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Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.
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Objective To investigate the effectiveness of 4M1E refined management method in reducing dispensing time of outpatient prescription in outpatient pharmacies under the implementation of a long-term prescription policy.Methods The hospital started to implement 4M1E refinement management in July 2022.Ten thousand prescriptions were randomly selected for each of the pre-implementation(from January to June 2022)and post-implementation(from July to December 2022)human-machine hybrid dispensing windows.The dispensing time of a single prescription,the volume of prescriptions dispensed and the number of drugs prescribed during peak periods,the use of intelligent equipment,and patient satisfaction before and after imple-mentation were compared.Results After implementation,the single prescription drug dispensing time at the mixed human-ma-chine dispensing window was reduced from(96.88±1 401.17)s to(55.84±526.24)s(P<0.01);The number of prescriptions dispensed in the window increased from(135.20±21.06)to(147.19±21.24)prescriptions per 2 h,and the number of drugs pre-scribed increased from(871.74±215.61)to(1 008.53±267.87)prescriptions per 2 h during peak hours.The rate of straight prescription and the rate of equipment automation have been greatly improved.Outpatient satisfaction was higher than before man-agement.The data showed statistical differences(P<0.05).Conclusion Under long-term prescription pressure,hospital outpa-tient pharmacies can greatly reduce prescription dispensing time and improve patient satisfaction after applying the 4M1E fine management method.
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In the context of high-quality development in medical institutions, the supply-processing-distribution(SPD) management mode has gradually been widely applied. The authors described in detail the procurement, supply, inventory, distribution, and settlement management of medical consumables and in vitro diagnostic reagents in a certain hospital under the SPD mode. It was found that SPD was conducive to strengthening the supervision of medical consumables and in vitro diagnostic reagents in the hospital, ensuring quality and safety of use, reducing hospital operating costs, and improving hospital′s competitiveness. However, attention should be paid to preventing data security risks, strengthening operational management, and improving the cost-benefit analysis of in vitro diagnostic reagents.
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In recent years, public hospitals have been facing pressure from the reform of medical insurance payment methods. It is urgent to strengthen the operation and management of public hospitals. In June 2022, a tertiary public hospital utilized hospital intelligent agents to carry out refined cost management practices for medical service charging projects, sorted out medical service charging projects, designed management paths, and calculated project costs. The hospital conducted refined management on the cost of medical service charging items from three control dimensions of project unit cost with manpower, equipment and consumables, and two comparative directions with horizontal and vertical. The refined cost management practice not only pointted out the direction for global refinement cost control within the hospital, but also reduced the proportion of hospital consumption, which provided reference for improving the level of refined operation and management of public hospital hospitals.
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In recent years, the rapid increase in cancer treatment costs in China had brought a huge economic burden to society, and it was urgent to standardize the rational application of anti-tumor drugs. In the context of the reform of group payment related to disease diagnosis, a tertiary first-class hospital focused on the needs of patients and guided by value-based healthcare, established a professional and normalized refined anti-tumor drug management system, setted up a multidisciplinary diagnosis and treatment team, and promoted " Internet plus pharmaceutical services" in December 2018.From 2019 to 2021, the proportion of hospital drugs were 30.8%, 30.1%, and 27.3%, respectively. The amount of money spent on anti-tumor drugs were 83.25 million yuan, 76.41 million yuan, and 62.48 million yuan, respectively, showing a decreasing trend year by year. The practice of refined management of anti-tumor drugs fully reflected the core concept of value based healthcare, achieving closed-loop management of the entire process of drugs, improving the level of rational drug use, reducing the economic burden on patients, and providing reference for improving the level of rational use of anti-tumor drugs in public hospitals.
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In order to promote the high-quality development of public hospitals and ensure the safety and health of the people, it is important toachieve full traceability and refined management of high-value consumables throughout their entire life cycle.The author designed and implemented a refined management of high-value consumables in orthopedics based on one item, one code. In the closed-loop management process, hospital staff labelled high value orthopedic consumables, achieving the integration of disinfection traceability code, product qualification certificate, and billing traceability code; Three parties, including the chief surgeon, circulating nurse, and handwashing nurse, should sign and confirm the code, ensuring that the item code could not be separated; And real-time intraoperative billing, postoperative counting, and case tracking were used. At the same time, the design utilized a hospital consignment warehouse. The comprehensive promotion of this practice by the hospital saved costs, improved the overall efficiency of the entire business process of orthopedic high-value consumables, and met the requirements of relevant policy supervision and hospital refined management.
