Under the correct guidance of hospital leaders at all levels, with the strong support and cooperation of various functional departments and clinical departments in the hospital area, the work plan of orthopedics/KLOC-0 was launched in an all-round way in 20xx, focusing on "special rectification of antibacterial drugs", "controlling unreasonable growth of medical expenses" and shortening hospitalization time, constantly emancipating the mind, updating concepts and strictly managing, and focusing on the comprehensive management goal in 20xx, in order to improve the hospital management system and strengthen medical quality management. To prevent medical safety, improve their professional level, do a good job in continuing medical education, improve comprehensive management indicators, and make our medical work to a new level, the following work plan is formulated in 20xx:
First, resolutely implement hospital rules and regulations, clarify management responsibilities, and ensure the effective implementation of various work systems.
1, according to the current working mode of the department, continue to improve the working system, workflow, post responsibilities and performance appraisal standards of personnel at all levels of the department, and earnestly implement them. The three-level rotation management system of director-attending physician-resident is implemented in the department, which ensures the accurate implementation of hospital systems, responsibilities and processes, improves medical quality, keeps close doctor-patient relationship and ensures medical safety.
2, according to the requirements of the hospital, earnestly implement the specific content of total target management, implement the target management responsibility system, strict management, strict implementation, strengthen process management and link control, and successfully complete all work indicators.
Second, strengthen self-study, strengthen self-management ability, improve medical quality and ensure the smooth development of departments.
1, under the leadership and guidance of Director Chen Jinghui, along the 20xx-year learning mode reform, once a week, continue to do a good job in business learning. Attending doctors and residents in the department take turns to sit in the clinic, and the director and deputy director give detailed guidance, and discuss the difficult cases in the department, master the condition, make the operation plan and discuss the operation process.
2. In line with the service concept of "patient-centered, improving the quality of medical service", treat patients well, correct their work style, carefully accept patients, treat patients patiently, explain, comfort, understand, warm and help patients more, improve the service quality of departments, close the relationship between doctors and patients and promote the improvement of medical quality.
3, the department set up a quality control team, establish a feasible quality control scheme and regular effect evaluation system, so that the department's three-level ward round, consultation, discussion of difficult cases and other work are implemented, so that the medical quality is fully guaranteed.
4. Educate medical staff to clarify the significance of post responsibility system, improve various rules and regulations of departments, and check the implementation of medical conditions and post responsibility system from time to time. Combined with the problems existing in the work, we should constantly improve and deal with them, establish preventive measures for medical defects, implement the accountability system for medical defects, and educate medical personnel to put medical safety first.
5, strengthen the management of medical documents, make medical documents standardized, standardized and detailed. Regular spot checks, lack of timely feedback in the morning meeting, timeliness, accuracy and timeliness under the development of electronic medical records, to ensure the integrity of medical records.
Three, strengthen their own learning, improve the professional level, do a good job in continuing education.
1. With the deepening of an aging society, osteoporosis has gradually become one of the important goals that plague the quality of life of the elderly population. Continue to do a good job in the treatment of osteoporosis and osteopathy, establish follow-up files, and collect scientific research data.
2. In order to improve the medical quality, it is planned to continue to send 1 ~ 2 key personnel from various departments to well-known hospitals such as Zhengzhou and Nanchang for further study, focusing on acupuncture, rehabilitation and massage.
3. According to the structural level of the existing personnel in the department, conduct hierarchical training. Residents should combine their posts, cultivate professional technical knowledge and skills, master professional technology and participate in scientific research projects, which can solve more complicated and difficult diseases; Attending doctors should closely combine their own specialties, consciously and strictly supplement and increase their professional skills with new theories, technologies and methods through self-study, full-time study and hospital training; Deputy directors and chief physicians should strictly control the quality, guide the all-round development of junior technicians, and strive to improve the professional quality of professional teams.
4. Pay attention to scientific research training, increase scientific research strength, instill scientific research consciousness, continue to do a good job in the declaration of scientific research projects and the writing of papers, so that orthopedics can walk in the forefront of hospitals and win honors for departments and individuals.
