国家临床重点专科建设项目绩效管理的探索与思考

国家临床重点专科建设是医院核心竞争力的重要体现,卓越的绩效管理是学科项目建设的有力保障。文章结合吉林大学第一医院开展国家临床重点专科建设的相关工作,分析其项目绩效管理体系的创新实践,为推动医院重点专科管理效力和绩效水平提供借鉴。     

医院绩效管理体系的构建与实施

绩效管理已逐渐成为医院管理进步的重要标志。但目前我国还尚未形成较为科学的医院绩效评估体系,医院绩效管理在从理论研究阶段向深层应用推进的过程中受到了较大的阻力。文章通过总结我院绩效管理中的问题,设计和探索新的绩效管理体系与实施策略,为绩效管理的落实提供思路和借鉴。     

医院绩效评估实践的发展

通过总结相关文献对部分国外医院绩效评估项目进行了描述，对这一领域的发展进行了简要总结。分析表明评估的基本框架已经得到广泛认可，评估项目需要结合特定的对象得以实施，注重反馈和改进措施。同国外的实践相比，国内的医院绩效评估实践需要深化细节，并同公立医院的内部绩效管理相融合。     

对完善我国公立医院绩效分配模式的思考

公立医院绩效分配模式的完善是公立医院改革的重点和难点。在全国推行绩效工资的宏观背景下,探讨绩效分配模式具有十分重要的现实意义。公立医院绩效的内涵可以总结为经济运行绩效、患者绩效和社会绩效。一个完善的绩效分配方式的理想目标是三者的统筹兼顾,但现实中,我国的医院差异很大,应在充分考虑各种影响因素的基础上,因地制宜地选择顺应卫生体制改革要求的绩效分配模式,以公益性和公平性为目标,寻求各方利益的平衡点,实现由原来的工资奖金分配制度向绩效工资改革的平稳过渡。

     

浅论医院绩效反馈环节中存在的问题及对策

绩效反馈是医院绩效管理工作的关键一环,能否达到绩效管理的预期目的,取决于绩效反馈的实施效果。针对目前医院在绩效反馈中存在的一些不足,提出优化方案,以提高绩效反馈效用。     

以相对价值为基础的医师绩效薪酬分配模式研究

以资源为基础的相对比率方法,是一种合理支付医生服务酬金的新方法。利用某三级医院临床科室的数据,采用相对价值法对体现医师工作绩效的项目进行赋值,并比较赋值后医师的绩效薪酬。研究表明,该方法能够反映客观医师的工作绩效,具有合理性。     

构建中小型企业绩效评估体系的研究

本文将研究构建中小型企业绩效评估体系的问题,这对现代企业管理来说是非常重要的。我们在分析中小型企业的特点,研究构建绩效评估体系的原则的基础上。设计了中小型企业绩效评估体系新的层次结构。     

医院绩效管理的二次转型

医药卫生体制改革对医院管理提出新的、更高的要求,需要构建有效的绩效管理体系,实现医院绩效管理的二次转型。绩效管理是将医院整体发展战略落实为医护人员个人具体工作和效果的有效手段,传统的绩效管理关注部门和科室整体绩效水平,二次转型的重要内容是医护人员个人效能的提高,特别是提升医院中效能较低人员的绩效。从严预算、流程优化、提升科室经济管理能力等有助于实现绩效管理的二次转型,提升医院深层次核心竞争力。     

生态保护项目绩效评估的技术方法体系

自20世纪90年代以来,以各种形式的生态补偿政策和工程项目为代表的生态保护项目在全球广泛实施。1998年长江大洪水之后,我国也陆续实施了天然林保护工程、退耕还林还草工程、京津风沙源治理工程、森林生态效益补偿基金、退田还湖还湿工程、生态转移支付等一系列生态保护项目。近年来,政府、研究人员和社会各界越来越重视这些项目产生的生态、经济和社会效益。不过,我国生态保护项目绩效评估还处于起步阶段,主要体现在定量化不足、研究设计不严密、基准线选取不规范、评估方法过于简易、因果推理证据不足、评估结果可信度较差。不管是从学术研究、国家战略,还是实际生态管理的角度,都迫切需要推动和完善我国生态保护项目的绩效评估。结合过去十多年的理论和案例研究经验,对绩效评估的研究设计、基准线选取、评估方法、以及评估分析中面临的问题和挑战进行了系统地归纳与梳理,以期为进一步开展生态保护项目绩效评估提供技术参考。     

