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。     

基于结构方程模型的公立医院治理结构与医院行为关系研究

??????? 目的 分析治理结构与医院行为的关系,为公立医院法人治理结构改革和完善提供依据。方法 问卷调查北京、山东、河南三地92家大型公立医院。使用结构方程模型分析治理结构与医院行为的关系。结果 治理结构与医院行为的标准化路径系数为0.644,检验具有显著意义;市场监管、问责和社会功能的加强有利于医院行为,特别是长期行为的改善。结论 问责、市场监管的加强以及社会功能的明晰是重要的改革方向。     

公立医院法人治理结构与改革

随着国务院医改近期重点实施方案的出台,公立医院法人治理结构的改革模式也渐渐明朗。公立医院法人治理结构改革是创新公立医院体制机制的关键任务之一,是维护公立医院公益性的重要制度保障。针对公立医院法人治理结构的内涵作了阐述,从公立医院的多层委托代理关系、产权制度等多角度分析了我国公立医院法人治理结构的现状和问题,提出了我国公立医院法人治理结构改革的具体措施。     

医疗联合体绩效评估理论框架的构建

目前,国内公开发表的文献中尚未见到对医疗联体体绩效进行定量评估的报道。经由利益相关者分析,并借鉴经典的“结构—过程—结果”模型,在文献阅读和分析的基础之上,进一步发现和分析医疗联合体工作推进的关键点。研究初步形成医疗联合体绩效评估的理论框架包含治理结构、卫生资源投入等方面,涉及到人员协作机制、资源共享机制等要素。可为开展类似的评估项目提供参考。

     

宁夏县级公立医院利益相关者补偿机制研究

目的 通过对公立医院运行中各利益相关者之间博弈情况的分析,探讨更为合理、有效的公立医院补偿机制,为公立医院改革提供政策建议。方法 采用定量数据收集方法、多维细分法、博弈均衡分析法及描述性分析方法。结果 根据公立医院补偿主要利益相关者政府、医疗保险机构、医疗卫生服务需方和公立医院的情况,构建和测算出6种补偿模型。结论 结合公立医院利益相关者情况实施公立医院新型补偿模型。     

公立医院法人治理结构改革试点效果与对策分析

以河南科技大学第二附属医院为对象,使用问卷调查、深度访谈等方法,对医院法人治理结构改革现状进行分析。结果发现,改革在提升了医院服务质量和社会公信力的同时,仍然存在法人治理结构不规范、医管局权责不明晰、财政补偿机制不完善、内部治理改革所需要的外部条件缺失、产权结构单一等问题。最后提出了相应的完善对策,包括强化政府中立角色和政府责任;推进信息公开与问责制度,完善监督评估机制;完善法人治理管理办法;实施股权结构多元化经营;坚持并完善理事会型法人治理结构。     

我国公立医院法人治理结构下的管理者激励机制探讨

建立管理者有效激励机制,化解公立医院法人治理结构下的委托代理问题是公立医院体制改革的重要保障。该激励机制通过弥合管理者与所有者的价值及行为取向差异,促使管理者自觉自愿地履行并实现公共利益。但由于机制建立过程中存在效益目标不明晰、绩效水平难于考量等难题。为此,需以公共利益为导向设置董事机构,加强效益评价指标体系和外部监管制度建设,同时创新激励手段,从而提高公立医院法人治理结构下的整体绩效。     

三明市药品供应保障改革的利益相关者分析

三明市药品供应保障改革中涉及四大方面的主要利益相关者,即政府部门、医药企业、医疗服务提供者和医疗服务需求者。本研究重点分析各利益相关者在改革中的角色定位、基本诉求,各利益相关者影响改革或受改革影响的情况,以及改革中可能存在的问题,有利于明晰改革的动力和阻力,为三明改革的可持续性与可复制性提供建议。     

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。     

北京市公立医院法人治理结构改革的外部环境分析

从公立医院法人治理结构改革的市场环境、筹资支付系统和政府监管三方面探讨改革的动力和阻力。动力来自社会需求、医药卫生体制改革的目标和发展方向及医疗服务市场的完善,阻力来自于公立医院所处的市场地位,优质资源的不足和尚未理顺的管理体制和机制。

     

StakeMeter: Value-Based Stakeholder Identification and Quantification Framework for Value-Based Software Systems

Value-based requirements engineering plays a vital role in the development of value-based software (VBS). Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ) approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called ‘StakeMeter’. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error.     

