Study on proper applying TQM in classroom teaching

1 Introduction-What is Total Quality Management (TQM)? There are many definitions of Total Quality Management(TQM)around.Some define TQM in a way different to some others.But in general definition of TQM should contain the following characteristics:     

区域医疗服务模式在医疗物联网中扮演的角色

目的：通过对医疗物联网的应用,认知其给区域卫生院的服务模式带来的变革,从而逐步转换职能,以治疗为中心的模式向预防为主服务模式转变。方法：区域卫生院以及居民家庭可以小规模应用医疗物联网设备、集成应用平台系统,检测、传送居民健康信息。结果：通过对其应用,增强社区医院以及卫生管理中心保健预防功能,以保健预防为主服务新模式。结论：通过探索行之有效的服务新模式,促进社区医院以及卫生管理中心职能转变,谋求自身发展。     

综合医院全科医学科指导基层卫生服务的SWOT分析

以社区卫生服务中心及乡镇卫生院为代表的基层卫生服务机构作为我国医疗卫生系统的重要组成,是提供基本医疗卫生服务的主体,其服务能力建设在构建高效有序的分级诊疗体系中具有重大的战略意义。随着我国医药卫生体制改革的不断推进,基本医疗卫生服务的重要性愈发凸显,但当前我国基层医疗卫生服务发展仍处于初级阶段,基层卫生服务人员不足、质量不高仍是限制基层医疗水平的主要问题。如何探索有效途径,全面提升基层卫生服务能力,已成为推动基层卫生发展的关键所在。近年来,综合医院全科医学科在国家政策支持下,学科建构及基地建设不断完善,作为联系基层与综合医院的桥梁,依靠医疗、教育、科研等优势,有能力、有责任对基层医疗卫生服务的开展进行指导与帮扶,促进上、下级医疗机构的合作交流。本文以SWOT分析法,结合综合医院、社区卫生机构及卫生行政部门相关专家的研讨意见,系统梳理综合医院参与指导基层医疗卫生服务的优势(strengths)、劣势(weaknesses)、机遇(opportunities)和风险(threats),全面分析综合医院全科医学科指导社区卫生服务的必要性与可行性,并在发挥优势,克服劣势,抓住机遇,规避风险等角度提出相应的发展策略,为进一步提升基层卫生服务能力、推动分级诊疗体系建设提供借鉴和参考。      

从突发公共卫生事件的应对看全科医学科的职责和定位

全科医生是居民的健康守门人,在突发公共卫生事件和重大传染病防控中承担重要责任.自新型冠状病毒肺炎疫情蔓延以来,全国上下开展了一场史无前例的疫情阻击战,基层医疗卫生机构医务人员全部出动,在疫情防控中发挥了积极作用.但是,此次疫情也暴露了全科医学服务的部分缺陷,如全科医生数量不足;全科医生服务能力,尤其是公共卫生服务能力不...     

心理科护理推行ISO9000质量管理体系的体会

目的：介绍在心理科护理中推行ISO9000质量管理体系的体会。方法：制定心理科护理质量标准和评分细则，进行综合性考核，建立、健全心理科住院患者组织管理制度，落实健康教育责任制，合理调配护理人力资源，对影响护理质量的关键环节进行控制。结果：体系运行后，护理质量明显提高，各项护理服务质量考核成绩名列医院前茅，患者综合满意度为98％，个性化亲情护理服务为99％，护患纠纷与上年度相比下降了10％。结论：此项活动既规范了护理服务质量管理，又增加了患者的满意度，提高了科室的经济效益和社会效益，实现了心理科护弹服务质量的自我完善和持续改讲。     

农村基本医疗服务网络中纵向连续性服务质量链的关键评价指标研究

基于我国农村基本医疗服务网络整体性缺乏、连续性不足的现状,通过引入系统工程学中的质量链管理概念和基本研究方法,对农村连续性基本医疗服务的现状和存在的问题进行分析,总结出评价农村纵向连续性服务质量链的关键指标,为质量链管理理论在卫生系统研究中的应用提供前期的理论研究基础。     

