| BackgroundIn recent years, as healthcare reform in Shanghai has been constantly pushed forward, development of community health services has become an important part of the healthcare reform. Staffing and allocation of human resources have played a crucial role in the development process of community health service institutions. In October 2008, Shanghai Commission Office for Public Sector Reform, Shanghai Municipal Health Bureau, Shanghai Municipal Finance Bureau, and Shanghai Municipal Bureau of Civil Affairs jointly printed and issued Opinions on Implementation of Establishment and Staffing of Community Health Service Institutions in Shanghai(the Opinions). As the comprehensive reform of community health services in Shanghai has been advancing continuously, "six in one" function has been further defined and the mechanisms of "separation between revenue and expenditure; prospective payment system for medical insurance" have come into effect. Besides, "three-stop" service (community health service center-service station-family) has formed gradually. However, more often than not, staffing and personnel allocation of community health service institutions fail to follow the Opinions. Meanwhile, as the public service functions of community health service institutions are continuously expanded, quantity and number of service items keep increasing and shortage of community health service institutions becomes prominent.How is the implementation of the Opinions going? What is the influence of policy implementation on human resources? Do policies and standards conform to work requirement of existingcommunity health service centers? Those questions are the key questions for development of community health service institutions.ObjectivesBased on the orientations of the functions of the community-based health service agencies and the meaning of the "Mechanism of Services by Family Doctors", through the survey and analysis of the current situation of the implementation of staffing system of the community-based health service agencies in Shanghai and the actual number of employed workforce in this sector as well as taking into consideration of the actual operation of the community-based health service agencies and the demands for human resources, suggestions are herein proposed for the staffing system which is suitable for the sustainable development of community-based health service agencies.ApproachThe topic applies such methods as literature research, questionnaire survey, expert consultation and case analysis, investigates and surveys implementation status of staffing of community health service institutions in Shanghai in a thorough and meticulous way.1. Literature study:literature indexes should mainly cover literature under the titles or with the key words including "community", "staffing and healthcare", "human resources" and "staffing standard".2. SurveyThrough conducting surveys on the directors of the human resources departments of 17 county-level community-based health service agencies in Shanghai, relevant data on the staffing of those agencies are collected for the analysis of their current situation of human resources.A principle of geographical layering will be followed in conducting the survey: the remote suburbs, nearby suburbs, downtown areas and Pudong New District are selected; in this regards, on a random basis, Qingpu District is selected for the category of remote suburbs, Minhang District for nearby suburbs, Zhabei, Changning and Xuhui districts for downtowns of different economic development levels.Human resource directors of 17 county-level community-based health service agencies, directors, human resource officials and 280 medical workers of 14 sampled community service centers participated in this survey.3. Expert consultingA total of 15 experts in community health service and human resources in medical and healthcare are consulted by means of seminars and interviews. Various survey questionnaires are formulated to collect data in the key rings in the process of formulation and implementation of the staffing policy of community-based health service agencies. The experts are also consulted in terms of the staffing requirements of those agencies which have been defined through the study.4. Case studyResearch was done into 9 community-based health service agencies in Zhabei District as typical case studies. The participants of the questionnaire survey are the directors, human resource personnel and medical workers of these 9 agencies.ResultsWith highlight on the current situation of the human resources of the community-based health service agencies in Shanghai, survey and analysis was conducted on the age, title, professionals and turnover rate of the formal and informal staff. As of December 31,2011, there were 2,2513 formal employees in the community-based health service agencies in the 17 districts and counties; among them, 13 of these 17 districts and counties are found that their formal employees accounted for less than 80% of their total staff; the informal employees in Minhang, Songjiang, Yangpu, Jiading, Changning, Xuhui and Jinshan districts even represented more than 30% of the total medical workers.And focuses on implementation situation of staffing verification of existing sample community health service institutions in districts and counties, gap between allocated personnel and document requirements, age, title and major of permanent staff and extra-organizational personnel, as well as other problems. Formal medical workers in the 14 sampled communities totaled at 2,327. As a whole,6 communities in 4 districts and counties have formal medical workers at a rate far lower than required. There were even some communities facing a lack of more than 300 positions of formal medical workers.In the case of Zhabei District, a survey on all community health service institutions in the district was conducted to further analyze various problems brought by shortage of staff. Generally speaking,9 communities in Zhabei Districts conform to the requirements in terms of the verified staffing number despite an uneven internal distribution.4 communities, namely Community 3, Community 4, Community 6 and Community 7 were found 184 formal workers short compared with the minimum requirement and 375 short compared with highest standards.A conclusion was made on the implementation of the document "Suggestions on Implementation" (or the "Suggestions" for short), which shows that less than 50% of the districts and counties in Shanghai have fully met the requirements of the "Suggestions".15 of the 17 communities (88.23%) are verified as not being able to meet the demands from their own communities.Conclusion and SuggestionsOnly 7 out of the total of 17 districts and communities in Shanghai (41.18%) are found that they have re-verified their staffing system completely according to the "Suggestions"; some communities in 5 districts and counties (29.41%) partially carried out re-verification; another 5 districts and communities (29.41%) did not re-verified at all. The existing problems in the implementation of the "Suggestions" in Shanghai are mainly as below:1. A definite requirement is not in place for the verification of staffing numbers based on the population of permanent residents;2. Standards are lack in defining the number of hospital beds and the corresponding staffing number required;3. The demands on staffing number from policies on the services by family doctors are not taken into consideration;4. The requirements on the staffing of other medical professionals, auxiliary technicians and management are too general.Suggestions:1. Remedial suggestions on staffing and resource allocation standards according to the "Suggestions":1). Verifying the staffing in communities based on the population of permanent residents.2). Formulating standards for medical workers for patient rooms;3). Establishing standards by referring to the policies of services by family doctors;4). Imposing more detailed requirements on the staffing of other medical professionals, auxiliary technicians and management;2. Enhance the enforcement of the policy to establish regular management on staffing system;3. Offering incentives through policies to help the communities to attract and retain talents;4. Coordinating all parties concerned to standardize the management of informal staff. |
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