【作者】 李莉；

【导师】 郑建中；

【作者基本信息】 山西医科大学 ， 流行病与卫生统计学， 2008， 博士

【摘要】 1.目的和意义为了进一步增强山西省三级综合医院医疗服务提供能力和整体绩效水平,基于三级综合医院临床医师个人绩效提高对医院整体竞争能力具有强大推动作用的假设,引入全面绩效计分卡思想,将临床医师个人关键成功因素与传统平衡计分卡绩效评价过程相结合,构建一套以三级综合医院医疗人力资源开发为目的,适合知识型临床医师特点的绩效评价体系。通过开发科学合理的绩效评价体系,促进三级综合医院激励约束机制和人力资源培训体制的逐步完善,为解决社会和单位迫切关注的人力资源开发效益最大化问题,为政府及行政管理部门开展医疗机构卫生技术人员的绩效评价提供借鉴。2.资料来源与研究方法定性资料来源于:①国家、省部级卫生政策、卫生行政法规和文件的相关规定;②从事医院、人力资源管理理论研究与实践的专家和不同级别医师的多层次访谈。定量资料来源于:①山西省2006年卫生统计年鉴相关数据;②山西省22所三级综合医院与2所三级专科医院(作为对照)从事医疗服务工作的临床医师的问卷调查。研究方法:通过文献研究,广泛搜集适合医院、科室以及医疗专业技术人员的绩效评价指标;运用焦点群体访谈、深度访谈、德尔菲法、SWOT分析与价值链分析等定性研究方法,深入发掘传统平衡计分卡在进行绩效评价时的优势与不足;引入全面绩效计分卡(Total Performance Scorecard,TPS)思想,进行基于TPS的临床医师绩效评价体系的开发。定量资料调查问卷采用SPSS13.0的one-way ANOVA和两两比较的LSD检验进行描述性分析和方差分析;进行探索性因素分析时,主客观相结合运用因子分析(主成分分析)、离散趋势以及专家咨询等多种评价方法,构建山西省三级综合医院临床医师绩效评价指标体系;在此基础上,借助LISREL8.53软件通过结构方程的测量模型和结构模型开展验证性因素分析,对探索性因素分析的结果进行结构效度和因果关系检验,确定绩效评价指标体系;最后,通过层次分析法、秩和比法、平均趋势法的综合运用,对所构建的临床医师绩效评价指标体系进行实例验证。3.主要结果3.1山西省三级综合医院共同愿景通过对山西省22所三级综合医院愿景的比对分析,提取“共同愿景”所具有的因素,结合山西省自身发展状况,总结出作为山西省三级综合医院共同的愿景为“创建政府、患者、职工满意的,现代化、多功能、学习型名牌医院”。3.2差异化战略与价值增值分析通过对三级综合医院的SWOT分析,认为在市场竞争面前三级综合医院面临着优势一威胁组合(ST策略),提出三级综合医院应采取差异化竞争的策略,不断加大医学科学研究的力度,在本地区乃至全国创造出独特性和相对优势,增加对病员的吸引力;通过医院价值链分析,总结出患者作为整个价值链唯一的社会效益与经济效益的来源,他们所感知的交易价值和关系价值获得增值最为重要,同时提出医务部门所提供的医疗服务活动是产生患者能够感知的交易价值和关系价值增值的主要来源。3.3绩效评价体系构建依据TPS研究思路,提出组织层面医院、科室及个人(2个维度)三个层次的绩效可以从学习创新、内部流程、组织运营、社会服务四个维度去衡量,个人层面的绩效可以从知识学习、内部、外部、财务四个维度去衡量;而最终山西省三级综合医院临床医师的绩效评价可以从个人成功、社会满意、医疗质量、学习创新四个维度去衡量。3.4不同群体临床医师对绩效评价体系存在认识差异从三级医院选取1700名临床医师组成抽样样本(22所三级综合医院与2所三级专科医院)开展问卷调查,经样本方差分析认为由于生活、工作、学习经历的不同,按照不同群体特点分类的临床医师对个人绩效不同方面重要性的认识存在差异。3.5三级综合医院临床医师绩效评价体系的验证首先通过对三级综合医院1439份有效调查问卷进行探索性因素分析,以因子分析结论提取的10个公共因子作为基本框架,综合运用因子分析、离散趋势以及专家咨询等多种评价方法,构建出包括维度层(4个维度)、目标层(10个目标)、指标层(53指标)三个递进层次的山西省三级综合医院临床医师绩效评价指标体系;其次通过验证性因素的分析,分别对所构建指标体系的结构效度和4个维度之间的因果关系进行研究,最终提出个人绩效提高过程中存在“学习成长—医疗质量—社会满意—个人成功—学习成长”闭环价值循环。3.6绩效评价体系的实证研究按层次分析法分别计算出指标体系维度层、目标层以及指标层的组合权重系数,并经一致性检验符合CR≤0.1标准;以平均值预测法为主结合其它方法,为指标层53个指标确定出标准值;同时以某医院4个科室29名临床医师为例,通过秩和比法计算加权RSR值,并用可以反映绩效水平高低的RSR值所转化成的概率单位,将29名临床医师按绩效水平划分为优秀、合格、基本合格和待提高四个层次;将绩效考核结果用于包括岗位聘任、职务异动、薪酬管理、绩效改进以及培训与开发成长等人力资源管理的实践中,并创造性地提出“绩效包”概念。4.研究结论借鉴全面绩效计分卡思想,通过个人和组织平衡计分卡的结合,克服传统平衡计分卡绩效评价在组织绩效目标与个人绩效目标联系方面所造成的割裂,建立起基于临床医师个人成功、社会满意、医疗质量、学习创新四维一体的卫生专业技术人员绩效评价体系,从而实现绩效评价目的从传统的奖惩到医疗人力资源开发的转换,最终达到以临床医师个人绩效提升推动三级综合医院整体绩效改善的目标。创新点:1.在我国医院人力资源绩效评价研究方法上,首次尝试引入世界先进的全面绩效计分卡思想,构建绩效评价体系。2.首次提出基于全面绩效计分卡思想的医疗人力资源开发为目的的三级综合医院卫生技术人员绩效评价体系;提出临床医师绩效提升过程存在的“学习成长—医疗质量—社会满意—个人成功—学习成长”闭环价值循环。3.分别构建了由重点不同的四部绩效指标库组成的三级综合医院组织(医院)、部门(科室)、个人(临床医师)绩效评价指标词典。4.运用统计学方法在对探索性因素的分析结果进行验证时,首次将结构方程模型应用到对卫生人力资源绩效评价体系中。5.在绩效结果应用研究中提出“绩效包”概念,试图对我国公立医院所固有的、体现在医师个人身上的、社会效益与经济效益矛盾冲突的解决,提供一定的借鉴意义。更多还原

【Abstract】 Purpose and SignificanceTo further enhance the capacity of medical services and to raise the level of performance assessment in the tri-grade general hospitals of Shanxi,based on the assumption that improving the individual performance of clinicians will greatly promote the hospital’s overall competitiveness,this study introduces the concept of Total Performance Scorecard(TPS),aiming to set up a performance assessment system which integrates the key success factors of the clinicians with the traditional Balanced Score Card(BSC).This performance assessment system will be applicable to the knowledge-based staff and will serve the purpose of developing human