Research On The Optimization Of The Administrative Penalty Behavior Of Medical And Health Supervision Based On PDCA Cycle

BackgroundHealth supervision is an important part of China’s health system and an important way to strengthen health management.As an important means to achieve the effect of health supervision,health administrative punishment plays an extremely important role in maintaining and improving people’s health level and maintaining the legal and orderly operation of the medical service market.Medical supervision is an important branch of health supervision.The mainly responsibility of it is to supervise and inspect whether medical institutions,medical personnel and individuals carry out diagnosis and treatment activities in accordance with the law,and to impose administrative punishments on illegal practice and unlicensed medical practice in accordance with the law.Through the field investigation of medical and health supervision in recent years and the induction and analysis of the data of administrative punishment of medical supervision,it is found that in the process of making the administrative punishment of medical supervision,the health supervision institutions at all levels have encountered many problems,which are mainly manifested in the two aspects of medical institutions and medical personnel,and the unlicensed medical practice.When imposing administrative punishment on the illegal practice of medical institutions and medical personnel,there are some problems,such as the lack of knowledge reserve,the untimely collection of evidence,the difficulty of fixing evidence,and the incompleteness of making records,etc.When the administrative punishment is imposed on the unlicensed medical practice,there are some problems,such as the difficulty in finding the illegal behavior,the difficulty in concealing the illegal place to obtain evidence,the difficulty in determining the punishment,the strength of administrative punishment is relatively small and the incomplete settlement of the case,etc.These problems appear in the process of making administrative punishments,and widely exist in the acceptance and filing of administrative punishments,investigation and evidence collection,punishment decisions,implementation and settlement of cases and other links.If the main problems in the key links can not be solved all the time,which causes obstacles in the process of administrative punishment,it will cause certain risks and difficulties for the smooth implementation of the whole health administrative punishment.This will not only lead to the health supervision institutions in the implementation of health administrative punishment faced with various constraints,but also bring many negative effects on the improvement of the level and quality of the whole medical supervision.ObjectiveThe objective of this research is to discover and solve the main problems in the links of acceptance and filing of administrative punishment,investigation and evidence collection,punishment decision,execution and settlement of cases,standardizing and optimizing the administrative punishment of medical supervision as a whole,and providing reasonable policy suggestions according to the research results,by using PDCA cycle to optimize the process of making administrative punishment of medical supervision.MethodApply PDCA cycle to the process of administrative punishment of medical supervision in R district of Jining City.The main problems and influence factors in administrative punishment are determined by brainstorming,questionnaire survey,key person interview and "fishbone diagram" quality management tool in the process of acceptance and filing of administrative punishment,investigation and evidence collection,punishment decision,execution and settlement of administrative punishment.Then,selecting and determining the key indicators of optimization,and then beginning to plan,implement,check and deal with each link in turn according to PDCA cycle.PDCA optimization cycle lasts for one year,this research compare the relevant data and evaluation indexes of administrative punishment before the cycle optimization in 2017 with those after the cycle optimization in 2018,gradually improve and solve the main problems existing in each link,and promote the administrative punishment behavior of medical supervision by optimizing the process of making administrative punishment.ResultsThe administrative punishment behavior of medical and health supervision includes the administrative punishment behavior of medical institutions and medical personnel,and the administrative punishment behavior of unlicensed medical practice.The specific PDCA cycle optimization scheme is formulated for these two aspects and the first cycle of PDCA is carried out in R district of Jining City.It is found that in the optimization process of administrative punishment of medical institutions and medical personnel,the main problems exist in the process of acceptance and filing,investigation and evidence collection,and punishment decision making are single source of case,difficulty in fixing evidence,and excessive punishment in summary procedure;in the optimization process of administrative punishment of unlicensed medical practice,the main problems exist in the process of investigation and evidence collection,punishment decision making,execution and settlement are the difficulty in determining the punishment,,the number of cases of confiscating illegal income and drugs and instruments is small,and the nonperformance of the party in the administrative punishment decision.After the first round of PDCA cycle optimization,in the optimization process of administrative punishment behaviors of medical institutions and medical personnel,the sources of accepting and filing cases increased significantly(p<0.05),the difficulty of evidence fixation in investigation and evidence collection was no longer the main problem(p<0.05),the problem of too much summary procedure punishment in punishment decision-making was not significantly improved(p>0.05);in the optimization process of administrative punishment of unlicensed medical practice,there were significantly more cases of evidence collection found in hidden places such as investigation and evidence collection leasing(p<0.05),more cases of confiscating illegal income and drugs and instruments in the decision-making process of punishment(p<0.05),and the performance of the decision of administrative punishment by the parties involved in the execution and settlement process was significantly improved(p<0.05),the acceptance and filing links without problems were not optimized.After the first round of PDCA cycle optimization,in terms of the overall optimization of the administrative punishment behavior of medical supervision,in the quality dimension,the rate of timely settlement of administrative punishment increased from 92.3%to 100.0%,the rate of unlicensed medical practice decreased from 8.8%to 1.0%,and the change was statistically significant(p<0.05)by Fisher’s accurate test;in the quantity dimension,the number of cases investigated and punished increased from 39 to 111,and the amount of fine increased from RMB 301000 to RMB 779000,the number of administrative punishment cases per capita increased from 3.5 to 10.1;the number of administrative punishment cases in medical institutions and medical personnel increased from 30 to 92,and the amount of fine increased from RMB 156000 to RMB 491000;the number of administrative punishment cases of unlicensed medical practice increased from 9 to 19,and the amount of fine increased from RMB 145000 to RMB 288000.Conclusions and SuggestionsPDCA cycle plays an optimization role in the process of administrative punishment of medical and health supervision in R district,which is mainly reflected in the process optimization of administrative punishment of medical institutions and medical personnel and the administrative punishment of unlicensed medical practice.The links of acceptance and filing,investigation and evidence collection,punishment decision,execution and closure have been optimized to varying degrees.Among them,in the decision-making process of administrative punishment of medical institutions and medical personnel,the optimization effect is not obvious,the reason may be that the health supervision and law enforcement personnel have insufficient cognition of the punishment procedure.PDCA cycle has played an optimized role in the administrative punishment of medical and health supervision in R district as a whole,which is mainly reflected in the following aspects:in terms of quality,the rate of timely settlement of administrative punishment has increased to 100%,and the rate of unlicensed medical practice has greatly decreased;in terms of quantity,the number of cases investigated and punished,the amount of fines and the number of administrative punishment cases per capita have all been increased.The overall optimization result of the administrative punishment behavior of medical institutions and medical personnel is better than that of unlicensed medical practice.It is suggested that PDCA cycle optimization should be applied in the administrative punishment of medical supervision.In the process of optimizing the administrative punishment behavior of medical institutions and medical personnel,it is necessary to strengthen the awareness of health supervision and law enforcement personnel on the administrative punishment procedure in the punishment decision process.