医院员工对医院组织文化认知现状的调查与分析

目的 了解员工对医院组织文化认知现状,并分析相关因素,提出对策措施,为医院今后制定合理有效的医院文化发展战略计划提供依据。方法 采用配额抽样的方法抽取乌鲁木齐市3家医院的743名员工进行问卷调查。结果 制度规范、竞争意识、持续发展和社会责任4个维度的得分最高,授权、组织协调、患者导向和成本控制4个维度的得分最低,职称、工作性质、本院工作年限的职工医院组织文化存在显著差异（P<0.05）。结论 针对存在的问题给出了相应的意见及建议, 如加强社会责任,树立以病人为中心的理念是医院文化建设的共同点;医院管理者应该注意激励员工将医院发展的大目标内化为自身发展的小目标,坚持“病人利益至上”,充分考虑患者的需求并积极听取患者的建议来改进自己的工作;在进行文化建设时要注重对不同岗位的员工群体采取不同的激励方式。     

我国公立医院病人安全文化的影响因素分析

目的 探索我国公立医院病人安全文化的影响因素。方法 采用中国版医疗机构病人安全文化调查量表对我国东、中、西3省（直辖市）54家公立医院员工进行问卷调查。结果 管理者对病人安全文化总体评价高于医生、护士和医技人员;儿科、ICU、急诊科的员工评价相对较低,而眼耳鼻喉科的员工评价较高。在调整员工个人特征后,湖北省医院病人安全文化评分较高,但湖北省内各医院间病人安全文化差异较大。结论 我国公立医院管理者应加强与临床一线人员的交流与沟通,关注儿科、ICU和急诊科病人安全文化的建设,积极探索改善区域内病人安全文化的有效途径。     

我国公立医院病人安全文化的现状研究

目的 构建适合我国公立医院的病人安全文化测评量表,并分析我国公立医院病人安全文化现状。方法 对我国东、中、西部3省（直辖市）54所公立医院员工进行问卷调查。结果 中国版医疗机构病人安全文化调查量表信、效度可以接受;我国公立医院病人安全文化处于中上水平（总体平均分为3.80分）;在“害怕受责备与惩罚”“害怕受羞辱”“提供安全的医疗保健”和“组织安全资源”的维度上,评分相对较低;不同地区、等级公立医院病人安全文化存在一定差异。结论 我国公立医院病人安全文化尚未达到令人满意的程度,政府卫生主管部门和医院管理者需要营造更好的病人安全文化,尤其应加强西部地区医院和二级医院的病人安全文化建设。     

青岛市部分三级医院员工HPWS相关职业体验调查分析

目的 采用高绩效工作体系调查表评估青岛市2家三级医院人力资源管理实践,分析员工作满意度之间的关系。方法 运用HPWS相关员工职业体验调查问卷收集2家医院员工职业体验相关统计数据。结果 样本医院团队合作与回报得分最高,在就业安全感、授权、组织承诺、自主性、员工间关系、信任、平等等方面得分较高;晋升、情绪完好状态和绩效管理等方面得分较低;团队合作、授权、信息支持与员工工作满意度和员工感受的病人服务正相关。结论 我国医院管理实践中包含了大量HPWS的内容,HPWS与员工工作满意度呈正向关系,因此也适用于我国。     

综合性三级医院公益性评价的灰关联聚类分析

摘要 目的 对不同地区的7家综合性三级医院进行公益性水平的初步评价与分析。方法 运用灰关联聚类分析。 结果 7家三级医院的公益性水平总体偏低,仅各有一家医院经灰关联聚类分析归类为好与中,其余5家医院均归类为欠佳,不同地区三级医院公益性水平有一定差别。结论 灰关联聚类分析证明公立三级综合性医院公益性水平亟待加强,应从公益性的影响因素入手提高与改善公立三级医院的公益性水平。     

医院患者安全文化认知现状及影响因素研究

目的 从医院和科室两个层面探讨患者安全文化影响因素,为医院管理者提供政策建议。方法 采用问卷调查方法,采用描述性分析、单因素分析、多元线性回归分析筛选患者安全文化的影响因素。结果 患者安全文化总体水平良好;科室内团队合作、组织的学习和持续改进、对差错的沟通反馈三个维度认知度较高;年龄及对患者安全文化的熟悉程度是影响患者安全文化水平的主要因素。结论 医院应建立患者参与、医患信任、系统防控、管理走访等特点的全方位安全管理模式,加强教育培训,促进医院与员工安全理念的共同培育与发展。     

