The effect of national tertiary public hospital performance assessment on the functional orientation of provincial public hospitals / 中华医院管理杂志

Objective:To analyze the impact of the national tertiary public hospital performance assessment(hereinafter referred to as the national examination) on the functional orientation of the provincial public hospitals in Zhejiang province, for reference to improve the allocation of provincial medical resources and high-quality development of public hospitals.Methods:The data came from the hospital financial data of 17 provincial tertiary public hospitals in Zhejiang province from 2012 to 2021 and the DRG quality performance analysis report of the tertiary hospitals in Zhejiang province from 2020 to 2021. The information of the number of employees and actual number of beds at the end of the period, etc., were extracted to analyze the overall operation of the hospital. The ratio of outpatient times to discharged times and the proportion of discharged patients undergoing surgery, as well as the proportion of discharged patients′ day surgery and level-4 surgery in hospital and in province were took as evaluation indicators to analyze the functional positioning of tertiary public hospitals.Results:Compared with 2012 to 2018, the average number of employees at the end of the period and actual number of beds in 17 hospitals from 2019 to 2021 increased by 761 and 303 respectively, and the average number of hospitalization days decreased by 2.26 days. The average ratio of outpatient times to discharged times in the hospital decreased from 175.76 in 2012 to 67.51 in 2021. The average proportion of discharged patients undergoing surgery in general hospitals increased from 0.39 in 2012 to 0.46 in 2021, and that in non-general hospitals decreased from 0.67 to 0.43. The average proportion of discharged patients undergoing day surgery in hospital and in province increased from 0.20 and 0.03 in 2020 to 0.23 and 0.04 in 2021 respectively, and the average proportion of discharged patients undergoing level-4 surgery in province increased from 0.04 to 0.05.Conclusions:The national examination could be conducive to strengthening the functional orientation of public hospitals. After the national examination, the ratio of outpatient times to discharged times in the provincial tertiary public hospitals in Zhejiang province had declined as a whole, the proportion of discharged patients in general hospitals had increased, but the proportion of level-4 surgery in hospitals needs to be further improved. The author suggested that we should continue to strengthen the operation mechanism of functional positioning of provincial public hospitals, improve the service capacity of hospitals for difficult and critical diseases, and improve the performance evaluation system of tertiary public hospitals.

The Need To Reform The Hospital Payment System In Indonesia

@#One of the crucial health policies in hospitals is about physician payment methods. Indonesia had implemented the National Health Assurance since 2014 to achieve Universal Health Coverage by 2019. Most of hospital revenue is packaging from the National Health Insurance Agent (called BPJS). However, Fee-for-service (FFS) payment method is still dominant in many hospitals. How can hospitals make policy to rearrange the payment method to attain hospital performance? The purpose of this research is to analyze the payment system that can improve employee satisfaction and performances. Mix method was used to collect data and make an interpretation. Data collected from 185 respondents and four key informants. The result showed that the policy in private and public hospitals in Indonesia of the physician payment is diverse. Most of the hospitals use the pure FFS for self-employee physicians (part timer employee). For full time employee, they applied FFS mixed with salary, or remuneration. To improve employee satisfaction and performance, the hospitals should make a policy to link the FFS to pay for performances. The hospital should make the tailoring program by involving the physician in a designing method of the hospital remuneration.

Appraisal of efficiency and performance of public hospitals in Sanming / 中华医院管理杂志

Objective To evaluate the performance and efficiency of public hospitals in Sanming city,for suggestions on bettering their medical resources deployment efficiency and operational efficiency.Methods Descriptive analysis was used to longitudinally describe the general performances of such hospitals,leveraging the operating data of 21 public hospitals of the city.Meanwhile,appropriate indexes were selected to construct data envelopment analysis models for analysis of hospital operational efficiency and variations.Results Longitudinal analysis showed the operation process as stable,the efficiency as improved,and the structure as optimized thanks to the reform.Horizontal analysis found three hospitals (14％ of all) as efficient in general,and seven (33％) as efficient technically.Those hospitals found as inefficient technically suffer from overinvestment or output deficiency to varying extents.Three hospitals (14％) were found with scale efficiency,while those found without scale efficiency were regarded as diminishing returns on scale.Conclusions Reforms measures must be adhered to consolidate outcomes of the ongoing reform;Regional healthcare resources planning must be consolidated to improve the efficiency of resource allocation;Delicacy management must be made to enhance service delivery capabilities.

