【作者】 张铁山；

【导师】 许树强；

【作者基本信息】 吉林大学 ， 社会医学与卫生事业管理， 2013， 博士

【摘要】 “岗位”是医院管理的最基本单元和要素。岗位管理是医院管理创新和医院发展战略的基础和落脚点。自2000年以来，我国医院从理论和实践方面积极探索推行岗位管理，但无论是理论研究还是实践操作，从整体看进展缓慢。在医院岗位管理中，近年来不同学者利用国外成熟的技术、借鉴国外的岗位评价模型，改建和自建了了不同的岗位评价模型，为医院岗位评价提供了很好的工具。但是岗位评价模型只是经过了内部效度的系列验证，还缺少从应用角度进行评估、也缺少模型间的应用效果评估，岗位评价模型停留在理论研究的层面，难以进入实践应用。研究内容：本研究利用要素计点法，构建了23要素通用型综合医院岗位评价模型，以此为基础，通过大样本、多中心的问卷调查，对岗位评价要素的人口统计学差异进行了细致的描述和差异性的统计学检验，基于调查问卷获得的数据，利用因子分析方法继续构建了综合医院医师岗位评价模型、护理岗位评价模型、医辅岗位评价模型、管理岗位评价模型四个不同岗位族的评价模型，通过对医院评价模型进行“解构”，深入评估评价模型的内部公平性和有效性。四个模型充分体现了综合医院不同岗位族的特性，很好的做到了岗位评价的内部公平性原则，对于岗位评价工作的推广，以及基于岗位评价的绩效考核与薪酬管理提供了基础。研究结果：利用混合模型、通用模型对36个标杆岗位，和一个信息管理部门11个岗位进行了岗位评价及绩效考核与薪酬管理的探索性应用。比较发现，混合模型、通用模型以及我国学者研究的两个岗位评价模型（地坛医院模型和南方医科大学模型）在岗位相对价值区分上具有很好的一致性。由此说明，通用型岗位模型能够体现我国医院岗位评价的特点，混合岗位评价模型既能够有效的区分医院岗位的相对价值，同时能够体现不同岗位族的内在特性，很好的兼顾了岗位评价的有效性和内部公平性原则，具有代表性、适用性和适用性，具有推广使用价值。具体岗位评价模型如下：1、综合医院通用岗位评价模型：5个维度，23个要素。维度1岗位责任（0.364）：患者服务职责（0.084，8级）、质量安全职责（0.070，6级）、管理决策与实施职责（0.060，5级）、财务与资产管理职责（0.047，6级）、人员管理职责（0.040，6级）、信息资源管理职责（0.034，6级）、科学研究职责（0.030，6级）；维度2能力要求（0.285）：沟通与人际关系能力（0.065，5级）、操作能力（0.061，5级）、分析与判断能力（0.057，4级）、应对突发事件能力（0.030，5级）、创新能力（0.041，5级）、计划与组织能力（0.029，5级）；维度3知识技能（0.146）：专业技术知识（0.076，8级）、经验（0.040，7级）、培训（0.032，5级）；维度4强度与环境（0.117）：体力强度（0.026，5级）、脑力强度（0.034，5级）、心理与精神强度（0.031，4级）、工作环境（0.026，5级）；维度5工作特性（0.088）：工作自主性（0.034，6级）、工作关联系（0.031，5级）、工作时间特性（0.022，5级）。2、综合医院医师岗位评价模型：3个维度，22个要素。维度1临床服务（0.720）：分析与判断能力（0.062，4级）、应对突发事件能力（0.065，5级）、操作能力（0.061，5级）、经验（0.058，7级）、沟通与人际关系能力（0.062，5级）、培训（0.068，5级）、患者服务职责（0.074，8级）、计划与组织能力（0.073，5级）、专业技术知识（0.050，8级）、创新能力（0.079，5级）、质量安全职责（0.068，6级）；维度2管理研究（0.145）：科学研究职责（0.032，6级）、管理决策与实施职责（0.030，5级）、财务与资产管理职责（0.029，6级）、人员管理职责（0.027，6级）、信息资源管理职责（0.027，6级）；维度3工作特性（0.135）：体力强度（0.022，5级）、脑力强度（0.021，5级）、心理与精神强度（0.024，4级）、工作环境（0.021，5级）；工作自主性（0.023，6级）、工作时间特性（0.024，5级）。3、综合医院护理岗位评价模型：3个维度，23个要素。维度1临床服务（0.748）：经验（0.065，7级）、培训（0.070，5级）、应对突发事件能力（0.062，5级）、分析与判断能力（0.070，4级）、计划与组织能力（0.071，5级）、专业技术知识（0.059，8级）、操作能力（0.064，5级）、沟通与人际关系能力（0.062，5级）、患者服务职责（0.068，8级）、创新能力（0.082，5级）、质量安全职责（0.075，6级）；维度2工作特性（0.143）：脑力强度（0.019，5级）、体力强度（0.022，5级）、心理与精神强度（0.020，4级）、工作环境（0.019，5级）；工作时间特性（0.020，5级）、工作自主性（0.021，6级）、工作关联系（0.022，5级）；维度3管理研究（0.109）：人员管理职责（0.022，6级）、管理决策与实施职责（0.021，5级）、财务与资产管理职责（0.023，6级）、科学研究职责（0.022，6级）、信息资源管理职责（0.021，6级）；4、综合医院医辅岗位评价模型：4个维度，21个要素。维度1工作特性（0.655）：脑力强度（0.100，5级）、体力强度（0.089，5级）、心理与精神强度（0.091，4级）、工作环境（0.095，5级）；工作时间特性（0.094，5级）、工作自主性（0.087，6级）、工作关联系（0.099，5级）；维度2服务患者（0.157）：创新能力（0.030，5级）、计划与组织能力（0.029，5级）、分析与判断能力（0.025，4级）、应对突发事件能力（0.023，5级）、沟通与人际关系能力（0.026，5级）、患者服务职责（0.025，8级）；维度3管理职责（0.118）：管理决策与实施职责（0.029，5级）、人员管理职责（0.029，6级）、财务与资产管理职责（0.031，6级）、信息资源管理职责（0.028，6级）；维度4岗位能力（0.070）：专业技术知识（0.015，8级）、经验（0.017，7级）、操作能力（0.017，5级）、质量安全职责（0.021，6级）；5、综合医院管理岗位评价模型：4个维度、22个要素维度1管理能力（0.716）：分析与判断能力（0.087，4级）、沟通与人际关系能力（0.080，5级）、经验（0.085，7级）、计划与组织能力（0.088，5级）、应对突发事件能力（0.093，5级）、专业技术知识（0.098，8级）、创新能力（0.097，5级）、培训（0.089，5级）；维度2工作特性（0.118）：脑力强度（0.018，5级）、心理与精神强度（0.020，4级）、工作环境（0.020，5级）、体力强度（0.023，5级）、工作自主性（0.018，6级）、工作关联系（0.019，5级）；维度3管理研究（0.089）：人员管理职责（0.019，6级）、财务与资产管理职责（0.018，6级）、管理决策与实施职责（0.018，5级）、信息资源管理职责（0.017，6级）科学研究职责（0.018，6级）；维度4患者服务（0.077）：患者服务职责（0.026，8级）、操作能力（0.025，5级）、质量安全职责（0.026，6级）；研究结论：五个模型分别经过了数理统计学的信度和效度验证，将混合模型软件化后，比较通用模型、混合模型及我国现有的岗位评价模型，不同模型间具有很好的岗位区分度，通过人口统计学评估及分岗位族模型重构的评估，本研究建所选择的岗位评价要素具有适用性，岗位评价模型体系在优化后更具有实用性，多模型间的岗位区分效果具有很好的一致性，研究表明，岗位评价要素、体系建构的技术方案和结果科学可靠，建议在医院岗位管理实践中综合应用、整体规划、分步实施，推动医院人力资源管理精细化水平，调动职工的积极性。更多还原

