| ObjectivesThe objectives of the study are to set deployment standards of internal departments and human resource in Public medical institutions in Shenzhen city.Contents1. The allocation standards of departments and sections in the general hospitals at the second and the third levels;2. The allocation standards of doctors and nurses for all departments of the general hospitals at the second and the third level;3. The allocation standards of types of health staff in general hospitals at the second and the third levels.Methods1. Documentary research method;2. The method of the key person consultation;3. Field survey;4. Focus analysis.Results1. Comparing proportions of health staffs and rear service staff in the different cities, the percentages were 80.46% and 11.07% respectively, which ranked the first in the cities' comparison; the percentage of administrative was 5.41%, which ranked the last in the comparison; the percentages of other technicians also ranked the last second in the comparison; the percentage of doctors was 39.68%, which ranked the first among the comparison; the percentage of other health technicians was 6.64%, which ranked last in the comparison; the daily outpatient visits per doctor in Shenzhen was 14,172 visits, which ranked the first, and the daily inpatient bed-day was 1.072 bed-days, which ranked the second.2. The allocation standards of departments and sections in the general hospitals at the third level:①Clinical-Emergency Department-Internal system consists of 20 departments, including the emergency department, clinics and others.②Clinical-Emergency Department-surgical system consists of 19 departments, including cardiovascular surgery, thoracic surgery and others.③Clinical-inpatient-Medical systems consists of 17 departments, including the ICU, pediatrics and others.④Clinical-inpatient-surgical system consists of 18 departments, including bone and joint surgery, spine surgery and others.⑤medical technical department consists of 15 departments, including pathology, ultrasound imaging department and others.⑥administrative department consists of 18 departments, including the Security Section, Finance and others.3. The allocation standards of health staff for all departments of the general hospitals at the third level:①doctors in authorized size of a Section= daily clinic visits in a section÷the standard visits of doctor per hour÷6 hrs÷0.65. The standard visits of doctor per hour are different among the departments.②doctors in charge of inpatient bed in authorized size of a section= number of beds×the standard utilization rate of inpatient bed (93%)÷the number of inpatient beds in subdivision per doctor÷0.65. The number of inpatient beds in subdivision per doctor was different among the departments, ranging 3.0 to 10.2.③Number of second-line doctor= the standard percentage of second-line doctors and doctors in charge of inpatient beds×the number of doctors in charge of inpatient beds, of which, the standard percentage of second-line doctors and doctors in charge of inpatient beds was 0.63 for the medicine departments,0.58 for surgery.④The ratio of doctors and nurses in emergency department, outpatient and medical departments, dental outpatient departments were:1:1.55-1.90,1:0.85-1.92,1: 0.61-0.84, and 1:0.58-0.83.⑤The nurse allocation in inpatient department is calculated by beds per nurse. The rate of beds per nurse ranges from 0.3-to 2.7.4. The allocation standards of health staff for all departments of the general hospitals at the second level:①Clinical-Emergency Department-Internal system consists of 8 departments, including the emergency department, pediatrics department and others.②Clinic-Emergency Department-surgical system consists of 8 departments, including orthopedics, ENT, and others. ③Clinical-patient-medical system consists of 8 departments, including orthopedic, urology and others.⑤Medical technical department consists of 9 departments, including pathology, ultrasound imaging department and others.⑥Administrative departments consists of 15 departments, including Security Section, Finance and others.5. The allocation standards of health staff for all departments of the general hospitals at the second level:①doctors in authorized size of a Section= daily clinic visits in a section÷the standard visits of doctor per hour÷6 hrs÷0.65. The standard visits of doctor per hour are different among the departments, ranging from 2.3 to 7.2 visits;②doctors in charge of inpatient bed in authorized size of a section= number of beds×the standard utilization rate of inpatient bed (93%)÷the number of inpatient beds in subdivision per doctors÷0.65. The number of inpatient beds in subdivision per doctors was different among the departments, ranging from 3.0 to 10.1.③Number of second-line doctor= the standard percentage of second-line doctors and doctors in charge of inpatient beds X the number of doctors in charge of inpatient beds, of which, the standard percentage of second-line doctors and doctors in charge of inpatient beds was 0.51 for the medicine departments,0.43 for surgery.④The ratio of doctors and nurses in emergency department, outpatient and medical departments, dental outpatient departments were:1:1.55-1.90,1:0.85-1.92,1: 0.61-0.84,1:0.58-0.83.