大型综合医院基层社区卫生服务模式探索与实践

目的：探索大型综合医院如何将优质的医疗资源下沉到基层,解决边远地区群众看病难的问题,为大中型公立医院基层社区卫生服务创新和改革进行探索和实践。方法：投资480万元购买检查设备齐全的健康直送车,组织成立博士专家团、名医专家团、义工服务团,每周深入到偏远山区、湖区等经济落后、交通不便的地区开展健康咨询、健康查体、健康大课堂、乡村医生培训。结果：提高了基层群众健康观念;为基层医疗机构增加了技术活力,拓展了业务量,为大医院注入医疗科研资源;有效缓解了群众看病难。结论：健康直送车作为载体,把综合医院优质的医疗资源送到基层,正符合新医改的方向,也是对大中型公立医院的创新和改革所做的有意义的探索和实践。     

社区卫生服务机构全面质量管理探析

当前,社区卫生服务机构亟需构建全面、全员、全程的质量管理体系。全面质量管理对于社区卫生服务机构提高质量管理水平、实施可持续性发展至关重要。社区卫生服务机构通过落实质量管理制度、完善监控模式、强化配套人才体系等措施实施全面质量管理,可以提高相关工作人员抓质量的积极性和主动性,促进质量观念的进一步转变,从而提升机构的综合服务水平。现对社区卫生服务机构实施全面质量管理的现状及应注意的问题予以综述。     

基于利益相关者导向的公立医院绩效管理策略研究

公立医院的绩效管理对提升我国医疗服务体系效率和推进公立医院改革具有十分重要的战略意义。本文对公立医院的核心利益相关者进行了界定,并基于利益相关者导向的理论框架对公立医院绩效管理中存在的问题展开了分析。而后,本文分别从政府导向、员工导向、市场导向三个方面探讨了公立医院绩效管理的提升策略,以期为改善公立医院整体绩效提供借鉴和参考。     

民营医院营销战略分析

以SWOT分析法为基础，针对决定民营医院发展战略的各因素，运用7Ps营销组合模式分析，结果认为民营医院需对医疗服务产品、医疗服务价格、市场定位、医院形象树立、卫生服务人员培养、医疗环境构建、服务过程完善等7个方面进行组合，扩展营销渠道，提高民营医院的影响力，从而在竞争日益激烈的医疗市场中占有一定的市场份额。     

我国中医药健康服务现状及提升路径研究

目的:分析《中医药法》实施背景下中医药健康服务基本情况。方法:利用2017-2018年《中国卫生统计年鉴》《全国中医药统计摘编》及2018年5月底《中医药法》调研评估数据,对中医药医疗卫生资源与服务、中医预防和养生保健、政策和经费支持等方面进行分析与研究。结果:2017年末,全国中医类医院、每千人口中医执业(助理)医师、每千人口公立中医类医院床位分别达4566所、0.38人、0.59张;截至2018年5月底,全国开办备案制中医诊所2894所;2017年全国中医类医疗卫生机构诊疗人次、出院人数分别达10.2亿人次、0.33亿人次;全国中医类医院提供中医治未病服务1983万人次;各省均已将中医药发展经费纳入本级财政预算。结论:《中医药法》实施后,中医药健康服务能力提升显著,但与居民多层次多样化健康需求仍有较大差距。建议优先补充和提高中医药健康服务人才队伍,围绕中医药健康服务特色,筑牢基层中医服务阵地,强化中医药法配套政策落实监管,建立中医药事业经费投入长效机制,完善中医药健康服务体系。     

Is point of care testing in Irish hospitals ready for the laboratory modernisation process? An audit against the current national Irish guidelines

Background

The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing.

Aims

An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive.

Methods

The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme.

Results

Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues.

Conclusions

Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.     

