In the process of further deepening the comprehensive reform of urban public hospitals and building a tiered diagnosis and treatment system, under the idea that the government should streamline administration and delegate power and implement the responsibility of medical management, in the construction of a new mechanism that emphasizes both maintaining public welfare and mobilizing enthusiasm, how should relevant government departments run hospitals well, and what leading and driving role should large public hospitals play? At the main forum of the Second Large Public Hospital Development Summit Forum, the guests expressed their views one after another.
Performance appraisal has moved from extensive to refined management
Chen Jianping, director of the Development Center of Shanghai Shenkang Hospital,
Since its establishment in 2005, the Shanghai Shenkang Hospital Development Center, which is positioned as the responsible entity for medical management and state-owned asset investment and operation, has been shrouded in a mysterious veil. By this year, Shenkang has gone through ten years of medical care. Chen Jianping, director of the center, said that after ten years of hard work, in the process of exploring the way of running public hospitals, Shenkang has always regarded himself as a large group of municipal hospitals.
In implementing the medical responsibility of 28 Shanghai municipal hospitals and 10 tertiary hospitals to jointly build tertiary hospitals, Shenkang has adopted a series of unique practices, among which the president's performance appraisal method has attracted much attention from the industry. Chen Jianping said that by selecting 23 quantitative indicators and two qualitative indicators, Shenkang strives to guide hospitals to attach great importance to the direction of hospital management.
Among them, patient satisfaction, medical quality, and cost control indicators account for 50% of the total assessment score, aiming to guide hospitals to improve patient satisfaction, medical care quality and control medical expenses. By assessing the per capita business volume per doctor, the business volume of 10,000 yuan in national assets, and the scientific research funds obtained by every 100 health and technical personnel, we will lead the hospital to control scale and improve efficiency.
, Director of Beijing Medical Administration Bureau Feng Guosheng,
, As one of the first batch of pilot cities for urban public hospital reform, the Beijing Medical Administration Bureau also pays attention to the performance appraisal of the 22 municipal public hospitals. Feng Guosheng, director of the bureau, said that since 2012, the Beijing Municipal Medical Administration Bureau has launched the performance appraisal of municipal hospitals, set 23 quantitative indicators, and added daily evaluation indicators to highlight assessment indicators such as service quality, service efficiency and patient satisfaction, and strive to establish a public hospital evaluation system with public welfare as the core and unified standards.
Feng Guosheng said that the purpose of performing performance appraisal of hospitals is to guide municipal hospitals from scale expansion to quality and efficiency in terms of development mode by assessing the hospital's social evaluation, internal management, medical quality, operation efficiency, etc. In terms of management model, hospital managers are encouraged and restrained to focus more on hospital management, and through scientific analysis of hospital performance data, practical measures are formulated to promote the transformation of hospital management from extensive administrative management to refined information management.
Transformation mechanism from "running volume" to increasing gold content
In the new round of medical reform, it is the key and difficult to break the profit-seeking nature and build a new mechanism for maintaining public welfare, mobilizing enthusiasm and ensuring sustainable operation of public hospitals.
Chen Jianping said that at present, it is no longer sustainable for large urban public hospitals to seek development by relying on "volume running", and it is urgently necessary to change to focus on connotation, improve capabilities, and improve value. To this end, Shenkang launched the reform of the internal operating mechanism of municipal hospitals in 2012 to promote the "transformation of methods, structures, and mechanisms" of municipal hospitals.
Through a comprehensive budget and approved income and expenditure, Shenkang focuses on monitoring the five indicators of hospital medical income, medical costs, drug and sanitary materials income, total wages, discipline construction and talent training expenditure, and clearly stipulates that the increase in business volume of medical institutions should be greater than or equal to the increase in business income, the increase in business income should be greater than or equal to the increase in business expenditure, and the increase in business expenditure should be greater than or equal to the increase in total employee salary. At present, the goal of "double control and double reduction" has been initially achieved to control the growth rate of medical income, medical cost expenditure growth rate, and reduce the growth rate of drug income and sanitary materials income growth rate.
In terms of the reform of the internal performance and distribution system of the hospital, Shenkang has changed the traditional distribution model based on department revenue and expenditure surplus as the base. In order to focus on eight factors such as the difference between doing more and doing less, doing more and doing less, doing easy to do differently, quality is different, and satisfaction is different. A classified assessment of medical personnel in different positions and ranks has been fully implemented, and a two-level assessment and two-level distribution in the hospital have been widely implemented. An income distribution system based on performance and based on assessment has been initially established.
