Public hospital reform: what to change and how to change

[Talk about health]

Editor's note

Public hospitals are the main body of my country's medical service system.

According to the Statistics Bulletin on the Development of my country's Health Care Services in 2019, my country's public hospitals had 3.27 billion visits in 2019, accounting for 85.2% of the total number of hospitals; the number of admissions in public hospitals was 174.87 million, accounting for 82.6% of the total number of hospitals; public hospital health technology The staff is 5.098 million, accounting for 78.6% of the total number of hospitals.

The reform and development of public hospitals are related to people's livelihood, and whether the innovative consciousness and intellectual value of the intellectual group of medical staff can be stimulated and embodied.

The General Office of the State Council recently issued the "Opinions on Promoting the High-Quality Development of Public Hospitals" (hereinafter referred to as the "Opinions"). This version of the survey was launched on the official Weibo of Guangming Daily as soon as possible.

Combining social concerns, we will work with experts to focus on the development of public hospitals.

The "Opinions" put forward that through five years of hard work, the development mode of public hospitals will shift from scale expansion to improved quality and efficiency, the operation mode will shift from extensive management to fine management, and resource allocation will shift from focusing on material elements to focusing more on talents and technology.

The reform of public hospitals is directly related to the people's sense of security and gain in seeing a doctor.

What and how to reform public hospitals?

We especially invited Song Shuli, Secretary of the Party Committee of the China-Japan Friendship Hospital, Qiao Jie, Dean of Peking University Third Hospital, and Li Weimin, Dean of West China Hospital of Sichuan University for dialogue.

Improve the homogeneity level of medical services in different levels of hospitals

■Social concern: When encountering difficult and miscellaneous diseases, it is difficult to register and see a doctor in big hospitals in big cities. It is not easy for patients and their families. When can public hospitals of different regions and levels provide homogeneous medical services?

The "Opinions" are clear: Give full play to the leading role of public hospitals in urban medical groups.

According to grid-based layout management, the establishment of a compact type led by a tertiary public hospital or a hospital representing the medical level of the jurisdiction (including social hospitals and traditional Chinese medicine hospitals), and several other hospitals, primary medical and health institutions, public health institutions, etc. as members The Urban Medical Group is responsible for the overall planning of integrated medical services such as prevention, treatment, rehabilitation, and health promotion of residents in the grid, and drives the grassroots medical and health institutions to improve their service capabilities and management levels.

Continuously improve the medical quality management system and standard system, and raise the level of homogeneity of medical services in public hospitals of different regions and levels.

Qiao Jie:

Public hospitals should be oriented to meet the clinical needs of major diseases, focusing on the development of clinical specialties such as critical illness, tumor, cardiovascular and cerebrovascular, respiratory, digestive, infection, pediatrics, anesthesia, imaging, pathology, laboratory, etc., and the development of specialties drives the diagnosis and treatment capabilities And the level is improved.

It is necessary to give full play to the leading role of tertiary public hospitals, and combine lower-level medical institutions and primary-level medical and health institutions to create a compact medical consortium, drive the grassroots to improve service capabilities and management levels, and promote hierarchical diagnosis and treatment.

  At the same time, we must rely on the quality control system to continuously improve the level of homogeneity of medical services.

At present, my country has basically established a medical quality management system centered on quality control and improvement centers at the national, provincial and municipal levels, and districts and counties, popularized advanced and appropriate technologies, and gradually improved the level of homogeneity of medical services.

Li Weimin:

As the leading hospital of the medical consortium, tertiary public hospitals must strengthen standardized medical quality management within the medical consortium, optimize the mutual recognition mechanism of inspection and test results, and continuously improve the level of homogeneity of medical services; on the other hand, ensure data On the premise of safety, establish a "medical consortium cloud information platform" to realize the sharing of information resources, and on this basis, further build a specialist/specialist medical consortium, through joint construction of specialists, education and training collaboration, scientific research project collaboration, etc. Ways to improve the medical service capabilities and management level of member units, and gradually form a benign mechanism of partial coordination, collaboration and sharing in the medical association, so that the general public can enjoy a full-process, continuous, and active medical service experience.

