Cross-national policy learning in health system reform: The case of Diagnosis Related Groups

Observations of policy convergence and the cross-national diffusion of ideas, knowledge and policies have raised the question about the ways countries might learn from their peers. This article examines the role of cross-national learning with regard to Diagnosis Related Groups (DRGs). We review the spread of this policy instrument and analyse the implementation of DRGs in three late-adopting countries: Germany, Switzerland and the Netherlands. The three cases show that the implementation of this policy instrument required intense studies, cooperation with stakeholders and adjustment to country-specific needs. The countries learned from foreign experience, but it was only with the introduction of a regulatory framework for competition between sickness funds that DRGs came fully onto the political agenda. While Germany and Switzerland drew upon foreign DRG models, the Netherlands developed an alternative system to classify patients according to case-mix.     

南通市乡镇医院人力资源情况分析

目的：了解民营乡镇医院卫生人力资源发展情况及其影响。方法：以整群抽样的方式,调查了南通市3个县（市）所有改制乡镇卫生院。结果：民营乡镇医院卫生技术人员数量不足,专业素质提高缓慢,卫生人才队伍不稳定。结论：民营乡镇医院卫生人力资源发展落后,影响农村基本医疗卫生保障;乡镇卫生技术人员素质亟待提高;强化农村卫生的政府责任,保障农村居民公平享有基本医疗卫生服务。     

医德教育、医德修养与医院文化行为

医院文化行为是医德的心理发生机制 ,它与医德教育、医德修养有着密切关系。二者在目的、内容、习得方式、培养途径及境界实现等方面具有互动的可能性。这种互动一方面使医院文化行为在抉择取舍时更具科学性 ,更能促进医学道德的发展 ;另一方面使医德教育与修养的内容和方式符合于医院文化行为特征 ,能更好地为医学发展服务     

The perceptions of hospital social workers in Saudi Arabia regarding the organisational factors that impact on their role

The perceptions of ten social workers regarding their practice within the organisational context of Saudi hospitals were examined using semi-structured interviews. A qualitative analysis employing a thematic approach informed by grounded theory was undertaken and produced the two broad interrelated themes – organisational structure and management processes – which highlighted an overarching concern of an 'us and them' division between social workers and management. The discussion shows how solutions to the perceived difficulties of social workers in hospital settings require a consideration of how partnership between practitioners and management personnel may be enhanced.     

For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

基于数据包络分析的江苏省三级民营医院运营效率研究

目的：研究江苏省三级民营医院运营效率的动态静态变化情况。方法：采用数据包络分析法中的BCC模型和Malmquist指数模型对2014—2016年江苏省三级民营医院的相对有效率进行测算和比较。结果：江苏省三级民营医院三年综合效率平均值为0.944,全要素生产率指数年均增长2.1%,技术变动年均增长4.1%,效率变动平均下降1.9%,全要素生产率增长主要得益于技术进步,而发展缓慢主要是受到了规模效率变动指数下降的限制。结论：江苏省三级民营医院目前总体上处于平稳发展的状态。医院发展要兼顾技术和技术效率,优化资源配置、完善管理模式与运行机制、重视技术创新、不断培养高水平人才,才能持续提升三级民营医院的运营效率。     

医院精益管理中的门诊窗口结算流程优化设计探析

以“精益管理”为理论基础,结合S医院的实际情况,以项目管理中时间管理的方法,将研究理论切实地应用于实际工作中的各个环节?从如何缩短患者等待的时间点出发,研究出一套切实?落地?可行的优化方案,并对方案实施效果进行前后的对比分析,为医院的发展以及卫生行业内相关研究提供科学?有效的依据和数据支持?     

医院简介编译策略探析

基于中美30家医院官网英文简介的文本分析,对比中美医院英文简介在传播内容、文本结构、修辞手段和多模态使用等四个方面的异同,讨论中国医院英文简介存在的不足,旨在探讨编译策略在医院简介翻译中的应用。认为医院简介的英译不可采取一一对应的完全翻译策略,而是应充分考虑读者的接受度,通过精简篇幅、筛选内容、厘清结构、变换人称以及增加模态等编译策略使译文无论是在内容层面还是结构形式上都更易为读者所接受,以期达到理想的传播效果。     

江苏省民营医院发展状况及策略研究

目的：揭示江苏省民营医院的发展状况,为进一步鼓励和吸引社会资本投资医疗卫生领域,提供有效的政策建议。方法：采用描述分析和对比分析对江苏省2011—2015年的民营医院数量、等级情况、床位配置、卫生人力资源、诊疗服务能力、服务效率进行研究。结果：目前江苏省民营医院整体在快速成长,医院数量、病床数、服务量等医疗服务市场占有量都有了较快增长,但是仍然存在诸如自身市场定位不清、医疗卫生资源短缺、政策落实困难等一系列问题。结论：民营医院要坚持多元化发展,正确定位;加强自身人才建设,形成人才储备;做好政府监管,规范医疗服务市场。     

Clinical Capital and the Risk of Maternal Labor and Delivery Complications: Hospital Scheduling,Timing, and Cohort Turnover Effects

The establishment of interventions to maximize maternal health requires the identification of modifiable risk factors. Toward the identification of modifiable hospital‐based factors, we analyze over 2 million births from 2005 to 2010 in Texas, employing a series of quasi‐experimental tests involving hourly, daily, and monthly circumstances where medical service quality (or clinical capital) is known to vary exogenously. Motivated by a clinician's choice model, we investigate whether maternal delivery complications (1) vary by work shift, (2) increase by the hours worked within shifts, (3) increase on weekends and holidays when hospitals are typically understaffed, and (4) are higher in July when a new cohort of residents enter teaching hospitals. We find consistent evidence of a sizable statistical relationship between deliveries during nonstandard schedules and negative patient outcomes. Delivery complications are higher during night shifts (OR = 1.21, 95% CI: 1.18–1.25), and on weekends (OR = 1.09, 95% CI: 1.04–1.14) and holidays (OR = 1.29, 95% CI: 1.04–1.60), when hospitals are understaffed and less experienced doctors are more likely to work. Within shifts, we show deterioration of occupational performance per additional hour worked (OR = 1.02, 95% CI: 1.01–1.02). We observe substantial additional risk at teaching hospitals in July (OR = 1.28, 95% CI: 1.14–1.43), reflecting a cohort‐turnover effect. All results are robust to the exclusion of noninduced births and intuitively falsified with analyses of chromosomal disorders. Results from our multiple‐test strategy indicate that hospitals can meaningfully attenuate harm to maternal health through strategic scheduling of staff.