八年级建立健全医院立体化绩效考核评价体系

《八年级建立健全医院立体化绩效考核评价体系》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

n掌握NE5000E/80E/40E产品的体系结构n掌握NE5000E/80E/40E的单板构成n掌握NE5000E/80E/40E换板操作n了解NE5000E/80E/40E升级操作建立健全医院立体化绩效考核评价体系On3-DimensionedPerformanceAssessmentandAppraisalSystem1、前言：1.Preface在医疗改革呼声日益高涨和医疗市场竞争不断加剧的今天，医院如何改变原有的运行管理模式，适应新形势的变化，提高医院的核心竞争力，是医院管理者不可回避的重要问题。我国医院的发展经历了从设备竞争——技术竞争——服务竞争——战略竞争的过程，目前正向文化竞争发展。竞争就要有目标，目标是医院发展的方向，在当前医疗市场的竞争中，实施目标管理是医疗机构保持竞争实力的最常用方法之一，更是医院管理的最常用手段之一。由于目标管理事先有比较明确的目标作为标准和动力，人们随时进行自我管理，并努力完成既定的工作目标。目标管理辅以绩效考核的手段，可以督促人们在实现目标过程中，及时调整方向进行资源整合，最终达到组织利益的实现。Howcanhospitaltransformthecurrentmodeofoperationandmanagement?Howcanhospitaladaptitselftothenewsituation?Howcanhospitalimproveitscentralcompetitivestrength?Thosechallengeshavetobeapproachedbyhospitalmanagerstoday70

1especiallywhenhealthcarereformisearnestlycalledforbythemedicalmarketwithintensivecompetition.ThedevelopmentofhospitalsinChinahasexperiencedthecompetitioninequipment,technology,serviceandstrategyrespectivelyandnowisgettingintotheculturalcompetition.Competition,ofcourse,feelslikeanobjective,whichisthedirectionofahospital.Inthemedicalmarketcompetition,however,objectivemanagementisthemostpopularpracticeforamedicalagencytomaintainitscompetitivestrengthaswellastomanageahospital.Asobjectivemanagementcriesoutforadefiniteobjectiveinadvance,whichservesasastandardandimpetus,peoplecanconductselfmanagementatanytimeandstrivetoreachtheirgoal.Withhelpofperformanceappraisal,however,objectivemanagementmayenhancetimelyadjustmentofthecourseduringrealizationoftheobjectivetointegrateresourcesandeventuallytoobtainbenefits.1、相关背景资料：2.Background近十年来，随着国务院及其他政府部门相关医疗政策的出台，以及中国加入WTO70

2后医疗市场的逐步对外放开，国内的医疗行业状况发生了巨大的变化。民营医院大量崛起，其中有些甚至收购了多家公立医院；外资医院或机构正在大举入侵，其凭借独特的技术和服务优势占得了不小的市场份额；随处可见的私人诊所和药店也如雨后春笋般出现。这些都给公立医院的生存与发展带来了一定的冲击。国家医改方案迟迟不能出台，虽然先后有十套方案相继出炉，却始终未能形成一套适合中国医疗市场的总体改革方案，医疗体制改革举步维艰，公立医院发展前景不明朗。无锡市针对国际国内形势变化，在没有任何经验可借鉴的情况下，在国内率先进行了“政事分开，管办分离”运行机制的改革。卫生局作为行政执法部门对公立医院的经营行为进行监管；由卫生局分离出来的医院管理中心（以下简称医管中心）成为政府“办医院”和“管资产”的责任主体，“办医院”就是在法律法规及政策的框架下，通过优化配置资源，提高医疗质量，提供满足不同层次需求的代表市属医院水平的优质医疗产品。“管资产”就是要确保国有资产保值和效益最大化。在医管中心成立后，将前几年进行的以经济指标考核为主的“托管制”改革进一步深化为注重对社会效益和工作业绩综合考核的“医疗服务、资产经营委托管理法人代表任期目标责任制”改革，把解决医院建设和运行目标作为重点，探索所有权和经营权分离的模式，达到既尽显公益性特征、又增强医院活力的目的。职能上下放医院经营管理、人事用工和经济分配权，激发医院活力。医院则是专科建设、人才培养、医疗服务与经营的主体。面对医管中心下达的涉及医院管理、医院信息、医疗安全、医疗服务、经济运作、医德医风六个方面内容，八大类17项数百条共1000分的考核标准，医院该如何确立一个符合自身发展需求的总体目标，并能按计划有步骤地加以实施，则显得尤为重要。AshealthcarepolicieshavebeenpromulgatedbytheState70

3CouncilandothergovernmentalbodiesandthemedicalmarkethasbeengraduallyunveiledtooutsideafterChinaenteredWTOinthepast10years,agreatchangehashappenedtoChinesemedicalindustry,wherearerisingalotofprivatehospitals,someevenacquisitionedafewpublichospitals;meanwhile,manyforeign-fundedhospitalsoragenciesarerushingofftheirheadintoChinaandtheyhaveamuchshareofthemarketthankstotheiruniquesuperiorityinbothserviceandtechnology;andontheotherhand,privateclinicsanddrugstoreshaveemergedhereandthere,which,insomedegree,istroublingthesurvivalanddevelopmentofpublichospitals.10nationalhealth-care-reformprograms,althoughpublishedinsuccession,failtobringaboutageneralschemewhichissuitableforChinesemedicalmarket.Inthisconnection,thehealthcarereformisstillfarfrommaturedand,asaresult,publichospitalisstillfightingitswaytosurviveanddevelop.Inviewofthepresentsituationathomeandabroad,WuxiCityhaspioneeredtoundertakethereformonhospitaloperationsmechanism,i.e.“Separatinggovernmentfunctionsfrompublicinstitutionsandadministrationfrombusinessrunning”withoutanyexperiencetobereferenced.Asanenforcingbody,theBureauofHealthofWuxiCityservestosupervisethebusinessofpublichospitals;theHospitalManagementCenter(HMC)separatedfromtheBureauof70

4Healthisaresponsibleentityofthegovernmentto“runhospitals”and“manageassets”.“Runninghospital”callsforprovidingqualitymedicalproductsonamunicipallevelwhichcanmeetdemandfromdifferentwalksoflifebyoptimizingarrangementofresourcesandfurtherimprovingthequalityofhealthcareincompliancewithlaws,rulesandregulations.“Managingassets”,however,callsformaintainingstateownedassetsandmaximizingtheirbenefits.AfterHMCwasestablished,“entrustingsystem”reform,characteristicofeconomicindexassessmentputintopracticeyearsago,hasbeenfurtheredintothereformof“targetresponsibilitysystemsetfortheofficetermofthelegalrepresentativeentrustedtomanagemedicalserviceandassetsoperation”.Thissystemfocusesoncomprehensiveassessmentwhichismadeoverthesocialbenefitsandbusinessperformanceandattachesimportancetoreachingthegoalofhospitaloperations,withaviewtoexploringamodeofseparatingownershipandmanagementtorealizepublicwelfareandactivatehospital.Intermsoffunction,thepoweroverhospitalbusinessmanagement,humanresourcesrecruitandfinancialallocationisdistributedtolowerlevelstoenergizehospital,whichservestoundertakefacultyconstruction,talentstraining,medicalservicesandoperations.HMChasissuedhundredsofassessmentcriteriaamountingto1000markscomposedof17itemscovering70

5eighttypesandsixaspects,namelyhospitalmanagement,hospitalinformation,medicalsecurity,medialservice,financialpracticeandmedicalethics.Inthisconnection,itisveryimportantforahospitaltocorrectlyestablishageneralgoalwhichsatisfiesitsowndevelopmentandactonthisgoalasplannedstepbystep.我所在的无锡市第四人民医院是一所集医疗、教学、科研、预防、保健为一体的卫生部首批三级综合性医院，是无锡市肿瘤医院和苏州大学附属第四医院；也是苏州大学生命科学学院临床肿瘤和分子生物研究所、无锡市肿瘤防治研究所所在地；无锡市心胸外科治疗中心和无锡市麻醉科质量控制中心均设在我院。医院技术力量雄厚，专科特色明显。以肿瘤诊断治疗为重点，其他学科协调发展。医院开放床位1050张，肿瘤床位占总开放床位的50%以上。医护员工1250名，其中医师430名，护士458名；拥有高级职称138名，其中主任医师、教授34名，副主任医师、副教授94名。年门、急诊量60万人次，出院病人2.8万人次。Myemployer,WuxiFourthPeople’sHospital(WFPH),isoneofthefirstlotofgrade3comprehensivehospitalscertifiedbyMinistryofHealthofthePeople’sRepublicofChina,whichintegrateshealthservice,training,research,illnesspreventionandhealthcare.ItsimultaneouslyservesasWuxiCancerHospitalandFourthHospitalAttachedtoSuzhouUniversity.Meanwhile,thishospitalalsohousesClinicalCancer&MolecularBiologyResearchInstitute70

6attachedtoSuzhouUniversityLifeScienceSchool,WuxiCancerPreventionandTreatmentResearchInstitute,WuxiCardiothoracicSurgeryTreatmentCenterandWuxiAnesthesiaQualityControlCenter.Powerfulintechnologyandcharacteristicofspecialfaculty,thishospitalfocusesoncancerdiagnosisandtreatmentwithotherfacultiesdevelopedinbalance.Thereare1050beds,ofwhichthoseusedforcancerfacultyaccountforover50%.Thehospitalisstaffedwith1250employees,430beingphysiciansand458beingnurses;138employeesareofseniortechnician,34ofthembeingchiefphysiciansorprofessorsand94beingassociatechiefphysiciansorassociateprofessors.600,000patient·timescomeforemergencyorasoutpatientinayear,ofwhichthereare28,000dischargedpatient·times.经过三十年的建设，我院已成为一所区域性的肿瘤诊治中心。进一步提高肿瘤诊治水平，完善综合医学救治能力，满足广大病员日益增长的诊治需求，在挽救病人生命与改善病人生活质量方面作出不懈地努力，成为名副其实的苏南地区具有影响力的肿瘤中心，是我们大家共同的愿景和重要的任务。After30years’efforts,thishospitalhascometobeacancerdiagnosisandtreatmentcenterinthisregionandwehopethatwecanbeworthyofthefamouscancercenterinSouthJiangsubyfurtherimprovingcancerdiagnosisandtreatment,perfecting70

7comprehensivemedicaltreatment,satisfyingpatients’increasingdemandfordiagnosisandtreatmentandsparingnoeffortstosavepatients’lifeandimprovetheirlivingquality.作为一家大型国有公立医院，如何适应医疗体制未变，但运行机制却发生改变的形势，全面完成医管中心下达的目标任务；如何面对社会对医疗服务过高需求与员工自身素质参差不齐的考验；如何在市场经济的大潮中，面对医疗市场开放后外资医院的竞相涌入，面对国内民营医院的蓬勃发展，面对公立医院之间的激烈竞争，保持旺盛的生命力等等。挑战是全方位的，压力也是前所未有的。但挑战总是与机遇并存。作为医院管理者，不仅要自己明确医院发展方向，更要让员工明确奋斗目标与前进航向，寻求一种职工共同参与、自我管理的方式，同舟共济，则是所有医院管理者所期盼的。Howcanwe,asalarge-sizedstate-ownedpublichospital,adapttothenewsituationwherethemedicalsystemisunchangedbutthebusinessoperationischangedtocompletetasksassignedbyHMC?Howcanweapproachthechallengeswhenpeoplehaveanover-demandformedicalservicesbuttheemployeesareirregularinquality?Howcanwemaintainexuberantvitalitywhenforeign-fundedhospitalsfloodedinafterthemedicalmarketwasopened,vigorousdevelopmentofprivatehospitalsathomeandacutecompetitionbetweenpublichospitalsinthemarketeconomy?Althoughthereareall-aroundandunprecedentedchallenges,they70

8areaccompaniedbyopportunities.Ahospitalmanagershallnotonlyspecifythehospital’sdirection,butalsoleadthestafftospecifytheirown.Ofcourse,allmanagerslookforwardtohavingamethodbywhichthestaffareinvolvedtogetherandmakeselfmanagementsothateveryonehasaclearmindthattheyareinthesameboat.3、绩效管理文献回顾：Reviewoftheliteratureonperformancemanagement:绩效考核是医院管理的一个重要手段和方法，是对管理目标实现和评价的客观、公正的体现。目标管理于20世纪50年代中期出现，是以泰罗的科学管理和行为科学理论为基础形成的一套管理制度，可以调动人们亲自参加工作目标制定的积极性。持续改进与提高管理水平需要制订科学合理、注重实绩的考评体系，才能进行全面、客观、公正、公平的评价，这是落实管理的基点。Asanimportantwaytomanagehospitals,performanceassessmentcanimpartiallyandobjectivelyembodyrealizationofmanagementbyobjectives.Borninmid-1950s,managementbyobjectivesisasetofmanagementsystemsformedonthebasisofthereasonablemanagementandbehaviorsciencetheoryfoundedbyFrederickWinslowTaylor,whichisexpectedtoarousepeople’senthusiasmtoinvolvepersonallyinmakingtheobjective.Inordertocontinuouslyrenovateandimprovemanagement,itisnecessary70

