【文章內(nèi)容簡(jiǎn)介】 ），該模式將遠(yuǎn)期設(shè)備和服務(wù)選擇，中層決策支持以及考慮了結(jié)構(gòu)約束后的社區(qū)醫(yī)院績(jī)效聯(lián)系起來(lái)。該研究在使人們對(duì)戰(zhàn)略操作管理決策有了更進(jìn)一步理解的同時(shí)，確定了在操作決策過(guò)程中的一些因果關(guān)系及在醫(yī)院績(jī)效方面的作用。該研究還找出了在變化著的醫(yī)療服務(wù)環(huán)境中有助于提高社區(qū)醫(yī)院績(jī)效的關(guān)鍵戰(zhàn)略決策。其中，“平衡計(jì)分卡”作為績(jī)效管理的一種最新、最有效的管理模式，吸引了眾多的學(xué)者和管理實(shí)踐者。Study on measuring performance of a health care organization is still on the way and study on performance measuring criterion is made in a view that there is no standard system to measure performance adopted by a health care organization. Review of the literature on performance in a medical body indicates that a study (1) made in University of Ohio has advanced a general framework to measure performance of a health service body. The performance measurement in this framework consists of internal evaluation and external evaluation, each having two evaluation dimensions, namely performance in cost/finance and that in quality。 according to the study on performance measuring system, any single measuring system in neither finance nor operation can enable managers to successfully control performance in a plicated market falling in the acute petition. Therefore, multiindex starts service gradually to measure performance: some are “hard index”, including various kinds of financial and nonfinancial measures and some are “soft index”, including quality, attitude and the similar criteria. The existing literature shows that, besides application of information developed or provided by the system, the heated study on performance measuring system includes study of action and effect of performance measuring system on an organization and study on performance management mode. In Britain, the new performance management mode always includes nonfinancial measures, which represents a trend of performance management oriented by strategy. Under the “Tableau de Bord” performance management mode in French panies, strategy is divided into financial index and nonfinancial index, which acts as a popular practice (2). A study on munity hospital conducted in USA is related to development of a strategic operation amp。 management mode（3）, which gets connected longterm equipment and service choice, middlelevel decision support and munity hospital performance which has taken structural confinement into consideration. While helping further understand decision over strategic operation management, the abovementioned study determines some causeeffect relations and their action on hospital performance in the course of decision on operation. Furthermore, this study also finds out a key strategic decision helping improve performance of munity hospital in the changing environment of medical service. Among them, the “balance score card” is the latest and most effective mode for performance management, which is attracting a number of scholars and management workers. 對(duì)于醫(yī)院績(jī)效評(píng)價(jià)研究，國(guó)外醫(yī)院績(jī)效評(píng)價(jià)研究也包括三個(gè)層面。一個(gè)是以醫(yī)院為對(duì)象進(jìn)行績(jī)效評(píng)價(jià)：一個(gè)是對(duì)中層管理人員進(jìn)行工作能力評(píng)價(jià)；最后就是員工的績(jī)效評(píng)價(jià)。Robin S、Turpin利用PAJ模式對(duì)醫(yī)院績(jī)效指標(biāo)設(shè)置合理性進(jìn)行了評(píng)估（4）；全面質(zhì)量管理(TQM)則對(duì)醫(yī)院績(jī)效改進(jìn)進(jìn)行了研究（5）。另有一些對(duì)中層管理人員工作和能力評(píng)價(jià)的研究，并嘗試開(kāi)發(fā)了綜合性的能力與工作評(píng)價(jià)工具（6），而員工評(píng)價(jià)目前比較盛行的是同級(jí)評(píng)價(jià) （7）。但從整體看，對(duì)個(gè)人的評(píng)價(jià)多為針對(duì)醫(yī)師類(lèi)的，較為單一，對(duì)醫(yī)院內(nèi)多種成員組成的現(xiàn)狀考慮不足。