Shanxi practice of extending the registration validity period and adjusting outpatient operation and management methods——
"No. 1 manages three days" to seek a "better solution"
At dusk on January 16, Shen Li, director of the outpatient department of Shanxi Provincial People's Hospital, discovered that many outpatient doctors had not gotten off work yet and were still seeing patients.
In the past few days, many hospitals in Shanxi have successively implemented the "one number for three days" medical treatment model. In principle, patients only register once for the entire outpatient medical treatment process from registration, treatment, examination and medicine collection. If the patient cannot complete the diagnosis and treatment on the same day due to auxiliary examinations, with the authorization of the initial physician, when the patient brings the examination results for a follow-up visit, in principle, within 3 days (including the day of treatment) in the same hospital area, the same department, and the same disease, no secondary registration fees will be paid. This is a practical measure to improve the medical environment and enhance the medical experience.
Patients who came for follow-up consultations with a 0-yuan number applauded the new policy. Many middle-aged and elderly patients with chronic diseases said that this new policy not only saved them money, but also urged them to review the examination reports in a timely manner and treat their symptoms early.
While it is convenient for patients, the workload on doctors has increased. The implementation of a service policy that benefits the people is also a test of the hospital's management capabilities.
How to optimize the internal management of the hospital and let medical staff accept the new policies? While protecting medical rights and interests, how can we allow the people to truly enjoy the dividends of the New Deal? Shanxi Provincial People's Hospital has made "great efforts".
“N+1” gives doctors autonomy
In front of the cardiology clinic of Shanxi Provincial People's Hospital, there is a sign saying, "If you return for a follow-up visit within three days to review the report, in principle, the order of treatment will be in the 'N+1' mode." N is determined by the doctors who see you on the day. Some doctors choose to see a follow-up patient every five first-time patients, while some doctors choose to see all the first-time patients before seeing a follow-up patient.
Giving doctors autonomy is a transitional measure at the beginning of the implementation of the new policy. Shen Li explained that at present, the follow-up number does not occupy the original number pool. Taking the Department of Cardiology as an example, 40% of patients need to review reports every day. The review rate on Monday can reach 44%. Half can review the report on the same day and half within 72 hours. A triage nurse in the Cardiology Department said: "At least half of the patients in each doctor's hands come back to review the examination report." According to the nurse's rough statistics, on the day of the reporter's visit, about 40 patients who had been under "No. 1 supervision for three days" came to review the examination reports.
Statistics from Shanxi Provincial People's Hospital show that from November 20 to December 4, 2023, the "No. 1 for three days" policy has benefited a total of 16,529 people, with a total of 348,965 yuan in fee reductions. According to estimates by medical staff, the monthly average data in January this year has only increased.
"It means that doctors have to increase their workload on the original basis, but the follow-up consultation number is not included in the doctor's performance evaluation for the time being, and the doctors are still doing 'voluntary labor'." Shen Li said.
In order to allow doctors to reasonably plan their working hours and gradually accept the new policy conceptually, the hospital decided to give doctors sufficient autonomy to decide the order in which patients should be reviewed.
But for patients, having the doctor decide the order of follow-up consultations means that the time for their consultation is uncertain. Ms. Zhang, a Taiyuan citizen, had such concerns when she accompanied her father for a follow-up consultation. She told reporters, "The follow-up consultation number needs to be called on-site, but whether it can be called and when it can be called can only be determined on-site."
But after reporting to the outpatient clinic, Ms. Zhang's concerns were dispelled. On the screen, patients returning for follow-up visits can see their order in real time after checking in, and can have a rough estimate of the treatment time. Shen Li said that some follow-up patients can fill in the number vacancies of patients who did not come for the first visit. In addition, "doctors are very cooperative. As long as there are follow-up patients who come to report, they will basically not refuse treatment."
The implementation of "N+1" is not only for the initial transition of doctors, but also a process of collecting data, discovering and solving problems in practice. Shen Li said that in the future, the hospital will issue scientific and unified management policies for the "one-day management for three days", including planning doctor performance and launching an online registration system. “Only by allowing doctors to fully try the practice in the early stage, can the most appropriate management plan be derived in the later stage.”
During the transition period, "one subject, one policy" will be implemented
In addition to giving doctors autonomy, each department can also maximize the freedom to choose a follow-up consultation model that suits them during the transition period.
Shen Li has a folder in her hand, which collects the opinions of 48 department directors of the outpatient department on the "one number for three days" treatment model.
At first, the outpatient department gave the department directors three options: First, "one person is responsible for the end". The first-diagnosing doctor will use fragmented time to go to the outpatient clinic to review the report for free, and inform the patient in person during the first diagnosis of the time and place to review the report. In actual operation, after the patient arrives at the outpatient clinic, the triage nurse will contact the first-seeing doctor and come to the outpatient department to review the report. The second is "medical team management", where doctors who frequently visit outpatient clinics are responsible for reporting and review. The third is "professional co-management", where department team members help each other and assign a visiting doctor or medical team to review the report for free on the same day.
