On July 1, the National Health Commission issued the "Notice on the National Monitoring and Analysis of the Performance Assessment of National Tertiary Public Hospitals in 2018". The results of the first round of "National Examination" for the performance of tertiary public hospi

7On July 1, the National Health Commission issued the "Notice on the National Monitoring and Analysis of the Performance Assessment of National Tertiary Public Hospitals in 2018". The results of the first round of "National Examination" for the performance of tertiary public hospitals were announced, which attracted great attention from the industry. So, how do psychiatric hospitals perform on the big test? Regarding the overall evaluation and ranking, what do each psychiatric hospital think? What inspirations will the assessment results bring to the next development? With these questions, we interviewed relevant managers of Shanghai Mental Health Center, Beijing Anding Hospital, Wuhan Mental Health Center and Xi'an Mental Health Center .

- Editor

Xu Yifeng

There is still a big gap between A and A﹢﹢

Xu Yifeng, Director of Shanghai Mental Health Center

According to the 2018 national monitoring and analysis of the performance appraisal of national tertiary public hospitals announced by the National Health Commission, Shanghai The Municipal Mental Health Center’s national monitoring index score is 903 points, and its assessment grade is A, ranking first among psychiatric hospitals nationwide. I am satisfied with this result and it was also expected.

The "National Examination" for tertiary public hospitals is a new thing. This assessment is the first to comprehensively evaluate hospitals from the four dimensions of medical quality, operational efficiency, sustainable development and satisfaction evaluation, and is reflected through 55 tertiary monitoring indicators. the operation of the entire hospital. The design of the entire assessment system starts from maintaining the hospital's public welfare, mobilizing doctors' enthusiasm, and enhancing the public's sense of gain, and embodies the goal pursuit of "what patients need, performance will be assessed." Therefore, I think that the entire assessment system and the design of each assessment indicator have been carefully thought out, and the assessment results are relatively objective.

We carefully analyzed 55 monitoring indicators and the scores of each indicator. Due to the particularity of psychiatric hospitals and their service objects, 7 indicators are not applicable, including the proportion of day surgeries in elective surgeries, the proportion of discharged patients undergoing surgeries, the proportion of discharged patients undergoing minimally invasive surgeries, and the proportion of discharged patients undergoing four-level surgeries. Ratio, surgical patient complication rate, Class I incision surgical site infection rate and single disease quality control and other indicators. The remaining 48 indicators of

mostly reflect common problems in tertiary public hospitals. Take the secondary indicator monitoring of the ratio of commented prescriptions to the total number of prescriptions in the rational use of drugs. Commenting on prescriptions is very important to patients, but this is exactly what many specialized hospitals do. Not good enough. For example, indicators such as the intensity of antibacterial drug use (DDDs), the proportion of outpatient prescriptions for essential drugs, and the proportion of essential drug procurement varieties are very important to each type of hospital and are common issues.

Judging from the overall assessment results, the assessment grade of Shanghai Mental Health Center is A, which is still far behind the best rating of A﹢﹢ in the assessment results of tertiary public hospitals. Therefore, we still have many aspects that need to be comprehensively improved. Learned in the hospital. Take the electronic medical record application function level classification as an example. We are the only psychiatric hospital in China that has passed electronic medical record level 5. However, this indicator reflects the reform and development direction of the information construction of all third-level public hospitals and should be a unanimous effort by everyone. direction.

analyzed the specific indicator scores. Among the 48 indicators applicable to psychiatric hospitals, the Shanghai Mental Health Center lost points in 7 indicators. This allows us to clearly see our shortcomings and also It points out the direction for the next step of reform and development. For example, we scored 88 points in patient satisfaction evaluation. This is actually not a high score. Compared with many brother units, we still have a lot of room for improvement. At the same time, the results of the "National Examination" also remind us to further strengthen hospital discipline construction, improve overall service levels, accelerate bed turnover growth, control the growth of medical expenses, and encourage teaching staff to actively apply for teaching projects at the provincial and ministerial level or above.

