体系建立体系建立健全医院立体化绩效考核评价

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1、 建立健全医院立体化绩效考核评价体系On 3-Dimensioned Performance Assessment and 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

2、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 and management? How can hospital adapt itself to the new situation? How can hospital improve its central competitive strength? Those challenges have to be

3、approached by hospital managers today especially when health care reform is earnestly called for by the medical market with intensive competition. The development of hospitals in China has experienced the competition in equipment, technology, service and strategy respectively and now is getting into

4、 the cultural competition. Competition, of course, feels like an objective, which is the direction of a hospital. In the medical market competition, however, objective management is the most popular practice for a medical agency to maintain its competitive strength as well as to manage a hospital. A

5、s objective management cries out for a definite objective in advance, which serves as a standard and impetus, people can conduct self management at any time and strive to reach their goal. With help of performance appraisal, however, objective management may enhance timely adjustment of the course d

6、uring realization of the objective 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。国家医改方案迟迟

7、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

8、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 c

9、are policies have been promulgated by the State Council and other governmental bodies and the medical market has been gradually unveiled to outside after China entered WTO in the past 10 years, a great change has happened to Chinese medical industry, where are rising a lot of private hospitals, some

10、 even acquisitioned a few public hospitals; meanwhile, many foreign-funded hospitals or agencies are rushing off their head into China and they have a much share of the market thanks to their unique superiority in both service and technology; and on the other hand, private clinics and drug stores ha

11、ve emerged here and there, which, in some degree, is troubling the survival and development of public hospitals. 10 national health-care-reform programs, although published in succession, fail to bring about a general scheme which is suitable for Chinese medical market. In this connection, the healt

12、h care reform is still far from matured and, as a result, public hospital is still fighting its way to survive and develop. In view of the present situation at home and abroad, Wuxi City has pioneered to undertake the reform on hospital operations mechanism, i.e. “Separating government functions fro

13、m public institutions and administration from business running” without any experience to be referenced. As an enforcing body, the Bureau of Health of Wuxi City serves to supervise the business of public hospitals; the Hospital Management Center (HMC) separated from the Bureau of Health is a respons

14、ible entity of the government to “run hospitals” and “manage assets”. “Running hospital” calls for providing quality medical products on a municipal level which can meet demand from different walks of life by optimizing arrangement of resources and further improving the quality of health care in com

15、pliance with laws, rules and regulations. “Managing assets”, however, calls for maintaining state owned assets and maximizing their benefits. After HMC was established, “entrusting system” reform, characteristic of economic index assessment put into practice years ago, has been furthered into the re

16、form of “target responsibility system set for the office term of the legal representative entrusted to manage medical service and assets operation”. This system focuses on comprehensive assessment which is made over the social benefits and business performance and attaches importance to reaching the

17、 goal of hospital operations, with a view to exploring a mode of separating ownership and management to realize public welfare and activate hospital. In terms of function, the power over hospital business management, human resources recruit and financial allocation is distributed to lower levels to

18、energize hospital, which serves to undertake faculty construction, talents training, medical services and operations. HMC has issued hundreds of assessment criteria amounting to 1000 marks composed of 17 items covering eight types and six aspects, namely hospital management, hospital information, me

19、dical security, medial service, financial practice and medical ethics. In this connection, it is very important for a hospital to correctly establish a general goal which satisfies its own development 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

20、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 one of the fi

21、rst lot of grade 3 comprehensive hospitals certified by Ministry of Health of the Peoples Republic of China, which integrates health service, training, research, illness prevention and health care. It simultaneously serves as Wuxi Cancer Hospital and Fourth Hospital Attached to Suzhou University. Me

22、anwhile, this hospital also houses Clinical Cancer & Molecular Biology Research Institute attached to Suzhou University Life Science School, Wuxi Cancer Prevention and Treatment Research Institute, Wuxi Cardiothoracic Surgery Treatment Center and Wuxi Anesthesia Quality Control Center. Powerful in t

23、echnology and characteristic of special faculty, this hospital focuses on cancer diagnosis and treatment with other faculties developed in balance. There are 1050 beds, of which those used for cancer faculty account for over 50%. The hospital is staffed with 1250 employees, 430 being physicians and

24、458 being nurses; 138 employees are of senior technician, 34 of them being chief physicians or professors and 94 being associate chief physicians or associate professors. 600,000 patient times come for emergency or as outpatient in a year, of which there are 28,000 discharged patient times. 经过三十年的建设

25、，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，是我们大家共同的愿景和重要的任务。After 30 years efforts, this hospital has come to be a cancer diagnosis and treatment center in this region and we hope that we can be worthy of the famous cancer center in Sout

26、h Jiangsu by further improving cancer diagnosis and treatment, perfecting comprehensive medical treatment, satisfying patients increasing demand for diagnosis and treatment and sparing no efforts to save patients 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

27、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。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 large-sized state-owned public hospital, adapt to the new situation whe

