医院管理中应处理好学术权力和行政权力的关系

学术权力和行政权力是共存于医院的两种基本权力,两者均为医疗质量服务,又在某些方面冲突,必然导致医院权力结构的复杂性和多样性.通过分析我国医院经营管理中结构现状,提倡学术权力、行政权力分离和相互服务,学术权力是基础,行政权力为学术权力服务,统一于医院服务质量.     

医院挂号收费的服务现状及对策

挂号和收费窗口作为医院医疗服务的一线窗口,其服务水平的高低直接影响着医院的整体服务质量和声誉.本文对当前医院挂号和收费窗口的服务现状进行了汾析,并从服务意识和服务质量的提高、制度和激励考核机制的建设、医疗服务流程魄优化、收费人员的培训和心理疏导、工作环境和工作条件的改善等五个方面提出了改进方法和建议.     

创建"五个好"党组织,提高医院服务水平

创建医院先进的服务理念和医院文化,首先是提高领导班子的思想觉悟,从"五个好"出发展开全院调整,让群众满意的医院党组织工作!     

加强财务管理推动医院可持续发展

财务管理是医院经济管理工作的核心,公立医院应不断创新医院财务管理的理念、内容、目标和方法,努力实现财务预算战略化,成本最低化、分配个性化、效益最大化、人员智能化、决策科学化.信息一体化、服务人性化,以保证医院的经营活动顺利进行,为社会提供优质、高效和低耗的医疗服务.     

以创新思想,谋求医院新发展,树立医院新形象

创新已悄然成为当今时代的主旋律.我国在逐渐构建国家创新体系的过程中,注重思想的创新建设,尤其是创新的服务体系的构建.作为医院人应在思想观念上时刻做好创新准备,成为国家创新服务体系的重要组成部分.因此在当前环境下如何利用创新的思想来促进提高医院的服务质量,扩大医院服务的效果和服务能力,提升医院的新形象,成为推进医疗卫生顺利改革、提高医院现代化管理水平、构建和谐医院的重要途径.     

医院基建档案管理存在的问题及对策

医院基建档案管理工作是医院工作的一个重要组成部分,它是医院规划建设管理重要历史依据和素材.目前医院基建档案管理还存在一些问题,只有完基建档案管理相关制度,充分挖掘档案的利用价值,才能为医院建设更好的服务.     

分析病人满意度强化医疗服务意识

目前医疗机构正面临着日益激烈的市场竞争,医疗服务的竞争已不再局限于医疗质量和价格。优质的医疗服务是医院在现代医疗市场营销的最好载体,以现代服务理念为指导,为病人提供优质的服务,     

发展我国社区医疗卫生服务体系的思考

新的医改方案已经把社区医疗服务定位为老百姓的健康守门人.目前我国城市社区医疗服务机构存在数量少、基础设施投入不足、人员素质和服务水平低,以及管理不规范等问题,与此同时人们的医疗服务选择也受到消费理念变更的影响,因此建议引入大医院连锁经营模式,借助大医院的优势发展社区医疗服务体系.     

医院应收账款风险及管理的思考

应收款项是在提供医疗服务或开展其他有偿服务业务活动中,所形成的应收而未收的各种款项.由于医疗应收款的欠收或缓收,严重地影响了医院在经济收支上的良性循环和正常运作,而且占用时间过长,容易发生坏账损失,也使医院的会计信息失真.因此,医院要严格控制应收款的产生,防止可能发生的意外和损失.     

论医院图书馆个性化读者信息服务

信息时代的网络知识环境使传统图书馆的功能正在发生本质变化,告别是在医院图馆中,医学信息资源的专业性带给图书馆巨大的变化,个性化读者信息服务已成为各类型图书馆发展的一个必然趋势,本文论述了医院图书馆中个性化信息服务的必要和实现途径.     

The role of psychology and psychiatry in general hospital settings in Alabama.

Investigated the availability of psychiatric units in general hospitals, the variety of staff personnel employed, and the range of treatment methods utilized in Alabama. 36% of the responding hospitals provided inpatient psychiatric services. Larger hospitals were more apt to provide these services. The type of staff employed and treatment utilized were similar for both psychiatric institutions and general community hospitals. 89% of the hospitals providing psychiatric services employed psychologists (PhDs and/or MAs). Findings are discussed with reference to the expanding role of psychology at the community level. Emphasis is given to the need for training programs at general hospitals. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of hospital postpartum and postabortion rubella vaccination policies in Los Angeles County, 1992

OBJECTIVE: To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies. DESIGN: A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A remainder and second survey was mailed to ICPs who did not respond to the first mailing. RESULTS: Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had post-partum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women. CONCLUSION: Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.     

