Construction and application of multidisciplinary scientific research outpatient in clinical research / 中华医院管理杂志

In recent years, some large public hospitals in China had successively opened scientific research outpatients to provide consulting services for clinical research, but there were generally problems such as insufficient audience and single role of expert teams. In July 2021, Shanghai Clinical Research Center established a multidisciplinary scientific research outpatient for the entire clinical research cycle, providing medical staffs with such services as clinical research design and project application, paper revision and achievement transformation. It also provided clerkship for medical students on campus to cultivate their standardized clinical research thinking. As of July 2022, the outpatient had provided research consulting services 16 times, teaching 8 class hours to medical students, and collaborated to solve multi-dimensional clinical research practical problems throughout the entire cycle, such as clinical trial design, project application, and paper publication. Good results had been achieved by this outpatient to provide reference for promoting the development of scientific research outpatients in China and improving the clinical research level of hospitals.

Prevalência e desfechos da sepse em crianças internadas em hospitais públicos e privados na América Latina: um estudo observacional multicêntrico / Prevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study

RESUMO Objetivo: Relatar a prevalência e os desfechos da sepse em crianças admitidas em hospitais públicos e privados na América Latina. Métodos: Análise post-hoc dos dados do Latin American Pediatric Sepsis Study (LAPSES), um estudo de coorte que avaliou a prevalência e os desfechos da sepse em crianças admitidas em 21 unidades de terapia intensiva pediátricas de cinco países latino-americanos. Resultados: Dentre os 464 pacientes com sepse, 369 (79,5%) foram admitidos em hospitais públicos e 95 (20,5%) em privados. Em comparação com os admitidos em hospitais privados, os pacientes com sepse admitidos em hospitais públicos não diferiram em termos de idade, sexo, condição de imunização, tempo de permanência no hospital ou tipo de admissão, porém tiveram incidência mais alta de choque séptico, escores Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2) e Pediatric Logistic Organ Dysfunction (PELOD) mais altos e taxas mais elevadas de doenças de base e analfabetismo materno. A proporção entre pacientes admitidos a partir de enfermarias pediátricas e mortalidade relacionada à sepse foi mais alta nos hospitais públicos. A análise multivariada não mostrou qualquer correlação entre mortalidade e tipo de hospital, porém, nos hospitais públicos, a mortalidade se associou com níveis mais altos de gravidade no momento da admissão à unidade de terapia intensiva. Conclusão: Nesta amostra de crianças admitidas em condições críticas em cinco países latino-americanos, a prevalência de choque séptico nas primeiras 24 horas da admissão e a mortalidade relacionada à sepse foram mais elevadas em hospitais públicos do que nos privados. A mortalidade relacionada à sepse mais elevada em crianças admitidas em unidades de terapia intensiva pediátrica de hospitais públicos se associou com maior gravidade por ocasião da admissão à unidade de terapia intensiva, porém não com o tipo de hospital. São necessários novos estudos para elucidar as causas da maior prevalência e mortalidade de sepse pediátrica em hospitais públicos.

ABSTRACT Objective: To report the prevalence and outcomes of sepsis in children admitted to public and private hospitals. Methods: Post hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data, a cohort study that analyzed the prevalence and outcomes of sepsis in critically ill children with sepsis on admission at 21 pediatric intensive care units in five Latin American countries. Results: Of the 464 sepsis patients, 369 (79.5%) were admitted to public hospitals and 95 (20.5%) to private hospitals. Compared to those admitted to private hospitals, sepsis patients admitted to public hospitals did not differ in age, sex, immunization status, hospital length of stay or type of admission but had higher rates of septic shock, higher Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2), and Pediatric Logistic Organ Dysfunction (PELOD) scores, and higher rates of underlying diseases and maternal illiteracy. The proportion of patients admitted from pediatric wards and sepsis-related mortality were higher in public hospitals. Multivariate analysis did not show any correlation between mortality and the type of hospital, but mortality was associated with greater severity on pediatric intensive care unit admission in patients from public hospitals. Conclusion: In this sample of critically ill children from five countries in Latin America, the prevalence of septic shock within the first 24 hours at admission and sepsis-related mortality were higher in public hospitals than in private hospitals. Higher sepsis-related mortality in children admitted to public pediatric intensive care units was associated with greater severity on pediatric intensive care unit admission but not with the type of hospital. New studies will be necessary to elucidate the causes of the higher prevalence and mortality of pediatric sepsis in public hospitals.