【Abstract】 "Job" is the most basic unit and the elements of hospital management. Positionmanagement is the foundation and the goal of development strategy innovation ofhospital management and hospital.Since2000, the public hospital in China from the aspects of theory and practiceto actively explore the implementation of post management, but both theoretical studyand practice, overall progress is slow. Management positions in the hospital, in recentyears, different scholars use the foreign mature technology, learn from foreign modelof job evaluation, reconstruction and build the post evaluation of different model,provide a good tool for hospital job evaluation. But the post evaluation model isverified through a series of internal validity, but also the lack of evaluation, from theapplication point of the lack of application of model evaluation, post evaluation modestays in the theoretical level, difficult to enter the practical application.Objects:In this study, using the point factor method, to build a post23elementsof general hospital evaluation model, based on this, through the questionnaire surveyof large sample, multi center, was tested statistically described and differences indetail for the demographic differences post evaluation factor, questionnaire based onthe data obtained, using factor analysis methods to construct the comprehensivehospital doctor job evaluation model, nursing job evaluation model, medical assistantjob evaluation model, management job evaluation model in four different positionsand evaluation model. The four model fully embodies the characteristics of generalhospitals of different post family, do well the principles of internal fairness of jobevaluation, for the promotion of post evaluation, as well as providing a basis for jobevaluation based performance appraisal and salary management.Outcomes：On36benchmark jobs using the general model, hybrid model, andan information management department11post of the exploratory application of jobevaluation and performance appraisal and salary management. In comparison, two ofjob evaluation, the general model and mixed model in our research model (Ditanhospital model and the Southern Medical University model) in position relative valuedistinction with remarkable consistency. Therefore, the general post model can reflectthe characteristic evaluation of hospital posts in China, relative value of post evaluation model of mixed both can effectively distinguish between hospital post, alsocan reflect the inherent characteristics of different job family, good job evaluationvalidity and internal fairness principle, with our hospital representative sex, isrecommended.The following specific job evaluation model:1、General hospital general post evaluation model:5dimensions,23elements.D1Job responsibilities (0.364): the patient services (0.084,8), quality andsafety responsibilities (0.070,6), management decision-making and implementationof duties (0.060,5), financial and asset management (0.047,6), personnelmanagement responsibilities (0.040,6), information resources managementresponsibilities (0.034,6), scientific research duty (0.030,6);D2Requirements:(0.285) the ability of communication and interpersonal skills(0.065,5), operation ability (0.061,5), analysis and judgment ability (0.057,4), theability to deal with unexpected events (0.030,5), innovation ability (0.041,5),planning and organizing (0.029,5);D3Knowledge and skills (0.146): professional knowledge (0.076,8),(0.040,7)experience, training (0.032,5);D4Strength and environment (0.117): physical strength (0.026,5), mentalstrength (0.034,5), psychological and spiritual strength (0.031,4), the workingenvironment (0.026,5);D5Job characteristics (0.088): job autonomy (0.034,6), working relationship(0.031,5), work time (0.022,5).2、The comprehensive evaluation model of physicians in hospitals:3dimensions,22elements.D1Clinical services (0.720): analysis and judgment ability (0.062,4), theability to deal with unexpected events (0.065,5), operation ability (0.061,5),(0.058,7)experience, communication and interpersonal skills (0.062,5), training (0.068,5)patient services,(0.074,8), planning and organizing skills (0.073,5), professional andtechnical knowledge (0.050,8), innovation ability (0.079,5), quality and safetyresponsibilities (0.068,6);D2Management Research (0.145): scientific research duty (0.032,6),management decision-making and implementation of duties (0.030,5), financial and asset management (0.029,6), personnel