9toestablishareasonableassessmentsystemwhichfocusesonactualperformance.Onlyinthiswaycanappraisalbemadefully,equally,objectivelyandimpartially.Thisisthebasepointtorealizesuchmanagement.绩效管理已在发达国家，特别是国际成功企业中被广泛采用，美国及欧洲一些国家的医院，在各个层次都成功实施了绩效管理。医院在某些方面类似于企业，医院管理、经营的许多理念，方式均始于企业或由企业演化而来。不同的是企业讲利润最大化，追求的是经济效益；而医院首先讲救死扶伤，并只能在追求社会效益的前提下，讲成本核算。医院在进行绩效评估与绩效管理时，应采取扬弃的态度，充分借鉴企业的做法与经验，并注重结合本行业的实际，实事求是地进行绩效评估与绩效管理。如何将更科学的考核体系和良性竞争的动态机制融入到医院评价比较之中，科室单元内部又如何以科学公正的绩效指标评价每位人才的价值和贡献，目前缺少一套成熟而又实用的评价体系，这是目前各医院管理者迫切需要研究与探讨的重要课题。Performancemanagementhasbeenwidelyusedindevelopedcountries,particularlyinthoseworldfamousenterprises.HospitalsinUSAandsomeEuropeancountriesalsohavesuccessfullyconductedperformancemanagementonvariouslevels.Insomeaspects,ahospitalismuchsimilartoanenterpriseandmanyideasandmethodsinhospitalmanagementoriginateorareevolvedfromenterprise.Differently,enterprisesseekformaximal70

10profitsandeconomicbenefits;hospitals,however,basicallyservetohealthewoundedandrescuethedyingandtakeintoaccountcostaccountingonlyunderthepremiseseekingforsocialresults.Ahospitalshallhandleperformanceappraisalandmanagementbyapplyingtheapplicablepracticeofanenterprisetoitsownlineaccordingtothefact.Rightnowitstillcriesoutforamatureandpracticableassessmentsystemtoapproachhowtorollamorereasonableassessmentsystemandadynamicmechanismwithvirtuouscompetitionintohospitalappraisalandcomparisonandhowtoassesseachtalent’sperformancewithhelpofreasonableandimpartialperformanceindexindifferentunitsofadepartment.Thisisthesubjectcallingforanimmediatesolutionofferedbyhospitalmanagers.有关卫生组织绩效测量的研究正在开展，绩效测量标准的研究是鉴于卫生保健机构没有一个标准的绩效测量系统，美国俄亥俄州大学的一项研究(1)在回顾有关医疗组织绩效文献的基础上，提出了卫生保健机构绩效测量的总体框架。该框架中的绩效测量包括内部与外部评价两个方面，每个方面都有成本／财务绩效及质量绩效两个评价维度;绩效测量系统的研究，任何单独的财务方面或经营方面的测量系统都不能使管理者在复杂竞争的市场环境中成功地对绩效进行管理。因70

11此，人们逐渐开始采用多重指标来衡量绩效，其中有些是“硬指标”，包括各种经济和非经济尺度；有些是“软指标”，包括质量、员工态度及其类似的标准。现有文献表明对绩效测量系统的研究热点除系统开发及系统所提供信息的利用以外，还有关于绩效测量系统对组织作用及影响的研究和绩效管理模式的研究。在英国，新的绩效管理模式往往包括非财务措施，它代表了一种以战略为导向的绩效管理趋势。在法国公司，在“TableaudeBord”绩效管理模式里，将战略分解为财务与非财务指标，作为流行的一种作法(2)。美国最近的一项有关社区医院的研究已涉及到开发一个战略操作管理模式（3），该模式将远期设备和服务选择，中层决策支持以及考虑了结构约束后的社区医院绩效联系起来。该研究在使人们对战略操作管理决策有了更进一步理解的同时，确定了在操作决策过程中的一些因果关系及在医院绩效方面的作用。该研究还找出了在变化着的医疗服务环境中有助于提高社区医院绩效的关键战略决策。其中，“平衡计分卡”作为绩效管理的一种最新、最有效的管理模式，吸引了众多的学者和管理实践者。Studyonmeasuringperformanceofahealthcareorganizationisstillonthewayandstudyonperformancemeasuringcriterionismadeinaviewthatthereisnostandardsystemtomeasureperformanceadoptedbyahealthcareorganization.Reviewoftheliteratureonperformanceinamedicalbodyindicatesthatastudy(1)madeinUniversityofOhiohasadvancedageneralframeworktomeasureperformanceofahealthservicebody.Theperformancemeasurementinthisframeworkconsistsofinternalevaluationandexternalevaluation,eachhavingtwoevaluationdimensions,70

12namelyperformanceincost/financeandthatinquality;accordingtothestudyonperformancemeasuringsystem,anysinglemeasuringsysteminneitherfinancenoroperationcanenablemanagerstosuccessfullycontrolperformanceinacomplicatedmarketfallingintheacutecompetition.Therefore,multi-indexstartsservicegraduallytomeasureperformance:someare“hardindex”,includingvariouskindsoffinancialandnon-financialmeasuresandsomeare“softindex”,includingquality,attitudeandthesimilarcriteria.Theexistingliteratureshowsthat,besidesapplicationofinformationdevelopedorprovidedbythesystem,theheatedstudyonperformancemeasuringsystemincludesstudyofactionandeffectofperformancemeasuringsystemonanorganizationandstudyonperformancemanagementmode.InBritain,thenewperformancemanagementmodealwaysincludesnon-financialmeasures,whichrepresentsatrendofperformancemanagementorientedbystrategy.Underthe“TableaudeBord”performancemanagementmodeinFrenchcompanies,strategyisdividedintofinancialindexandnon-financialindex,whichactsasapopularpractice(2).AstudyoncommunityhospitalconductedinUSAisrelatedtodevelopmentofastrategicoperation&managementmode（3）,whichgetsconnectedlong-termequipmentandservicechoice,middle-leveldecisionsupportandcommunityhospital70

13performancewhichhastakenstructuralconfinementintoconsideration.Whilehelpingfurtherunderstanddecisionoverstrategicoperationmanagement,theabovementionedstudydeterminessomecause-effectrelationsandtheiractiononhospitalperformanceinthecourseofdecisiononoperation.Furthermore,thisstudyalsofindsoutakeystrategicdecisionhelpingimproveperformanceofcommunityhospitalinthechangingenvironmentofmedicalservice.Amongthem,the“balancescorecard”isthelatestandmosteffectivemodeforperformancemanagement,whichisattractinganumberofscholarsandmanagementworkers.对于医院绩效评价研究，国外医院绩效评价研究也包括三个层面。一个是以医院为对象进行绩效评价：一个是对中层管理人员进行工作能力评价；最后就是员工的绩效评价。RobinS、Turpin利用PAJ模式对医院绩效指标设置合理性进行了评估（4）；全面质量管理(TQM)则对医院绩效改进进行了研究（5）。另有一些对中层管理人员工作和能力评价的研究，并尝试开发了综合性的能力与工作评价工具（6），而员工评价目前比较盛行的是同级评价（7）。但从整体看，对个人的评价多为针对医师类的，较为单一，对医院内多种成员组成的现状考虑不足。Studyonhospitalperformanceappraisalabroadalsoconsistsofthreelevels:oneisperformanceappraisalonhospitalasawhole,oneisabilityappraisalonmiddle-levelmanagers,andtheotheris70

14performanceappraisalonemployees.RobinS.TurpinhasemployedthePAJmodetoappraisereasonabilityofhospitalperformanceindex（4）andTotalQualityManagement(TQM)tostudyimprovementofhospitalperformance（5）.Meanwhile,hehasalsostudiedperformanceandabilityofmiddle-levelmanagersanddevelopedanoveralltooltoappraiseabilityandperformance（6）.Foremployeeappraisal,however,peerappraisalisratherpopularatthepresent（7）.Onawholebasis,appraisalonindividualsismostlyadoptedbytargetingphysicians,which,however,takesintoinadequateconsiderationahospital’scompositionofmembersinvariety.而在我国，经济领域基本上完成了由计划经济向市场经济的转化，但社会事业领域改革相对滞后，现有的医疗卫生体制是在计划经济理论下建立的。作为一种科学的管理体系，绩效管理正在受到国内各级医院管理者的重视，大多也是从医院、科室及科室管理者、员工个人三个层面来进行探讨。根据中文科技期刊数据库检索，自1989年-2008年2月，涉及医院绩效的相关文章共有567篇，有关“绩效考核”的文章共有129篇，符合“绩效管理”检索主题词要求的文章有122篇，而建立绩效考核评价体系的文章仅26篇。早在1993年西安第四军医大学胡琳、于爽等制订了“医院综合效益评价体系”，指标按投入、产出分成两大类，包括人员、设备、物资、经费、社会效益和经济效益6个方面（8）；1994年浙江省舟山市卫生局庄汉国（9）70

15对综合性医院的社会、经济效益指标体系的设置及评价方法等问题作了探讨，筛选出基本指标25项，作为评价指标体系。近年来随着管理理论的深化和管理模式的探索，2001年，解放军空军总医院陈明敏等提出了粗放型的医疗质量评价管理模式，主要指标为床日门诊指数、床位利用指数、CD型率(总病例中复杂疑难危重病例所占比例)、人均医疗费、病员满意度等（10）；2001年，上海第二军医大学高岱峰、张鹭鹭等采用加权百分位次累加法建立评价模型，构建了“医院综合竞争力评价体系”，指标体系分竞争力资产、竞争力过程、竞争力环境3个方面；2002年，复旦大学胡善联、李国红等利用现场调查法和专家咨询法，从业务水平、经营状况和病人满意度方面选出32个指标，建立医院绩效评价指标体系，并提出星级医院评审的思想（11）。2005年《医院管理评估指南》中将社会效益、工作效率、经济运行状况三个方面作为医院绩效评价的主要内容（12）。众多文章都是从不同的角度对医院绩效进行评价，建立医院绩效评价指标体系时均有自己的侧重点，而且在实际工作中也的确起到了促进医院持续稳定发展、提高医院核心竞争力的作用。医院绩效评价体系是一个复杂的评价系统，目前国内采用的指标大多从业务、财务等方面分类考核，而专家咨询法是筛选指标的方法。尽管企业领域绩效管理的方法已发展得比较成熟，但在国内医疗卫生领域中比较通用和权威的绩效考核指标还有待更深入的探索。而对于科室与个人的考核也有多篇研究报告。70

16国内医院在临床科主任的绩效评价方面也有部分尝试，国内较具有代表性的有以下几种评价方法：将平衡记分卡应用于绩效评价；使用360度绩效考核法考核临床科主任；应用关键绩效指标（KPI）的考核指标体系；运用目标管理的方法建立绩效评估体系。InChina,transitionhasbeencompletedfromplanningeconomytomarketeconomy,butreformonsocialinstitutionsisstillrelativelylaggingbehind,wherethecurrenthealthcaresystemwasbornundertheplanningeconomy.Asareasonablesystem,performancemanagementishavingmuchattentionfromhospitalmanagersondifferentlevelsinChina,whichismostlydiscussedinthreelayers,i.e.hospital,facultyanditsmanagers,andindividualemployees.MysearchingthedatabaseoftechnologicalperiodicalswritteninChineseindicatesthatthereare567papersonhospitalperformancepublishedfrom1989toFebruary2008,129relatingto“performanceassessment”,122satisfyingthekeywordofsearchforhospitalperformanceandonly26papersonestablishmentofperformanceassessmentandappraisalsystem.Asearlyas1993,HuLin,YuShuangandetc.withFourthMilitaryMedicalUniversitybasedinXi’anbuilta“hospitalcomprehensivebenefitappraisalsystem”,whoseindexisdividedintotwogroupsasperinputandoutput,including6aspects:personnel,equipment,supplies,funds,socialbenefitsandeconomicbenefits（8）;in1994,ZhuangHanguo（9）withBureauofHealthofZhoushanCity,ZhejiangProvinceprobedintohospital’sestablishmentofasocialandeconomic70

