| Functional orientation of major public hospitals have been clear to take on critical illness diagnosis and disorders and diseases treatment as the new round of medical reform further develop.Development and scientific management of Critical Care Medicine (CCM)which is the medical ward that responsible for the treatment of acute and critically ill patients and continuity of life support, integrated care and treatment of critically ill patients directly impact on hospitals achieving this primary responsibility.Nowadays, most of the hospital CCM is not fully play a critical role in critically ill patients treatment. The reason is that this discipline lack of organization and management under unscientific inefficient work mode and have discordant inter-subjects collaboration phenomenon. There are lots of foreign researches to suggest that personnel composition, operation mode and process, the degree of understanding of critical illness, controlling the equipment ability of CCM and the relationship with other disciplines all have high influence on its medical work results. Although, many hospitals have begun to pay attention to and increased investment for CCM, the results are unsatisfactory. Not only will cause the waste of medical resources, but also makes resources scatter and limit individual strength development, did not reflect critically ill patients treated more "overall" thought, at the same time, also can’t form a complete competitive edge discipline. With the rapid economic development of society, there is increasing demand for medical services. Despite the medical science develop by leaps and bounds, subject continually subdivision, all clinical disciplines or sub discipline has generally been developed to a high level, doctors and patients needs of medical process and the overall effect still unable to meet. This has led to General Hospital adapt to the development situation of medical advances and competition, and must constantly seek and optimize in order to meet the new general model of diagnosis and treatment of patients needs.In recent years, the multidisciplinary team (MDT) appears for transformation of the medical model bring a new idea. The aim of this idea try to translate the individual experience of the traditional medical model into a modern team mode; to solve Intensive Care Unit (ICU) common hard problems through each discipline give free rein to their specialist technical advantage; to norm medical staff behavior; to make comprehensive professional diagnosis and treatment strategy; reasonably integrate and configurate medical resources; health care resources, technical advice, training and quality control systems; to standardize the technical guidance, training and quality control system to improve ICUs’ overall expertise and sub-discipline various skills. Obviously, compared with traditional comprehensive or special ICU, the MDT-ICU has its characteristics such as networked organizational structure, blurred organization boundaries, separated from the core functions and departments, medical teaching and research activities without boundaries, the integration of resources, operating flexibility, cooperation of contractual and timeliness. MDT mode construction will establish a set of hospital intensive medicine standardized treatment mode and process according to the actual situation, play disciplines agglomeration advantage of related specialty and the coordinating function, strengthen communication, rapid emergency response process and optimization of human resources, eventually achieve to standardize medical staff behavior, improve the level of treatment, reduce the management cost and improve the quality of medical treatment.Application of MDT in ICU will also bring challenges for hospital management. Questions about flat organizational structures, organizational boundaries blurred, multi-disciplinary professional and technical guidance and training, information communication, distribution of interests among the members, organizational incentives and risk sharing have emerged. There is an urgent need for the innovative model of management theory and methods research facing the opportunities and challenges of the MDT model for providing guidance of the operational management.This thesis with the era background of the ICU standardized management development as the foundation; summarizes the development status of ICU management mode at home and abroad. Moreover it expounds the reality demand of the MDT model in our country large general hospitals’ICU; systematically studied the establishment of the mechanism in hospital MDT organization and model of medical MDT theory architecture of ICU management, including the construction of organizational functions and its supporting conditions. Based on successful practice of ICU collaboration Center of Nanjing General Hospital of Nanjing military command it explores feasibility and superiority of MDT management mode development from the perspective of hospital practice and looked forward to hospital MDT model and the future development trend.This paper expounds the severe medicine production and the development of The Times background and significance, and puts forward the intensive medicine adopts a multidisciplinary joint collaboration medical concept combined with intensive medical management of bottlenecks from the current progress of medical science and medical service in our country several obvious trend analysis in prolegomena.The first chapter is the development of intensive medicine. It mainly summarizes the advantages and disadvantages of each management mode after summing up the development situation and model of foreign hospital ICU. This paper statistics the hospital for CCM construction and management pattern by