The most important thing is that we must closely integrate the performance appraisal of public hospitals with daily management work, and break down various indicators into daily management work.More than ten years ago, the Shanghai Mental Health Center formulated internal rules and regulations. It now has a set of seven management systems including party and mass management, personnel and financial management, scientific research and teaching, medical care, pharmaceutical and medical technology, equipment logistics and comprehensive administrative management. , it will be revised every two or three years as the situation changes, and it has now been updated to the 7th edition. In the next revision work, we will closely combine the national assessment requirements to carry out the revision work.

Wang Gang

Problem-oriented, seeking greater breakthroughs

Wang Gang, President of Beijing Anding Hospital

In the 2018 national performance assessment of tertiary public hospitals, Beijing Anding Hospital ranked second among psychiatric hospitals nationwide. I think this assessment result is still More objective.

It can be said that the industry has long been looking forward to such an authoritative data-based evaluation system led by the national administrative department. Many indicators of this performance appraisal system are based on the medical reform guidance documents in recent years. Among the 55 third-level indicators, 50 are quantitative indicators, which ensures the scientificity and objectivity of the assessment results to a certain extent. sex. From the perspective of the long-term development of the hospital, under the guidance of this evaluation system, our hospital management has become more comprehensive, detailed and specific. Although

does not have an advantage in the evaluation of some indicators, this can also help us seek greater breakthroughs in a problem-oriented manner. For example, in the assessment of hospital function positioning, one indicator is the ratio of the number of outpatients to the number of discharged patients. Its orientation is to guide tertiary public hospitals to focus on treating difficult and complex diseases and patients in the acute stage of the disease, and to refer suitable patients downwards to improve Medical resource utilization efficiency. However, the outpatient volume of Anding Hospital has always been large. In 2019, the number of outpatient visits was 660,000. This is actually the patient's personal choice. We cannot rashly reject patients who come for consultation before we find a better solution.

In order to solve this problem, we have formed some specific plans, mainly planning to combine the construction of medical consortium with Internet medical care to promote the upward transfer and downward transfer of patients.

After I became the president of Anding Hospital, I have been committed to the construction of horizontal and vertical medical alliances, hoping to give full play to the role of medical alliances in hierarchical diagnosis and treatment and up-down referrals. I am also in charge of the Beijing Mental Health Care Institute, which is affiliated with Anding Hospital. It is mainly responsible for the prevention and treatment of mental health in Beijing and has long provided technical guidance services to various regions in Beijing.

Currently, the Beijing Mental Health Care Institute has applied for a financial guarantee project for information construction, and Anding Hospital has also obtained Internet medical qualifications. Next, we plan to organically combine the two to build an online medical consortium network linking Anding Hospital and the 16 districts of Beijing, so that we can better meet the medical needs of the grassroots people and at the same time make patients more comfortable. Turning up and down becomes more convenient and smoother.

Li Yi

has developed into a specialized hospital that is “not partial to specialties”

Li Yi, Director of Wuhan Mental Health Center

As the first public tertiary-level psychiatric hospital in Hubei Province, in the performance appraisal of tertiary public hospitals in 2018, There are highlights and shortcomings.

First of all, the performance appraisal of tertiary public hospitals is based on data, and some indicators of the hospital are quantified and scored, which to a certain extent reflects the overall performance level of the center. However, this assessment is inevitably affected by certain objective factors: for example, this assessment is the first "national examination", and the explanation of some indicators is not very clear, so we have certain errors in understanding and filling in the indicators. In the new 2019 performance assessment of tertiary public hospitals, the state has unified and supplemented the meaning, explanation, and caliber of the indicators. For example, the number of outpatient visits, discharge service volume and other data involved in the assessment indicators are all in the same caliber. I believe it can More accurately reflects the overall strength of the hospital.

's current assessment system is mainly composed of four modules: medical quality, operational efficiency, sustainable development, and satisfaction evaluation. It basically covers the main modules of hospital development. The requirements for hospitals are more comprehensive and relatively strict. Once they are "partial", it will be very difficult. It is difficult to achieve good results. As a psychiatric hospital, Wuhan Mental Health Center needs to balance the public welfare of the hospital and the enthusiasm of the staff; it needs to continuously improve the quality of medical care while clarifying the functional positioning of the hospital; it also needs to optimize the revenue and expenditure structure and improve Only by taking into account operational efficiency, talent training and discipline construction with equal emphasis and coordinated development can the hospital achieve sustainable development.

