Study on the Causes and Countermeasures of Medical Staff Turnover in County Public Hospitals from the Perspective of Developmental Psychology

This study aims to explore the causes of medical staff turnover in county public hospitals from the perspective of developmental psychology and put forward effective countermeasures.Through qualitative research method,a semi-structured in-depth interview was conducted with 23 medical staff in Liannan County Hospital to analyze the current situation and influencing factors of their loss.The study found that difficult working environment,lack of career development opportunities,poor sociocultural adaptation and inconsistency between personal values and organizational goals were the main reasons leading to the turnover of medical staff.In response to these problems,the research puts forward countermeasures and suggestions to improve the working environment,provide career development platform,strengthen social and cultural support,and promote the integration of individual values with organizational goals.The results of this study provide a new perspective for understanding and solving the problem of medical staff turnover in county public hospitals,and provide a reference for relevant policy formulation and hospital management practice.

Are mindfulness and self-efficacy related to presenteeism among primary medical staff: A cross-sectional study

Objectives: In ensuring public welfare with primary medical and health services,the primary medical staff faces new tasks.Increasing workload,and therefore degrees of stress and burnout,can influence job satisfaction and lead to presenteeism,which is defined as the appearance to be on the job but not actually working.The purpose of this study is to investigate the current worling situation and the relationship between presenteeism and mindfulness of primary medical staff and determine the mediating effect of self-efficacy on this relationship.Method: A cross-sectional survey was performed with 580 primary medical staff from 9 hospitals in Shaanxi province,northwest China.Presenteeism,mindfulness,and self-efficacy were measured by using a general information questionnaire,the Five-Facet Mindfulness Questionnaire,the General Self-Efficacy Scale,and the Stanford Presenteeism Scale.Mediating effect was analyzed by a series of hierarchical multiple regressions.Results: A high level of presenteeism was found among 47.4% of the study participants.Presenteeism was negatively correlated with mindfulness(r--0.409,P < 0.001) and self-efficacy(r--0.678,P < 0.001).A positive correlation was found between mindfulness and self-efficacy(r-0.584,P< 0.001).When controlling for self-efficacy (β =-0.018,P> 0.05),the association was insignificant between presenteeism and mindfulness.Conclusion: The results identified the effect of mindfulness on presenteeism of primary medical staff is realized through self-efficacy,which also suggested to enhance self-efficacy on center location when developing management strategies for mental health education or training among primary medical staff.

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.

The Psychological Experience of the Nursing Staff of the Medical Oncology Department in Cameroon: Case of the YaoundéGeneral Hospital

Background: The world of cancer care is an emotional place, given the severity of the disease being treated, the heavy workload, the suffering of patients, and the high number of deaths. The nursing staff who work there may be exposed to constant stress from these factors. This study aimed to explore the psychological experience of the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Methods: We carried out a cross-sectional study, in June 2017, involving the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Results: Sixteen out of 18 nurses were interviewed. All had worked in at least one other department prior to Oncology. The number of years of experience in Oncology ranged from less than one year to 13 years. The choice of the Oncology department was involuntary for 100% of the staff;of these, 62% had intentions of changing departments. Twenty-five percent had applied for a change of department, which was unsuccessful. Stress was expressed by 94% of the staff;93% thought that there was a solution to the stress experienced on a daily basis in the Oncology department. The main solutions proposed to manage this stress were: support for the staff, provision of work materials, and staff training. Conclusion: The nursing staff of the Medical Oncology Department of the Yaoundé General Hospital experiences a high level of stress and are in need of solutions.

System for the Management of the Continuity of Use of Medical Devices in Hospitals

The Technical Services and the Medical Administration of the Hospitals of Trieste have been working for years to ensure the optimal functioning of the Surgery, Intensive Care, Diagnostics and Research Services offered to the Patients and to the University in an 800-bed hospital complex, transforming and innovating the buildings and support installations. We have dedicated special attention to the technologies necessary to guarantee the continuity of the power supply to the electromedical devices, increasingly numerous in highly specialized hospitals. We report the power of the generator sets and the UPS and our opinion that their power must be related to the overall consumption of the hospital, with a reserve margin.

