【摘要】 目的 基于期望理论框架，设计一套科学合理的手术绩效评价方案，优化医生激励机制，提升医院手术相关绩效运营管理水平。方法 通过知情人访谈充分挖掘现有手术绩效评价存在问题，在此基础上基于手术疑难指数的聚类和绩效比例的测算构建“四级九档”绩效方案，并通过计算新旧方案的卡林斯基-哈拉巴斯指数和簇内平方和，并设计问卷向临床科室进行征询，测试新方案效果。结果 模拟显示该方案能够更加合理区分不同资源消耗和疑难程度的手术并进行补偿，有助于发挥绩效引导作用，有效提升临床进行高难度手术，同时帮助临床科室形成资源管控意识。结论 在进行手术绩效评价时应平衡临床科室医务人员期望与医院绩效运营管理需求，通过合理的方案设置、配套管控举措的应用和及时的动态调整，实现适度激励，为医院手术绩效管理提供更科学的路径。更多还原

【Abstract】 Objective Based on the expectation theory framework, design a scientifically reasonable surgical performance evaluation plan,optimize the doctor incentive mechanism,and improve the hospital’s surgical related performance operation and management level. Method Through in-depth interviews with insiders,it fully explored the existing problems in surgical performance evaluation. Based on this,it constructed a “four-level,nine-grade”performance scheme based on the clustering of surgical difficulty index and the calculation of performance ratio. It tested the effectiveness of the new scheme by calculating the Karensky-Harabasz index and within-cluster sum of squares for the new and old schemes, and designed a questionnaire to consult clinical departments. Result Simulations showed that the scheme could more reasonably distinguish and compensate for surgeries with different resource consumption and difficulty levels, which helped to exert the guiding role of performance and effectively improve the hospital’s ability to perform high-difficulty surgeries, while also helping clinical departments form a sense of resource control. Conclusion When conducting surgical performance evaluation,it is necessary to balance the expectations of medical staff in clinical departments with the needs of hospital performance operational management. Through reasonable scheme setting,application of supporting control measures,and timely dynamic adjustments, appropriate incentives can be achieved, providing a more scientific path for hospital surgical performance management.更多还原