体系建立体系建立健全医院立体化绩效考核评价.pdf

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1、建立健全医院立体化绩效考核评价体系建立健全医院立体化绩效考核评价体系On 3-Dimensioned Performance AssessmentOn 3-Dimensioned Performance Assessmentand Appraisal Systemand Appraisal System1、前言:1。Preface在医疗改革呼声日益高涨和医疗市场竞争不断加剧的今天，医院如何改变原有的运行管理模式,适应新形势的变化,提高医院的核心竞争力，是医院管理者不可回避的重要问题。我国医院的发展经历了从设备竞争-技术竞争-服务竞争-战略竞争的过程，目前正向文化竞争发展。竞争就要有目标，目标是

2、医院发展的方向，在当前医疗市场的竞争中，实施目标管理是医疗机构保持竞争实力的最常用方法之一，更是医院管理的最常用手段之一。由于目标管理事先有比较明确的目标作为标准和动力,人们随时进行自我管理,并努力完成既定的工作目标。目标管理辅以绩效考核的手段，可以督促人们在实现目标过程中,及时调整方向进行资源整合，最终达到组织利益的实现。How can hospital transform the current mode of operation andmanagement?How can hospital adapt itself to the new situation？How can hospita

3、l improve its central competitive strength？Thosechallenges have to be approached by hospital managers todayespecially when health care reform is earnestly called for by the1medical market with intensive competition.The development ofhospitals in China has experienced the competition in equipment,tec

4、hnology，service and strategy respectively and now is gettinginto the cultural competition。Competition,of course,feels like anobjective,which is the direction of a hospital。In the medicalmarket competition,however,objective management is the mostpopular practice for a medical agency to maintain its c

5、ompetitivestrength as well as to manage a hospital。As objectivemanagement cries out for a definite objective in advance,whichserves as a standard and impetus，people can conduct selfmanagement at any time and strive to reach their goal.With help ofperformance appraisal，however，objective management ma

6、yenhance timely adjustment of the course during realization of theobjective to integrate resources and eventually to obtain benefits。2、相关背景资料：2.Background近十年来，随着国务院及其他政府部门相关医疗政策的出台，以及中国加入 WTO 后医疗市场的逐步对外放开，国内的医疗行业状况发生了巨大的变化。民营医院大量崛起，其中有些甚至收购了多家公立医院；外资医院或机构正在大举入侵，其凭借独特的技术和服务优势占得了不小的市场份额；随处可见的私人诊所和药店也如

7、雨后春笋般出现.这些都给公立医院的生存与发展带来了一定的冲击。国家医2改方案迟迟不能出台，虽然先后有十套方案相继出炉，却始终未能形成一套适合中国医疗市场的总体改革方案，医疗体制改革举步维艰，公立医院发展前景不明朗。无锡市针对国际国内形势变化，在没有任何经验可借鉴的情况下，在国内率先进行了“政事分开，管办分离”运行机制的改革。卫生局作为行政执法部门对公立医院的经营行为进行监管;由卫生局分离出来的医院管理中心（以下简称医管中心)成为政府“办医院”和“管资产”的责任主体，“办医院”就是在法律法规及政策的框架下，通过优化配置资源，提高医疗质量，提供满足不同层次需求的代表市属医院水平的优质医疗产品.“管

8、资产就是要确保国有资产保值和效益最大化.在医管中心成立后，将前几年进行的以经济指标考核为主的“托管制”改革进一步深化为注重对社会效益和工作业绩综合考核的“医疗服务、资产经营委托管理法人代表任期目标责任制”改革，把解决医院建设和运行目标作为重点，探索所有权和经营权分离的模式，达到既尽显公益性特征、又增强医院活力的目的。职能上下放医院经营管理、人事用工和经济分配权,激发医院活力。医院则是专科建设、人才培养、医疗服务与经营的主体.面对医管中心下达的涉及医院管理、医院信息、医疗安全、医疗服务、经济运作、医德医风六个方面内容,八大类 17 项数百条共 1000 分的考核标准，医院该如何确立一个符合自身发

9、展需求的总体目标，并能按计划有步骤地加以实施，则显得尤为重要。As health care policies have been promulgated by the StateCouncil and other governmental bodies and the medical market3has been gradually unveiled to outside after China entered WTO inthe past 10 years，a great change has happened to Chinesemedical industry,where are ri

10、sing a lot of private hospitals,someeven acquisitioned a few public hospitals；meanwhile，manyforeignfunded hospitals or agencies are rushing off their headinto China and they have a much share of the market thanks totheir unique superiority in both service and technology;and on theother hand，private