Evaluation of patient safety culture as perceived by nurses during the COVID-19 pandemic

Objectives:A good patient safety culture(PSC)is linked to a reduced risk of patient problems and minimal undesirable occurrences.This study investigated the PSC levels from nurses'perspectives during the COVID-19 pandemic.Methods:A descriptive cross-sectional design was applied.The Hospital Survey on Patient Safety Culture(HSOPSC)questionnaire was administered to 315 nurses working at 2 major hospitals in Jeddah,Saudi Arabia.The data were analyzed using descriptive statistics,a t-test,and a one-way ANOVA test.The statistical significance of the correlation was determined at the 0.05 level.Results:PSC was rated as medium overall according to the nurses,with a weighted mean of 2.88–0.76 and a relative weight of 57.57%.In addition,all PSC composites were rated from medium to high,except organizational learning,which was rated low.The correlation between sociodemographic variables as well as PSC levels was investigated using the t-test and one-way ANOVA test.The association is statistically significant when P≤0.05.The findings revealed a statistically significant correlation between nurse nationality(t=-4.399,P=0.000),age(F=7.917,P=0.000),experience in years(F=3.760,P=0.024),and hospital(t=-0.401,P=0.689).Conclusions:The nurses in this study had a medium overall PSC level,and all PSC composites ranged from a medium to a high level,except organizational learning,which had a low level.In addition,the findings showed that there is a significant relationship between PSC levels,nurses'nationalities,experience in years,and the hospital itself.

公立医院高质量发展新文化指标体系构建研究

目的研究构建公立医院高质量发展新文化指标体系,为评价公立医院新文化建设水平、推进高质量发展提供科学工具。方法基于政策梳理和文献研究建立指标池,通过德尔菲专家咨询论证形成指标体系,并运用层次分析法赋予权重系数。结果公立医院新文化指标体系包含医院文化制度建设、强化患者需求导向、关心关爱医务人员和特色鲜明医院文化4个一级指标、8个二级指标和23个具体条目,开展成效作为附加维度包含2个二级指标和8个具体条目。一级指标权重均衡;二级指标中,制度规划(0.250)、员工关怀(0.170)、医疗服务(0.130)、学科品牌(0.125)和职业精神(0.125)权重相对较高。结论所构建的公立医院高质量发展新文化指标体系契合习近平文化思想和建设公立医院高质量发展新文化要求;需关注文化制度规划,强化员工关怀及职业精神培养,注重医疗服务和学科品牌建设,促进公立医院新文化建设与国家战略要求同频共振。

三级公立医院绩效考核背景下医院运营管理的研究

国家三级公立医院绩效考核开始于2019年,运营效率作为考核的一部分,相关的国家监测指标有9个,包含收支结构和费用控制。绩效考核是医改工作的有力抓手,也是加快现代医院管理制度建立的强劲推手。通过分析某三级甲等口腔专科医院在绩效考核背景下运营效率指标的得分情况,找出原因;并通过加强党建引领,做好医院运营管理体系架构顶层设计,加强医疗质量管理,落实医改相关政策,加强能耗管理,不断提高员工福利待遇,强化公立医院功能定位,提高医疗服务收入占比,绩效分配体现医务人员的劳动技术价值,提高运营管理能力,助推医院高质量发展。

大型公立医院构建三尺质控模型的实践探索

目的构建“三尺”质控模型,促进医疗质量全面内涵管理。方法构建由“标尺、量尺、戒尺”组成的“三尺”质控模型,具体包括:以各项质量指标的标准化保障质量的基础管理,形成“标尺”;以“标尺”为准绳,落实全面质控和监督机制,保障质量的环节管理,形成“量尺”;运用绩效奖惩等措施落实质量的终末管理,形成“戒尺”。结果“三尺”质控模型的构建形成了全方位医疗质量监督管理机制,强化了医疗质量全面内涵管理,夯实医院高质量发展根基。结论“三尺”质控模型的构建与推广,有助于医疗质量持续改进和医疗服务能力有效提升,为我国各级医院医疗质量持续改进提供参考。

基于“阳光医院”模式药物治疗联合多维度心理干预对倒班医务人员失眠的疗效

目的观察“阳光医院”模式下药物联合多维度心理干预对倒班医务人员失眠的影响,为改善一线倒班医务人员身心健康提供参考。方法纳入武汉市患有失眠的倒班医务人员140例,采用随机数字表法分为治疗组和对照组各70例,对照组给予药物治疗,治疗组基于“阳光医院”模式给予药物治疗联合多维度心理干预。基线期、访视1(基线+干预1个月)、访视2(基线+干预3个月),采用匹兹堡睡眠质量指数量表(PSQI)、失眠严重指数量表(ISI)、爱泼沃斯嗜睡量表(ESS)、疲劳评估量表(FAS)评估两组睡眠情况,采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、抑郁症自我评估量表(PHQ-9)、焦虑自评量表(SAS)评价两组心理状态。结果治疗组各方面均优于对照组。(1)睡眠:治疗组与对照组PSQI量表7个维度评分及总分、ISI、ESS、FAS总分在不同时间段均存在组内差异(P<0.05);其中,两组PSQI评分在访视2时差异有统计学意义(P<0.05);两组访视1、访视2时睡眠质量、睡眠效率评分、ESS、FAS均差异有统计学意义(P<0.05)。(2)心理状况:两组不同时间段HAMD、HAMA、PHQ-9、SAS评分均差异有统计学意义(P<0.05);访视2时两组HAMA、SAS评分均差异有统计学意义(P<0.05)。结论基于“阳光医院”模式的药物治疗联合多维度心理干预,短期可明显改善倒班医务人员嗜睡、疲劳症状和睡眠质量、睡眠效率及焦虑抑郁情绪,长期可明显改善整体失眠情况及焦虑情绪。

