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基于诊疗效率评价体系的医疗过程创新研究

A Research of Process Innovation Based on the Clinical Treatment Efficiency Evaluation System

【作者】 张罗

【导师】 齐二石;

【作者基本信息】 天津大学 , 管理科学与工程, 2012, 博士

【摘要】 本文理论上基于目前管理学界三个方面的研究成果:一是知识密集型服务业及其创新过程的研究,综述了其定义、界定方法、运行特点和分类,并深入研究了其创新过程的六代模型,认识到创新的启动点逐渐由企业自身向市场反应转移,逐渐由企业自身能力向内外部客户需求转移;二是客户感知价值的研究,综述了客户感知价值的概念发展、国内外关于其驱动因素的研究,总结了目前所知研究缺陷,明确了研究要立足顾客角度、选择竞争性指标、开展过程研究;三是知识管理研究,系统阐述了知识循环过程,认为该理论在知识密集型服务业的激励机制设计方面具有很强的指导作用,并根据其管理效益不易测算这一缺陷,提出以知识存量、工作产出、内外客户满意度等指标进行弥补。本文首先对医疗机构进行了特征研究,认为其符合知识密集型服务业的特点,之后对医疗机构的运行特点以及社会经济技术发展和医疗体制改革对其影响做了概述,并通过中美对比研究,提出提升医师满意度、提高有效医疗普及率、提高患者满意度是解决当前医改矛盾的有效手段。在研究中,提出以医师满意度、患者感知价值、临床工作量为一级指标,以沟通满意度等14个指标为二级指标建立诊疗过程评价体系,之后在此框架之内以过敏性鼻炎诊疗过程创新为例进行研究。研究采用多元回归分析和模糊多层次分析方法,得到患者感知多元回归价值模型和医师满意度多元回归模型,并调研出实施过程创新的启动点和关键点,在过敏性疾病免疫特异治疗中心进行过程创新,采用模糊多层次分析法计算诊疗流程创新前后诊疗效率,发现计算结果与问卷和访谈结果完全一致,证明流程创新成功。研究发现掌握核心知识员工(称为“关键员工”)是影响客户感知价值最关键的因素;还发现建立良好的科教环境,推动知识循环对提高其满意度具有较大影响力。虽然研究集中在个别科室,但是由于研究比较深入,而且在规模上和创新方式上具有一定代表性,所以可以反映出医院以及知识密集型服务机构的一般运行规律,具有一定的推广价值。

【Abstract】 The study was based on three theories of management science achievements. The first is the knowledge of intensive service industry and its innovation process research. We reviewed the definition, the study methods, its characteristics and classification. After focusing on the innovation of the six generation models, we realized that the innovation started from enterprise itself to market response shift depending on the ability of the company to customer demand transfer. The second is the customer perceived value research. We reviewed the development of the concept of customer perceived value on the study of the driving factors. After summarizing the current knowledge on defects, we defined the current research should be based on the customer perspective. And we selected the competitive index. The third is the knowledge of management research. The system elaborated knowledge circulation process. And the theory in the knowledge intensive service industry incentive mechanism design has a strong guiding role. According to its management efficiency, we found that it was not easy to calculate this defect, the work output, as well as the internal and external customer satisfaction index.This paper firstly analized the features of medical institutions, which matched the knowledge intensive service industry characteristics. Then we reformed the medical system on the effects outlined. During the comparative study, we put forward to promote physician satisfaction, improve the effective medical coverage and the patients’satisfaction. In order to put forward to physicians, patients perceived value satisfaction, as well as the clinical workload for level indicators, we divied the communication satisfaction and other 14 indicators into two grade index to establish evaluation system after treatment. The framework in allergic rhinitis treatment process was innovated.For statistical analysis, we used multiple regression analysis and the fuzzy multiple hierarchy analysis method, after we set up patient perceived value model of multivariate regression and physician satisfaction in multivariate regression models. The fuzzy multiple hierarchy analysis method was used to calculate the treatment process of innovation before and after treatment efficiency by using questionnaire and interview. The outcomes were completely consistent. The study found that the mastery of core knowledge workers (known as the" key personnel") is the impact of customer perceived value of the most critical factors. We also proofed that the establish a good education environment could promote the knowledge cycle and further improve the degree of satisfaction with great influence.Although the study focused on the individual sections, but the more in-depth study, as the scale and innovation has certain representative. It can influence the operations of the hospitals as well as the knowledge intensive services.

  • 【网络出版投稿人】 天津大学
  • 【网络出版年期】2012年 08期
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