复件陈院长项目摘要（英文）

附件5

中国医院协会医院科技创新奖

推荐项目摘要

（中英文）

Summary for recommended project of hospital technical innovation reward of China Hospital Association

Project: Hospital performance payment reform based on quality and difficulty of patient cases

The first responsible person and institution of the project: Jing Chen, Yuxi Municipal Hospital of Yunnan Province

Start and finish time of the project: August of 2009 to May of 2010

Source of research fund: Hospital self-arranged

Introduction

General objective

We developed a reform program involving hospital HR reasonable allocation, performance improving, and reward schemes based on through investigation and research. Well defined protocols and detailed implementation plans were proposed. The program aimed to improve quality of care, performance of hospital service, and hospital competitiveness in regional market.

Specific objective

1．To have a clear definition, classification, and description of HR allocation, performance, reward system in the hospital. And it also introduced the international development of HR allocation, performance management, reward system.

2. To appraise the impact of existing HR allocation, performance management, reward system in the hospital. And it well describes the existing hospital performance management system.

3. To analyze main influencing factors to existing hospital performance. And to compare the impact of quality of care with different performance management system.

4. To have a constructive suggestion of hospital HR allocation, performance management, reward system reform. To establish a hospital performance management measurement and weighting system, and a model of hospital performance practice.

5． To analyze the feasibility of the reform of hospital HR allocation, performance management, reward system. To discuss the risks followed by change of hospital performance management model.

Expecting results

1． A descriptive report in terms of hospital HR allocation, performance management, reward system.

2. An evaluating report of influencing factors of hospital HR allocation, performance management, reward system.

3．An efficacy analyzing report for main influencing factors of hospital HR allocation, performance management, reward system.

4．A proposal of hospital HR allocation, performance management, reward system reform.

5．An implementation plan proposal of hospital HR allocation, performance management, reward system reform.

Risks and strategy

1、It might cause error as the main designer and responsible person hasn’t been working long in the hospital and was not familiar fully with hospital environment. So a through support is needed from local medical institutions, and a well organized sub-project system as well.

2、It is an essential for fully understanding and corporation within each department and unit to generate true and accurate data. It is required to collect high quality data during the process of project.

3、Hospital may implement hospital HR allocation, performance management, reward system reform according to self development strategy and practical situation, and also suggestion of project proposal as well. The hospital will gradually form a well established HR allocation, performance management, reward system instead of an impractical copy one.

Research content and methods

Research content：To study the existing problems and ways of reform for hospital HR allocation, performance management, reward system.

1.Qualitative data

Information collected via interview by individual expert or group experts in terms of various management reform problems, and showed in a fishbone chart. Problem solving decisions were acquired via SWOT by expert group.

Key influencing factors related to hospital HR allocation, performance management, reward system were acquired via literature review and questionnaire.

2. Quantitative data

1. Front pages of hospital records from 2007 to 2009.

2. Outpatient and inpatient medical orders from hospital electronic data base in 2007 to 2009.

3. Hospital financial report from 2007 to 2009.

4. Monthly staff salary and bonus detailed chart from 2007 to 2009.

5. Teaching and research information from 2007 to 2009.

6. Department HR structure from 2007 to 2009.

7. Department income and expenditure list from 2007 to 2009.

8. Hospital staff list from 2007 to 2009.

Research methods：

（一）General principle of the project： A through communication and corporation is needed between hospital and department, among different departments, and among various individual researcher from the start to the practice of the project, and until final evaluation. An effective feedback and communication channel is the guarantee for the success of the project. Meanwhile the whole process is a good way of communication, corporation, training to improve management ability through various departments and divisions to reach multiple-win results.

（二）specific research methods

1、Qualitative research methods

⑴ Delphi method： Expert review to collect information in terms of hospital HR allocation, performance management, and reward system, and also the understanding, appraising, action taken, believes of hospital management of different stakeholders including government, hospital, department director, health professional, patient.

(2) Brain-storming method：A collective discussion was held among various department experts. It was helpful to communicate and inspire, and to generate better protocol and new information.

（3） Questionnaire：A questionnaire form according to Delphi method and Brain-storming method result was then designed to get information about staff understanding, believes, and desire for hospital HR allocation, performance management, and reward system.

（4）Rootcause analyze chart(Fishbone chart):If it is difficult to determine cause and effect relationships among many factors under complicated circumstances, Fishbone chart is a powerful way to address the main factor, minor factor, and to understand relationships among them.

（5）Flow chart analyze： To define, classify, and describe the flow chart of hospital service and clinical pathways. To analyze hospital service flow and find out main problems which affecting performance, and then drill down to the exact step.

（6）Pareto Optimality： Key factors evaluation to find the main cause.

（7）SWOT analyze：According to problems raised from Brain-storming method, an analyze was made both on internal and external environments, especially on threats and opportunities. Meanwhile further analyze targets on strengths and weaknesses to form final effective strategy.

2、Quantitative research methods：

⑴ Measure principle： Hospital service performance includes treatment, teaching, and research, and measures target on both department and individual at the same time.

⑵ specific methods：

1Diagnostic Related Groups（DRGs）： We calculated different clinical department output according to DRGs weighting criteria of Beijing level Ⅲ hospital from patient discharging front page information.

②Clinical pathways： Common diseases treatment guidelines were initiated according to Evidence Based Medicine. And then optimized care flows were implemented under the new guidelines.

③Common item resource list： A common item resource list was developed based on US. RBRVS, Japanese count chart, and practical measure data.

④Cost and cost-benefit analyze： An analyze was made in terms of hospital DRGs and service profit and loss condition under Beijing standards to find the causes, and then improvements were encouraged.

⑤Hospital position evaluation：Hospital position evaluation based on medical expertise, problem solving ability, position risks, and position instruction.

⑥Staff efficiency analyze： Staff efficiency analyze was made based on front page information of medical records, medical orders, charging fees, and individual behavior in past 3 years. The analyze focus on low efficiency flows and steps, evaluation the rationality of HR allocation, and then determination of final plan and key measures.

⑦Balanced Score Card（BSC）： To monitor hospital financial, management, staff and patient conditions before and after the reform.

3、Systematic policy analyze：

To have a full scale Systematic analyze for whole hospital, including behavior studying (What is it?), value studying (What do you want?), norm studying (What will it should be?), and practical alternative protocols.

Technical routes and innovations：

Technical routes:

1、Qualitative methods： Expert review and group review to generate cause effect map, and then a SWOT analyze focus on problems related to hospital HR allocation, performance management, and reward system. A comparison was made as result of behavior change and possible improvement followed, and finally the feasibility of the reform.

2、Quantitative methods： Staff income structure calculation is based on cost management and history records. Staff position was defined with Hay scale, and a staff position evaluation system then established. Staff efficiency was analyzed according to DRGs, clinical pathways, and history records, then HR allocation and work load in different departments were defined. Staff expenditure budget, measures and reward plan were fixed according to cost management and history records.

3、Qualitative and quantitative data were systematic reviewed to initiate the best plan.

Features and innovations

The practical performance and reward reform program was based on global standard methods and a through analyze of history records.