法人治理结构体制下的现代职业化医院管理模式

我国正在进行以＂法人治理结构＂为核心的公立医院管理体制改革。构建与＂法人治理结构＂相一致的新型医院管理模式就成为目前我们亟待解决的课题。笔者经过对东西方理念与文化融合的研究,于2001年10月提出＂现代职业化医院管理模式＂后,经过近十年的实践印证与改进,总结提出＂法人治理结构体制下的医院管理模式——现代职业化医院管理模式＂。此模式的提出将有利于改变我国医院管理的＂行政化与官员化＂,实现医院管理的＂专业化与职业化＂,从而加速我国医院管理的现代化进程,实现＂解放生产力、发展生产力、优化生产力＂之目的。     

当前公立医院法人治理结构改革进展及相关问题的认知分析——部分试点地区的典型调查

目的：了解部分试点城市公立医院法人治理结构改革的思路、举措、预期效果和所需条件,以利于总结经验、发现问题以及研判改革的形势.方法：对深圳、北京、昆明3个公立医院改革国家联系试点城市进行现场调查,采用个人深入访谈法,访谈了9位院长和8位行政管理人员.结果：（1）对推进法人治理结构改革的必要性认识存在分歧,在具体措施和改革进程上存在较大差异;（2）公立医院法人治理结构改革中的主要问题包括：思想不统一、改革的顶层设计仍不清晰、部门利益主导改革进程、涉及多方利益调整、缺乏利益相关者参与治理的有效途径、盲目照搬国有企业法人治理改革的经验、配套改革和外部制度环境欠缺.结论：推进公立医院法人治理结构改革还要从统一思想认识出发;鼓励地方探索,注重实效,摒弃模式之争是必要途径;制度性创新是推进法人治理结构改革的关键环节;注重利益相关者的利益平衡,防止强势利益相关者侵害弱势利益群体;改善外部治理机制依然任重道远.     

Mentorship in urological laparoscopic surgery: lessons learned

OBJECTIVE

To review the results of our experience with a mentorship programme in laparoscopic nephrectomy, set up in 1999 by the British Association of Urological Surgeons Section of Endourology.

METHODS

Mentors were contacted in 2007 to submit data on the number of visits and the outcome, which included whether a urologist was able to establish an independent laparoscopic practice and sustain it.

RESULTS

Four urologists acting as mentors reported a total of 164 procedures carried out in the training of 39 urologists during 148 visits. There were no conversions to open surgery and only one major complication. Overall, 29 of 39 mentored consultants were able to establish an independent laparoscopic practice and 23 continue to do so. The number of visits was associated with initial success, although this was not statistically significant. Working in a large department was associated with being able to sustain a laparoscopic practice. More experienced consultants were less likely to have initial success, but were more likely to sustain a successful practice.

CONCLUSIONS

Mentorship for laparoscopic nephrectomy has been carried out safely thus far. Sustaining a laparoscopic practice requires a critical volume of cases. Future efforts should be focused on trainees rather than consultants.     

推进公立医院改革之我见

根据医改确立的公立医院改革目标,结合东阳市人民医院的改革实践,认为用较少的资源生产更多的适应社会需求的医疗服务产品,更好地维护人民群众健康,是公立医院肩负的社会责任,并提出推进和深化公立医院改革,关键在于构建公立医院法人治理结构,建立规范高效的运行机制,设置科学合理的医疗服务价格体系。     

公立医院法人治理结构研究

建立具有中国特色的公立医院法人治理结构是现阶段我国医药卫生体制改革的目标之一。当前在医疗改革的背景下．要建立具有中国特色的公立医院法人治理结构,必须借鉴企业和国外医院管理的成功经验。通过对目前我国公立医院法人治理结构现状进行了分析,并就建立和完善这一体制作了有益的探讨。     

What are academic pharmacy organizations doing to reward performance and retain their star faculty?

BackgroundEvidence suggests that stars in an organization, including academia, drive much of its productivity and reputation. There has been much said within academic pharmacy about recruitment, but little in regard to retaining its top faculty.ObjectiveTo identify perceptions among pharmacy faculty on how faculty are currently rewarded; what is done versus what should be done at their institution to recruit and retain star faculty; what is versus what should be done in developing faculty, and compare these perceptions across certain personal and work characteristics.MethodsA questionnaire survey designed in Qualtrics was distributed via email to a census sample of 3378 members comprising 2018 AACP list-servs. Faculty activities and organization actions were derived from literatures and pilot testing. Frequency distributions and Kruskal-Wallis tests were conducted to describe the data.ResultsResponses from 463 faculty indicated scholarly publishing as paramount for receipt of organizational rewards. They indicated that their organizations very infrequently employed action to retain star faculty. They indicated that more should be done to retain stars, and this was largely agreed upon by those in supervisory positions, even though there were a few differences between supervisors and non-supervisors over what is already being done. While there were differences in perception primarily by respondent institution type, there were many more similarities than differences of opinion about actions taken and that should be taken to retain star faculty.ConclusionsPharmacy faculty affirmed the salience of scholarly productivity in the allocation of organizational rewards and indicated that certain activities like high-quality clinical practice and good citizenship behaviors were less likely to result in recognition. The results offer considerations for faculty retention strategies and the need for administrators to communicate actions taken to retain star faculty.     

Dietitians and supervision: should we be doing more?

As the role of the dietitian has expanded over recent years, many are becoming increasingly involved in the care and management of vulnerable individuals, both alone and as part of multidisciplinary teams. This raises an important question – how are we as a profession managing our changing role in the health care setting? The advent of Clinical Governance means there is a need for dietitians to join the debate on the issue of supervision, which has been raging in the nursing and other health professions over recent years. This article attempts to define the terms supervision and clinical supervision both globally and in the context of dietetics, to describe models of clinical supervision being used in other professional groups and to put forward a framework for addressing whether there is a need for clinical supervision in all areas of dietetic practice.     

Addiction and personal responsibility as solutions to the contradictions of neoliberal consumerism

The article analyses the idealization of moderate alcohol consumption and of personal responsibility for controlling drinking behaviour as a sociocultural solution for a central contradiction in modern consumer societies. The application of neoliberal ideals of consumer sovereignty, free market access at any hour of the day or night and unrestrained market promotion tends to push upward the population's alcohol consumption. But in many aspects of daily life – for instance, when at work, when driving a car, when minding children – modern societies require sobriety. The ideological solution to this societal dilemma is to individualize the responsibility for handling it, apotheosizing the ideal of the moderate drinker, at the cultural level as a dream to reach for and at the individual level as an ideal of a secular pilgrim's progress.     

数字治理推动医保经办增能：应用逻辑与实现路径

数字治理推动医保经办增能，其应用逻辑是以需求导向为应用理念，以履行第三方购买机制为重点应用场域，以多主体无边界数字治理平台为应用基础，以权力运行机制变革为应用支撑。实现路径是从循证决策走向“循数决策”；从行政管制式经办走向契约式治理；从粗放式基金管理走向精细化；从人工监管走向智能算法监管以及从人力密集型组织建设向技术密集型转变。     

营利性与非营利性医院的界定

界定营利性或非营利性医院是公共财政的需要，有利于对不同性质医院进行分类管理。该从理论上阐述了医院经济属性的基本分类，提出了一系列界定营利性与非营利性医院的条件以及实施判别的指标和方法。