杭州地区大型公立医院涉外医疗现状调查

以杭州市三级公立医院为典型调查对象,通过对医院工作者和在杭外籍人士的双重视角的问卷调查,结合文献研究,发现和总结杭州市公立医院涉外医疗服务方面存在以下4个普遍性问题:医生与外籍患者存在沟通障碍,医疗服务信息沟通不到位,服务环境和服务态度还不尽人意,医疗保险及收费体制问题.据此提出了政府完善涉外医疗服务体系的政策建议,包括要创建与国际接轨的医疗服务质量管理规范、收费体制改革及医保管理和涉外医疗服务机构的规划和宣传,以及医院内部关键要素的管理对策.

Abstract：

The study focused on tertiary public hospitals in Hangzhou,investigating the comments of both hospitals workers and foreigners in the city with questionnaires and literature search.The foilowing four problems were identified in the study in the foreigner medical services in Hangzhou:Communication barriers between doctors and foreign patients,insufficient communication of medical service information,poor service environment and service attitude,and payment mechanism for medical insurance and charges.On such basis,the authors recommended policy changes for the government to improve foreigner-oriented medical services,including building the regulations up to intemational customs for medical services,reforms in the payment system,medical insurance management,as well as planning and promotions of foreigner-related service institutions,and management strategies for key elements within the hospital     

戴明循环在医院医疗投诉管控中的应用

通过探讨戴明循环(PDCA循环)在医院医疗投诉管理中的应用,将PDCA循环引入医院医疗投诉管控体系,运用PDCA循环实施有效管理医疗投诉过程中的各项工作.自2006年起在医院通过引入PDCA循环,进行医疗投诉管控,到2009年底有效减少了医疗投诉的发生,并将医疗投诉在产生的初期就得到控制,减少了向医疗纠纷方向的转化,明显提高了医疗质量.应用PDCA循环可以有效控制医疗投诉发生,加强医疗安全,构建和谐医患环境.

Abstract：

A study of PDCA Cycle in managing hospital medical complaints may introduce such a cycle into the medical complaints control system of a hospital, effectively handling the medical complaints process. Since 2006 when the cycle was introduced into the hospital for medical complaints control, such complaints have been cut back significantly by the end of 2009. Furthermore, such complaints are under control from the start, and prevented from growing into medical disputes, effectively improving quality of care. Such a cycle can effectively avoid medical complaints, enhance medical safety, and build a harmonious doctor-patient relationship.     

民营医院履行社会责任的实践探索

介绍了我院作为改制后的民营医院,在医院文化建设方面,通过创建爱康医院家的文化,树立爱康价值观,构建和谐的医院工作环境;在管理体制改革方面,实施管办分离,成立了支持系统和运营系统,通过先进的管理方法改进医疗服务质量;在回报社会方面,通过积极救助弱势群体、积极承担公共卫生服务、热心慈善等,付出真诚的爱心,切实履行社会责任.

Abstract：

The paper introduced the organization culture building of a private hospital, in creating the Aikang hospital as your home culture and Aikang values for building a harmonious workplace for the hospital. The management system reform features the separation between regulations and management,building of the supporting system and operating system, for better quality of care with advanced management practice. The social rewards feature great efforts in supporting the disadvantageous population, and undertaking public health service and charity activities. These care and love to the community help the hospital to fulfill its social responsibilities.     

完善医疗保障制度实现全民医保

介绍了上海医疗保障体系的概况和实施成效,分析存在的问题和面临的挑战,提出完善医疗保障体系的总体目标和重点任务.上海已初步形成"三纵三横"的医疗保障制度体系,为减轻参保人员医疗费用负担、推动经济社会发展起到了积极作用,已基本实现国家医改意见中提出的基本医疗保障制度建设近期目标.为进一步贯彻落实国家医改要求,上海将通过整合各类制度、缩小待遇差距、完善医保管理、建立老年护理保障制度等举措进一步完善医疗保障体系,力争2012年户籍人口医疗保障制度覆盖率达到98%,常住人口覆盖率达到90%.

Abstract：

The paper introduces an overview of Shanghai medical security system, analyzes its effectiveness and challenges, and put forward overall goals and key tasks in the future. Shanghai has formed a multiple, medical security system and basically achieved the short-term goal of medical security system establishment which was requested to put forward in national health system reform. Shanghai medical insurance system has played a positive role in promoting economic and social development and reducing the burden of medical expenses. To further implement requirements of national health system reform, Shanghai will be conducting the integration of different schemes , narrow down the gap of benefit packages, improvement of health care management and the initiatives of nursing care insurance to further improve the medical security system, and strive to cover 98% of household population and 90% resident population in 2012.     

