公立医院改革汇报

公立医院改革汇报 ***人民医院 公立医院改革现状和面临的主要困难 一(医院基本情况 ***人民医院始建于1942年～医院占地面积2.2万平方米～建筑面积为1.8万平方米～开展床位250张～在职职工287人～是县域内唯一一所二级甲等综合性医院。2011年门诊患者5.6万人次～住院患者6900人次～业务收入2000余万元～医药比为37.8%～病床使用率为80%。 医院设有办公室、医务科、公共卫生科、护理部、质控科、医院感染管理科、财务科及后勤办等八个行政职能科室～有门诊部、急诊科～住院部有内一科、内二科、内三科,感染科,、儿科、中医科、外一科、外二科、妇产科、骨科等九个临床科室～有检验、放射、功能、药械科、手术麻醉等五个医技科室。能够常规收治冠心病、心肌梗死、高血压、糖尿病、急性脑血管意外、肝硬化、肺心病等常见疾病～能够开展胆囊、胃、脾、肠道、疝、阑尾、甲状腺、卵巢、子宫、白内障、扁桃体、鼻腔等手术和四肢脊柱骨伤的各种内外固定术。 医院拥有螺旋CT、数字胃肠机、CR拍片机、G60彩色超声诊断仪、V-7 0电子胃镜、英国百斯麻醉机、脉动预真空消毒锅、牙科综合治疗机、BT2000全自动生化分析仪、体外碎石机、骨科C型臂、眼科显微镜、腹腔镜等大型医疗设备3 0余台～价值1300余万元。 二(我院近年公立医院改革现状 近年来～在县委县政府和县卫生局的领导下～医院领导Is team-oriented and team building. Persisting in democratic centralism, improve the level of team science decision, a democratic decision. Strengthening the concept of collective leadership, by collective discussions and decisions on major issues. 5 years, between members of the team did Frank, equal treatment, mutual trust, mutual support and form a innovation-oriented, democratic solidarity and diligent people, honest type of four good teams. Second, focus on the transformation of work style. Requires team members to actively think, active officers to organize work, active inspection work, initiative, by the Office and of the primary station and village (community), and make sure regardless of Division of labor and mutual support, mutual Help and complement each other, understand each other, improve leadership skills of managing. Third party organizations are weak and lax, strengthening regulation (community) party organizations and cadres, improve service levels, and enhance team effectiveness. The work style of the party members and cadres in the whole town has been further changes. 2. the cadres, and improve the overall quality of party members and cadres. First, grasp the cadres team construction. Cadres of the new and improved the regulation, the town village appraisal methods, training of party members and other 8 work, effectively promote the work, put an end to the previous shuffle, prevarication is not responsible for the phenomenon. Second, strengthening the construction of grassroots party organizations and party members. Catch the party branch Secretary of team-building, improving overall quality. Healthy village (community) cadre appointment system. Perfect village 班子坚定不移地以科学发展观统领全局～不断深化医疗体制改革～牢固树立“以病人为中心”的服务理念～努力构建和谐的医疗卫生服务环境和医患关系～坚持把维护人民健康放在第一位～着力提高医疗质量～降低医疗费用～全面推行化、标准化、人性化服务。 ,一,落实“新农合”各项政策～切实减轻农民就医负担。我县自2003试点运行农村合作医疗以来～医院作为全县唯一的医疗机构～实施“新农合”各项惠民制度～切实感受到就医农民住院费用逐年减轻～就医积极性提高～健康保健意识增强。2011年起我院实行新型农村合作医疗总额付费制度～全年共收治新农合患者3039人次～总住院费用681.83万元～较去年下降4%～支付报销费用415.92万元～人均报销1368元～较上年提高了16.6%,实际报销比例为61%～较去年提高了9个百分点。全年“一站式医疗服务”～救助119人次～共补助费用11.75万元～实际补助比为92.77%。 ,二,积极使用国家基本药物～执行药物零差率销售。2010年起我院积极落实国家基本药物制度～目前我院基本药物目录品种360种～占全部药品的80%。2011年起实行基本药物网上采购配送方式～2012年1月起执行国家基本药物零差率销售～进一步减轻就医群众的医疗负担。 ,三,不断加强业务管理～着力提高医疗服务质量。以 rall quality of party members and cadres. First, grasp the cadres team conThe work style of the party members and cadres in the whole town has been further changes. 