基于DRGs和RBRVS的医院绩效管理体系构建

在DRGs付费方式改革的背景下,公立医院的绩效管理方式受到很大影响,单一的RBRVS或DRGs绩效考核方式不能完全满足公立医院的管理需求。为满足公立医院“多劳多得、优劳优得、兼顾公平”的原则,并充分体现医务人员的劳动价值,公立医院可以尝试构建DRGs和RBRVS相结合的绩效管理体系,优势互补,从而更好地促进医院良性发展。     

绩效管理在公立医院的应用研究——H省人民医院绩效改革案例

绩效管理是公立医院运行机制改革的核心,是推动医院发展与改革的原动力。随着医改的逐步深入要求公立医院要彻底改变医务个人收入与开单收费之间的联接关系,改变以往传统分配中的利益驱动导向,要把公益性贯穿于公立医院绩效管理始终。H省人民医院从2012年起开始实行以工作量为基础的新绩效分配管理模式。以资源投入为基础的相对价值比率(Resource Based Relative Value Scale,RBRVS)理论作为国际公认的医务人员劳务价值单独定价的公允系统,为医务人员的劳动薪酬分配方案提供了有效的理论依据和实践参考。同时建立医生、护理、医技、管理不同岗位绩效薪酬体系,分类管理考核。     

公立医院经济运行的“三驾马车”——预算、成本和绩效管理

公立医院改革强调,公立医院须坚持公益性质的原则,严格预算管理,加强成本管控,开展有效的绩效评价体系．调动医务人员的积极性．提供更加有质量的医疗服务。结合改革要求和医院发展实际情况．本文探讨了医院预算管理、成本管理和绩效管理三者的管理内涵及相互关系,阐述了将三者有效结合对维护公立医院公益性的影响。     

浅析医院绩效管理体系的构建

2009年4月,国家对公立医院的管理提出了明确的要求：“建立规范的公立医院运行机制,坚持以病人为中心,优化服务流程,形成有责任、有激励、有约束、有竞争、有活力的机制。完善分配激励机制,严格工资总额管理,实行以服务质量及岗位工作量为主的综合绩效考核和岗位绩效工资制度,有效调动医务人员的积极性”。十八届三中全会中提出：建立现代医院管理制度,开展医院管理服务创新。这对医院管理者提出了更高要求,需要通过构建有效的绩效管理体系来实现。绩效管理是一个完整的动态循环过程。包括绩效目标、绩效目标的分解与实施、绩效考核、绩效评价和绩效反馈5个阶段,它们相互配合,层层递进,只有这5个阶段都能够有效实施和运行,形成持续、整体的工作链,绩效管理才能真正发挥其作用。     

新医改背景下公立医院绩效管理模式的创新探讨

我国的医疗改革进程逐步推进,公立医院的发展迎来了新的挑战,要在绩效管理的模式中将其作为改革重点,推进医疗改革更进一步的创新探索,发挥绩效管理工作的积极作用,提高公立医院绩效管理模式的有效性,强化公立医院的发展竞争力.文章对新医改背景下公立医院绩效管理现状进行了探讨,提出了新医改背景下公立医院绩效管理中存在的问题,分析了公立医院绩效管理模式的创新策略.     

公立医院创新带组医师绩效管理模式改革实践

公立医院高质量发展背景下,带组医师绩效管理模式有助于推进公立医院绩效考核体系全面提升,发挥绩效管理的杠杆作用,控制医疗费用不合理增长,推进医院可持续发展。以公益性为导向,结合公立医院综合改革试点的指导意见,研究RBRVS绩效管理方法应用到带组医师个人绩效考核的改革实践,构建以带组医师为最小单元、以RBRVS为基础、以平衡计分卡考核为补充的绩效评价体系。结果表明此方案能够优化医疗收入结构,压缩药品、耗材占比,合理配置医院内医疗资源,体现出医务人员医疗服务价值。据此,提出RBRVS下带组医师绩效管理模式推广与借鉴的建议。     