Empowerment of nurses from a hospital in the south of Chile / Empoderamento de enfermeiros de um hospital no sul do Chile / Empoderamiento de los enfermeros de un hospital del sur de Chile

ABSTRACT Objective: to identify the level of empowerment among the nurses from a hospital located in the south of Chile and verify its potential association with personal and professional characterization variables. Method: cross-sectional and descriptive study conducted with 117 nurses from a hospital in the south of Chile. Data were collected in 2018 using a personal and professional characterization form and the Spanish version of the Conditions of Work Effectiveness Questionnaire II. Data were analyzed using descriptive and inferential statistics. Results: the means of the factors of the empowerment scale were: Opportunity (4.11±0.82); Information (3.81±0.90); Support (3.81±0.86), and Resources (3.13±0.97). Statistically significant differences were found between empowerment and having greater professional experience, working in the medical-surgical unit, having from 3 to 10 patients under responsibility, job satisfaction, and intention to quit their jobs. Conclusion: the nurses reported a positive perception of empowerment in their roles, especially concerning having opportunities to perform tasks that contribute to acquiring new knowledge and skills at work.

RESUMO Objetivo: identificar o nível de empoderamento dos enfermeiros de um hospital no sul do Chile e verificar as possíveis associações com variáveis de caracterização pessoal e profissional. Método: estudo transversal e descriptivo com uma amostra de 117 enfermeiros de um hospital no sul do Chile. A coleta de dados foi realizada em 2018 usando um formulário de caracterização pessoal e profissional e a versão em espanhol do Conditions of Work Effectiveness Questionnaire II. Os dados foram analisados usando estatísticas descritivas e inferenciais. Resultados: as médias dos fatores da escala de empoderamento foram: Oportunidade (4,11±0,82); Informação (3,81±0,90); Suporte (3,81±0,86) e Recursos (3,13±0,97). Diferenças statisticamente significativas foram encontradas entre empoderamento e maior experiência professional, trabalhar no Bloco Médico Cirúrgico, ter de 3 a 10 pacientes sob responsabilidade, satisfação com o trabalho e intenção de abandonar o emprego. Conclusão: os enfermeiros têm uma percepção positiva de empoderamento em seus papéis, especialmente com relação à oportunidade de realizar tarefas que contribuem para a aquisição de novos conhecimentos e habilidades no trabalho.

RESUMEN Objetivo: identificar el nivel de empoderamiento de los enfermeros de un hospital en el Sur de Chile y verificar posibles asociaciones con variables de caracterización personal y profesional. Método: se realizó un estudio transversal y descriptivo, con un muestreo de 117 enfermeros de un Hospital del sur de Chile. La recogida de datos fue realizada en 2018, con una ficha de caracterización personal y profesional y la versión en español del Conditions of Work Effectiveness Questionnaire II. Los datos fueron analizados a través de estadísticas descriptivas e inferenciales. Resultados: las medias de los factores de la escala de empoderamiento fueron: Oportunidad (4,11 ± 0,82); Información (3,81 ± 0,90); Suporte (3,81 ± 0,86) y Recursos (3,13 ± 0,97). Se identificó diferencia estadísticamente significativa del empoderamiento con más tiempo de experiencia profesional, el servicio Bloque Médico Quirúrgico, con una cantidad de 3 a 10 pacientes bajo su responsabilidad, satisfacción con el trabajo e intención de dejar el trabajo. Conclusión: los enfermeros tienen una percepción positiva acerca del empoderamiento en su rol, especialmente con relación a las oportunidades de desarrollar tareas que contribuyen para la adquisición de nuevos conocimientos y habilidades en el trabajo.

