公立医院的双边市场属性分析

????? 公立医院具有双边市场的主要特征。可以作为调整公立医院组织结构的基础。使用双边市场理论描述公立医院的组织特征,分析公立医院平台与医患双方的关系。医患双方的交叉网络外部性对公立医院的运作具有显著的影响。随着医疗体制改革的深入,公立医院的双边市场属性将得到进一步凸显。

     

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。     

北京市公立医院治理结构现状调查

??????? 目的 调查北京市公立医院治理结构的现状,为公立医院法人治理结构改革政策的完善提供依据。方法 以北京市500张床以上的三级公立医院以及区县级综合医院作为调查对象,根据研究框架设计调查问卷对医院高层管理者进行调查,共调查公立医院51家。 结果 公立医院具有较高的决策权和剩余索取权,较低程度的市场开放度、问责机制,政府对公立医院的社会功能缺乏明晰的规定和相应的补助。结论 目前治理结构中公立医院的激励机制和监督机制的不匹配,可能是导致公立医院偏离公益性的关键原因。     

医生对绩效考核与分配要素的认识与实践感受研究

目的 了解公立医院临床医生对绩效考核与分配要素重要性的认识与实践感受的差异以及临床医生绩效考核与分配的要素权重。方法 调研某公立医院各专业层面的临床一线医生,采用问卷测量的方法对绩效考核与分配要素进行检验,统计分析方法包括信度和效度分析、因子分析与配对样本t检验分析等。结果 通过分析,发现临床医生对绩效考核与分配部分要素重要性的认识与实践感受有统计学差异,临床医生认为绩效考核要素中最重要的是医德医风(0.363),绩效分配要素中最重要的是工龄(0.210)。结论 临床医生绩效考核与分配需突出医疗质量等主体要素,绩效制度只有获得临床医生的认可,医疗改革才能获得成功。     

医生与管理者对医院核心人力资源管理制度评价研究

目的 了解公立医院医生和管理者对薪酬、晋升与学习成长这医院3大核心人事制度的认知与评价。方法运用自行设计的人事制度管理状况调查表对我国东、中、西3省、直辖市9个地区的128所公立医院进行调查。结果 医院核心人事制度3个因子中,被调查者不清楚率最高的是“晋升”（5.21%）,不认同率最高的是“薪酬”（25.02%）。多元logistic分析显示,是否是管理者、院内工龄等与被调查者对3大医院核心人事制度的评价有显著关联（P<0.05）。结论 普通医生与管理者对医院核心人事制度的知晓度尚可,医院管理者对医院核心人事制度的评价均显著优于普通医生。     

公立医院治理制度改革的利益相关者识别分析

目的 准确识别公立医院治理制度变革涉及的各利益相关者,厘清各方之间的关系和地位,推进公立医院治理制度改革。方法 采用文献综述法、政策法规分析法和专家访谈法,采访地方行政官员、医院管理者和临床医生等共15人,列举分析各个利益相关者的类型和改革中的职权变化。结果 公立医院治理制度改革涉及14个利益相关者,改革的推进会导致各利益相关方工作量的增加或权益的减少,改革比较复杂,难度较大。结论 利益相关者在公立医院治理制度改革中的力量不容小觑,行政决策首脑必须明确改革的方向,描绘清晰的愿景,设立权威联系人,建立联动机制,设立改革专项经费,补偿各利益相关者的额外劳务,才能保证改革的可行性。     

医德医风与医院履责对

目的 探讨医院医德医风和医生感知的医院责任履行状况对医生自身责任履行的影响。方法 运用自行设计的调查问卷对我国东、中、西3省、直辖市9个地区的128所公立医院医生进行调查。结果 回归分析显示,医德医风和医院履责对医生自身履责解释力均显著。在控制了个体变量与医院地区级别变量之后,医德医风对医生交易、发展、关系与理念责任的履行均具有显著正向影响（P＜0.001）,而医院履责对医生履责的影响有不同的对应性。结论 医院医德医风对医生自身责任的履行有积极促进作用。医院4类责任的履行状况与医生四类责任履行有紧密关联,但对应性略有不同。     