公立医院开展项目支出预算绩效评价的探讨

目前,我国大部分公立医院尚未广泛开展内部项目支出预算绩效评价工作。随着财政部与国家卫生和计划生育委员会的预算项目绩效管理的深入开展,公立医院通过加强多部门的合作,以战略发展为导向开展项目支出预算绩效评价工作对提高资金使用效益具有重要意义。     

试析公立医院财务管理职能的转变

新医院财务制度、会计制度的实施,医改的深入以及医院经济绩效考评工作的开展,对公立医院财务部门提出了更高的要求,公立医院财务部门必须适应新的形势,实现从传统的记账职能到财务管理职能的转变。要加强财务信息系统一体化建设并注重系统的安全;通过预算、成本核算及绩效管理工作,加强财务分析职能;改变原有的工作方式,加强与临床科室的沟通;财务人员需及时更新现有知识,不仅要有专业的财务知识,还要有经济管理的知识和概念,才能胜任现有的财务工作。     

基于卫生经济学的公立医院国有资产管理策略探讨

随着医院财务制度的完善和医院精细化管理的推进,公立医院国有资产管理将更加注重科学有效的方法学。研究主要针对设备使用率低、库存物资闲置、无形资产保护不足等3个医院面临的主要资产管理问题,探讨需求分析、市场战略分析、成本效益分析、成本核算、预算控制等卫生经济学方法在公立医院资产管理中的应用与实践,以此探索公立医院资产管理的科学方法,提高资产管理效率。     

Care management and mental health.

The community care reforms will produce a new kind of key worker who will organise and budget for packages of care: the care manager. Care management goes live in April 1993 but is still poorly rehearsed and its performance may yet disappoint. This overview sets out the origins of case management, its transformation into care management, and the principles guiding its practice. To spell out how the concept works, plans for care management in Southwark''s mental health services are described.     

Health resources management and physician control in a San Francisco,California, hospital.

The continued escalation in health care spending has caused money to become an increasingly limited resource, which may eventually affect the ability of health professionals to provide complete health care services. Health care payers have stressed efficiency and the appropriateness of health care measures and are putting greater financial pressures on health professionals by making them more accountable for services provided. Hospitals and physicians must take a more active role in monitoring health care delivery and work together to improve performance efficiency. Efficiency can be gained through a comprehensive program that emphasizes high-quality care and the effective use of health care resources. The Health Resource Management Program is a model for carrying out this function that integrates data analysis and physician input and education.     

水库磷收支及其调控措施研究进展

磷是主要的富营养化限制性因子,其收支途径和调控措施的研究是水库生态安全的重要保障.为推动水库磷的系统研究,进一步完善磷调控体系,本文归纳了水库磷的收支途径,分析了不同因素对磷收支的影响,并对常规调控措施进行了梳理.水库磷输入的主要来源包括上游河流、地表径流、生活生产污染、养殖投入、大气沉降和底泥释放.其中上游河流的输入是水库磷最大的来源.磷主要的输出途径为泄洪或放水,并受不同排水方式的影响.另外生物收获也会输出部分磷.水库磷收支平衡受水库功能、水文条件和水体理化性质等因素的影响,不同季节和地域的收支情况差异很大.在磷的调控治理上,人工湿地、前置库、底泥疏浚和生物操纵法是目前采取的主要措施.为有效去除磷,需根据水库不同生态特性和水质管理目标,选择或结合多种不同的调控方式.因此,未来的研究应突出水库生态特性,进一步对水库磷收支及其影响因素进行系统分析,并开展水库磷收支与其他营养物质之间影响关系的研究,在此基础上构建科学完善的管理体系,是有效削减水库磷的根本保障.     

