【作者】 高红霞；

【导师】 方鹏骞；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2008， 博士

【摘要】 研究目的公立医院作为卫生领域组织的典型代表,凸显人力资本价值、实现公立医院价值最大化的支撑基础是医院人力资本价值最大化,因此人力资本投资在医院经营中占有重要地位。连续、高效、敏捷的公立医院人力资本投资能力成为其生命线。但人力资本投资具有风险性甚至高风险性,已被国内外人力资本投资的理论和实践所验证。鉴于国内特别是卫生领域人力资本投资风险研究相对薄弱,尚不能构成完整体系,本文选择公立医院为研究对象,期望通过系统研究,完善和拓展公立医院人力资本投资的理论体系,分析导致人力资本投资风险的关键环节和影响因素,构建公立医院人力资本投资风险的理论模型,设计具有可操作性的医院人力资本投资风险分散模式,以期推进当前医院人力资本投资风险的研究与实践。研究方法本研究主要采取了理论探讨与实证研究相结合、定性和定量相结合的研究方法。首先运用通过内容分析和二次分析方法开展文献资料分析工作,吸收人力资本管理理论、人力资本产权理论、风险管理理论等理论基础,对公立医院人力资本投资的相关理论进行分析。设计研究方案,在全国范围内按照经济水平抽取12家公立医院(二级医院和三级医院各6家)作为现场调查对象,对其人事部主任、中层管理者和副高级以上职称员工共508位进行问卷调查,对医院的关键知情人进行半结构化访谈。现场收集的资料利用EpiData3.1进行数据录入,运用SPSS12.0进行统计分析,包括描述性分析、卡方检验、非参数检验、Logstic回归分析、因子分析、层次分析和模糊综合评判等;对研究中专家咨询、访谈等资料进行定性分析。研究结果1.基本概念的界定借鉴国内外其他领域人力资本投资的研究成果,对公立医院人力资本、公立医院人力资本投资、公立医院人力资本投资风险等概念进行界定。从人力资本投资预决策环节、人才资本引进投资环节、开发与培训投资环节、配置投资环节、使用投资环节(包括维持使用投资)构建公立医院人力资本投资的理论模型。2.公立医院人力资本投资风险的理论分析提出从外部环境和医院内部管理两大角度对公立医院人力资本投资风险进行划分。外部环境风险包括一般环境风险和具体竞争环境风险,其中一般环境中的宏观政治经济社会环境风险属于较小概率风险;宏观行业环境风险中公立医院既具备了人力资本集中投资优势,但同时医院人力资本的配置、使用和流失存在潜在威胁因素。在具体竞争环境中,当地的经济技术环境、医疗服务市场竞争、竞争对手间人力资本争夺等直接影响了公立医院人力资本投资效果。医院内部环节管理风险根据产生主体的不同分为管理者行为风险和被管理者反应行为风险,在此基础上根据理论分析结果初步设计了公立医院人力资本投资风险环节模型。公立医院人力资本投资风险原因包括人力资本投资的特征原因、人力资本产权特征、不完全信息和不对称信息特征、人的异质性特征等等。3.公立医院人力资本投资内部管理风险的实证研究结果人力资本投资管理过程在不同级别医院之间呈现差异。对医院所处的具体外部环境越满意,医院的人力资本流失风险越低,反之则离开本单位的倾向越强烈。不同级别的医院内部人力资源管理制度的完善程度不同,三级医院的各项制度建设情况要好于二级医院,包括医院人力资本引进计划(χ2=8.723 P<0.01)、医院科室环境建设(p<0.05)、取得工作成果情况(χ2=36.174 p<0.01)等等。二级医院对薪酬待遇满意程度(p<0.01)、职业生涯管理实施情况(χ2=4.746 p<0.05)要好于三级医院。人力资本投资管理过程在不同科室性质之间呈现差异。临床科室的各项制度建设情况要好于行政科室,包括人力资本引进计划制定(χ2=4.986 P<0.01)、培训制度(p<0.05)、培训计划(χ2=14.330 p<0.01)、职业生涯管理情况(χ2=0.029 p<0.05)、激励奖惩情况(p<0.05)等等。人力资本投资管理在普通员工和中层管理者之间呈现差异。普通员工对当前收入满意情况、对薪酬制度、福利待遇满意情况、考核制度合理程度、科室团队凝聚力评价要低于中层管理者(p<0.01);中层管理者对医院发展信心大于普通员工(p<0.05);普通员工因为身体状况影响工作可能性要高于中层管理者(p<0.05)。医院管理者行为中发现的问题:科室主任人事决策权较小;员工对医院战略目标认同度较差;培训对象因素未引起管理者的重视,被培训者本人的需求、培训内容与培训对象的适应性被摆在后位;培训考核制度尚未建立;培训效果较差;职业生涯管理和工作分析等管理尚需提高等等。通过公立医院人力资本流失风险Logistic回归分析,发现人力资本载体对薪酬福利制度满意情况(OR=0.515, P=0.007)、对医院文化建设满意情况(OR=0.437, P=0.007)、离开本地区倾向(OR=6.260, P=0.000)是人力资本流失风险的主要影响因素。合同的约束力、最高学历等因素对人力资本流失影响有待进一步研究。4.公立医院人力资本投资风险模型研究结果通过管理者行为和被管理者反应行为的因子分析发现,在中层管理者行为中,医院制度建设、医院实力、人事决策权归属以及人力资本信息风险是最容易导致人力资本投资风险的影响因子。在被管理者反应行为中,医院内部制度与环境满意度、医院的地区环境、中高层管理者对人力资本重视度、单位倦怠、工作倦怠、主动流失、人力资本与岗位的匹配性、人力资本培训需求是主要影响因子。对这12个潜在因子进行深层次分析,归结为四类:员工个人因素、科室因素、医院因素和医院地区因素,由此构建了公立医院人力资本投资主要风险管理模型。5.公立医院人力资本投资管理风险评价结果本研究通过德尔菲法和层次分析法构建公立医院人力资本投资管理风险三级评价指标,并运用模糊综合评价法对二级医院和三级医院、以及12家医院的人力资本投资各环节风险水平和总体风险水平进行评价。结果发现,三级医院、二级医院在外部环境风险、人力资本引进风险、开发与培训风险环节的风险程度较小,在人力资本配置与使用环节管理风险程度中等,在预决策投资管理环节风险程度较大。两个级别医院的总体风险水平均为风险较小稍偏中等风险水平;但通过加权平均法发现三级医院总体风险水平要稍高于二级医院;不同级别医院在人力资本流失环节风险程度不一。从各家医院环节风险情况看,在外部环境管理风险方面,医院的风险程度不一;每家医院在人力资本预决策投资环节风险普遍较大;在配置与使用环节上,由于医院对人力资源管理制度建设的重视,因此表现出由于管理不善而导致的人力资本投资风险程度较小。利用加权平均法,对每家医院总体风险进行综合评价,结果为尽管各家医院人力资本投资管理风险总体显示风险较小,但基本上都稍偏风险中等水平。对策建议:1.公立医院人力资本投资风险的风险管理。提出从风险环节与因素识别机制、风险审计机制、风险评估机制、风险防范机制、风险控制机制构建完整的公立医院人力资本投资风险管理机制。综合本文的研究内容和研究结果,本研究提出公立医院人力资本投资风险识别主要包括:(1)风险类型的识别,包括外部环境风险和内部管理风险;管理者行为风险和被管理者行为风险。(2)风险产生环节的识别,从医院内部看,风险产生环节包括预决策环节、人力资本引进环节、人力资本开发与培训环节、配置与使用环节;从人力资本载体看,主要包括代理风险和流失风险。(3)风险因素的识别,从管理者行为风险看,医院人力资本投资风险的产生与医院内部管理制度的健全程度息息相关;从人力资本流失风险看,主要风险因素包括薪酬福利制度、医院文化建设情况、医院所处的地区环境、医院级别等。在医院人力资本投资风险审计中,审计者应根据医院识别的风险来源、风险环节和风险因素进行逐一审计,看投资活动对这些风险是否跟踪识别,是否采取了相应的风险控制措施。在风险防范机制中,其中内部管理风险防范主要通过医院人力资本运营以达到防范目的,外部环境风险防范应重点进行环境分析和竞争对手分析。2.公立医院人力资本运营与风险防范。人力资本运营机制从人力资本投资预决策机制、人力资本引进机制、人力资本培训开发机制、人力资本使用机制进行构建。在预决策机制中,要建立和完善医院人力资本投资集体决策制度、做好医院人力资本投资规划、关注人力资本承载力、明确医院战略目标;在人力资本引进机制中,应做好人力资本引进需求分析、制定与本院发展规划相符合的人力资本引进计划、进行人力资本引进结果评估。在培训与开发机制中,设计完善的医院培训管理体系。从体系流程看,应包括培训计划制定、培训需求分析、培训对象确定、培训内容和方式的选择、培训效果评估。在人力资本使用机制中,重点做好工作分析、人力资本数量和质量的合理配置、推行员工职业生涯规划管理、重视健康维持投资、重视医院文化和医院环境建设。3.从人力资本产权角度进行人力资本投资风险防范。本研究提出主要从人力资本产权化的薪酬激励机制设计、约束措施与风险防范、心理契约与风险防范三个方面进行风险防范。在人力资本产权化的薪酬激励机制设计中应包括薪酬激励、福利激励、职业发展激励等;薪酬福利是影响人力资本使用效率和稳定性的主要因素之一,因此医院应设计科学合理的薪资激励方案。1)薪资政策要保持对外的竞争性;2)薪资水平要结合医院实际;3)薪资要重视员工的福利愿望;4)按表现支付薪资,按岗位、责任、日常表现、贡献等因素确定不同的数额,实行差别化薪资;5)关注激励的公平性问题。在约束机制中,除考核机制外,还应包括管理者行为约束、员工行为约束和契约约束;同时考虑到调查结果显示66.1%人认为合同并不能构成约束其离开单位的有效手段,由此提示契约约束并不是防范医院人力资本流失风险的最终策略,提出将心理契约、事业感情投资、人际关系投资作为风险防范的重要途径。更多还原