management responsibilities (0.027,6),information resources management responsibilities (0.027,6);D3Job characteristics (0.135): physical strength (0.022,5), mental strength(0.021,5), psychological and spiritual strength (0.024,4), the working environment(0.021,5); job autonomy (0.023,6), work time (0.024,5).3、Evaluation of nursing post comprehensive hospital model:3dimensions,23elements.D1Clinical services (0.748): experience (0.065,7), training (0.070,5), theability to deal with unexpected events (0.062,5), analysis and judgment ability (0.070,4), planning and organizing skills (0.071,5), professional and technical knowledge(0.059,8), operation ability (0.064,5), communication and interpersonal skills (0.062,5),(0.068,8patients with service level), innovation ability (0.082,5), quality andsafety responsibilities (0.075,6);D2Job characteristics (0.143): mental strength (0.019,5), physical strength(0.022,5), psychological and spiritual strength (0.020,4), the working environment(0.019,5); the working time characteristics (0.020,5), job autonomy (0.021,6), workrelated department (0.022,5);D3Management Research (0.109): personnel management responsibilities(0.022,6), management decision-making and implementation of duties (0.021,5),financial and asset management (0.023,6), scientific research duty (0.022,6),information resources management responsibilities (0.021,6);4、Comprehensive hospital auxiliary post evaluation model:4dimension,21elements.D1Job characteristics (0.655): mental strength (0.100,5), physical strength(0.089,5), psychological and spiritual strength (0.091,4), the working environment(0.095,5); the working time characteristics (0.094,5), job autonomy (0.087,6), workrelated department (0.099,5);D2Service (0.157patients): innovation ability (0.030,5), planning andorganizing skills (0.029,5), analysis and judgment ability (0.025,4), the ability todeal with unexpected events (0.023,5), communication and interpersonal skills (0.026,5), patient services (0.025,8grade);D3Management responsibilities (0.118): management decision-making andimplementation of duties (0.029,5), personnel management responsibilities (0.029,6), financial and asset management (0.031,6), information resources managementresponsibilities (0.028,6);D4The post ability (0.070): professional knowledge (0.015,8),(0.017,7)experience, skills (0.017,5), quality and safety responsibilities (0.021,6);5、 General hospital management post evaluation model:4dimension,22elementsD1Management ability (0.716): analysis and judgment ability (0.087,4),communication and interpersonal skills (0.080,5),(0.085,7) experience, planning andorganizing skills (0.088,5), the ability to deal with unexpected events (0.093,5),professional and technical knowledge (0.098,8), innovation ability (0.097,5), training(0.089,5);D2Job characteristics (0.118): mental strength (0.018,5), psychological andspiritual strength (0.020,4), the working environment (0.020,5), physical strength(0.023,5), job autonomy (0.018,6), working relationship (0.019,5);D3Management Research (0.089): personnel management responsibilities(0.019,6), financial and asset management (0.018,6), management decision-makingand implementation of duties (0.018,5), information resources managementresponsibilities (0.017,6) scientific research duty (0.018,6);D4Patients (0.077): the patient services (0.026,8), operation ability (0.025,5),quality and safety responsibilities (0.026,6);Results： The five models respectively after the reliability and validity ofmathematical statistics, the hybrid model software, general model, hybrid model andour country’s existing job evaluation model, with post a good discrimination betweendifferent models, the comprehensive application, positions in the hospitalmanagement practice in the overall planning, step-by-step implementation, promotehospital human resources management level of fine, mobilize the enthusiasm of staffand workers.更多还原