Provide patients with "one-stop" diagnosis and treatment services

■Social concern: Big hospitals are crowded with people, and at least half a day is needed to go there. The relevant departments have broken legs, and the results of the examinations do not recognize each other. If you encounter intractable diseases, you are at a loss. How to solve the problem of seeing a doctor?

The "Opinions" are clear: to strengthen patient demand orientation and promote multidisciplinary diagnosis and treatment models.

Vigorously promote day surgery and increase the proportion of day surgery in elective surgery.

Set up rational drug use consultation or drug treatment management outpatient clinics, and carry out precise drug use services.

Promote the comprehensive diagnosis and treatment model of traditional Chinese medicine, the multi-disciplinary integrated diagnosis and treatment model, and the whole chain service model, and implement the pilot clinical collaboration between Chinese and Western medicine for major and difficult diseases.

Carry out time-based appointments for diagnosis and treatment and centralized appointments for inspections, and carry out services such as clinic (bedside) settlement and mutual recognition of inspection and inspection results.

Song Shuli:

Public hospitals must uphold the people's supremacy, life supremacy, respect the laws of medical science, observe medical ethics, follow clinical diagnosis and treatment technical specifications, optimize the whole process of medical services, and let "patients run less errands and information more run."

At the same time, it is necessary to actively carry out public welfare, social work, and volunteer services, build friendly hospitals for the elderly, and provide convenience and assistance to groups such as the elderly, children, and the disabled.

  In the face of disease, both doctors and patients are comrades-in-arms, and building a harmonious doctor-patient relationship is crucial to curing the disease.

Public hospitals must actively establish and improve the doctor-patient communication system, establish long-term contacts with patients through patient clubs, volunteer services, and social supervision, carry out health management and health education, and attract patients to participate in medical services and health promotion, in order to build harmony The doctor-patient relationship creates a good social atmosphere.

Qiao Jie:

With the development of modern economy, people have higher requirements and expectations for health.

Medical institutions should pay attention to population health issues from the source, guide healthy and reasonable lifestyles, exercise methods, carry out guidance work that is beneficial to physical and mental health, such as motor function evaluation under the guidance of multidisciplinary cooperation, and reduce medication use through rehabilitation therapy under multidisciplinary cooperation With invasive treatment.

  For difficult and complex diseases, multi-system and multi-organ diseases, medical institutions can provide patients with "one-stop" diagnosis and treatment services through multidisciplinary diagnosis and treatment (MDT).

MDT services should place more emphasis on fixed teams and fixed disease types, and provide patients with personalized and continuous "standardized multidisciplinary" comprehensive diagnosis and treatment programs.

Reform and perfect the evaluation mechanism of medical talents, highlighting moral ability and performance orientation

■Social concern: Medical staff not only have to work hard to be a good doctor who relieves patients’ pain, but also have to work hard to publish papers and award awards. How to establish a medical talent evaluation system that can truly mobilize the enthusiasm and creativity of medical staff, so that doctors Be a good doctor with peace of mind?

The "Opinions" are clear: Reform and improve the talent evaluation mechanism, adhere to hierarchical and categorized evaluation, reasonably set evaluation standards, highlight moral ability and performance orientation, increase the number and quality of clinical work, explore the implementation of a representative work system, and dilute the number of papers.

We will steadily delegate the authority to review professional titles, and explore pilots of tertiary public hospitals with reasonable job settings, complete personnel management, and willingness to conduct independent reviews to independently conduct senior professional title reviews.

Song Shuli: To

promote the high-quality development of public hospitals, we must always put the solution to human problems in a prominent position, and protect the enthusiasm, initiative and creativity of the majority of medical staff.

