Hospitals' marketing challenge: influencing physician behavior

Physicians' referring and admitting behavior as well as their clinical management practices are major determinants of hospitals' profitability under prospective payment. Four techniques are available to hospitals that seek to increase market share: Recruitment and retention strategies. In planning the mix of specialties represented on staff, hospitals should consider the effects of a physician's practice on the hospital's case mix. Peer pressure. Peer review programs in hospitals as well as through medical or specialty societies may help persuade physicians to alter their use of services. Education and information programs. Hospitals can assist physicians in patient management by conducting economic grand rounds, developing committees to study and communicate cost data to physicians, and providing information on alternatives to hospitalization. Incentives. Putting physicians at risk by linking planned expenditures to hospital financial performance can influence practice patterns. Other techniques include offering limited partnerships to medical staff members and merging the hospital and medical staff into one corporation. Hospitals may also need to influence physicians away from ventures that compete directly with the institution, such as ambulatory surgery centers.     

Standards for peer evaluation: the hospital quality assurance committee.

Required recertification of physicians has been proposed as a way to improve quality of care. Hospital medical staff quality assurance committees may be more meaningful targets for reform than individual physicians. Review standards are needed to make these committees effective monitors. Increasing regulatory attention to medical staff peer review can be expected.     

Hospital system works to ensure risk management, quality of care

A health care corporation that includes several hospitals and other related health services conducts a wide variety of institutional and corporate activities and programs of risk management and quality assurance. Some of these efforts include board review of medical staff organization and privileges, medical and nursing audits, patient care evaluation, a risk manager and steering committee, patient education, equipment maintenance, and safety programs.     

对北京市涉外医疗服务的思考

在改革放开的新形势下，涉外医疗服务市场迅速扩大，北京市的大医院纷纷挂在外宾门诊，外宾急诊或外宾病房的牌子，中外合资，合作的医疗门诊部也开始兴起，在涉外医疗服务迅速发展的过程中，也存在着一些亟待解决的问题，卫生行政部门应对其加强管理，严格审批，审核制度，理顺管理程序，涉外医疗服务机构也应完善内部管理，在此基础上拓展外向型的服务方式。     

Hospital-physician relationships: imperative for clinical enterprise collaboration

The need for new venues for physician-hospital collaboration is significant and growing, especially between independent physicians and health systems. Often physicians and hospitals act independently of each other, even though maintaining and sustaining a productive relationship between physicians and hospitals is essential to good patient care and improving the health status of the communities we serve. The tension in physician-hospital relationships is a long-standing and widely acknowledged concern. The old model of hospital-physician relationships, governed by the rules of the organized medical staff structure, doesn't work in the current environment, which has grown increasingly complex as a result of economic, legal, and care-delivery changes. These complexities make relationship management challenging. Hospitals and physicians struggle to align behaviors to achieve cost and quality goals. The need has never been greater for hospitals and physicians to work together as a joint clinical enterprise to improve quality, reduce practice variation, and control the cost of healthcare. This article explores the challenges and some options for improving the physician-hospital relationship in the current environment.     

Innovative Peer Review Model for Rural Physicians: System Design and Implementation

ABSTRACT:  Context: The peer review process in small rural hospitals is complicated by limited numbers of physicians, conflict of interest, issues related to appropriate utilization of new technology, possibility for conflicting recommendations, and need for external expertise. Purpose: The purpose of this project was to design, test, and implement a virtual peer review system for small rural hospitals in Texas. We sought to define the characteristics of a virtual peer review system in the context of rural health care, and to explore the benefits from peer review administration within a rural network supported by a university. Methods: Physicians from small rural hospitals participated in pilot testing of the system. Policies and procedures reflecting the innovative character of the new peer review process were developed based on legal/regulatory requirements and desired educational focus of the process. An information technology system to support the virtual peer review was selected, tested, and deployed. Findings: The system tests suggested feasibility of the procedures, reliability of the communication lines, and functional anonymity of the hospitals and physicians participating in the virtual peer review. Participating institutions and individual physicians expressed satisfaction with the reliability and user friendliness of the system as demonstrated during the pilot tests. Conclusions: Hospital licensing and accreditation require a process to monitor and evaluate the care of patients. Utilizing means of virtual communication is a viable option for small rural hospitals. This process is dependable, user-friendly and provides functional anonymity to participating hospitals and physicians. The peer review system has successfully functioned since 2004.     

Passing the torch. Medical staff retirement planning maintains continuity of care

A medical staff retirement program can ensure long-term accessibility to care for the community and financial viability for the hospital. Thus hospitals should become actively involved in the physician retirement planning process. By so doing, they can preserve a patient base that may have taken years to develop and, once lost, may be difficult to recover. To establish a successful medical staff retirement plan, hospitals should: 1. Analyze medical staff demographics. 2. Set procedures for determining the practice's value. 3. Develop an approach for financing the sale. 4. Define the hospital's role as a financial intermediary in the sale. 5. Determine whether the hospital will share costs with the seller. 6. Establish a communication plan to introduce the retirement program to the medical staff. In the sale of a physician's practice, some of the hospital's options include purchasing the practice, helping the seller find an associate to purchase the practice, initiating a group at the hospital and merging the practices into the group, or simply providing the physician with moral support.     