resources in the tri-grade general hospitals.With the development of such a scientific and rational system,we hope to see a gradual improvement in the incentive and restraint mechanisms and human resources development and training system.We also hope to offer some information and reference for solving the most concerned problem of how to maximize the effectiveness of human resources development,as well as for carrying out performance evaluation in the medical institutions.Source of Information and MethodsFirstly,qualitative information comes from the relevant health policies of the State Council and Ministry,as well as health regulations of Shanxi.Secondly,theory material comes from the variety interviews with some experts who are engaged in the research and practice of human resources.Then,quantitative information comes from the data of Health Yearbook 2006 of Shanxi.What’s more,gaining the information of questionnaires which have been answered by the sampling persons who are all clinicians from the 22 tri-grade general hospitals and 2 tri-grade specialized hospitals in Shanxi.Research methods of the paper include the evaluation system indicators widely from home and abroad,which connected diverse organizations,departments and individuals by questing in electronic documents and paper documents.In-depth interviews and group interviews are applied to illustrate the advantage and disadvantages of the traditional BSC,using qualitative research methods and such qualitative analysis tools as SWOT analysis,Value Chain analysis.It is expected that with the introduction of the concept of comprehensive performance scorecards,a TPS-based clinicians performance assessment system can be developed.One-way ANOVA SPSS13.0 and LSD test for descriptive analysis and variance analysis are applied in the first place.Then,exploratory analysis follows by using SPSS13.0 statistic analysis software.A performance assessment system is hoped to be built up on the basis of the integration of different evaluation methods such as the factor analysis,discrete trends and expert advice.On this basis, Performance Evaluation System is determined through confirmatory factor analysis,using LISREL8.53 software in structural equation model and structure model,examining the results and the effectiveness through the exploratory factor analysis.Finally,clinicians performance assessment system is verified by a combination of the Analytic Hierarchy Process with RSR Method and the average trend.Main Results1.A common vision of the tri-grade general hospitals in ShanxiAs a result of comparison and contrast about the visions of the 22 hospitals,a common vision of the tri-grade general hospitals in Shanxi is presented that modern,multi-functional and learning hospitals are to be established to satisfy the public,the patients and the staff.2.Discrepancy strategy and analysis of value chainAccording to the SWOT analysis,a conclusion has been reached that tri-grade general hospitals,faced with the competition of the market,have both advantages and disadvantages. These hospitals should take measures to utilize the difference,strengthen medical and scientific research and create originality and comparative advantages to attract more patients.Moreover, according to hospital Value Chain analysis,a