On October 24, the National Health Commission launched the performance appraisal of secondary and ** public hospitals in 2023, and the results are also being announced one after another. According to reports, the General Office of the National Health Commission has issued a notice on December 11, announcing the results of the 2022 performance appraisal of maternal and child health care institutions.
This is since the General Office of the People's Republic of China issued the "Opinions on Strengthening the Performance Appraisal of Public Hospitals" in 2019, the performance appraisal of public hospitals has been carried out for five consecutive years, and the number of participating public hospitals has increased, which not only provides effective data support for the management decisions of hospitals and regions.
At the end of the first five years of the "National Examination", CDSREPORT summarized the recent training, conferences and other contents with the theme of "performance appraisal of public hospitals", and summarized the "examination" experience of some leading regions and hospitals.
It has become a trend that the results of the national examination are linked to the grade evaluation
In the past five years since the performance appraisal work was carried out, more and more second-class public hospitals have participated, and the ability of public hospitals to solve difficult and complex diseases has been steadily improved, medical service behaviors have become more standardized, and medical service models have been innovated and developed. In order to promote the development of performance appraisal, all localities have gradually linked it with various reward and punishment measures and resource allocation.
At the provincial and municipal levels, corresponding incentives have been introduced, both bonuses and in-kind rewards, such as rewarding the da Vinci surgical robot to hospitals with high rankings in the "national examination". At the hospital level, Peking University Third Hospital is an examplePerformance appraisal rewards are fixed according to the category of personnel to ensure that each on-the-job employee can benefit, and on this basis, personalized incentives are set according to the work content of specific departmentsFor example, the main medical and technical departments are assessed according to the basic workload + incremental workload, and the incremental part is rewarded in stages.
Beijing also takes performance appraisal as an important reference for resource allocation and the implementation of rewards and punishments, and sets up a "special fund for performance appraisal and rewards".According to the corresponding reward standards of the assessment level, it is used as an important basis for decision-making such as the total salary of the approved hospital and the establishment of major projectsAt the same time, it is also used as an important reference for team evaluation and cadre performance. It is understood that the Beijing Municipal Health Commission will also work with the Municipal Medical Insurance Bureau and the Municipal Food and Drug Administration to jointly study and formulate the performance appraisal and evaluation index system of "three medical linkages" public hospitals, and intends to evaluate and assess from seven aspects: hospital functional positioning, medical safety, medical quality, operational efficiency, sustainable development and innovation, service satisfaction, and comprehensive management of medical insurance, so as to realize the expansion and application of assessment results.
In addition, the link between performance appraisal and grade hospital review is also closer. A number of regions have linked the results of the "national examination" to the evaluation of hospital grades, and included the results of the "national examination" in the "one-vote veto" item. For example, the 2022 version of the ** hospital evaluation rules in Anhui Province makes it clear that hospitals that are included in the list of "canceling the qualification assessment" by the state cannot participate in the ** hospital review;Fujian Province will take the latest "national examination" score of grade B and above as a pre-requirement;The evaluation standards for Sichuan Provincial Grade Hospitals also refine the requirements for the results of the "National Examination": the latest performance appraisal of ** public hospitals must reach grade B or above, those applying for promotion to ** Class A need to enter the top 70% of the provincial examination rankings (ethnic autonomous areas enter the top 75%), and the latest provincial performance appraisal of hospitals applying for promotion to ** Class B needs to enter the top 80% of the provincial examination rankings (ethnic autonomous areas enter the top 85%).
At the performance appraisal training meeting held recently, relevant personnel from the health department of Zhejiang Province also revealedConsideration is being given to linking performance appraisal results to hospital grade evaluation, not only setting a threshold for national examination results for grade promotion, but also setting up an "exit mechanism", and hospitals that lag behind in the national examination will be downgraded.
Refine the assessment indicators and give full play to their role as a "baton".
Due to the different functional positioning of hospitals, it is not suitable to use unified assessment standards, and it is a common strategy for the head areas of the "national examination" to formulate a more perfect assessment and evaluation system according to local conditions.