从38家三级医院的核心价值观分析人文精神

通过对全国38家三级医院的核心价值观进行分析,指出人文精神是贯穿这些医院核心价值观的主线和灵魂,仁爱厚德、精医敬业、创新求真是其重要的三个组成部分.阐述医院人文精神的倡扬,适应了医学模式转型的需要,适应了医院管理体制完善的需要,适应了医务人员人文素养提高的需要.最后指出人文精神的氛围营造是一个系统的过程,只有把握教育的关键人,找准实践的施力点,激发内在的创新力,人文精神才能发挥其应有的力量.

Abstract：

An analysis of the core value of 38 tertiary hospitals in the country identified the humanistic spirit as the lifeline of their core value, comprising such factors as benevolence,professionalism and innovation. It also found that upholding of such a spirit is in line with medical model reform, with improvement of hospital management system, and with the upgrading of hospital staff's humanistic competence. The author pointed out that the atmosphere building of such spirit is a systematic process, and that such a spirit can only exert its entire potential by identifying the key person(s) of education and the point of force application, and igniting the inherent innovation power.     

我国合理用药监测体系建设初步探讨

建立国家合理用药监测体系对促进临床合理用药、落实国家基本药物政策、促进医疗质量和医疗安全的持续改进具有重要意义.概括了合理用药监测工作的国际经验,介绍了我国合理用药监测体系初步建立的情况,并针对目前存在的问题就如何进一步完善监测体系进行了分析和探讨.

Abstract：

A detection system for rational drug use is vital for promoting rational drug use clinically, implementing the primary drugs policy of the state, and encouraging constant improvement of both quality of care and medical safety. This paper presented a summary of international experiences on rational drug use, introduced the initial progress to build a detection system for drug use in China, and came up with analysis on measures to further improve existing defects.     

深圳市公立医院法人治理改革探索

分析了目前公立医院体制机制方面存在的问题,按照"政事分开、管办分开、医药分开、营利性与非营利性分开"的改革原则,制定了公立医院法人治理改革实施路径.一是建立公立医院管理委员会,统筹政府办医保障职能;建立公立医院管理机构,提高举办医院的行政管理水平;转变卫生行政部门职能,形成多元化办医格局.二是建立分级决策机制、自主经营制度及多元监管制度,解决政事分开问题.三是研究制定公立医院章程,促进公立医院向法定机构转变,通过法制化巩固法人治理改革成果.

Abstract：

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of "Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals", the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.     

国外灾后医疗救助体制的特点与启示

分析了英、美、日等国灾后医疗救助体制的特点,结合我国现阶段的国情,提出政府应制定和完善灾后医疗救助法律体系、完善医疗保障相关制度、建立应对灾后医疗救助问题的长效管理机制、建立和完善灾后紧急预防和心理干预机制等建议.

Abstract：

This paper analyzed the characteristics of post-disaster medical assistance systems in Anglo-American countries and Japan. In consideration of China's national conditions at present, it come up with recommendations that the government should formulate and perfect the legal system of postdisaster medical assistance, improve the related systems of medical care, establish post-disaster medical assistance responding as a long-term management mechanism, establish and improve emergency preparedness, and post-disaster psychological intervention in mechanisms.     

四国医疗风险与预警监测管理模式分析

通过检索英国、美国、加拿大、澳大利亚4国医疗风险管理相关官网资料,比较4国医疗风险管理相关机构设置、政策法规和不良事件上报管理机制.4国均设立国家级病人安全管理机构,采取国家、地方、医疗机构和非政府组织多级综合管理;美国以法律法规,英国、澳大利亚以指南作为医疗安全的政策保障;4国通过国家主导或与行业协会合作,管理不良事件上报.启示我国要加强医疗安全管理的组织机构建设,健全医疗安全管理制度并倡导安全文化,建立国家级医疗安全事件报告和学习系统,提高医疗风险管理水平.