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Objective:To analyze the cost of diagnosis-intervention packet(DIP) in a certain hospital in 2021 based on hospital intelligent agents, so as to provide feasible ideas for refined management of DIP costs.Methods:On the basis of the construction of the hospital intelligent agent platform and the results of project cost accounting in the early stage, a total of 60 187 cases and 4 860 DIP diseases in the hospital in 2021 were selected as the research objects. The project superposition method was applied to calculate the unit cost of all DIP diseases in the hospital. Based on the results of DIP cost accounting, the ideas and methods of fine management of DIP costs were explored from the perspectives of DIP disease classification, management of all hospital diseases and medical insurance diseases, vertical and horizontal comparative analysis of DIP costs, and management of medical insurance cases and non medical insurance cases under the same DIP disease category.Results:Twenty-two advantageous DIP disease types, 67 key disease types, 1 590 potential disease types, and 3 181 disadvantageous disease types were identified. Introducing medical income as an intermediate indicator facilitated the classification of DIP disease types under medical insurance, 1 072 advantageous disease types, 917 key disease types, 458 potential disease types, and 815 disadvantageous disease types in medical insurance were identified. Through refined accounting, it was found that the average cost of non medical insurance cases under the same DIP disease category was generally higher than that of medical insurance cases, and there were differences in DIP costs at different levels during different time periods.Conclusions:By determining and analyzing the advantages and disadvantages of disease types in the entire hospital, common problems of disease types under the same category can be identified, and targeted control measures can be proposed. By analyzing the two dimensions of medical insurance surplus and medical surplus, the advantages and disadvantages of medical insurance diseases can be quickly determined, providing a lever for the control of medical insurance diseases. The horizontal and vertical comparative analysis of DIP costs, as well as the analysis of medical insurance cases and non medical insurance cases under the same DIP disease category, can provide feasible methods for hospitals to manage DIP costs at multiple levels and dimensions.
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In recent years， in order to meet the needs of high-quality development， more and more hospitals have begun to carry out refined drug management. Based on the theory of value chain management， this study analyzed and practiced the refined drug management. First of all， the value chain model of drug management was constructed to clarify the drug management process and classification. Secondly， the current situation and demand of drug management were analyzed to clarify the management needs of procurement， logistics， inventory， distribution and use in the management process. Then， based on the value chain theory， the basic activities and auxiliary activities of drug management were reconstructed and optimized. The performance evaluation suggested that refined drug management based on the value chain theory could improve the efficiency of drug management， provide better services for patients， and help the hospital develop with high quality.
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Objective:To analyze the DIP medical insurance settlement situation of neonatology and its influencing factors,to optimize the medical insurance settlement rules of neonatology,and to promote the fine management of payment method reform.Methods:City Y,the pilot city of national DIP payment method,was selected as the case area,and the data of the whole sample of patients in neonatology department of City Y were analyzed by descriptive analysis,four-quadrant bubble chart,and multivariate linear regression methods,combined with qualitative data analysis and interview study.Results:There were 1 372 neonates in City Y in 2022,with a health insurance billing rate of 84.82%and 81.10%in tertiary care facilities.There were 718 unenrolled cases.Tertiary care institutions,not enrolled,low-birth-weight babies,higher days of hospitalization,lower days of birth,and lower settlement scores were the influencing factors for the low rate of health insurance settlement in neonatology(P<0.05).Conclusion:Neonatology medical insurance settlement rate was significantly lower than that of the city,and tertiary care institutions had higher deficits,which may lead to the risk of shirking critically ill neonatal patients.There were problems of insufficient grouping refinement and score distortion in neonatology.Recommendation:We should improve the management and adjustment mechanism of core elements,optimize the DIP grouping of neonatology,comprehensively consider the resource consumption characteristics of neonates,rationally and dynamically adjust the price of neonatal medical services,and scientifically set the neonatology markup coefficients,so as to achieve synergistic improvement in the development of neonatology and health insurance,and to push forward the connotative and refined development of the reform of the payment method of health insurance.