28、re the medical system is unchanged but the business operation is changed to complete tasks assigned by HMC? How can we approach the challenges when people have an over-demand for medical services but the employees are irregular in quality? How can we maintain exuberant vitality when foreign-funded h

29、ospitals flooded in after the medical market was opened, vigorous development of private hospitals at home and acute competition between public hospitals in the market economy? Although there are all-around and unprecedented challenges, they are accompanied by opportunities. A hospital manager shall

30、 not only specify the hospitals direction, but also lead the staff to specify their own. Of course, all managers look forward to having a method by which the staff are involved together and make self management so that everyone has a clear mind that they are in the same boat. 3、绩效管理文献回顾：Review of th

31、e 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, performance assessment can impartially and objective

32、ly embody realization of management by objectives. Born in mid-1950s, management by objectives is a set of management systems formed on the basis of the reasonable management and behavior science theory founded by Frederick Winslow Taylor, which is expected to arouse peoples enthusiasm to involve pe

33、rsonally in making the objective. In order to continuously renovate and improve management, it is necessary to establish a reasonable assessment system which focuses on actual performance. Only in this way can appraisal be made fully, equally, objectively and impartially. This is the base point to r

34、ealize 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。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

35、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 developed countries, particularly in those world famous enterprises. Hospitals in USA and some European countries also have successfully conducted performance management on various levels. In some aspec

36、ts, a hospital is much similar to an enterprise and many ideas and methods in hospital management originate or are evolved from enterprise. Differently, enterprises seek for maximal profits and economic benefits; hospitals, however, basically serve to heal the wounded and rescue the dying and take i

37、nto account cost accounting only under the premise seeking for social results. A hospital shall handle performance appraisal and management by applying the applicable practice of an enterprise to its own line according to the fact. Right now it still cries out for a mature and practicable assessment

38、 system to approach how to roll a more reasonable assessment system and a dynamic mechanism with virtuous competition into hospital appraisal and comparison and how to assess each talents performance with help of reasonable and impartial performance index in different units of a department. This is

39、the subject calling for an immediate solution offered by hospital managers. 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。因此，人们逐渐开始采用多重指标

40、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

41、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 organization is still on the way and study on performance measuring criterion is made in a view that ther

42、e is no standard system to measure performance adopted by a health care organization. Review of the literature on performance in a medical body indicates that a study (1) made in University of Ohio has advanced a general framework to measure performance of a health service body. The performance meas

43、urement in this framework consists of internal evaluation and external evaluation, each having two evaluation dimensions, namely performance in cost/finance and that in quality; according to the study on performance measuring system, any single measuring system in neither finance nor operation can e

44、nable managers to successfully control performance in a complicated market falling in the acute competition. Therefore, multi-index starts service gradually to measure performance: some are “hard index”, including various kinds of financial and non-financial measures and some are “soft index”, inclu

45、ding quality, attitude and the similar criteria. The existing literature shows that, besides application of information developed or provided by the system, the heated study on performance measuring system includes study of action and effect of performance measuring system on an organization and stu

46、dy on performance management mode. In Britain, the new performance management mode always includes non-financial measures, which represents a trend of performance management oriented by strategy. Under the “Tableau de Bord” performance management mode in French companies, strategy is divided into fi

47、nancial index and non-financial index, which acts as a popular practice (2). A study on community hospital conducted in USA is related to development of a strategic operation & management mode（3）, which gets connected long-term equipment and service choice, middle-level decision support and communit

48、y hospital performance which has taken structural confinement into consideration. While helping further understand decision over strategic operation management, the abovementioned study determines some cause-effect relations and their action on hospital performance in the course of decision on opera

49、tion. Furthermore, this study also finds out a key strategic decision helping improve performance of community hospital in the changing environment of medical service. Among them, the “balance score card” is the latest and most effective mode for performance management, which is attracting a number

50、of scholars 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。Study o

51、n hospital performance appraisal abroad also consists of three levels: one is performance appraisal on hospital as a whole, one is ability appraisal on middle-level managers, and the other is performance appraisal on employees. Robin S. Turpin has employed the PAJ mode to appraise reasonability of h

52、ospital performance index（4）and Total Quality Management (TQM) to study improvement of hospital performance（5）. Meanwhile, he has also studied performance and ability of middle-level managers and developed an overall tool to appraise ability and performance（6）. For employee appraisal, however, peer

53、appraisal is rather popular at the present（7）. On a whole basis, appraisal on individuals is mostly adopted by targeting physicians, which, however, takes into inadequate consideration a hospitals composition of members in variety. 而在我国，经济领域基本上完成了由计划经济向市场经济的转化，但社会事业领域改革相对滞后，现有的医疗卫生体制是在计划经济理论下建立的。作为一