In recent years, China has achieved certain results in improving the career development space of medical staff, but at the same time it should be noted that the measures to care for medical staff need to be further implemented and detailed, and the talent evaluation mechanism must be reformed and improved, and the hierarchical and classified evaluation must be adhered to. , Follow the characteristics of the medical industry and the law of talent growth, set reasonable evaluation standards, highlight the performance orientation of moral ability, focus on clinical work quality indicators, explore the implementation of a representative work system, and eliminate the "four uniques" and other bad tendencies, so that people can make the best use of their talents and talents. Its use is to help medical staff establish a sense of professional identity.

Qiao Jie:

At present, various evaluations of clinical research rely more on peer reviews and objective data such as the publication and citation of papers, the promotion of results, and the incorporation of guidelines.

To make clinical research results benefit patients and produce social benefits, more attention should be paid to the feasibility and time limit of clinical transformation of research results, the promotion of clinical technology, the promotion of appropriate technologies, the radiation scope of standard norms and guidelines, and the degree of benefit to patients.

We should rely on public hospitals to establish a number of national core medical research platform institutions covering major health problems, set mid- and long-term goals, promote the development of clinical medicine with innovative research, and solve basic and source problems.

Li Weimin: To

establish a modern new human resource management system, the focus is to take job management as the core, and further subdivide the job levels of each series of medical, teaching, scientific research, administration, and logistics into multiple levels, and develop a clear, flexible and dynamic path The evaluation and promotion mechanism of the company establishes a two-way flow mechanism of "can be up and down, can enter and exit", so that "the able can get up and those who can't get down" and "everyone has the opportunity, but no one can relax." So as to effectively stimulate the potential and vitality of the entire medical talent team.

Positive incentives, let medical staff gain a sense of value

■Social concern: The medical industry is characterized by long training cycles, high professional risks, high technical difficulties, and heavy responsibility. However, the current salary system does not truly reflect the knowledge value of medical staff. How to solve it?

How to further create a social atmosphere that respects doctors and respects health?

The "Opinions" make it clear: Establish a salary system that mainly reflects job responsibilities and knowledge value, implement job-based responsibilities, job-based wages, appropriate responsibilities and salaries, and assessments.

Within the approved total salary, public hospitals can adopt a variety of methods to allocate independently.

Hospitals can independently set up salary projects that reflect the characteristics of the medical industry, labor characteristics and job value, give full play to the guarantee and incentives of various projects, and pay more attention to the guarantee function of the salary system.

Encourage the implementation of an annual salary system for the main persons in charge.

Li Weimin:

Public hospitals should give full play to the positive incentive effect of internal performance appraisal on talents and technical elements, and establish a performance appraisal and salary distribution system based on RBRVS (surgical coefficient) and DRGs (disease diagnosis related groups). For example, doctors' medical performance should highlight technology Difficulty, medical quality, patient satisfaction and other dimensions, encourage the admission and treatment of critically ill patients, and encourage the development of new technologies and methods with good effects, high efficiency, and low resource usage.

  At the same time, it is necessary to broaden the space for professional development of medical staff and improve the training system for medical staff so that every medical staff has the opportunity to receive continuing education and vocational retraining, so as to realize the renewal of knowledge.

Accelerate the cultivation of high-level compound medical talents, and cultivate a group of international-level strategic talents, leading talents and innovative teams.

Song Shuli:

Public hospitals should respect medical staff, understand medical staff, build a platform for them to display their talents, implement a system of study, work, rest and paid leave, and effectively solve the practical difficulties of medical staff; encourage public hospitals to establish youth learning funds Caring for the growth of young medical staff in various ways, including strengthening hospital safety and precautions, improving necessary security inspection facilities, bringing the resolution of medical disputes into the track of the rule of law, and resolutely protecting the safety of medical staff.

At the same time, medical staff must be caring for patients and take the initiative to care for patients.

The so-called "major doctors" start with sincerity and become exquisite.

We expect that in the process of serving patients, medical staff can realize the sense of value and happiness in their work.

  (Reporter Jin Zhenya)