Internal control development at public hospitals in Ya'an city: problems and countermeasures / 中华医院管理杂志

Internal control of public hospital can prevent and control risk exposure of public hospitals in their economic activities,in order to reasonably guarantee their legal compliance,safety and effective use of assets,as well as their authenticity and integrity of financial information.It can also effectively fend off fraud,corruption,and improve the quality of public health services and service efficiency.The authors analyzed the present situation and existing problems of internal control efforts at public hospitals in Ya'an city,and put forward countermeasures and suggestions as well.

Influence of the clinic-pharmacy separation reform on a Beijing hospital / 中华医院管理杂志

Objective To understand the impact of the clinic-pharmacy separation reform on a tertiary hospital in Beijing.Methods In a comparative analysis,data in the HIS of the hospital were analyzed in descriptive statistics,covering such data as the number of visits,expense per visit,medical income and income structure change in the period between June and December in 2016 and 2017,and were analyzed by the methods of t test and descriptive statistics as well.Results Compared with the same period between June and December in 2016,the number of visits at its outpatient department reduced by 12.06％,expense per visit increased by 31.42 yuan (P ＜ 0.05),while the expense per visit of patients with medical insurance increased by 28.51 yuan (P ＜ 0.05) between June and December in 2017.The number of hospitalizations at the inpatient department increased by 2.94％,expense per hospitalization increased by 877.71 yuan,and that of patients with medical insurance decreased by 42.87 yuan (P ＞ 0.05)between the abovementioned periods.The case mixed index of inpatients rose by 0.01,and patient satisfaction rose by 4.22 percentage points.Conclusions This reform has reduced outpatient visits at hospitals,increased the coefficient of difficulty of hospital inpatients,and improved patients' experiences for medical services.Hospitals are recommended to further their internal management in a fine manner,and curb unreasonable growth of medical expenses.

Analysis of the cost structure of inpatients in a hospital in Tianjin based on DRGs / 中华医院管理杂志

Objective To analyze the impact of the comprehensive reform of public hospitals in Tianjin on the cost structure of inpatients at a tertiary general hospital.Methods Homepage data of the medical records from January 2015 to June 2018 were selected from a tertiary general hospital in Tianjin.The Beijing version of diagnosis related groupings(BJ-DRGs) was used to compare the expense structure of these inpatients before and after such a reform.Wilcoxon signed rank sum test,Z test and Pearson correlation analysis were performed for each index.Results Since the reform,the number of hospital discharges and that of DRGs had remained basically stable,while the case mixed index(CMI) weight increased slightly(from 1.0065 to 1.0386);the total hospitalization expenses,medical expenses,nursing expenses,management expenses and consumables expenses had increased.On the other hand,the expenses of medication and medical technology decreased,and the differences of these expenses were statistically significant (P ＜0.05).The time consumption index (0.87) and drug consumption index (0.80) were always lower than average,but the cost consumption index (1.38) remains above average with a slight rise.Conclusions The reform of public hospitals in Tianjin has encouraged such hospitals to improve their service procedures by adjusting such measures as pricing of medical services,and promoted their proactive management of hospitals.Hence the initial goal of "controlling costs,adjusting structure,and reducing costs" has been met.However,cost rise control still deserves major attention.

Research on the coupling and coordination of scale, efficiency and quality of public hospitals in Anhui / 中华医院管理杂志

Objective@#To evaluate the scale, efficiency and quality of secondary and tertiary public hospitals in Anhui province, and analyze the degree of coupling and coordination among the three dimensions.@*Methods@#Thirty-two hospitals′ data were extracted from the direct reporting system of Anhui Health Commission. Hospital efficiency was evaluated by DEA model, hospital quality was evaluated by TOPSIS model, and coupling coordination degree was analyzed by coupling function.@*Results@#In the single-dimension evaluation, there were significant differences in the distribution of the three dimensions among different levels of hospitals, and the efficiency and quality of secondary hospitals were better than those of tertiary hospitals. In the coupling evaluation, the average degree of coupling coordination in Anhui was 0.637, which was in the " primary coordination" level. The overall coupling and coordination degree of the tertiary hospitals were better than that of the secondary hospitals, and the highest score was in central Anhui.@*Conclusions@#Single-dimensional evaluation method cannot objectively represent a general picture of the hospitals. On the other hand, coupling coordination degree evaluation can provide a more comprehensive and objective result. The development strategy of hospitals should be made to fit local conditions and to coordinate the development of scale, efficiency and quality.