11、clinics and drug stores have emerged here andthere，which，in some degree,is troubling the survival anddevelopment of public hospitals.10 national health carereformprograms,although published in succession,fail to bring about ageneral scheme which is suitable for Chinese medical market.Inthis connecti

12、on,the health care reform is still far from matured and,as a result，public hospital is still fighting its way to survive anddevelop.In view of the present situation at home and abroad,WuxiCity has pioneered to undertake the reform on hospital operationsmechanism,i.e.“Separating government functions

13、from publicinstitutions and administration from business running without anyexperience to be referenced.As an enforcing body，the Bureau ofHealth of Wuxi City serves to supervise the business of publichospitals；the Hospital Management Center（HMC）separatedfrom the Bureau of Health is a responsible ent

14、ity of the government4to“run hospitals”and“manage assets”.“Running hospital”calls forproviding quality medical products on a municipal level which canmeet demand from different walks of life by optimizing arrangementof resources and further improving the quality of health care incompliance with laws

15、,rules and regulations.“Managing assets,however，calls for maintaining state owned assets and maximizingtheir benefits.After HMC was established，“entrusting system”reform，characteristic of economic index assessment put intopractice years ago，has been furthered into the reform of“targetresponsibilitys

16、ystemsetfortheofficetermofthelegalrepresentative entrusted to manage medical service and assetsoperation。This system focuses on comprehensive assessmentwhich is made over the social benefits and business performanceandattachesimportancetoreachingthegoalofhospitaloperations，with a view to exploring a

17、 mode of separatingownership and management to realize public welfare and activatehospital。In terms of function,the power over hospital businessmanagement,human resources recruit and financial allocation isdistributed to lower levels to energize hospital,which serves toundertake faculty construction

18、,talents training，medical servicesand operations.HMC has issued hundreds of assessment criteriaamounting to 1000 marks composed of 17 items covering eight5types and six aspects,namely hospital management,hospitalinformation，medical security,medial service,financial practiceand medical ethics.In this

19、 connection，it is very important for ahospital to correctly establish a general goal which satisfies its owndevelopment and act on this goal as planned step by step。我所在的无锡市第四人民医院是一所集医疗、教学、科研、预防、保健为一体的卫生部首批三级综合性医院，是无锡市肿瘤医院和苏州大学附属第四医院;也是苏州大学生命科学学院临床肿瘤和分子生物研究所、无锡市肿瘤防治研究所所在地;无锡市心胸外科治疗中心和无锡市麻醉科质量控制中心均设在我

20、院.医院技术力量雄厚，专科特色明显.以肿瘤诊断治疗为重点，其他学科协调发展。医院开放床位1050 张，肿瘤床位占总开放床位的 50%以上。医护员工 1250 名，其中医师 430 名，护士 458 名;拥有高级职称 138 名,其中主任医师、教授 34 名,副主任医师、副教授 94 名.年门、急诊量 60 万人次，出院病人 2。8 万人次。My employer，Wuxi Fourth Peoples Hospital（WFPH),is oneof the first lot of grade 3 comprehensive hospitals certified byMinistry of

21、Health of the Peoples Republic of China，whichintegrates health service，training,research，illness preventionand health care。It simultaneously serves as Wuxi Cancer Hospitaland Fourth Hospital Attached to Suzhou University.Meanwhile,thishospitalalsohousesClinicalCancerMolecularBiology6Research Institu

22、te attached to Suzhou University Life ScienceSchool,WuxiCancerPreventionandTreatmentResearchInstitute，Wuxi Cardiothoracic Surgery Treatment Center and WuxiAnesthesia Quality Control Center.Powerful in technology andcharacteristic of special faculty，this hospital focuses on cancerdiagnosis and treatm

23、ent with other faculties developed in balance.There are 1050 beds,of which those used for cancer facultyaccount for over 50%。The hospital is staffed with 1250 employees,430 being physicians and 458 being nurses;138 employees are ofsenior technician,34 of them being chief physicians or professorsand

24、94 being associate chief physicians or associate professors.600,000 patient times come for emergency or as outpatient in ayear,of which there are 28，000 discharged patient times。经过三十年的建设，我院已成为一所区域性的肿瘤诊治中心.进一步提高肿瘤诊治水平，完善综合医学救治能力，满足广大病员日益增长的诊治需求，在挽救病人生命与改善病人生活质量方面作出不懈地努力，成为名副其实的苏南地区具有影响力的肿瘤中心，是我们大家共同的

25、愿景和重要的任务。After 30 years efforts,this hospital has come to bea cancerdiagnosis and treatment center in this region and we hope that wecan be worthy of the famous cancer center in South Jiangsu byfurther improving cancer diagnosis and treatment，perfecting7comprehensive medical treatment，satisfying pat