17benefitindexsystemanditsappraisalapproachandselected25basicindicesasanappraisalindexsystem.Withthetheoryofmanagementdeepenedandmanagementmodeexploredrecently,ChenMingminandetc.withtheGeneralHospitalofAirForceputforwardamedicalqualityappraisalmanagementmodeinanextensiveformin2001,whosemajorindexisofbed·dayoutpatientindex,bedutilizationindex,TypesC&Dratio(theratioofTypesCandDcasestothetotalcases),personalaveragemedicalexpense,patients’satisfactiondegree（10）;in2001,GaoDaifeng,ZhangLuluandetc.establisheda“hospitalcomprehensivecompetitivenessappraisalsystem”bymeansofweighthundredth-placeadditioninaccumulationandtheindexsystemconsistsofcompetitivenessassets,competitivenessprocessandcompetitivenessenvironment;in2002,HuShanlian,LiGuohong,etc.withFudanUniversityestablishedahospitalperformanceappraisalindexsystemandadvancedanideatoappraisestar-levelhospitalafterselecting32indicesfrombusinesslevel,operationstatusandpatients’satisfactionwithhelpofthesiteinvestigationmethodandexpertconsultationmethod（11）.In2005,socialbenefit,workefficiencyandeconomicoperationstatuswereregardedasthemaincontenttoappraisehospitalperformanceinGuideforHospitalManagementAppraisal70

18（12）.Alargenumberofarticlesaimtoappraisehospitalperformanceindifferentanglesandemphasizestheirpointswhenmentioningestablishmentofahospitalperformanceappraisalindexsystemand,inpractice,theyhavereallyenhancedhospitals’continuousandsteadydevelopmentandimprovedtheircorecompetitiveness.Actually,thehospitalperformanceappraisalsystemisrathercomplicatedandtheindicesadoptedinChinamostlytakesingleappraisalinbusinessorfinance,etc..Theexpertconsultationmethod,however,isoneusedtoselectindicesonly.Althoughperformancemanagementforenterpriseshasgrownrathermature,theperformanceassessmentindexpopularandcommandinginChinesehealthcircleisstilltobeexplored.Thereareafewstudyreportsonassessmentoffacultyandindividuals.SomeattemptshavebeenmadeinappraisingperformanceofclinicaldepartmentdirectorsinsomeChinesehospitalsandtherepresentativeappraisalapproachesareapplicationofbalancescorecardtoperformanceappraisal,applicationof360-degreeperformanceassessmentmethodtoassessthedirectorofclinicaldepartment,applicationoftheassessmentindexsystemoutofKeyPerformanceIndex(KPI),andapplicationofthemethodofmanagementbyobjectivestoestablishaperformanceappraisalsystem.70

19目前公立医院仍然被国家列为事业单位，大部分医院的绩效考核还在沿用行政机关、事业单位工作人员年度考核制度，医院里不论什么专业、什么层次的人员，都在使用统一的考核标准，所考核的德、能、勤、绩内容也很笼统，难以反映不同岗位不同人员的业绩贡献。这样的考核必然会流于形式，考核结果与员工的实际使用难以挂钩，不利于调动员工的积极性。刘灿均等（13）谈到，从形式上看，医院通常采用年度考核和聘期考核两种方法。用这类考核结果作为对员工一年来的工作评价，并以此作为年终奖金或来年工资发放、聘任、晋升等方面的依据。这种考核形式是根据我国医院所有制性质决定的，由于我国公立医院都属于具有行政级别、受行政管理的事业单位，而年终考核则是上级行政部门要求必须完成的一项行政工作，因此公立医院都实施这种绩效评价方式（14）。在科室综合目标责任制中，除了按要求完成医疗任务，以取得最佳经济效益外，没有什么特殊的工作需要完成，而且这种医疗任务一般不设最低要求，也很难设置最低要求。而在年度考核中，由于没有具体的考核指标，员工只要在保证不违反特定的规定，就可以达到相关的合格标准，这样就容易产生趋中趋势，因此要引入竞争的概念（15），《对综合性医院临床业务科主任绩效考核工作的思考》（16）及《建立医院管理干部绩效考核体系的实践与思考》（17）70

20中指出，以医院管理价值观为引导，对个人管理能力、经营能力、综合协调能力及其他管理素质的提升进行有效激励。通过建立临床业务科主任绩效考评体系从而实现使临床业务科主任岗位设置能更好地符合现代医院规范化科学管理的要求；医院战略目标分解到各临床业务科室，明确临床业务科主任岗位职责；使每位科主任更高效地行使管理职能，完成医疗管理、教学管理、科研管理、经济管理、人才管理的目标任务；对每位科主任任期内的关键绩指标进行有效的量化，从而提高绩效；充分发挥每位科主任的潜能，期为提高绩效和达成目标而积极主动工作；吸引留住科主任群体中的优秀人才，为医院长远发展奠定坚实的人力资源基础。吕东环（18）则用认为系统的方法、原理，评定、测量工作人员在职务上的工作行为和工作效果，检查和评定工作人员对职位所规定的职责的履行程度。绩效考核的目的是改善工作人员的工作表现，通过对工作人员全面综合的评估，判断他们是否称职，并以此作为医院人力资源管理的基本依据，以达到医院的经营管理目标，并提高工作人员的满意程度和未来的成就感。郑西川等（19）用三维框架依基础指标、业务工作指标和科研教学指标，建立了临床医师自然信息、人员素质、工作效率、工作质量、经济效益、论文论著、新技术及业务考核等7个方面的指标内容，共筛选出56个具体指标。主要是三方面功能：一是鉴定科室的医师绩效，定量区分其绩效水平．选拔出优秀的科室人才；二是利用实际绩效的评价对被评价对象的行为加以控制，引导其向目标靠近；三是管理部门能及时动态地掌握情况，既可以清楚地看到本单位人才整体优势与特色，又可以看到问题与劣势，并找出产生问题的原因，及时加以解决，为决策提供科学的依据（20）。医生绩效考核模型的建立及应用（21）、通过考评体系提高医务人员能力（22）、考核指标及评分标准的确定（23）以及从多角度获取员工行为观察方法（24）70

21等有关文献也进行了大量研究。Now,publichospitalsstillserveaspublicinstitutionsinChinaandperformanceassessmentinmosthospitalsstillborrowtheemployeeassessmentsystempracticedannuallyinadministrativebodiesandpublicinstitutions.Allemployees,despiteinwhatfacultyoronwhatlevel,havethesameassessmentstandardandthecontentof“Ethics,Ability,AttendanceandPerformance”thereintobeappraiseisverygeneral,whichisdifficulttoreflecttheperformanceofdifferentemployees.Theassessmentisboundtobeformalisticandtheresultofthesaidassessmentisdifficulttobeconnectedwithactualuseofemployeesandimpossibletoarousetheirenthusiasm.AccordingtoLiuCanjunandetc.（13）,annualassessmentandtermassessmentareusuallyadoptedbyhospitalsintheviewoftheirform,whoseresultservesastheevaluationonanemployee’sperformanceinayearandthebasisforannualbonusorpay,appointmentorpromotion,etc.inthefollowingyear.ThiskindofassessmentisdeterminedaccordingtothepropertiesofhospitalownershipinChina.AsallofChinesepublichospitalsareregardedaspublicinstitutiononacertainadministrativelevelandundertheadministrativemanagementandannualassessmentisanadministrativejobtobefinishedasamustrequiredbytheupperadministrativedepartment,allofthepublichospitalsadopt70

22thisperformanceappraisalmethod（14）.Intheoverallobjectiveresponsibilitysystem,thereisnoparticularworknecessarilytobefinishedotherthanmedicaltasksdoneasrequiredtoobtainthebesteconomicbenefits.Andthereisnominimumrequirementsetforsuchmedicaltasks.Ofcourse,itisdifficulttosetaminimumrequirement.Intheannualassessment,however,whichhasnospecificassessmentindex,onlywhenemployeesdonotviolatetherelevantregulationcantheymeetthecorrespondingstandarduptoeligibility,whichislikelytocauseamedium-biasedtrend.Forthisreason,itisnecessarytobringincompetition（15）.AsmentionedinReflectionofPerformanceAssessmentonDirectorofClinicalFacultyinaComprehensiveHospital（16）andPractice&ReflectiononEstablishmentofPerformanceAssessmentonHospitalManagers（17）,motivationismadeforpromotingpersonalmanagementability,operatingability,overallcoordinatingabilityandotherqualitiesinmanagement,guidedbythehospitalmanagementvalue.Aperformanceassessmentsystemfordirectorofclinicalfacultyisestablishedtoensurethatthepostasdirectorofclinicalfacultyenablesamodernhospitaltomeettherequirementsonstandardizedreasonablemanagement;thestrategicobjectivesofahospitalaredistributedtoeachclinicalbusinessofficesoastospecifytheon-jobresponsibilitiesofclinicaldepartmentdirector70

23;thedirectorofeachdepartmentismadetomoreefficientlyexercisehis/hermanagementfunctionsandaccomplishthetasksofmedical,training,research,financialandtalentsmanagement;thekeyindexonperformanceofdirectorofeachfacultyiseffectivelyquantifiableduringhis/herofficetermsoastoimprovehis/herperformance;thepotentialsofeachfacultydirectorcanbegivenfullplayinthehopethattheyworkhardtoimprovetheirperformanceandmeettheirobjective;excellenttalentsamongthegroupoffacultydirectorsareattractedsoastolayasolidfoundationofhumanresourcesforthehospital’slong-termdevelopment.LuDonghuan（18）,however,employedasystematicapproachandprincipletoassessandmeasuretheworkbehaviorandoutcomeofemployeesontheirpost,checkandappraiseemployees’fulfillmentoftheirdutiesasstipulatedbytheirpost.Performanceassessmentisdesignedtoimprovetheperformanceofemployees,seewhethertheyarecompetentbymakingoverallappraisalonemployees,andmakeitselfafundamentalbasisofhumanresourcesmanagementforahospitalsoastoreachitsbusinessobjectivesaswellasimproveemployees’satisfactionandsenseofsuccessinthefuture.ZhengXichuanandetc.（19）haveestablishedindexcontainingnaturalinformationofclinicalphysiciansandtheirpersonalquality,efficiency,workquality,economicbenefit,thesis&treatise,new70

24technologyandbusinessassessmentbymeansof3-dimensionedframeworkaccordingtobasicindex,businessindex,researchandtrainingindex.Theyselected56itemsspecificindexintotalcoveringthreekindsoffunction:oneistoappraiseperformanceofphysiciansinafaculty,quantitativelyspecifytheirperformanceandselectexcellenttalentsforthisfaculty;oneistoappraisebehavioroftheappraisalsubjectiscontrolledbymeansofappraisalontheactualperformancesoastoleadhim/hertoapproachthesetobjective;theotheristhatthemanagementdepartmentcantimelyanddynamicallycommandthecurrentsituation,notonlyseeclearlythesuperiorityandspecialtyoftalentsinthisorganizationasawhole,butalsofindouttheexistingproblemsanddisadvantages,detecttheircauseandtimelysolvethemsoastoprovidescientificevidencefordecisionmaking（20）.Meanwhile,alargenumberofstudieshavebeenmadeintheliteraturesuchasEstablishmentandApplicationoftheDoctor’sPerformanceAssessmentModel（21）,ImprovingMedicalWorkersSkillbytheAssessmentSystem（22）,DeterminationofAssessmentIndexandMarkingCriterion（23）andObservationMethodbyHavingEmployees’BehaviorinMulti-AngledView（24）.70

25在公立医院，绩效考核的目的在于体现医护人员的工作量，减少浪费，提高医院运行效率，但目前的方式难以奏效。那么，如何建立真正有效的绩效考核方法?在大量的研究报告中，难以找到全面、系统包含三层面的考核方案，更多的是在某一方面进行了探索。由于不同级别的医院情况不同，绩效考核办法也不同，目前大家都处于摸索阶段。国内外学者建立了数百种综合评价方法，但至今尚无一种全球通行的考核评价方法。卫生部规财司领导指出，建立一个比较科学的绩效评价体系有一定难度，在现行制度下应该研究一个既合理，又简单的评价方法（25）。所以有专家提出，开展基于方法集的组合评价方法（26）来作为综合的评价体系。绩效评价与管理体制关系很大，如果仅考虑效率按项目收费，会出现过度服务的问题；如果按病种收费，要考虑医疗质量的问题。我国大部分公立医院基本上都是自主收支、自负盈亏，国家财政只能补偿极少部分，公立医院必须依靠增加收入，进行成本核算来提高效益，以使自己在市场中占有一席之地。从当前公立医院资源配置和管理的实际状况来看，很多医院也已经开始进行提高经济效益、进行成本核算、拉开职工收入差距等方面的尝试。国内外理论研究和实践探索表明，一套规范的外部评价体系，对医疗机构的绩效提升和医疗质量的持续改进能起到强有力的推动作用。但是由于长期受计划经济体制的影响，加之医疗服务行业的特殊性，相对于其他单位而言，公立医院的各方面改革步伐都是比较滞后的，有效的竞争激励机制和自我约束机制还没有完全形成。Inpublichospitals,performanceassessmentisdesignedtoindicatetheworkloadofmedicalstaff,reducewasteandimprovehospitalrunningefficiency,butthecurrentpracticecan’tmeetthis70