运用ServQual量表评价医院医疗服务质量

目的 测评医院患者和职工的感知服务质量,了解患者就诊和职工工作满意程度,提升医疗服务质量。方法 根据ServQual量表5个维度定义设计患者组与职工组两套量表,每套量表共设22个问项的问卷调查表,分别对医院门诊、住院患者和职工发放问卷,并让职工填写患者卷自评对患者提供的服务质量,用数据SPSS20.0统计分析。结果 患者卷和职工自评卷5个维度感受满意。职工卷有形性感受满意,移情性和可靠性感受性差,保证性与响应性感受性次之。女职工较男职工感受性好,30～49岁组职工感受性差,临床一线职工感受性差,其中以医技人员和医生为突出。结论 医院应保护职工利益、需求,合理安排工作时间与强度。提升职工感知服务质量更能提升患者感知的医疗服务质量。     

华东某省三级公立医院员工薪酬现状调查

目的 分析华东某省三级公立医院薪酬结构和薪酬水平并提出合理化建议,为公立医院薪酬制度改革和补偿机制改革提供决策依据。方法 以某省58家三级公立医院为研究对象,运用描述性分析、t检验和方差分析等方法,对薪酬结构和薪酬水平进行统计分析。结果 财政补助收入仅占总收入的4%;薪酬支出占总支出的26.6%,无地域差异;医务员工年人均收入9.47万元,存在地域差异;医务员工薪酬水平是非私营单位在岗职工的1.76倍。结论 政府应加大对公立医院的财政补助力度,放宽对医疗行业薪酬总量管控,提升医务员工薪酬水平和社会薪酬地位;公立医院迫切需要建立一套科学、合理的薪酬分配体系。     

信息管理系统在医院绩效考核分配中的应用研究

建立和完善医院内部绩效考核和收入分配制度,坚持公立医院公益性,是深化公立医院改革的一项重要内容;依托医院信息平台,开发建设基于临床数据仓库的智能化医院绩效考核分配信息管理系统,是各医院推进精细化管理所面临的重要课题。本文分析了信息管理系统在国内外医院内部绩效考核中的应用,剖析存在的问题,并提出了相应的建议和对策。     

大型公立医院实行院务公开制度的实践探索

为了进一步提高公立医院的透明度，通过在社会、患者、内部职工等各个层面开展院务公开工作，提升了医院外部形象，使患者对公立医院的内部结构、就医流程、个人账目等一目了然，改善了医患之间的关系，提高了医生和患者的满意度，同时有助于杜绝腐败现象的发生。     

公立医院临床医师对临床路径实施工作及效果的评价

目的 了解我国公立医院临床医师对临床路径实施工作及效果的评价。方法 对我国东、中、西3省（直辖市）1638名临床医师进行问卷调查。结果 我国公立医院临床医师对临床路径实施工作和实施效果的总体评价分别为3.16分和3.41分。并且,不同地区、等级公立医院临床医师的评价存在一定差异。结论 我国公立医院临床医师对临床路径实施工作的认可度不高;西部地区和二级医院的临床医师更偏好实施临床路径;临床医师对临床路径实施可提高医疗服务过程质量的认同度相对较高。     

Family physicians' attitudes toward advance directives.

OBJECTIVE: To examine the attitudes toward, the experience with and the knowledge of advance directives of family physicians in Ontario. DESIGN: Cross-sectional survey. PARTICIPANTS: A questionnaire was mailed to 1000 family physicians, representing a random sample of one-third of the active members of the Ontario College of Family Physicians; 643 (64%) responded. RESULTS: In all, 86% of the physicians favoured the use of advance directives, but only 19% had ever discussed them with more than 10 patients. Most of the physicians agreed with statements supporting the use of advance directives and disagreed with statements opposing their use. Of the respondents 80% reported that they had never used a directive in managing an incompetent patient. Of the physicians who responded that they had such experience, over half said that they had not always followed the directions contained in the directive. The proportions of physicians who responded that certain patient groups should be offered the opportunity to complete an advance directive were 96% for terminally ill patients, 95% for chronically ill patients, 85% for people with human immunodeficiency virus infection, 77% for people over 65 years of age, 43% for all adults, 40% for people admitted to hospital on an elective basis and 33% for people admitted on an emergency basis. The proportions of physicians who felt that the following strategies would encourage them to offer advance directives to their patients were 92% for public education, 90% for professional education, 89% for legislation protecting physicians against liability when following a directive, 80% for legislation supporting the use of directives, 79% for hospital policy supporting the use of directives, 73% for reimbursement for time spent discussing directives with patients and 64% for hospital policy requiring that all patients be routinely offered the opportunity to complete a directive at the time of admission. CONCLUSIONS: Family physicians favour advance directives but use them infrequently. Most physicians support offering them to terminally or chronically ill patients but not to all patients at the time of admission to hospital. Although governments emphasize legislation, most physicians believe that public and professional education programs would be at least as likely as legislation to encourage them to offer advance directives to their patients.     

