significantly decline when controlling for length of employment or organizational rationality. Role orientation is, however, simificantly associated with a worker's chronological age. Results lead to program planning recommendations meant to influence staff training paradigms in home health care.     

Role divergence and complexity in gerontological home care.

This study documents high levels of role complexity and functional overlap in the field of home health care. Personnel perform a wide range of "professional/organizational" and "community/familial" service functions though the emphasis is on the delivery of a battery of pseudo family-like tasks. The importance of a familial orientation does not significantly decline when controlling for length of employment or organizational rationality. Role orientation is, however, significantly associated with a worker's chronological age. Results lead to program planning recommendations meant to influence staff training paradigms in home health care.     

2010年青岛市预防保健与社区卫生服务机构间分工合作情况调查分析

[目的]找出制约预防保健机构与社区卫生服务机构之间建立分工协作关系的症结,提出建设性意见。[方法]2010年,用6种调查问卷,对全市疾病预防控制、妇幼保健和12个社区卫生服务机构的负责人和工作人员进行调查,了解其合作关系状况、服务情况和效果等。[结果]72.22%的疾控人员、68.06%妇幼人员认为预防保健机构的技术指导滞后,90.28%的疾控人员、91.67%妇幼人员认为信息沟通不畅,65.28%的疾控人员、68.06%妇幼人员认为合作关系未理顺;不同机构对存在问题的态度存在显著性差异。[结论]应明确预防保健机构的职能定位,理顺其与社区卫生服务机构的合作关系,完善技术指导和信息报告制度,以促进基本公共卫生服务工作的顺利开展。     

Rapid assessment of an African district health system. Test of a planning tool

Occasional rapid health care system assessments are potentially useful for planning, for monitoring health care systems development over time, and for comparing health systems in different areas. With the decentralization of health sector management, for example in Kenya, there is a growing need of such assessments at district and sub-district levels. Can rapid assessments be conducted at affordable cost at these levels? What variables and methods are feasible? This paper reports on a rapid health system assessment conducted in rural Kenya during 1991. It required the completion at each health facility of a self-administered questionnaire which included questions on resources, health care programmes, management, service output, and prominent problems. It also included interviews with officers in charge of each health institution in the sub-district and an examination of records and reports available at each facility The paper presents the range of issues addressed, the indicators used, the methods applied, the problems encountered, the costs of the assessment, and a small selection of the findings. We conclude that the assessment model is manageable at district level with modest planning and analysis support from central level. Field staff need more precise instructions for completion of the questionnaire, and more population-based estimates need to be calculated. Reassessment taking place every 3–5 years should be adequate for monitoring the process of change in the local health care system.     

Motivating health workers through nutrition training: an example from Egypt

Inappropriate training of primary health care staff and underuseof health facilities are two widely recognized problems in Egypt.Collaboration between the regional health services, a universitynutrition department and external technical assistance enableda successful programme of nutrition training to be set up inthe governorate of Alexandria. Locally adapted training materialswere produced. The training improved teamwork in the healthcentre and increased levels of nutrition activities within motherand child health (MCH) care. This, together with wide publicityof the aims of the programme, increased activity, continuityof care and established mothers' groups, resulted in greateruptake of services, and better infant feeding practices. Regular supervision of staff, using field staff as trainers,and constructive feedback were identified as factors which increasedthe motivation and morale of health centre personnel. The integrationof the project with local health management structures ensuredthat the lessons learnt were well disseminated and incorporatedinto future planning. Recommendations are made in this paperon community consultation, supervision by health care managers,and on local analysis and relevance of the health information.     

The manager and continuing education

Continuing education in health care organizations consists of that which is required by law or regulation and that which is optional. The required is done because it must be done; the other, including most management development and some staff education, is often ignored. Nonrequired education is one of the first items to go during budget-cutting exercises. Yet continuing education at all levels, for managers as well as nonmanagers, is essential in keeping health care workers abreast of rapid change. Much continuing education, even that for rank-and-file staff, is up to the department manager, and with few exceptions, the pursuit of continuing management development is left largely to the individual manager. The department manager is an educator of staff and is also largely responsible for self-development.     

