论医院文化建设的意义

医院文化是医院物质文化和精神文化的总和,包括物态文化、制度文化和文化心态三个层面.建设医院文化对于促进医院改革、发展和管理等具有重要的意义.在医院文化建设中,医院领导者要有文化头脑,善于从文化角度去观察和认识问题,运用文化手段去做好医院各项工作,这是搞好医院文化建设的关键.     

公立医院的治理结构 ——一个基于交易费用理论的分析框架

理论上,公立医院治理结构被视为在公立医院参与各方(出资人、医生、经营者、患者、供应商)的自我保护机制,当这种保护缺乏或者"不适应"的时候,参与方就会提高价格。实践中,我国公立医院的治理结构改革从未间断,对于公立医院治理结构改革路径尤其是构成成员存在较大差异和争议。文章运用交易费用理论分析了公立医院治理结构构成以及其参与机制(享有表决权的成员还是仅享有知情权的成员),在此基础上,提出应该赋予出资人、医生、经营者表决权;赋予供应商、患者知情权,并分别由两类主体构成理事会(出资人、医生、经营者)和监事会(供应商、患者)。     

医院岗位绩效考核平衡计分卡指标的设计

公立医院的社会公益性质要求医院建立一套既突出岗位价值与贡献和工作效率，又避免以追求创收为目的、经济指标为主的岗位薪酬考核体系。综合运用现代人力资源理论和管理科学理论、结合我国公立医院薪酬体系的现状，设计一套系统、科学有效的按岗取酬、按服务质量和工作效率取酬的岗位考核平衡计分卡指标。运用双层规划法将业务部门的指标考核联系到职能部门，应用层次分析法辅助确认指标权重。     

Bayesian Inference for Hospital Quality in a Selection Model

This paper develops new econometric methods to infer hospital quality in a model with discrete dependent variables and nonrandom selection. Mortality rates in patient discharge records are widely used to infer hospital quality. However, hospital admission is not random and some hospitals may attract patients with greater unobserved severity of illness than others. In this situation the assumption of random admission leads to spurious inference about hospital quality. This study controls for hospital selection using a model in which distance between the patient's residence and alternative hospitals are key exogenous variables. Bayesian inference in this model is feasible using a Markov chain Monte Carlo posterior simulator, and attaches posterior probabilities to quality comparisons between individual hospitals and groups of hospitals. The study uses data on 74,848 Medicare patients admitted to 114 hospitals in Los Angeles County from 1989 through 1992 with a diagnosis of pneumonia. It finds the smallest and largest hospitals to be of the highest quality. There is strong evidence of dependence between the unobserved severity of illness and the assignment of patients to hospitals, whereby patients with a high unobserved severity of illness are disproportionately admitted to high quality hospitals. Consequently a conventional probit model leads to inferences about quality that are markedly different from those in this study's selection model.