2. the cadres, and improve the ove rove service levels, and enhance team effectiveness. imp of managing. Third party organizations are weak and lax, strengthening regulation (community) party organizations and cadres, Division of labor and mutual support, mutual Help and complement each other, understand each other, improve leadership skills s ofactive inspection work, initiative, by the Office and of the primary station and village (community), and make sure regardles Second, focus on the transformation of work style. Requires team members to actively think, active officers to organize work, oriented, democratic solidarity and diligent people, honest type of four good teams.-al trust, mutual support and form a innovationy collective discussions and decisions on major issues. 5 years, between members of the team did Frank, equal treatment, mutuision. Strengthening the concept of collective leadership, boriented and team building. Persisting in democratic centralism, improve the level of team science decision, a democratic dec-Is teambuilding, improving overall quality. Healthy village (community) cadre appointment system. Perfect village-of teamSecond, strengthening the construction of grassroots party organizations and party members. Catch the party branch Secretary menon.ther 8 work, effectively promote the work, put an end to the previous shuffle, prevarication is not responsible for the phenostruction. Cadres of the new and improved the regulation, the town village appraisal methods, training of party members and o2 提高医疗质量、满足人民健康需要为工作重心～积极落实新医改。执行医务人员不良执业记录制度～落实医务人员“四个排队”～医疗机构“八个排队”制度。落实医疗核心制度～加强医疗管理。积极开展技术比武和学术活动～加强人才队伍建设～培养“政治素质优、岗位技能优、工作业绩优、群众评价优”的“四优”型专业人才。加强中医科建设～落实中医师到西医科室的会诊和查房～把西医科室的中药使用率作为科室的重要考核指标～大力推进中医药工作～充分发挥祖国传统医学的优势。 ,四,尝试开展临床路径管理。2011年～我院根据医院业务实际情况～先后确定了按照每个科室2个常见病种,内科3个病种,共13个病种在我院开展临床路径管理探索～取得了较明显的成效。今年以来～医院总结开展临床路径经验～增加脑出血、股骨干骨折和髌骨骨折、性剖宫产等疾病开展临床路径管理～目前我院开展临床路径的病种达到17种～ 2012年第一季度共有103例病人进入临床路径管理。 ,五,深化医疗体制改革的其他工作。包括争取政府项目资金建设了门急诊医技综合楼和行政保障楼～极大的改善了医疗条件,加强医德医风建设～开展“三好一满意”活动～切实提高患者的满意度等。 三(我院在公立医院改革面临的主要困难 ,一,专业人才的现状与医院实际工作和发展要求之间 ening regulation (community) party organizations and cadres, improve service levels, and enhance team effectiveness. ach other, understand each other, improve leadership skills of managing. Third party organizations are weak and lax, strengthment eary station and village (community), and make sure regardless of Division of labor and mutual support, mutual Help and compleembers to actively think, active officers to organize work, active inspection work, initiative, by the Office and of the primork style. Requires team moriented, democratic solidarity and diligent people, honest type of four good teams. Second, focus on the transformation of w-tween members of the team did Frank, equal treatment, mutual trust, mutual support and form a innovationbeision. Strengthening the concept of collective leadership, by collective discussions and decisions on major issues. 5 years, oriented and team building. Persisting in democratic centralism, improve the level of team science decision, a democratic dec-eamIs tbuilding, improving overall quality. Healthy village (community) cadre appointment system. Perfect village-ations and party members. Catch the party branch Secretary of teamrganizus shuffle, prevarication is not responsible for the phenomenon. Second, strengthening the construction of grassroots party ovillage appraisal methods, training of party members and other 8 work, effectively promote the work, put an end to the previotown ty of party members and cadres. First, grasp the cadres team construction. Cadres of the new and improved the regulation, thetyle of the party members and cadres in the whole town has been further changes. 