Study On The Performance Appraisal Index System For Public Hospitals

[Backgrounds]Hospital performance appraisal as an effective regulatory regime and management systems, not only is a self-monitoring and self-restraint means of the hospital, but also has become a new strategic management tool for hospitals under the new competitive environment.The performance appraisal indicators is an important carrier of the performance appraisal work, can play its fitting role to a certain extent, but each indicator can not be perfect,so it requires trade-offs about pros and cons of indicators in a comparative environmental factors,then selects the appropriate indicators.After completing the indicators analysis, we carry out the empirical research for performance appraisal by using hospital data. The Shanghai Municipal Government, supplying medical service (hereinafter referred to as "Shen Kang"), implement the large public hospitals performance appraisal index system to the23public hospitals since2006. And whether the performance appraisal systems achieve the desired results, or what are the resistances in practical application?Research on the Secondary-level hospitals’performance appraisal is less and the appraisal itself there is often some problems.It is imperative to carry out the performance appraisal research on the Secondary-level hospitals, based on learning from the experience of the tertiary-level hospitals’ performance appraisal.[Objectives]First, we rationalize the theoretical basis of the public hospitals’ performance appraisal, and clear the framework and dimensions of the public hospitals’ performance appraisal, then develop the index system and operational methods.Secondly, we study on the practical application of the appraisal indicators in the tertiary-level hospitals,understand the expected results and the resistance from the objects.With the change of external factors, to find out some appropriate alternative indicators to improve the performance appraisal index system.Subsequently, we study on the application evaluations about the performance appraisal index system in the tertiary-level hospitals, and understand the differences of the medical costs, manpower efficiency and asset operating between the experimental group (23hospitals affiliated with Shen Kang) and the control group (six hospitals affiliated with Ministry of Health) in2002-2010, to verify the performance appraisal effective.Finally, we design the operable performance appraisal system for the Secondary-level hospitals. Then carry out the simulation evaluation research by the obtained data.[Contents and Methods]From the government who supply medical service, we build the large public hospitals performance appraisal system by the methods of literature analysis, expert consultation, brainstorming, and the Delphi.On the basis of the popular selection of indicators, we evaluate various types of indicators further through expert advice and group discussion. The first is to determine which indicators are most appropriate during a number of indicators of the specific dimensions, followed by analysis of the advantages/disadvantages and the application obstacles of the indicators, the last is to propose solutions for the application obstacles of the indicators, such as increasing the modification indicators, or adjusting the scoring method.We obtain29tertiary hospitals’ data in2002-2010from the Shanghai Municipal Health Bureau Information Center, and then divide the29tertiary hospitals into2groups, one is the experimental group and the other is the control group. Limited by availability of the data about the subordinate hospitals, this study only analyze the11indicators in three levels, such as medical expenses, human and beds efficiency and asset operational efficiency by using the Stata10.0and EXCEL2007for statistical analysis.Basing on the above researches, we also carry out the expand research which is the performance assessment on the Secondary hospitals, including research for the development of the performance assessment indicators system about the Secondary hospitals and the simulation estimates. Through using the multi-dimensional combination evaluation methods and learning from the tertiary hospitals’ performance appraisal system to build the indicators system of the Secondary hospitals’performance appraisal system. We obtain19Secondary hospitals’ data in2005-2009from the Shanghai Municipal Health Bureau Information Center, then analysis on the13indicators.[Results and Conclusions] We have build major public hospitals’performance appraisal index system, including five assessment dimensions,such as customer or social benefits, health care quality, operational efficiency, and financial condition, and23performance appraisal indicators. Then we develop appropriate operational methods for the indicators, and take the means of the combination of quantitative and qualitative assessment to assess the objects, reflecting the principle of objective and impartial.The results of the indicators research show that the23indicators play a certain role in practical applications. Such as the indicators of the questionnaire scores of health system and Shanghai health care quality inspection scoring, are third-party evaluation, not only avoiding additional burdens to the hospitals, but also introducing the third parties (patients or health bureau) to carry out the supervision and assessment for the hospitals; the indicators of the average medical cost, to some extent, control the excessive growth of medical expenses, while there may be decomposition treatment phenomenons, or refuse to receive the critical difficult patients;the indicators of the energy consumption expenditures for medical income (ten thousand yuan) and the Sanitary material expenditures for medical income (ten thousand yuan), response the call of the national energy saving,and promote the hospitals to take the "energy efficient" fine line.In this context, it is necessary to do the empirical research. The results show that to some extent the experimental group has reduced the medical expenses, and improved workforce productivity and asset operational efficiency, while has to strengthen the beds efficiency.Finally,we expand the performance appraisal research on the Secondary-level hospitals.Then we not only analysis the absolute value and the trend of the13indicators about the19Secondary-level hospitals in2005-2009, but also receive the scores and its rank sequence based on13indicators.The simulation results have a certain reference value, and provide the direction for the Secondary-level hospitals construction.