However, due to some particularities and limitations of psychiatric hospitals, the indicators in this assessment temporarily lack some characteristic indicators to measure the quality of psychiatric medical care, such as the recovery and improvement rate of mental illness, protective restraint rate, and suicide/self-injury incidence rate. Wait for these indicators.

This "National Examination" provides important direction and reference significance for the development planning of Wuhan Mental Health Center. We will rely on the "baton" role of the performance appraisal of tertiary public hospitals to continue to maintain indicators with good assessment results. We will focus on construction and development of weak links in the assessment, such as informatization, science and education, etc.

At the same time, the "National Examination" exposed the development trend of many psychiatric hospitals that emphasize medical care and neglect management. For example, the median values ​​of many psychiatric hospitals’ electronic medical record levels, scientific research project funding, and the passing rate of residents taking the physician qualification examination for the first time are not too high.

Performance appraisal of tertiary public hospitals is the starting point to promote the development of the hospital. We will continue to break down the indicators one by one, carry out performance reforms, and conduct performance appraisals for departments and individuals to improve individual work efficiency and work quality to drive improvements in department levels, thereby Promote hospital development. At the same time, we will continue to increase investment in hospital informatization construction, build an Internet hospital as soon as possible, improve the level of hospital informatization, and better serve patients.

In addition, the Wuhan Mental Health Center will continue to deepen its cooperation with Huazhong University of Science and Technology and China University of Geosciences (Wuhan), increase the introduction and training of talents, continue to increase investment in the construction of central laboratories, and strive to achieve the highest level of scientific research hardware construction in the country The first echelon of specialist institutions vigorously promotes the parallel development of the center's medical care, scientific research and teaching.

Zhang Hui

Make up for the shortcomings of informatization construction

Zhang Hui, Vice President of Xi’an Mental Health Center

Judging from the national monitoring and analysis rankings of the performance appraisal of national tertiary public hospitals in 2018, Xi’an Mental Health Center ranks first in the country medium level. The 55 indicators in 4 dimensions in the assessment system basically reflect the true situation and overall development level of the hospital, but also expose some problems.

We analyzed the scores of various assessment indicators and found that the main reason for losing points lies in hardware construction. The biggest shortcoming of our hospital is the lag in informatization construction, which directly increases the difficulty of data capture and affects the authenticity of the data. In the next step, we will also make up for the shortcomings in informatization through the construction of smart hospitals and strive for comprehensive improvement in all aspects of the hospital.

From the perspective of the guiding role of the assessment system in hospital development, we hope to add some characteristic indicators of psychiatric hospitals. For example, for psychiatric medical institutions, MECT (convulsant-free electroconvulsive therapy), as a traditional and very effective physical therapy method, is a key indicator that reflects the service group, service capabilities and overall operation of a mental medical institution. In addition, psychiatrists often treat some common diseases and chronic diseases, most of which are treated with drugs, so the precise use of drugs is very important. If these indicators can be included in the assessment, I think we can better guide the development of psychiatric hospitals and better meet the needs of the people.

Let’s talk about the dimension of satisfaction evaluation. For psychiatric hospitals, because most of the service targets are patients with mental illness, it is more difficult to survey patient satisfaction. If the satisfaction of family members can be added to the assessment indicators , it can reflect the real situation more easily and objectively.From the perspective of medical staff satisfaction, due to the particularity of service objects, there are some objective differences between the salary and benefits, work content and environment of medical staff in psychiatric hospitals and medical staff in general hospitals with the same seniority. We still need to find ways to solve.

From a long-term development perspective, psychiatric hospitals in the traditional sense can no longer meet the people's growing mental health and mental health needs. Epidemiological data show that the number of people suffering from various mental and psychological diseases such as anxiety, depression, and insomnia in my country reaches 16.5%. This requires us to speed up the construction of sub-professionals and talent echelons as soon as possible in the next step, improve service capabilities, and further meet the needs of People's needs.

Source: Health News Culture Channel

Editor: Gao Yankun

Production: Zhang Haohua

Review: Meng Xiaojie