In the field of hospital personnel system reform, the reform of public hospital staffing management launched by Beijing in the first half of this year has become a hot topic in the industry. Feng Guosheng said that at present, the contradiction between the establishment control and the development needs of public hospitals is becoming increasingly greater. Under the premise that the state strictly stipulates that the number of establishments cannot be increased, Beijing municipal hospitals have implemented the establishment control number management, that is, the establishment control number is not the actual establishment number of the hospital, but when assessing indicators such as hospital allocation and introduction of talents, it can be calculated according to this number. Through this flexible method, it does not break through the country's rigid control of staffing, and solves the needs of hospital investment and employment.
However, the reform of the operating mechanism of public hospitals also faces a lot of confusion. Feng Guosheng said that how to change management methods and strengthen the employment system and job management; how to establish a employment system that determines jobs based on affairs, positions, and job management; how to establish a salary assessment system that can mobilize the enthusiasm of medical personnel, and scientifically and reasonably reflects the labor value and work contribution of medical personnel; and how to adapt to the characteristics of "free person" management, which can manage people well, retain people, and fully exert human resources efficiency, needs further exploration.
Graded diagnosis and treatment has shifted from taking all the top and bottom to misaligned development
Wang Guobin, director of Wuhan Union Hospital,
At present, the public has a weak sense of gain of the dividends of medical reform. The main reason is that large public hospitals have siphoned talents and resources, resulting in weak service capabilities at the grassroots level, and large hospitals are overcrowded and difficult to find a number of numbers. Wang Guobin, director of Wuhan Union Hospital, believes that the continuous expansion of large public hospitals not only makes it difficult to ensure service quality and medical safety, but also causes large hospitals to have unclear positioning, small profits but quick turnover, and low efficiency. How to encourage large hospitals to focus on the creation of difficult and critical care centers and implement staggered development with primary medical institutions should be the common focus of the government and large hospitals.
Jiao Yahui, Director of the Medical Resources Department of the Medical Administration and Administration Bureau of the National Health and Family Planning Commission,
Let large hospitals and grassroots hospitals be in their respective positions. The construction of a tiered diagnosis and treatment system can be said to be both a means of medical reform and a goal of reform. Jiao Yahui, director of the Medical Resources Department of the Medical Administration and Administration Bureau of the National Health and Family Planning Commission, believes that the construction of tiered diagnosis and treatment system is more about the creation of a medical service system and the improvement of medical treatment model and medical order. To achieve tiered diagnosis and treatment, we must rely on top and bottom linkages to sink the high-quality resources of large hospitals through building hospital groups and medical alliances.
Jiao Yahui said that to build a tiered diagnosis and treatment system, the medical behavior of medical institutions, especially tertiary hospitals, must be changed. In the next step, the outpatient volume of tertiary hospitals will no longer be used as the hospital's assessment indicator, and the larger the better, the more the better; the average hospitalization day of tertiary hospitals should also be shorter than that of tertiary hospitals, and large hospitals should be guided to transfer chronic diseases. In the future, the management ideas of directors of large public hospitals should also change. The number of outpatients and more patients is not the main performance. The key is whether the structure of outpatients has been adjusted and the efficiency of the average hospitalization day has not been improved. The foundation of
tiered diagnosis and treatment is undoubtedly "strengthening the grassroots level". However, Jiao Yahui believes that improving the grassroots medical service capabilities through the establishment of the general practitioner system is a general direction, but it is very difficult to quickly cultivate a large number of qualified general practitioners in a short period of time; by improving the performance allocation system reform at the grassroots level, it will take time to support and retain these general practitioners.
Therefore, Jiao Yahui believes that in the current or in a considerable period in the future, improving primary medical services cannot be mainly based on general practitioners, but must rely on large public hospitals to give full play to their public welfare. Through various methods such as counterpart support, counterpart assistance, and multi-point practice of doctors, we can promote the vertical flow of resources, improve the service capabilities of grassroots, increase the attractiveness of grassroots to patients, and gradually achieve the goal of first-time consultation at the grassroots level.
Wang Guobin also believes that large public hospitals have ushered in a new turning point in development, namely, from scale expansion to quality and efficiency transformation, from taking all the way up and down to creating precision medicine. At the critical moment when public hospital reform is entering a critical moment when it overcomes difficulties, large public hospitals are not bystanders, nor are they stumbling blocks. Through their respective explorations, everyone is working hard to find the coordinates of their own development and be the main force of medical reform.
text/Health Daily reporter Ye Longjie Chief reporter Yan Yan Han Lu
or above are original works of "Health Daily". If reprinted, you must obtain authorization from this newspaper.
