Study On Designing Urban Community Health Institutions' Positions In China

Community health services will play a key role in China's health system, the relevant policies identified the basic functions, basic staffing of community health institutions. But there is little research about appropriate human resources'standards, structure, training methods and management regulations. In addition, the community health services reform is in very important stage, designing reasonable job position mode and standard help to improve the humane resource management system and long term plan, and help to improve the development of China community health system, so the relevant studies need to be implemented immediately. This study was implemented based on the background.1. Research PurposesTo achieve the basic functions of community health institutions, calculate appropriate staffing standards of community health institutions based on people's health needs; design efficiency and appropriate job position framework and management system by theory of institutions'organization and job evaluation. So the results will help to improve the efficiency of community health institutions, provide good references to community health manpower long-term planning, ensure the quality and quantity of community health services.2. Research MethodsThis study used Expert Consultation, Group Interviews, Comprehensive Evaluation, Job Evaluation, Health Manpower Calculation methods to evaluate the human resources needs of community health system. In addition, this study investigated 6 national piloting cities to analyze the appropriate human resources need and structure and job position structure, to evaluate job position's importance and management system.3. Research Results3.1 Modes and Evaluations of Community Health Institutions'Job PositionNow, there are not enough community health human resources, low academic qualifications and professional titles, unreasonable professional structure in community health institutions by the analysis of 6 national piloting cities field survey.The study evaluated the provision of community health services and found the community health institutions didn't provide enough primary health services to people, but they are changing the traditional medical services methods and put more attention to them. The General Practioners Group+Hospitalization Healing Group can realize more functions of community health institutions.Compared the General Practioners Group Mode, Basic Medical+Public Health Services Group Mode and General Practioners Group+Hospitalization Healing Group Mode and found the Basic Medical+Public Health Services Group Mode has low staff satisfaction and stabilization rate, General Practioners Group+Hospitalization Healing Group Mode was higher.3.2 Total Manpower Need of the Chinese Community HealthIn this section, the study evaluated the appropriate services items, responsibilities and number of different professional staffs by Health Demands Methods, Health Needs Methods, Hospital Planning Methods, Services Objective Methods and Experts Consultations etc.First, the study selected 120 appropriate services items by expert consultation. Second, the study calculated the work time for providing all services and each service. Third, the study calculated the total humane resources'demands by 260 work days every person every year. The appropriate staff is 151 professional staff every 100 thousand people.3.3 Designing Community Health Institutions'Job PositionsAccording to theory of Organizational Designing, Organizational Reengineering, and Organizational Development, combined with the national and international experiences of developing community health services, the study proposed appropriate mode of Job Positions in community health institutions.This study analyzed the international community manpower organization mode and found there was no best mode, different countries have different models of community health manpower; community health workers had relatively clear and single responsibilities; community health institutions had clear functions and objectives. This study analyzed relevant policies and regulations and used them to design job positions of community of health institutions.According to flat organizations and team-oriented developing trends, principal of designing job positions based on tasks, contingency theory of organizations'management, the study put the Total General Practioners Group Mode and General Practioners Group+ Primary Medical Team Mode.3.4 Evaluation of Community Health Organization's Job PositionsThe theory of evaluating importance and value of different job positions include Position Ranking Method, Position Classification Method, Position Point Rating Method, Hay Guide Chart-profile Method etc. This section evaluated the job position in community health institutions by employee self-evaluation and external evaluation.Employee self-evaluation found that general practitioners position face the highest professional risk, public health service positions face the most new issues and difficulties to do work, have the largest amount of organization and coordination works.Expert external evaluation found that the general practitioner positions have the highest importance and responsibilities and technical complexity and workload. The staffs hope to be general practitioners mostly. Medical technicians positions'working environment is relatively poor.Expert external evaluation's score is higher than self-evaluation, this section used weight ratio of 3:7 to give a comprehensive evaluation. The ratio of general practitioners: nurses:public health services physicians:maternal and child health doctors:Chinese medicine practitioners:medical technicians Practioners is 1:0.95:0.97:0.93:0.91:0.84, this can be used as indicators of salary to enhance fairness of different positions'salary.3.5 Administration Systems of Community Health Institutions'Job PositionsAccording to basic organization management theory and innovative approach, combined with functions and responsibilities of community health institutions and results of job evaluation, this study designed responsibilities and performance evaluating indicators and principal of setting salary of job positions in community health institutions.4. Policy RecommendationsThis study proposed three aspects of policy recommendations according to the health human resources demands, job positions setting, job evaluation. First is about health manpower planning, for instances, designing appropriate and comprehensive community health human resources developing plan, establishment of systematic training system, paying more attentions to attracting more professional staffs and developing of staffs' professional career. Second is about designing job positions in community health institutions, such as designing appropriate job position model of community health institutions, researching the applicability of functional organizational model, inducing the community health institutions pay more attentions to public and primary health services. Third is about community health human resource management, such as flexible working time, improving the employee satisfaction rate, establishing new performance evaluation system.