54、种科学的管理体系，绩效管理正在受到国内各级医院管理者的重视，大多也是从医院、科室及科室管理者、员工个人三个层面来进行探讨。根据中文科技期刊数据库检索，自1989年-2008年2月，涉及医院绩效的相关文章共有567篇，有关“绩效考核”的文章共有129篇，符合“绩效管理”检索主题词要求的文章有122篇，而建立绩效考核评价体系的文章仅26篇。早在1993年西安第四军医大学胡琳、于爽等制订了“医院综合效益评价体系”，指标按投入、产出分成两大类，包括人员、设备、物资、经费、社会效益和经济效益6个方面（8）；1994年浙江省舟山市卫生局庄汉国（9）对综合性医院的社会、经济效益指标体系的设置及评价方法等问题

55、作了探讨，筛选出基本指标25项，作为评价指标体系。近年来随着管理理论的深化和管理模式的探索，2001年，解放军空军总医院陈明敏等提出了粗放型的医疗质量评价管理模式，主要指标为床日门诊指数、床位利用指数、CD型率(总病例中复杂疑难危重病例所占比例)、人均医疗费、病员满意度等 （10）；2001年，上海第二军医大学高岱峰、张鹭鹭等采用加权百分位次累加法建立评价模型，构建了“医院综合竞争力评价体系”，指标体系分竞争力资产、竞争力过程、竞争力环境3个方面；2002年，复旦大学胡善联、李国红等利用现场调查法和专家咨询法，从业务水平、经营状况和病人满意度方面选出32个指标，建立医院绩效评价指标体系，并提出

56、星级医院评审的思想（11）。2005年医院管理评估指南中将社会效益、工作效率、经济运行状况三个方面作为医院绩效评价的主要内容（12）。众多文章都是从不同的角度对医院绩效进行评价，建立医院绩效评价指标体系时均有自己的侧重点，而且在实际工作中也的确起到了促进医院持续稳定发展、提高医院核心竞争力的作用。医院绩效评价体系是一个复杂的评价系统，目前国内采用的指标大多从业务、财务等方面分类考核，而专家咨询法是筛选指标的方法。尽管企业领域绩效管理的方法已发展得比较成熟，但在国内医疗卫生领域中比较通用和权威的绩效考核指标还有待更深入的探索。而对于科室与个人的考核也有多篇研究报告。国内医院在临床科主任的绩效评价

57、方面也有部分尝试，国内较具有代表性的有以下几种评价方法：将平衡记分卡应用于绩效评价；使用360度绩效考核法考核临床科主任；应用关键绩效指标（KPI）的考核指标体系；运用目标管理的方法建立绩效评估体系。In China, transition has been completed from planning economy to market economy, but reform on social institutions is still relatively lagging behind, where the current health care system was born und

58、er the planning economy. As a reasonable system, performance management is having much attention from hospital managers on different levels in China, which is mostly discussed in three layers, i.e. hospital, faculty and its managers, and individual employees. My searching the database of technologic

59、al periodicals written in Chinese indicates that there are 567 papers on hospital performance published from 1989 to February 2008, 129 relating to “performance assessment”, 122 satisfying the key word of search for hospital performance and only 26 papers on establishment of performance assessment a

60、nd appraisal system. As early as 1993, Hu Lin, Yu Shuang and etc. with Fourth Military Medical University based in Xian built a “hospital comprehensive benefit appraisal system”, whose index is divided into two groups as per input and output, including 6 aspects: personnel, equipment, supplies, fund

61、s, social benefits and economic benefits（8）; in 1994, Zhuang Hanguo（9） with Bureau of Health of Zhoushan City, Zhejiang Province probed into hospitals establishment of a social and economic benefit index system and its appraisal approach and selected 25 basic indices as an appraisal index system. Wi

62、th the theory of management deepened and management mode explored recently, Chen Mingmin and etc. with the General Hospital of Air Force put forward a medical quality appraisal management mode in an extensive form in 2001, whose major index is of bedday outpatient index, bed utilization index, Types

63、 C & D ratio (the ratio of Types C and D cases to the total cases), personal average medical expense, patients satisfaction degree（10）; in 2001, Gao Daifeng, Zhang Lulu and etc. established a “hospital comprehensive competitiveness appraisal system” by means of weight hundredth-place addition in acc

64、umulation and the index system consists of competitiveness assets, competitiveness process and competitiveness environment; in 2002, Hu Shanlian, Li Guohong, etc. with Fudan University established a hospital performance appraisal index system and advanced an idea to appraise star-level hospital afte

65、r selecting 32 indices from business level, operation status and patients satisfaction with help of the site investigation method and expert consultation method（11）. In 2005, social benefit, work efficiency and economic operation status were regarded as the main content to appraise hospital performa

66、nce in Guide for Hospital Management Appraisal（12）. A large number of articles aim to appraise hospital performance in different angles and emphasizes their points when mentioning establishment of a hospital performance appraisal index system and, in practice, they have really enhanced hospitals continuous and steady development and improved their core competitiveness.