Development and validation of methodology of multi-axial evaluation of management quality of health care organizations

建立并验证了医疗机构管理质量的多轴评价方法：1、对医院评审方法、管理质量奖评定标准、ISO和BS管理体系要求进行了比较和检验，作为医院管理综合评价的框架。以下要素是有效管理的共同重要因素，需要加以改进。在大多数医疗保健组织中：领导力与政策部署、目标管理和临床治理相结合；以流程为导向的部门内和部门间合作、流程标准化、个人护理层面和组织层面的系统规划、投诉和事件管理系统以及改进和纠正措施的全面跟进、绩效衡量和反馈、客户满意度。分析了顾客满意度、员工满意度和组织改进活动的分布、相关和相互关系。不同医院之间的满意度有很大差异，满意度取决于患者的身体和精神状态，也取决于期望。工作满意度各分量表与质量改进活动维度之间存在特定维度的相关关系，对100多家医院的缺血性心脏病、子宫肌瘤、股骨颈骨折、夹闭手术等临床指标进行了测量。这些差异在医疗机构之间有所不同，在风险调整后，这些差异有所扩大。除收入外，根据作者开发的患者水平成本计算框架，通过使用来衡量成本。对示范医院各级卫生服务的收入、成本和利润进行了测算和分析，并对利用这些数据进行组织管理的方法进行了检验。

The methodology of multi-axial evaluation of management quality of health care organizations was developed and validated as follows :1 : As frameworks to evaluate hospital management comprehensively, the hospital accreditation method, management quality award assessment criteria, and ISO and BS management system requirements were compared and examined. The following elements are the commonly important for the effective management and they need to be improved. in most of healthcare organizations : Leadership integrated with policy deployment, management by objective, and clinical governance ; process-oriented intra-and inter-departmental collaboration, standardization of process, systematic planning at individual care level and at the organizational level, the system of management of complaints and incidents and thorough follow-up of improvement and corrective actions, performance measurement and feedback, customer satisfaction. The distribution, correlates and inter-relationship were analyzed on customer satisfaction, staff satisfaction and organizational improvement activities. Substantial variation among hospitals were found and satisfaction was found to be dependent upon the patient physical and mental status and also on expectation. Dimension specific interrelation was found among the subscales of job satisfaction and quality improvement activities.Clinical indicators including process and outcome aspects were measured among more than 100 hospitals in cases of ischemic heart diseases, myoma uterus, femoral neck fracture, clipping surgery. They varied among healthcare organizations, and these variation got widened after the risk adjustment. Besides income, costs were measured by use if the patient-level costing framework which was developed by the author. revenue, cost and profit were measured and analyzed at various levels of health care at model hospitals, and the methods too use these data for the organizational management were examined.