社区医疗服务质量管理评价研究
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摘要
社区卫生服务是适应社会发展、深化卫生体制改革的新兴卫生服务模式。随着社区卫生服务工作的广泛开展,作为其核心的社区全科医疗服务在全国范围内已普遍开展,但其医疗质量管理存在着诸多问题,如规章制度较为滞后、医疗质量的衡量与评价缺少必要的标准、质量管理体系和评价体系亟待建立和完善等等。这或多或少阻碍了社区卫生服务的发展。本文综合运用质量管理理论、经济学相关理论、顾客满意理论、伦理学理论及行为科学理论等,结合我国社区医疗服务质量管理现状,采取理论分析与现场调查、定性分析与定量分析相结合的方法,在明确本论文研究的目的和意义并分析国内外研究现状的前提下,对社区医疗服务质量管理、评价及其指标体系展开了较为系统的研究。①界定了社区医疗服务质量的内涵,阐明了社区医疗服务质量的特性和内容。②在解析现代质量管理八项原则及社区医疗服务的公益、公平、效率和可及性原则的基础上,探讨了社区医疗服务质量管理体系的构建模式及特点,提出现阶段我国社区医疗卫生机构应采用“以过程为基础的社区医疗服务质量管理体系模式”。③系统研究了国外社区医疗服务质量管理方法及评价体系,提出了其中值得我们借鉴的经验。④探讨了社区医疗服务质量评价指标体系的界定、缺陷、选择与构建的理论与方法,通过现场调研及专家咨询活动对社区医疗服务质量评价指标体系进行了探索性研究,提出了适合我国现阶段社区医疗服务质量评价的指标体系。⑤在阐明社区医疗服务质量评价一般理论的基础上,研究了社区医疗服务质量综合评价方法和社区医疗服务顾客满意度评价方法,通过实例将SERVQUAL评价模型引入到社区医疗服务质量评价中。⑥对我国部分城市社区医疗卫生机构医疗服务质量管理现状进行了调查,研究了在社区医疗卫生机构医疗服务质量管理研究中使用定性和定量研究方法的适用性,通过对欧美的顾客满意度指数模型的研究,提出了我国社区医疗服务顾客满意度指数简化评价模型。⑦结合社区医疗服务质量管理基本原理及相关研究,提出了社区医疗卫生机构实现医疗服务质量改进的建议、对策和方法。⑧最后对本文的研究结论进行了总结,对未来相关问题的研究进行了展望。
Community health service is a new health service mode to fit social development and deepen the reform of health system. Along with the extensive development of community health services, the all-round medical services have generally been carried out throughout the country. Nevertheless, there are still many problems in the management of medical care quality. For instance, rules and regulations are stagnant. The measurement and evaluation of medical care quality lacks standardized critera. Quality management system and evaluation system are waiting to be established and improved. Such problems more or less hinder the development of community health services. In this paper, the quality management theory, principles of economics , customer satisfaction theory, theory of ethics and behavioral science are synthetically adopted. The paper makes systematic research on the community medical service quality management and evaluation on the basis of the present status of the quality management of China's community medical services. It takes the method of combining theoretical analysis with practical investigations, qualitative analysis with quantitative analysis, under the premise of understanding the research purpose and significance and reviewing the literature in this field at home and abroad. This paper defines the quality of community medical service and elaborates the characteristics and contents of it. Based on the eight principles of modern quality management and commonweal, equity, efficiency and accessibility of community medical services, the paper tries to establish a mode analyzing features of community medical service quality management system. It proposes that nowadays China's community health service organizations should adopt " the quality management system mode of community medical service taking the process as the base ". The paper studies the quality management method and the evaluation systems practised in foreign community medical care services and then puts forward the experiences which we can draw lessons from. It discusses the theories and methods in the definition, weaknesses, options and construction of the community medical care service quality evaluation system. It tentatively examines the evaluation indexes of the community medical care service quality through on-the-spot investigations and experts' consultation. It puts forward the evaluation index system of the community medical care service quality that is suitable for our country at the present stage. Based on the general theory used in the evaluation of community medical care service quality, the paper studies the comprehensive evaluation method of community medical care service quality and customer satisfaction evaluation methods. It introduces the so-called SERVQUAL evaluation model to evaluate the community medical care service quality through an actual example for the first time. THe paper investigates the status of medical service quality management in some urban community medical care agencies and studies the applicability of using of qualitative and quantitative research methods in the quality management of community medical care agencies. Through the review of customer satisfaction index model pratised in Europe and America, the paper puts forward the simplified evaluation model of customer satisfaction index for China's community medical care services. Combining the basic principles and related research on community medical service quality management, the paper puts forward some policy proposals, measures and methods for community health agencies to improve their service quality. Finally, it summarizes the research conclusions, and presents the outlook of the related problem in the future.
Community health service is a new health service mode to fit social development and deepen the reform of health system. Along with the extensive development of community health services, the all-round medical services have generally been carried out throughout the country. Nevertheless, there are still many problems in the management of medical care quality. For instance, rules and regulations are stagnant. The measurement and evaluation of medical care quality lacks standardized critera. Quality management system and evaluation system are waiting to be established and improved. Such problems more or less hinder the development of community health services. In this paper, the quality management theory, principles of economics , customer satisfaction theory, theory of ethics and behavioral science are synthetically adopted. The paper makes systematic research on the community medical service quality management and evaluation on the basis of the present status of the quality management of China's community medical services. It takes the method of combining theoretical analysis with practical investigations, qualitative analysis with quantitative analysis, under the premise of understanding the research purpose and significance and reviewing the literature in this field at home and abroad. This paper defines the quality of community medical service and elaborates the characteristics and contents of it. Based on the eight principles of modern quality management and commonweal, equity, efficiency and accessibility of community medical services, the paper tries to establish a mode analyzing features of community medical service quality management system. It proposes that nowadays China's community health service organizations should adopt " the quality management system mode of community medical service taking the process as the base ". The paper studies the quality management method and the evaluation systems practised in foreign community medical care services and then puts forward the experiences which we can draw lessons from. It discusses the theories and methods in the definition, weaknesses, options and construction of the community medical care service quality evaluation system. It tentatively examines the evaluation indexes of the community medical care service quality through on-the-spot investigations and experts' consultation. It puts forward the evaluation index system of the community medical care service quality that is suitable for our country at the present stage. Based on the general theory used in the evaluation of community medical care service quality, the paper studies the comprehensive evaluation method of community medical care service quality and customer satisfaction evaluation methods. It introduces the so-called SERVQUAL evaluation model to evaluate the community medical care service quality through an actual example for the first time. THe paper investigates the status of medical service quality management in some urban community medical care agencies and studies the applicability of using of qualitative and quantitative research methods in the quality management of community medical care agencies. Through the review of customer satisfaction index model pratised in Europe and America, the paper puts forward the simplified evaluation model of customer satisfaction index for China's community medical care services. Combining the basic principles and related research on community medical service quality management, the paper puts forward some policy proposals, measures and methods for community health agencies to improve their service quality. Finally, it summarizes the research conclusions, and presents the outlook of the related problem in the future.
引文
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