A quality management intervention to improve clinical laboratory use in acute myocardial infarction

OBJECTIVE: To assess the effect of a total quality management (TQM) approach on the appropriateness of clinical laboratory testing of patients with acute myocardial infarction. DESIGN: Retrospective, control-group, quasi-experimental study. SETTING: Two metropolitan teaching hospitals: one involved in the intervention (TQM experimental group); the other had no intervention (control group). INTERVENTION: A multidisciplinary team involved in the development of improvement strategies, including laboratory testing guidelines, education programs, data collection, monitoring and feedback. OUTCOME MEASURES: Total number of requested clinically indicated and non-clinically indicated tests. RESULTS: The proportion of clinically indicated tests that were requested increased from 77.5% to 88.2% (P < 0.01) and the number of non-clinically indicated tests was reduced by 81.7% with the introduction of the TQM strategies (P < 0.01). CONCLUSIONS: The introduction of a TQM approach has improved the appropriateness of test ordering in acute myocardial infarction. The reduction in non-clinically indicated tests could produce substantial savings in hospital pathology costs, and the increase in clinically indicated tests provides better patient care.     

Consensus standards for the care of children and adolescents in Australian health services

The medical and psychosocial needs of children and adolescents differ from those of adults, and this should be reflected in the care they receive in all areas of a health service. Children and adolescents must be accommodated separately to adults to ensure that their unique needs are met and risks of harm are minimised. The Standards for the care of children and adolescents in health services have been developed by a working group of clinicians, health service providers and consumer advocates based on a combination of available research evidence, published best practice guidelines and multidisciplinary expert consensus. Stakeholder input was obtained through invitations to comment, and pilot testing of the Standards was conducted in six metropolitan, regional and rural hospitals. The Standards provide detailed recommendations in the areas of recognising rights; the provision of child-, adolescent- and family-friendly health service facilities; the availability of child- and adolescent-specific equipment; and the importance of appropriately trained staff. To facilitate implementation and allow ongoing performance monitoring, the Standards have been developed for use alongside the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program. The Standards provide a vehicle to ensure patient safety and to facilitate the provision of high-quality care for children and adolescents in Australian health services.     

科学发展观与教学医院的可持续发展

以人为本、全面协调可持续的科学发展观是新时期我们党提出的重要战略思想,解决了什么是发展、为什么发展和怎样发展等一系列重大问题.本文结合承担医疗、教学、科研任务的综合性教学医院的实际情况,深入分析了医院发展中的战略关键和可持续发展必须正确处理的几种关系,希望能为医院教学实现可持续发展提供可资借鉴的经验.     

A need for managed care in Saudi Arabia

Is the Kingdom of Saudi Arabia getting value for money invested in health? Quality care is being provided throughout health facilities in the Kingdom, however there is minimal control of utilization in all health sectors, consequently leading to abuse and over utilization, particularly in the public sector. Managed care programs have proven effective in reducing unnecessary inpatient and ancillary service utilization by reducing use of expensive procedures and unnecessary, highly specialized services, and shifting to less expensive care options. Health maintenance organizations are the best example of a managed health care model; tracking good performance and cost savings averaging between 20-40% compared to more traditional health plans. Key features of health maintenance organizations include serving a defined population voluntarily enrolled in the health plan; assumption of contractual responsibility and financial risk by plan to provide a range of services, and payment of a fixed periodic payment by the enrollee, independent of the actual use of services. The key characteristic that distinguishes health maintenance organizations from other delivery systems is prepayment for the care that is provided. Preferred Provider Organizations offer discounts for services received from a selected set of physicians and hospitals. Services received by enrollees are not fully reimbursed from this selected list of providers. Preferred Provider Organizations use health maintenance organizations administrative processes for controlling costs but do not include some of the intrinsic cost and quality controls of health maintenance organizations. Review of several studies indicate that patients enrolled in prepaid group practices (managed care organizations) were hospitalized 15-40% less often than those enrolled in fee-for-service health plans.     