关于公立医院绩效工资与绩效管理的探讨

绩效工资分配的科学性、合理性与绩效管理开展的有效性、准确性直接影响着公立医院发展的稳定性、长久性。基于此,本文以公立医院绩效改革为研究对象,从绩效工资与绩效管理相关概述入手,就公立医院绩效工资与绩效管理现状进行了简要分析,明确公里医院绩效制度创新发展存在的重难点,并在此基础上提出几点优化建议,以供参考。     

公立医院医务人员个人所得税代扣代缴管理工作分析

公立医院作为我国面向社会的公益性服务组织,国家不但在财政上给予公立医院很多补助,还特批公立医院减免税务。《中华人民共和国个人税法》实施后,要求医务人员的个人所得税实行代扣代缴工作,让公立医院成为了代扣代缴主要责任主体。因此,公立医院应从税收优惠政策出发,对医务人员的绩效、奖金等进行一定比例的计算,选择最佳方案进行纳税筹划,保障医务人员的个人利益。     

我国公立医院绩效管理现状及其解决对策

公立医院的绩效管理是人力资源管理中的重要内容,是激发工作人员积极性和保留优秀人才的有效措施。近年来,随着医疗改革的不断深入,我国公立医院的绩效管理工作也获得了较大进展。但是通过对公立医院绩效管理的现状分析发现,从整体上看我国公立医院的绩效管理中仍存在很多问题,制约着医院的发展。文章将对公立医院绩效管理中存在的问题进行分析并提出相关解决对策。     

公立医院内部绩效管理存在的问题及优化建议

<正>一、公立医院内部绩效管理存在的问题一是绩效管理系统与预算管理系统分离,不能有效支撑医院战略发展。部分公立医院的预算管理系统和绩效管理系统的运行相对独立,缺少数据关联与接口链接,制约了公立医院预算编制、执行、控制的效果,削弱了责任约束力,影响了公立医院内部管理的精益化。同时,不少公立医院绩效管理系统与战略目标相分离,没有将医院的战略目标层层分解形成部门和员工个人的目标,缺乏战略牵引和驱动,不能有效支撑医院战略发展,     

社区医疗企业的经营策略研究

社区医疗经营的好坏关系到广大人民群众的切身利益,同时发展社区医疗存在大量的商机,但是目前许多问题阻碍了社区医疗的进一步发展。文章指出,如何去发掘潜力、发展壮大社区医疗,关键是要有创新的思维,目前社区医疗走与大医院联营或者与大医院直接经营的方式应该是一种值得尝试的途径。     

The adoption,character and impact of strategic human resource management: a case study of two large metropolitan Vietnamese public hospitals

In this paper the researchers set out to explore the adoption, character and impact of strategic human resource management (SHRM) in two large metropolitan Vietnamese public hospitals using a multi-level qualitative research design. Data are analyzed from 21 interviews and 5 focus groups with key players from the hospitals and government authorities. Findings show that the State controls many of the core day-to-day HR functions of public hospitals, curtailing local autonomy and management innovation. This is compacted by inadequate government funding, poor training of medical staff, and inadequate management and business skills of hospital managers. Inhibiting greater experimentation with SHRM is the fear of developing management initiatives out of sync with the State. Consequently, many managers and clinicians held negative views of the HR department and their relevance for the day-to-day management of healthcare services. Respondents reported that they perceived these factors had a negative impact on the well-being of medical staff and the quality of patient care. The paper concludes with a discussion on the necessity for continued State reforms that can enable greater autonomy of the hospitals' HRM functions and greater investment in local HR capabilities to materialize the link between SHRM, employee well-being and quality of patient care.     

Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal

Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.     