创新文化建设 赋能公立医院高质量发展

医院文化是现代医院的核心竞争力,是公立医院发展的内生动力,渗透并影响着医院的医疗质量、现代管理、科研教学、人才培养等多个方面。先进的医院文化有助于提升医院核心竞争力,树立良好的医院形象,建立和谐的医患关系,助力医院高质量发展。常州市第一人民医院坚持以党建为引领,锚定“532”发展战略,创新建设医院精神、制度、服务、廉政、品牌的“五化”路径,通过打造医院精神文化,筑牢职工思想根基;加强医院制度文化,提高科学管理水平;深耕医院服务文化,改善患者就医体验;构建医院廉政文化,提升医疗服务意识;塑造医院品牌文化,扩大行业影响力,不断提高医院管理水平,改善患者就医体验,促进医院高质量发展。

医务人员医院文化认知与体验感现况及影响因素分析

目的了解医务人员医院文化认知与体验感现况,并分析其影响因素,为进一步发挥医院文化建设对医务人员的激励作用、提高医务人员的工作积极性提供参考依据。方法基于课题组前期研制的医务人员医院文化认知与体验感量表,以样本医院医务人员作为调查对象开展问卷调查,采用描述性分析、单因素分析和多元线性回归研究医务人员医院文化认知与体验感及其影响因素。结果共收集到629份有效问卷。医务人员医院文化认知与体验感总体得分率超九成,其中,使命担当子量表得分率最高,得分较高的维度是愿景与目标,但对工作环境、晋升制度和科研环境的体验感相对较低。单因素分析结果显示:不同学历、职称和工作岗位医务人员医院文化认知与体验感得分差异有统计学意义(P<0.05)。结论医务人员普遍支持医院文化建设。建议以员工为主体、以目标、问题和需求为导向,制定医院文化发展策略,因人制宜持续提升医务人员对医院文化的认知与体验感,发挥文化建设对医院高质量发展的正向作用。

公立医院文化软实力评价指标体系构建

目的:探讨公立医院文化软实力的重要性及核心内涵,构建科学的公立医院文化软实力评价指标体系,为医院文化建设和高质量发展提供参考。方法:采用文献回顾法,整合文化软实力相关国内外理论与实践,初步构建公立医院文化软实力评估指标;运用德尔菲法,经两轮专家咨询后确立指标内容与层次,并应用加权平均法确定各指标权重。结果:构建了公立医院文化软实力评价体系,包括5项一级指标、14项二级指标和42项三级指标,确定了各指标权重。结论:本研究从多角度、多层次构建的公立医院文化软实力评价指标体系具有科学性和适用性,为公立医院文化软实力评估与提升提供了科学工具,对公立医院高质量发展有积极意义。

公立医院高质量发展背景下医用耗材遴选体系的构建与思考

目的构建医用耗材遴选体系,遴选出适应医院和业务发展需求、患者满意的质优价廉产品,促进临床科学、合理使用医用耗材。方法分析医疗机构医用耗材遴选管理现状及难点,从明确总体要求、确定管理架构及制度、建立规范遴选流程、选择合适遴选品种、设定遴选标准方面着手,并依托医用耗材采购交易平台以及借助SPD模式,构建科学完善的医用耗材遴选体系。结果同类耗材品种减少,耗材单价平均降幅达14.63%以上,临床科室满意度达90%。结论构建科学完善的医用耗材遴选体系有助于降低患者费用及医院成本,改善服务质量,适应公立医院高质量发展要求。

