Courtesy of Visual China.
China Youth Daily, China Youth Network Intern Reporter Wang Xueer Reporter Hu Zhizhong.
On January 16, at dusk, Shen Li, director of the outpatient department of Shanxi Provincial People's Hospital, found that many outpatient doctors had not yet left work and were still seeing patients.
In the past few days, many hospitals in Shanxi have successively implemented the "No. 1 tube for three days" treatment mode, and patients only register once in principle for the entire outpatient medical treatment link from **, medical treatment, inspection and examination to taking medicine. If the patient cannot complete the diagnosis and treatment on the same day due to auxiliary examinations, with the authorization of the initial doctor, when the patient returns with the results of the examination, in principle, the same hospital, the same department, and the same disease will not be paid for the second ** within 3 days (including the day of medical treatment). This is a practical measure to improve the medical environment and enhance the medical experience of the masses.
Many middle-aged and elderly patients with chronic diseases said that this new policy not only saves them money, but also urges them to review the examination report in time and get the first symptoms early.
At the same time as the convenience of patients, the workload of doctors has increased, and the implementation of a service policy that benefits the people is also a test of the hospital's management ability.
How to optimize the internal management of the hospital and make the new policy acceptable to medical staff? While protecting the rights and interests of medical care, how can the people truly enjoy the dividends of the new deal? Shanxi Provincial People's Hospital has made a "great effort".
Shanxi Provincial People's Hospital Cardiology Outpatient Consultation Area Reminder Board, indicating the order of the patient's follow-up number. Photo by Wang Xueer, trainee reporter of China Youth Daily and China Youth Network.
n 1 "Give autonomy to doctors.
In front of the cardiology clinic of Shanxi Provincial People's Hospital, there is a reminder that reads, "If you are reviewing the report within three days, in principle, the order of treatment will be 'n 1' mode." n is decided by the attending physician on the same day, some doctors choose to see a follow-up patient every 5 first-time patients, and some doctors choose to see a follow-up patient after seeing all the first-time patients.
Giving doctors autonomy is a transitional approach at the beginning of the new policy, Shen Li explained, adding that at present, follow-up numbers do not occupy the number plate of the original number pool. Taking cardiology as an example, there are 40 patients who need to review the report every day, and the revisit rate on Monday can reach 44, half of them can be reviewed on the same day, and half of them can be revisited within 72 hours. According to the rough statistics, on the day of the reporter's visit, there were about more than 40 follow-up patients who were "three days in the No. 1 tube" came to look back at the examination report.
According to a data from Shanxi Provincial People's Hospital, from November 20 to December 4, 2023, a total of 16,529 people have benefited from the "One Number Tube for Three Days" policy, and a cumulative fee reduction of 348965 yuan has been reduced. According to estimates by medical staff, the monthly average data in January this year has only increased.
It is equivalent to adding some workload to the original on the basis of doctors, but the follow-up number is not included in the performance evaluation of doctors for the time being, and doctors are still 'voluntary labor'. Shen Li said.
In order to allow doctors to plan their working hours rationally and gradually accept the new policy conceptually, the hospital decided to give doctors enough autonomy to decide on the order of returning patients.
But for patients, having their doctor decide the order of their follow-up appointments means that the timing of their visits is uncertain. Ms. Zhang, a citizen of Taiyuan, had such concerns when she accompanied her father for a follow-up, she told reporters, "The follow-up number needs to be hung on the spot, but whether it can be hung up and when it can be seen need to be determined at the scene."
But after reporting to the outpatient clinic, Ms. Zhang's concerns were dispelled. On the screen, returning patients can also see their own ranking in real time after check-in, and can have a rough estimate of the time of visit. Shen Li introduced that some follow-up patients can fill the number vacancy of the first-time patients who did not come, and in addition, "the doctors are very cooperative, as long as there are follow-up patients who come to report, they will basically not refuse to be treated."
The implementation of "n 1" is not only to give doctors an initial transition, but also a process of collecting data, identifying problems in practice, and solving problems. Shen Li said that in the future, the hospital will issue a scientific and unified management policy for the "No. 1 tube for three days", including planning the performance of doctors and launching the first-class system. "Only when doctors are fully allowed to try practice in the early stage can the most appropriate management plan be deduced in the later stage. ”
The outpatient department of Shanxi Provincial People's Hospital collects the implementation opinions of various departments and collects them into a book. Photo by Wang Xueer, trainee reporter of China Youth Daily and China Youth Network.
During the transition period, "one subject and one policy" will be implemented
In addition to giving doctors autonomy, departments can also have maximum freedom to choose the follow-up mode that suits them during the transition period.
Shen Li has a folder in her hand, which collects the opinions of the "No. 1 tube for three days" treatment mode signed and selected by 48 department directors of the outpatient department.