【Abstract】 Objectives:As the typical representative of the health organization, the foundation to realize the human capital value and the hospital value maximum is human capital value. So the human capital investment played an important role in hospital management. But it is confirmed by theory and practice that there is high risk in the human capital investment at home and abroad. In view of the research of human capital investment in health field is relatively weak, the article system research public hospital to improve theoretical system of public hospital human capital investment, analyze the key risk unit and influencing factors, and construct theoretical model of risk management of public hospital investment. Hope to promote the research and practice.Methods:The article applies to theory discussion and demonstration research, combining with Qualitative and quantitative study on human capital investment risk in public hospital. At first, author carry on content analysis and secondary analysis on the basis of collecting a great amount of documents. Combining theories such as human capital management, human capital property right, risk management and so on. Secondly the author designs the research approach. Objective to investigate the risk influencing factors of human capital investment, a procedure of stratified cluster random sampling was conducted in nation based on geographical location and economical condition, including 6 secondary hospitals and 6 tertiary hospitals. The subject are personnel manager, midlevel manager and senior employees a total of 508. All data are processed by SPSS for Windows 12.00. Statistical Analysis methods include Descriptive Statistics, nonparametric test, chi-squared analysis, factor analysis, the Analysis Hierarchy Process and Fuzzy Comprehensive Evaluation. At last the article analysis the results of experts consultation, nominal group discussion, and the interview results. Results and Conclusions:1. The basic concepts are defined. The article use for reference from results of human capital investment in other field at home and abroad, including Human capital of public hospital, human capital investment of public hospital and human capital investment risk of public hospital etc. The author construct theory model from five taches on management risk in hospital: prediction and decision risk, recruitment risk, development and training risk, distribution and use risk.2.The theory analysis of human capital investment of public hospital. The author thinks the investment risk should be divided into 2 ways: environment risk and management risk. The former include general environment risk and concrete environmental. The environment risk of politics, economy and society is small probability. The industry environment endow with public hospital some superiority on human capital investment, but there are potential threat through distribution, use and loss of human capital. In addition, there are a series of factors in concrete environmental, such as the local economy and technology environment, the competition within medical service market, the contest of human capital within competitor etc. It affects the effect of human capital investment inevitably. According to the difference of risk subject, the management risk in public hospital could be divided