26、ients increasingdemand for diagnosis and treatment and sparing no efforts to savepatients life and improve their living quality。作为一家大型国有公立医院，如何适应医疗体制未变，但运行机制却发生改变的形势,全面完成医管中心下达的目标任务;如何面对社会对医疗服务过高需求与员工自身素质参差不齐的考验；如何在市场经济的大潮中，面对医疗市场开放后外资医院的竞相涌入，面对国内民营医院的蓬勃发展，面对公立医院之间的激烈竞争，保持旺盛的生命力等等。挑战是全方位的，压力也是前所未有的。

27、但挑战总是与机遇并存。作为医院管理者，不仅要自己明确医院发展方向，更要让员工明确奋斗目标与前进航向，寻求一种职工共同参与、自我管理的方式，同舟共济，则是所有医院管理者所期盼的。How can we，as a largesized state-owned public hospital,adapt to the new situation where the medical system is unchangedbut the business operation is changed to complete tasks assignedby HMC？How can we approach th

28、e challenges when peoplehave an over-demand for medical services but the employees areirregular in quality?How can we maintain exuberant vitality whenforeign-funded hospitals flooded in after the medical market wasopened,vigorous development of private hospitals at home andacutecompetitionbetweenpub

29、lichospitalsinthemarketeconomy？Although there are allaround and unprecedented8challenges,they are accompanied by opportunities。A hospitalmanager shall not only specify the hospital s direction,but also leadthe staff to specify their own.Of course，all managers look forwardto having a method by which

30、the staff are involved together andmake self management so that everyone has a clear mind that theyare in the same boat。3、绩效管理文献回顾：Review of the literature on performance management:绩效考核是医院管理的一个重要手段和方法,是对管理目标实现和评价的客观、公正的体现。目标管理于20 世纪 50 年代中期出现，是以泰罗的科学管理和行为科学理论为基础形成的一套管理制度,可以调动人们亲自参加工作目标制定的积极性.持续改进与提

31、高管理水平需要制订科学合理、注重实绩的考评体系，才能进行全面、客观、公正、公平的评价，这是落实管理的基点.As an important way to manage hospitals，performanceassessment can impartially and objectively embody realization ofmanagement by objectives。Born in mid1950s,management byobjectives is a set of management systems formed on the basis ofthe reasonabl

32、e management and behavior science theory foundedby Frederick Winslow Taylor，which is expected to arouse peoplesenthusiasm to involve personally in making the objective。In orderto continuously renovate and improve management，it is9necessary to establish a reasonable assessment system whichfocuses on

33、actual performance.Only in this way can appraisal bemade fully，equally,objectively and impartially.This is the basepoint to realize such management。绩效管理已在发达国家，特别是国际成功企业中被广泛采用,美国及欧洲一些国家的医院，在各个层次都成功实施了绩效管理。医院在某些方面类似于企业，医院管理、经营的许多理念，方式均始于企业或由企业演化而来.不同的是企业讲利润最大化,追求的是经济效益;而医院首先讲救死扶伤,并只能在追求社会效益的前提下，讲成本核算。

34、医院在进行绩效评估与绩效管理时，应采取扬弃的态度，充分借鉴企业的做法与经验,并注重结合本行业的实际，实事求是地进行绩效评估与绩效管理.如何将更科学的考核体系和良性竞争的动态机制融入到医院评价比较之中,科室单元内部又如何以科学公正的绩效指标评价每位人才的价值和贡献,目前缺少一套成熟而又实用的评价体系,这是目前各医院管理者迫切需要研究与探讨的重要课题.Performance management has been widely used in developedcountries，particularly in those world famous enterprises.Hospitals in

35、 USA and some European countries also havesuccessfully conducted performance management on variouslevels。In some aspects,a hospital is much similar to anenterprise and many ideas and methods in hospital managementoriginate or are evolved from enterprise.Differently,enterprises10seek for maximal prof

36、its and economic benefits;hospitals,however，basically serve to heal the wounded and rescue thedying and take into account cost accounting only under thepremise seeking for social results。A hospital shall handleperformanceappraisalandmanagementbyapplyingtheapplicable practice of an enterprise to its

37、own line according to thefact.Right now it still cries out for a mature and practicableassessment system to approach how to roll a more reasonableassessment system and a dynamic mechanism with virtuouscompetition into hospital appraisal and comparison and how toassess each talent s performance with

