使用标化工作值升级社区公共卫生科室运行能级的探索与实践

背景　用绩效作为杠杆，保障医务人员工作积极性和患者安全，已成为卫生行业薪酬改革的共识，标化工作值是基层医疗卫生机构实现绩效考核的测度工具。目的　探索基于标化工作值的社区公共卫生版块绩效分配方案，以调动基层公共卫生医师工作的积极性，提高社区卫生服务的工作效率和服务质量。方法　于2019年1-12月，由上海市虹口区北外滩街道社区卫生服务中心业务部门成员及外部专家4名，通过文献检索、焦点小组会议、专家咨询等方式，对本中心社区科6个业务组正在开展的服务项目进行全面梳理汇总，计算各项目的标化工作值，确定基于标化工作值的绩效考核薪酬占总薪酬的比例，确定单人标化工作值总量分配办法，最终，通过绩效总额管理、各项目标化工作值精确赋值管理、单人标化工作值总量管理，在将总任务合理分解到个人的同时，用标化工作值体现社区公共卫生人员每一份工作投入的劳务价值。结果　梳理出两类不同颗粒度的共计353项服务内容的总服务项目清单，确立了公共卫生部门各组统一的基准项目，测算出各项服务内容的标化工作值，基于标化工作值的绩效薪酬占总薪酬比例为45%~65%，依据全部门人均标化工作值总量分配各人标化工作值总量，通过比对调整后与调整前的员工绩效分配方式及结果，以及员工对调整后方案的评价，确认员工对新确立的绩效分配方案较认可。结论　通过全面梳理公共卫生模块总服务项目清单，科学测算单项目标化工作值，合理分配单人的标化工作值总量，既体现了员工的劳务价值，提升了其积极性，也保证了每位成员合理的工作强度，提升了服务质量。本研究为实现社区公共卫生版块员工绩效制激励和考核做出了初步有益探索，对公共卫生人员工作的认可和积极性的提升，有助于建设更扎实更稳固的社区基层公共卫生防控网络。

Theoretical and Practical Exploration of Using Standardized Workload Method to Upgrade the Operation Level of Community Public Health Sector

Background　Using performance assessment as a lever to ensure the working enthusiasm of medical workers and patient safety has become a consensus in salary reform of the healthcare industry，and standardized workload method is a measurement tool for performance evaluation of primary care workers. Objective　To develop a performance allocation scheme for community public health sector using standardized workload method to incentivize the working enthusiasm of primary public health physicians to improve the delivery efficiency and quality of community health services. Methods　From January to December 2019，using literature review，focus group interview，and expert consultation，and standardized workload method，4 professionals（consisting of members from the public health department of Shanghai Hongkou District Beiwaitan Subdistrict Community Health Center and experts invited from other institutions） developed a performance allocation scheme for community public health workers，and used it to measure the performance of 6 teams of this health center in implementing the ongoing service projects，to be specific，calculating the standardized value of each item，determining the ratio of performance-based pay（calculated using the standardized workload method） to the total salary，and the method for allocating the total standardized workload for individuals，in other words，through means of management of the total performance of the staff，precise assignment management of each service item，and management of the total standardized workload of individuals，the tasks may be properly assigned to individuals and performance assessed using standardized workload method may reflect the value of services provided by each public health worker. Results　 Using this new scheme，we made a list of two categories of services（353 scope items in total） with different granularity levels，determined the uniform benchmark projects for different public health teams，calculated the standardized value for each service，and determined the ratio of performance-based pay（calculated using the standardized workload method） to the total salary as 45%-65%，and the individual standardized workload was assigned by the total standardized workload of public health staff. The comparisons of the performance allocation method and results before and after using the new scheme，combined with public health workers' assessment of the new scheme suggested that the new performance allocation scheme has gained acceptance in these workers. Conclusion　Using the scheme，we comprehensively sorted out the scope items of public health module，scientifically calculated the standardized value of each item，and rationally assigned the total standardized workload for individuals，which reflect the value of services delivered by public health workers，and improve their quality of services via incentivizing working enthusiasm and ensuring rational intensity of workload. Our explorative study may be contributive to the performance incentivization and assessment for community public health workers，showing the recognition of the value of their services，by which their working enthusiasm may be improved，ultimately benefiting the building of a more solid and stable community-based public health prevention and control network.