2. the cadres, and improve the overall qualiThe work s3 还存在较大的差距。目前我院专业人员现状:专业技术人员232名～高级职称,副主任医师或护师,23 名～中级职称52名～初级职称157名,本科学历55名～大中专学历177名。医生78名～护士111名～医技、药人员43名～专业技术人员占全院职工的85%～专业技术人员中合同聘用人员72人～占31%。存在的问题主要表现在:1.人才梯队建设和专业人才培养有一定困难～缺乏学科带头人～很多科室高级、中级和初级的比例失调～个别科室在人员紧缺的情况下仍然长期坚持比较繁重的工作。从人员结构上看～全日制本科毕业的专业人员所占比重低～一些大中专毕业生在短期内不能取得医师资格证～还无法进入相应岗位工作。从人才培养方面～因人员绝对短缺～医院无法按照计划派出人员到上级医院进修学习～从而制约了我院医疗水平的提高。2.护士以临时聘用为主～在同工同酬方面～医院没有能力为她们提供和正式职工相当的工资待遇～尽管尽最大努力逐年上调工资～但总体收入水平仍偏低～尤其和省市级医院相比～存在很大的差距～因此造成护理队伍极不稳定～经常面临无人可用的尴尬局面。3.管理人员以兼职为主～包括医务、质控、院感、公卫等职能科室人员均为兼职工作～无法全力进行业务管理和监督工作。 ,二,财务资金运转存在一定的困难。1.医院目前还是差额拨款单位～目前医院职工的工资政府拨款60%～医院自 rove service levels, and enhance team effectiveness. imp of managing. Third party organizations are weak and lax, strengthening regulation (community) party organizations and cadres, Division of labor and mutual support, mutual Help and complement each other, understand each other, improve leadership skills s ofactive inspection work, initiative, by the Office and of the primary station and village (community), and make sure regardles Second, focus on the transformation of work style. Requires team members to actively think, active officers to organize work, oriented, democratic solidarity and diligent people, honest type of four good teams.-al trust, mutual support and form a innovationy collective discussions and decisions on major issues. 5 years, between members of the team did Frank, equal treatment, mutuision. Strengthening the concept of collective leadership, boriented and team building. Persisting in democratic centralism, improve the level of team science decision, a democratic dec-Is teambuilding, improving overall quality. Healthy village (community) cadre appointment system. Perfect village-of teamSecond, strengthening the construction of grassroots party organizations and party members. Catch the party branch Secretary menon.ther 8 work, effectively promote the work, put an end to the previous shuffle, prevarication is not responsible for the phenostruction. Cadres of the new and improved the regulation, the town village appraisal methods, training of party members and orall quality of party members and cadres. First, grasp the cadres team conThe work style of the party members and cadres in the whole town has been further changes. 2. the cadres, and improve the ove4 筹40%～同时还要支付100多名临时聘用人员的工资和全院职工的奖金福利～总体负担较重。2.政策性因素导致的医疗实际收入减少～尤其新农合和医保部门单方面制定的住院患者次均费用支付制度和医院实际诊疗费用之间存在着较大的差距～行政管理部门可能因为医院诸多“不合理因素”扣除应该给医院支付的资金～从而造成医院的收入减少。3.另一方面～物价的不断上升使医院的各项支出不断增加。这些都造成了医院财务资金的运转困难～旧设备更新和购买符合业务发展的新设备都无力完成。 ,三,医疗政策及政策执行方式对县级医院造成的困难。1.在人才建设方面～近年大中专毕业生分配只面对乡镇卫生院～但县级医院面临大学毕业生分配的“黑洞”～不利于人才培养。2.某些政策和制度未充分考虑县级医院的实际情况～而要求必须执行～实行年底考核“一票否决”。如对聘用护士实行同工同酬制度～如果没有政府部门的支持和参与～医院根本不可能达到。3.医保政策方面～始终执行降低医疗费用的各项控制管理办法～没有充分考虑医院的发展和医疗费用合理增长。3.新农合和医保实行市级统筹～在很多政策和制度执行方面～仅仅以“扣罚”为管理手段～尤其在不合理检查、单病种方面～农合部门单方面认定～未能充分考虑医疗的实际情况。4.某些政策的推行缺乏相应的配套政策～加重了医院的负担。