26goal.Howcanweestablishaneffectiveperformanceassessmentapproach?Itisdifficulttogetanoverallandsystematicassessmentschemecoveringthreelevelsinsomanystudyreports,which,mostly,probeintoacertainaspect.Differentinthehospitalsondifferentlevels,performanceassessmentapproachisstillunderexploit.Hundredsofappraisalapproacheshavebeenestablishedbyscholarsathomeandabroad,butnoneofthemisinpracticearoundtheworld.AspointedoutbyaleaderatMinistryofHealthFinancialPlanningDepartment,itisdifficulttobuildaratherreasonableperformanceassessmentsystemanditisamusttoworkoutasimpleandreasonableapproachpracticableinthecurrentsystem（25）.Therefore,someexpertssuggestanoverallappraisalapproachbasedonthemethodgatheringasacomprehensiveappraisalsystem.Performanceappraisalhasmuchtodowithmanagementsystem:theremaybeover-serviceifpaymentiscollectedasperitemsinconsiderationofefficiencyonly;medicalqualityshallbetakenintoaccountifpaymentiscollectedasperillnessclassification.MostofpublichospitalsinChinahandlerevenueandexpenditurebythemselvesandtakesoleresponsibilityfortheirprofitandlosses,onlyasmallpartofwhichiscompensatedthroughfinancialappropriation.Forthatreasonpublichospitalsshallimprovetheirbenefitsbyincreasingrevenue70

27andmakingcostaccountingsoastosurvivethemarket.Accordingtotheactualconditionoftheresourcesallocationandmanagementinpublichospitalsatthepresent,manyofthemhaveattemptedtoimprovetheireconomicbenefits,makecostaccountingandwidendisparityofemployees’income.Thetheoreticstudyandpracticalexploitmadeathomeandabroadindicatethatastandardexternalappraisalsystemcanpowerfullyenhancetheperformanceandcontinuouslyimprovethemedicalqualityofamedicalorganization.However,influencedbytheplanningeconomyforlong,publichospitalreforminmanyaspectsisstilllaggingfarbehindwhencomparedtootherorganizationsduetospecialtraitsofmedicalserviceindustry.Aneffectivecompetition&inspirationmechanismandself-restrictingmechanismfailstobeformedcompletely.4、立体化考核评价体系的建立3-dimensionedassessmentandappraisalsystem70

28面对迟迟难以出台医改方案的尴尬境地，面对连续三年国家卫生部开展“医院管理年”活动，面对无锡市医院运行机制的改革，医院该如何适应形势的变化，如何将上级的要求转化为医院自身的目标，如何让科室、员工的愿景与医院的愿景一致起来，是医院管理的落脚点。我院根据国家卫生部《医院管理评价指南》，以医管中心下达的目标任务为主体框架，结合医院自身特点形成医院发展的总体目标——构成面，总体目标分解成科室管理目标——构成线，再将科室管理目标分解成个人量化考核——构成点，实行点-线-面的有机结合，建立健全立体化的绩效考核管理体系。Inthefacethatthehealthcarereformschemeisstillfarfrombeingformed,thattheMinistryofHealthhasperformed“HospitalManagementYear”forthreeyearsonendandthathospitalrunningmechanisminWuxiisbeingreformed,eachhospitalshallapproachhowtofollowthenewsituation,howtotransformtherequirementsoftheupperlevelintotheirownobjectivesandhowtoadapttheprospectofeachfacultyandeachemployeetoitsown.AccordingtoGuideforHospitalManagementAppraisalpromulgatedbyMinistryofHealthandbasedontheobjectivesandtasksdesignatedbyHMC,whichserveasthemainframe,ageneralobjective–that’stheplane–isformedinthishospitalinaccordancewithourcharacters,thegeneralobjectiveisdividedintosub-objectivesforeachfaculty–that’sthelineandthenthosesub-objectivesaretranslatedintopersonalquantifiableassessment–that’sthepoint.Inthisway,theperformanceassessmentmanagementsystemisestablishedandperfectedincombinationofpoint–line–plane.4.1医院在确定总的中长期发展战略后，每一年都要再确定年度自身发展的总体目标。既有《医院管理评价指南》为纲领，又有医管中心下达的《70

29无锡市医院管理中心“十一五”医院发展建设标准》为指南，以及“医疗服务、资产经营委托管理法人代表任期目标责任制”签订的目标责任书所涉及医院管理、医院信息、医疗安全、医疗服务、经济运作、医德医风六个方面任务，该任务可细分为八大类17项共数百条指标，医管中心以契约形式将医院的医疗服务、资产经营权委托给医院院长。具体包含（1）全面执行医管中心制订的“十一五”医院发展建设标准（20分），医院管理、医疗安全、医疗服务、经济运作四方面内容各占20%，医院信息、医德医风两项内容各占10%；（2）医院综合满意度达标（8分）；（3）医院医教研工作不断提升，保持和提高医院等级，各级重点专科、学科建设保持和高于上年水平，科研、教学工作保持较高水平（20分）；（4）严格控制医疗费用和药占比，门诊患者人均医疗费用、出院病人平均费用达到省颁标准（6分）；（5）确保医院国有资产安全、良好运行，净资产每年有增长，医院年度经济结余为正数（20分）；（6）完成政府和上级主管部门指令性任务（7分）；（7）组织开展“平安医院”、“和谐医院”创建活动并形成长效机制，确保单位综合安全，无重大生产、火灾事故，无二级以上医疗事故（11分）；（8）在医疗服务和资产经营中切实做到遵纪守法（8分）。由此构成医院总体目标的主体框架。医院领导集团依据上级部门的要求、自身的发展方向、对医疗市场的了解，对竞争对手的了解和对自己竞争实力的了解以及对质量、贡献、品牌、信誉、特色、服务理念等要求，提出70

30以建设国际化、现代化医院为目标，以市场需求和科技发展为导向，提升医疗质量为主线，深化内部改革为动力，加快技术创新为重点，深化专科建设为突破口，提高患者和社会综合满意度为方向，以肿瘤诊疗为主体、省市级重点专科快速发展，特色专科不断壮大、普通学科协调共进的大原则形成医院总体目标。由此构成了医院考核的多个立“面”。Afterageneraldevelopmentstrategyforamiddleandlongtermisdeterminedinthishospital,ageneralannualgoalforitsgrowthwillbedeterminedeachyear,whichisnotonlydirectedbyGuideforHospitalManagementAppraisal,butalsobyCriterionforHospitalDevelopmentandConstructionin11thFiveYearsissuedbyHMC.Meanwhile,signedaccordingtothe“targetresponsibilitysystemfortheofficetermoflegalrepresentativewhoisentrustedtohandlethemedicalserviceandassetsmanagement”,thetargetresponsibilitydocumentrelatedtohundredsofassessmentstandardscomposedof17itemscoveringeighttypesandsixaspects,namelyhospitalmanagement,hospitalinformation,medicalsecurity,medialservice,financialpracticeandmedicalethics.Intheformofcontract,HMCentruststhepresidentofahospitaltomanageitsmedicalservicesandassetsoperation.Itincludes(1)faithfulcompliancewithCriterionforHospitalDevelopmentandConstructionin11thFiveYearsissuedbyHMC(20marks),ofwhichhospitalmanagement,medicalsecurity,medicalserviceandeconomicoperationaccountfor20%each,andhospitalinformationandmedicalethicsaccountfor10%each;70

31(2)overallhospitalsatisfaction(8marks);(3)medicalpractice,trainingandresearchinthehospitalcontinuouslyraised,maintainingandimprovingthehospitalgrade,keyfacultiesonvariouslevelsmaintainedandkepthigherthanthatinthepreviousyear,researchandtrainingmaintainedonaratherhighlevel(20marks);(4)strictlycontrollingmedicalexpenseandmedicineuseratio,averagemedicalexpenseofeachoutpatientandofeachdischargedpatientreachingtheprovincialstandard(6marks);(5)ensuringthestate-ownedassetsinthehospitalrunwellandsafely,netassetsincreasingeachyear,annualfinancialbalanceremainingpositive(20marks);(6)finishingtasksassignedbythegovernmentandtheupperauthority(7marks);(7)performingconstructionof“peacefulhospital”and“harmonioushospital”andformingalong-termmechanismsoastoensureoverallsecurity,avoidingvitalaccidentsastoproductionorfireandgrade2medicalaccidentormoreserious(11marks);and(8)lawcomplianceduringmedicalserviceandassetsmanagement(8marks).Theyconstitutethemainframeofageneralobjective.Inaccordancewiththerequirementsoftheupperauthority,ourdevelopmentdirection,ourknowledgeofthecompetitorsandcompetitivestrengthaswellasrequirementsonquality,contribution,brand,credit,specialtyandserviceconception,themanagementofWFPHhasputforward70

32ageneralobjectiveformedintheoverwhelmingprinciplebyregardingconstructionofaninternationalandmodernhospitalasourgoal,marketdemandandtechnicaldevelopmentasorientation,improvementofmedicalqualityasroute,deepeningofinternalreformasmotivation,accelerationoftechnicalinnovationaskeypoint,deepeningoffacultyconstructionasbreakthrough,improvementofpatients’andsocialcomprehensivesatisfactionasdirectionandcancerdiagnosis&treatmentasmainstayincooperationwithswiftdevelopmentofkeyfacultiesonaprovincialormunicipallevel,continuousgrowthofcharacteristicfacultiesandbalancedadvancementofgeneralfaculties.Theyconstitutemulti-“plane”forassessmentinthishospital.4.2总体目标只有具体分解到各个部门并加以实施才能最终得以落实。这涉及到对科室目标任务的确立和对管理干部的绩效考核，一要考核他所领导的团队完成的整体工作目标；二要考核他本人作为管理人员在管理技能上的提升目标。这就涉及部门目标设定和管理者个人目标设定两个方面。而业务科室（临床和医技）科主任是医院提高医疗质量和影响医院运作效率的核心群体，是完成医院总体目标的关键人物。我院在实施五年多下达《70

33科主任综合目标责任书》的基础上，逐步完善，开始推行“科主任任期目标责任制”。“科主任任期目标责任制”的基本框架是院部根据医院总体目标任务和科主任职责，对一级科主任和实行二级核算的二级科主任分别下达《科主任任期目标责任书》和《安全责任目标任务书》，实行年度目标，季度考核，科主任对所辖科室的医疗服务、资产经营活动和行为负总责，科主任在任期内必须率众完成与院长签订的任期内各项责任目标，使科室在医疗服务资产经营过程中实现效益最大化和效率最优化。院部根据其目标任务的完成情况，决定科主任的奖惩和所辖科室集体的经济分配总额。对科主任的总体要求是：（1）完成与院长签订的任期内各项责任目标；（2）专科建设保持或高于上年度水平，科研教学保持较高水平；（3）按照医院部署，认真开展“平安医院”创建活动，全面完成《安全责任目标任务书》的各项任务目标；（4）完成院部下达的各项指令性任务；（5）积极有效开展各项业务工作，做到遵纪守法，无违反国家法律法规行为。其考核内容涉及医政管理达标、科研教学达标、经济运营完成相关指标、科室综合满意度达标，无违反国家法律法规行为、按时完成上级下达的指令性任务及职工收入达到或超过上年水平（科主任任期目标责任书和考核方案见附件）。考核的方式采用百分制，分别以医政科教45%、经济运行40%、党建行风8%、安全管理2%及完成指令性任务5%的权重进行考核，同时设定了发生医疗事故或严重医疗差错、发生重大生产、消防、信息安全事故、牟取不正当利益、严重违反职业道德和医学伦理道德的情形等一票否决条款。业务科室之间又根据工作性质与特点不同分为临床科室（手术科室、非手术科室）和医技科室两大主线，考核内容与指标有所不同。Onlyafterbeingredividedtoandimplementedbyeachdepartmentcanthegeneralobjectivebemeteventuallyasawhole.70

