基于医院发展战略护理绩效管理系统的建立

摘要

Objective To explore a multi-dimensional nursing post performance management system based on hospital development as the objective and workload account as the foundation. Methods A total of 1 321 nursing staff in the nursing post of Changzhou Second People's Hospital Affiliated to Nanjing Medical University was selected as the study object, to observe the effect of the nursing performance appraisal team formally established in our hospital since November 2015 on nursing performane, the nursing department, the management office, etc departments jointly developed the nursing performance allocation principle, program and allocation method, the hospital resource planning (HRP) system, hospital information system (HIS) and self-made questionnaire were used to collect data, and the changes of various indexes before implementation of performance reform (from December 2014 to November 2015) and after implementation of performance reform (from December 2015 to November 2016) were compared and analyzed; the indexes were as follows: average monthly business income, average monthly nursing income, annual clinical non-receivable consumables expenditure, nursing human resources flexible allocation rate, nurses' degree of satisfaction with performance (remuneration and paying score, performance assessment system score) and qualified rate of nursing care quality. Results After the implementation of performance reform, average monthly business income, the average monthly nursing income, nursing human resources flexible allocation rate, compensation, paying scores and performance appraisal system scores were significantly higher than those before the implementation of performance reform [average monthly business income (ten thousand yuan): 13 653.24±1 309.49 vs. 11 869.26±991.16, average monthly nursing income (ten thousand yuan): 264.2 (252.1, 269.7) vs. 88.5 (80.8, 95.2), the ratio of nursing human resources flexible allocation rate: (1.74±0.52)% vs. (0.43±0.23)%, compensation and payment score: 4.76 (4.62, 4.85) vs. 3.47 (3.12, 3.60), performance appraisal system score: 4.88 (4.78, 4.95) vs. 2.80 (2.70, 3.14)], the difference was statistically significant (all P < 0.05), the annual clinical non-receivable consumables expenditure was decreased significantly compared with those before implementation performance reform (million yuan: 1.88±0.21 vs. 2.62±0.14, P < 0.05), and the qualified rate of nursing quality after performance appraisal were significantly improved compared with those before performance appraisal [nursing grading: (97.83±1.90)% vs. (91.11±1.61)%, ward management: (96.64±2.90)% vs. (90.06±2.40)%, nursing writing: (97.30±2.51)% vs. (91.33±1.96)%, nursing safety: (97.40±2.67)% vs. (90.13±1.96)%, first aid items: (97.44±2.64)% vs. (92.27±2.56)%, perioperative period: (96.86±2.50)% vs. (90.83±3.06)%, blood transfusion quality: (97.51±2.21)% vs. (92.13±2.37)%, disinfection and isolation: (97.43±2.70) % vs. (88.50±2.57)%, basic operation: (93.48±2.22)% vs. (87.51±2.03)%, practical ability: (93.38±1.97)% vs. (85.85±2.58)%, all P < 0.05]. Conclusion The establishment and application of the new performance management system mobilizes the enthusiasm of the department to actively control costs and decrease the expenditure of non-chargeable consumables, the nursing management staff can more flexibly arrange human resources and exert the management potential of middle-level cadres, and the nurses' degree of satisfaction and the nursing quality are significantly higher than those before nursing performance reform.%目的 探索以医院发展为目标、以工作量核算为基础的多维度护理岗位绩效管理系统.方法 以南京医科大学附属常州市第二人民医院护理岗位1 321名护理人员为研究对象,观察本院自2015年11月正式成立护理绩效考核小组后对医院护理绩效的影响.新绩效考核系统由护理部与经管办等科室共同制定护理绩效分配原则、方案及分配方法,采用医院资源规划(HRP)系统、医院信息系统(HIS)、自制调查问卷等方法收集资料,比较实施绩效改革前(2014年12月至2015年11月)和实施绩效改革后(2015年12月至2016年11月)平均每月业务收入、平均每月护理收入、年临床不可收费耗材支出、护理人力资源弹性调配率、护士对绩效满意度(报酬与付出评分、绩效考核制度评分)、护理质量合格率的差异.结果 实施绩效改革后平均每月业务收入、平均每月护理收入、护理人力资源弹性调配率、报酬与付出评分和绩效考核制度评分均较实施绩效改革前明显增长〔平均每月业务收入(万元):13 653.24±1 309.49比11 869.26±991.16,平均每月护理收入(万元):264.2(252.1,269.7)比88.5(80.8,95.2),护理人力资源弹性调配率:(1.74±0.52)%比(0.43±0.23)%,报酬与付出评分(分):4.76(4.62,4.85)比3.47(3.12,3.60),绩效考核制度评分(分):4.88(4.78, 4.95)比2.80(2.70,3.14)〕,差异均有统计学意义(均P＜0.05),年临床不可收费耗材支出较实施绩效改革前明显下降(百万元:1.88±0.21比2.62±0.14,P＜0.05);实施绩效考核改革后护理质量合格率较改革前明显提高〔分级护理:(97.83±1.90)%比(91.11±1.61)%,病房管理:(96.64±2.90)%比(90.06±2.40)%,护理书写:(97.30±2.51)%比(91.33±1.96)%,护理安全:(97.40±2.67)%比(90.13±1.96)%,急救物品:(97.44±2.64)%比(92.27±2.56)%,围 手 术 期:(96.86±2.50)% 比(90.83±3.06)%,输 血 质 量:(97.51±2.21)% 比(92.13±2.37)%,消毒隔离:(97.43±2.70)%比(88.50±2.57)%,基础操作:(93.48±2.22)%比(87.51±2.03)%,实践能力:(93.38±1.97)%比(85.85±2.58)%,均P＜0.05〕.结论 新绩效管理系统的建立和应用调动了科室主动控制成本的积极性,不可收费耗材支出下降,护理管理人员更能弹性安排人力资源,发挥了中层干部管理潜能,护士满意度、护理质量较改革前显著提高.