四川省某市市属公立医院薪酬制度改革现状分析

Current status of salary system reform in municipal public hospitals in a city of Sichuan Province

目的分析四川省绵阳市公立医院的薪酬制度改革实践现状,为公立医院薪酬制度改革向纵深推进提供参考。方法2023年4—5月,采用自行设计的调查问卷,通过问卷星平台对5家市属三级公立医院的医务人员进行问卷调查,调查问卷内容主要包括调查对象基本情况、薪酬制度实施现况和员工薪酬满意度;2023年5月,采用半结构式访谈对涉及改革的政府部门和公立医院的相关人员进行访谈,访谈内容包括采取的改革措施及产生的影响、改革后医务人员的薪酬变化、当前改革面临的困境等。对资料进行描述性分析,采用χ^(2)检验对计数资料进行比较,薪酬水平与调查对象基本情况的相关性分析采用Kendall′s tau-b检验。结果绵阳市在公立医院薪酬制度改革中主要采取了制度建设、薪酬总额核定及动态调控、编外员工薪酬管理等措施。回收有效问卷826份,有效回收率为94.5%。年收入水平与年龄、文化程度、工作年限、职称级别分别呈正相关关系(r=0.420,P<0.001;r=0.245,P<0.001;r=0.364,P<0.001;r=0.504,P<0.001)。与四川省其他市州同级医院的同类岗位人员相比,274人(33.2%)对现有薪酬水平感觉比较满意或非常满意;350人(42.3%)对薪酬分配机制感到比较满意或非常满意;441人(53.4%)对非经济性薪酬感到比较满意或非常满意。认为现有薪酬结构、绩效考核方式均能体现个人实际工作价值的调查对象占比分别为464人(56.2%)、423人(51.2%)。共对10人进行访谈,4人次认为改革后的薪酬水平有所增长,但与改革前相比变化不大;8人次认为现有改革未涉及到薪酬结构改革;6人次认为医院内部绩效薪酬分配机制不健全;3人次认为对非经济性薪酬改革的关注不足;7人次认为薪酬制度改革的困境主要集中在对政策的统一性认识、如何确定调增薪酬总额及合理进行内部分配方面。结论绵阳市较为科学地核定了薪酬总额并进行动态调控,增强了公立医院的公益性,同时兼顾了编制内外员工的薪酬管理,促进同工同酬。但也出现了薪酬总额动态调整方面存在意见分歧,医院内部分配机制不健全,薪酬制度改革不够全面等问题,需进一步加强顶层设计,合理提高薪酬水平,健全内部分配机制,优化薪酬结构,以持续深化公立医院薪酬制度改革。

ObjectiveTo analyze the current status of salary system reform in public hospitals in Mianyang City,Sichuan Province,and provide reference for the deepening of salary system reform in public hospitals.MethodsFrom April to May 2023,a self-designed survey questionnaire was used to conduct a survey of medical staff in five municipal tertiary public hospitals through the Wenjuanxing platform.The survey questionnaire mainly included the basic information of the survey subjects,the implementation status of the salary system,and employee satisfaction with salary.In May 2023,semi-structured interviews were conducted with relevant personnel from government departments and public hospitals involved in the reform.The interview content included the reform measures taken and their impact,changes in medical staff salaries after the reform,and the current difficulties faced by the reform.Descriptive analysis was conducted on the data,and Chi-square test was used to compare the count data.Kendall′s tau-b test was used to analyze the correlation between salary level and basic information of the survey subjects.ResultsIn the reform of the salary system in public hospitals in Mianyang City,measures such as system construction,total salary quota determination and dynamic control,and salary management for non-establishment employees have been mainly adopted.826 valid questionnaires were collected,with an effective response rate of 94.5%.The annual income level was positively correlated with age,education level,years of work experience,and professional title level(r=0.420,P<0.001;r=0.245,P<0.001;r=0.364,P<0.001;r=0.504,P<0.001).Compared with the personnel in the same positions at the same level of hospitals in other cities and states in Sichuan Province,274 people(33.2%)were quite satisfied or very satisfied with the current salary level;350 people(42.3%)were quite satisfied or very satisfied with the salary distribution mechanism,and 441 people(53.4%)were quite satisfied or very satisfied with non-economic salaries.The proportion of survey respondents who believe that the existing salary structure and performance evaluation methods could reflect their actual work value was 464 people(56.2%)and 423 people(51.2%),respectively.A total of 10 people were interviewed,with 4 individuals believing that the salary level has increased after the reform,but the change was not significant compared to before the reform;8 individuals believed that the current reform does not involve the reform of the salary structure;6 individuals believed that the internal performance based salary distribution mechanism in hospitals was not sound;3 individuals believed that there was insufficient attention to the reform of non-economic compensation;7 individuals believe that the difficulties in the salary system reform were mainly concentrated on the unified understanding of policies,how to determine the increase in the total salary quota,and how to reasonably distribute it internally.ConclusionsMianyang City has scientifically determined the total salary and implemented dynamic control,enhancing the public welfare nature of public hospitals,while also taking into account the salary management of employees both inside and outside the establishment,promoting equal pay for equal work.However,there were also issues such as disagreements on the dynamic adjustment of the total salary,an imperfect internal distribution mechanism within hospitals,and an incomplete salary system reform.It is necessary to further strengthen top-level design,reasonably increase salary levels,improve the internal distribution mechanism,and optimize the salary structure to continue deepening the reform of the salary system in public hospital.