Implementing an organised cervical screening programme in the Republic of Moldova—Stakeholder identification and engagement

IntroductionSuccessfully implementing cervical screening programmes requires them to be adapted to the local context and have broad stakeholder support. This can be achieved by actively engaging local stakeholders in planning as well as implementing the programmes. The Moldovan government started implementing an organised cervical screening programme in 2010 with the first step being stakeholder identification and engagement.Materials and methodsThis process started by contacting easily identified stakeholders with each asked to recommend others and the process continued until no new ones were identified. Stakeholders were then involved in a series of individual and group meetings over a 2-year period to build confidence and encourage progressively greater engagement.ResultsIn total, 87 individuals from 46 organisations were identified. Over the 2-year process, the individual and group meetings facilitated a change in stakeholder attitudes from disinterest, to acceptance and finally to active cooperation in designing the screening programme and preparing an implementation plan that were both well adapted to the Moldovan context.DiscussionDeveloping the broad support needed to implement cervical screening programmes required ongoing interaction with stakeholders over an extended period. This interaction allowed stakeholder concerns to be identified and addressed, progress to be demonstrated, and stakeholders to be educated about organised screening programmes so they had the knowledge to progressively take greater responsibility and ownership.     

Analysing stakeholders’ perceptions of wolf,lynx and fox in a Dutch riverine area

In the last decades, populations of large carnivores have been making a spectacular return, especially in the USA and Western Europe. These population recoveries result partially from protective legislation and reintroduction programs, but possibly also from land use changes and from large carnivores adapting to human environments. Although public support for large carnivore protection seems to be growing, some stakeholders still have a negative perception of large carnivores because of their alleged negative impacts on livestock and humans. Perceptions of large carnivores are partly determined by underlying visions of nature which differ between stakeholder groups. We therefore examined the relationship between different stakeholder groups’ perceptions of nature and the presence of the fox (Vulpes vulpes), and the possible establishment of the wolf (Canis lupus) and lynx (Lynx lynx) in a Dutch riverine landscape. Stakeholder groups comprised the general public, farmers, scientists and nature conservationists. Although perceptions of large carnivores differed significantly across the stakeholder groups, public support for large carnivores was generally higher than expected. Farmers show the most negative perception, especially regarding the wolf and lynx. This is related to their vision of nature, which is more strongly aligned with mastery over nature compared to other stakeholder groups. Scientists, prominent adherers of stewardship of nature, appear to have the most positive perception of large carnivores. Despite these differences in visions of nature, respondents generally adhere to the stewardship of nature relationship. This could be a good starting point to find common ground when disputes arise over large carnivores.     

A proposed process for applying a structured decision‐making framework to restoration planning in the Atchafalaya River Basin,Louisiana, U.S.A.

Environmental decision‐making issues in the Atchafalaya River Basin (ARB), Louisiana require innovative approaches that combine scientific understanding and local stakeholder values. Management of the ARB has evolved from strong federal control to establish the ARB as a primary floodway of the Mississippi River and Tributaries Project to a state and federal collaboration to accommodate fish and wildlife resource promotion, recreational opportunities, and economic development. The management policy has expanded to include a growing number of stakeholders, but the decision‐making process has not kept pace. Current conflicts among many local stakeholder groups, due in part to their lack of involvement in the decision‐making process, impede restoration efforts. The absence of a long‐term collective vision for the ARB by both local stakeholder groups and management agencies further confounds these efforts. This paper proposes a process to apply a structured decision‐making framework, a values‐based approach that explicitly defines objectives, to promote stakeholder‐driven restoration efforts in the ARB and to better prepare for and manage long‐term environmental issues. The goals of this approach are: (1) to create a process founded on stakeholder values and supported by rigorous scientific assessment to meet management agency mandates and (2) to establish a transparent process for restoration planning in the ARB that incorporates current and future non‐governmental stakeholders into the decision‐making process. Similar frameworks have been successful in other river basins; we feel the structure of current restoration efforts in the ARB is well‐suited to adopt a values‐focused management framework.     