Study on hospital performance appraisal abroad also consists of three levels: one is performance appraisal on hospital as a whole, one is ability appraisal on middlelevel managers, and the other is performance appraisal on employees. Robin S. Turpin has employed the PAJ mode to appraise reasonability of hospital performance index（4）and Total Quality Management (TQM) to study improvement of hospital performance（5）. Meanwhile, he has also studied performance and ability of middlelevel managers and developed an overall tool to appraise ability and performance（6）. For employee appraisal, however, peer appraisal is rather popular at the present（7）. On a whole basis, appraisal on individuals is mostly adopted by targeting physicians, which, however, takes into inadequate consideration a hospital’s position of members in variety. 而在我國(guó)，經(jīng)濟(jì)領(lǐng)域基本上完成了由計(jì)劃經(jīng)濟(jì)向市場(chǎng)經(jīng)濟(jì)的轉(zhuǎn)化，但社會(huì)事業(yè)領(lǐng)域改革相對(duì)滯后，現(xiàn)有的醫(yī)療衛(wèi)生體制是在計(jì)劃經(jīng)濟(jì)理論下建立的。作為一種科學(xué)的管理體系，績(jī)效管理正在受到國(guó)內(nèi)各級(jí)醫(yī)院管理者的重視，大多也是從醫(yī)院、科室及科室管理者、員工個(gè)人三個(gè)層面來(lái)進(jìn)行探討。根據(jù)中文科技期刊數(shù)據(jù)庫(kù)檢索，自1989年2008年2月，涉及醫(yī)院績(jī)效的相關(guān)文章共有567篇，有關(guān)“績(jī)效考核”的文章共有129篇，符合“績(jī)效管理”檢索主題詞要求的文章有122篇，而建立績(jī)效考核評(píng)價(jià)體系的文章僅26篇。早在1993年西安第四軍醫(yī)大學(xué)胡琳、于爽等制訂了“醫(yī)院綜合效益評(píng)價(jià)體系”，指標(biāo)按投入、產(chǎn)出分成兩大類(lèi)，包括人員、設(shè)備、物資、經(jīng)費(fèi)、社會(huì)效益和經(jīng)濟(jì)效益6個(gè)方面（8）；1994年浙江省舟山市衛(wèi)生局莊漢國(guó)（9）對(duì)綜合性醫(yī)院的社會(huì)、經(jīng)濟(jì)效益指標(biāo)體系的設(shè)置及評(píng)價(jià)方法等問(wèn)題作了探討，篩選出基本指標(biāo)25項(xiàng)，作為評(píng)價(jià)指標(biāo)體系。近年來(lái)隨著管理理論的深化和管理模式的探索，2001年，解放軍空軍總醫(yī)院陳明敏等提出了粗放型的醫(yī)療質(zhì)量評(píng)價(jià)管理模式，主要指標(biāo)為床日門(mén)診指數(shù)、床位利用指數(shù)、CD型率(總病例中復(fù)雜疑難危重病例所占比例)、人均醫(yī)療費(fèi)、病員滿意度等 （10）；2001年，上海第二軍醫(yī)大學(xué)高岱峰、張鷺鷺等采用加權(quán)百分位次累加法建立評(píng)價(jià)模型，構(gòu)建了“醫(yī)院綜合競(jìng)爭(zhēng)力評(píng)價(jià)體系”，指標(biāo)體系分競(jìng)爭(zhēng)力資產(chǎn)、競(jìng)爭(zhēng)力過(guò)程、競(jìng)爭(zhēng)力環(huán)境3個(gè)方面；2002年，復(fù)旦大學(xué)胡善聯(lián)、李國(guó)紅等利用現(xiàn)場(chǎng)調(diào)查法和專家咨詢法，從業(yè)務(wù)水平、經(jīng)營(yíng)狀況和病人滿意度方面選出32個(gè)指標(biāo)，建立醫(yī)院績(jī)效評(píng)價(jià)指標(biāo)體系，并提出星級(jí)醫(yī)院評(píng)審的思想（11）。2005年《醫(yī)院管理評(píng)估指南》中將社會(huì)效益、工作效率、經(jīng)濟(jì)運(yùn)行狀況三個(gè)方面作為醫(yī)院績(jī)效評(píng)價(jià)的主要內(nèi)容（12）。眾多文章都是從不同的角度對(duì)醫(yī)院績(jī)效進(jìn)行評(píng)價(jià)，建立醫(yī)院績(jī)效評(píng)價(jià)指標(biāo)體系時(shí)均有自己的側(cè)重點(diǎn)，而且在實(shí)際工作中也的確起到了促進(jìn)醫(yī)院持續(xù)穩(wěn)定發(fā)展、提高醫(yī)院核心競(jìng)爭(zhēng)力的作用。醫(yī)院績(jī)效評(píng)價(jià)體系是一個(gè)復(fù)雜的評(píng)價(jià)系統(tǒng)，目前國(guó)內(nèi)采用的指標(biāo)大多從業(yè)務(wù)、財(cái)務(wù)等方面分類(lèi)考核，而專家咨詢法是篩選指標(biāo)的方法。盡管企業(yè)領(lǐng)域績(jī)效管理的方法已發(fā)展得比較成熟，但在國(guó)內(nèi)醫(yī)療衛(wèi)生領(lǐng)域中比較通用和權(quán)威的績(jī)效考核指標(biāo)還有待更深入的探索。而對(duì)于科室與個(gè)人的考核也有多篇研究報(bào)告。國(guó)內(nèi)醫(yī)院在臨床科主任的績(jī)效評(píng)價(jià)方面也有部分嘗試，國(guó)內(nèi)較具有代表性的有以下幾種評(píng)價(jià)方法：將平衡記分卡應(yīng)用于績(jī)效評(píng)價(jià)；使用360度績(jī)效考核法考核臨床科主任；應(yīng)用關(guān)鍵績(jī)效指標(biāo)（KPI）的考核指標(biāo)體系；運(yùn)用目標(biāo)管理的方法建立績(jī)效評(píng)估體系。In China, transition has been pleted from planning economy to market economy, but reform on social institutions is still relatively lagging behind, where the current health care system was born under the planning economy. As a reasonable system, performance management is having much attention from hospital managers on different levels in China, which is mostly discussed in three layers, . hospital, faculty and its managers, and individual employees. My searching the database of technological periodicals written in Chinese indicates that there are 567 papers on hospital performance published from 1989 to February 2008, 129 relating to “performance assessment”, 122 satisfying the key word of search for hospital performance and only 26 papers on establishment of performance assessment and appraisal system. As early as 1993, Hu Lin, Yu Shuang and etc. with Fourth Military Medical University based in Xi’an built a “hospital prehensive benefit appraisal system”, whose index is divided into two groups as per input and output, including 6 aspects: personnel, equ