Access to usual source of care by race and income in ten urban areas

In terms of less access to private sources of care (as distinguished from hospital-public clinics) and longer travel time to usual source of care, poverty areas are at a disadvantage. Within the ten areas studied, the poor have less access than the nonpoor, with access differences even greater between the races than between income groups. Blacks generally have less access than whites when income differences are taken into account. Both the type of usual source of care and travel time appear to be related to differential utilizations of ambulatory care resources: persons reporting private sources of care and persons with shorter travel time to their usual source of care tend to make more physician visits in a year. Mechanisms for public financing of health care will not likely alleviate the problems of inaccessibility presented by poverty areas. It is in these areas of low access that public responsibility to organize and locate facilities will continue even after the advent of a fairly comprehensive payment mechanism for health care among the poor.Ms. Okada is Statistician and Mr. Sparer is Acting Director, Division of Health Services Evaluation, National Center for Health Services Research, Health Resources Administration, Department of Health, Education, and Welfare, Parklawn Building, Rockville, Maryland 20852.     

Oral health problems and support as experienced by people with severe mental illness living in community‐based subsidised housing – a qualitative study

The purpose of this study was to explore how persons with severe mental illness (SMI) experience oral health problems (especially dry mouth), and weigh the support they received in this regard from professionals and staff at community‐based congregate housing through a controlled intervention programme. Oral health problems and dry mouth are found in association with apathy and indifference, cognitive deficits, and long‐term medication with psycho‐pharmacological drugs. The present study describes the results from one part of a longitudinal intervention programme, which sought effective ways of mitigating dry mouth through increased support with oral health problems. This part consists of 67 informal interviews with ten participants in two community‐based urban housing projects between November 2006 and June 2007, with a follow‐up session in December 2007. Content analysis of the results yielded five categories: The shame of having poor dental health, history of dental care, experiences of self‐care, handling of oral health problems, and experiences of staff support. Poor oral health caused shame and limited participation in social activities. Participants avoided oral health issues by such circumventions as denial of a tooth ache or dental infections, or postponing oral problems with the hope that they would die away. Offers of support were frequently resisted because of unsatisfactory prior encounters with dental professionals and staff. Our findings suggest that self‐care needs to be facilitated in an unobtrusive manner with minimal staff involvement, and clients should be referred to dental care providers experienced in treating people with SMI.     

医院药房管理中存在的问题及其改进措施

医院药房管理在目前的医疗管理工作中，占据着非常重要的地位，不仅影响医患关系的发展，同时对社会上的舆论走向以及国家医疗事业的进步，也产生了较大的作用。相对而言，医院药房管理当中的问题比较多，大部分的问题都是堆积已久的，不容易解决。在今后的药房管理当中，必须建立管理工作中的良性循环，提高工作人员的素质，健全药房管理的手段和体制，从根源上治理问题，而不是暂时压制问题。     

Continuing training plan in a clinical management unit

Continuing Care Unit (UCA) focused the attention of frail patients, polypathological patients and palliative care. UCA attend patients at home, consulting, day unit, telephone consulting and in two hospitals of the health area. From 2002 UCA began as a management unit, training has been a priority for development. Key elements include: providing education to the workplace, including key aspects of the most prevalent health care problems in daily work, directing training to all staff including organizational aspects of patient safety and the environment, improved working environment, development of new skills and knowledge supported by the evidence-based care for the development of different skills. The unit can be the ideal setting to undertake the reforms necessary conceptual training of professionals to improve the quality of care.     

Plan de formación continuada en una unidad de gestión clínica

Continuing Care Unit (UCA) focused the attention of frail patients, polypathological patients and palliative care. UCA attend patients at home, consulting, day unit, telephone consulting and in two hospitals of the health area. From2002 UCA began as a management unit, training has been a priority for development. Key elements include: providing education to the workplace, including key aspects of the most prevalent health care problems in daily work, directing training to all staff including organizational aspects of patient safety and the environment, improved working environment, development of new skills and knowledge supported by the evidence-based care for the development of different skills. The unit can be the ideal setting to undertake the reforms necessary conceptual training of professionals to improve the quality of care.     