Social impacts and life cycle assessment: proposals for methodological development for SMEs in the European food and drink sector

Purpose

Small and medium enterprises (SMEs) account for 99 % of companies operating in the European food and drink industry and, often, are part of highly fragmented and complex food chains. The article focuses on the development of a social impact assessment methodology for SMEs in selected food and drink products as part of the EU-FP7 SENSE research project. The proposed methodology employs a top-down and bottom-up approach and focuses on labour rights/working conditions along the product supply chain as the key social impact indicator, limiting key stakeholder classification to workers/employees and local communities impacted by the production process. Problems related to this emerging field are discussed, and questions for further research are expounded.

Methods

The article reviews both academic and ‘grey’ literature on life cycle assessment (LCA) and its relationship to social LCA (S-LCA) and SMEs at the beginning of 2013 and includes case study evidence from the food sector. A pilot questionnaire survey sent to European food and drink sector SMEs and trade associations (as partners in the research project) about their knowledge, experience and engagement with social impacts is presented. Proposals are elaborated for a social impact assessment methodology that identifies the key data for SMEs to collect.

Results and discussion

The literature reveals the complexity of the S-LCA approach as it aims to unite disparate and often conflicting interests. Findings from the pilot questionnaire are discussed. Using a top-down and bottom-up approach, the proposed methodology assesses data from SMEs along the supply chain in order to gauge social improvements in the management of labour-related issues for different product sectors. Issues relating to the ‘attributional’ choice of a social impact indicator and key stakeholder categories are discussed. How ‘scoring’ is interpreted and reported and what the intended effect of its use will be are also elaborated upon.

Conclusions

Whilst recognising the difficulty of devising a robust social impact assessment for SMEs in the food and drink sector, it is argued that the proposed methodology makes a useful contribution in this fast-emerging field.     

Integrated Healthcare Delivery: A Qualitative Research Approach to Identifying and Harmonizing Perspectives of Integrated Neglected Tropical Disease Programs

BackgroundWhile some evidence supports the beneficial effects of integrating neglected tropical disease (NTD) programs to optimize coverage and reduce costs, there is minimal information regarding when or how to effectively operationalize program integration. The lack of systematic analyses of integration experiences and of integration processes may act as an impediment to achieving more effective NTD programming. We aimed to learn about the experiences of NTD stakeholders and their perceptions of integration.MethodologyWe evaluated differences in the definitions, roles, perceived effectiveness, and implementation experiences of integrated NTD programs among a variety of NTD stakeholder groups, including multilateral organizations, funding partners, implementation partners, national Ministry of Health (MOH) teams, district MOH teams, volunteer rural health workers, and community members participating in NTD campaigns. Semi-structured key informant interviews were conducted. Coding of themes involved a mix of applying in-vivo open coding and a priori thematic coding from a start list.FindingsIn total, 41 interviews were conducted. Salient themes varied by stakeholder, however dominant themes on integration included: significant variations in definitions, differential effectiveness of specific integrated NTD activities, community member perceptions of NTD programs, the influence of funders, perceived facilitators, perceived barriers, and the effects of integration on health system strength. In general, stakeholder groups provided unique perspectives, rather than contrarian points of view, on the same topics. The stakeholders identified more advantages to integration than disadvantages, however there are a number of both unique facilitators and challenges to integration from the perspective of each stakeholder group.ConclusionsQualitative data suggest several structural, process, and technical opportunities that could be addressed to promote more effective and efficient integrated NTD elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. For example, public health stakeholders should embrace a broader perspective of community-based health needs, including and beyond NTDs, and available platforms for addressing those needs.     

From Assessment to Policy: Lessons Learned from the U.S. National Assessment

The process of translating scientific information into timely and useful insights that inform policy and resource management decisions, despite the existence of uncertainties, is a difficult and challenging task. Policy-focused assessment is one approach to achieving this end. It is an ongoing process that engages both researchers and end-users to analyze, evaluate and interpret information from multiple disciplines to draw conclusions that are timely and useful for decision makers. This paper discusses key characteristics of a policy-focused assessment process, including (1) ongoing collaboration between the research, assessment, and stakeholder communities; (2) a focus on stakeholder information needs; (3) multidisciplinary approaches; (4) use of scenarios to deal with uncertainties; and (5) evaluation of risk management options. We illustrate the particular challenge to assessors of providing the specific types of insights stakeholders need to effectively influence policy decisions. And we discuss the role that assessment can play in formulating an agenda for future research. Examples from the U.S. National Assessment of “The Potential Consequences of Climate Variability and Change for the United States” are used to illustrate a policy-focused assessment process. For many of the participants, the first U.S. National Assessment was an extraordinary learning experience about how to develop better ways of conducting assessments.     