38、help of reasonable andimpartial performance index in different units of a department.Thisis the subject calling for an immediate solution offered by hospitalmanagers.有关卫生组织绩效测量的研究正在开展,绩效测量标准的研究是鉴于卫生保健机构没有一个标准的绩效测量系统，美国俄亥俄州大学的一项研究（1）在回顾有关医疗组织绩效文献的基础上,提出了卫生保健机构绩效测量的总体框架。该框架中的绩效测量包括内部与外部评价两个方面,每个方面都有成本

39、财务绩效及质量绩效两个评价维度；绩效测量系统的研究，任何单独的财务方面或经营方面的测量系统都不能使管理者在复杂竞争的市场环境中成功地对绩效进行管理.因11此，人们逐渐开始采用多重指标来衡量绩效,其中有些是“硬指标，包括各种经济和非经济尺度；有些是“软指标”,包括质量、员工态度及其类似的标准。现有文献表明对绩效测量系统的研究热点除系统开发及系统所提供信息的利用以外，还有关于绩效测量系统对组织作用及影响的研究和绩效管理模式的研究。在英国,新的绩效管理模式往往包括非财务措施,它代表了一种以战略为导向的绩效管理趋势.在法国公司，在“Tableau de Bord绩效管理模式里，将战略分解为财务与非财务

40、指标，作为流行的一种作法(2）。美国最近的一项有关社区医院的研究已涉及到开发一个战略操作管理模式(3),该模式将远期设备和服务选择,中层决策支持以及考虑了结构约束后的社区医院绩效联系起来。该研究在使人们对战略操作管理决策有了更进一步理解的同时，确定了在操作决策过程中的一些因果关系及在医院绩效方面的作用。该研究还找出了在变化着的医疗服务环境中有助于提高社区医院绩效的关键战略决策。其中，“平衡计分卡”作为绩效管理的一种最新、最有效的管理模式，吸引了众多的学者和管理实践者.Study on measuring performance of a health care organizationis s

41、till on the way and study on performance measuring criterion ismade in a view that there is no standard system to measureperformance adopted by a health care organization。Review of theliterature on performance in a medical body indicates that a study(1)made in University of Ohio has advanced a gener

42、al framework tomeasure performance of a health service body.The performance12measurement in this framework consists of internal evaluation andexternal evaluation，each having two evaluation dimensions，namely performance in cost/finance and that in quality;according tothe study on performance measurin

43、g system,any single measuringsystem in neither finance nor operation can enable managers tosuccessfully control performance in a complicated market falling inthe acute competition.Therefore，multiindex starts servicegradually to measure performance:some are“hard index，including various kinds of finan

44、cial and non-financial measures andsome are“soft index”,including quality,attitude and the similarcriteria。The existing literature shows that，besides application ofinformation developed or provided by the system,the heated studyon performance measuring system includes study of action andeffect of pe

45、rformance measuring system on an organization andstudy on performance management mode.In Britain，the newperformance management mode always includes nonfinancialmeasures,which represents a trend of performance managementoriented by strategy.Under the“Tableau de Bord”performancemanagement mode in Fren

46、ch companies,strategy is divided intofinancial index and nonfinancial index，which acts as a popularpractice（2）.A study on community hospital conducted in USA isrelated to development of a strategic operation&management13mode（3），which gets connected long-term equipment and servicechoice,middlelevel d

47、ecision support and community hospitalperformancewhichhastakenstructuralconfinementintoconsideration。While helping further understand decision overstrategicoperationmanagement,theabovementionedstudydetermines some causeeffect relations and their action onhospital performance in the course of decisio

48、n on operation。Furthermore，this study also finds out a key strategic decisionhelpingimproveperformanceofcommunityhospitalinthechanging environment of medical service.Among them,the“balance score card”is the latest and most effective mode forperformance management，which is attracting a number ofschol

49、ars and management workers.对于医院绩效评价研究，国外医院绩效评价研究也包括三个层面。一个是以医院为对象进行绩效评价：一个是对中层管理人员进行工作能力评价；最后就是员工的绩效评价。Robin S、Turpin利用PAJ模式对医院绩效指标设置合理性进行了评估（4）;全面质量管理(TQM)则对医院绩效改进进行了研究（5).另有一些对中层管理人员工作和能力评价的研究，并尝试开发了综合性的能力与工作评价工具（6），而员工评价目前比较盛行的是同级评价（7）。但从整体看，对个人的评价多为针对医师类的,较为单一，对医院内多种成员组成的现状考虑不足。14Study on hospit

50、al performance appraisal abroad also consistsof three levels:one is performance appraisal on hospital as a whole,one is ability appraisal on middle-level managers，and the other isperformanceappraisalonemployees.RobinS.Turpinhasemployed the PAJ mode to appraise reasonability of hospitalperformance in