Research On Construction Of Performance Evaluation System Of Clinics In Towns And Townships Based On Balance Scorecard Theory

BackgroundNowadays,there is still maldistribution of health resources in our country,and the limited medical resources is collocated inefficiently.As a result,on one hand,tertiary hospitals gather an increasing majority of fiscal input,human resources and then patients,which leads to overcrowding and overload.On the other hand,secondary hospitals,clinics in towns and townships and community health center,with much less patients,work inefficiently.To help the masses cope with the difficulty in seeing a doctor,the State Council General Office publicated guidance of construction of hierarchical medical system(contained in[2015]70).Accompanied with the gradual implement of hierarchical medical system,a growing number of cases of common diseases,frequently-occurring ones and chronic ones will be diverted to secondary hospitals and primary health institutions,which is bound to challenge the service capability of these two types of organizations,especially the latter one with smaller scale and slower technology upgrading.In the meanwhile,because of the comprehensive reform of clinics in towns and townships caused by the New Medical Reform,clinics have transformed from institutions providing just medical assistance to ones having function for both medical assistance and public health,to which the traditional performance evaluation system focusing on treatment of diseases is no longer applicable.So a new assessment system emphasizing on both medical assistant and public health is needed.In order to evaluate performance of clinics in towns and townships objectively and direct them to improve service ability accurately,research designed a new evaluation system based on balanced scorecard theory.The new assessment system can guide managers’ of clinics to allocate more of health resources on prevetion and healthcare,which is pulic benefitial but unprofitable.Moreover,increasing attention to prevention and healthcare can drive rural medical model to transform from underlining disease treatment to underlining disease prevention and then improve the health standard of people overall area,which is helpful for building the Healthy Rural.Objectives’To establish a performance evaluation system,suitable to the development trend,of clinics in towns and townships in the framework of balanced scorecard model and to provide reference for relevant medical administrative department to implement performance assessment of clinics in towns and townships.Methods1.Literature analysisThrough academic resources on the Internet,such as network library,Google Academic and Baidu Academic,this research sought advances in performance evaluation of primary health institution and clinics in towns and townships,and studied cases of evaluation systems put in effect in non-profit organizations especially in healthcare institutions.After analyzing and appraising kinds of models of performance evaluation,the most suitable method of this study was selected.2.Semi-structured interviewA semi-structured interview was carried out among chiefs of medical department or public health department from three clinics in towns and townships in north-east of Guangzhou and one community healthcare center in south of Guangzhou and administators,in charge of rural clinics administration,from a health and family planning bureau.During the interview,those invited experts were consulted about daily operation situation and problems occurring in their clinics and were asked for advice about the index pool,which helped to design a relatively comprehensive and reasonable research plan.3.Delphi methodUsing self-designed questionnaires,the Delphi surveys were carried out among a total of 49 invited consultant experts.After three rounds of formal consultation and a round of supplementary one,the determined indexes were set and the weight of which was also assigned.Result1.A performance evaluation index system of clinics in towns and townships based on balanced scorecard theoretical frmework was constructed.Trough literature analysis and semi-structured interview,the research drafted an index pool of performance evaluation for township clinics.After that,Delphi method and analytic hierarchy process(AHP)were applied to build the evaluation index system of clinics in towns and townships based on balanced scorecard theory,which contained four dimensions-financial(32.75%),patient(25.43%),internal process(18.70%)and learning and growing(23.12%)-and a total of 34 indexes whose weight were also assigned.2.Analysis of consultation resultsPositive coefficient,authority coefficient and Kendall coordination coefficient were used to analyze the results of three rounds of expert consultation.The positive coefficient of the consultants in three rounds was 86.7%,100%and 100%,the authority coefficient was 0.600,0.725 and 0.805,and the Kendall coefficient of the consultation was 0.160,0.476 and 0.447,by the chi-square test,p<0.05.According to the data analysis above,it means that the consultant had a relatively great authority and the experts’ opinion was coming into agreement with each other.Conclusions1.The balanced scorecard performance evaluation model is of great reference significance for improving the service capacity of clinics in towns and townships.By evaluating the performance of townships clinics in balanced scorecard model,it helps to keep the balance between performance and operation behavior,the one between patient satisfaction and staff satisfaction,and the one between economic benefit and social benefit,changing the traditional assessment model focusing on financial indexes only.Through the balanced scorecard evaluation model,townships clinics is equipped to clearly realize their function orientation and accurately identify the problems casusing low service capacity,which provides constructive guidance to improve clinics’ service ability and promote implementation of the hierarchical medical system.2.Financial indicators and patient satisfaction are still the focus of health administration.In balanced scorecard,financial and patient are the two dimensions closest to the strategic target,which also represent economic benefit and social benefit of organization.In consideration of the importance of these two dimensions,the consulting experts assigned high weight to them during the Delphi surveys,which reminds administrators of townships clinics pay more attention to the indicators in the two dimesions and explore more measures,out of the evaluation system,to improve performance described by them.3.Continuous improvement is needed for the evaluation system to meet the requirement of the development of primary healthcare.Designing evaluation system is just the beginning of performance management,it is continuous improvement that plays a key role in activating performance management.Nowadays,with China’s healthcare reform entering "deep-water zone",primary health organizations must stick to the development trend.Medical administration should keep performance management in acoordance with the development trend of primary healthcare by continuously adjusting and ameliorating the evaluation system,directing clinics in towns and townships to improve health service quality persistently.