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@#With widespread popularization, the radiological diagnosis and treatment technology has played an increasingly important role in clinical practice. The tertiary general hospital is generally featured as multiple types of radioisotope and radiation equipment, wide involvement of departments and persons, and many ways of use and potential harms of the radiological diagnosis and treatment technology. Radiation protection has become a content that cannot be ignored in hospital management. This article analyzes the radiation protection management structure of the tertiary general hospital - Guangdong Provincial People’s Hospital. The hospital radiation protection management is gradually improved by clarifying the main leading department, refining duties and responsibilities, strengthening multi-departmental communication and cooperation, and sorting out key connection links. A closed loop of refined management is formed through digging and correcting problems and continuously improving the management level and work efficiency. Valid qualifications are ensured to be obtained in time by radiation workers, radioactive drugs, equipment, and the venues to guarantee the radiation safety of radiation workers and patients and to further promote the construction of the Safe Hospital.
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Under the background of the new medical reform, the performance evaluation of public hospitals is become increasingly strict and the operating pressure as well. Refined management of public hospitals is an effective way to improve the operation and management efficiency of public hospitals and promote its high-quality development. In view of the main problems faced in operation and management, a tertiary hospital launched the practice of refined management in May 2019. Through the implementation of the DRG-PPS reform, construction of information-based operation management system, reconstruction of the performance evaluation index system and promotion of Internet hospital diagnosis and treatment services, the hospital effectively improved its medical service quality, clinical path management capacity and department operation and management efficiency, comprehensively advancing high-quality development of the hospital.
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OBJECTIVE：To explore refined management mode of outpatient pharmacy ，and to improve the efficiency and quality of outpatient pharmacy service. METHODS ：From the hospital information and big data center of our hospital ，the outpatient pharmacy prescription data under the traditional management mode were collected ；fish bone analysis was used to find out the factors that may affect the waiting time of patients ，the work efficiency and quality of pharmacy ；4M1E method was adopted to improve the related problems and implement refined management. The prescription data of 10 working days before improvement，stage 1 and stage 2 of refined management were selected. The work efficiency of pharmacists ，average waiting time of patients ，dispensing errors and inventory errors before and after the improvement were compared and analyzed to evaluate the effects of refined management. RESULTS ：By fishbone diagram ，the factors influencing the waiting time of patients ，the work efficiency and quality of outpatient pharmacy service in our hospital included personnel factors ，machine factors ，material factors ， method factors ，environmental factors ，such as the number of personel and time alloction was unreasonable ，the machine was aging，etc. After the implementation of refined management ，the outpatient pharmacy of our hospital had taken a variety of measures，such as adjusting the staff working time and refining the performance rew ard scheme ，maintaining the automatic dispensing machine and updating the prescription scanning equipment，setting up temporary drug containers and opti- mizing the location number ，strengthening drug management and relevant personnel training ， openning the window ofcharacteristic single variety dispensing. The statistical results com showed that in the first stage of fine management ，the number of dispensing prescriptions and the number of p rescription items in the outpatient pharmacy of our hospital increased slightly in 10 working days. Due to the decrease of the number of on-the-job staff and the change of the number and time of open windows ，the cumulative working hours of on-the-job staff decreased from 1 680 hours to 1 440 hours；the number of dispensing prescriptions and prescription items per hour per capita increased from 52.0 pieces，58.7 to 65.1 pieces，69.6（P＜0.05）；the number of dispensing errors decreased from 30 to 5；there was no significant change in waiting time of patients and inventory errors. In the second stage of fine management ，when the amount of dispensing prescriptions in outpatient pharmacy of our hospital was similar ，the number of dispensing prescriptions and the number of prescription items per hour per capita increased from 52.0 pieces，58.7 to 59.9 pieces，67.3，respectively（P＜0.05）；the average waiting time of patients decreased from 9.30 min to 7.32 min（P＜0.05）. After further refining the error data collection method and adjusting the performance incentive scheme ，the number of dispensing errors in outpatient pharmacy increased to 75，and the number of inventory errors decreased from 5 to 0. CONCLUSIONS ：By 4M1E method，outpatient pharmacy of our hospital carry out refined management ，to achieve the improvement of work efficiency and quality，shorten the waiting time of patients
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OBJECTIVE：To realize refined management of tablets i n the inpatient pharmacy ，and to ensure the medication safety of patients. METHODS ：Based on intelligent pharmacy ，the dispensing and packaging process under the automated drug dispensing and packaging system （ADDPS）mode was optimized and modified ；PDA barcode scanning technology was applied in all links of taking ，dismantling and adding ，so as to realize the real-time tracking of batch number and inventory ，and improve the drug closed-loop management of tablets. The error rate ，staff consumption time and pharmacist/nurse satisfaction were compared before and after the process improvement. RESULTS ：After the process improvement ，the dispensing error rate was decreased from 1.637‰ before improvement to 0.082‰（P＜0.01）；the staff consumption time decreased from （7.52±0.33）h to （5.11±0.24）h （P＜0.01）；the pharmacist/nurse satisfaction increased from 66.5％ to 93.4％（P＜0.01）. CONCLUSIONS ：Based on ADDPS ，the application of PDA barcode scanning technology standardizes the tablets management of inpatient pharmacy ，supplements and improves the drug closed-loop information ，realizes batch number tracking and inventory management ，reduces the occurrence of tablet dispensing errors ，improves the work efficiency and satisfaction of pharmacists ，and ensures the safety of clinical medication.