34Thisconcernsestablishmentofobjectivesandtasksinafacultyandassessmentonperformanceofacadre:toassesstheoverallobjectiveaccomplishedbytheteamunderhis/herleadership;andtoassesstheobjectiveofthecadreindevelopment,asamanagerinmanagementskill.Thisfurtherconcernssettingdepartmentalobjectivesandpersonal(asamanager)objectives.However,thedirectorsofbusinessdepartments(clinicalandmedicaltechnique)constituteacoregroupwhoareinapositiontoimprovemedicalqualityandinfluenceoperationefficiencyinahospitalandareimportantpersonstoaccomplishthegeneralobjectiveofWFPH.BasedonOverallTargetResponsibilityDocumentforDepartmentalDirectorswhichhasputintopracticeforoverfiveyears,the“targetresponsibilityduringtheofficetermofdepartmentaldirectors”isgraduallyperfectedandbeginstobepopularized.AccordingtothegeneralobjectivesandtasksofWFPHandthedutiesofdepartmentaldirectors,thebasicframeofthesaidsystemisTargetResponsibilityDocumentDuringtheOfficeTermofDepartmentalDirectorsandSafety-RelatedTargetResponsibilityDocumentissuedforGrade1departmentaldirectorsandGrade2departmentaldirectorswhotakegrade2accounting.Wherein,annualobjectiveandquarterlyobjectiveareundertaken;thedepartmentaldirectorisgenerallyresponsibleformedicalservices70

35andassetsoperationsinthedepartmentunderhis/herleadership;andhe/shemustcompletewithhis/herstaffobjectivesandtaskswithinhis/herofficetermstatedintheDocumentsignedwiththePresidentofthehospitalsothatthedepartmentcanrealizebenefitmaximizationandefficiencyoptimizationinthecourseofmedicalserviceandassetsoperation.Prizefororpunishmentonthedepartmentaldirectorandthetotalfinancialallocationtothedepartmentalstaffaredeterminedaccordingtothestatusofaccomplishmentoftheobjectivesandtasks.Thegeneralrequirementsuponadepartmentaldirectorare:(1)toaccomplishtheresponsibleobjectivesduringhis/herofficetermascontractedwiththePresident;(2)tomaintainthefacultyconstructionatorhigherthanthepreviouslevelandtomaintainresearchandtrainingatahighlevel;(3)toearnestlyperformconstructionofa“PeacefulHospital”asarrangedbyWFPHandfullyaccomplishtasksandobjectivesstatedinSafety-RelatedTargetResponsibilityDocument;(4)toaccomplishthetasksdesignedbythetopmanagementofWFPH;(5)toactivelyperformvarioustasksbycompliancewithlaws,rulesandregulationsandnon-violationofthelaws,rulesandregulations.Theassessmentonhim/herincludesqualificationforhospitalmanagement,forresearchandtraining,forcomprehensivesatisfactionofthedepartment,indexforaccomplishmentof70

36economicoperation,non-violationoflaws,rulesandregulations,timelyaccomplishmentoftasksassignedbytheupperauthority,andemployees’incomereachingorexceedingthatinthepreviousyear(forDocumentofTargetResponsibilityduringtheOfficeTermofDepartmentalDirectorsandtheassessmentscheme,pleaserefertotheenclosure).Theassessmentadopts100-scoresystemandismadeasfollows:hospitalmanagement,researchandtraining45%,economicoperation40%,Partyconstructionandmedicalmorals8%,securitymanagement2%andaccomplishmentofassignedtasks5%.Meanwhile,thereisavetoarticleincaseofmedicalaccident,seriousmedicalmistake,seriousaccidentastooperation,fireorinformation,profiteering,seriousviolationofmedicalorprofessionalethics.Accordingtothetraits,businessdepartmentisalsodividedintoclinicaldepartment(operationsectionandnon-operationsection)andtechnologicaldepartment,sotheassessmentonthemisdifferentfromeachother.70

37医院管理人员虽属于非主体系列，但他们在医院运行中所发挥的作用不可低估。职能部门管理人员的工作重点要根据医院工作的总体目标，开展本部门工作，制定部门工作人员的工作职责，为临床一线提供保障和支撑，所以管理工作具有较强的服务性和辅助性。另外，管理人员的工作成效难以用经济效益衡量，具有较强的不显现性和间接性。虽然医院的管理工作者不能直接为医院带来效益，但医院社会效益和经济效益的实现却离不开管理。因而在以往的考核中，职能科室均为95分左右的高分，缺失了奖惩的意义。为此，我们制定了“70

38机关职能部门工作责任制”，目的是进一步树立“效率最大化、效益最优化、责任人人化”的管理理念，进一步落实“职责明确、目标分解、任务落实”的管理责任，进一步建立“关键任务、实绩考核和激励奖惩”相结合的管理模式；实现“管理出效益”的管理目标，实现医院又好又快前进的发展目标，实现医疗服务能力有新提升、医疗服务质量有新提高、医疗科技水平有新发展、医疗服务环境有新改善、医疗服务经营有新改革的总体目标。以各部门根据具体业务和工作职能来制定日常工作目标，完成相关条线、上级部门布置的各项工作，和其他条线提请协助的工作为基础工作，同时通过目标任务书的形式，将科室的综合满意度、信息上报数、论文发表及继续教育列入考核的指标；以院部根据《医疗服务、资产经营委托管理法人代表任期目标责任制》确定的医院八大类内容，医院职代会通过的年度工作任务，以及医院可持续发展需要完成的阶段性、临时性、突击性工作目标，通过院长办公会等形式，由院长定期布置下达，确定各部门承担的工作为重点工作；以各部门顺应时代发展的新要求和医院发展的实际需要，积极思考和开展自主性工作，并在省、市内取得佳绩的为创新工作。各职能科室采用关键目标定期考核与一般目标缺陷处罚相结合的办法进行考核，分别以60%、30%和10%的权重进行每季度考核（见附件3）。同时明确职能科室成员的绩效考核用岗位系数法核发，基数先按临床、医技科室人均绩效奖的85%确定，再乘以考核得分率和岗位系数而得。Althoughtheyarenotofmajority,hospitalmanagersstandinaveryimportantposition.AccordingtothegeneralobjectiveofWFPH,managersoffunctionaldepartmentsperformbusinessoftheirowndepartment,designdutiesforthestaffandprovidesecurityandsupportforthefrontclinicalline,sotheirmanagementismuchofserviceandassistance.Additionally,managers’workisdifficulttobemeasuredeconomically,soitisveryinvisibleandindirect.Althoughmanagersofhospitalcan’tbringabouteconomicbenefitdirectly,socialresultsandeconomicbenefitsofhospitalcan’tberealizedwithoutmanagement.Inthepastassessment,however,functionaldepartmentsalwaysgot95marks;thusitwasmeaninglesstoperformprizeorpunishment.Inthisconnection,weparticularlyestablishthe“SystemofBusinessResponsibilityforFunctionalDepartments”tofurtherstress“EfficiencyMaximization,BenefitOptimizationandResponsibilityPersonalization”,fulfil“DutyDefinition,ObjectiveDivisionandMissionImplementation”,andestablishthemanagementmodeincombinationwith“KeyTask,PerformanceAssessmentandFinancialMotivation”;tohavebenefitsfrommanagement,leadthehospitaltogetonwellandgrowquicklyandreachthegeneralobjectivetoupgrademedicalservicequalityandcapacity,improvemedicaltechnologyand70

39serviceenvironment,andtransformmedicalserviceoperations.Meanwhile,wearerequestedtosetroutineobjectivesaccordingtospecificbusinessandfunctionsofeachdepartment,finishtherelevantworkinvarietyassignedbytheupperdepartmentandrequestedbyotherlinescallingforassistance,andincludeinassessmentintheformofoverallsatisfactionofthedepartmentontargetedtasksanditsamountofinformationreportedtotheupperlevel,thesispublicationandfurthereducation.ThecontentoftheeighttypesdeterminedbythetopmanagementaccordingtoTargetResponsibilitySystemduringOfficeTermofLegalRepresentativeEntrustedtoManageMedicalServicesandAssetsOperations,theannualtaskspassedinHospitalEmployeeRepresentativeConventionandtheperiodical,temporaryorsuddentaskstobenecessarilyfinishedaimingforsustainabledevelopmentofthehospitalareassignedregularlybythePresidentthroughPresidentOfficeMeetingandetc.soastoconfirmtheworktobehandledbyeachdepartment.ExcellentachievementobtainedonaprovincialormunicipallevelbyeachdepartmentwhohastakenaninitiativetoworkhardbymeetingnewrequirementsarisingfromtheTimeandactualneedsbythehospitaldevelopmentisregardedasinnovation.Eachfunctionaldepartmentemploystheapproachcombiningregularassessmentofkeyobjectiveswithpunishmentagainst70

40ordinaryobjective-relateddefecttomakeassessmentquarterlyasperweightof60%,30%and10%(seeEncl.3).Meanwhile,performanceassessmentofemployeewithafunctionaldepartmentisspecifiedbymeansofthejobcoefficientapproach,andthecoefficientisfirstfixedasper85%ofaverageperformanceprizeofanemployeewiththeclinicalortechnicaldepartmentandthenisobtainedwithitsmultiplicationbyassessmentscoringrateandthejobcoefficient.该方案的实施，临床、医技科室主任就会迅速分解目标，趋利避害，落实责任，真正做到管理科室、经营科室，实现目标明确化、质量最优化、绩效最大化。职能部门的考核分数迅速拉开，曾出现最低60分的科室，平均仅为72.5分的低成绩，对于他们是一次强烈的震撼。随着考核的深入，争先创优的意识不断加强，考核的成绩不断提升。医院的总体目标始终是指导大家工作的“指挥棒”，各部门的主动性、积极性被充分调动起来了。Byimplementationofthisscheme,directorsofclinicalortechnicaldepartmentscanquicklydivideobjectives,trendtowardsbenefit,avoiddisadvantage,fulfillresponsibilities,runtheirofficeandeffectobjectivedefinition,qualityoptimizationandachievementmaximization.Inthisway,ascoreafunctionaldepartmentobtainedfromassessmentsoonwidens:inacase,onedepartmenthad60marksatthelowestandtheaveragewasonly72.5marks,which70

41reallyshockedalltheemployees.Withassessmentgoingprofound,awarenessofstrivingforexcellenceiscontinuouslyenhancedandscoreobtainedbyassessmentcontinuouslygoesup.Thegeneralobjectiveofthehospitalalwaysservestodirecteverybodyandtheinitiativeandenthusiasmofeachdepartmentisfullyandsuccessfullyaroused.通过业务部门和职能部门两大块三根主线的目标确立与绩效考核方法的制定，较好地构架出了医院目标完成的框架和基础。Theframeworkandfoundationforaccomplishmentofhospitalobjectivesareconstructedbyestablishinganobjectiveacross2sectionsand3mainlinesofbusinessandfunctionaldepartments.后勤是医院完成各项目标的支持、保障部门，本着各类人员分类管理，区别对待的原则（27），我院在后勤部门实行了工资总额包干办法，这是医院继续深化人事制度、分配制度改革的重要组成部分，是建立健全不同岗位分配机制的客观要求。实行工资总额包干管理，有利于建立健全后勤科室内部约束机制和激励机制，调动后勤工作人员的积极性；有利于促进后勤科室提高技术和管理水平，优化后勤基本保障能力，拓展后勤服务项目，增强自我发展能力；有利于后勤部门增收节支意识的提高，逐步降低医院对后勤部门定额补助标准，减少医院经费支出。Thelogisticsdepartmentservestoensureaccomplishmentofeachobjectiveinthishospital.Intheprinciplethatdifferenttypesof70

42personnelaretreatedandmanagedindifferentways（27）,thelump-sumwagesystemisadoptedinthelogisticsdepartment,whichispracticabletohelpdeepenreformofthepersonnelsystemandthewagesystemandobjectivelynecessarytohelpestablishwagemechanismfordifferentposts.Managementoflump-sumwagesystemfavorsestablishmentandperfectionofinternalrestrictingmechanismandmotivatingmechanisminthelogisticsdepartmentsoastoarouseenthusiasmofemployeestherein;tourgethelogisticsdepartmenttoimprovetheirtechniqueandmanagementsoastooptimizethebasiccapacityoflogisticsecurity,expandlogisticserviceandstrengthenselfdevelopment;andforlogisticdepartmenttoimprovetheirawarenesstoraiseincomeandreduceexpendituresoastograduallylowerthestandardoffixedsubsidytologisticdepartmentandreduceexpenditure.实行工资总额包干管理的基本原则是：在执行国家制定的事业单位工资制度的基础上，将工资总额包干与后勤部门部分项目经费包干相结合，根据医院有关规定核定后勤部门年度工资总额，增人不增工资总额，减人不减工资总额，节余留用，超支抵扣，科室包干使用，享有科室内部工资分配自主权。内部分配中要贯彻按劳分配原则，进一步打破平均主义，做到责、权、利相统一。Thebasicprincipleforfulfillmentofthelump-sumwagesystem70