建立分级诊疗制度的动力与阻力分析——基于利益相关者理论

分级诊疗体系的构建和运行涉及到医疗卫生服务的需求方、供给方、管理方和筹资方等多个利益相关方。各利益相关方的利益诉求、政策影响力和执行意愿各异,在建立分级诊疗制度的过程中发挥着不同程度的推动或阻碍作用。本文从利益相关者的角度深入分析分级诊疗,认为卫生部门和医保部门是建立分级诊疗制度的主要推动力量,但二者在实施路径上存在差异;财政、发改(物价)等部门的协调配合是分级诊疗顺利推进的必要条件;基层医疗卫生机构的管理者和医务人员是分级诊疗的重要推动因素,但前提是要对相关体制机制进行深层次改革;医院的管理者和医务人员在分级诊疗中利益受损的可能性较大,是政策推行的主要阻碍因素,但二者的阻碍程度不同;居民/患者本应是分级诊疗的重要受益者,但若政策运行不畅、引导措施不当,也有可能成为阻碍因素;医药器械商选择性地参与部分环节,有望成为推动分级诊疗的支持力量。     

Mental health training and development needs of community agency staff

Emphasis has long been placed in UK national policy on providing 'seamless' mental health services to meet both the health and social care needs of service users. While attention has been paid to the training required by specialist mental health and primary care staff in order to achieve this, the needs of other community agency staff have received less attention. The present article describes a study designed to identify the training needs of staff working within a broad range of agencies. Focus group discussions were used to explore participants' experiences of mental health problems amongst clients, their confidence in dealing with these, current sources of support and perceived training needs. The results indicate that participants in all agencies routinely encountered a range of problems. Colleagues were the main source of support, followed by line managers, but supervision structures and wider organisational support were lacking in some cases. Joint working with specialist mental health services was almost universally problematic and all groups identified a range of training needs. On the basis of the results, the present authors put forward suggestions as to how these needs might be met.     

全国三级妇幼保健机构人力资源调查分析

目的 通过调查分析我国三级妇幼保健机构人力资源状况,为今后妇幼卫生政策的制定提供依据.方法 在全国抽取11个省级、30个地/市级、76个区/县级妇幼保健机构,采用信函调查方法,调查辖区人口经济状况、现有人力资源状况、保健服务量.结果 在各级妇幼保健机构,专职妇幼保健人员占专业技术人员的比例均较低;专职妇幼保健人员中,中专学历的比例比较大,市级和县级妇幼保健机构高级职称者的比例都小于11%;与《各级妇幼保健机构编制标准》相比,各级妇幼保健机构专职保健人力配备不足,而绝大多数妇幼保健机构2000年保健服务实际投入人力远远超出拥有的妇幼保健人力.结论 我国三级妇幼保健机构存在保健人员专业素质低、专职保健人力配备不足、不能满足实际妇幼保健工作需求的问题.     

A training pack. Field programme management: food and nutrition

One of the main barriers to development is the lack of adequately trained field staff. It is now widely recognized that the field worker plays a crucial role in implementing community development programmes. National development plans may look promising on paper but without the staff in the field, capable of managing the programmes, there is little chance for substantial gain from development efforts. To help address the problem of training for field workers, the Food Policy and Nutrition Division has produced the Training Pack. Its aim is to help field workers develop simple management skills which can be used in their daily work. The material in the Pack stresses those management techniques required by all field workers, whether their primary responsibility is agriculture, health, nutrition or community development. The Pack uses aspects of food and nutrition to illustrate the basic management skills, without attempting to turn the field workers into nutritionists. The emphasis of the Course is on the planning, implementation and evaluation of community activities. The practical approach advocated by these training materials is described in detail here.