Reared in adversity: institutional care of children in the 18th century

The earliest public pediatric care of the 18th century in this country took the form of "outdoor relief." Institutional care followed, first almshouses were built; then orphanages, hospitals, and dispensaries. Almshouses not only included workhouses but provided comprehensive medical services. Throughout the 18th century, people often referred to the almshouses as hospitals. As general hospitals, they rendered a variety of pediatric services to sick children, including the idiotic and hopelessly crippled, and the newborns delivered in the maternity wards; and they tendered services for well children, such as foundlings, abandoned children, and the children of destitute parents, placing infants in foster homes and indenturing older children for training in various trades and crafts. The voluntary hospitals, on the other hand, were for the "worthy" poor and limited their services to the insane and the curable sick. There were only two opened during the 18th century-the Pennsylvania Hospital in 1752 and the New York Hospital in 1791. The former excluded young children during the 18th century. Orphanages preceded the voluntary hospitals in point of time, offering many pediatric services to children, well and sick. Finally, at the end of the century, the independent dispensaries appeared, the first in Philadelphia in 1786. By the middle of this 20th century, practically all of them had been absorbed by hospitals. In these institutions, pediatric knowledge advanced and medical manpower developed even during the 18th century. By the end of that century, social movements began from which evolved the 19th-century concern for the welfare of children.     

Rural hospital health promotion: programs, methods, resource limitations

Most hospitals provide health promotion programs for community residents. There is little information concerning the specific types of services offered by rural hospitals. A questionnaire was sent to every acute care hospital in Iowa (N = 124), including 99 rural hospitals and 25 urban hospitals. Surveys were returned from 95 rural hospitals (96%) and 20 urban hospitals (80%). Results indicated that 98.9% of rural hospitals offered health promotion services to community residents. These services provided on average 7.5 programs on a regular basis, while using only 1.2 full-time equivalent (FTE) employees. Urban hospitals provided 9.5 regular programs with 2.4 FTE. The most common types of rural promotion programs were blood pressure screening, cholesterol screening, safety and protection programs, diet/nutrition programs, prenatal/maternal health, and breast cancer screening. Over 40% of rural respondents stated that other less common programs, including substance abuse prevention and mental health promotion, were needed but could not be offered because of resource limitations; these types of services were offered more commonly in urban hospitals. Rural hospital health promotion programs are attempting to meet a wide variety of programming needs with limited resources, and attention may be well directed towards finding how best to provide various programs with limited resources to maximize their impact on community health.     

Clinical pharmacy services in hospitals educating pharmacy students

In 1995 we conducted a national survey of 1102 acute care hospitals in the United States to determine types of clinical pharmacy services, patient-focused care, and pharmaceutical care used to educate and train pharmacy students, and compared outcomes with surveys in 1989 and 1992. Clinical pharmacy services offered in 50% or more of Pharm.D.-affiliated hospitals (core services) were drug-use evaluation, in-service education, pharmacokinetic consultations, adverse drug reaction management, drug therapy monitoring, protocol management (most common for aminoglycosides, nutrition, antibiotics, heparin, warfarin, theophylline), nutrition team, and drug counseling. Comprehensive pharmaceutical care programs were established in 64%, 42%, and 33% of Pharm.D., B.S., and nonteaching hospitals, respectively. Patient-focused care programs were beginning or established in 77%, 71%, and 60%, respectively. Pharmacists served as care team leaders in 23% of hospitals affiliated with a college of pharmacy. Most common ambulatory care clinics were oncology, anticoagulation, diabetes, geriatrics, refill, and infectious diseases/HIV. For-profit hospitals rarely provided education for pharmacy students. Thus patient-focused and comprehensive pharmaceutical care programs exist according to a hospital's academic program affiliation with Pharm.D. or B.S. degree program.     