如我院根据卫生局的要求于2012 The work s ening regulation (community) party organizations and cadres, improve service levels, and enhance team effectiveness. ach other, understand each other, improve leadership skills of managing. Third party organizations are weak and lax, strengthment eary station and village (community), and make sure regardless of Division of labor and mutual support, mutual Help and compleembers to actively think, active officers to organize work, active inspection work, initiative, by the Office and of the primork style. Requires team moriented, democratic solidarity and diligent people, honest type of four good teams. Second, focus on the transformation of w-tween members of the team did Frank, equal treatment, mutual trust, mutual support and form a innovationbeision. Strengthening the concept of collective leadership, by collective discussions and decisions on major issues. 5 years, oriented and team building. Persisting in democratic centralism, improve the level of team science decision, a democratic dec-eamIs tbuilding, improving overall quality. Healthy village (community) cadre appointment system. Perfect village-ations and party members. Catch the party branch Secretary of teamrganizus shuffle, prevarication is not responsible for the phenomenon. Second, strengthening the construction of grassroots party ovillage appraisal methods, training of party members and other 8 work, effectively promote the work, put an end to the previotown ty of party members and cadres. First, grasp the cadres team construction. Cadres of the new and improved the regulation, thetyle of the party members and cadres in the whole town has been further changes. 2. the cadres, and improve the overall quali5 年1月实行基本药物零差率销售～但到目前为止～还没有相关的配套政策解决执行药物零差率后的相关费用补助。 ,四,在基础条件方面～还存在医疗设备落后、陈旧～部分医疗用房不符合国家建设标准等问题～医院发展空间相对狭小～各项落实不力等。 ,五,县级医院在医疗资源和医疗市场占有方面处于绝对的劣势～尤其像我县在距离省城很近的情况下～医院基本业务的发展面临巨大的挑战。做为县级医院～我们始终忠实落实国家各项惠民的政策～使广大的老百姓切实得到各项政策的实惠。但同时～我们希望政府能够给予县级医院以最大的支持和帮助～重点解决发展中存在的问题～从而能够使服务质量更进一步提高～使广大人民群众的健康保障水平能够更进一步发展。 ther 8 work, effectively promote the work, put an end to the previous shuffle, prevarication is not responsible for the phenostruction. Cadres of the new and improved the regulation, the town village appraisal methods, training of party members and orall quality of party members and cadres. First, grasp the cadres team conThe work style of the party members and cadres in the whole town has been further changes. 2. the cadres, and improve the ove rove service levels, and enhance team effectiveness. imp of managing. Third party organizations are weak and lax, strengthening regulation (community) party organizations and cadres, Division of labor and mutual support, mutual Help and complement each other, understand each other, improve leadership skills s ofactive inspection work, initiative, by the Office and of the primary station and village (community), and make sure regardles Second, focus on the transformation of work style. Requires team members to actively think, active officers to organize work, oriented, democratic solidarity and diligent people, honest type of four good teams.-al trust, mutual support and form a innovationy collective discussions and decisions on major issues. 5 years, between members of the team did Frank, equal treatment, mutuision. Strengthening the concept of collective leadership, boriented and team building. Persisting in democratic centralism, improve the level of team science decision, a democratic dec-Is teambuilding, improving overall quality. Healthy village (community) cadre appointment system. Perfect village-of teamSecond, strengthening the construction of grassroots party organizations and party members. Catch the party branch Secretary menon.6