【作者】 荣晓琦；

【导师】 罗五金；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2006， 博士

【摘要】 学习型组织理论是当今世界最前沿的管理理论，医院作为知识密集型和技术密集型单位，引进和运用这一理论是十分必要的。美国多家大医院已采用该理论和模式进行革新，并取得了较显著的效果。在中国政府提出创建“学习型社会”的号召之后，中国的一些企业、医院和学校等进行了创建学习型组织的理论研究和实践工作，并取得了显著的成效。本研究以河南省平顶山煤业集团总医院从2001至2005年创建学习型医院的工作实践为典型，对如何结合中国医院的现状创建和评价学习型医院进行了比较系统和深入的研究。研究目的：本研究通过综合应用定性和定量的分析方法，特别是运用运筹学和统计学的方法来研究学习型医院的创建模式和评价体系。资料来源：本研究以河南省平顶山市煤业集团总医院从2001年开始酝酿创建学习型组织，2003年开始建立直至2005年这五年创建学习型医院前后的实践工作作为典型调查对象。具体的调查对象包括：①有关专家：对院领导和主要业务科室负责人以及医院管理专家，采用访谈和专题小组讨论的方法进行了咨询；②医院职工：以科室为分层依据，分层随机抽样调查了各业务科室和行政管理科室中的医院职工，累计达225人；③居民：汇总医院在2003年创建学习型医院时入户调查的资料。2003年研究者作为调查组织者之一，组织了对居民的入户调查。调查采用多阶段抽样调查的方法，第一阶段用分层抽样的方法将调查对象分为平顶山市区内和近郊的3个县居民，第二阶段对市区内居民按照街道采用整群抽样的方法抽取2个街道，对街道内的居民全部入户调查；对近郊3个县各抽取1个乡，每个乡抽取2个村，共计6个村，对这6个村的村民全部入户调查。最终调查了市内居民300户，1000人。近郊县居民300户，1000人。医院主要的业绩运行指标来自于医院科教信息部和医务部相关报表和总结报告。平顶山煤业集团总医院这五年的经济情况直接来自于医院财务报表。研究内容、方法：主要内容：1、具有中国特色的学习型医院框架模型，包括学习型医院所处的环境平台、其欲达到的目标(共同愿景)、创建手段(五项修炼)、创建内容(过程)与功能模块间的关联；2、符合中国国情的学习型医院创建模式与评价模式，包括以构建和谐医院为特色的组织文化模块，以目标节点控制为特色的团队学习模块，基于模糊数学原理的组织评价模块，将灰关联聚类和数据包络分析(DEA)两大技术相结合的绩效评价模块等四个子模块。主要研究方法：本研究综合运用定性和定量相结合的方法，在定量分析上，采用了运筹学、统计学和模糊数学的方法，并且运用系统动力学理论，建立了用于战略决策的学习型医院初步模型，并通过平顶山煤业集团总医院五年来创建学习型医院的实践与成果来对模型的正确性、可操作性和可持续性进行优化。研究方法：1、灰关联聚类：过去人们对多因素的复杂系统进行多维综合评估分析时，所采用的评估分析方法有因素关联分析，模糊聚类，系统聚类，灰色聚类等。本研究将灰关联分析和聚类思想方法进行了融汇、扩充，创立了“灰关联聚类方法”，既区别于关联分析，亦非一般的聚类方法，它是把灰关联度演化成刻划待评对象之间的亲合度，进行聚类分析的新方法。该方法与一般的聚类方法相比，具有简洁性、有效性、灵活性、实用性等特点。2、数据包络分析(DEA)：数据包络分析(Data Envelopment Analysis，简称DEA)是运筹学、管理科学和数理经济学交叉研究所开发出来的新的研究方法。DEA通过使用数学规划模型评价具有多个输入和多个输出的“部门”或“单位”(称为决策单元，简记为DMU)间的相对有效性(称为DEA有效)。使用DEA对DMU进行效率评价时，可以得到很多具有深刻经济学含义的管理信息。研究结果：在平顶山煤业集团总医院创建学习型医院的五年实践中，总结和提炼出创建和评价学习型医院的理论与实践基本模式，特别是形成了一些符合中国国情的特色子模块。1、以“医院思想政治工作”为特色的组织文化模块。该模块着重九个交融，即思想政治工作与业务工作交融；领导与群众交融；工作与学习交融；领导学习与政治文明学习交融；个人学习与团组学习交融；严格的科学管理与宽松环境交融；职业化管理与人性化管理交融；精神文明与物质文明交融；全院学习与全员交流交融。以实现七大特色，即交融式文化的渗透作用；理念文化的引领作用；绩效文化的激励作用；团组文化的凝聚作用；执行文化的保障作用、沟通文化的协调作用和价值文化的导向作用。2、基于模糊数学理论的系统评价和评估模块。自身评价和第三方的评估相结合，为学习型医院提供反馈，调整其工作。对学习型医院建立模式的正确性、可操作性和可持续性进行验证和优化。3、以灰关联聚类和数据包络分析(DEA)两大技术相结合的绩效评价模块。限于目前对学习型医院的认知，如何评价其效果和效率并没有非常成熟的方法。因此，本研究通过对学习型医院的效果运用灰关联聚类的分析方法进行比较，同时结合对学习型医院建立的投入，将运筹学中DEA的方法运用到学习型医院建立的效率评价中来，将这二者结合，为学习型医院的绩效评价开创出一种科学考核模块。此外，我们在系统深入研究学习型医院创建和评价的理论基础上，结合专家咨询的结果和医院的组织特点，以及平顶山煤业集团总医院创建学习型医院的实践，初步总结出创建学习型医院应具备的五大特征、三大要点及五大基础。学习型医院创建过程中的五大特征为：变革性、创新性、持续性、认同性和扁平性。学习型医院创建必须掌握的三大要点是：理论的创新与实践的可行性相结合，组织的创建与员工个人生涯设计和体现员工价值相结合，执行能力与系统思考的战略决策能力相结合。学习型医院创建必须夯实的五大基础是：事业的紧迫性、领导的持续性、骨干的跟随性、群众的积极性和员工的认同性。研究的创新点：1、首次提出了中国学习型医院创建的框架模型。本研究在国内第一次将学习型组织理论在创建学习型医院中的具体实践上升到了理论阶段，特别是首次提出了中国学习型医院创建的框架模型，并对学习型组织的理论进行了进一步深化。本研究首次提出的中国学习型医院框架模型既是静态的，又是动态的；既是系统模型，又是表征某一时段的局部模型；既表达了医院目前的环境平台，其欲达到的目标(共同愿景)、创建手段(五项修炼)、创建内容(过程)与功能模块间的关联，又反映了创建阶段的递进性，三种内核力(学习力、创造力、价值力)不断提升及与环境平台间的交互性与增长性，共同愿景不断更新、提升而带动创建台阶的持续性和功能模块增新性。2、提出了中国学习型医院创建的可行评价方法和指标。本研究对如何评价学习型医院的创建成效进行了系统的研究，在专家咨询的基础上提出了一些可行的评价学习型医院创建效果和效率的指标，并在国内第一次将模糊数学理论、灰关联聚类、数据包络分析(DEA)等方法用于学习型医院创建的评价。3、提出了具有中国特色的学习型医院创建策略和措施。本研究在系统和深入研究学习型医院创建与评价模式的基础上，结合国内医院的现状，提出了具有中国特色和较强操作性的学习型医院创建与评价策略和措施，具有一定的推广价值。由于学习型组织理论是一种全新的管理理论，其创建也是一项复杂的系统工程，因此对于学习型医院创建和评价的研究是一个永远没有终点的过程，需要今后不断地总结和深入，也有待于在今后的工作实践中深入、系统地开展。更多还原