Experience and reflection on the construction of medical alliances in a government and hospital partnership model / 中华医院管理杂志

Active exploration for building a model of medical alliances fitting local needs, proves imperative for the functional positioning of medical institutions, promoting inter-institutional cooperation and enhancing the capacity of primary medical services. The authors described experiences and insights of the No.1 Affiliated Hospital and the People′s government of Quangang District in their partnership, and building a brand new model of medical alliance between a hospital and a local government. Also presented are characteristics of such a model, and analysis of operational data in benefiting the people. They held that such a partnership is a worthy attempt in the healthcare reform, by means of building medical alliances between local government and provincial hospitals. Such a practice can provide valuable references for promoting government-hospital synergy, elevating primary healthcare capacity and advancing the hierarchical medical system.

Status quo survey of surgical instrument maintenance at 549 hospitals in China / 中华医院管理杂志

Objective@#To investigate the status quo of surgical instrument maintenance at 549 hospitals nationwide and analyze the existing problems, so as to lay a foundation for further development of relevant standards.@*Methods@#In January 2019, 549 hospitals of different grades in 33 provinces, autonomous regions and municipalities were surveyed by a convenience sampling. The survey covered the basic information, the cognition of the management personnel on instrument maintenance, and the status quo of surgical instrument maintenances of the hospitals. Descriptive analysis was carried out on the data, and the number and percentage of counting data were described.@*Results@#368(59.74%)hospitals were manned with special post for cleaning precision surgical instruments, 426(69.16%) were manned with special post for cleaning quality inspection, and 382(62.01%) were manned with special post for assembly and packaging. 347(56.33%)for manufacturers training, 299(48.53%)for self-study manufacturers instruction, 420(68.18%)by department internal training; 116(18.83%)for manual cleaning, 413(67.05%)for manual and ultrasonic cleaning, 87(14.12%)for mechanical cleaning; High pressure steam sterilization was used in 518(84.10%), hydrogen peroxide plasma sterilization was used in 398(64.61%), and ethylene oxide sterilization was used in 222(36.04%) hospitals.@*Conclusions@#The maintenance of surgical instruments should be carried out by professional personnel, relevant training should be carried out, management personnel should strengthen the inspection, and relevant standards and norms should be formulated to unify the management of surgical instruments.

Discussion on the conflict of interests in the achievements transformation in hospitals / 中华医院管理杂志

With the constant growth of national investment in science and technology, biomedical scientific and technological achievements keep mushrooming. Hospitals, as a powerful force in high-tech research and development, experimental translation and industrialization of biomedicine research, play an important role in the transfer and translation of scientific and technological achievements. This paper analyzed the conflicts of interest in the achievements translation in hospitals, and considered that conflicts of interest are widespread in practice. Under the background of encouraging innovation and promoting the achievements translation, projects with conflicts of interest should be carried out in hospitals conditionally. While reducing the conflicts of interest, the achievements translation should be done properly.

Public hospitals′ salary status and effectiveness of salary reform in Zhejiang province / 中华医院管理杂志

The salary reform in public hospital is not only related to the interests of medical staffs, but also to the health care reform. Based on data of 17 provincial public hospitals in Zhejiang province from 2012 to 2017, and having calculated such factors as drug markup rate, hospital scale and general/specialized hospital characteristics, the authors analyzed the effectiveness of public hospitals salaries reform from the perspectives of public duties performance, service quantity, medical expenditure, cost containment, service efficiency, implementation of insurance policies, among others. The growth rate of performance salary in Zhejiang provincial hospitals was less than 15%, and the performance salary accounted for less than 70% of the total compensation. Such factors as cost containment, improvement of efficiency, service quantity and public welfare duties performance impose, though having minimal impact, were found to be significantly positively correlated to such compensation. Given the minimum impact of reforms in health care expenditure and insurance policy on public hospital salaries, lower medical expenditure and insurance refusal rates are conducive to raising such salaries. The salary reform of provincial public hospitals has achieved initial success, yet their salary system calls for further improvement.