In the process of formulating provincial performance appraisal indicators, Zhejiang Province has adjusted the requirements of comprehensive management indicatorsAccording to the functional positioning of the hospital, some indicators are allowed to be missing. For example, first-class hospitals do not strictly assess the number of outpatient and emergency visits per year, while first-class hospitals hope to admit more clinical patients, so they are allowed to lack indicators such as research strength, academic influence, and high-level talentsLevel 2 hospitals allow the absence of the activity index for day care services. In terms of index assessment, targets are also set for different levels of hospitalsTaking the indicator of "proportion of third- and fourth-level surgeries" as an example, **Class A hospitals require 20%, *Class B hospitals require 12%;In terms of "clinical pathway management", **Class A and **B hospitals are required to be no less than 50%, and Class II hospitals are required to be no less than 70%.
For hospitals, it is necessary to use the baton of performance appraisal well, aim at indicators, find out gaps, and gradually improve. At a recent performance appraisal training conference, the manager of West China Hospital of Sichuan University said that before the start of the "national examination", West China Hospital also faced problems such as low enthusiasm of doctors to admit difficult and critical patients and carry out difficult surgeries, and insufficient clinical innovation and transformation motivation of doctors. The response is to analyze and compare the indicators of the "national examination" and carry out regular evaluations, and at the same time guide the performance allocation of the hospital to favor the treatment of difficult and critical cases, the internal medicine department focuses on the case mix index (CMI), and the surgery department establishes a resource-based relative value system (RBRVS).
By comparing the "national examination" indicators, Subei People's Hospital found that there is a lot of room for improvement in the patient admission process, so the hospital has carried out measures to continuously optimize the patient admission process, implemented unified management of inpatient admission, and realized the "five concentrations" of admission services: centralized bed management, centralized admission handling, centralized admission evaluation, centralized examination appointment, and centralized blood sampling and testing. The hospital also adjusts the number of beds according to seasonal changes and the characteristics of the diseases admitted to the specialty through the operation service center, and dynamically allocates bed resources.
Strengthen data governance and carry out data quality control
In the process of performance appraisal, strictly standardize data collection, cleaning, quality control, analysis and other standards to ensure that performance appraisal is fair, just and objective.
In order to ensure the quality of the reported data,The provincial and municipal health administrative departments in Sichuan Province have set up data quality control expert groups, and regularly carried out full-coverage and sub-district training, and carried out special training on shortcomings, personalized guidance for C-level hospitals to upgrade, 24-hour Q&A and other measures to effectively ensure the quality of data filling and provide technical support for all participating hospitals.
Through the establishment of a provincial-level public hospital performance appraisal platform, Zhejiang Province carries out monthly data reporting and data quality control of hospitals, finds the reasons for the reported outliers or extreme values in a timely manner, returns to the hospital for modification, and organizes relevant quality control centers and experts to carry out guidance and training according to the problems found. In the 2021 performance appraisal of public hospitals, Zhejiang Province summarized and published various data quality issues on the first page of inpatient medical records, including data reporting problems, data filling problems, coding matching problems and other problems.
At the hospital level, problems with the quality of reported data can lead to large fluctuations in performance appraisal results, so regular self-inspection and quality control have become particularly important. In the hospital self-inspection stage, the hospital can standardize the index quality control process by clarifying the responsible subjectFor example, clinical departments can carry out data collection and quality control on a monthly, quarterly, semi-annual, and annual basisThe quality control department and other functional departments of the hospital are responsible for summarizing the source data of each department, conducting comprehensive analysis and data quality controlThe president in charge and the legal person held a phased data quality control report and analysis meeting, found problems, and adjusted the working methods in a timely manner.
In 2021, Yuhuan People's Hospital of Zhejiang Province, which ranked first in the list of second-level public hospitals in the country, has made great efforts in the analysis of indicator data. The hospital deeply integrates the performance appraisal and operation management of public hospitals with discipline development and DRG, and establishes a performance appraisal medical indicator monitoring databaseEvaluate and analyze indicator data on a monthly basis, propose corrective measures for disadvantaged indicators and follow up continuously.