1 Measures to strengthen medical quality management
1.1 The establishment of a quality management appraisal system is the basic way of medical quality management Developing a set of scientific, standardized, rigorous, and realistic medical quality evaluation index system is directly related to the effect of medical quality management. This set of evaluation system should be combined with individual quality control, departmental quality control, hospital-level quality control and comprehensive quality control to develop, and the whole process of control and focus on the combination of control, individual control and organizational control, intra-departmental control and inter-departmental control, and finally carefully organized evaluation work to ensure that the evaluation is not a mere formality [1]. Using the case as a quality unit of management evaluation, the establishment of selective, practical, immediate, operable case typing index model, the effect and process, quality and cost of organic combination, a comprehensive scientific evaluation. Implementing the "comprehensive evaluation of clinicians" method, including medical ethics, work attitude, work quantity, work quality, business ability, technical level and other eight elements, each evaluated physician ultimately has a comprehensive score, within the department and the hospital within the same position for sorting, so that everyone has a good understanding of their own positioning.
These are the first eight components of the evaluation.
1.2 Qualified management personnel is the focus of hospital quality management Hospitals should have specialized medical technology managers and specialized administrative managers. Medical technology managers to grasp the direction of the development of medical technology in the hospital and the level of development; administrative managers to be responsible for good internal hospital administration, logistics and other management, do a good job of protection. In the face of the market economy, knowledge-based economy, global economy and other new economic concepts and patterns, in the face of China's accession to the WTO to introduce strong competition, in the face of the reform of the health care system, the hospital's cultural connotation of the construction, in the face of the people's health needs, the personnel policy, technical, collaborative, commercial, control and other integrated capacity to put forward special requirements, and China's current hospital managers non-professional status quo is difficult to cope with. The quality of hospital managers has not simply just decide the level of quality of the hospital, but to determine the survival of the hospital, to determine the success or failure of China's health reform and modernization process. Therefore, as soon as possible to realize the professionalization of hospital managers is imperative [2].
1.3 Optimization of the medical service process is the means of hospital competition Hospitals to adapt to market changes, high social demand for the project to expand, strengthen; less social demand, is shrinking the project, to be resolutely compressed, merged; to combine with the actuality of carrying out specialties with characteristics, specialist clinics or new technologies, new projects, to characteristics to attract patients to features to cultivate a new point of growth to stimulate the hospital's survival! Vitality of the hospital. Hospitals should optimize the medical service process without increasing wards and personnel, which determines the cost and competitiveness of hospitals, which largely enhances the long-term viability of hospitals. To achieve this goal, hospitals must efficiently configure available resources, identify potential bottlenecks in a timely manner, and reduce duplication and waste by balancing the various components of the process, so that the hospital's existing hardware and software to achieve a greater utilization rate and a better level of utilization, as far as possible to play the ability of professional and technical staff to meet the needs of patients, and to achieve greater economic and social benefits [3]. At the same time, to implement the dynamic analysis and management of the medical service process, so that medical services are in a dynamic adaptation to the changing needs of the health care market, can not waste the supply of medical services in the trough, increase the amount of services provided in the peak, to build a new model of efficient, lean and dynamic medical institutions.
1.4 Sound system and mechanism is the basis of medical quality management At present, China has issued more than 20 health laws and regulations such as the "Practicing Physicians Law", "Regulations on the Administration of Medical Institutions" and "Regulations on the Handling of Medical Accidents", and hundreds of health laws and regulations, which regulate the behavior of medical services, strengthen the quality of supervision of hospitals, and ensure that the interests of patients. To strictly implement the medical technology service standards, to ensure the quality of medical services, reflecting the people-oriented, patient-centered connotation, so that the quality of medical services to maximize to meet the needs of patients. Health legal means for health legal system construction, for medical quality management provides a legal weapon, for hospitals and professional and technical personnel to provide a fair environment for competition. At the same time, it is also necessary to strengthen the construction and improvement of medical service supervision mechanism, the establishment of medical institutions and professional and technical personnel to pass the access and exit standards, purify the team of medical institutions, shaping a good image of the health system [4].
1.5 The implementation of comprehensive monitoring is to strengthen the protection of medical quality management (1) full monitoring: everyone is the monitoring of the recipient, everyone is the monitoring of the implementer, so that medical personnel are always in serious self-control and self-awareness of each other in the control. (2) Full-post monitoring: outpatient, clinical, medical and technical departments, as well as medical administrative functions, have clear quality indicators and specific monitoring measures. The work of each position in the hospital is under close monitoring and normal operation. (3) All-item monitoring: checking, treatment, nursing work in the quality of the standard situation, basic quality, link quality, end quality, all quality programs are under monitoring. (4) Full-time monitoring: 24h tracking and monitoring of medical quality, all-weather monitoring. There are no holidays in medical quality monitoring; no matter whether the superior inspection or after the inspection, the quality control work is not relaxed; no matter whether the summary of the evaluation or usual, the quality control work has no gap [5].