Fourth, strict teaching management.
1. Composition of teaching staff: in 20xx, with the strong support of hospital leaders, there are currently 8 departmental physicians in our department, including deputy chief physician 1 person, attending physician 1 person and 3 residents.
2, combined with the composition and title of the department team, set up a teaching team and always teach, the director personally checks, and completes the teaching task with a serious and responsible attitude.
Five, set an example, do a good job in medical safety management.
1. Carry out medical safety education and study on relevant laws and regulations for general medical staff, standardize medical behavior according to law, strictly implement personnel access and technical access, and hold lectures, trainings and examinations on the prevention and treatment of medical disputes on a regular basis.
2. Strengthen medical safety prevention, start with controlling medical defects, strictly implement the system of medical disputes, medical accident handling and accountability, sum up experience from medical accidents and disputes in other hospitals, and make continuous progress.
3, from the control of medical defects, strengthen the difficult, iatrogenic injury, special, critical, serious complications, patients with potential disputes at any time to report to the director.
4. Hold regular medical safety meetings of this department, report the hidden dangers of this department, sum up experience, and put an end to medical disputes and accidents.
Sixth, work ideas.
1, to carry out minimally invasive treatment and research of spine.
2. Establish an orthopedic rehabilitation center and train orthopedic professional rehabilitation trainers.
3. Continue to send key personnel to well-known hospitals such as Zhengzhou and Nanchang for further study;
4. Explore effective methods of osteoporosis treatment, do a good job in comprehensive management, innovate osteoporosis movement, do a good job in diagnosis, treatment and follow-up of patients, and lay a foundation for scientific research;
5. Create a painless ward, realize painless management and create a good atmosphere for medical treatment.
In the hard work, we have gone through 20xx years, and in the spirit of "patient-centered", we have sent light to patients and brought the gospel of life. At the same time, 20xx is more joy for all medical staff in orthopedics. While ensuring the quality of medical care, the comprehensive goal of 20xx was successfully achieved. I hope that in 20xx, under the management of medical quality and medical safety, our orthopedics department will improve its teaching and scientific research ability.
The second half of this year is a crucial half year for the development of orthopedics in our hospital. In order to meet the needs of the development of departments, the new systematic medical work plan will be formally introduced and implemented, which will also make the development of hospitals face new opportunities and challenges. The next six months will be a crucial period for our hospital to accelerate its development. Strengthening the management of departments, promoting the connotation construction and improving the overall quality of departments are of great significance for improving the service ability and competitiveness of hospitals, pushing hospitals into the fast lane of development and successfully realizing hospital planning objectives. We will firmly establish people-oriented thinking, pragmatic style and positive consciousness, invigorate the spirit, strengthen confidence, seize the opportunity, dare to challenge, and strive to create a new situation in hospital orthopedics work.
As a department manager, I make the following plans for the development of department work in the next six months:
Guided by the important ideas of "running a hospital with integrity" and "practicing according to law", we should adhere to Scientific Outlook on Development, closely focus on the two major themes of hospital reform and development, keep in line with the hospital ideologically, actively do a good job in the construction of departmental teams and disciplines, do a good job in the internal harmony of departments, effectively improve the medical quality, technical level and comprehensive quality of medical staff, make the whole department have a qualitative leap, and promote the comprehensive, coordinated and sustainable development of departments.
career objective
Medical quality, department management, technical update, economic benefits and social benefits have all reached a new level.
1) Continuously improve medical quality: medical quality has always been the focus of our clinical work, and improving medical quality is our only first goal in the second half of the year, even from beginning to end.
2) Department management has reached a new level, and various management systems and processes are more perfect: Department management is an important guarantee for the good implementation of our work.
3) Strive for new breakthroughs in discipline construction and technological renewal.
