With the transformation of modern medical model and the change of medical demand, medical quality has involved many aspects such as work efficiency, cost control, service attitude and so on. , and has become a comprehensive embodiment of the quality of medical staff, technical service level, facilities and environmental conditions, medical expenses and management level. The quality management of modern hospitals is a quality management that breaks through the role of pure medical technology and biomedicine, and becomes an all-round quality management that organically combines commercial management, scientific management and medical business management, thus upgrading quality management to the hospital development strategy. Because the social and economic benefits of the hospital will ultimately be reflected by the quality of medical care, it is the primary task of the hospital to strengthen the management of medical quality and ensure and improve the quality of medical service.

1 Measures to strengthen medical quality management

1. 1 Establishing a quality management evaluation system is the basic way of medical quality management, and a set of scientific, standardized, rigorous and practical medical quality evaluation index system is directly related to the effect of medical quality management. This evaluation system should be a combination of personal quality control, departmental quality control, college quality control and total quality control, whole process control and key control, personal control and organizational control, intra-departmental control and inter-departmental control. Finally, the evaluation work should be carefully organized to ensure that the evaluation does not become a mere formality [1]. By using the management evaluation method with case as the quality unit, a case classification index model with selectivity, practicability, immediacy and operability is established, and the effect and process, quality and cost are organically combined to make a comprehensive and scientific evaluation. The implementation of the "comprehensive evaluation of clinicians" method includes eight contents, including medical ethics, work attitude, work quantity, work quality, professional ability and technical level. Each evaluated physician will eventually get a comprehensive score, which will be sorted in the same position within the department and the whole hospital, so that everyone can know their positions well.

1.2 Qualified managers are the key point of hospital quality management. Hospitals should have specialized medical technical management personnel and specialized administrative management personnel. Medical technology managers should grasp the development direction and level of medical technology in their hospitals; Administrative personnel should be responsible for the internal administration and logistics of the hospital and do a good job in security. Facing the new economic concepts and patterns such as market economy, knowledge economy and global economy, facing the fierce competition brought by China's entry into WTO, facing the reform of medical and health system, the construction of hospital cultural connotation, and facing the health needs of the people, special requirements are put forward in personnel policy, technology, cooperation, commerce and control, which are difficult for non-professional hospital managers in China. The quality of hospital administrators not only determines the quality level of hospitals, but also determines the life and death of hospitals and the success or failure of China's health reform and modernization process. Therefore, it is imperative to realize the professionalization of hospital administrators as soon as possible [2].

1.3 Optimizing medical service process is a means of hospital competition. Hospitals should adapt to market changes and make projects with high social demand bigger and stronger. Projects that have little social demand and are shrinking should be resolutely compressed and merged; According to the actual situation, carry out special specialties, special disease clinics or new technologies and projects to attract special patients, cultivate special new growth points and stimulate the vitality of hospitals. On the basis of not increasing wards and staff, the optimized medical service process determines the cost and competitiveness of the hospital, which greatly enhances the long-term viability of the hospital. To achieve this goal, the hospital must allocate available resources efficiently, find potential bottlenecks in time, reduce duplication and waste by balancing all components in the process, make the existing hardware and software of the hospital achieve greater utilization rate and better utilization level, give full play to the ability of professional and technical personnel as much as possible, meet the needs of patients, and achieve greater economic and social benefits [3]. At the same time, it is necessary to dynamically analyze and manage the medical service process, so as to make the medical service in a dynamic state, to adapt to the changing needs of the medical market, to increase the supply of medical services during peak hours without wasting, and to build an efficient, lean and dynamic new medical institution model.

1.4 A sound system and mechanism is the basis of medical quality management. At present, China has promulgated more than 20 health laws and regulations, including the Law on Medical Practitioners, Regulations on Management of Medical Institutions and Regulations on Handling Medical Accidents, and hundreds of health laws and regulations. These laws and regulations standardize the medical service behavior, strengthen the quality supervision of hospitals and protect the interests of patients. It is necessary to strictly implement the medical technical service standards, ensure the quality of medical services, embody the connotation of people-oriented and patient-centered, and make the quality of medical services meet the needs of patients to the greatest extent. Health legal means provide legal weapons for health legal system construction, medical quality management and fair competition environment for hospitals and professional and technical personnel. At the same time, it is necessary to strengthen the construction and improvement of the medical service supervision mechanism, establish the access and exit standards for medical institutions and professional and technical personnel, purify the ranks of medical institutions, and shape a good image of the health system [4].

1.5 Implementing comprehensive monitoring is the guarantee for strengthening medical quality management (1) All-staff monitoring: everyone is the receiver and implementer of monitoring, so that medical staff are always in serious self-control and conscious mutual control. (2) On-the-job monitoring: outpatient, clinical, medical technology and medical administration departments have clear quality indicators and specific monitoring measures. Make the work of all posts in the hospital run normally under strict monitoring. (3) Whole process monitoring: monitoring all quality standards, basic quality, link quality and terminal quality in inspection, treatment and nursing. (4) Whole process monitoring: 24-hour follow-up monitoring of medical quality and all-weather monitoring. There are no holidays for medical quality monitoring; No matter the superior inspection or after the inspection, the quality control work is not relaxed; There is no gap between the summary evaluation and the usual quality control work [5].