医院维和医疗分队派遣工作的组织与准备

派遣医疗分队参加国际维和行动的卫勤保障,是我国越来越多地参与国际事务,国际地位日益提高的重要标志。医院作为派遣维和医疗分队的主体,依据联合国所赋予的各项任务,在派遣工作的组织和准备上,需要有明确的目标和周密的计划。担负派遣任务的军队医院还必须在人员选拔和抽组、各种技能的培训、物资装备的筹措、分队的组织与管理、卫勤任务的评估等方面进行充分准备,确保所派遣的医疗分队能顺利地完成联合国赋予的维和卫勤保障任务。     

Hospital infection control in Poland

During the last 10 years, as in other areas of the public sector in Poland, the healthcare system has undergone important changes presenting a challenge for medical staff and healthcare managers alike. Since 1997, the Polish Government has undertaken important healthcare reforms. New regulations have introduced decentralization of management and a financing system for hospitals. These changes have provided favourable conditions in which to implement an infection control system for hospitals. The most important recent initiatives are training courses and workshops for hospital staff organized in co-operation with microbiologists and epidemiologists as well as preparation of recommendations and guidelines for hospitals. Several non-governmental organizations have been set up to improve hospital hygiene, infection control and monitoring of antimicrobial resistance.     

Quality improvement of medical diagnostic laboratories

Service quality in medical laboratories is influenced by a number of variables. Medical laboratories have long recognized the need for total quality management that incorporates the continuous improvement of all stages, such as the pre-analytical, analytical and post-analytical phases, of the diagnostic process, in addition to the traditional internal and external quality control of analytical procedures. Based on national and international experience, continuous improvement of quality and its external assessment are of high priority in order to guarantee a reliable, effective and cost-effective diagnostic service. Certification of health care services, according to ISO 9001 standards in Hungarian hospitals, is not sufficient to prove professional competence of medical laboratories, which called for a system of laboratory accreditation. Accreditation is an external professional audit by which an independent accreditation body gives formal recognition that the medical laboratory is competent to provide high quality services that are compliant with rigorous professional standards of best practice. The primary aim of accreditation is the improvement of the quality of diagnostic services by voluntary participation, professional peer review, continuous training and education and compliance with professional standards. In vitro medical laboratories have pioneered quality control and quality assurance in health care. Based on these strengths and traditions, the introduction of the accreditation program of medical laboratories in Hungary is one of the key professional and ethical responsibilities of diagnostic professions, in order to improve the quality, efficiency and effectiveness of laboratory services during the course of Hungary's accession to the European Union.     

医务人员对三级公立医院绩效考核政策的关注度及其影响因素分析

目的调查医务人员对国家三级公立医院绩效考核政策的关注度及其影响因素。方法多阶段随机抽取我国东部、中部、西部地区2019年度考核等级结果为优秀、良好、一般的各一家三级公立医院（共计9家）,对13 211名医务人员进行问卷调查。使用SPSS 22.0软件对数据进行统计分析。结果医务人员对国考政策的医疗质量、运营效率、持续发展、患者满意度、医务人员满意度5个维度关注度分别为95.88%、94.00%、94.58%、93.26%、98.27%;总关注度为97.78%,影响因素包括地区、专业技术职称以及行政管理职务。 结论医务人员对国考政策总体关注情况良好,低职称者以及无管理职务者是关注度的重点提升人群。建议医院管理者对不同类别医务人员进行个性化管理,从医院绩效管理循环入手,提升医务人员关注度,促进国考政策落实。     

Hospital adaptation to risk-bearing: managerial implications of changes in purchaser-provider contracting

A number of countries have adopted contracting reforms in which hospitals are placed at financial risk. This risk has stimulated a number of adaptive strategies to achieve organizational success. This paper presents a model of six forms of contracting relationships and reviews the adaptation strategies observed in three health systems: the USA, England and the Netherlands. These strategies include service diversification, improved management information systems, the employment of marketing and contract managers, the use of clinical pathways, case management and concurrent/retrospective review of hospital stays, quality management and quality assurance programs, pre-admission authorization, discharge planning, and physician profiling and participation in management. These adaptive strategies have three implications for managers: increased 'partnering', with purchasers, collaboration with medical staff, and assumption of managed care roles. Two groups of institutions are at risk from the changes in hospital contracting: university teaching hospitals and inner-city hospitals serving socially deprived populations. The paper ends with implications for the education of hospital managers and research on hospital management and adaptation to contracting.     

Implementing meaningful CME as an essential component in a community hospital quality assurance plan.

