【作者】 余江；

【导师】 王振维；

【作者基本信息】 第三军医大学 ， 社会医学与卫生事业管理， 2008， 博士

【摘要】 风险的客观存在是一个不争的事实,20世纪90年代以来随着科技的迅猛发展和经济的全球化,以及在WTO运行的大背景下,世界变成了“风险社会”。面对现实,风险管理已经逐步成为组织加强管理的内在需求——组织不得不加强对重大风险、重大事件的管理,并以重要流程的内部控制为重点,积极开展全面风险管理。近几年来有不少国内外学者对此领域进行了研究与探讨,并积累了丰富的研究成果。医疗卫生服务行业是高技术、高风险、高难度、高知识密集的行业,其服务对象的特殊性决定了现代医院的责任和风险,医院风险贯穿医院经营的全过程。军队综合性医院的病床数量、大型医用设备数量、医疗技术力量及技术水平等一系列综合指标在国内处于先进行列,军队综合性医院的特殊性质决定了它在平时和战时的重要作用。军队综合性医院在建设与发展过程中,和国内其它医疗机构一样,既面临着巨大的发展机遇,也面临着严峻的风险挑战。为帮助医院更好的应对风险,本研究以国内外风险管理研究理论为依据,以企业风险管理流程为参考,较为系统和全面的对军队综合性医院的风险管理进行了研究:(1)调查分析了军队综合性医院的风险管理现状以及风险管理的需求,发放调查问卷240份,回收有效问卷220份,发现军队综合性医院的工作人员建立了一定的风险意识,医院的风险管理现状比较平稳,但是医院5年内的风险发生率较高,发生的风险种类较多,工作人员理解的风险内涵较为片面和狭义,对风险管理的需求增加,医院的风险管理存在很大的理论和实践研究空间;(2)探索和理清了军队综合性医院存在的内外部风险因素和主要的风险事件,对医院面对的风险进行了提炼、总结和分类,通过专家咨询法修正后构建了军队综合性医院风险识别三维模型,结合军队综合性医院的实际情况进一步深入分析了总结出的17类风险;(3)应用“风险矩阵量化”方法,采用专家咨询法对17类风险进行了量化评估,构建了军队综合性医院风险量化矩阵,并进行了分析。同时运用竞争理论学说中的“SWOT”战略分析模型和迈克尔·波特的“五种竞争力量理论模型”分析军队综合性医院的内外部风险因素,提出了医院风险管理的战略框架;(4)运用系统动力学的理论和研究方法,构建了军队综合性医院风险预警系统动力学模型和三维预警指标体系;构建了军队综合性医院的风险防范系统动力学模型,分析了军队综合性医院的风险防范机制,构建了风险规避、风险转移、风险减轻和风险接受四种风险控制的系统动力学模型;提出了军队综合性医院风险预警、防范与控制的整合思路。结合军队综合性医院的实际,依据因果关系原则、平衡原则、适度原则、SMART原则、全员参与逐步调整原则和成本效益原则,对风险管理组织框架的构建进行了初步探讨;(5)为了更好的识别和尽早感知医院管理人员的风险行为,将其给医院带来的种种不良后果减至最低,本研究参照风险行为的研究成果,依据人口统计、个性、组织和工作环境三方面的决定因素,结合军队综合性医院的实际,对设立的风险倾向的研究假设进行了实证验证和分析,发放调查问卷243份,回收有效问卷186份,发现在军队特殊环境中,风险偏好的决定因素有所改变,但总的风险倾向是可测的。本研究共计发放两种类别的问卷(调查问卷和专家咨询问卷)550余份,回收有效样本合计464份,并使用相关分析(Correlation Analysis)和描述性统计分析(Descriptive Statistics Analysis)等方法对咨询和调查结果进行分析和验证。更多还原

【Abstract】 It is obviously that the risk is all the way. It has been becoming a world of risk on the background of WTO practice and due to the dramatic advance of science and technology and economical globalization. Any organization has to intensify the risk management of key risks and main events and put priority on the internal control of the essential process, which has become the internal requirement of management enhancement. Recently, many scholars in the world have studied on this field and accumulated a great deal of achievement. The healthcare industry, well known for high technology, high risk, great difficulty and knowledge intensification, shoulders great reseponserbility and faces great risks due to the particularity of its clients. The risks prevail in all the activities and every process of operation of hospitals. The indicators such as the number of beds and equipments, the medical technology edge of the military general hospitals lead the local, the army and even the country. They are playing very important role in healthcare support for the people and soldiers and furthermore in the social stability and national economic construction and advancement for its nature. However, both the severe risk challenges and the great development chance present in the military general hospitals as in the other healthcare organizations in our country.To render a help in the risks prevention in hospitals, basing on the risk management theories in the world and the enterprice management process, we made a systematic and comprehensive study on the risk management process in the military general hospitals. The main results of this study included:1) The demand for the risk management and the present state of the risk management in the military general hospitals were investigated and analyzed. 240 questionnaires were handed out and 220 effective ones were collected, which was found that the risks awareness is in a sense hold by staffs in the hospitals and the present state of risk management keeps somehow stable, but the risk occurrence remains high and the staffs understanding of risks was limited and there exists a great room both in theoretic study and practice. 2) The external risk factors and main risk-related events existing in the military general hospitals were explored and made clear. The risks faced by the hospitals were extracted, summarized and classified and modified with the Delphi method to construct the three-dimensional model of risk indentifition. And 17 risks were summarized by further analysis of the practice of the hospitals.3) By using the method of risk matrix quantification, the 17 risks were evaluated quantitatively with the Delphi method. The risk matrix quantification of the military general hospitals was made and analyzed. Meanwhile, the SWOT strategic analysis model in the competition theory and five competitive forces by Michael Porter were used to analyze the external and internal factors and the risk strategy in hospitals was put forwards.4) The methods and process of system dynamics theory were used to construct the risks alarm model in military general hospital and the risk prevention mechanism was analyzed. The four system dynamics models of risks control were constructed and the idea of integration of risks alarm, prevention and control was given. At last, the construction of risk management organizations frame was set up and will gradually adjust according to the reality of military general hospitals and the principles of cause and effect relation, balance, moderation, SMART, participation of the whole staff and effect-cost.5) To better identify and early monitor the risky acts of hospital management staff so as to reduce the various bad result on the hospitals to the minimum, the study has taken the previous research achievements as a reference to make a empiricism test on the research hypothesis of risk propensity, basing on the reality of the military general hospitals and the three decisive factors as demography, personality, organization and working environment. It finds out that the decisive factors of risk preference change a little but the tendency can be tested in the whole.Totally 550 investigations and expert consulting questionnaires were handed out and the 464 of effective sample were collected, whose results were analyzed and tested by using the methods of Correlation Analysis and Descriptive Statistics Analysis.更多还原