Shanghai Clinical Center for Sustainable Development Strategies_2756

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Shanghai Clinical Center for Sustainable Development Strategies_2756

    Shanghai Clinical Center for Sustainable Development Strategies

     Author: Xu Ping, Li Ai-jun Wu Hong Zhou Lin

     Abstract that this is with Shanghai Health Bureau of 33 clinical centers objective analysis of results of the assessment revealed the

    clinical centers in the development of the common problems presented to the policy as the main content of the six-point proposal, to ensure that

    the clinical Medical Center's leading position and enhance sustainable development capacity to provide reference.

     Key words Clinical Center; management; sustainable development; countermeasures

     Abstract According to the objective analysis of 33 clinical medicine centers by the Board of Health in Shanghai, this paper revealed

    problems which exist in the development of clinical medicine center, and offered six proposals for ensuring the leading role of clinical medicine center and improving the capability of sustainable development.

     Key words clinical medicine center; management; sustainable

    development; countermeasure

     Shanghai Clinical Center to address the existence of hard to assess, it is difficult to compare the actual landscape, as well as the performance evaluation process can be the Clinical Center to find the

    problems, the introduction of cases on the basis of classification, by practical application amendments to the final testing and feedback was established in Shanghai Clinical Center for evaluation index system, thus achieving the objective of the clinical centers, scientific, quantitative evaluation and sorting, as the center of Shanghai Health Bureau to develop clinical development planning and conduct of clinical Center for evaluation of scientific basis.

     A problem

     According to Shanghai Municipal Health Bureau on the 33 clinical centers of the evaluation results, clinical centers found that the prevalence of the following questions:

     1.1 Clinical Center personnel supply and demand more prominent

     As the Center's special status and commitment of the special mission requires not only have an excellent academic leaders, but also the backbone of a strong team and enough talent pool. However, inherent in the staffing in this area do not have enough policy supporting facilities, the

    Center personnel reserve requirements and the authorized staffing of the more obvious contradictions. Some central backbone to face title, treatment of topical issues such as confusion, in the fierce market competition environment, there has been a tendency to brain drain backbone

    of its greater potential hazards. Talent pool and talents get in, should not come out of issues such as personnel, there will be a better solution.

     1.2 emphasis on hardware over software is quite prominent in the construction of

     Clinical Center of the construction fund total investment, the vast majority are used for ward, operating room renovation and expansion, as well as the purchase of major equipment such as hardware construction, and only less than 10% to 20% of the funds for scientific research, new

    technology research and development and personnel training of software such as construction, objectively lead to "an emphasis on hardware over software" and "emphasize the invisible visible light" situation, contrary

    to the central building of the overall goals. In the Clinical Center of the construction process, the implementation of "soft" or "hard" carrot policy, strengthen management, scientific research, the effective realization of academic reorganization and truly optimize the treatment of

    disease patterns is that all centers must meet new challenges.

     1.3 insurance policies restrict the development of clinical centers

     Existing medical insurance policies mainly to solve the people's basic medical needs, and in the centers carry out various high-risk,

    difficult diagnosis and treatment of severe diseases, are not effective special policies. Therefore, there to solve every case of complex and difficult cases, each carrying out a major high and difficult surgery,

    should affect the authorized amount to the hospital's medical insurance, for a "more pay for more punishment, whipping the fast ox" in an unfavorable situation, the medical center bring to the workplace and

negative effects of economic pressures, but also impeded the medical

    personnel for technical services revenue increased, and dampen the enthusiasm for work, so that both doctors and patients in a dilemma.

     Two policy recommendations

     Clinical center for the problems, we should center on the "overall

    planning, scientific management, coordinated development and common progress," development ideas, will-centered development and evaluation of

    clinical medicine into the science track, motivate organizations and individuals, and further Clinical Center to promote sustainable


     2.1 Clinical Center-oriented development planning

     Clinical Center of the planning is not only the medical disciplinary development needs, but also in Shanghai and the national population health

    care needs, it should seize the clinical research center for planning, establishing and implementing the scientific concept of development. First, from the authorities concerned, through investigation and study, full feasibility studies, the number of experts of the center, structure

    and layout of scientific proof, correct guidance, dealing with growth and the quantity and quality, speed and efficiency of the relationship between the spirit of "appropriate scale , moderate quantity and improving quality

    "principle, namely, to have long-term planning, but also have immediate

    plans. The second is the development from the hospital perspective, each hospital should develop its key subjects of scientific planning. Many professionals in general hospitals, in general increase, based on the

    choose a medical profession as a key development should be fully argued in the context of the hospital based on its own terms, consider the market factors, supporting conditions, specialist technology, and so on. For the basic conditions relative to similar departments, priority should be given option to the whole hospital's medical technology can play a greater leading role of the specialist. Third, each center itself, should develop the discipline of technology development plans and annual plans, a careful

    analysis of its current level, personnel structure, technical characteristics and on-site needs, main attack to seize the technology focus, not only to pay attention to the edge of subjects, difficult cases , but also pay attention to common and frequently-occurring disease,

    caused great harm to the disease, the formation of "people have me have, people have my excellent, excellent I were fine, fine people I study" a good pattern.