Research on the Equity of Secondary Allocation for Hospital Performance Based on Gini Coefficient / 中国卫生经济

Objective:To evaluate the equity of the secondary performance allocation in target hospital.Methods:Through the comparison on the Gini coefficient calculation,the calculation method of Gini coefficient developed by Jianhua Zhang was applied to estimate the secondary allocation result of performance salary in the target hospital from 2014 to 2015.Results:From 2014 to 2015,the Gini coefficient remained at 0.22 or so,the overall allocation was average.Conclusion:Estimating the Gini coefficient was beneficial for the hospital managers control the structure and level of the second performance distribution and modulate the program of the sencond performance distribution in time,so that the distribution of performance salary would be accordant to the designed program and acts as the direction of motivation.

Analysis and Application of Performance Assessment Mode of Administrative Department in Public Hospitals / 中国医院管理

Performance assessment of administrative department in public hospitals is the difficulty of hospital performance management due to the lack of homogeneity,measurability and incentive.Comments are brought forward to improve and perfect performance assessment management of hospital administrative department through analysis of various performance assessment patterns of administrative departments in public hospitals in China at present,in combination with exploration and application of related mode in performance assessment in the hospital.

The status quo and trend of research about hospital performance:A social network analysis based on the periodical data / 中国卫生政策研究

With a combination of the periodical data of the CNKI database,and the literature with the keyword hospital performance,this paper makes a study on statistical analysis and visualization of relevant keywords.This research has found that study of hospital performance covers four areas:the doctor-patient relationship and medical quality,system reform,management innovation,and practice research.Hospital performance research covers three levels:performance management analysis within the hospital,institutional analysis,and analysis of relevant factors.This paper argues that scholars should regard people-oriented as the foothold,and expand research field from the following aspects:the medical insurance payment methods,the hospital linkage and government regulation and so on.

The status quo and trend of research about hospital performance:A social network analysis based on the periodical data / 中国卫生政策研究

With a combination of the periodical data of the CNKI database,and the literature with the keyword hospital performance,this paper makes a study on statistical analysis and visualization of relevant keywords.This research has found that study of hospital performance covers four areas:the doctor-patient relationship and medical quality,system reform,management innovation,and practice research.Hospital performance research covers three levels:performance management analysis within the hospital,institutional analysis,and analysis of relevant factors.This paper argues that scholars should regard people-oriented as the foothold,and expand research field from the following aspects:the medical insurance payment methods,the hospital linkage and government regulation and so on.

Examination and evaluation of employee satisfaction index in hospital performance evaluation / 中华医院管理杂志

Objective Examination and evaluation of employee satisfaction index in the hospital performance evaluation.Methods Stratified sampling,field survey and telephone survey were used in customizing a questionnaire for two surveys in July and December 201 5 respectively.Results The standardized score of employee satisfaction was 86.252±1 5.1 53,and the lowest score was found in the canteen environment and food quality.Conclusion Employee satisfaction is found as good overall,and targeted measures are recommended to improve insufficiencies for better employee satisfaction.

A New Approach of Measuring Hospital Performance for Lowand Middle-income Countries

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance.

"WORK EFFICIENCY ""FOUR -WHEEL DRIVEN"" HOSPITAL PERFORMANCE DISTRIBU-TION PATTERN" / 现代医院

The paper aims to analyze the flaws of new medical reform policies of cost accounting and bonus based on performance by introducing encouraging mechanism in bonus of the front two wheels: workload efficiency management and cost control management and the refraining mechanism by the two wheels: daily flaws management and key KPI checking.This efficiency-oriented four-wheel driven management mode reflects the reality of work-performance-based distribution, avoidsNine Forbiddingand reflect the public welfare.