2 Trends in the development of medical quality management
2.1 The establishment of CQI (Continuous Quality Improvement) group to clinical diagnostic and treatment technology quality control as the focus of quality control methodology research, through the "clinical pathway" research, according to the same type of disease in a number of cases from the beginning to the end of the examination, diagnosis, treatment (including the disposal of prescription medications, Through the study of "clinical path", registration, statistics, analysis, comparison and evaluation of technology and service items, medical effect and service satisfaction of the whole medical process of several cases of the same disease from the beginning to the end of examination, diagnosis, treatment (including disposal, prescription and use of drugs, surgery, etc.), nursing care, meals, etc., are carried out to determine the medical quality control plan of the disease, promote the standardization of medical behaviors, and improve the quality of medical services. The responsibility of medical quality management should not only be borne by the managers, but more mainly by the wide participation of medical and nursing staff, forming quality control groups (QC) beyond the boundaries of disciplines, and carrying out quality improvement research on thematic projects. This mass research and improvement activity will be synchronized with clinical research to continuously improve the quality of medical care, while advancing the development of medical science and technology in a broader sense [6]. Continuous quality improvement in hospitals can include: assessing the current situation, establishing improvement goals, finding, evaluating and implementing solutions, measuring, examining and analyzing results. Specifically manifested in the hospital assessment indicators after the effective assessment, so as to ensure that the assessment indicators of the hospital's overall management of the improvement and enhancement of continuous guidance.
2.2 Implementation of the whole process, the full range of medical quality management Comprehensive quality control of medical quality, including clinical departments, medical and technical departments and medical functions to meet the standards, the "three basics" training, systematic holistic care and other basic quality management; to strengthen the third-level physician visits, nursing visits, surgery, first aid, and other medical technology throughout the process of quality control It also strengthens the quality control of the whole process of medical technology such as third-level physician's visit, nursing visit, surgery, first aid and indoor quality control of medical technology, pays close attention to the quality management of single-type of disease, and adopts the comprehensive evaluation of the efficiency rate, average hospitalization day and average hospitalization cost, so as to promote and drive the quality of all aspects of the hospital. The organic combination of systematic overall care and nursing quality management will further improve the nursing quality system. Clinical pharmacy, medical testing, pathology, nutrition and anesthesia will generally adopt quality control technology and improve the quality system of each specialty. To be patient-centered, in which the quality of medical technology is the intrinsic quality and quality service is the extrinsic quality of medical service. If only the comprehensive quality control of medical technology, but ignore the importance of medical service style, service attitude, can not realize the patient-centered hospital purpose. Ensuring medical safety, preventing errors and accidents, and reducing disputes are important and indispensable aspects of all-round quality management in hospitals. Hospital operation must adhere to the social benefits as the highest criterion, put an end to one-sided pursuit of the hospital's own economic benefits, while ignoring the quality of the benefits and social benefits, otherwise the quality of medical services will inevitably slide across the board. Control of medical costs, is to ensure the quality of medical services under the premise of reducing medical consumption and medical costs, with less medical costs for patients to provide quality services [7, 8].
2.3 Increase the strength of personnel training and continuing medical education Persistently grasp the talent training, grasp the academic education, on-the-job education and pre-service training, improve the quality of the whole staff. According to the needs of various specialties, personnel with intermediate titles or above should be continuously sent to major hospitals at home and abroad for further training and study, enriching and absorbing advanced technology, and supporting them to use what they have learned for medical work. Basic training is strengthened, theoretical lectures are regularly conducted to popularize the knowledge of resuscitation of critical illnesses; the principle of self-study is adhered to to stimulate the initiative of medical staff to learn; experts from home and abroad are invited to the hospital to give academic lectures to promote two-way exchanges. Organize assessment groups in phases to carry out theoretical assessment and skill operation assessment after lectures, and their scores will be linked to the year-end assessment and evaluation of the comprehensive level of medical care, so as to promote the gradual systematization, institutionalization and standardization of medical personnel's subject knowledge [9].
2.4 Increase the strength of medical quality grading supervision The health authorities at all levels should actively create conditions to increase the strength and frequency of medical quality supervision as soon as possible, supervise hospitals to strengthen quality management, and gradually form a quality-benefit-oriented hospital development model. Hospitals with obvious medical quality or quality management problems should be notified and criticized, and rectification should be made within a limited period of time; hospitals with ineffective rectification and serious medical quality problems or quality management problems should be dealt with seriously in accordance with the "Regulations on the Administration of Medical Institutions" and other provisions, so as to effectively fulfill the duties of medical quality supervision and management. To quality management rules of quality control measures, level by level, public understanding, responsibility to a person, timely and fair and strict award and punishment, depending on the quality of medical care, in the award and punishment of the parties concerned at the same time, together with the relevant leadership and reward and punishment. The quality of health care winning unit, award employees, more award leaders; poor quality of the department in the criticism of the punishment of the parties at the same time, doubling the punishment of the main leadership of the department.
2.5 Increase the strength of social supervision and control of hospital quality management With the development of the market economy and social progress, the state will be for the quality of industrial products and services to establish a social supervision and control mechanism, medical services are no exception. This supervision and control will gradually from the soft constraints (mass supervision, news media supervision) to the development of hard constraints (legal and economic constraints), so that this level of social constraints with the masses, the legal system and the nature of economic compensation [10].