上海三级医院门诊预约市级统一平台的构建

为了创造有序就医的诊疗环境，提高预约患者比例，针对上海三级医院存在的预约电话、网站、服务商不统一带来的诸多不便，借助体制和技术优势，整合三级医院预约号源，设计构建市级统一公益性平台。将就相关背景、三级医院预约现状及统一平台的建设原则和内容进行阐述。     

Physician retirement: a case for concern in Canadian hospitals.

Mandatory retirement is being challenged on the basis of age discrimination, and physicians are not divorced from this social trend. In January 1982 legal precedent was set by the Manitoba Court of Appeal concerning the retirement policy for physicians in Canada. Currently, Canadian hospital bylaws include clauses that require a change in membership status once a physician reaches 65 years of age. The main arguments in favour of this change include easier physician manpower management, ensured public safety and, in some instances, greater productivity. The main arguments against this change include loss of income to physicians, loss of skilled manpower to the profession and adverse effects on the mental and physical health of retiring physicians. In an effort to resolve this conflict some Canadian hospitals are developing strategies for reviewing the specific privileges and responsibilities physicians will retain once they reach age 65. The medical staff of the Victoria General Hospital in Halifax, NS have addressed this issue through their annual reappointment process.     

基于融合理念的公立医院内部绩效考核体系探索研究

目的 建立与公立医院目标任务及外部绩效评价相匹配的内部绩效考核体系。方法 监控样本公立医院内部绩效考核体系的运行状态,对现行内部绩效考核体系的运行效果及医务人员反馈意见进行分析。调研管理部门、临床科室,访谈部门科室管理人员。结果 总结了现行内部绩效考核体系待改进的问题,提出基于医疗过程和医疗结果相结合进行全面评价、改进内部绩效工资测算方法、建立完善职能部门绩效评价体系、建立绩效沟通数据平台、融合政策执行评估的改进方案。结论 内部绩效考核体系的动态改进是公立医院实现医院目标任务、执行外部绩效评价的必然要求。     

A comparative study of congenital toxoplasmosis between public and private hospitals from Uberlândia, MG, Brazil

The main purpose of the present study was to examine if there is difference in terms of incidence rates of congenital toxoplasmosis among populations assisted in public and private hospitals from Uberlandia, state of Minas Gerais, Brazil. A total of 805 serum samples from cord blood were collected, being 500 from public hospital and 305 from private hospital, and all patients answered a questionnaire about pregnancy and newborns. An indirect enzyme linked immunosorbent assay (ELISA) was performed to detect IgG antibodies to Toxoplasma gondii and the positive samples were retested to verify the presence of specific IgM and IgA antibodies in a capture ELISA. We found significant differences among data from both hospitals with respect to maternal age, origin city, gestational age, number of visits to physicians during pregnancy, type of delivery, and birth weight. Seroprevalence of IgG antibodies against T. gondii for patients from public and private hospitals was 57.6% and 41.9% respectively, and this difference was statistically significant (P < 0.0001). In addition, the frequency of congenital toxoplasmosis measured by the presence of IgM and/or IgA antibodies toward T. gondii was exclusively located in samples from public hospital (0.8%), and no positive sample was seen in private hospital (0%). Considering that almost all babies suffering from congenital toxoplasmosis, if undiagnosed and untreated, will develop visual or neurological impairments by adulthood, the results presented herein emphasized the importance to accomplish screening programs for toxoplasmosis during pregnancy, particularly in the public hospitals, due to the expressive rate of congenital disease showed in the patients attended at these centers.     

RFID analytics for hospital ward management

In this paper, we present an RFID-enabled platform for hospital ward management. Active RFID tags are attached to individuals and assets in the wards. Active RFID readers communicate with the tags continuously and automatically to keep track of the real-time information about the locations of the tagged objects. The data regarding the locations and other transmitted information are stored in the ward management system. This platform enables capabilities of real-time monitoring and tracking of individuals and assets, reporting of ward statistics, and providing intelligence and analytics for hospital ward management. All of these capabilities benefit hospital ward management by enhanced patient safety, increased operational efficiency and throughput, and mitigation of risk of infectious disease widespread. A prototype developed based on our proposed architecture of the platform was tested in a pilot study, which was conducted in two medical wards of the intensive care unit of one of the largest public general hospitals in Hong Kong. This pilot study demonstrates the feasibility of the implementation of this RFID-enabled platform for practical use in hospital wards. Furthermore, the data collected from the pilot study are used to provide data analytics for hospital ward management.