A superlotação dos serviços de emergência hospitalar como evidência de baixo desempenho organizacional / The overcrowding of hospital emergency services as evidence of low organizational performance

O estudo teve como objetivo investigar a superlotação nos serviços de emergência hospitalar (SEH). Para tal, foram elaborados dois artigos, já publicados. O primeiro, elaborado durante a crise dos serviços de emergência hospitalar de 2005, discutiu as características estruturantes do Programa QUALISUS do Ministério da Saúde do Brasil, em curso de implantação, analisou as especificidades desses serviços e fez algumas considerações sobre o sistema de saúde do município do Rio de Janeiro, sede do início do programa QUALISUS. Com a complexidade do cenário onde o programa era implementado, exemplificado pela grave crise na assistência àqueles que demandavam cuidados nos serviços de emergência, assim como as características da matriz da qualidade sugerida pelo programa, cuja ênfase é na reorganização da rede dos serviços de emergência e na recepção dos serviços de emergência hospitalar, voltados para o acolhimento e a classificação de risco, optou-se pelo aprofundamento do estudo sobre os SEH. A partir de uma revisão sistemática, discutiu-se as intervenções voltadas para solucionar o problema da superlotação dos Serviços de Emergência Hospitalar, e identificou-se evidências de baixo desempenho organizacional. A revisão sistemática partiu de um universo de 2.992 títulos, onde foram selecionados 822 títulos para análise de resumos e textos integrais, entre o período de 2000 a junho de 2007. A superlotação foi caracterizada como um fenômeno mundial, com causas e conseqüências. As intervenções que interferiram positivamente no principal indicador da superlotação, o tempo de permanência no SEH, apontaram para a melhoria do fluxo de saída dos pacientes dos serviços de emergência hospitalar, através do aumento do desempenho organizacional. Os resultados dessa revisão desmistificaram as soluções que aumentam as barreiras de acesso ou melhoram a estrutura...

The study aimed to investigate the overcrowding in the public hospitals emergency rooms (ER). For such, two articles had been elaborated and are already published. The first one is related to the crisis of the public hospitals emergency rooms services which took place in the year of 2005 in Brazil. It presents the major characteristics of the Ministry of Health QUALISUS Program, analyzes the specificities of these services and made some considerations about the city of Rio de Janeiro health system, QUALISUS headquarter. Given the complexity of the broad picture where the program was implemented, leaded by the serious crisis in the emergency rooms medical care, as well as the characteristics of the quality matrix suggested by the program, whose emphasis is the reorganization of the emergency services network and in the reception of the services of hospital emergency driven toward the shelter and the classification of risk, it was decided to deepen the research on the emergency room aspects. From a thorough systematic review based on a universe of 2.992 titles, 882 full articles and abstracts from the period between 2.000 and 2.007 were analyzed. Overcrowding was characterized as a world-wide phenomenon, with causes and consequences. Among the main aspects, this literature raise up a range of interventions to solve the emergency room overcrowding. Low organizational performance is a scientific finding. Interventions that had modified positively the main indicator of overcrowding, the time of permanence in the emergency room, dealt with the improvement of the patients discharge from emergency rooms through the increase of the organizational performance. The results of this systematic revision had demystified the solutions that increase access barriers...

El ajuste por riesgo en la evaluación del desempeño hospitalario / Risk-adjustment in the assessment of hospital performance

Los indicadores de resultados constituyen parte esencial de la evaluación de la calidad de la atención hospitalaria. Son también atractivos pues permiten estimar el beneficio que representa el hospital para la comunidad, pero no son útiles para comparaciones en el espacio y el tiempo si no se ajustan por las características de los pacientes que fueron incluidos en el cálculo de los indicadores. La primera noción de esta necesidad proviene del siglo XIX y ya a mediados del siglo XX el ajuste por riesgo era una realidad en la comparación de desempeño hospitalario de países desarrollados. En Cuba aún no se realizan comparaciones de resultados en tiempo y espacio, dentro y entre hospitales o servicios hospitalarios, ajustadas por riesgo. Con el presente trabajo se pretende introducir el tema a los interesados y también abrir el debate en torno a la mejor forma de comenzar a realizar el ajuste por riesgo, imprescindible en las evaluaciones del desempeño hospitalario.

Outcome indicators are an essential part of the hospital care quality assessment. They are also attractive elements that allow estimating the benefits that hospital brings to the community, but they are not useful in spatial and time comparisons if they are not adjusted to the characteristics of those patients included in the indicator calculations. The first notion of this requirement dated back to the 19th century, and at the middle of the 20th century, the risk-adjustment had already been included in the comparison of hospital performances in the developed countries. However, risk-adjusted spatial and time comparisons of outcomes inside the hospital or between hospitals or hospital services are not made in Cuba yet. The present paper attempted to submit this topic to the interested people and to pave the way for debate around the best form of introducing the risk-adjustment since it is essential for hospital performance assessments.