| Background: The CPC Central Committee and the State Council had introducedSuggestion to Deepen the Medical and Health System Reform, which requires tofurther promote the public hospital management system, improve the functions andresponsibilities of the hospital and improve the operating efficiency of health care. Ithad proposed higher requirements on hospital resource allocation and use, quality,safety and patients’ satisfaction.As an important part of China’s medical and healthservice, hospitals plays an important role on meeting the people’s demand for healthservices.But because of the influence of unreasonable resources allocation andinternal management level, there are the phenomenon of co-existence of insufficientinputs and low efficiency, which affect the quality and equity in different sense.As animportant part of hospital, the performance of nursing has an important influence onthe overall performance of hospital."Chinese Nursing Career Development Plan(2011-2015)" had proposed that hospitals should allocate nurses rationally, establishand improve nursing performance system, form an effective incentive and restraintmechanism to achieve scientific, professional and fine nursing management of publichospitals. It has been a big problem hospital administrators concerning and dealingwith how to evaluate nursing performance scientifically and reasonably to realize theefficient allocation and rational utilization of resources, improve internal hospitalmanagement mechanism, and improve service quality, efficiency and patients’satisfaction.Purpose: Based on production theory, system theory and equity theoryestablished the nursing performance evaluation index system of Tertiary A-levelcomprehensive hospitals. Use the DEA method to evaluate the16hospital nursingperformance of Tertiary A-level comprehensive hospitals in Jilin Province andanalyze the difference of the efficiency, find the DEA ineffective hospitals and thereason of inefficiency,analyze the impact factors which affected the nursing performance of Tertiary A-level comprehensive hospitals, and reveal the root cause ofinefficiency referring to the qualitative research methods.After the analysis of theempirical results, proposed the countermeasures to enhance the nursing performanceof Tertiary A-level comprehensive hospitals,which had provided an objective basisfor the government and health authorities to formulate relevant policies.Method: Based on the production theory, using the document review and theDelphi method, through the consultation to specialists to establish Tertiary A-levelcomprehensive hospitals nursing performance evaluation index system; Through theCCR model and the BCC model of DEA method, to evaluate the nursing technicalefficiency, pure technical efficiency and scale efficiency of16Tertiary A-levelcomprehensive hospitals in Jilin Province, compare and analyze the input resourcesand output results and efficiency standard; Use multiple linear regression analysis toanalyze the effect of input and output indexes on hospital nursingperformance.Through qualitative interviews, randomly select10Presidents ofHospital in charge of nursing and (Deputy) Directors of Nursing Department asinterviewees, to carry out semi-structured interviews around the implementation ofhospital nursing performance.According to DEA empirical findings and the researchresult of effecting factors of nursing performance evaluation in Tertiary A-levelcomprehensive hospitals, look for countermeasures.Result: Through two round Delphi consulting, Tertiary A-level comprehensivehospitals nursing performance evaluation index system was established, whichconsists of input and output dimensions. The input dimension includes3first-levelindexes on manpower input, material input and finance input and8secondary-levelindexes. The output dimension includes3first-level indexes on nursing service output,nursing research output and talents output and8secondary-level indexes. ThroughDEA method to evaluate the nursing technical efficiency, pure technical efficiencyand scale efficiency. In2years, there is no hospital DEA efficient in technicalefficiency. There are3hospitals and2hospitals DEA efficient in pure technicalefficiency, respectively. There are4hospitals and3hospitals DEA efficient in scaleefficiency, respectively.Through quantitative research, found that "the ratio of thetotal number of registered nurses to the actual number of the open beds","the ratio ofthe total value of fixed assets to the actual number of the open beds", and "the yearlyincidences of nursing defect on hospitalized patients" are the main affecting factors of technical efficiency and pure technical efficiency. The main affecting factors of scaleefficiency of Tertiary A-level comprehensive hospitals is" the hospitalized patients’satisfaction for nursing work".Through quantitative research, we found that thecountry began to focus on and promote the evaluation of hospitals nursingperformance. But there was no systematic evaluation system and standardizedevaluation criteria of hospitals nursing performance. Currently, some hospitals beganto try, but hospital administrators were lack of understanding of the theoretical andsystematic knowledge, therefore the evaluation criteria was not standardized.Meanwhile, the rigid internal management lack of incentive, traditional thinking ofhospital medical staff and the sufficient capability of nurses have become the mainfactors to shackle the hospitals nursing performance evaluation.Conclusion:1. The study was based on production theory, through literature review and theDelphi method to establish the hospital nursing performance evaluation index system,which consisted of input and output dimensions.Through DEA empirical research,verified the operability and usability of this index system.2. Through DEA method, evaluated the nursing performance of16TertiaryA-level comprehensive hospitals in Jilin Province in2011and2012. This researchshowed an upward trend on56.25%hospitals’ nursing technical efficiency, puretechnical efficiency and scale efficiency, a downward trend on43.75%hospitals’nursing performance.Although manpower input, material input and finance input werein a steady upward trend,they are not fully utilized under best scale and technicallevel, which lead to output results unbalanced. There was still a large improvementroom for16hospitals’ nursing performance.Hospitals should reasonably control thescale and allocation of resources, make the best combination of manpower,materialand finance resources, meanwhile strengthen internal management and connotationconstruction, and improve the overall nursing performance.3. Through multiple linear regression analysis, the nursing performance level oftertiary A-class comprehensives hospitals can be improved by increasing the quantityof nurses according to its scale, adjusting or controlling the expanding of hospitalsand investment proportion, effectively preventing the defect incidents of hospitalizedpatients, pay attention to the experience of hospitalizing, enhancing the satisfaction ofhospitalized patients.Qualitative research shows that it is beneficial for the development of a Tertiary A-level comprehensive hospital by improving nationaltop-level design capabilities, enhancing the attention and support of hospitals andnurses’ ability.4. Proposed countermeasures to enhance the Tertiary A-level comprehensivehospitals’ nursing performance:①reasonable invest and increase resource utilization;②improve efficiency and achieve maximum output;③strengthen external policyguidance to promote nursing reform;④change concepts to improve internalmanagement mechanism. |
PDF Full Text Request