43managementis:overallrationingoftotalwageiscombinedwithoverallrationingoffundsforpartialprojectswithlogisticdepartmentbasedonfulfillmentofthewagesystemforpublicinstitutions;theannualtotalwageforlogisticdepartmentasawholeisverifiedinaccordancewiththerelevantregulationandusedwhollybythedepartment,whichisentitledtodistributethedepartment-widewagetoitsemployees,intheprinciplethatthetotalwagewouldnotbeincreasedordecreasedwithincreaseordecreaseofemployeesandthattheremainingcouldbekeptbuttheexceededexpenditureshouldbededucted.Theprincipleofinternaldistributionaccordingtoworkshallbeimplementedtofurtherbreakupequalitarianism,ensuringunityofresponsibility,rightandbenefit.该方案的制定，为医院绩效管理做了有益的补充。　Thisschemeisadvantageoussupplementarytoperformancemanagementalloverthehospital.4.3随着我国卫生事业的发展，如何评价医院不同岗位不同人员的工作水平和能力，如何在没有明确的绩效评价标准时，衡量其任务完成情况，70

44如何将岗位评价与绩效考核结合起来，确定岗位评价系数，再根据医院的发展战略，分解医院绩效考核指标，形成个人的指标考核，最后将岗位评价与绩效有机的结合起来，构建新型的分配体系，成为我们讨论的关键所在。绩效管理是医院人力资源管理的一个重要的有机组成部分，而绩效考核是完整绩效管理过程中的一个环节，也是最重要的一环。实施绩效考核的作用在于通过评估，使医院员工知道自己哪方面做得好，哪方面还需要改进。另一方面，绩效考核的结果有非常多的用途：（1）作为绩效工资的依据，使报酬具有激励作用；（2）用于调迁、升降、委任等职位变动的依据；（3）提供信息，制定员工培训计划和绩效改进计划；（4）用于员工选拔和培训的有效性评价（28）。WithdevelopmentofChinesehealthservice,itcomestobethecriticalissuesunderourdiscussionhowtoappraisebusinessperformanceandcapabilityofdifferentpersonnelondifferentposts,howtomeasurethestatusofaccomplishmentoftasksbyanemployeewithoutaspecificstandardtoassesstheperformance,howtocombinepostappraisalwithperformanceassessmenttodeterminethepostappraisalcoefficient,todividethehospital-wideperformanceassessmentindexaccordingtothedevelopmentstrategyofWFPHsoastoformapersonalassessmentindex,andfinallytobuildanewwagesystembycombiningpostappraisalwithperformanceappraisal.Performancemanagementisvitallyintegraltohumanresourcesmanagement,whileperformanceassessmentisoneprocessinanoverallperformancemanagement,whichisaveryimportantone.Fulfillmentofperformanceassessmentenablesemployeestounderstandwhatisdoneperfectlyandwhatneedsimprovement.Ontheotherhand,performanceassessmentcan70

45serve:(1)asthebasisforperformance-basedwagesoastomakewagestimulating;(2)asthebasisforpositiontransfer,promotion,demotionorappointment,etc.;(3)toprovideinformationusedtodesignemployeetrainingprogramandperformanceimprovementplan;and(4)aseffectiveappraisalforemployeeselectionandtraining（28）.绩效评价一般采用定性和定量评价相结合的办法，如何进行有效的定量评价一直是绩效评价工作追求的理想。为了进一步调动医院员工的积极性和创造性，充分发挥量化考核的激励和导向作用，公正、公平、全面、客观地评价广大员工的德才表现和工作业绩，激励员工自觉提高业务水平、工作质量、科研能力、服务意识，加强医德医风建设，医院人员绩效评价体系由多个基本要素构成，包括目标、内容、指标、标准、业绩评价等。我院自行设定了各级各类人员的年度量化考核表，依据不同的岗位，不同的职责要求，不同的工作职位说明书，考核指标也理当有所不同。按手术科室医师、非手术科室医师、医技科室人员、药剂人员、护理人员、职能科室管理人员及后勤员工七大类，分别根据其工作性质与特点确定关键绩效指标和评价标准以及提供基础数据的责任部门。在前五类人员中又根据其职称高低以及在工作中所承担的责任不同，同类人员尽管考核项目相同，但关键绩效指标所占权重比有所不同。它能以同一标准评价员工，可以解决以往行政人员和后勤人员考核难以量化、随意性较大的缺点，提高考核的公信力。为此，共设计了各级各类人员量化考核表七大类19种。70

46Performanceappraisalusuallycombinesqualitativeappraisalandquantitativeappraisalandhowtomakequantitativeappraisaleffectivelyisstillpending.Inordertofurtherarouseenthusiasmandcreativityofemployees,fullygiveplaytomotivationanddirectionofquantitativeappraisal,appraiseemployeeperformancewholly,equally,impartiallyandobjectivelybothinethicsandbusiness,stimulateemployeestoimprovetheirskills,workquality,researchabilityandserviceawareness,andstrengthenmedicalethicsconstruction,theperformanceappraisalsysteminWFPHconsistsofseveralbasicfactors,includingobjective,content,index,criterionandachievementappraisal.Wehavedesignedanannualquantifiableassessmenttableforpersonnelondifferentlevelsandassessmentindicesaredifferentbasedondifferentjobs,requirementsondifferentdutiesanddifferentjobdescriptions.Thekeyperformanceindex,theappraisalcriterionandtheresponsibledepartmenttoprovidebasicdataaredeterminedaccordingtothepropertiesofworkandthecharacteristicsofoperationphysicians,non-operationphysicians,technicalstaff,pharmacystaff,nursingstaff,managersoffunctionaldepartmentsandlogisticstaffrespectively.Amongthepersonneloffirstfivegroups,theweightratioofkeyperformanceindexisdifferent,althoughtheassessedprogramsarethesameforthesimilar-typepersonnel,accordingto70

47theirdifferentprofessionaltitlesandresponsibilitiesundertakenintheirjob.Itcanbeusedtoappraiseemployeesbyonestandardand,asaresult,overcometheproblemwhere,inthepast,assessmentonadministrativeandlogisticstaffcouldn’tbemadeonaquantitativebasiswithmuchrandom,thusimprovingpublictrustofsuchassessment.Therefore,wehavedesigned7typesofquantifiableassessmenttablefordifferent-typeanddifferent-levelpersonnel,amountingto19itemsinclassification.考核方案颁布的同时对考核标准掌握的细则也作出了解释，便于操作。不仅对于年度考核制定了客观标准，也明确提出了对个人的目标要求，便于在全年的工作中努力去完成；科主任在日常管理中可以随时对照目标要求进行总结，及时掌握工作进展；更有利于在同科室同类同级人员中作出比较，也是绩效考核的重要参考指标，更便于下一年度的聘用。人员考核中充分包含了360度绩效考核等方法。当然评价的目的不是为了单纯评出名次和优劣程度，为评价而评价是没有意义的，重要的是鼓励员工向正确的目标发展。医院对全体员工按不同层次进行立体化绩效评价，通过纵向、横向对比分析，可以发现问题、找出差距，有针对性地加强内部管理，提高组织的持续发展能力。Whiletheassessmentschemewaspublished,therulesforimplementationoftheassessmentcriteriawerealsospecifiedtofacilitatetheirpractice.Wenotonlymadeobjectivestandardforannualassessment,butalsoadvancedpersonalrequirementson70

48theobjectivetobemetannuallythroughefforts;intheday-to-daymanagement,adepartmentaldirectorcancallforreviewmadebyemployeesatanytimeovertheirpersonalobjectivetohavetheprogressofwork;thisschemeisalsogoodforpersonnelofthesametype,levelanddepartmenttomakecomparison,thusservingasakeyreferenceindexforperformanceassessmentandfacilitatingrecruitforthefollowingyear.Personnelassessmentfullycontains360-degreeperformanceassessment,etc..Certainlyappraisalisnotmadefortellingsuperiorityandinferiorityonlyanditismeaninglesstotakeappraisalforappraisalitself.Itisimportanttoencourageemployeestotakethecorrectdirectioninthisway.3-dimensionedperformanceappraisalismadeoverthestaffofthehospitalondifferentlevelsand,throughverticalandhorizontalanalyses,itcanbeusedtospotgapanddefectsoastopertinentlystrengtheninternalmanagementandimprovesustainabilityofdevelopmentwithintheorganization.美国思想家拿破仑·希尔说“制定目标而能产生效果，秘密就是‘明确’二字。成功目标，必须是明确的。没有量化，就不是目标。”作为工作必须有目标，考核就要有标准，标准必须量化，不量化就不是标准，就无法测定，也就无法考核。全员量化考核方案的制定，构成了医院绩效管理的每一个点。NapoleonHill,theAmericanideologist,remarkedthatthe70

49secretofsettingaproductiveobjectiveis“specification”,asuccessfulobjectivemustbespecific,andthereisnoobjectivewithoutquantification.Workmusthaveitsobjectiveandassessmentmusthaveitsstandard,which,however,mustbequantifiable.Anon-quantifiablestandardisnotastandard,whichcan’tbemeasuredormakeassessmentimpossible.Formulationofaquantifiableassessmentschemecoveringallthestaffconstitutesapointofhospitalperformancemanagement.每一个员工都是绩效管理的一个节点，每一个节点共同会聚构成完成科室目标这根长线，所有科室组成的根根长线织成了医院目标完成的多个立面。Eachemployeeservesasanodeinperformancemanagement,allnodesconstitutealinetoaccomplishtheobjectivewithinadepartmentandallthelinesonthedepartmentallevelconstituteaplanetoaccomplishtheobjectivewithinthehospitalasawhole.点-线-面结合的立体化绩效考核体系由此形成。Thatformsa3-dimensionedperformanceassessmentsystemincombinationofpoint,lineandplane.5、立体化考核体系的成效Achievementsof3-dimensionedassessmentsystem70

50开展医院绩效评价有利于卫生系统整体绩效的提升。2000年WHO发表的《2000年世界卫生报告——卫生系统：改善绩效》提出了分析不同国家卫生系统绩效的新框架。卫生系统的目标包括：健康状况的提高、卫生系统反应性的改善以及筹资的公平性。医院作为卫生服务体系的主体，在此目标的奋斗过程中肩负着重大的责任，开展医院绩效评价可以充分调动卫生人员的积极性，不断提高卫生服务的质量和效率，从而使整个卫生系统绩效得到有效提高。其次，开展医院绩效评价有利于医院内部管理效率的提高。绩效评价是绩效管理的核心环节，通过绩效管理工具的充分运用，能成为医院内部管理价值链的关键环节，促进医院管理水平不断提升。具体作用表现在能成为落实医院发展战略的工具，为医院人事改革、成本核算、质量管理等相关管理工作的深入拓展创建激励平台，同时绩效评价的结果能为人事选拔、聘任及医院薪酬制度的改革提供依据，成为提升传统奖金分配工作品质的重要工具（29）。用一套系统的、规范的程序和方法对科室、对员工在医疗服务工作中所表现出来的工作态度、工作能力和工作业绩等，进行以关键绩效指标为主导，以工作事实为依据的评价，并使评价以及评价之后的科室管理、人力资源管理有助于医院经营目标和员工个人发展目标的实现。不管何种考核体系，其根本目的都在于通过对被考核者的激励，引导其行为，使其以最大限度的努力来完成预定的考核目标（30）。Conductinghospitalperformanceappraisalisadvantageoustopromoteperformanceofthehealthsystemasawhole.WorldHealthReport2000–HealthSystem:ImprovingPerformancepublishedbyWHOin2000introducesanewframeworktoanalyze70

51thehealthsystemperformanceindifferentcountries.Theobjectiveofahealthsystemincludes:enhancementofhealth,improvementofhealthsystemresponseandimpartialityoffinancing.Astheprincipalofhealthservicesystem,hospitalbearsresponsibilitiesinthecourseofstrugglingtomeetthisobjective.Conductinghospitalperformanceappraisalcanfullyarouseenthusiasmofhealthstaffandcontinuouslyimprovequalityandefficiencyofhealthservicesoastoimproveperformanceofthehealthsystemasawhole.Secondly,conductinghospitalperformanceappraisalcanfacilitateimprovementofmanagementefficiencywithinthehospital.Performanceappraisalisthecoreofperformancemanagementandcanbeakeynodeofitsinternalmanagementvaluechainbyfullapplicationoftheperformancemanagementtooltoenhancecontinuousimprovementofhospitalmanagement.Definitely,itcanbeatooltoimplementthehospitaldevelopmentstrategyandcreateamotivationplatformtoprofoundexpansionofpersonnelreform,costaccountingandqualitymanagement,etc.inahospital.Meanwhile,theresultofperformanceappraisalcanevidencepersonnelselection,appointmentandwagesystemandactasanimportanttooltoimprovethetraditionalbonusdistribution（29）.Asetofsystematicandstandardizedproceduresandapproachescanbeemployedtoevaluate,directedbykeyperformanceindex70