     2.2 The implementation of the scientific management of clinical


     Clinical Center of the construction and development, is an include

    infrastructure, business development and technical team building, including systems engineering. To be human, financial, material, time, information, implementation of a comprehensive scientific management, and tap the inherent potential to reduce cost of ownership, improve medical quality, and give full play to advantages in order to create the largest and best subjects of social and economic benefits. First, we must strictly

    declaration, examination and approval procedures, and improve process management. A set of scientific and feasible declaration, approval procedures and administrative rules are conducive to the work of inspection and guidance that will help management efficiency. Competent authorities must strictly a good job access and Clinical Center, but also in the assessment after the passage to the next round of review, the strengthening of dynamic management, supervision and clinical center

    implementation plan. Those who are found not guarantee that the status as a domestic advanced clinical center that was found in the construction process in a timely manner, guidance, and can not be improved to achieve the requirements to be withdrawn, according to the principle of survival

    of the fittest, and are done center "in, up, left, down, withdrawal. " Second, establish and improve the evaluation criteria. Establish and improve the clinical center evaluation index system is directly related to the central reporting, evaluation, management of all aspects, the evaluation criteria should reflect the advanced and scientific, we must advance with the times, keep up the pace of development in medical technology to make it in line with today's medical advances.

     2.3 The Clinical Center of hardware and software to enhance the building of

     For the Clinical Center "an emphasis on hardware over software" of the situation, we should further strengthen the clinical centers of hardware and software building, particularly in personnel training,

    research and management issues in software development. Training of qualified personnel as an example:

     2.3.1 emphasis on academic leaders to select and train leaders, the level of discipline, capacity size, a direct impact on the level and

    quality of specialized construction, need to train with the promotion of capacity development in emerging and frontier disciplines of the academic leaders, from the employment positions and employment for selection to support the needs, from the thinking, work style, academic level and the organizational and leadership capabilities and many other considerations, by introducing and training a combination of approaches, so that those with the ability to promote development of academic disciplines to fully

    display their talents in order to continuously improve its academic level of technology and innovation.

     2.3.2 Center to train technicians team talent foundation for sustainable development depended not only on academic leaders, but also

    depends on the technical backbone of the overall quality and level of

    opening to vigorously train the backbone of the current young, while actively introducing high-level talents. Medical science with practical, sustained and strong community features, only those with a tiered

    reasonable, and the overall quality is good, high level of technology, medical ethics is good, with unity, hard work, dedication, and technical personnel, in order to improve discipline competitive strength and sustained development. Reposted elsewhere in the paper for free download http://

     2.3.3 continuous improvement of the conditions supporting advanced, supporting specialist equipment, laboratories, library materials, information network, medical space and to a certain size bed is the

    central prerequisite for technological development. Certain conditions, laboratory and scale of key disciplines beds can ensure the conduct of scientific research and technology and advantages. Therefore, to ensure that capital investment, and to develop appropriate governance first, stressed that private investment funds, equipment, acquisition of stress highly sophisticated, application and matched to ensure that discipline in infrastructure, technology development and medical services needs.

     2.3.4 High-tech efforts in technological innovation tip technology, major diseases, and difficult critical illness diagnosis and treatment technology, is the central symbol of the level is to improve the competitiveness of the core. To make the technical level is always at the leading position and the advanced level, we must always concentrate on focused, to develop leading edge, the starting point must be high, features to highlight. Is only aimed at domestic and international trends

    and leading technology disciplines, focus on resolving common and frequently occurring at the same time pay attention to the emerging, cross, marginal fields, to fill gaps in subject areas in order to really enhance the core competitiveness of subjects [2], and ultimately achieve

    sustainable and high-level academic position and level of technology.

     2.3.5 Although the current incentive system to improve the talent has broken the big pot, but the income gap is not big enough Also, distribution to the clinical front line of efforts to tilt talent is not enough, the welfare of the factors motivating factor too much too little. Therefore, to establish an effective incentive and restriction mechanism and reflects the "hard work and excellent pay excellent workers" and

    support the knowledge, technology and management factors in distribution, widen the income gap reflects the value of human resources for the implementation of a small number of people with outstanding contributions "annual salary system."