北京市属医院手术分级管理现状调查与分析

目的 了解北京市医管局所属的22家市属医院现有手术分级管理工作开展现状,探讨其在运行中出现的问题,并提出改进意见。方法 采用问卷普查的方法,发放《市属医院手术分级管理现况调查表》至22家市属医院进行调研,通过被调查机构的相关负责人员填写收集数据。结果 22家市属医院除3家因专业特色未开展手术分级管理,其余19家医院均已进行,但手术分级目录、医师授权、动态管理工作进展各异。各家医院在制定手术分级目录时参照的标准不统一;84.2%的医院是按照手术级别对医师进行授权,参考指标为职称、手术级别和手术技能;14家医院已对手术分级进行信息化管理。结论 统一手术分级目录、扩充医师授权体系、完善分级管理信息系统是加强手术分级管理进一步落实的重要举措。     

以“三个核心”为突破口的医院质量建设新思维

针对当前很多医院处于高负荷运转状态，内涵质量建设存在不少薄弱环节的实际，创新提出以“三个核心”为突破口，聚焦质量建设基础，狠抓“核心制度”落实，紧扣质量建设主旨，强化“核心指标”监管，扭住质量建设关键，深挖“核心员工”潜能，不断提升内涵质量建设水平，夯实可持续发展根基，为推进医院质量建设开拓了新的思路，为医院可持续发展奠定了基础。     

我国城乡医院联动现状及动力分析

新医改方案提出要发挥县医院的“龙头”作用,建立城市医院对口支援农村医疗卫生工作的制度。各个地区纷纷开展了城市医院对口支援县医院的工作。太白“团队整体帮扶模式”、洛川医院“紧密型整体托管模式”和中国医科大学附属第一医院“协作医院模式”均取得了良好的效果。在分析了3种模式联动的特征、内容和效果的基础上,运用利益相关者理论指出了城乡医院联动的动力所在,同时提出了新形势下加强城乡医院联动,推进县医院建设的相关建议。     

医院品牌内涵建设医院精神的贯彻与实施

医院精神建设是医院品牌内涵建设的主要内容,是一个医院赖以生存和发展的关键,是在长期的历史发展中形成的文化传统,为全体医护工作者的道德规范和价值取向。我院坚持以病人为中心,以医疗质量和医疗安全管理为核心,推行以"德法为本、效能优先、严谨规范、求实创新"的管理理念,全体工作人员均在管理理念的督促下奋力工作。医院将管理理念深入到日常医院建设中,从文化建设、医院管理、医疗工作、科研学术、党群工作、廉政建设等方面进行全面改善,为提升医院的品牌内涵、缓和医患关系起到了重要作用。     

公益化视角下公立医院社会责任体系构建

公立医院是我国医疗服务的主体,同时也是社会责任的必然承担者。公益化视角下公立医院在获取自身生存和发展的同时,应最大程度地承担起“救死扶伤、生命至上”的社会责任新内涵。公立医院社会责任缺失与医疗市场越位、政府补偿缺位及医务人员宗旨意识错位有关。公益化视角下公立医院社会责任体系重建要改革公立医院运行机制、统筹利用社会各方力量、积极营造社会责任的文化氛围、提高医院综合管理水平及建立基于公益性的绩效考核方案。因此,要发挥公立医院社会责任要正确认识公立医院社会责任本质,应正确处理好社会责任与经营性之间的关系及充分发挥公立医院社会责任的利益相关方力量。有关企业社会责任及治理结构的理论和方法对研究医院相关问题有重要借鉴作用,但不能照搬,中国经济、管理和卫生领域专家在公立医院社会责任及实现机制方面的探索还有许多工作要做。     

The Combined Effects of Hospital and Surgeon Volume on Short-Term Survival after Hepatic Resection in a Population-Based Study

Background

The influence of different hospital and surgeon volumes on short-term survival after hepatic resection is not clearly clarified. By taking the known prognostic factors into account, the purpose of this study is to assess the combined effects of hospital and surgeon volume on short-term survival after hepatic resection.

Methods

13,159 patients who underwent hepatic resection between 2002 and 2006 were identified in the Taiwan National Health Insurance Research Database. Data were extracted from it and short-term survivals were confirmed through 2006. The Cox proportional hazards model was used to assess the relationship between survival and different hospital, surgeon volume and caseload combinations.

Results

High-volume surgeons in high-volume hospitals had the highest short-term survivals, following by high-volume surgeons in low-volume hospitals, low-volume surgeons in high-volume hospitals and low-volume surgeons in low-volume hospitals. Based on Cox proportional hazard models, although high-volume hospitals and surgeons both showed significant lower risks of short-term mortality at hospital and surgeon level analysis, after combining hospital and surgeon volume into account, high-volume surgeons in high-volume hospitals had significantly better outcomes; the hazard ratio of other three caseload combinations ranging from 1.66 to 2.08 (p<0.001) in 3-month mortality, and 1.28 to 1.58 (p<0.01) in 1-year mortality.

Conclusions

The combined effects of hospital and surgeon volume influenced the short-term survival after hepatic resection largely. After adjusting for the prognostic factors in the case mix, high-volume surgeons in high-volume hospitals had better short-term survivals. Centralization of hepatic resection to few surgeons and hospitals might improve patients’ prognosis.     