Evaluation on the management effectiveness of performance management for administrative departments at public hospitals / 中华医院管理杂志

Objective@#To evaluate the implementation effectiveness of performance management for administrative departments.@*Methods@#By means of questionnaires, the authors made a comparative analysis of the performance perception of service recipients of these departments before and after the implementation of the scheme, and the change of external performance appraisal results of the case hospital was analyzed through third-party evaluation. Then face to face interviews were used to conduct performance communication with the management staff.@*Results@#Questionnaire results showed that the satisfaction of those served by these administrative departments for their work improvement and work results was generally elevated, scoring 4.31 for their satisfaction elevation(higher than 3.0 of the neutral attitude). A third party external performance appraisal indicated a capability enhancement as shown by the hospital in the appraisal indicators by the hospital′s authorities, scoring 91.52 in 2018 as compared to 82.34 in 2016. In-depth interviews exhibited that the ranking of the total scoring of performance appraisal of these departments was more in line with the staff′s psychological feelings. These departments also agreed with the appraisal system, the algorithm of performance scoring and the appraisal results.@*Conclusions@#The performance management of these departments of the hospital had achieved the goal of effective implementation and elementarily improved the efficiency of the hospital′s internal management.

Empirical research on the performance appraisal model and implementation framework for administrative departments at public hospitals / 中华医院管理杂志

Efficient measurement of administrative departments at public hospitals is key to performance appraisal for such units. The authors analyzed the current situation and problems of performance management of such departments of public hospitals, and made case studies for the formulating and implementing process of the performance appraisal system.Furthermore, they probed into appraisal methods for these departments and presented a performance appraisal model of " expectation-response" . Combined with the practice of the case hospitals, the authors recommended an annual personalized evaluation indicator system. Based on analysis of the operation process of the case hospitals from 2016 to 2018, namely theory study-practical exploration-experience summary-program readjustment for further practice. These efforts studied the implementation framework of performance management for these departments, summarized the by-stage practice experiences of the appraisal from the " basic version" to " specialized version" . Thus the paper provided references for their performance management of these hospitals.

Status quo survey of surgical instrument maintenance at 549 hospitals in China / 中华医院管理杂志

Objective To investigate the status quo of surgical instrument maintenance at 549 hospitals nationwide and analyze the existing problems,so as to lay a foundation for further development of relevant standards.Methods In January 2019,549 hospitals of different grades in 33 provinces,autonomous regions and municipalities were surveyed by a convenience sampling.The survey covered the basic information,the cognition of the management personnel on instrument maintenance,and the status quo of surgical instrument maintenances of the hospitals.Descriptive analysis was carried out on the data,and the number and percentage of counting data were described.Results 368 (59.74％) hospitals were manned with special post for cleaning precision surgical instruments,426 (69.16％) were manned with special post for cleaning quality inspection,and 382 (62.01％) were manned with special post for assembly and packaging.347 (56.33％) for manufacturers training,299 (48.53％) for self-study manufacturers instruction,420 (68.18％) by department internal training;116 (18.83％) for manual cleaning,413 (67.05 ％)for manual and ultrasonic cleaning,87 (14.12％) for mechanical cleaning;High pressure steam sterilization was used in 518 (84.10％),hydrogen peroxide plasma sterilization was used in 398 (64.61％),and ethylene oxide sterilization was used in 222 (36.04％) hospitals.Conclusions The maintenance of surgical instruments should be carried out by professional personnel,relevant training should be carried out,management personnel should strengthen the inspection,and relevant standards and norms should be formulated to unify the management of surgical instruments.

Discussion on the conflict of interests in the achievements transformation in hospitals / 中华医院管理杂志

With the constant growth of national investment in science and technology,biomedical scientific and technological achievements keep mushrooming.Hospitals,as a powerful force in high-tech research and development,experimental translation and industrialization of biomedicine research,play an important role in the transfer and translation of scientific and technological achievements.This paper analyzed the conflicts of interest in the achievements translation in hospitals,and considered that conflicts of interest are widespread in practice.Under the background of encouraging innovation and promoting the achievements translation,projects with conflicts of interest should be carried out in hospitals conditionally.While reducing the conflicts of interest,the achievements translation should be done properly.

