【作者】 汪孔亮；

【导师】 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2010， 博士

【摘要】 医院绩效管理是既是当前医院管理领域研究的热点和难点问题,又是新医改政策加强公立医院监管的重要措施。1研究目的通过对公立综合医院战略绩效的内涵和本质特征的探讨,构建基于社会公益性、所有者权益和医院长期发展需要的战略绩效管理体系,为解决医院绩效管理问题提供理论指导和思路方法。2资料来源与分析方法资料来源于卫生统计年鉴、政府及医院公开数据资料、文献资料数据库、专家访谈资料。理论部分运用文献检索、文献分析、规范性分析和逻辑推理等方法,运用人力资源管理、制度经济学、公共政策学、卫生政策与医院管理等相关理论进行分析。统计分析采用SAS9.0软件。3结果分析通过分析组织绩效的内涵,结合医院特征,探讨了医院绩效的概念、内涵、性质和表现形式。通过对比分析政府部门、事业单位等组织绩效管理的特征和经验,形成了医院绩效管理的概念和特征。通过研究公益性和社会责任内涵,构建了绩效评价内容的判断原则和标准,再结合本研究提出的公立综合医院分类标准,筛选出不同类型公立综合医院战略绩效评价内容框架。定性和定量预测了该内容框架对公立医院行为影响情况。运用简约化方法,模拟了不同状态下公立医院战略绩效形成的趋势变化。对比分析了各绩效形成主体对战略绩效的影响作用,探讨了战略绩效形成的关键环节和主要绩效管理问题,为战略绩效管理提供依据。设计了包括2个层面、4个模块和7个循环子系统的公立医院战略绩效管理体系,以战略为目标,以改进绩效为宗旨,将政府与公立医院作为绩效管理责任主体,通过绩效循环实施对医疗、经济、人力资源、医院管理等医院绩效类型的综合有效管理。研究了公立医院治理机制对战略绩效管理的影响,进而分析在治理结构变革中最具代表性的理事会监管医院模式下战略绩效管理责任和医院院长战略绩效激励机制。重点探讨了医院内部战略绩效管理组织框架与责任体系。4结论与建议战略绩效目标对公立综合医院绩效具有明显的导向作用。其中,公益性和公共服务最大化的价值理念在战略绩效形成过程中发挥着原动力的作用。在核心价值理念驱动下,政府及医院管理组织必须采取各种管理措施才能将各种类型绩效综合汇聚为战略绩效。对战略绩效的有效管理,还取决于责任主体的动力和能力。公立医院法人治理结构有利于加强政府层面战略绩效管理责任,理事会监管绩效的形式提高了绩效管理能力。为公立医院院长设置的基于实现战略绩效的激励机制增强了管理动力。理顺医院内部战略绩效管理责任体系是提升医院能力的现实需要。5创新与不足提出医院绩效有结果产出、行为表现和能力储备三种表现形式,扩大了其概念范畴和内涵,为研究医院管理绩效提供了理论基础。研究了战略绩效形成机制,为动态分析战略绩效,探寻绩效管理的关键环节和解决绩效管理问题提供了线索。设计出基于公益性和社会责任的绩效评价内容判别原则,为筛选绩效评价内容及指标提供了方法和标准。提出了各类公立综合医院战略绩效评价内容框架。设计的2层4维7环节的医院战略绩效循环体系理论,是解决当前绩效管理问题的一种有益探索。研究治理机制、理事会和院长激励机制对战略绩效管理的影响和作用,既是对新医改政策改进医院绩效的呼应又是对政府层面加强绩效管理措施的探索。部分假设和结论还缺乏足够的现实证据予以验证,缺乏现场调研数据支持。更多还原

【Abstract】 Hospital performance management is not only a focus difficult problem in currently hospital management research field, but also an important measure to promote to strengthening supervision to public hospitals in the new medical reform policy.ObjectiveIt aims to set up the strategic performance management system based on public welfare, equity and development needs of the public hospital, through the study on the content and characteristic of the strategic performance of the public general hospital. So it could provide theoretical guidance and ideas to solve the problem of hospital performance management.Data source and analysis methodThe information collects from the health statistics yearbook, the government and public hospital data, literature database, expert interviews. It adopts to several methods, such as the literature search, document analysis, standard analysis and logical reasoning to analyse human resources management, institutional economics, public policy, health policy, hospital management and so on in the theoretical analysis part. It use SAS9.0 software in the statistical analysis part.Analysis of resultsIt analyses the concept and form of the hospital performance, through the analysis of the content, feature and form of the organizational performance, combined with hospital characteristics. It also analyses the concept and feature of the hospital performance management, combined with the comparative study of government departments, institutions and other organization performance management.It constructs the criterion principles of strategic performance evaluation under the public welfare and social responsibility. The criterion principles filter the content frame of strategic performance evaluation for different types general hospital, combined with the classification of public general hospitals. Then it forecasts the influence to the public hospital behaviors using the qualitative and quantitative methods. It establishes several models to simulate the performance formation in different condition, using the simple method. It compares the influence of subject on strategic performance, and tries to find the key of the performance formation, and provides the basis for strategic performance management.It designes the strategic performance management system in public hospital, which including two levels, four blocks and seven loop subsystems. It sets government and public hospital as the subject in charge in strategic performance management in order to achieve strategic objectives and continuously improve performance, integrates the hospital performance such as medical, financial, human resources, hospital management performance through the performance cycle. The establishment of corporate governance structure in public hospital could adjust the strategic performance management system, set clear strategic objectives, give the responsibility of performance management. The board should undertake the regulation responsibility of the strategic performance in public hospitals. Several performance incentive mechanism of operator in public hospital, such as economy, power, reputation and promotion is analyzed, under the restriction of nonprofit responsibility and strategic mission. Then it focus on organizational framework and responsibilities within the hospital.Conclusions and suggestionThe strategic performance goals play a significant role in implementation performance in public hospital. The public welfare and public service values are the impetus role in the strategic performance formation process. The government and hospital management organizations must take all kinds of management measures to integrate all types of performance together as a strategic performance, driven by core values. The effective management depends on the motivation and ability of the person in charge. The corporate governance of public hospital could strengthen performance management responsibilities in the government level. The board in the form of regulatory could improve the performance management capabilities. The performance incentive mechanism can motivate the operator of public hospital. It is actual needs to distinguish the responsibility of the performance management system in the hospital level.Innovation and shortageIt propose three forms of the hospital performance, such as output, behavior and ability, expands the scope and content of the concept, provides the theoretical basis for the study on the hospital management performance. It studies the strategic performance formation mechanism, which provide a clue to dynamic analyse the strategic performance, try to find the key problem of the performance management. It designes the criterion principles based on public welfare and social responsibility, to provide methods and standards to filter performance evaluation contents and index. It proposes performance evaluation framework in various general hospital, using these criterion principles. The strategic performance circulation system theory is a useful exploration to solve the current problem. The study on the impact on the strategic performance management which including governance mechanism, the board and the operator incentive mechanism and so on, is not only the requirements of developing hospital performance in the new medical reform period, but also the exploration to strengthen performance management in the government level.Part of the assumptions and conclusions lack of sufficient evidence to verify the reality. It also lacks of field research data.更多还原