Hospital Standardized Mortality Ratio: Consequences of Adjusting Hospital Mortality with Indirect Standardization

Background

The hospital standardized mortality ratio (HSMR) is developed to evaluate and improve hospital quality. Different methods can be used to standardize the hospital mortality ratio. Our aim was to assess the validity and applicability of directly and indirectly standardized hospital mortality ratios.

Methods

Retrospective scenario analysis using routinely collected hospital data to compare deaths predicted by the indirectly standardized case-mix adjustment method with observed deaths. Discharges from Dutch hospitals in the period 2003–2009 were used to estimate the underlying prediction models. We analysed variation in indirectly standardized hospital mortality ratios (HSMRs) when changing the case-mix distributions using different scenarios. Sixty-one Dutch hospitals were included in our scenario analysis.

Results

A numerical example showed that when interaction between hospital and case-mix is present and case-mix differs between hospitals, indirectly standardized HSMRs vary between hospitals providing the same quality of care. In empirical data analysis, the differences between directly and indirectly standardized HSMRs for individual hospitals were limited.

Conclusion

Direct standardization is not affected by the presence of interaction between hospital and case-mix and is therefore theoretically preferable over indirect standardization. Since direct standardization is practically impossible when multiple predictors are included in the case-mix adjustment model, indirect standardization is the only available method to compute the HSMR. Before interpreting such indirectly standardized HSMRs the case-mix distributions of individual hospitals and the presence of interactions between hospital and case-mix should be assessed.     

公立医院管理会计体系建设的意义与对策

我国已进入经济社会发展新常态,公立医院既要面对进一步深化医疗体制改革,实现医院公益性、福利性的任务,又要面对社会资本进入医疗领域带来的激烈的市场竞争,就要求公立医院必须建立公立医院管理会计体系。通过明确公立医院管理会计体系,阐述公立医院管理会计体系建设的意义,而后找出当前我国公立医院管理会计体系建设的中存在的问题,并针对这些问题提出相应对策。     

The PATHWAYS Hospital Project

In 1995, the Hospital Ethics Committee Consortium organized by Midwest Bioethics Center created the PATHWAYS to Patient-Centered Palliative Care: A Community Approach--a guideline document, or "how to" manual for hospitals that want to improve care of the seriously ill and dying. Following the publication and wide dissemination of this manual, the Center began to implement strategies to produce positive change in the way hospitals respond to dying persons and their families. Spurred by the same desire to alter hospital culture through improved care of the dying, eleven hospitals collaborated with the Center to form the PATHWAYS Hospital Project.     

Using Quality Measures for Quality Improvement: The Perspective of Hospital Staff

Research objective

This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals.

Study design

A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness) indicators.

Population studied

93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran.

Principal findings

On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05).

Conclusions

There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and effectiveness indicators is needed to support internal quality improvement processes at hospital level.     

试论现代医院领导力的创新发展

领导力是现代医院实现创新转型的关键环节,其理论随着实践不断发展。文章分析了领导力的内涵和现代医院领导力的创新本质,并从组织文化、发展战略、信息化领导力和职业化管理四个方面探讨了领导力建设内容,并介绍了医院领导力建设成效以及下一步发展方向。     

Variations and Determinants of Hospital Costs for Acute Stroke in China

Background

The burden of stroke is high and increasing in China. We modelled variations in, and predictors of, the costs of hospital care for patients with acute stroke in China.

Methods and Findings

Baseline characteristics and hospital costs for 5,255 patients were collected using the prospective register-based ChinaQUEST study, conducted in 48 Level 3 and 14 Level 2 hospitals in China during 2006–2007. Ordinary least squares estimation was used to determine factors associated with hospital costs. Overall mean cost of hospitalisation was 11,216 Chinese Yuan Renminbi (CNY) (≈US$1,602) per patient, which equates to more than half the average annual wage in China. Variations in cost were largely attributable to stroke severity and length of hospital stay (LOS). Model forecasts showed that reducing LOS from the mean of 20 days for Level 3 and 18 days for Level 2 hospitals to a duration of 1 week, which is common among Western countries, afforded cost reductions of 49% and 19%, respectively. Other lesser determinants varied by hospital level: in Level 3 hospitals, health insurance and the occurrence of in-hospital complications were each associated with 10% and 18% increases in cost, respectively, whilst treatment in a teaching hospital was associated with approximately 39% decrease in cost on average. For Level 2 hospitals, stroke due to intracerebral haemorrhage was associated with a 19% greater cost than for ischaemic stroke.

Conclusions

Changes to hospital policies to standardise resource use and reduce the variation in LOS could attenuate costs and improve efficiencies for acute stroke management in China. The success of these strategies will be enhanced by broader policy initiatives currently underway to reform hospital reimbursement systems.