into 2 sections, the behavior risk of manager and the reaction behavior risk of being managed. The main reason of human capital investment include the character of human capital investment, the character of human capital property right, incomplete information and asymmetric information among the investmeng, human heterogeneity etc.3. The demonstration research of the public hospital’s management risk of human capital investment.The management of investment presentes differences along with different level of hospital. The higher satisfaction with local environment of hospital, the lower risk of human capital loss. It is different about the policy of human resources management in different level of hospital. In general, perfect degree of HRM in the tertiary hospitals is better than the secondary hospitals, including the human capital‘s recruitment plan(χ2=8.723 P<0.01), the hospital’s environment (p<0.05)etc. But in secondary hospitals, the satisfaction with salary(p<0.01), career management (χ2=4.746 p<0.05)is better than the tertiary hospitals.The management of investment presentes differences along with different department. In general, the system of HRM in clinical department is better than the administrate office, including the human capital‘s recruitment plan(χ2=4.986 P<0.01), training system(p<0.05), training plan(χ2=14.330 p<0.01), career management(χ2=0.029 p<0.05), and so on.The management of investment presentes differences along with midlevel manager and senior employees. The satisfaction of enior employees with salary, Examination System , confidence in hospital development is lower than midlevel manager(p<0.01). Logistic regression analysis of loss risk of human capital investment showed that the satisfaction of salary(OR=0.437, P<0.01), hospital culture(OR=0.437, P=P<0.01) and want to leave area (OR=6.260, P=P<0.01)are the main factors.4.The factor analysis result through the behavior of manager show that the hospital management system, the hospital strength, the decision right of personnel, and the information risk of human capital are the main impact factors of investment risk. And The factor analysis result through the reaction behavior of being managed show that there are 8 factors: the satisfaction with hospital system and environment, the local environment, the job burnout and so on.The article goes on to study 14 factors and find that it can be divided into 4 class: the individual factor of employee, the department factor, the hospital factor and the local factor. The theory model of main investment risk is designed on this basis.5. The article construct risk rate index of human capital investment through the Delphi method and AHP. Evaluate the investment tache risk and the whole investment risk in the tertiary hospitals, the secondary hospitals and in each hospital with Fuzzy Comprehensive Evaluation. It shows that the risk level is low in environment risk, recruitment risk, development and training risk. The distribution and use risk is midding, and the prediction and decision risk is high. The whole risk in public hospital is low, but the tertiary hospitals investment risk is higher than the secondary hospitals. There is difference of loss risk in the tertiary hospitals and secondary hospitals. The evaluation of each hospital shows that the level of environment risk is different, but the prediction and decision risk is high in each hospital. The distribution and use risk is low as a result of the perfect HRM system.Suggestions:1.The risk management of human capital investment in public hospital. The article define the system of risk management, including the system of risk identification, the system of risk auditing, the system of