     2.4 The central role played by clinical center

     Clinical Center is to explore the establishment of specialist technologies and new theories, and create new technologies to provide new

experiences, and bring the whole of Shanghai's rapid development of

    medical and health undertakings. The composition of the same clinical specialty technology center in Shanghai in collaboration network of radiation through technology, collaboration to achieve mutual promotion, learn from each other and jointly improve the clinical scientific and

    technological level, that is, to adapt to the needs of development of medical technology, but also the need to speed up hospital construction, but also to meet the medical needs of the people's increasing needs. Therefore, first, at all levels must recognize that it is not only a hospital operational matters, but also in order to meet the health needs of Shanghai, to play in Shanghai Clinical Center for medical and health undertakings in the Construction of the role of the lead and radiation.

    Second, clinical centers themselves to learn new skills and innovative, improved and timely introduction of international advanced technology; to other units responsible for operational guidance, technical co-Bang Dai

    and collaboration, through exchange of experience, on-site re-education

    guidance, training of fellows and other methods to promote the improvement of medical technology in Shanghai and popularization; to summarize clinical center management experience, for the center model, success

    stories and problems to sum up, exchange, improve the hospital management level.

     2.5 to Clinical Center for the "leading" to build edge

    interdisciplinary group of

     Today's world of science and technology disciplines, the intersections between disciplines become more frequent, new technologies, new disciplines to flourish, a true sense of the major technological breakthrough, an outstanding talent, a leader in the birth of subjects, closely rely on the a person, a power of departments is not enough, and

    only rely on the collective wisdom and strength, increase hospital disciplines and talents adjustment of the internal structure, promote unity and cooperation, pioneering and innovative team, in practice between the disciplines of complementary advantages, strong alliance, led by the whole subject to a higher goal, or to achieve the mutual cross-

    disciplinary integration, has introduced a new discipline for needs of the times, build strengths disciplinary group [3].

     Edge in certain disciplines that focus on a particular subject group is the development of specific objectives and tasks, by a number of similar categories of relevant disciplines or cross-disciplinary

    combination of discipline clusters, through mutual cross-cutting,

    penetration and joint, so that advantages and effectiveness of the original subjects to play a greater discipline groups. Advantage of high-

    tech knowledge, discipline group is a concentrated expression of the hospital is the main force of innovation in the hospital. Medical and

    scientific research resources through the establishment of a "joint, open, shared" scientific management system, integration of different disciplines to build a long, reflects the advantages of group collaboration, interdisciplinary joint research subject groups, can form a strong

    comprehensive strength, thus achieving the knowledge, technological innovation and the promotion of new knowledge should be.

     2.6 in case classification, based on a reasonable evaluation of medical quality

     Case classification theory as applied research, this study, four of the Second Military Medical University, Changhai Hospital, clinical centers and 24 clinical departments to assess, evaluate results and hospital medical work in a high degree of matching of the actual situation

    shows that the results can be directly on the hospital clinical departments of medical quality and reasonable quantitative assessment, so as to fair, objective and comprehensive assessment of clinical departments provide a new model of medical quality. As the Clinical Center with a specialty in the local technical advantages, can be difficult to attract a large number of critical cases surrounding areas. Ordinary cases, however, critical illness and the difficult technical methods at the clinic, health

    resource consumption to vary considerably, if it does not distinguish between its, it is difficult to reasonable implementation of quality control.

     Traditional assessment indicators such as cure rate, with an average length of stay, bed turnover rate and death rate among the different medical units of the lack of comparability, based on these indicators to evaluate the medical units often do not reflect the actual situation [4,5] . Case classification theory of management in patients with illness,

    will be hospitalized cases of scientific classification, to solve the current hospital management system, inadequate health care quality indicators, classification too thick, poor comparability issues. The clinical departments to prevent one-sided emphasis on "target-centric" to

    encourage more complex and critical cases admitted to the medical quality management has played a positive guidance role. At the same time conducive to bonus allocation, speak of smb awards, job promotions and personnel training, medical insurance claims and other measures for improvement.


     [1] Zhang Kan, Xutie Feng, Xia Qing World. Shanghai Clinical Center for Construction Research and Practice [J]. Medical information, 2004,8: 1


     [2] Lin Zhou, Zhu Min, Xu Ping, et al. The core competitiveness of the hospital assessment [J]. China Modern Hospital Management Journal, 2003,1

(1): 3.

     [3] Li Jing, Qiu Changrong, Cheng Chuan Miao, et al. Teaching Hospital edge interdisciplinary group of construction [J]. People's Liberation Army Hospital Management Journal, 2003,10 (3): 268 272.

     [4] tension, DONG Jun, HUANG Feng Jun, et al. Cases of classification in case of quality assessment [J]. China Hospital Management Journal, 2000,16 (7): 394.

     [5] Liu Yang, Jie Ning, Tan-Lin, et al. The use of case classification

    principle to determine the average length of stay standard values [J]. People's Liberation Army Hospital Management Journal, 2003,10 (3): 125. Reposted elsewhere in the paper for free download http: / /

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