52andbasedonthefactofwork,employees’attitudes,abilitiesandachievementsindicatedintheirserviceandleadtheappraisalanddepartmentalmanagementandhumanresourcesmanagementaftersuchappraisaltofacilitaterealizationofhospitalbusinessobjectiveandemployee’spersonalobjective.Assessmentsystem,nomaterinwhattype,isbasicallydesignedtoguidetheexaminees’behaviorbymotivatingthemsoastohelpthemexerttheirutmosteffortstoaccomplishthesetobjective（30）.建立一个具有地方特色，既适应运行机制变化，又满足医院管理需求的考核评价体系，是我们管理者的追求。经过七年左右的时间，我们在绩效考核方案的建立上日臻完善，从较粗放的《科室综合目标考核制》逐步完善为涵盖员工个人、各类科室及整个医院的绩效考核体系，消除了管理的空白点，取得了明显成效。We,hospitalmanagers,areearnestlylookingforwardtoestablishingalocallycharacteristicassessmentandappraisalsystem,whichcannotonlymeetchangesoftheoperationsystem,butalsomeettherequirementsuponhospitalmanagement.After7years’efforts,wehaveincreasinglyperfectedtheperformanceassessmentschemeinitsestablishment,fromtheveryextensiveComprehensiveObjectiveAssessmentSystemforDepartmentstotheperformanceassessmentsystemcoveringemployees,departmentsandhospital,whichsuccessfullyeliminatestheblank70

53inmanagementandisveryproductive.5.1培训了一批善于管理、敢于管理的高素质中层干部队伍。全员绩效考核由于采用的全面、全员考核，层层考核，所以所有中层管理干部每个月都要对所属员工进行绩效考核，对考核的公平与否，都直接影响群众对其本身的认可度以及科室内的凝聚力。所以说绩效考核是对中层干部的一个考验，有助于提高本身各方面的素质，提高他们发现问题、解决问题的能力，同时通过绩效考核，促使他们学会运用考核来激励下属，提高工作积极性。通过统计分析，我们明白自身的优势、劣势、机会和威胁，主动调整科室结构和经营策略，优化科室资源，提高工作效率和服务质量，增强科室竞争力评价。Wehavetrainedalotofhigh-qualitymiddle-levelcadreswhoareskilledinmanagement.Astheoverallperformanceassessmentadoptsoverallassessmentmadelayerbylayer,themiddle-levelmanagersassesstheperformanceoftheirstaffand,asaresult,itwouldmattertheirrecognitionbytheirstaffandthecohesionwithintheirdepartmentwhetherornottheassessmentismadeimpartially.Inthisconnection,performanceassessmentisjustchallengingthemiddle-levelcadres,whichhelpsimprovetheirmultifacetedqualities,enhancetheirabilitiestodetectandsolveproblems.Meanwhile,performanceassessmentalsourgesthemtolearntomotivatetheirsubordinatesbymeansofassessmentsoastoraisetheirenthusiasm.Accordingtostatisticalanalysis,weunderstand70

54theadvantages,disadvantages,opportunitiesandthreatswithusandtakeaninitiativetoadjustthedepartmentalconstructionandbusinessstrategy,optimizedepartmentalresources,improveworkefficiencyandservicequalityandstrengthenthecompetitivepowerinadepartmentunderappraisal.科主任的绩效评价是医院战略管理的一个重要组成部分。临床科主任的绩效评价相对来说是最完整的，主要包括科室管理、医疗、教学、科研等方面，但只是对科室整体的绩效评价要求，而非对科主任个人的要求。我们的考核体系设计中科主任的绩效不仅要与科室绩效挂钩，本人也要通过量化考核的评判。通过对科主任的绩效评价实现的医院战略管理目标包括：第一，通过绩效评估形成医院竞争策略或讨论医院竞争战略；第二，通过绩效评价，对医院管理及医院目标市场的竞争态势实施动态控制与分析；第三，通过绩效评价对医院财务状况进行有效监控；第四，借助绩效评价培育和强化医院全体科主任的职业准则、岗位道德和科室文化。科主任的绩效评价设计也是培育和发展医院价值观的管理行为，是医院对科主任实施价值管理的基本手段，是医院建立和发展医院内部信息交流系统、业务分析系统和建议反馈系统的组织环节（16）70

55。战略目标分解到各临床业务科室，明确临床业务科主任岗位职能的职责；使每位科主任更高效地行使管理职能，完成医疗管理、教学管理、科研管理、经济管理、人才管理的目标任务；对每位科主任任期内的关键绩效指标进行有效的量化，从而提高绩效；充分发挥每位科主任的潜能，期为提高绩效和达成目标而积极主动工作；吸引留住科主任群体中的优秀人才，为医院长远发展奠定坚实的人力资源基础。Performanceappraisalofdepartmentaldirectorsisvitallyintegraltohospitalstrategymanagement.Relatively,performanceappraisalofclinicaldirectorsisthemostcomprehensive,whichismadeupofdepartmentalmanagement,medicalservice,trainingandresearch,etc.,butitisdesignedforperformanceassessmentofeachdepartmentasawhole,notforthatofdirectorsthemselves.Accordingtoourassessmentsystem,performanceofdepartmentaldirectorsisnotonlylinkedtothatofthedepartment,butalsohasevaluationthroughquantifiableappraisal.Theobjectiveofhospitalstrategymanagementrealizedthroughappraisalofdepartmentaldirectors’performanceismadeupasfollows:1.buildingordiscussinghospitalcompetitionstrategythroughperformanceappraisal;2.controllingandanalyzingthehospitalmanagementandthecompetitionstatusofhospital’stargetmarketdynamicallythroughperformanceappraisal;3.effectivelymonitoringhospital’sfinancialstatusthroughperformanceappraisal;and4.cultivatingandstrengtheningtheoccupationalrules,postethicsofalldepartmentaldirectorsandthedepartmentalculturethroughoutthehospitalwithhelpofperformanceappraisal.Departmentaldirectors’designofperformanceappraisalisalsothemanagement70

56behaviorincultivatinganddevelopinghospital’svalue,thebasicmethodtomakevaluemanagementoverdepartmentaldirectorsandtheprocesstoestablishanddevelopinternalinformationexchangesystem,businessanalysissystemandsuggestions’feedbacksystem（16）.Afterthestrategicobjectiveisdividedtoeachclinicaldepartment,specifythedutiesofdirectorofeachclinicaldepartment;makeeachdirectorexercisemanagementfunctionsmoreefficiently,whoisexpectedtocompletethetargetedtasksastomedical,training,research,financialandtalentsmanagement;makequantifiablethekeyperformanceindexforeachdirectorduringhis/herofficetermsoastoimprovetheperformance;fullyunleashthepotentialsofeachdirectorsothattheywillworkhardtoimproveperformanceandreachtheobjective;andattractandmaintainexcellenttalentsinthegroupofdirectorssoastolayasolidfoundationofhumanresourcesforthehospitaltoadvanceinthelongrun.5.2员工进一步规范自己的行为，激发了员工的工作热情和创新潜能，科室的团队精神、凝聚力不断增强，激励效果不断优化。70

57对全体员工的绩效评价指标进行科学的概括和提升，形成了整套的评估指标体系，其特点在于：一是评价比较合理，评价的主体是全体员工，其价值是由其社会角色和社会作用决定的。在指标体系的设置中，充分考虑了各类人员医教研全面发展及德才兼备的价值取向；二是绩效评价目的的前瞻性，进行绩效评价的目的有两方面：一方面是便于确定全员的发展目标，确定如何激励员工使其有更高的绩效表现．帮助员工建立适宜的职业目标，另一方面是管理者的评价和决策，为职称晋升、薪酬等级的设定和任务分派等提供依据。员工进一步规范自己的行为，激发了员工的工作热情和创新潜能，科室的团队精神、凝聚力不断增强，激励效果不断优化。Byfurtherstandardizingtheirbehavior,employeesarousetheirenthusiasminserviceandpotentialincreation;teamworkandcohesionamongadepartmentiscontinuouslyenhancedsothatstimulationiscontinuouslyoptimized.Byscientificallyoutliningandpromotingtheperformanceappraisalindexcoveringthestaffisformedacompletesetofappraisalindexsystem,whichischaracterizedasfollows:1.appraisalisratherreasonable,whereitssubjectisthestaff,whosevalueisdeterminedbytheirsocialroleandfunction.Theindexsystemsettinghastakenintofullaccountsomepersonnelwhoarewelldevelopedintheircareer,teachingandresearchandequippedbothwithexcellentethicsandtalents;and2.prospectiveistheobjectiveofperformanceappraisal,whichfacilitatesestablishingdevelopmentobjectiveofthestaffandconfirminghowtomotivateemployeessoastohelpthemhavebetterperformanceandestablishcareergoalsuitableforthemand,ontheotherhand,helpsmanagersmakeappraisalanddecisionso70

58astoevidencesettingpromotionandwagegradeandassignedtasks.Byfurtherstandardizingtheirbehavior,employeesarousetheirenthusiasminserviceandpotentialincreation;teamworkandcohesionamongadepartmentiscontinuouslyenhancedsothatstimulationiscontinuouslyoptimized.5.3把医院的战略目标分解为可以运行的医院、科室、员工三个层次，各级指标之间具有严密的连续性和因果关系。构成符合医院运行特点，与医院总体发展目标紧密结合的关键绩效指标,且该KPI符合“SMART”的原则,医院的目标管理得以实现。由于我们把管理者的管理理念和方法融人到具体的考核中，通过实施全员绩效考核，适时推动全院各项改革的顺利进行，同时通过考核反馈机制的建立及时修改全院决策及制度上的一些误差，达到医院目标管理的效果，医院实现社会效益、经济效益双丰收。全员绩效考核促进了医院各项改革的顺利进行，使医院呈现一派生机勃勃的景象，员工行为不断规范，综合素质不断提高，工作热情及创新潜能被激发。医院的医疗质量及服务质量不断提高，经济效益逐年增加，职工收入也逐年增加，形成了一个良好的循环，医院步入了一个发展壮大的大好时机。通过统计分析，我们应该明白自身的优势、劣势、机会和威胁，主动调整科室结构和经营策略，优化科室资源，提高工作效率和服务质量，增强科室竞争力评价。Hospitalstrategicobjectiveisdividedintothreeoperablelayers,namely:hospital,departmentandemployeeandbetweenthe70

59indicesofeachgradeexisttherigorouscontinuityandcause-effectrelation,which,inclosecombinationwiththegeneraldevelopmentgoal,constituteKeyPerformanceIndex,whichmeetsthetraitsofhospitaloperationandthe“SMART”principle,soastoeffecttheobjectivemanagement.Weincorporatemanagers’managementconceptandmethodintothespecificassessment,pushforwardeachitemsofreformaroundthehospitalsmoothlyatagoodtimethroughperformanceassessmentonthestaffandtimelycorrectsomeerrorsofhospital-widedecisionsandsystemsbyestablishingtheassessmentfeedbackmechanismsoastomakethehospitalobjectivemanagementfruitful.Forthisreason,wehavehadgoodharvestbothinsocialbenefitandeconomicbenefit.Duetotheoverallperformanceassessment,eachitemofreformgoesverywell,whichmakesthehospitallively:behaviorofemployeesstandardized,theircomprehensivequalityimprovedandtheirenthusiasminserviceandpotentialincreationstimulated.Themedicalandservicequalityinthehospitaliscontinuouslyenhanced,theeconomicbenefitandtheemployees’incomearebothraisedyearbyyear,thuscomingtobeafavorablecycle,andthehospitalhasfacedthewonderfulopportunityleadingtostrength.Accordingtostatisticalanalysis,weunderstandtheadvantages,disadvantages,opportunitiesandthreatswithusandtakean70

60initiativetoadjustthedepartmentalconstructionandbusinessstrategy,optimizedepartmentalresources,improveworkefficiencyandservicequalityandstrengthenthecompetitivenessinadepartmentunderappraisal.6、考评体系的缺憾与对策：Defectoftheassessmentsystemandcountermeasure立体化考核评价体系的建立，为医院通过绩效考核走向绩效管理铺平了道路。考核方法故然重要，但更重要的是建立一个完整的考核体系，在管理范围内不留盲区，不留空白点。从考核中识别机会和发现问题是考核得分结果分析的重要目的之一，也是高层管理者需要的高价值信息。医院绩效评价有利于系统的进一步发展和完善，能使我国开展多年的医院管理年活动的内容变得更加丰富，并能促进该工作与医院具体管理实践有效结合。医院绩效评价有利于医院内部管理效率的提高。绩效评价是绩效管理的核心环节，它通过绩效管理工具的充分运用，能成为医院内部管理价值链的关键环节，促进医院管理水平不断提升。绩效评价将与绩效目标的设定、绩效辅导、绩效反馈和应用一起，构成医院绩效管理的全过程。在管理实践中，我们也清醒地认识到，目前制定的评价体系还存在一定的不足，还需要在今后的工作中加以完善，不断修正。Theestablishmentof3-dimensionedassessmentandappraisalsystemhaspavedthewayforthehospitaltoapproachperformancemanagementbymeansofperformanceassessment.70