At first, the outpatient department gave the department directors three choices: one is "one person to the end", the first doctor uses the fragmented time to go to the outpatient clinic to review the report for free, and the patient is informed of the time and place of the report in person during the first consultation. In practice, after the patient arrives at the outpatient clinic, the triage medical staff contacts the first doctor and comes to the outpatient department to review the report. The second is the "medical team management", and the doctor who often goes out of the outpatient clinic is responsible for the report review. The third is "professional co-management", where team members of the department help each other and appoint the visiting doctor or medical team to review the report for free on the same day.
In addition to these three plans, departments can also put forward other personalized options, and some departments write "online follow-up" or set up "special person" follow-up on the consultation form.
It is understood that patients can ask doctors to review the report through the online app of Shanxi Provincial People's Hospital for follow-up, and doctors can query the examination report from the hospital system and communicate with patients in a targeted manner.
After preliminary consultation, Shanxi Provincial People's Hospital has brought together 5 specific plans: there are 208 of the departments choose "one person to manage the end", 146 of the departments selected "medical team" tube, 542 departments choose "professional co-management", and the rest of the departments choose "online management" or "special management".
Shen Li said that each department has its own professional characteristics and personnel structure characteristics, and in the face of the new policy of "one number for three days", the difficulty of operation is also different. Shen Li said that taking neurology and cardiology as examples, the daily outpatient volume of the first diagnosis is very large, "when there is no 'No. 1 tube for three days', I can't get off work at noon, and the doctor has to see 1 o'clock in the afternoon, and now I have to add so many follow-up numbers, and there are too many uncontrollable factors."
"One department, one policy" is to fully respect the wishes of all departments during the transition period, better implement policies, and make the people feel the dividends. Shen Li explained, "Let's do this first, fully try out various methods in the first two or three months, and then coordinate with us on any problems that arise in the process, and finally the whole court adopts a method of subordination of the minority to the majority."
In order to solve the difficulties and pain points of policy implementation, "consultation and prescription".
Since the implementation of the "No. 1 management for three days" policy, the Shanxi Provincial Health Commission has organized many work publicity and implementation meetings, invited hospitals at all levels to participate in the meeting, introduced the work progress of the pilot hospitals, collected relevant issues, and reached a consensus.
It is reported that the Shanxi Provincial Health Commission issued the "Shanxi Province "One Time Management for Three Days" Medical Mode Implementation Plan (hereinafter referred to as the "Plan") to launch the province's first batch of "one time for three days" medical treatment mode pilot list, including Datong, Xinzhou, Shuozhou, Luliang, Yangquan, Changzhi, Jincheng, Yuncheng 8 cities, as well as Shanxi Provincial People's Hospital, Shanxi Bethune Hospital, Shanxi Medical University First Hospital, Shanxi Medical University Second Hospital 4 hospitals. At the same time, it is proposed that by the end of 2024, it will cover the province's secondary and above public general hospitals.
After the meeting, other hospitals will also ask about more specific practices, including performance algorithms for doctors' workload. Shen Li said that hospitals in various cities are facing similar problems, and discussing with each other can promote the implementation of practical experience.
Some netizens said that the hospital has increased the speed of optimizing the inspection, and the results of the day will come out on the same day, so there may be no need for "three days of the No. 1 tube". Shen Li said that in recent years, hospitals have accelerated the feedback of inspection results, and "the waiting time must be shortened", so that the convenience policy is meaningful. At present, Shanxi Provincial People's Hospital CT and B ultrasound results can be produced on the same day, and the completion rate of MRI on the same day has been nearly 90.
According to reports, the People's Hospital of Jinxiang County, Jining, Shandong Province has implemented the initiative of "three days at a time" since last year. By improving the relevant functions of the information system, the hospital has opened relevant permissions to each triage desk and post, and assisted in triage and clinic, so that the first and follow-up patients can achieve orderly treatment, thus effectively coordinating the sequence balance between the source of the first diagnosis number and the source of the follow-up number.
Shen Li said that after the outpatient department straightens out the process and establishes a unified system, it can further promote information management and realize the "Internet" of the follow-up number.
The "No. 1 Tube for Three Days" policy has brought tangible benefits to the people, but it has also encountered new problems when it is implemented. Shen Li said that at present, for hospitals, how to achieve closed-loop management of medical records, "how to divide responsibilities in the event of a dispute between multiple doctors is a problem found in practice and needs to be improved in the future."
According to reports, the Shanxi Provincial Health Commission invited hospitals in Shandong Province that have implemented the "No. 1 Tube for Three Days" to communicate with the pilot hospitals in Shanxi Province and seek practical experience from other provinces. Similarly, hospitals from the Inner Mongolia Autonomous Region have come to Shanxi Provincial People's Hospital for exchange and study.
*: China Youth Daily.