conclusion can be got that patients,as the sole source of social benefits and economic benefits,should be put in the utmost place,considering their transaction value and their relation value.In addition,medical service is the main way to obtain and earn those incomes.3.Construction of performance assessment systemBased on the concept of comprehensive TPS,it is suggested that the performance assessment of the organization(hospital and different units) should be measured in terms of innovation,internal affairs processes,organizational operations and social services while that of the individuals in terms of personal achievement,social satisfaction,quality and innovation.4.Discrepancy of different group clinicians value about personal assessmentThere exists a wide range of differences among the 1700 clinicians sampled from 22 tri-grade general hospitals and 2 tri-grade specialized hospitals,and these differences are due to their different living,working,learning experiences.5.Assessment performance of clinicians test about the tri-grade general hospitalsA performance assessment indicators system,which includes a 4-dimension level,a 10-goal level and a 53-index level,is built up as a result of the exploratory factor analysis.According to confirmatory factor analysis,a closed cycle of value is advanced,which is "learning and growth, medical service quality,social satisfaction,personal achievement and leaming and growth".6.Study of validation performance assessmentStandard values for the 53 indexes are determined through AHP;29 clinicians were respectively graded "Excellent","Qualified","Less qualified" and "To be improved".The results of performance assessment should be applied to such human resources management practice as the appointment,transferring,salary management,performance improvement and growth and training.Performance Package,a creative concept,is put forward.ConclusionsA four-dimension performance assessment system,based on clinicians’ personal achievement,Social satisfaction,medical service quality and innovation,combines the Personal Balanced Scorecard and Organizational Balanced Scorecard.It can bridge the gap between the organizational performance objectives and the individual performance objectives with the ultimate aim to improve the overall performance in the hospital.Innovations1.For the first time,the concept of a comprehensive performance assessment scorecard is introduced to construct a performance assessment system.2.For the first time,a performance assessment system is intended to develop medical human resources and a closed cycle of value is believed to exist in the performance promotion, which is "learning and growth,medical service quality,social satisfaction,personal achievement and learning and growth".3.A performance assessment dictionary is composed of four different kinds of performance indicators with respective focuses.4.For the first time,structural equation model is applied to the performance assessment system about medical human resources in verifying the results of the exploratory factor analysis.5.A "performance package" concept is advanced with an attempt to solve the conflict between the social benefits and the economic profits long existing in the public hospitals but embodied in the doctors themselves.更多还原