【作者】 周晨；

【导师】 顾海；

【作者基本信息】 南京大学 ， 公共管理硕士（MPA）（专业学位）， 2015， 硕士

【副题名】以东南大学附属中大医院为例

【摘要】 绩效考核的概念来自于企业管理。随着近年来医院市场化的运作模式,绩效考核被渐渐引入医院管理中。我国医院的绩效考核始于上世纪90年代,从当时的情况看,绩效管理是一次从无到有的突破,对医院的管理和发展起到了积极的作用:医院拥有了适用的绩效管理工具;一定程度上调动了医护人员的工作积极性;适度降低了医院运营成本;医院效益,特别是经济效益有了明显提高。但是,经过一段时间的实施,单纯经济效益的考核逐渐显现出弊端:医院内部普遍反映考核没有有效解决分配公平性问题,也无法体现医院的公益性,容易导致开大处方、过度治疗等情况发生。公立医院是带有一定福利政策的社会公益事业的主要载体,但由于政府投入不足、体制不健全等原因,医院处于自负盈亏的状态,首先必须克服生存和市场竞争的重重阻力。因此,医院现有的绩效考核制度很难彻底脱离对经济指标追求的道路。除此之外,大收减大支的粗放型绩效考核制度,会造成医院及医生追逐经济利益的价值观念,让收益少、难度大、技术要求高的医疗服务项目不被医生所重视,开展数量减少,取而代之的是一些成本低、收益高、挣钱快的项目。最终受害的,将是广大患者及全社会。本人通过所在医院的科室,用一年的时间针对绩效考核前后科室绩效、医疗指标和人员薪酬的比较,对绩效考核做了进一步的研究。明显感到,实施绩效考核确实提高了医生的工作积极性,提高了科室收入及个人收入,使临床指标有了较明显的优化。但细致的绩效考核是一个复杂的工作,强调经济指标的绩效考核仍有它的弊端和不完善之处,还需要不断地探索和努力。在此之下,本文提出了几点对于绩效改革的建议。改革绩效考核的本质是改革薪酬分配制度,需要转变以经济目标为主导的核算方式为以工作量为主导的核算方式,且质量重于数量,向难度大、技术性强、责任重的岗位倾斜,鼓励新技术新项目的开展和应用,鼓励医疗手段多样化,重视医疗质量和患者满意度,重视成本的控制管理,在此,有一些优秀的绩效考核评估系统,如RBRVS,值得借鉴采纳,当然也需要不断地磨合。在新形势新环境下,合理地对医院绩效工作有效地考核。在以工作量为主导的核算方式下,拒绝“吃大锅饭”,变科室的二次分配为多次分配,医护分开考核。用医院文化、医院内涵促进绩效管理工作,真正树立医院的公益性。我国也有不少医院,他们医疗成本低、医疗效率高、患者满意度高,而正是有效的绩效管理模式在其中发挥了重要的作用,值得我们借鉴。绩效考核的最终目的是为了控制成本,提高质量,减少患者看病费用,提高患者满意度。将绩效考核做好,亦能有效地缓解“看病难、看病贵”的现实问题,是为百姓、为社会谋福祉的阳光事业。更多还原

【Abstract】 The concept of performance appraisal is from enterprise management.With the mode of operation of the hospital market in recent years,Performance appraisal is gradually introduced into hospital management.Our hospital performance appraisal started from 90’s of last century.From the situation of that time,it was a scratch breakthrough.Performance appraisal played a positive role in the development and management of the hospital,which is hospital has a suitable performance management tools;mobilize the enthusiasm of the medical staff to a certain extent;reduce the cost of the hospital;hospital benefit,especially the economic efficiency has been significantly improved.However,after a period of implementation,the assessment on economic benefits gradually shows disadvantages that are hospital internal generally reflect the assessment fails to solve the fairness problem and the public welfare of hospital,because excessive treatment prescription occurred more often,etc.Public hospital is the main carrier of a kind of public welfare undertakings,but because of the lack of government’s input,the system is not perfect and other reasons,hospital needs to preside over their own profits and losses.To survive and compete in the market,so many obstacles must be overcome firstly.Therefore,the hospital performance appraisal system is very difficult to completely out of the road of pursuit of economic indicators.In addition,the way to calculate the main differences between income and spending,will cause the value pursuit of economic interests of hospitals and doctors and make medical service items which are less income,difficulty and high technical requirement cannot catch doctors’ attention and be carried out less and less.Replace these are items low cost,high profit,to make money fast.The ultimate victims,will be the majority of patients and the whole society.In a department of a hospital as an example,the author through the comparing with before and after performance appraisal in department appraisal,performance indicators,and medical personnel salary,make a further research on the performance appraisal.The author obviously felt,the implementation of the performance appraisal is to improve the work enthusiasm of doctors,improve our income and personal income,make the clinical indexes be better.But the detailed performance appraisal is a complex work,the emphasis on economic indicators of performance appraisal still has its shortcomings and imperfections.We also need to continue to explore and try.Under this background,this paper puts forward some suggestions on the reform of the performance.The essence of the reform of performance appraisal is the salary distribution system reform.We need the transformation of the mode of accounting approach from the economic oriented goal to the workload measure,which is lean toward the post of more difficulty,strong technology,heavy responsibility,the quality is more important than quantity.Encourage the development and application of new technologies and new projects,medical means diversification,and pay more attention to quality of care,patient satisfaction and cost control management.There are some excellent performance evaluation systems,such as RBRVS,is worth using for reference and adopted to keep running.In the new situation and environment,we should have reasonable performance appraisal on hospital to make work effectively.In the method of workload measure as the leading,refuse to eat from the same big pot,change the way of bonus distribution to multiple distributions,separate assessment from doctors and nurses.To set up the public welfare of hospital in the way of performance management that including connotation and culture of hospital.There are many hospitals in China,which hold low cost,high efficiency and high Medical satisfaction of patients.An important reason of that is the effective performance management,which is deserved to learn from.The ultimate goal of performance appraisal is to control costs,improve quality,reduce the medical expense of patients,and improve patient satisfaction.To make the performance appraisal better,can effectively alleviate the practical problem of"medical treatment is difficult and expensive".It is a cause of the people’s livelihood for the people and the benefit of the social.更多还原