深化专家督导科主任查房制度对医疗质量的促进作用

目的：建立专家督导科主任查房的长效机制,根据医院实际情况选择不同重点,有针对性地发现和解决医疗质量管理中存在的问题,做到逐年医疗质量持续改进。方法：准确选择查房重点,不断修正检查标准细则,通过信息化平台选择病例,专家为主体对口查房督导;综合讲评存在问题,制定改进措施。结果：发现和解决深层次的问题,不断深化质量管理。结论：深化专家组督导科主任查房是促进医院医疗质量持续改进的有效举措。     

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。     

浅谈加强科主任查房管理

加强科主任查房是提高科室医疗技术与质量的重要环节.现根据我院科主任查房管理的经验,从4个方面对科主任查房进行探讨.     

实施科主任教学查房考评的做法

实施科主任教学查房考评的做法隋友乐作者单位：２６５２００山东省莱阳市解放军一四五医院医务处为了适应市场经济，切实提高医疗质量，我们对临床科主任教学查房质量进行了调查。（一）教学查房存在的问题：①查房目的不明确。②查房准备不充分。③部分年轻科主任“三基...     

淮南市第一人民医院启动科主任规范化查房评价工作

8月15日，淮南市第一人民医院医务科组织该院医疗质量管理委员会部分成员对神经内科张主任查房进行现场观摩评价，这也拉开了该院科主任规范化查房评价工作的序幕。科主任规范化查房评价工作是今年该院按照PDCA循环管理模式，为促进科室行政管理与业务管理相结合而开展的一项重要医疗管理工作。医院于8月5日按照“三级医师查房制度”有关规定，结合该院实际情况。制定下发了《临床科主任查房规范（试行）》和《科主任查房规范评分标准》，将于2013年8月15日至2014年3月6日陆续开展一轮科主任查房现场评价工作。医务科将组织该院有关专家按照《科主任查房规范评分标准》进行现场观摩，针对科主任查房时的科室准备（病人、病历、病房、物品等）、仪表着装、查房人员站住、人文关怀爱护意识、具体查房内容情况进行评价，评价结束后现场反馈评价情况，考核结果也将以一定形式在院内进行公布，同时也将作为年终科主任考核的一项指标。     

院级综合质量查房在医院医疗质量建设中的应用

查房是医疗活动中极为重要的环节,也是提高医疗质量的有力措施,通常有院级查房、三级查房(住院医师、主治医师、科主任或主任医师查房),而院级查房又是查房的重要组成部分,其质量的优劣,不仅反映医院科学管理的水平,也是衡量医院医疗质量内涵深浅的重要标志。我院自1995年开始,对院级质量查房的形式、内容进行了大胆的改革创新,实行医院综合质量查房管理,取得了显著成     

提高科主任查房质量的探索与实践

加强医院科室质量管理，提高科主任查房质量，是科室和医院业务建设一项基本的、长期的、重要的工作.近年来，本院在提高科主任查房质量方面做了积极的探索和实践，取得了较好的效果，提高了医疗质．量和诊治水平，促进了医院的建设和发展。     

360度评估在综合医院内科科主任查房质量监控中的应用

目的探讨360度评估应用于综合医院内科科主任查房质量监控的可行性和实用性。方法依据360度评估的原则，选择上级、平级、下级及外部评估者作为评估对象，分别针对各类评估者制定不同的评估内容，采用专家评议法确定各部分内容的权重，采用现场评估的方法收集评估资料。结果360度评估用于科主任查房的质量监控可以全面、有效地收集内科科主任查房质量的信息，可以及时发现内科科主任查房中存在的问题。结论采用360度评估对内科科主任查房质量进行监控具有一定的可行性和实用性。     

规范科主任查房的对策

科主任查房是由科主任负责实施、各级医师参加的双向性、实践性诊疗活动。抓好科主任查房,对学科发展甚至医院整体建设具有重要意义。1存在问题1.1查房功能被弱化受市场经济影响,科主任院外活动增加,不能拿出足够、有效的时间做准备;加上工作量大、军队体制编制调整导致医生紧缺等因素影响,科主任查房有逐渐被弱化的趋势。个别科主任只顾自己看病人,既没有病情分析,也没有诊断探讨;还存在只关注影像诊断、不对疾病作全面分析、物理检查不够细致等现象。1.2查房记录质量不高查房记录内容苍白单调,流于形式,常见是“某主任看过病人”,或“某主…     

科主任教学大查房与医疗质量安全管理

目的通过开展科主任教学大查房工作,确保医疗质量和医疗安全。方法全院33个内、外科临床科室每月各进行一次,全面规范地开展了科主任教学大查房。科教科派出专家组给予定期督查,考评结果作为临床科室和科主任绩效考核的重要内容。结果从2007年9月开始至今,全院共进行594次科主任教学大查房,参加人数平均达10 692人次。其中优秀81%,良好13%,合格6%。结论经过1年多的临床实践,提高和巩固了各级医生的医学基础理论水平,训练了临床思维能力,促进了医疗质量的提高,确保了医疗安全,打造了学习型医院,收到了良好的效果。     

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     

Lessons learned hiring HMO medical directors

A medical director has enormous influence on medical cost and quality in managed care organizations. Little empirical work has been done on the attributes of an effective HMO medical director. The survey discussed in this article sought to examine those desirable traits from the perspective of medical directors who have risen in the ranks to become employers of medical directors. Mailed questionnaires asked 30 experts to rate skills and personality qualities based on what they would look for in a prospective hire. The factors that emerged as significant were communication and interpersonal skills, clinical credibility, ego strength, concern about quality, motivation, data orientation, and leadership qualities, along with organizational/systemic variables. Implications for hiring and physician education are drawn.     

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.     

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.     

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.     

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.     

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。     

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.     

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.