⑤The nurse allocation in inpatient department is calculated by beds per nurse. The rate of beds per nurse ranges from 0.3 to 2.7.6. The number of types of health personnel in various hospitals by the number of beds①In the general hospital at the third level, the allocation standard was made up by the ratio (4.9:1) of average daily outpatient visits to inpatient beds; The percentage of the administrative staff in total authorized size ranged from 5.2% to 6.7%, the percentage of other technical staff in total authorized size ranged from 2.1% to 3.6%; the percentage of health technicians in total authorized size ranged from 89.7% to 92.7%.②In the general hospital at the second level, the allocation standards were made up by the ratio (6.1:1 and 10.7:1)) of average daily outpatient visits to inpatient beds.In the general hospital with less than 400 hundred beds at the second level, the percentage of the administrative staff in total authorized size ranged from 6.7% to 8.2%, the percentage of other technical staff in total authorized size ranged from 2.4% to 3.9%; the percentage of health technicians in total authorized size ranged from 89.7% to 90.9%.In the general hospital with more than 400 hundred beds at the second level, the percentage of the administrative staff in total authorized size ranged from 5.6% to 7.1%, the percentage of other technical staff in total authorized size ranged from 2.9% to 4.4%; the percentage of health technicians in total authorized size ranged from 88.5% to 91.5%.7. The number of types of health personnel in various hospitals by workload.①For the general hospital at the third level, the general hospital with less than 400 hundred beds at the second level and the general hospital with more than 400 hundred beds at the second level, the average daily outpatient visits per doctor ranged from 33.7 to 43.1, from 21.5 to 30.7, from 25.2 to 33.4 and from 25.2 to 33.4 respectively.②The number of first-line emergent doctor in authorized size of a hospital= the average daily emergent outpatient visits÷the standard average daily visits per doctor÷0.65÷the elastic coefficient of average daily visits per doctor in emergent departments. The standard average daily visits per doctor were the same as the above. The elastic coefficients of average daily visits per doctor in emergent departments were 0.330,0.299, and 0.338.③The number of second-line emergent doctor in authorized size of a hospital= the number of first-line emergent doctor X the percentage of the number of second-line emergent doctor and the number of first-line emergent doctor.For the general hospital at the third level and the general hospital with more than 400 hundred beds at the second level, the percentage of the number of second-line emergent doctor and the number of first-line emergent doctor were 0.607 and 0.463.④The number of health examination doctor in authorized size of a hospital= the number of people with health examination÷26.40÷0.65⑤The numbers of inpatient beds in subdivision per doctor in three types of general hospitals ranged from 9.5 to 10.4, from 9.5 to 11.4, and from 10.3 to 10.8 respectively.⑥The number of second-line doctor in authorized size of a hospital= the number of doctors in charge of inpatient beds X the standard percentage of the number of second-line doctor and the number of doctors in charge of inpatient beds. The standard percentage of the number of second-line doctor and the number of doctors in charge of inpatient beds ranged from 0.533 to 0.682, from 0.394 to 0.613, and from 0.392 to 0.534 for three types of general hospitals.⑦The number of outpatient doctor in authorized size= the number of day-shift doctor in authorized size+ the number of first-line emergent doctor in authorized size+ the number of second-line emergent doctor in authorized size+ the number of doctors in charge of inpatient beds in authorized size+ the number of health examination doctor in authorized size.The number of doctors in authorized size of a general hospital= the number of clinical doctor in authorized size÷0.90.⑧The number of inpatient nurse in authorized size of a general hospital= the inpatient beds×the standard percentage of inpatient beds and inpatient nurse×real bed utilization rate÷93%. The standard percentage of inpatient beds and inpatient nurse ranged from 0.488 to 0.711, from 0.354 to 0.443, and from 0.369 to 0.506 for three types of hospitals.The number of outpatient nurse in authorized size of a general hospital= the number of inpatient nurse in authorized size×the percentage of the number of outpatient nurse and the number of inpatient nurse. The percentage of the number of outpatient nurse and the number of inpatient nurse were 0.395,0.487 and 0.34 respectively for the three types of hospitals.