The enigmatic role of Mim1 in mitochondrial biogenesis

The translocase of the outer mitochondrial membrane (TOM complex) is a multi-subunit complex that serves as the general entry site for newly synthesized proteins into the organelle. The assembly of this complex is a multi-step process that requires the coordinated action of several proteins. A central, but rather undefined role in this process is played by Mim1, a mitochondrial outer membrane protein. The deletion of MIM1 leads to severe defects in the biogenesis of TOM complex subunits and to altered mitochondrial morphology. The protein is built from an N-terminal cytosolic domain, a central transmembrane segment, and a C-terminal domain facing the intermembrane space. In this review we summarize our current knowledge on the structure–function relationship of Mim1 and discuss some possibilities for its molecular function.     

Multiple conservation criteria,discursive conflicts and stakeholder preferences in the era of ecological modernization

Implementation of conservation plans as the final stage of a long process of institutionalization of modern strategic environmental management theory meets with difficulties in real world conditions. When actual application of scientific principles is confronted with public appreciation and engagement on the ground, the perception per se of—and reaction to—the scientific discourse and technical arguments regarding conservation value(s) of designated areas, it often turns into a critique by local communities of the preponderant role of experts and the dominance of a western scientific worldview in the ecological modernization era. In this paper, we develop the formalism—and use variations—of a multiplicative model of conservation value, involving concepts that are central to the IPBES decomposition of values into interacting meanings: principles and preferences. Technically, overall valuation after a suite of conservation criteria of an exemplary designated site, i.e. the Natura 2000 Kalloni Gulf, Greece, is decomposed into the product of two factors, technical score and appreciation, as perceived by a series of local influential stakeholder groups. We use a multi-criteria valuation profile adopted and promoted by scientific experts as reference to which respective valuations of stakeholder groups are contrasted. The study refers to a case where a two decade-long fierce social conflict drove to stagnation the implementation process. Divergence(s) in scoring and appreciation of conservation criteria between scientific experts versus local stakeholder groups are measured using our models variables and classic decomposition analysis techniques. Our model(s) treat the following problems: (1) the relative effects of singular conservation criteria when only one conservation criterion in one site is considered; (2) the relative effects of multiple conservation criteria when applied in one site. A narrative story is attempted regarding discursive conflicts between social groups in the studied case: (1) a pattern of mistrust of the public against scientific discourse on conservation planning: scientists are perceived just as ‘another stakeholder group’ promoting their own pro-conservation agenda; (2) a NIMBY-like reaction based on individuals’ property-defence discourse; and, (3) the by-effects of poor governance in downscaling decision-making from centralized to regional/local level.     

中国国家公园体制改革: 回顾与前瞻

自2013年提出建立国家公园体制, 我国国家公园体制改革已取得了重要进展, 成为整个生态文明体制改革任务中进展最快、成果最显著的综合性改革。过去5年, 通过国家公园体制改革试点, 初步完成了国家公园的顶层设计、明确了管理体制、启动了相关立法程序, 筑就了国家公园建设的基本框架。改革的主要经验可以总结为四个方面: 一是高层引领与改革创新, 二是试点先行和动态调整, 三是问题导向和顶层设计, 四是利益相关方参与和改善治理体系。然而, 未来国家公园体制建设仍然任重道远, 面临众多挑战和困难, 包括国家公园建设区通常人口众多、土地权属复杂、利益相关者众多、缺乏多方参与机制、地方管理能力薄弱等。今后, 应在总结国家公园体制改革经验的基础上, 坚持正确的改革取向, 进一步扩大开放和创新思维, 坚持法治优先、系统推进、分类指导、分阶段实施的基本原则, 采取顶层设计加试点先行的方式, 实现依法办园、科学办园、民主办园、开放办园; 加快推动国家公园和自然保护地立法, 建立国家公园现代化治理体系, 探索建立国家公园生态产品价值实现机制; 最终使以国家公园为主体的自然保护地体系得到整体保护, 人民利益得以最大化, 真正实现人与自然和谐发展。