Public hospitals' salary status and effectiveness of salary reform in Zhejiang province / 中华医院管理杂志

The salary reform in public hospital is not only related to the interests of medical staffs,but also to the health care reform.Based on data of 17 provincial public hospitals in Zhejiang province from 2012 to 2017,and having calculated such factors as drug markup rate,hospital scale and general/ specialized hospital characteristics,the authors analyzed the effectiveness of public hospitals salaries reform from the perspectives of public duties performance,service quantity,medical expenditure,cost containment,service efficiency,implementation of insurance policies,among others.The growth rate of performance salary in Zhejiang provincial hospitals was less than 15％,and the performance salary accounted for less than 70％ of the total compensation.Such factors as cost containment,improvement of efficiency,service quantity and public welfare duties performance impose,though having minimal impact,were found to be significantly positively correlated to such compensation.Given the minimum impact of reforms in health care expenditure and insurance policy on public hospital salaries,lower medical expenditure and insurance refusal rates are conducive to raising such salaries.The salary reform of provincial public hospitals has achieved initial success,yet their salary system calls for further improvement.

Evaluation on the management effectiveness of performance management for administrative departments at public hospitals / 中华医院管理杂志

Objective To evaluate the implementation effectiveness of performance management for administrative departments.Methods By means of questionnaires,the authors made a comparative analysis of the performance perception of service recipients of these departments before and after the implementation of the scheme,and the change of external performance appraisal results of the case hospital was analyzed through third-party evaluation.Then face to face interviews were used to conduct performance communication with the management staff.Results Questionnaire results showed that the satisfaction of those served by these administrative departments for their work improvement and work results was generally elevated,scoring 4.31 for their satisfaction elevation (higher than 3.0 of the neutral attitude).A third party external performance appraisal indicated a capability enhancement as shown by the hospital in the appraisal indicators by the hospital's authorities,scoring 91.52 in 2018 as compared to 82.34 in 2016.In-depth interviews exhibited that the ranking of the total scoring of performance appraisal of these departments was more in line with the staff's psychological feelings.These departments also agreed with the appraisal system,the algorithm of performance scoring and the appraisal results.Conclusions The performance management of these departments of the hospital had achieved the goal of effective implementation and elementarily improved the efficiency of the hospital's internal management.

Empirical research on the performance appraisal model and implementation framework for administrative departments at public hospitals / 中华医院管理杂志

Efficient measurement of administrative departments at public hospitals is key to performance appraisal for such units.The authors analyzed the current situation and problems of performance management of such departments of public hospitals,and made case studies for the formulating and implementing process of the performance appraisal system.Furthermore,they probed into appraisal methods for these departments and presented a performance appraisal model of " expectation-response".Combined with the practice of the case hospitals,the authors recommended an annual personalized evaluation indicator system.Based on analysis of the operation process of the case hospitals from 2016 to 2018,namely theory study-practical exploration-experience summary-program readjustment for further practice.These efforts studied the implementation framework of performance management for these departments,summarized the bystage practice experiences of the appraisal from the "basic version" to "specialized version".Thus the paper provided references for their performance management of these hospitals.

Design and application of performance appraisal program at clinical departments based on the concept of value transfer / 中华医院管理杂志

Performance appraisal is one of the key points of hospital management. The authors introduce a comprehensive hospital performance appraisal scheme based on the concept of value transfer, including qualitative and quantitative index system, weight and appraisal method.In the pilot practice of a hospital, it is found that the appraisal scheme can effectively improve the operational efficiency, social and economic benefits, and has a strong incentive role for employees. This scheme weighs the operability and scientificity of performance appraisal, and provides a reference for clinical department performance appraisal.

La culpa médica en la responsabilidad de los hospitales públicos / Medical malpractice in public hospitals

Under Chilean public law, liability of a public hospital appears when the institution fails to accomplish its mandatory duties or incurs in negligence. As in private law liability, this system requires to determine the duties of hospitals and, in case of a medical accident, professional standards or duties. This paper explores the two main categories of medical malpractice, namely erroneous diagnosis and treatment failures based on public law theory and judiciary methods.