Hospital reorganization after merger

Major organizational changes among hospitals, like system affiliation, merger, and closure, would seem to offer substantial opportunities for hospitals and health systems to be strategic in the local reconfiguration of health services. This report presents the results of a unique survey on what happened to hospitals after mergers occurring between 1983 and 1988, inclusive. Building on an ongoing verification process of the American Hospital Association, surviving institutions from all 74 mergers that occurred during the study frame were surveyed in the fall of 1991. Responses were received from 60 of the 74 mergers (81%), regarding the primary, postmerger use of the hospitals involved. Topics surveyed included the premerger competition between the hospitals and in their environment, and what happened to the hospitals after their mergers. Mergers frequently served to convert acute, inpatient capacity to other functions, with less than half of acquired hospitals continuing acute services after merger. In the context of health care reform, mergers may offer an expeditious way locally to restructure health services. Evidence on the postmerger uses of hospitals and about the reasons given for merger suggests that mergers may reflect two general strategies: elimination of direct acute competitors or expansion of acute care networks.     

Health maintenance organization penetration and general hospital psychiatric services: Expenditure and utilization trends.

Expenditures for inpatient and outpatient psychiatric services provided through general hospitals and the utilization of those mental health and substance abuse services through general hospitals is examined for all states grouped by level of health maintenance organization (HMO) penetration. Between 1983 and 1990, outpatient use for general hospitals increased substantially for the high-HMO group but decreased in the low-HMO group. During the same time period, per capita expenditures for inpatient and outpatient psychiatric services grew fastest in low-HMO areas. These findings suggest that HMOs restrain the growth of general hospital psychiatric expenditures and encourage the growth of outpatient alternatives to inpatient treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The provision of general surgical services in rural South Australia: a new model for rural surgery

BACKGROUND: Rural South Australia (SA), like other rural areas in Australia, faces a crisis in the medical workforce. It is also generally assumed that the same applies to rural surgical services but finding evidence to support this is scarce. METHODS: All hospitals situated outside the outer metropolitan area of SA were surveyed about surgical services (n = 57). Questions were asked about the frequency of emergency and elective theatre usage and which surgeons provided surgical services. RESULTS: Operating theatre facilities were in active use in 39 of the 57 hospitals studied. At the time of the study there were seven specialist general surgeons resident in rural SA. General practitioners continued to have a major input in the provision of surgical services, either by providing the general anaesthetic (34/39) or by performing the surgical procedures (26/39). CONCLUSIONS: The Department of Surgery at the University of Adelaide is instituting various measures to counter the rural surgical workforce problem and is developing a model that serves either the individual or the two-person surgical practice. Metropolitan teaching hospitals can play an important role in supporting current rural surgeons and can foster an increased commitment to the future of rural general surgery.     

Differences between metropolitan and country public hospital allied health services

This paper compares patient and episode characteristics in allied health services delivered in country and metropolitan hospitals. Eight public hospitals (46 allied health services) participated in the study (three country and five metropolitan sites, situated in South Australia, Queensland and Tasmania). Standardised rates of patient throughput were similar for country and metropolitan allied health services, despite smaller numbers of country staff providing services to larger geographical areas. Although the differences were not significant, country patients were generally older and had more chronic conditions than metropolitan patients. Fewer country patients than metropolitan patients were eligible for rebates in the private sector. In addition, fewer alternative services were available in country communities, which heightened the role of the public hospital outpatients services within the community. This paper provides an argument for similar funding arrangements for country and metropolitan ambulatory allied health services.     

Effects of Medicare's prospective payment system on service use by depressed elderly inpatients

OBJECTIVE: To determine the effects of Medicare's prospective payment system (PPS) on hospital care, changes in length of stay and intensity of clinical services received by 2,746 depressed elderly patients in 297 acute care general medical hospitals were studied. METHODS: A pre-post design was used, and differences in sickness at admission were controlled for. Data on length of stay and use of specific clinical services were obtained from the medical record using a medical record abstraction form. Care provided on units exempt from PPS was compared with care provided in nonexempt units. RESULTS: After implementation of PPS, the average length of stay fell by up to three days within the different types of acute care settings studied, but this decline was partially offset by proportionately more admissions to psychiatric units, which had longer lengths of stay. Intensity of clinical services increased after PPS implementation, especially in nonexempt psychiatric units. CONCLUSION: Despite financial incentives for hospitals to reduce clinical services under PPS, its implementation was not associated with a marked decline in length of stay, when averaged across all treatment settings, and was associated with an increase in the intensity of many clinical services used by depressed elderly patients in general hospitals.