searching the top100national hospital’s Internet home page, obtains large comprehensive hospitals with ICU discipline management and existing problems and describes general hospital for severe medical necessity of carrying out joint multidisciplinary collaboration.Chapter Ⅱ is MDT construction of ICU management mode. Articles from the research background of the model analysis of the its current development status; refines connotation of nosocomial multidisciplinary collaboration mode, classifies and sums up its work patterns; outlines the significant features of the multidisciplinary collaboration. In according to the development of hospital ICU, a multidisciplinary ICU collaborative management pattern is built from the perspective of the formation mechanism, as the main body of the management mode, responsibilities and functions of the multidisciplinary ICU collaboration team is proposed also, mainly including the quality of care, training, scientific management, trust and communication, and so on, for the construction of a multidisciplinary organization providing theory foundation.Chapter Ⅲ is management points of multidisciplinary ICU collaborative mode. First, in order to guarantee normal operation of the model, it requires a number of management mechanisms for protection, such as leadership mechanisms, incentive mechanism, conflict resolution mechanisms and information and knowledge sharing mechanism. At the same time, it also needs to strengthen cultural management and performance management for perfecting the management mechanism. On the one hand, it needs to clear the main content of the cultural management in order to give full play to the cohesion effect of organizational culture according to the features of the knowledge-type employees; On the other hand, to establish an effective performance management system after analyzing the influence factors of organization and the members of the working performance, for determining the main content of the performance evaluation and giving full play to the incentive role of performance management. Only under these mechanisms can promote the MDT management mode of ICU to achieve its full effectiveness and desired result.The fourth chapter was the of MDT information center construction of ICU. This chapter expounds the construction of information center from the characteristics of ICU information system. To match the ICU’s MDT team main functions as the goal, it discusses the main function of information center, including clinical work, improving the communication efficiency, providing decision support, improving the early warning system, setting up knowledge management platform and assisting the team’s learning and management. Information Centre has provided technical support to utilize subject’s resource, increase collaboration with each other to achieve efficiency and sharing information and knowledge.The fifth chapter is an empirical study of MDT. The Nanjing general hospital of Nanjing military region firstly sets up ICU coordination center. As a strong team that leads multidisciplinary collaboration mode of intensive full-time physicians medical treatment, it has spanned13specialized ICU and integrating resources and complementary advantages, consisting of specialized subjects experts and taking advantage of solving difficult diagnosis and severe combined treatment. This chapter introduces the basic framework of the ICU coordination center and its organizational functions from the main performance of the center, personnel training effect and clinical result of ICU indicators since its establishment and demonstrates the basic success of its organization operation. At the end of this chapter, it shows experiences, lessons learned and the results of the enlightenment during the center operating two years.The last chapter is the epilogue which puts forward to its future development prospects.This study mainly uses of literature retrieval method, case method, questionnaire method and interview method, and other many kinds of management methods. This paper has the follow innovations:(1) Innovating management model in hospital ICU. According to the current problems in ICU management, this study proposed a MDT for ICU (MDT-ICU) concept under the framework of the whole management theory. It identifies MDT position of ICU from formation mechanisms, organizational structure and key features in order to make the research more systematically for providing new ideas to the scientific management of ICU.(2) On the basis of the innovation practice of MDT-ICU this study also has carried on the empirical analysis. It treats innovation practice of MDT-ICU in some hospital as research foundation and object, theory of systematic and cames to the conclusion by objective indicators.(3) To provide insights for MDT in other areas of medical management applications. It is a useful exploration innovation that MDT model is combined with ICU management in the study. MDT-ICU model can be adjusted according to the characteristics and needs of different clinical professionals, so the pattern provides a reference frame for multidisciplinary organization in hospital other similar construction. Although this study has certain reference value to ICU standardized management of comprehensive hospital, the implementation of MDT mode is not only limited to this research, but flexible to application when MDT-ICU is used to other specific practices, so hospitals should determine contingency according to oneself circumstance. Second, when analyzing the comprehensive benefits of the pattern, the effectiveness study is still lacking from the humanity factor of argumentation, but does not affect the fundamental conclusions of the study. |
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