Study On Building Status And Development Strategy Of General Services Team In Community Health Services

ObjectiveChina’s new round of medical-sanitary reform has been launched following theannouncement of the State Council opinions on deepening the reform of themedical-sanitary in2009. The opinions highlight the welfare and reform of publichealth in order to assure the fairness and accessibility and to solve the problem of highcost and difficulty in medical treatment. Lately, Guiding opinions on theestablishment of general practitioners system(GPS) in the year of2011has clearlypointed to encourage the formation of general practitioner team consist of generalpractitioners, community nurses, public health physician or rural doctors etc, anddivide area to provide services for residents.As one of the experimental area, the development of community health service inGuangdong province has presented diversified. The model community health serviceagencies in Guangzhou, Shenzhen took the lead in practicing the construction andmanagement of general practitioner team. But so far, there is a lack of systematicresearch on team service mode. This research is commissioned by GuangdongProvincial Health Office to study the building status of General Services team of fourcities of Guangdong Provincial. Purpose:1. To understand the status of existing general service team building; 2. Through the investigation on the status of Guangdong Province generalservice team operation, we studied and analyzed the deficiency existed in generalservice group operation, and put forward the general service team developmentsuggestions.Methods1. Analysis of general service team theoryBy studying literature and related information to introduce the theory of generalservices team and understand the status of general services team at home.2. Site investigation(1) Investigation objects:13community health service center general service teams were randomlyselected from Guangzhou, Shenzhen, Foshan and Zhaoqing. Furthermore, we tookcommunity health service center as investigation scenes, carried out a questionnairesurvey with community residents who visited the community health serviceinstitutions,100residents each community health service centers.(2) Investigation methods:Self-administered and anonymous questionnaire investigation were carried outwith selected general service team members by cluster sampling and self-designedGuangdong Province community general service team members questionnaire.Questionnaire surveys were carried out a questionnaire survey with communityresidents who visited the community health service institutions by cluster samplingand self-designed Guangdong Province community residents questionnaire(3) Investigation contentInvestigation content of general service team members: general condition;cognition and job satisfaction of team members to general service team modeInvestigation content of community residents: gender, age, culture degree, occupation and other demographic characteristics; awareness of community residents to generalservice team; demands of community residents for health service.etc.3. Interviews with key personnelTeam captains or key members who are familiar with general team service,management and operation were selected as interview subjects, and to understandthe problems and main suggestions existed in the operation of general service team inGuangdong Province.4. Panel discussion groupPanel discussion group modified and perfected the questionnaire based on resultsfrom pre-surveys, and put forward general service team development suggestionsbased on the results from investigation of Guangdong Province general service teammembers and community residents.5. Expert consulting meetingConvene the seminar of Guangdong Province community general service teamstandardized construction and management mode research.The invited experts camefrom Guangzhou, Shenzhen, Foshan, Dongguan, and Zhongshan.They are directors,deputy directors or people in charge of departments. The main people ofadministrative institutions were also invited. A total of58experts attended, and thedevelopment suggestions of Guangdong Province community general service teamwere discussed.Results45general service teams are designed in this investigation, a total of295members; each team has a average of6.56members.Among the objects under investigation,197(66.8%) members support to carryout general service model.185(62.7%) members,193(65.4%) members,181(61.4%)members,173(58.6%) members and181(61.4%) members believe that carrying out general service model help to “develop community health service institutions”,“improve the enthusiasm of members”,“improve their own quality”,“improveefficiency” and “promote the trust of community residents”,90.7%of the team members think captain should have” the ability to inspiremembers”; Respectively,89.5%,88.7%and86.3%of team members think captainshould have “professional technical ability”,“business management ability” and“interpersonal communication ability”.Investigation on job satisfaction indicates that43.1%of members feel in generalon the daily work,23.0%of members are unsatisfied, meanwhile,70.5%of membershave no sense of belonging to the work, and reasons are as follow:” bad insurance andwelfare” and “no establishment”. Only17.3%of the members are satisfied withperformance appraisal.In the team staffing,104(35.3%) members think it should be made up of8-10persons;96(32.5%) members think it should consist of6-7persons.96.0%of teammembers consider the need for GPs;85.3%of team members feel it needs communitynurses; and81.3%of team members think the need for public health physicians.Qualitative survey find that team members identify with the effect before andafter the formation of general service team, and hope team constructions take methodscombining competition-appointment and two-way selection.General services team standardized construction model is determined by holding“Guangdong Provincial General Services team standardized construction andmanagement mode research” argumentation conference: by serving for10,000population each team, the team should has2-3GPs,2-3community nurses,0.5-1public health physician(0.5means two teams have one public health physician) and1-2other professional and technical personnel(i.e. decimeter, rehabilitators etc).Teamcaptains should be appointed by open competition and team members should beappointed by two-way selection method.The qualitative results show that, the problems currently exist in general serviceteam are:①the lack of human resources;②Inadequate compensation;③the basic quality of the team members should be improved;④performance appraisal systemneeds to be improved;⑤Normalization level is not high;⑥the lack ofunderstanding and support of residents;⑦the lack of relevant laws and regulations.This study investigated1258community residents, only300(23.8%) heard ofgeneral service team, the main pathway was “Community outreach” and “network ormedia”. Investigation on the health service demand of residents revealed that residentshad a urgent demand for medical services, health education services and door-to-doorservices of general service team.ConclusionsThe general team service has an important role in promoting innovation in communityhealth service operation mode. Currently, the development of Guangdong Provincegeneral team service is restricted by many factors such as government investment,personnel construction and operation management system construction. We shouldfurther strengthen the government support of community health service for fundinvestment, personnel training, institutional innovation and other aspects, in order topromote the general service team comprehensive, scientific, healthy and sustainabledevelopment.