The pursuit of high-quality patient care within a community hospital highlights the tenuous relationship between the hospital board and administration on one side and the voluntary medical staff on the other. Craddick describes the need to monitor and improve patient management, the commitment of physicians and administrators to high quality care, and the unfortunate failure of most hospital programs to go beyond paper exercises designed to satisfy the Joint Commission of Accreditation of Hospitals (JCAH). The American College of Surgeons summarizes current methods of monitoring the quality of patient care, and gives four examples of successful programs. The JCAH Manual sets standards for hospitals and medical staffs to achieve. However, thus far no one has described how a hospital's medical staff, board, and administration join forces to implement a comprehensive quality assurance program. This paper presents the experience of one community hospital in dealing with this problem over a two-year period.     

Physician relations: an evolving service not meeting its potential

The relatively new concept of physician relations can help hospitals work with their medical staff as colleagues rather than competitors. Every hospital has someone performing at least some physician relation tasks, but too often that person is at the level of an administrative assistant. Only a few hospitals have full-blown physician relations departments with full responsibility for medical staff relations, quality assurance, credentialing and medical liability.     

军队医院地方医保信息共享综合管理平台的整体设计

目的研制出可扩展的医保患者信息共享综合管理平台,为职能管理部门有效控制费用及制定管理策略提供数据支撑,将医务人员从繁重的医保政策执行和费用拒付压力中解放出来。方法建立业务层和管理层两大类功能模块,构建不同层面和粒度的医保信息网络化共享平台。结果形成军队医院与医保政策相结合的最优化业务模式。结论保障医院资金管理的精确性和安全性,提高军队医院适应地方医改的效能。     

Establishing a rural hospital cooperative: a case study.

Rural hospitals have traditionally been the providers of health services in rural areas. In recent years, however, rural hospitals have come under increasing economic and regulatory stress. Rural hospital cooperatives represent a new level of shared management that addresses mutual problems using a horizontal organizational model. In 1987, the Western New York Rural Health Care Cooperative was established by building on fragments of associations that had existed previously. Triggered by an opportunity for grant funding, a major regional cooperative evolved which has demonstrated effective responses to a variety of problems inherent in providing rural health care. Particularly successful programs have such features as a quality assurance plan that uses cooperative-wide peer review, nursing and allied health education, physician recruitment, and the active involvement of a university medical school. This paper is a case study of the development and success of the Western New York Rural Health Care Cooperative.     

Concealing Accidental Nursing Home Deaths

Nursing homes' ethics committees play a role in designing policies to assure ethical care. The administrative structure of nursing homes is not as large as that of hospitals. Nursing home staff and administration can respond to medical accidents in a way that treats family unethically and does serious harm to the facility. This paper describes incidents in which nursing homes attempted to conceal accidental deaths. It describes how such incidents are discovered, and the consequences of such efforts, and suggests ways to prevent such incidents.This paper presents a retrospective review of a convenience sample of eight cases in which it was discovered that a nursing home attempted to conceal an accidental death. The effort to conceal an accidental death requires a coordinated effort to: [1] limit dissemination of information about the accident by staff and records, [2] decrease suspicion about the death, and [3] decrease the likelihood that an inquiry, if launched, will succeed. This effort begins as a reflexive, emotional and defensive response to the accident and consolidates as an institutional strategy to conceal both the accident and the concealment. The effort is coordinated by administrators who coerce cooperation from front line staff, alter medical records, and fail to follow reporting procedures. The attempt to conceal a lethal accident adversely affects the facility and the healthcare system. Ethics committees should work with professional organizations and administrator to assure proper management and disclosure of harmful accidents.     

浅析基层医院医患纠纷的原因及防范

近年来,基层医院医患纠纷逐年增多,通过1999²013年在基层工作实践体会,发现基层医院医患纠纷发生的原因多个方面:基层医院改革和管理不成熟,医务人员技术水平、沟通、服务不到位,医院内部不团结、缺乏自我保护意识;患者对医疗服务期望值过高、依从性差、经济条件差并法制观念薄弱;以及社会、媒体等方面的原因。对此,应当加强基层医院的内部管理、提高医务人员综合素质、加强医患沟通、增强自我保护意识,树立基层医院良好的形象,才能有效缓解医患关系的紧张,构建和谐的医疗环境。     

International patients: a lucrative market for U.S. Hospitals

Ravaged by diminishing revenues and intense price competition, U.S. hospitals desperately need to find profitable areas of healthcare. International patients that travel to the United States for treatment offer such an opportunity. Marketing directors, administrators and medical staff of leading hospitals are recognizing the value of this market segment. They are making special efforts to attract foreign patients. They have developed tailored services for international patient and are forming alliances with civic and business organizations to support the needs of patients traveling from overseas.     

医院绩效管理的探讨

探讨如何建立和完善医院的绩效管理。医院绩效管理应结合战略管理和医院内部各岗位职责,加强绩效辅导和沟通,根据医院管理现状确认考核指标,强化考核结果应用,兼顾效率及质量。建立健全医院绩效管理体系,有利于激励医护员工的积极性,进一步规范优化医院的运行机制,提高医院的运行效率,提高医院的核心竞争力、实现医院的战略。