公立医院医务人员职业倦怠现状及危险因素分析

目的:分析公立医院医务人员职业倦怠现状及危险因素。方法:选取2018年6月—2021年6月德阳地区市属公立医院的100名医务人员作为研究对象,统计一般资料及职业倦怠评分,分析公立医院医务人员职业倦怠现状及危险因素。结果:100名医务人员中,无职业倦怠18.0%(18/100),轻度职业倦怠36.0%(36/100),中度职业倦怠26.0%(26/100),重度职业倦怠20.0%(20/100)。年龄、工作年限、婚姻状况、职业及日工作时间是医务人员职业倦怠的影响因素,差异有统计学意义(P<0.05)。年龄21~40岁、工作年限≥10年、未婚、护士职业、日工作时间>8 h是医务人员职业倦怠的危险因素,差异有统计学意义(P<0.001)。结论:针对医务人员职业倦怠的危险因素,医院管理者应加以重视,采取相应干预措施,改善医务人员的职业倦怠情况。

医院文化建设在医院管理中的作用

随着新医改的持续深入,医院管理也迎来了新的发展阶段。相比公立医院,医院文化建立是医院管理中的重要阶段,它既是维系医院内部稳定和推动医院发展的内在动力,也是促进医院形象提升的重要因素,更是实现医院管理手段的关键举措。所以,提高医院管理的高度,必须加强医院文化建立。文章分析了医院文化建立的深层次内容,着重从职工凝聚力的增强、医院内部文化建设、外部文化建设、物质文化建设、提升医院外界热度和提高院内管理等方面讲述了多层次医院文化建立的增强在现代医院管理中的重要性,更进一步论证优秀的医院文化建设可促进医疗技术水平和整体管理效率的提高,对增加职工凝聚力和医院执行力有明显作用,从而树立医院品牌,造就一流现代化综合性医院。

某大型公立医院人才培养与能力提升的建设实践

随着医改的逐渐深入,各级公立医院都在推进高质量发展,对医院来说既是机遇也是挑战。在公立医院高质量发展过程中,人才因素最为重要,是医院发展的基石,只有不断提升人才的综合能力和素质,才能推动医院良性可持续发展,提升医院的医疗服务水平。近年来,南京医科大学附属淮安第一医院在组建专病诊疗组、多学科诊疗、外聘学科带头人、专科联盟、新技术开展、基础医疗质量评价体系、急危重症管理体系建设、手术医师能力提升等方面做了许多探索,取得了显著成效,这些创新性举措的实施推动了医院人才培养与能力提升,为国内医院高质量发展提供借鉴。

对医护人员实施ICU感染防控管理的效果

目的分析对医护人员实施重症监护病房(intensive care unit,ICU)感染防控管理的效果。方法选取2022年1月—2023年12月在新疆生产建设兵团第九师医院ICU病房工作的21名医护人员作为研究对象,2022年1—12月(对照组)行常规管理,2023年1—12月(观察组)行ICU感染防控管理。对比两组医院感染发生情况与感染控制措施执行评分。结果观察组医护人员医院感染发生率为0,低于对照组的9.52%(2/21)。观察组环境控制评分为(95.43±2.23)分、物品消毒评分为(94.23±1.89)分、无菌操作评分为(95.13±3.87)分、手卫生评分为(95.09±3.92)分,均高于对照组的(90.34±3.14)分、(90.87±2.10)分、(90.11±2.87)分、(90.87±3.88)分,差异有统计学意义(t=7.239、6.514、5.707、4.191,P均<0.05)。结论ICU感染防控措施能有效减少医院感染情况,提高医护人员的感染控制措施执行力。

公立医院急诊患者安全管理与救援能力提升研究

在公立医院高质量发展的大背景下,提升疾病救治能力,为广大人民群众提供高质量、高水平的医疗服务,已成为各级公立医院的追求目标。急诊是反映医院医疗质量管理的窗口,各项急救工作高度依赖医生的判断以及医护人员的协作,属于高风险流程,需要医院管理者高度重视。淮安某公立医院利用医疗失效模式与效应分析工具(healthcare failure mode and effect analysis,HFMEA)对急诊患者进行安全管理,包括成立HFMEA团队,绘制现况价值流程,计算风险指数和决策树分析后实施改善方案,有效提升了急诊医疗质量与安全。同时通过建立健全应急救援组织架构、强化应急救援管理内涵质量、打造一流救援平台和优秀应急救援队伍,全面提升了医院在应急状态下的综合救援能力。

公立医院一院多区模式与紧密型城市医疗集团的功能解析与差异化发展

一院多区模式和紧密型城市医疗集团是中国医疗卫生服务体系应对城市化、人口老龄化和医疗资源不平衡等挑战的重要举措和我国医疗卫生体制改革的重要成果。二者在资源整合与服务协同等方面呈现出了一定的相似性,但同时在功能定位、理论基础、发展动因、组织结构等多个方面存在根本区别。本文对一院多区模式和紧密型城市医疗集团的定义、表现形式、功能和面临挑战进行辨析的基础上,对其差异化发展趋向和策略进行探讨。