【Abstract】 Learning organization theory is the most advanced management theory. Hospital is knowledge and technology—intensive unit, and it’s very necessary to introduce this theory into hospital. Many U.S. hospitals apply this theory to innovate and get remarkable effects. After China’s government asked Chinese people to establish the learning society, a few Chinese enterprises, hospitals and schools carry out the theory and get positive effects. This dissertation reviews the experience of Pingdingshan Coal Group’ Genral Hospital from 2001 to 2005, and deeply systematicly study how to establish and review the learning hospital in China.Objective:This thesis uses comprehensively qualitative and quantitative methods, especially the tools from operational research and statistics to study learning hospital’s construction modes and evaluation system.Source of materials:The source of materials: the data and other materials in this thesis come from the practice of Pingdingshan Coal Group’s General Hospital from 2001 onwards. Research contentsThe interviewees include the following:Experts: the hospital’s leadership and the directors of various departments, the investigation methods are interview and focus group discussion;Hospital staff: Based on the strata of various departments, we randomly investigate 225 employees in various medical and administrative departments.Household investigation: we sum up the materials of household investigaton from 2003, when we began the construction of learning hospital.The investigation uses the method of multi-stage investigation, first we classify the interviewees into various groups according to their residence, such as those in urban area or those in near suburbs, second we select randomly the residents in two blocks in urban area, and carry out household investigation in every households in the two blocks; and we select two village in the investigated township, and select one township in the investigated county, the number of investigated counties is 3, and the total number of investigated villages is 6; and we carry out household investigation in every family in the 6 villages.Finally,the total number of unban and country investigated households is 300,and the total number interviewees is 1000.The main operation indicators come from the charts and reports provided by the hospital’s information department and medical administration department.The ecomonic data from 2001 to 2005 of Pingdingshan Coal Group’s General Hospital come from the hospital’s financial reports.Content and methods:Research contents:1. The thesis’s contents include the framework and model of learning hospital with Chinese characteristics, the context and platform of such a hospital, its goal(the common ideal and vision), the constructive tools(the five exercises), the relationship between content and function modules, and the construction mode of learning hospital with Chinese characteristics, which includes organizational culture modules to set up harmonious hospital, group learning module with the characteristics of fingers’ joints, etc.2. The thesis’s contents include the review methods how to review the construction of learing hospital, learning hospital’s environmental platform, targets, ways and tools to set up(five exercises), establishment contents(progress) and functional modules, and the establishment stepsResearch methods: This research synthesizes the application to settle the problems with the method that the fixed amount combine together, on the quantitative analysis, the large quantity adopted the strategy to learn, statistics to learn with the method that misty mathematics, such as the grey correlation grouping and data envelopment analysis( DEA).The most creative methods in the study are the following:1. grey correlation grouping, this method combine grey correlation analysis with grouping method, and work out the grey correlation grouping, which is more concise, effective, flexible and universal.2. Data Envelopment Analysis, DEA, this method is the hybrid of operational