Requirements engineering: the key to designing complex medical systems

A variety of business systems, clinical work systems, instrumentation systems, information systems, infrastructure systems, and management systems interact to make the modern healthcare facility work. The key to designing for such a system is systems engineering, a skill often little appreciated among clinical engineers. At the heart of systems engineering is requirements engineering and management (REAM), which is defined as "the process of discovering, documenting and managing systems requirements." The principal activities of REAM include eliciting, understanding, negotiating, describing, validating, and managing system requirements. When REAM is done improperly, the resulting system will be satisfactory only if chance intervenes. Well-done REAM is likely to bring the project in on time, under budget, and at full performance.     

Building new university hospital--what citizens know and policy makers should be aware of

Survey of citizens' attitudes in the process of strategic decision making is one of the most important methods for determining health care priorities. We describe the results of a survey carried out in December 2001, with an aim to collect and analyze the attitudes of the citizens and health care professionals toward the possibilities and strategies of construction of the University Hospital in Blato, Zagreb. The first referendum on the construction of the new hospital was conducted among Zagreb citizens in 1982, when they agreed that the new University Hospital was much needed. Zagreb citizens confirmed once again their attitudes toward and opinions on the need to continue the construction of new hospital in the city outskirts. By 1992, when the construction of the hospital was halted due to insufficient financial means, Zagreb citizens had already invested over 150 epsilon million in the project. It is interesting that today, 89.4% of the citizens and 74.5% of physicians agree that the new hospital building should be completed. Also, 66.7% of the citizens and 88% of physicians think that this hospital should be a University hospital that could offer the most complex treatments and medical education. To finish the construction of the new hospital further 200 epsilon million needs to be invested. Survey showed that 71% of citizens and 82.2% of physicians think that funds should be raised from some form of credit or budget rather than by special local tax, additional tax or voluntary tax. This project will significantly determine the future of hospital and health care system in Croatia due to its capacities in terms of space, technology, and staff. Before the decision to continue with the new hospital construction be made, the expected future needs, demands, and supply of the health care services in hospital sector in Zagreb and Croatia should be provided using SWOT analysis for each of existing the facilities.     

我国主要类型生态系统结构功能与提高生产力途径研究──KJ85－06项目1991～1995研究进展简介

KJ 85-06项目是“八五”期间由中国科学院资助的最大的生态学研究计划.19个研究所、20个试验站、530余名科技人员参加了该项计划,5年总经费1000万元.研究工作取得了重大进展,迄今已发表论文450余篇、专着3部,尚有大量论文与多部专着将陆续出版.本文简要介绍了有关主要研究进展,并就生态系统优化管理研究和生态过程、人类活动影响联网研究提出了两点主张.     

军队医院科研创新存在的问题及对策分析

科学技术是第一生产力,科技的进步是医学不断发展的基础。随着我国医疗卫生体制改革的不断推进,医院科研管理的作 用越来越突出。近年来,军队医院的科研实力和水平面临着巨大的挑战。因此,建立完善的科研机制,实施科研创新战略是推动卫 生事业改革与发展的动力。科研创新是指在立项、论证、研究方法、数据处理等科研活动中所表现出的与前人不同的思维方式和 行为方式。科研活动本身是以现有的现象、认知和习惯为基础的活动,凭借知识和经验预测科研可能达到的科学目的。在不同层 次对人们熟悉的思维方式高度抽象或转换,是科研创新的主要特征。本研究分析现阶段军队医院科研管理存在的问题,探讨科研 创新的必要性,强调医院科研管理应贯彻系统化思想,建立多元化科研模式。     

Physicians in health care management: 1. Physicians as managers: roles and future challenges.

Physicians are increasingly expected to assume responsibility for the management of human and financial resources in health care, particularly in hospitals. Juggling their new management responsibilities with clinical care, teaching and research can lead to conflicting roles. However, their presence in management is crucial to shaping the future health care system. They bring to management positions important skills and values such as observation, problem-solving, analysis and ethical judgement. To improve their management skills physicians can benefit from management education programs such as those offered by the Physician-Manager Institute and several Canadian universities. To manage in the future environment they must increase their knowledge and skills in policy and political processes, financial strategies and management, human resources management, systems and program quality improvement and organizational design.