⑨The number of other types of health technicians in authorized size of a general hospital= the number of clinical doctors×the percentage of the number of other types of health technicians and the number of clinical doctors.For three types of general hospitals, the standard percentages of the number of pharmacists and the number of clinical doctors ranged from 0.120 to 0.152,from 0.157 to 0.185 and from 0.142 to 0.193 respectively; this percentage for medical test ranged from 0.085to 0.110, from 0.146to 0.191, and from 0.082 to 0.106 respectively; this percentage for the other medical technologies ranged from 0.101 to 0.180, from 0.118 to 0.194 and from 0.130 to 0.267; and this percentage for other technicians ranged from 0.058 to 0.100, from 0.053 to 0.119, and from 0.070 to 0.1658.Conclusions1,The allocation standards of health personnel and health technicians in Shenzhen are significantly different from the past and other areas, so we need to set a series of standards consistent with its practical situation.2,There were many outpatient and emergent visits and the number of people with health examination in the hospitals of Shenzhen, but the visits per 100 outpatient health staff was far lower than that of the national standards; The number of inpatient per doctor/per nurse of the hospitals in Shenzhen was rational, and there was a difference among the different types of hospitals.3.The work efficiency for the types of hospitals in Shenzhen was different. Relatively speaking, it was highest in the general hospitals at the third level.4. The percentages of different types of health personnel in different types of hospitals in Shenzhen were different significantly from one another.5. The work efficiency of hospitals was very high in the Shenzhen, which ranked the 10th in the country. Thus, there is a need to adjust to the health staff allocation by the work coefficient.Recommendations1. There is a need to increase the allocation of outpatient doctors and medical technicians, and to control the allocation growth rates of nurses and pharmacists. There is a need to seek common ground for the different types of hospitals.2. The allocation of medical staff should be calculated by workload, and by the types of doctors, such as the Doctors should be divided into dayshift outpatient doctors, emergency outpatient doctors, emergency outpatient second-line doctors, health examination doctor, the doctor in charge of bed, the second-line inpatient doctors; and Nurses also should be divided into outpatient nurse and inpatient nurse. Besides, the real occupation of the inpatient bed-days should also be considered so as to obtain a scientific, reasonable, reliable and feasible result.3. There were too much vacant positions for the authorized size in Shenzhen hospitals, thus the number of health technicians was suggested to be calculated by workload, and gradually make up the vacancies, and then the number of health technicians could be changed to be calculated by the inpatient beds from the minimum value to the maximum value.4. The priorities for the staff in the authorized size follow this order:high-quality, experienced clinical doctors, staff of radiology and ultrasound, and lab test, other medical technicians and administrative staff. Nurses and pharmacists are also important under the consideration of the substitute and the "separation of medical treatment and drug". It is feasible to allocate the health staff in key posts in medical care and medical technology, and so do to other technical staff. Besides, many non-permanent posts which are approved already can be allocated, such as legal appraisal, etc.5. The social organizations can hold the hospitals. The outsourcing can be gradually changed into the "professional outsourcing", and even some dispensaries and test labs can be "professional outsourcing", and the diagnosis and treatment was the main service for the hospitals.6 Most of the rear service staff in the Shenzhen hospitals has been outsourced, and can subsidize per capitation in reference to the rates.The innovations of the study1. The innovation in method. The opinions of medical experts and the experts in health management and human resources departments and the clinical practice was taken full consideration, and the relevant parameters were obtained from the multiple angles, and then they were processed scientifically. In the study, the outpatient doctors were divided into the day-shift doctor and night-shift doctor to calculate the relevant values; besides this, the medical service efficiency in other regions in the country was also taken into the consideration, thus, the result was reliable and rational. The author has not found the similar method of the study yet.2. The innovation in concept. The concepts of elastic coefficients of average daily visits per doctor in emergent departments and efficiency coefficient were first put forward.The limitations1. Due to the limitation of time and funding, the study analyses the allocation of medical technicians only in the overall perspective without studying the allocation of the health staff in the various sections.In the future, the allocation of medical technicians in various medical auxiliary sections can be defined from the aspects of equipment and workload.2. The study on the allocation of human resources was done only from the work practices and subjective feelings of experts, and there was lack of more detailed and depth research. In the future, the most reasonable and scientific processes and time used by doctors/nurses for a certain types of patients could be set from the aspect of the Industrial Engineering so that the more precise parameter values could be obtained.
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