4) The service attitude of medical staff has been further improved, medical quality complaints and compensation for medical disputes have been continuously reduced, even the incidence rate is zero, the comprehensive satisfaction of patients has been further improved, the annual evaluation of hospital management has achieved good results, and the comprehensive strength and sustainable development ability of departments have been significantly enhanced.
Specific measures and plans
(a) to improve the quality of medical care as the center of gravity, to ensure medical safety as the bottom line, strengthen the construction of basic medical care and nursing quality, build a quality and safety guarantee system, and promote the coordinated development of hospitals.
Medical quality is the foundation of the hospital, medical safety is the key to the survival of the hospital, and medical quality and medical safety are the top priorities of the hospital. We must establish the concept of medical quality as the core to ensure the safety and effectiveness of medical behavior.
Medical quality and safety work should:
First, strengthen the sense of responsibility, risk awareness and scientific rigor. Strive to make every medical staff work in strict accordance with the workflow of the department, so that the responsibilities are clear, the risks are reduced to zero errors, and scientific concepts and team consciousness are established. It is strictly forbidden to be "not reckless, not blind, not going it alone";
Second, improve the medical quality management evaluation system and nursing management system, and improve various routine emergency plans;
Third, focus on the strict implementation of the core system of medical quality and medical safety, and the strict implementation of the medical safety responsibility system;
Four, focus on the implementation of the basic knowledge of orthopedics learning plan (1 time/week), regular assessment of doctors, regular evaluation of medical quality.
It is necessary to strengthen the whole process monitoring of basic quality, link quality and final quality, and implement comprehensive measures such as real-time quality monitoring, regular evaluation and timely rectification, so that it can truly fall into all medical work, medical posts and various diagnosis and treatment links;
It is necessary to strengthen the writing norms of medical and nursing documents, strengthen the self-examination of medical record writers and the quality monitoring measures of medical records of department directors, pay attention to details, organize regular analysis of defective medical records, find out the existing problems, and draw inferences to improve the connotation quality of medical records; Strive to make Dr. Liu Xibing and Dr. Mou Jun fully master the writing format of medical records in February, and realize zero errors in the quality of medical records;
It is necessary to standardize medical behavior, strictly implement technical operation norms such as diagnosis and treatment routine and nursing routine, and effectively prevent medical errors and accidents;
It is necessary to strengthen the implementation of the operation management system, and if there are surgical medical errors, the responsibility should be clear to the people. There is no restriction on the enthusiasm of doctors for surgery and learning technology, and the safety of patients cannot be made a test field for doctors; In the second half of the year, strive to make Dr. Zhao Yong fully master the first type of surgery and master the second type of surgery; Strive to make Dr. Liu Xibing and Dr. Mou Jun proficient in surgery as the short-term goal of employees;
It is necessary to seriously organize and study nursing pre-job training, strengthen the construction of nursing team and standardize nursing behavior;
It is necessary to strengthen the monitoring measures of hospital infection, conscientiously study the relevant knowledge of hospital sense according to the requirements of hospital infection norms, and do a good job in establishing the hospital sense of medical staff in the hospital;
In view of the weak links in the supervision of hospital management activities, strictly implement the legal norms of medical management, practice according to law, strengthen the standardized management of prescriptions, and strengthen the rational use of antibacterial drugs;
It is necessary to strengthen quality and safety education for all staff, communicate with patients more, actively prevent and properly solve medical disputes, actively carry out activities to create a safe hospital, and maintain the normal working order of the hospital.
(2) Actively implement strategic planning, strengthen the construction of basic medical services, fully tap the potential, promote efficiency improvement, comprehensively enhance the comprehensive strength of departments, and add stamina to promote the rapid development of hospitals.
The first is to expand the clinic. As the portal and window of the hospital, outpatient department plays an important role in attracting patients to seek medical treatment, guiding patients' consumption and expanding hospital business. According to the present situation of outpatient service in our hospital, we should take strengthening outpatient service and increasing the number of outpatients as the primary task to realize the benefit growth, conscientiously implement the responsibility system of first consultation, formulate a detailed information registration system for outpatients, strictly implement the workflow of outpatient surgery, and actively carry out the whole process of quality service;
The second is to speed up the turnover of orthopedic beds. According to the actual situation of many orthopedic patients and the shortage of beds, we should actively take effective measures to make full use of hospital resources, improve service processes, improve work efficiency and increase bed turnover rate.