In addition to these three options, departments can also propose other personalized options. Some departments have written "online follow-up consultation" or set up "dedicated personnel to manage" follow-up consultation on the consultation form.
It is understood that patients can ask doctors to review reports and conduct follow-up consultations through the Shanxi Provincial People's Hospital online app. Doctors can query the examination reports from the hospital system and conduct targeted communication with patients.
After preliminary consultation, Shanxi Provincial People's Hospital has put together 5 specific plans: 20.8% of departments choose "one person to manage to the end", 14.6% of departments choose "medical team" to manage, 54.2% of departments choose "professional co-management", and the rest Departments choose "online management" or "dedicated management".
Shen Li said that each department has its own professional characteristics and personnel structure characteristics. Faced with the new policy of "one number in charge for three days", the operational difficulties are also different. Shen Li said that taking the Department of Neurology and Cardiology as an example, the number of daily first-patient outpatient visits is very large. “Without the ‘No. 1 in charge of three days’, the doctor would not be able to get off work at noon, and the doctor would have to see the doctor at 1 o’clock in the afternoon. Now, To add so many follow-up consultation numbers, there are too many uncontrollable factors.”
"One subject, one policy" is to fully respect the wishes of each department during the transition period, better implement the policy, and make the people truly feel the dividends. Shen Li explained, "Let's do this first. We will fully try various methods in the first two or three months. If any problems arise during the process, we will coordinate again. In the end, the whole hospital will adopt a minority-subordinate-majority approach."
In order to solve the difficulties and pain points of policy implementation, "inquiry and prescription"
Since the implementation of the "No. 1 for three days" policy, the Shanxi Provincial Health Commission has organized multiple work promotion meetings, inviting hospitals at all levels to participate, introducing the work progress of pilot hospitals, collecting relevant issues, and reaching consensus.
It is reported that the Shanxi Provincial Health Commission issued the "Implementation Plan for the "One Registration and Three Days" Medical Treatment Model in Shanxi Province (hereinafter referred to as the "Plan"), launching the province's first batch of pilot lists for the "One Registration and Three Days" medical treatment model. , including 8 cities: Datong, Xinzhou, Shuozhou, Luliang, Yangquan, Changzhi, Jincheng, and Yuncheng, as well as 4 hospitals: Shanxi Provincial People's Hospital, Shanxi Bethune Hospital, Shanxi Medical University First Hospital, and Shanxi Medical University Second Hospital. At the same time, it is proposed that by the end of 2024, it will cover public general hospitals at level 2 and above in the province.
"After the meeting, other hospitals will also call to ask for more specific practices, including performance algorithms for doctors' workload, etc." Shen Li said that municipal hospitals at all levels face similar problems, and mutual discussions can promote the implementation of practical experience. .
Some netizens said that if the hospital improves the speed of optimizing inspections and the results are released on the same day, there may be no need for "one-day management for three days." Shen Li said that in recent years, hospitals have accelerated the speed of feedback on test results and "waiting time must be shortened" so that convenience policies are meaningful. At present, Shanxi Provincial People's Hospital can produce CT and B-ultrasound results on the same day, and the completion rate of MRI on the same day is nearly 90%. "The hospital can turn around quickly so that people can really get good treatment."
According to reports, the Jinxiang County People's Hospital in Jining, Shandong Province began to implement the "one-time registration and management for three days" initiative last year. By improving the relevant functions of the information system, the hospital has opened relevant permissions to each triage desk and post, and the triage nurses have assisted in registration, so that first-time and follow-up patients can be treated in an orderly manner, thus effectively coordinating the number of first-time consultations and follow-up consultations. Source order balancing issue.
Shen Li said that after outpatient procedures are streamlined and a unified system is established, information management can be further promoted and the return diagnosis number can be "online".
The "No. 1 for three days" policy has brought tangible benefits to the people, but it also encountered new problems when it was implemented. Shen Li said that currently, for hospitals, how to achieve closed-loop management of medical records, "multiple doctors receive treatment, and how to divide responsibilities in the event of a dispute are issues that have been discovered in practice and need to be improved in the future."
According to reports, the Shanxi Provincial Health Commission invited hospitals in Shandong Province that have implemented "No. 1 management for three days" to communicate with the pilot hospitals in Shanxi Province and seek practical experience from other provinces. Similarly, some hospitals from the Inner Mongolia Autonomous Region went to Shanxi Provincial People's Hospital for exchange and study.
China Youth Daily·China Youth Daily trainee reporter Wang Xueer reporter Hu Zhizhong Source: China Youth Daily