61Despitetheassessmentmethod,itismoreimportanttoestablishanintegralassessmentsystemwithoutblindzoneandblankpointsleftintheterritoryofmanagement.Itisavitalgoalofassessmentscoreanalysistorecognizeopportunitiesanddetectproblemsfromtheassessment,whichisalsohigh-valueinformationneededbyhigh-levelmanagers.Hospitalperformanceappraisalfacilitatesfurtherdevelopmentandperfectionofthesystem,whichcanenrichthe“HospitalManagementYear”eventsperformedforyearsandenhanceeffectivecombinationofthisworkwithspecificpracticeinmanagement.Meanwhile,italsofacilitatesimprovementofefficiencyinhospitalinternalmanagement.Asthecorenodeofperformancemanagement,performanceappraisalcanbeakeynodeofthevaluechainofhospitalinternalmanagementbyfullapplicationofperformancemanagementtoolssoastoenhancehospitalmanagementcontinuously.Performanceappraisalwillconstitutethewholeprocessofhospitalperformancemanagementtogetherwithperformanceobjectivesetting,performancecoaching,performancefeedbackandapplication.Duringthepracticeinmanagement,wealsohaveaclearmindthattherearesomedefectsontheappraisalsystemmadeatthepresent,whichneedsfurtherperfectionandrevision.6.1缺憾与不足：70

62Defects:6.1.1考核目标设置不尽科学。由于医疗技术含量较高、专业性较强，医院岗位定量考核较难把握，在绩效评价的过程中，指标选择和权利分配方面缺乏科学的理论和依据；不同类型科室之间的公平性以及行政后勤部门的绩效评价较难统一，并非所有岗位职能都可以量化，而定性考核人为因素太多，考核标准很难做到公平合理。同时由于医院目标的多重性，部分目标难以定量或分解。Assessmentobjectivesettingisnotquitereasonable.Asitisuneasytocommandon-jobquantifiableassessmentwithmuchtechnologycontentandstrongprofession,scientifictheoryandevidencearestillunavailableforindicesselectionandrightsdistributioninthecourseofperformanceappraisal;itisdifficulttomakeuniformimpartialityamongdifferenttypesofdepartmentsandperformanceappraisaloveradministrativeandlogisticsdepartments,notallpostfunctionscanbequantifiable,therearetoomanyhumanfactorsforqualitativeassessment,andassessmentcriteriacan’tbemadeabsolutelyreasonableandimpartial.Meanwhile,astherearemultipleobjectivesforahospital,partialobjectivesaredifficulttobequantifiedordivided.6.1.270

63考核频率缺乏标准化。考核的频率也关系到考核是否合理，能否反映真实的情况。由于考核目标的完成有过程性，绩效考核时间过久，影响考核质量。考核频率的设置与考核的内容有关，对于一些临床科室任务绩效的指标，可能需要较短的考核周期，将平时考核与年终考核相结合，才能得出科学评价。Assessmentfrequencyislessnormalized.Thefrequencyofassessmentalsodeterminesifassessmentisreasonableandifitcanreflectthefact.Asaccomplishmentofassessmentobjectiveneedstime,atoolongperiodforperformanceassessmentwouldinfluencethequalityofassessment.Thesettingofassessmentfrequencyhassomethingtodowithitscontent;indicesforthetaskperformanceofsomeclinicaldepartmentsmaybeneedashortperiodofassessment,soscientificevaluationcanbeproducedonlywhencombiningregularassessmentwithyear-endassessment.6.1.3信息系统的滞后。目前考核多为人工操作，没有充分利用医院HIS系统的信息数据，也在一定程度上影响了评价体系的综合应用。对于绩效管理无法做到实时、动态。Theinformationsystemstilllagging:now,mostofassessmentismademanuallywithoutfullapplicationoftheinformationdatainHISsystem,whichhasinfluencedtheoverallapplicationoftheappraisalsysteminsomedegree.However,itisimpossibleforperformancemanagementtobemadereal-timeanddynamically.6.1.470

64评价结果的反馈作用有待进一步发挥。绩效考核与其前后工作脱节，考核反馈机制不够完善。绩效考核仅是绩效管理的一个环节，没有与绩效计划和绩效反馈联系起来。经常会出现孤立地看待考核的现象，绩效管理过程无法实施，最终绩效得不到反馈，从而使组织的绩效也无法提高。Appraisalfeedbacktobefurtheredinitsuse.Performanceassessmentisdisconnectedfromitspreviousandfollowedwork,sotheassessmentfeedbackmechanismislessperfected.Performanceassessmentisonlyaprocessofperformancemanagement,butnotlinkedtoperformanceplanandfeedback.Frequently,assessmentistreatedinasingleangle,performancemanagementcan’tbeimplementedandnofeedbackisobtainedfromthefinalperformancesothatperformanceinanorganizationisimpossiblyimproved.6.2相关对策设计：绩效评价作为现代医院管理的重要管理工具，引导医院的发展方向。绩效管理能否达到预期的效果，关键一点就在于绩效考核是否具有公正性和科学性。Relevantcountermeasure:asanimportantmanagementtoolformodernhospitalmanagement,performanceappraisalservestodirectthehospital’sdevelopment.Isperformancemanagementproductiveasexpected?Thatliesinwhethertheperformanceassessmentisimpartialandreasonable.6.2.170

65按不同的岗位设计标准不同的考核表，加强考核目标的针对性和科学性，提高考核的效果。尽可能多地规定全院考核中可统一的考核标准，逐步规范量化考核表的设计，可采用平衡记分卡的有关思想。Assessmenttableswithdifferentstandardwouldbedesignedasperdifferentpoststoenhancethepertinenceandreasonabilityofassessmentobjectivesandimprovetheoutcomeofassessment.Uniformstandardsforthehospital-wideassessmentwouldbesetasmanyaspossible,designofassessmenttableswouldbegraduallynormalizedandquantifiable,andsomeideasofthebalancescorecardmaybeadopted.6.2.2根据自身的情况，确定考核频率，并将它作为一项明文规定，避免绩效考核流于形式。使得绩效考核真正成为医院管理中的一种重要手段。Assessmentfrequencyisestablishedaccordingtotheconditionsofthehospitalandregardedasadefinitestipulationtopreventtheperformanceassessmentfrombeingformalistic,thusmakingperformanceassessmentanimportanttooltomanagethehospital.6.2.3绩效评价体系的信息化建立要与医院的功能定位相适应。依托医院网络系统数据资源，开发网络条件下各级各类人员绩效量化评价指标系统，以医院管理信息系统(HMIS)为基础，结合医院HIS系统数据，形成一套动态、实时且评价比较合理，绩效具有前瞻性的考核体系。Informationizationofperformanceassessmentsystemshall70

66accordwiththefunctionalorientationofthehospital.Withhelpofdataresourceofhospitalnetworksystem,performancequantifiableassessmentindexsystemforemployeesindifferenttypesandondifferentlevelsisdevelopedundernetwork;asetofassessmentsystemwhichismadereal-time,dynamicandreasonableinappraisalwithprospectiveperformanceisformedonthebasisofHospitalManagementInformationSystem(HMIS)incombinationwithhospitalHISsystemdata.6.2.4主管人员需要与员工进行有效绩效面谈，分析其考核结果，将考核结果告知员工，找出问题，共同制定工作改进的计划。只有将绩效考核与前后的环节联系起来，绩效考核才能做到有理有据，才能得到执行。Supervisorsmusthaveaperformancetalkwithemployeesfacetoface,analyzetheresultoftheirassessment,informthemofsuchresult,detecttheexistingproblemsandmakeanimprovingplanwiththem.Onlybylinkingperformanceassessmenttothepreviousandfollowedprocessescanperformanceassessmentbeconductedreasonablyandimplementedsuccessfully.7、结束语Closing70

67公立医院既要适应市场经济一般规律的要求，同时又要遵循卫生事业发展的内在规律，使医院沿着正确的方向发展，目前正在由计划经济向市场经济转换，计划中有市场，市场中有计划。所以需要我们进行管理上的深思，要有一个合理的、明确的、具有导向型的考评体系。在加强公立医院管理时要开拓新思路，要在管理内涵上多做一些事情，跳出以前的管理模式，进行新的探索。无锡市医院运行机制的改革，既激发了医院的活力，又促进了医院的管理，调动了医院的积极性和管理的主动性；既加强了专科建设，也增强了员工自我约束、自我发展的信心。立体化的考核评价体系的建立，扩大了考核的覆盖面、增强了考核的准确性、有效性、公正性，考核过程的实施及考核结果的运用，达到了医院整体目标、科室效益和个人职业生涯发展的多赢。立体化考核评价体系不是一种单一的考试方法，而是整合了多种评价体系的复合体。但在实践中还需要进一步修正与完善。Publichospitalsneednotonlytomeetrequirementsofthegeneralprincipleofmarketeconomy,butalsomeettheinternalprincipleofhealthserviceindevelopmentsimultaneouslysothatthehospitalisledtodevelopintherightcourse;itiscurrentlytransferredfromplanningeconomytomarketeconomywheremarketliesinplanningandplanningliesinmarket.Therefore,thisrequestsforourconsiderationonmanagement,whichrequiresareasonable,specificandorientedassessmentsystem.Whilestrengtheningpublichospitalmanagement,weshalldwellontheconnotationofmanagement,jumpoutoftheformermanagementmodeandtakefurtherexploit.Reformofthehospitalrunning70

68mechanisminWuxihasnotonlyenergizedhospitals,butalsoenhancedhospitalmanagement,whichhasarousedenthusiasmofhospitalsandtheirinitiativeinmanagement;andsuchreformhasstrengthenedfacultyconstructionandenhancedemployees’confidenceinselfrestrictionandselfdevelopment.Establishmentofthe3-dimensionedassessmentandappraisalsystemhasexpandedthecoverageoftheassessment,improveditscorrection,validityandimpartiality;assessmentfulfillmentandapplicationoftheappraisalresulthelpsachievemulti-wininhospital’sgeneralobjective,departmentalbenefitandpersonalcareerdevelopment.The3-dimensionedassessmentsystemisnotasinglemethodofexamination,butisacompoundintegratingkindsofappraisalsystem.Inpractice,however,itstillneedsfurtherrevisionandperfection.综上所述，临床医疗工作是包含了风险、责任心、技能等多方面因素的职业，其复杂性和特殊性决定了我们必须通过科学绩效评价与考核体系架构起工作过程中原因与结果之间的桥梁，以求对临床工作质量与效益实行客观公正的评价。将科学合理的绩效评价与考核指标应用于医院目标管理是十分必要的。70

69绩效评价是为落实医院发展战略服务的，整体外部评价是导向，科室和岗位等内部评价是基础，科室评价和岗位评价也互相补充，岗位绩效评价是最终的落脚点。建立医院绩效评价体系的核心内容体现在具体评价指标的选择和评价标准的确定上，其具体内容必须随着医院战略的变化而调整。它必将通过持续有效的工作成为医院日常管理工作的重要组成部分。Tosumup,clinicalmedicalworkisacareercontainingrisk,skill,responsibilityandotherfactors.Asit’scomplicatedandparticular,wemustbridgethecauseandeffectduringworkbyreasonableperformanceappraisalandassessmentsystemsoastomakeimpartialandobjectiveevaluationonqualityandbenefitoftheclinicalwork.Itisnecessarytoapplyscientificandreasonableperformanceappraisaltoassessmentindices.Performanceappraisalisdesignedtoeffectserviceforhospitaldevelopmentstrategywiththeoverallexternalappraisalastheorientation,theinternalappraisalfordepartmentsandposts(departmentappraisalandpostappraisalaresupplementarytoeachother)asthebasisandpostperformanceappraisalasthefinalstandingpoint.Thecentralcontentofestablishthehospitalperformanceappraisalsystemisembodiedinselectionofspecificappraisalindicesandconfirmationofappraisalstandard,whosedefinitecontentshallbeadjustedasthehospitalstrategyisaltered.Itwillbesurelyanimportantpartofregularhospitalmanagementbyworkingeffectivelyandcontinuously.70