risk evaluation, the system of risk prevention and the system of risk control.Upon the research contents and results, the Key Point of risk identification contains three parts: the first, the recognition of risk classification. Such as environment risk and management risk, the behavior risk of manager and the reaction behavior risk of being managed etc. The second, the recognition of risk unit. The author construct model of risk unit from five taches on management risk in hospital: prediction and decision risk, recruitment risk, development and training risk, distribution and use risk. The third, the recognition of risk factors. The investment risk is closely linked with management system in hospital. And among the possible factors of human capital loss, there are four main factors: the system of salary welfare, the hospital culture, the exterior environment of hospital and the level of hospital.In the process of risk audit, the auditor should audit risk source, risk unit and risk factor one by one, in order to make sure that hospital manager have take action to track,identify these potential risk.In the system of risk prevetion, we should take different way between management risk with environment risk.The emphases in risk prevetion of hospital environment is environment analysis and competitor analysis. But the management risk prevention recurs to human capital operation.2. The article put forward human capital operation to control investment risk. The system of human capital operation includes four parts: the system of prediction and decision, the system of recruitment, the system of development and training, and the system of using. In first part, the establishment and improvement of collective decision-making system, human capital investment planning, hospital stratagem is most important. In the system of development and training, the manager should put attention to training plan, the analysis of training demand, the training’s content and method, the evaluation of training effect etc. In the last part, manager should focus on job analysis, career management, health investment and hospital culture.3.The author put forward the innovaion of human capital property right to prevent investment risk in public hospital: the Motivation Mechanism, the Mechanism of psychological contract and the restriction mechanism.Three contents, the salary prompting, the walfare prompting and the career development prompting, are the most important among the salary and welfare system based on human capital property right. Upon the results above, the salary and welfare is one of the main factor affects the human capital’s efficiency and stability, so the hospital should design science and rational project on salary. The first, the salary project should keep rivalrousness with society and competitor. The second, the salary should consider the condition of the hospital financing. The fourth, the salary should pay attention to the walfare mind of employee. The last, the level of salary should relate with position, duty etc. The last, the equity of promotin also cann’t be ignored.Restriction system takes important role in the risk prevention of human capital investment risk. Except assessing system, there are behaviour restriction of manager and being, contract restriction. The results of investigation tell us that contract is not an effective way to prevent human capital loss risk, about 66.1 percent employee. So the contract restriction is not a finally atrategy to risk prevention. The article put forward prevent investment risk by other approach, such as the psychology contract, the career investment, the emotion investment, and the harmonious relationship investment.更多还原