research, management science and quantitative economics, which can bring us management information with deeper economic meaning.Conclusions :The thesis advances learning hospital’s framework and model of China’s characteristics. The model is both static and dynamic, both systematic and partial, which both deals with the relations of hospital’s present environmental platform, the common target, construction methods, contents and functional modules, and the progress of construction period; deals with three kinds of internal powers study, power, creation and value, continuously promote the interaction and increase, reflect the renew of common vision, promote the construction steps.In the five years’ practices, the candidate sum up the theoretical and practical modes, especially some sub-modules conforming to China’s characteristics, such as1. The organizational cultural modules, which emphasizes 9 fusions combine both the political and medical works, both the leadership and medical workers, both work and study, both strict management an cozy environment, both professional and humane management, both spiritual and material civilization, hospital learning and staff communication.2. The systematic evaluation modules based on fuzzy mathematics. Self-evaluation and peer review, provide feedback, modulate the work, verify better the construction modules.3. This research synthesizes the application to settle the problems with the method that the fixed amount combine together, on the quantitative analysis, the large quantity adopted the strategy to learn, statistics to learn with the method that misty mathematics, such as the grey correlation, data envelopment analysis(DEA).On the base of deep study of constructing learning hospital and evaluation’ theory, and consulting the experts concerned, and hospital’s organizational characteristics, and the practices of Pingdingshan Coal Group’s General Hospital, we initially sum up the five characteristics, three key points and five fundaments.The five characteristics are changeable, creativity, progressive, conforming and simplicity. The three key points are the combination of theoretical creation and practical feasibility, the combination of organization’s construction, staffs progress and values, and the combination of enforceability, systematic thinking, strategic decision. And the five fundaments are emergencies of business, leadership’s continuity, cadres’ following, the response and unity of medical workers.Creative conclusions:1. The thesis first sum up the experiences of the construction of learning hospital in China and advance the framework and model of China ’s learning hospital;. The model is both static and dynamic, both systematic and periodic. And it show us the relations between learning hospital’s environmental platform, targets, ways and tools to set up(five exercises), establishment contents(progress) and functional modules, and the establishment steps’ progressiveness.2. the thesis advances some feasible indicators of evaluating the effectiveness and efficiency of construction, and first apply the fuzzy mathematic grey correlation and DEA to the evaluation of construction;3. the thesis advances some feasible and concrete measures to the construction of learning hospital, which can be helpful for the domestic hospital’s construction of learning hospital.As learning organization is a brand new management theory, and the establishment of learning organization is a complicated systematic project, the study on learning hospital’s setup and review has a long way to walk.更多还原