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Objective To standardize the purchasing procedure of aseptic high-value consumables to benefit the hospital and patient.Methods The present situation of aseptic high-value consumables management was introduced,the purchasing procedure of them was analyzed,and some countermeasures were put forward aiming at the problems in the purchasing procedure.Results Some suggestions were brought out including normalizing the access qualification management and purchase procedure,executing barcode management to improve its tractability,training administrative staffs to promote refined management and completing aseptic high-value consumables management system.Conclusion The purchasing procedure of aseptic high-value consumables can be improved from the aspects of management system,information management,personnel training and etc.
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Objective To standardize the purchasing procedure of aseptic high-value consumables to benefit the hospital and patient.Methods The present situation of aseptic high-value consumables management was introduced,the purchasing procedure of them was analyzed,and some countermeasures were put forward aiming at the problems in the purchasing procedure.Results Some suggestions were brought out including normalizing the access qualification management and purchase procedure,executing barcode management to improve its tractability,training administrative staffs to promote refined management and completing aseptic high-value consumables management system.Conclusion The purchasing procedure of aseptic high-value consumables can be improved from the aspects of management system,information management,personnel training and etc.
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The innovation of medical technology and progress of health care are dependent on the effectiveness of hospital scientific research management.By integrating the concept of refined management and with the construction of research platforms,an innovative administration mode for hospital research management was established and a sustainable development of hospital scientific research administration becomes possible.
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Objective To evaluate the effectiveness of refined management on the prevention and control of multi-drug-resistant organisms (MDROs).Methods Refined management concept and methods were adopted to stand-ardize all aspects of management of MDROs,healthcare-associated infection (HAI)caused by MDROs in 2012 (be-fore refined management)and 2013 (after refined management )was compared.Results The percentage of MDRO infection in 2013 was lower than 2012 (36.65%[70/191 ]vs 48.44%[62/128]);rate of HAI reporting ,contact precautions implementation,and hand hygiene compliance in 2013 were all higher than 2012 (80.00% vs 32.25% ;70.16% vs 28.13%;75.86% vs 44.09%,all P <0.05).Conclusion Implementation of refined management can improve health care workers’awareness of prevention and control of MDRO HAI ,and promote continuous im-provement of HAI management quality.
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Refined management calls fordetail decides result,operated in health achievements transformation in hospital,which is a new try.First of all,the author expatiated upon the connotation of refined management in this paper,and then,elaborated the practice of refined management of health achievements transformation in hospital.After that,he analysed the shortage of health achievements transformation.Finally,according to the actuality of health achievements transformation in hospital,the author proposed some countermeasures,such as strengthening the application of scientific achievements and the transformation consciousness,reforming the management system,reinforcing the construction of talents rank,intensifying the construction of promotion institution of scientific and technological achievements,and enhancing the hospital and enterprise' s joint,actively absorbing research funds.
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Based on theories of career guidance and refined management,this paper introduced the investigation and practice of refined career planning and guidance for pharmacy graduate students in Peking University,and puts forward some ideas to improve the career planning and guidance in the future.
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To promote the development of key discipline construction in hospitals,we described the integration of refined management into the construction of key disciplines and different aspects including personnel training,featured specialty,research,and hardware were discussed.We concluded that refined management in essential to the development of hospital,and a mechanism needs to be established to ensure the long-term effect.