The third is to broaden the medical market. Renew market concepts, improve marketing models, and focus on strengthening network work in rural areas and communities.
The fourth is to control the proportion of drugs in the total income and reduce unnecessary medication, thus reducing the workload of nursing and improving the "gold content" of total business income.
(3) Pay special attention to team building, improve the overall quality of medical staff in departments, and strengthen organizational guarantee for promoting the sustainable development of hospitals.
Talents are the key factor and the first resource for the survival and development of hospitals. In order to smoothly promote the development of hospital work, we must have an excellent talent team. It is an important and urgent task to implement the strategy of strengthening the hospital with talents. Pay special attention to the construction of technical team, attach importance to personnel training and echelon construction, pay special attention to the on-the-job education of medical staff in departments, and comprehensively improve the comprehensive quality and ability of employees; According to the needs of discipline development, doctors will be sent for further study and a number of practical talents will be introduced. Strengthen the construction of professional ethics and industry style, regularly carry out satisfaction evaluation of inpatients, and collect public opinions and suggestions in time.
(4) Do a good job in discipline construction and promote technological renewal.
The discipline and technology construction of the hospital not only represents the level and characteristics of the hospital, but also determines its competitiveness and image. It is necessary to proceed from the overall situation of hospital construction, enhance the sense of urgency from the strategic height of facing the future, put the construction of disciplines and specialties on the important agenda, and constantly learn technology.
(5) Create excellent department culture, build specialty brands, and inject spiritual power into the all-round development of hospitals.
Department culture is an important part of department connotation construction. Through the innovation and construction of department culture, we should realize the harmonious unity of department culture and hospital development strategy, update the cultural concept in combination with hospital development strategy, take "patient-centered" as the core, vigorously carry forward the hospital spirit of "being kind and caring, saving the world and saving people", and fully stimulate the enthusiasm, creativity and team spirit of employees. Strengthen humanized service and put humanistic care through the whole process of medical service. Starting from every link, starting from every little thing, constantly improving the art of communication, constantly introducing new convenience service measures, and giving patients as much care as possible; Change service mode, improve service style, improve service attitude and improve service level; Create a good visual environment and humanistic environment of the hospital and establish a new image of the hospital.
Orthopedics III Work Plan Under the guidance of the hospital, in order to standardize medical behavior, strengthen medical quality and provide high-quality medical services for patients, the following work plan is put forward:
First, strengthen the professional training of professional and technical personnel and continue to do a good job in medical education.
According to the situation of our hospital, in line with the principle of what is lacking, what to learn, what to apply, and training on demand, medical staff are sent to provincial hospitals or mainland China to study, absorb advanced technology and improve their technical level when the hospital's economic conditions permit. Professional and technical personnel with intermediate titles should closely combine their own majors, consciously and strictly supplement them through self-study and full-time study, and increase the new theories, technologies and methods of their professional skills. Master the knowledge of interdisciplinary and related disciplines. Professional and technical personnel with primary titles should combine their posts, exercise their professional and technical knowledge and skills, master professional technology and participate in scientific research, so as to solve more complicated and difficult diseases. Strive for the principle of inviting yourself in, sending yourself out and learning by yourself, and do everything possible to improve the professional quality of professional teams. By inviting provincial experts to conduct professional and technical guidance rounds, operations, lectures and other forms, the level of business personnel in our hospital will be improved, and experts from various disciplines will be supported to develop new technologies and new businesses. The dean is responsible for arranging lectures in the department from time to time. Professionals are actively encouraged to study by themselves, department directors urge to consult business notes, and hospitals include business learning in the scope of regular evaluation.
Second, strengthen medical management and improve medical quality.
