Keywords: medical units, performance, discuss
Performance pay according to the technical content of the post, the size of the responsibility, labor intensity and environmental advantages and disadvantages to determine the post level, based on the results of the employee's labor to pay labor compensation, is the labor system, personnel system and wage system closely integrated wage system.
1. The necessity of the implementation of performance pay
1.1 Current problems in hospitals
Currently, public medical units have low utilization of resources, backward business mechanism, and lack of operational concepts. The sense of competition has increased, but there is a lack of effective incentives and constraints on the operating layer, and the treatment of medical staff is unreasonable. Social satisfaction with the hospital is low, the contradiction between doctors and patients is prominent, and the hospital revenue structure is unreasonable.
1.2 Challenges faced by hospitals
Competition in the medical service market: the trend of global economic integration will accelerate the development process of China's Sino-foreign joint venture hospitals, private hospitals, and advanced private clinics. The opening of the medical service market and the entry of foreign and private capital provides the most basic conditions for market diversification, and large and medium-sized cities will be the most competitive areas. With the cooperation of the new medical security system, medical services will be multi-level, that is, all levels and types of medical institutions must have a clear market positioning.
Competition in hospital management mode: The advanced experience and operation mode of international hospital management has been gradually introduced into China's healthcare market, such as the separation of hospital ownership and operation, the application of professional management mode for hospital operation, the implementation of entrepreneurial management in hospitals, the implementation of total quality control management, and the completion of the transformation from result management to process management. The implementation of quantitative management, control costs and expenditures. And the domestic medical industry management system has not been reformed, compared with the international hospital management level is far away.
The competition of medical talents: including medical research talents, clinical medical talents and hospital management talents. Global integration, participation in international competition is, in the final analysis, the competition for talent. Due to the emergence of Sino-foreign joint ventures, private hospitals, hospital management mechanism, talent mechanism will be a fundamental change. The distribution mechanism of foreign-funded hospitals will have a huge impact on the existing income situation of doctors. Just like other industries, once foreign capital intervention, they will hire the best talents with high salaries, and then to train them, so that the international talent in line. This will be a great attraction for talented people, and there is no corresponding talent mechanism of state-owned hospitals will face a shortage of talent or aging talent lagging situation.
The effect of the implementation of performance-based payroll distribution, directly affecting the retention of highly skilled personnel, affecting the staff's motivation and efficiency, while affecting the normal operation of the hospital.
2. Design of the performance allocation program
2.1 Clinical department performance
Clinical department performance = ∑ department medical items × performance unit price × (medical management evaluation score + nursing evaluation score) ± controllable cost difference × reward and punishment ratio ± other rewards and punishments
Medical and nursing management quality control assessment scores by the Ministry of Medical Affairs and the Department of Nursing organized by the experts. The assessment indexes can be designed according to the medical work priorities of each month or a certain period of time, combining fixed and variable.
The unit price of performance is the reward standard for each medical service item, excluding pharmaceutical items.
Controllable cost variance: the difference between the controllable cost for the next year, which is approved according to the previous year's controllable cost standard, and the actual cost. The amount of the difference is awarded and penalized according to one case.
2.2 Ward Nursing Staff Overwork Reward
In order to reflect the value of the labor of the ward nursing staff, there are beds set up for the daily workload, the nursing staff overwork reward is calculated on the basis of the number of intensive care bed days.
Critical care and level I care ≥ prescribed bed days, the excess part of each bed day will be rewarded.
2.3 Performance of medical and technical departments
Departmental performance = (volume of departmental services × unit price of performance) × medical quality control score ± controllable cost variance × proportion of rewards and penalties ± other rewards and penalties
(The actual performance of medical and technical departments shall not be greater than the balance of departmental income and expenditure.)
Can be based on the previous year's average monthly service volume, down 20% as the approved medical technology department monthly basic service volume.
The portion that is lower than the basic service volume shall be calculated based on the basic incentive unit price,
The portion that is higher than the basic service volume shall be calculated based on the basic incentive unit price x a certain multiplier.