Factors affecting development of crisis management mechanisms in hospitals

The growing competition among hospitals has almost dissolved hospitals’ absolute dominance over the physician–patient relationship. Many existing systems or regulations governing public organizations are so rigid that outstanding physicians in public hospitals may easily depart or be head hunted by competitors. Therefore, there will be more and starker challenges ahead of public hospitals. Through collection and analysis of a large sample, we attempt to apply a unique data validation method—nonlinear fuzzy neural network model to investigate the research issue. The questionnaire was administered to chairmen or physicians taking administrative positions in Taiwan’s public hospitals. The empirical results are as follows: Uncertainty of the hospital business environment is positively correlated with development of crisis management mechanisms; Operation of crisis management mechanisms is positively correlated with establishment of a medical risk management system; Organizational culture in public hospitals is disadvantageous to operation of crisis management mechanisms.     

新医改环境下市级公立医院全面预算实施研究

文章以市级公立医院为研究对象,研究新医改环境下医院如何有效实施全面预算管理模式。作为以公益性事业为目标的公立医院,在如今医疗市场逐渐开放,医院面临着取消药品加成、降低设备检查费等诸多医改新政策的形势下,从财政渠道取得的补偿资金远远满足不了医院发展的需要。因此,只有引入全面预算管理体系,科学编制预算方案,建立健全预算考评和绩效考核机制,公立医院才能实现可持续发展。     

新形势下公立医院人力资源管理的探讨

随着知识经济时代的到来和医学科技的飞速发展,人力资源管理的作用越来越重要,目前仍存在着诸多问题,现就目前公立医院人力资源管理的现状及建议做简要探讨。     

公立医院的绩效管理目标何去何从

近十年来,国内的医疗行业发生了显著的变化,大量民营医院迅速崛起,众多中外合资合作医院不断建立,公立医院的发展面临着前所未有的挑战。面对经济效益和社会效益的双重压力,公立医院必须建立一套适合自身的绩效考核制度。     

The disaster response performance of hospitals in Taiwan: evaluation and classification

Hospitals need disaster response plannings and temporary shelters to rescue victims in disasters. In Taiwan, there are 82 emergency medical service (EMS) hospitals are requested to possess guildlines of preparedness and responses to mitigation the damage and recovery the pre-event status in a disaster. A measurement chart including three major factors??facility, manpower, and disaster plan and drill mode??was created to evaluate the performance of disaster management of these EMS hospitals. Based on the expert opinions, some hospitals were selected as a reference set prior to the accreditation. Data envelopment analysis (DEA) is applied to classify each of the remaining hospitals into qualified or unqualified classes. Then, each unqualified hospital was recommended to improve its practice of disaster preparedness and responses into the qualified level. We also find that, on average, private hospitals perform better than public hospitals and medical centers perform better than the regional hospitals. But, the differences are not statistically significant.     

The Link Between Participation in Management Decision-Making and Quality of Patient Care as Perceived by Chinese Doctors

Abstract

This study examined whether and how participation by doctors in management decision-making was associated with patient care. A questionnaire survey was conducted in three hospitals operating in China. Staff members of the selected hospitals were invited to participate in the survey, measuring perceived quality of patient care, employee participation in management decisions, psychological empowerment and affective commitment. This study focuses on the results of the 160 doctors employed by the hospitals who completed the questionnaire. The study found that psychological empowerment and affective commitment mediated the relationship between participation in management decisions and the quality of patient care as perceived by the doctors. Implications are drawn for public management practice in Chinese health care settings.     

医院个性化关怀电子商务整体解决方案——以民营医院为例

病人是医院的命脉,只有赢得客户,才能赢得未来。病人就诊,除了关心医院本身的医疗实力,考虑最多,最影响决策的因素,就是医院的服务了。很显然,病人的需求在人满为患的公立医院是无法实现的。本文从电子商务的内涵及发展出发,分析了当今民营医院发展的处境和遇到的问题,并指出了在电子商务发展时代,加强客户关系管理是解决民营医院实际问题的最佳途径;本文还重点提出了民营医院个性化关怀通过电子商务实现的解决方式和发展策略。