"进一步改善医疗服务行动计划"(2015—2020年):第三方评估结果

Third-party evaluation of the China Healthcare Improvement Initiative from 2015 to 2020:findings and suggestions

目的评价2015年至2020年两轮"进一步改善医疗服务行动计划"(以下简称"行动计划")的落实情况与实施效果。方法2015年12月至2021年3月,对136~144家样本三级公立医院进行5次第三方评估调查。使用自行设计的《医疗机构调查表》《医护人员调查问卷》《门诊患者调查问卷》和《住院患者调查问卷》,通过专家打分、调查员现场/电话调查、手机自填等方式收集数据。在数据清理的基础上,对5次评估结果进行分析比较。结果医疗机构落实两轮"行动计划"总体进展良好,部分制度模式还存在提升空间;门诊和住院患者满意度总体处于高位且稳步提升,患者不满意主要集中在非临床服务方面;医护人员工作满意度有所提升,但医护人员工作负担重、薪酬待遇低、健康水平欠佳等问题依然存在。结论两轮"行动计划"的实施对于推动医院建立以患者为中心的制度模式作用明显,但部分重点难点问题的解决仍需持续投入和协同努力,特别是非临床服务的改善仍需得到重视。医护人员的工作满意度和福祉水平持续处于低位,需采取有力措施切实提高医护人员积极性,打造医患"双满意"医院。

Objective To assess the progress and impact of the China Healthcare Improvement Initiative(CHII)from 2015 to 2020,which aimed at improving patients healthcare experiences.Methods Five rounds of evaluation surveys were conducted from December 2015 to March 2021 among 136-214 tertiary public hospitals.Structured questionnaires to measure hospital actions and performance,satisfaction of patients and medical staff were designed,and the data were collected by the national and provincial survey teams via onsite inspection,face-to-face/telephone interviews and self-administered cellphone APPs respectively.After data cleaning,the results of five round evaluations were analyzed and compared.Results The sampled hospitals demonstrated high participation rate in the CHII,and their overall performance turned out to be satisfactory.And the patient healthcare experiences consistently improved over the period of CHII.In contrast to the high satisfaction rate with clinical quality of the sampled hospitals,patients were less satisfied with the non-clinical services such as food and supporting services.The job satisfaction of doctors and nurses experienced mild improvements,while the problems of heavy workload,low salary,and poor health were not effectively solved yet.Conclusions The implementation of CHII from 2015 to 2020 has played a significant role in promoting patient-centered service models in hospitals,but continuous inputs and coordinated efforts are still required in the future.The improvement of non-clinical services still needs to be addressed to further enhance patient satisfaction.The job satisfaction and well-being of doctors and nurses remain at low level,and effective measures need to be taken to maintain the stability of the medical staff.