Other incentives and penalties: other hospital departments stipulated by the incentives and penalties, such as: quality control, hospital sensory indicators, etc.
Controllable cost of the standard difference in the amount of the analysis by the month, according to the 5% incentives and penalties, semi-annual settlement.
Each month, 10% of the total reward is set aside as half a year after the cost and indicator assessment more or less.
2.4 Administrative Job Performance
Administrative logistics general job performance, the implementation of the post value system. Each position according to the nature of the job, the weight of the task, involving the size of the job design score.
Reward performance per point = total monthly performance/total points for the whole hospital
Job performance reward = reward performance per point x job points x comprehensive rating (self-rating 50% + 50% of the section supervisor) ± rewards and penalties
Administrative scoring indexes, such as: efficiency, cooperation and collaboration, problem-solving ability, learning and methodology, attendance.
2.5 Pharmacy job performance
Pharmacy job performance = ∑ number of prescriptions × performance unit price × comprehensive evaluation index score
Pharmacy job assessment indicators:
a, transfer accuracy
b, the average monthly stock of medicines shall not exceed one month's normal consumption
c, quarterly pharmacy, pharmacy inventory of the Loss rate of traditional Chinese medicine ≤ 1%, Western, proprietary drugs ≤ 0.5% within
2.6 individual performance
Encourage medical staff to strive to improve the level of medical care, to ensure that the quality of medical record writing, while reflecting the difference in medical difficulty, intensity, and level of technical skills, the hospital set up a medical record of acute and critical illnesses, difficult and complicated case management awards.
In order to satisfy the majority of patients on holidays and evenings to the hospital, encourage departments to send doctors to outpatient clinics on holidays and evenings to work, according to the holiday overtime pay standard incentives.
Outpatient clinic nurse performance incentives combined with the number of people guided to the clinic, the number of patient appointments, service attitude and the number of patient complaints after the assessment of the indicators issued.
2.7 Total performance control methods and secondary distribution methods
a, performance is divided into a combination of comprehensive reward performance and individual rewards, with comprehensive performance as the main.
b, the total amount of performance: control within the scope of the higher departments to set the verification, of which: 90% for the whole hospital performance issued; 10% in accordance with the provisions of the assessment for the whole hospital regulation, especially the quality of service and high service level, the workload of the department, the benefits of the rapid growth of the incentive performance of the Department of the Department of the lesser. Department in the distribution of nurses bonus, should be tilted to the nurses on night shift.
3. Suggestions for performance pay reform
3.1 At present, the hospital is still a poorly funded unit, but the essence of the self-supporting component of the absolute proportion. Hospitals are in constant pursuit of high quality, low-cost service concepts, has not much difference from running a business. The government should be strictly regulated in terms of medical practice behavior, while the self-supporting medical industry staff allocation can not be too tight, too tight will lose vitality and development momentum.
3.2 The total performance (including state stipulated allowances, basic performance and performance) according to a certain percentage of the business income of each hospital to be approved, various types of hospitals can be different proportions. Hospitals in the year the number of employees change, but the total performance of the year can not break through the approved ratio.
3.3 retain a certain percentage of the welfare fund from the balance of medical income and expenditure. Only good business management, cost saving expenditure can have medical balance, is to encourage hospitals to do their own business and development, to avoid waste of resources, more services to patients.
3.4 In order to ensure that the hospital salary and welfare costs are reasonable, can be formulated: First, the medical balance is negative hospitals are not allowed to pay welfare costs; Second, the hospital per capita income growth level shall not exceed the level of growth in operating income for the year. Through the total performance and per capita income does not exceed the current year's operating income growth rate of the double standard limit to regulate the distribution of medical industry reform.
Medical unit performance pay reform involves many interests, in the process of formulating the performance pay reform program, we must listen to the voices of different levels and different groups; in the construction of the index system, job evaluation, to determine the value of the job score and other professional and sensitive issues, to maximize the balance of interests of all parties, the successful completion of the task of the performance pay reform, to maintain the healthy development of the hospital.