河北省乡镇卫生院卫生服务运行效果研究

目的 调查研究河北省基本公共卫生服务均等化项目开展以来乡镇卫生院卫生服务的实施效果.方法 采用文献分析法、访谈法和随机抽样调查问卷法对河北省部分乡镇卫生院卫生服务运行效果进行了调查研究.结果 河北省基本公共卫生服务均等化项目的实施取得了显著的成绩,乡镇卫生院的建设与发展得到了极大改观,促进了基层公共卫生事业的有效发展;但在公共卫生服务运行中还存在一些问题,影响了乡镇卫生院的卫生服务效果.结论 通过对影响河北省乡镇卫生院卫生服务运行效果的影响因素分析,提出相应措施,以利于乡镇卫生院取得更好的卫生服务运行效果.     

2012年桂林市13家妇幼保健机构现状分析

目的：为了掌握桂林市各级妇幼保健机构基本情况和发展的现状,找出存在问题,为全市妇幼保健机构今后的发展规划和卫生行政部门的科学决策提供依据。方法：根据国家与自治区机构调查要求,组织辖区13家妇幼保健院进行本机构的机构调查,并及时录入到国家妇幼中心的全国妇幼保健机构监测信息网络直报系统,经各级数据审核通过后导出数据,对辖区妇幼保健机构的基本情况、人力资源、设备配置、服务运营情况等数据进行分析。结果：桂林市辖区13家妇幼保健院存在人员缺编1100人,人员素质偏低,群体保健人员严重不足,服务提供能力有限,县级妇幼保健院设备不足,妇幼保健机构工作经费紧张。结论：有关部门应根据市、县两级妇幼保健机构的功能定位,重新修订人员编制、加强妇幼保健人才队伍建设,建立稳定的妇幼保健机构补偿机制,落实妇幼保健机构人员经费、公共卫生服务经费,逐年增加投入,改善设备条件,保证妇幼保健机构可持续发展。     

三级医院联合社区卫生服务机构开展延续护理的SWOT分析

目的 探讨三级医院联合社区卫生服务机构开展延续护理的优势、劣势、机遇和挑战,为延续护理的可持续发展以及双向转诊、分级诊疗工作的推进提供思路和借鉴。 方法 采用SWOT分析法,从理论层面深入分析三级医院联合社区卫生服务机构开展延续护理的可行性和所面临的主要困境,同时结合宜昌市某三甲医院2012年5月以来的实践经验做进一步阐述。 结果 基于分病种三级医院联合社区卫生服务机构开展延续护理能够有效整合现有卫生资源,尤其是在三级医院床位紧张而社区卫生机构利用率不足的情况下,能够最大限度地发挥现有卫生资源优势,促进患者合理分流,提高三级医院的床位周转率,提升社区卫生服务机构医务人员的专业技术水平和群众对社区卫生服务机构的信任度,有利于分级诊疗工作的进一步推进。但是,社会对延续护理认识不足,双向转诊机制、延续护理体系不完善,社区专科护理发展不足,下转患者无力承接却是制约延续护理的关键。 结论 在各级政府的重视和政策、资源的支持下,充分发挥本地医疗资源优势,克服劣势,利用外部机会,化解各种挑战,采用三级医院联合社区卫生服务机构开展延续护理,可以确保延续护理得到可持续发展,并为双向转诊和分级诊疗工作的推进奠定基础。      

Integrated delivery systems: has their time come in Canada?

In the 1990s every Canadian province is struggling to reduce health care expenditures without jeopardizing access to health care or quality of care. The authors propose a new model for health care delivery: the Canadian Integrated Delivery System (CIDS). A CIDS is a network of health care organizations; it would provide, or arrange to provide, a coordinated continuum of services to a defined population and would be held clinically and fiscally accountable for the outcomes in and health status of that population. A CIDS would serve 100,000 to 2 million people; the care it would provide would be funded on a capitation basis. For providers, there would be explicit financial incentives to minimize costs. At the same time, service quality and consumer choice of primary care practitioner would be maintained. Primary care physicians and specialists would work with other health care service providers to offer a full spectrum of care. CIDS providers would form strategic alliances with community agencies, hospitals, the private sector and other health care services not managed by the CIDS, as needed. For physicians, affiliation with a CIDS that provided strong clinical leadership could be beneficial to their income stability and autonomy. Pilot projects of this model in several communities would determine whether this concept is feasible in the Canadian health care context.