The Research Of Index System Of Performance Assessment For Clinical Departments In A General Hospital

BackgroundWith China's accession to the WTO and the implementation of medical system reform, the external environment of hospital has changed greatly. In the last century, although the hospital got splendid performance in improving the health of the population, the development of the hospital is facing a new crisis, and facing the large challenge of management and strategy in recent years due to macro-economic environment and a wide range of reforms. For example, formation of the controlled medical system with three parts, including the supply, the demand and the control, competition between of the for-profit and the not-for-profit hospital, makes the medical market hot competition. Public hospitals loss their advantages for controlling the medical market, and are forced to accept the "personal doctor, a third party to pay" compensation system from government. As a result, it is a strategic revolution for public hospitals to adopt the assessment and management system which is sticking to the essential character of medical services.Performance assessment in public hospitals has been promoted gradually from the stage of experiment to implementation, and from the primary to extensive application. Performance assessment system, sticking to the service character of public hospitals, has been gradually formatted in the health system. However, in the hospital inside, how to establish an effective and scientific performance assessment system is needed to be in-depth studied by management departments. Performance assessment system is a scientific method of quantitative management for development and construction. It means to make the development plan converted to be quantitative indexes to be operational and measurable, and to be delivered to the staff. By this unique way, the performance assessment can identify problems and seek to improve and change. As a result, it has become an inevitable trend of scientific management for the hospital to further strengthen the research of performance assessment, and to develop the scientific and practical performance assessment index system. The purpose of this study is to explore new ideas and methods for performance assessment system of clinical departments by the construction of performance assessment index system for clinical departments in a general hospital.GoalsFirstly, to collect current performance assessment indexes for clinical departments in a general hospital, and to find the existing problems, and analyzes the underlying reasons of the problem;Secondly, to develop exclusive performance assessment index system for this general hospital, and to propose reasonable suggestions to relevant management departments.MethodsLiterature research and comparative research methods. By literature retrieval, to collect domestic and international successful performance assessment experiences and practices, to find performance assessment index system, framework and assessment methods of hospitals in developed and developing countries, and to understand the difference between the domestic and international hospitals. It is helpful to provide references for constructing exclusive performance assessment index system for Chinese hospitals.Qualitative and quantitative research. Through current management departments of performance assessment, to collect indexes currently used in performance assessment and the assessment results. Through holding a workshop of clinical departments' directors, and visiting hospital management experts, to have a good understanding of current performance assessment index system, and interviewees' views, expectations as well as value orientations on performance assessment.The Delphi method (Delphi Technique): Forty two clinical and medical technology departments' directors and one of vice directors in a "grade A tertiary care" general hospital were chosen as subjects. Eighty questionnaires were distributed to survey the current situation. Through questionnaires, the research team had the understanding of assessment index and choice of index system in different clinical departments, which is helpful for providing basic data for constituting department's performance assessment index system. Totally 30 experts from them were selected to conduct three-round of consultation. The first round of the Delphi is the choice of performance indexes. The second round is to determine the proposition (weight) of indexes. And the third round is to re-confirm the proposition (weight) of indexes.Main resultsThe study employed qualitative and quantitative research and Delphi methods, and it followed the principles of science, orientation, and feasibility. The research focuses on development requirements of state-owned tertiary general hospitals, with the theory of AHP, and constitutes performance assessment index system of clinical departments with indexes of medical service status, social economic status, and medical education and scientific research status.The first-class indexes for clinical departments were identified as indexes of medical service status, social economic status, and medical education and scientific research status. There were originally 51 second-class indexes, after the expert review, 4 second-class indexes were deleted, including average numbers of teaching trainee-doctors (more than six months) , numbers of participating the international academic communications, times of organizing international and national academic meetings , Per capita (above provincial and ministerial level) scientific research prize . Therefore, totally 47 second-class indexes have been selected, and their propositions have been determined.After conducting consultation widely with health services management experts, as well as medical and health experts in health administrative departments and health institution, the interviewees provided recommendations and suggestions for determining the selection of assessment indexes and their respective weights. On the basis of this, the assessment index system exclusive for the actual situation of the hospital was proposed. The reasonable recommendations to relevant functional departments also were put forward.Discussion and recommendationsIn the constitution of new performance assessment index system, experts highly agreed the index of medical service status, and also give the appropriate attention to the index of social economic status, at last, their recognition include the index of medical education and scientific research.In the implementation of the new performance management program, we should first make a complete performance plan, followed by the performance implementation and management, including performance management training, and performance-related data collection and arrangement, performance counseling, performance assessment, performance feedback and applications of performance assessment results. There are three advantages needed in the process of performance assessment. And the assessment should adapt to socialism market economy system, and be connected with the performance assessment framework of health system such as MOH's "assessment- guideline of hospital management", which is conducive to the development of health reform, conducive to the people's diversification and multi-level needs of health services, and conducive to mobilize internal motivation, initiative and creativity. Explore to use the Balanced Score Card for performance assessment.The recommendation is to set up supervising and management department for performance assessment, to ensure the consistency and timely availability of the index data. Through supervising assessment index regularly and analysis index data, to help the departments to find gaps as soon as possible for improvement. Coordination and management of performance work in all aspects will be the real work of implementing performance management in a hospital.