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公立医院改革下一步:从外部治理转向内部管理

2019-12-08 张斯文 健康界

12月6日,浙江大学医学院附属第二医院150周年系列学术活动暨第八届海峡两岸医院院长论坛在杭州召开。论坛汇聚两岸专家学者共话现代医院管理新动向。公立医院改革核心已转变为内部管理变革“近年来,公立医院得了四种病:逐利症、虚胖症、供给失调症、思食症。”国家卫生健康委体制改革司司长梁万年表示。梁万年进一步解释说,逐利症是指公立医院在运行过程中以经济利益为主,往往将公益性放在了次要位置;虚胖症是由于公

12月6日,浙江大学医学院附属第二医院150周年系列学术活动暨第八届海峡两岸医院院长论坛在杭州召开。论坛汇聚两岸专家学者共话现代医院管理新动向。

公立医院改革核心已转变为内部管理变革

“近年来,公立医院得了四种病:逐利症、虚胖症、供给失调症、思食症。”国家卫生健康委体制改革司司长梁万年表示。

梁万年进一步解释说,逐利症是指公立医院在运行过程中以经济利益为主,往往将公益性放在了次要位置;虚胖症是由于公立医院收入逐年增加,但收支结构不够合理,药品收入、耗材收入占比较高造成的;医院定位不明晰,医院间无序、盲目竞争是供给失调症的主要诱因;而“思食症”则是由于医院大小病“通吃”,尤其是三级医院门诊量过大,造成医疗资源的浪费现象。

“国家围绕这4个病拉动了一系列的改革,包括取消药品加成,今年又将所有公立医院的耗材加成取消,以此为切入点带动公立医院的政府投入责任、价格、医保支付、药品集中招标采购、编制、薪酬、人事及公立医院评价等一系列改革。”梁万年表示。

事实上,如何治疗公立医院上述四种病,国家层面早有探索。

2017年国务院办公厅出台《关于建立现代医院管理制度的指导意见》,2018年中共中央办公厅和国务院办公厅出台《加强公立医院党的建设的意见》,昭示着医疗体系公立医院改革进入了一个新阶段。

同时,国家也要求医院建立权责清晰、管理科学、治理完善、运行高效、监督有力的现代医院管理制度,要求加强党的领导,完善医院外部治理,加强医院内部管理。

“下一步,医改对公立医院改革的核心已逐渐从外部治理改革转向内部管理变革”梁万年提醒医院管理者,内部管理变革是需要从观念上认识到变革的必要性,才可以下手的。

传承文化脉络才能把握时代脉搏

在机遇与挑战并存的形势下,医院如何才能转变思维,找准方向,健康发展?

用十年时间,从复旦排行榜的五十强开外跻身到今年榜单的第十九位,浙江大学医学院附属第二医院(下称浙大二院)给出的参考答案值得借鉴。

精心细致、仁厚博爱、牺牲奉献的服务文化,与时俱进、结合实际、追求原创的创新文化与注重人文培育、夯实基础、强调实践的培育文化构成了正值建院150周年的浙大二院颇具内涵的文化脉络。

“在传承文化的基础上要有创新,结合时代特征、吸收时代烙印才能引领潮流。”浙大二院院长王建安介绍,医院一路走来,在服务文化当中强调更精细、安全和更高效,创新当中强调产学研、大数据和智能化,培育文化中注重专业化、全程化和全球化,形成了新的服务文化、创新文化和培育文化。

1989年,浙大二院成为了全国第一家三甲医院,并逐步推动医院的质量管理更加精细。在互联网医疗实践过程中,浙大二院将远程门诊与实地门诊结合,尽可能地帮助偏远地区提升重症监护服务能力。据了解,浙大二院托管了新疆克拉玛依医院的重症监护室,成立eICU,通过远程手段,帮助当地重症监护室医生看管病患。此外,浙大二院“最多跑一次”改革实践还得到了浙江省省委书记车俊的批示:在全省医疗健康系统推广。

在浙大二院150周年系列学术活动的开幕式上,100余位35周岁以下、近三年拿过国家级项目资助或发表过高影响因子论文的青年医生登台唱响院歌,诠释医院年轻一代的激情、活力与梦想,这也是浙大二院打上时代烙印的创新文化的直观体现。“我们特别注重以临床医生为主所提出的有利于临床发展的问题,并愿意为他们搭建创新平台,希望能联合材料、信息、影像等更多相关部门,为改善临床诊疗发出强大的浙大声音。”王建安表示。

用数据打破医院围墙

在医疗发展进程中,各类问题因地而异、无处不在,通过信息化手段打破地域界限加强交流与合作已经成为趋势。

来自台湾花莲慈济医院的医务秘书李毅表示,花莲慈济医院正在探索建立一个没有围墙的医院。据他介绍,台湾花莲市户籍人口有15万,其中四分之一属于少数民族,当地经济水平、教育水平、健康水平相对较低,医院的照护负担很大。为此,花莲慈济医院基于对民众的照护责任,从2014年开始,针对末期病人采用云端科技,提供高质量的末期病患居家照护。目前,医院已将这一经验拓展到花莲最困难的偏僻乡镇海端乡。

“精准健康或精准医学与大数据环环相扣,通过数据收集达到精准医学信息的募集,再反过来收集数据,之后进行循环,最终让企业、医院、患者在应用中受益。”台北护理健康大学信息管理系暨研究所教授徐建业在论坛上表示,将一个群体的健康数据特征进行抽取,会产生一些知识、推论、预测、解释、因果关系模型,从而形成个体化的健康医疗、决策支持、健康管理、行为建议等,最终可应用于个人化的精准健康照护。
 
现场精彩观点:

澳大利亚墨尔本大学教授林延龄:临床医学之父奥斯勒认为一个好医生要具备知识、智慧、怜悯、爱心、诚实、领导、中立、系统性、仔细思考病人、谦卑宁静的态度等基本条件。

加州大学洛杉矶分校医学中心人才引进、培训和组织发展资深主任 Robin  Ludewig:(能力+适应性)*投入=成长,因此能力是员工必备的基础条件。

法国格勒诺贝尔大学医院国际部主任 Duriez  Guillaume:在格勒诺贝尔大学医院有一个理念,我们认为仅凭一己之力在创新以及新理念的挖掘上是无法成功的,一定要与利益相关方共同合作,从他们的角度了解体验,才能知道他们想要什么。

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    2020-03-19 d830372
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    2019-12-17 一天没事干

    很好的学习机会

    0

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    2019-12-13 一天没事干

    很好的学习机会

    0

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两个重要文件,即将公布。

杭州将启动医共体支付方式改革

“到2022年,基层就诊率达到65%以上,县域就诊率达到90%以上。”记者了解到,《杭州市县域医共体医保支付方式改革实施细则》已于近日印发,今年,我市将全面启动医共体支付方式改革,明年全面实施,基本建成在总额预算管理下的多元复合式支付方式。多元复合式医保支付方式,是指在现有医保支付方式基础上,推进在总额预算管理下的DRGs点数法付费、按床日付费、按人头付费和按项目付费等相结合。具体一点说,就是对住

又一省,卫生院与村卫生室、村医合为一体

又一省推行乡镇卫生院与村卫生室一体化管理,村医身份转变进展加快。

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