2 the development trend of medical quality management

2. 1 set up a CQI (continuous quality improvement) team to study the quality control methods focusing on the quality control of clinical diagnosis and treatment technology. Through the "clinical pathway" research, we have registered, counted, analyzed, compared and evaluated the technology and service items, medical effects and service satisfaction of several cases of the same disease from beginning to end, including treatment, prescription medication and surgery. The responsibility of medical quality management should not only be borne by managers, but also be widely participated by medical personnel, forming a quality control group (QC) that transcends discipline boundaries to carry out quality improvement research of special projects. This kind of mass research and improvement activities will be carried out simultaneously with clinical scientific research, continuously improve the quality of medical care, and at the same time promote the development of medical science and technology in a broader sense [6]. Hospital continuous quality improvement can include: evaluating the current situation, establishing improvement goals, discovering, evaluating and implementing solutions, measuring, evaluating and analyzing the results. It is reflected in the effective evaluation of hospital assessment indicators to ensure that the assessment indicators have continuous guiding significance for the improvement and improvement of hospital overall management.

2.2 Implement all-round and all-round medical quality management, including basic quality management such as clinical departments, medical technology departments and medical functional standards, "three basics" training and systematic holistic nursing; Strengthen the whole process quality control of three-level doctors' rounds, nursing rounds, surgery, first aid and other medical technologies and indoor quality control of medical technology majors, pay close attention to the quality management of single diseases, comprehensively evaluate efficiency, average hospitalization days and average hospitalization expenses, and promote and drive the quality of hospital work in all aspects. The organic combination of systematic holistic nursing and nursing quality management will further improve the nursing quality system. Quality control technology will be widely used in clinical pharmacy, medical examination, pathology, nutrition and anesthesia, and the quality system of each specialty will be improved. We should take patients as the center, in which the quality of medical technology is the internal quality, and excellent service is the external quality of medical service. If we only have the total quality control of medical technology and ignore the importance of medical service style and attitude, we can't achieve the purpose of running a hospital with patients as the center. Ensuring medical safety, preventing mistakes and accidents and reducing disputes are indispensable aspects of total quality management in hospitals. Hospital management must adhere to social benefits as the highest criterion, and put an end to one-sided pursuit of the hospital's own economic benefits while ignoring quality benefits and social benefits, otherwise the quality of medical services will inevitably decline in an all-round way. Controlling medical expenses means reducing medical consumption and medical expenses on the premise of ensuring the quality of medical services, and providing patients with quality services with less medical expenses [7, 8].

2.3 Strengthen personnel training and continuing medical education, unremittingly pay special attention to personnel training, academic education, on-the-job education and pre-job training, and improve the quality of all staff. According to the needs of various professions, personnel with intermediate titles or above are sent to major hospitals at home and abroad for further study, enriching and absorbing advanced technology, and supporting them to apply what they have learned and engage in medical work. Strengthen basic training, give regular theoretical lectures, and popularize the knowledge of critical illness rescue; Adhere to the principle of self-study and stimulate the initiative of medical staff to learn; Invite domestic and foreign experts to give academic lectures to promote two-way communication. The assessment team will be organized in stages, and the theoretical assessment and skill operation assessment will be conducted after the lecture. The results will be linked to the year-end comprehensive medical level assessment, so that the subject knowledge of medical staff will be gradually systematized, institutionalized and standardized [9].

2.4 Strengthen graded supervision of medical quality. Health authorities at all levels should actively create conditions, increase the intensity and frequency of medical quality supervision as soon as possible, urge hospitals to strengthen quality management, and gradually form a quality and benefit-oriented hospital development model. Hospitals with obvious problems in medical quality or quality management should be informed criticism and rectified within a time limit; Hospitals with poor rectification and serious medical quality problems or quality management problems should be dealt with seriously in accordance with the Regulations on the Administration of Medical Institutions and earnestly perform their duties of medical quality supervision and management. The quality control measures specified in the detailed rules for quality management shall be solved openly step by step, with responsibility to the people, timely and fair, and strict rewards and punishments. Depending on the medical quality, the parties concerned shall be rewarded and punished in conjunction with relevant leaders. Reward employees and leaders with superior medical quality; For the department with poor quality, while criticizing and punishing the parties, the main leaders of the department will be punished twice.

2.5 Strengthening social supervision and restriction of hospital quality management With the development of market economy and social progress, the state will establish a social supervision and restriction mechanism for the quality of industrial products and services, and medical services are no exception. This kind of supervision and restriction will gradually develop from soft restriction (mass supervision and news media supervision) to hard restriction (legal and economic restriction), thus making this social restriction level have the nature of mass, legitimacy and economic compensation [10].