Abstract：

Comparison of the institutional setup, policies and adverse event report mechanism for medical risk control in the countries of UK, USA, Canada, and Australia by means of browsing information on their official websites. It is found that these countries maintain a national patient safety authority, coupled with a tiered management at national, local, medical institutions and NGOs level; the USA pattern features laws and regulations, that of UK and Australia features guidelines as policy guarantee for medical safety; these countries regulate adverse event reporting by either government leadership or cooperation with trade associations. Inspirations from this study suggest China to enhance institutional construction, complete regulations, and advocate the culture for medical safety, and to build the national-level reporting and study system for medical safety events, and improve medical risk management.     

医疗废物治理的制度设计

医疗废物造成的环境污染和人类健康问题的恶化越来越严重,良好的制度设计是医疗废物治理顺利、有效进行的重要保证.虽然我国已经颁布了一系列法律文件,为医疗废物治理纳入法制轨道奠定了一定基础.但在建设循环经济的时代背景之下,理清医疗废物治理的内涵、原则,构建医疗废物治理的核心制度已经成为必然.医疗废物治理的核心制度不仅对减少资源耗费、提升环境保护具有重大影响,而且对指导、规范治理医疗废物具有深远意义.     

医疗废物治理的制度设计

医疗废物造成的环境污染和人类健康问题的恶化越来越严重,良好的制度设计是医疗废物治理顺利、有效进行的重要保证.虽然我国已经颁布了一系列法律文件,为医疗废物治理纳入法制轨道奠定了一定基础.但在建设循环经济的时代背景之下,理清医疗废物治理的内涵、原则,构建医疗废物治理的核心制度已经成为必然.医疗废物治理的核心制度不仅对减少资源耗费、提升环境保护具有重大影响,而且对指导、规范治理医疗废物具有深远意义.     

The medical waste audit. A framework for hospitals to appraise options and financial implications

The generation, handling, and disposal of medical wastes involve virtually every department in the hospital. To enhance coordination, managers must comprehensively describe the total system and specify the roles of key functions and individuals. Hospitals produce about 77 percent of the approximately 500,000 tons of regulated medical waste produced annually in the United States. The amount produced by different hospitals varies, primarily because of differences in "waste-management practices." The Environmental Protection Agency is trying to develop a greater understanding of the types of medical wastes that are infectious, methods of transmission, and the likelihood of transmission in the handling and disposal of waste within the hospital environment. To ensure that medical waste is being handled and treated in the most cost-effective manner and with the least health risk to employees and the community, hospital administrators must undertake a comprehensive appraisal of the activities associated with the generation, handling, and disposal processes. A "medical waste audit" requires the following steps: Generation profile to identify origination points, categories or types of waste, and associated generation rates. Inventory of handling practices, including existing regulations, procedures and protocols, training programs, definitions regarding waste segregation, and documentation. Review of current disposal practices and existing and developing alternatives. Cost analysis     

Medical Waste Act. Requires physician compliance

In Michigan, the medical care community has a long history of carefully managing infectious medical wastes within their facilities to control communicable diseases. Never the less, concerns have surfaced about health risks posed by medical waste because of the notoriety of reported incidents of improperly disposed medical waste that led to the promulgation of emergency rules and now permanent statutes. As the environment reemerges as a national issue, the proper disposal of medical waste remains, at the very least, a highly visible and volatile part of this nation's solid waste crisis. To better develop appropriate controls for dealing with regulated medical waste, we will need to work together. Journal articles such as this provide an important opportunity to share and more forward our understanding of this problem so that we may all enjoy a safer and better environment. Proper handling and disposal of medical waste will remain a public issue as long as wastes believed to be of medical origin are found on beaches or at unauthorized storage or disposal locations. Hence, compliance with the regulations for the handling, storing, treating, transporting and ultimate disposal of regulated medical waste by providers of health care in Michigan must be observed.     

Hospital waste management and it's probable health effect: a lesson learned from Bangladesh

