基于标化工作量的社区卫生服务中心岗位管理研究

Standardized Workload-based Position Management for Community Health Centers

背景完善人员岗位管理是社区卫生综合改革的重要内容之一,涉及社区卫生服务机构业务目标的落实、社区工作人员能力和数量的匹配,从而影响机构运行成本的降低和效率的提高。目的研究浦东新区基于标化工作量的社区卫生服务中心理论岗位数与在岗职工状况,为优化社区卫生服务中心岗位管理提供建议。方法参照浦东新区区委地区办对新区街镇的4个分类,将浦东新区社区卫生服务中心分为A类(偏远农村)、B类(一般农村)、C类(城郊接合)、D类(城区)4类。通过浦东新区"社区云"管理平台收集2017年浦东新区各社区卫生服务中心的年标化工作量、全科医师标化工作总量数据,计算社区理论岗位核定数并与实际岗位核定数进行比较。结果 4类社区卫生服务中心全科医师标化工作总量分别为6 193 199、9 231 475、8 893 767、12 495 055,理论总岗位数分别为1 817、2 529、2 285、3 022个。4类社区卫生服务中心实际岗位总数低于理论岗位总数,其中全科医师、社区护士、公共卫生医师岗位在岗职工数均低于理论数,其他人员在岗职工数高于理论数。结论浦东新区岗位数总体欠缺,应按需增加社区卫生服务中心岗位数,建立岗位数动态增长机制;岗位结构欠合理,应规范岗位配置标准,优化内部岗位结构;实际岗位配置受多种因素影响,应完善相关激励机制,吸引稀缺卫生人才。

Background Position management improvement in community health centers is an important part of comprehensive reform of community healthcare,involving the achievement of healthcare goals of community healthcare institutions,and the match between staff's number and abilities and workload,and affecting the reduction of operating costs and efficiency improvement of such institutions.Objective To compare the estimated ideal number of workers obtained by standardized workload analysis with the actual number in community health centers(CHSs)in Pudong New Area,providing a reference for optimizing the position management in CHSs.Methods According to the classification criteria for streets and towns made by Pudong New Area Committee Office,we classified the CHSs in Pudong New Area into four types:A(remote rural areas),B(general rural areas),C(urban-rural fringe)and D(urban areas).Through the Pudong New Area Community Cloud Management Platform,we collected the annual standardized workload for each type of CHSs and for general practitioners(GPs)and GP assistants working in each type of CHSs in 2017.Then,by standardized workload analysis,we derived the estimated ideal numbers of positions in CHSs,and compared them with the actual numbers.Results The total annual standardized workload in 2017 for GPs and GP assistants in types A,B,C,and D CHSs were 6 193 199,9 231 475,8 893 767,and 12 495 055,respectively.The corresponding total ideal positions calculated by us were 1 817,2 529,2 285,and 3 022,respectively.However,all these CHSs were found with less number of total positions than the ideal.To be specific,the numbers of incumbent GPs,nurses,and public health physicians were all less than the ideal,but the numbers of other types of incumbent workers were all more than the ideal.Conclusion In general,the total numbers of positions in CHSs in Pudong New Area are insufficient,but the increase should be improved based on requirements.The improvement measures are given as follows:establishing a dynamic mechanism for increasing positions;rationalizing the position designation structure;standardizing the position designation;optimizing the internal structure of positions;reducing the effect of associated factors on actual position designation;improving the incentive mechanism to attract the scarce health talents.