A study was conducted to evaluate the current status of hospital waste management (HWM) in Bangladesh. The aim is to recognize the health effect of the existing practice, to determine the awareness level of doctors and nurses about hospital waste, to identify the weaknesses, and to provide suggestions for improvement. Hospital staff, waste pickers, and local residents were interviewed while in depth field observation, which included sample collection and laboratory analysis was also conducted. Through this investigation, it has been quite evident that a satisfactory hospital waste management system in government hospitals and several private clinics is severely lacking. At present, Bangladesh has no rigorous laws or regulation, which are enforced in this area. The waste is generally dumped together in a public place such as the hospital surroundings, the roadside or City Corporation dustbin. Many doctors and nurses are not fully aware about what constitutes as medical waste. Health care workers have only a basic understanding of health care and do not perceive handling or disposal of medial waste as a hazardous work. Laboratory analysis shows existing contamination of infectious agents in the environment. Some staff members interviewed were suffering from various kinds of infectious diseases such as viral hepatitis B/C, typhoid, skin disease/allergy, diarrhea, dysentery, tuberculosis, and malaria. During field observation it was discovered that improved HWM systems have only recently been introduced in a small number of private hospitals and clinics, some of which could be used as references to formulate guidelines for reaching the optimal at the national level. The study indicates that there is a need to improve the handling and disposal methods of hospital waste in almost all the available medical facilities. There are a few NGOs that have started awareness building and training on waste management for selected hospital staff and NGO officials. Based on the analysis of the situation, several suggestions and recommendations have been made to aid in the development of a waste management system.     

Hygienic aspects of medical waste management in Astana

The authors indicate the existing epidemiological risks on handling the scraps from the therapeutic-and-prophylactic institutions of Astana and forecast the volume of these waste till 2030. By analyzing the Russian experience in testing the technologies of medical waste disinfection, they have justified the choice of a thermal system to recycle Astana medical and biological wastes. The proposed measures to improve a waste collecting and recycling system of the city's therapeutic-and-prophylactic institutions are shown to be economically effective.     

Improper office disposal of needles and other sharps: an occupational hazard outside of health care institutions

An employee of a private disposal company suffered a finger needlestick injury while collecting waste at curbside from a building containing medical offices. Subsequent inspection of the contents of the garbage bags revealed the presence of used syringes and unsheathed needles. The Ministry of the Environment has developed a regulation and guidelines for the handling and disposal of biomedical waste including needles and other sharps. These specify that approved carriers and receivers are required for disposal; properly decontaminated waste is considered non-hazardous solid waste and can go to landfills. However, responsibility for curbside pickup of waste lies with municipalities; some municipalities have enacted by-laws which prohibit collection of this waste at the curbside. This incident illustrates that improper disposal of biomedical waste (including that from private practitioners' offices) may occur despite efforts to control its handling, and that needlestick injuries can occur outside of health care facilities among personnel who are not health care workers. Efforts are needed to increase the level of awareness among health professionals regarding their responsibility to ensure proper biomedical waste disposal from private offices. In addition, efforts should be made to bridge the gap between all levels of government regarding the disposal of biomedical waste.     

医疗废物专用通道在医疗管理中的应用分析

目的:为响应《医疗废物管理条例》的相关规定,防止医疗废物的扩散、泄露或丢失,在综合病房投入使用的过程中,启动废物通道专用电梯,避免医院出现交叉感染或院内感染等现象的发生,达到正确处理、使用医疗废物专用通道的目的.方法:通过建立健全医疗废物管理制度,对人员进行相关知识培训.结果:医疗废物专用通道的建立,有效的避免了院内疾病传播造成的院内感染,保证了患者和医护人员的健康安全.结论:医疗废物专用通道的使用,能够有效地避免医疗废物产生的危害,值得借鉴.     

广州港港湾医院医疗废物规范化管理对策

目的规范化管理医院医疗废物.方法评估广州港港湾医院医疗废物管理现状,按照<医疗废物管理条例>,完善医疗废物管理机构及管理细则,并开展全员培训工作.结果通过制度制约,强化人员培训,提高了医务人员等对医疗废物规范化管理的自觉性,达到分类处置目的.结论该院医疗废物管理制度有效可行,可指导临床工作,从而降低医疗废物对环境、人的健康造成的危害.     

某三级儿童医院2013年医疗投诉处理过程回顾性分析与思考

目的：了解医疗纠纷处理情况现状,探讨如何促进医疗纠纷高效解决。方法：收集徐州市儿童医院2013年51例纠纷处理过程的资料,进行描述性统计分析;查找相关文献资料,分析总结。结果：目前处理医疗纠纷的方式有三种,医院协商、调解中心调解和法院处理;2013年该院72.55%的纠纷由医院协商解决。结论：解决医疗纠纷对于医院来说经济压力、工作量压力都较大。引进医疗风险保险,分担赔偿金筹资负担,构建多元化的医患纠纷处理方式,分担医院单方面处理纠纷的压力。完善法制、重视舆论,共同促进医疗纠纷科学解决。