First of all, our hospital must take the reform and innovation as the driving force, take the key departments as the advantage, win the market with the quality of service, and achieve "four prohibitions" and "five prohibitions" on the development of medical quality, that is, it is forbidden to be indifferent, shirk the work style, accept the doctor hastily, and make a careless diagnosis and treatment; More explanation, more comfort, more understanding, more warmth and more help make the hospital service quality in the leading position in the county.
Secondly, quality control organizations at all levels are responsible for management according to their respective posts. Establish a feasible quality control scheme at all levels and a regular effect evaluation system, so that the system of three-level rounds, consultations and discussions in our hospital can be implemented and the medical quality can be fully guaranteed.
Third, it is necessary to regularly educate medical staff about the significance of post responsibility system, improve various rules and regulations, and regularly and irregularly check the medical situation and the implementation of post responsibility system. Pre-job education must be given to new employees. Clarify the hospital's various systems and professional ethics, constantly sum up experience, learn from each other's strengths and improve the management system. Establish preventive measures for medical defects, that is, deal with the plan to prevent medical accidents, implement the accountability system for medical defects, and educate the medical staff in the hospital to put medical safety first.
Fourth, strengthen the management of medical documents to standardize and standardize medical documents in various subjects. Regular inspection, timely feedback, improvement and improvement, so that the writing of medical documents can meet the requirements and objectives set by the Ministry of Health. Carry out informed choice activities, provide personalized services, and carefully fill in all kinds of informed consent forms. Make the qualified rate of Grade A medical record writing in the hospital reach 90%, and there is no Grade C medical record; The qualified rate of prescription should reach above 98%; All auxiliary inspection reports meet the requirements of the health department.
Third, prevent medical accidents and ensure medical safety.
We should conscientiously do a good job in medical quality evaluation, and carry out management work in strict accordance with management norms, work systems and evaluation rules. Strictly implement medical preventive measures, medical accident treatment plans and preventive plans, implement the accountability system for medical defects, and carry out medical activities in strict accordance with medical operating procedures and standards. Organize hospital staff to learn relevant medical laws and regulations. It is necessary to advocate health technicians to study medical skills assiduously, take a clear-cut stand, resolutely correct unhealthy practices in the industry, strengthen the quality management of key links and departments, and implement a grading system for medical project titles. Shift the focus of medical quality management from the final medical quality evaluation to the quality inspection and supervision of every link in the whole medical process.
IV. Overall objectives and tasks:
1, bed utilization rate ≥85%
2. Average hospitalization days ≤ 10 days.
3. The diagnosis rate is more than 90% within three days after admission.
4. The average preoperative hospital stay was ≤3 days.
5. The coincidence rate of admission and discharge diagnosis is ≥95%.
6, critically ill patients in hospital rescue success rate of 85% or higher.
7. The coincidence rate of diagnosis before and after operation is ≥90%.
8. The coincidence rate of clinical and pathological diagnosis is ≥90%.
9. The passing rate of "three basics" exam = 100%(80/ 100 points)
10, and the qualified rate of outpatient medical record writing is ≥ 90% (more than 90/100).
1 1, the first-class medical record rate is ≥90%, and there is no third-class medical record.
12, the intact rate of medical equipment and instruments is ≥90%.
13, the intact rate of first aid instruments and medicines = 100%
Verb (abbreviation of verb) medical safety management
1, continue to do a good job in medical safety education and related laws and regulations, standardize medical behavior according to law, strictly implement personnel access and technology access, strengthen medical safety education for medical personnel, and hold lectures, trainings and examinations on prevention and treatment of medical disputes.
2, strengthen medical safety prevention, starting from the control of medical defects, strictly implement the system of medical disputes, medical accident treatment and accountability, for disputes that have a significant impact on the hospital and are identified as medical accidents, accountability should be carried out. Pay attention to learning from experience and lessons.
3, from the control of medical defects, strengthen the difficult, iatrogenic injury, special, critical, serious complications, disputes and other patients at any time reporting system.
4. Hold regular medical safety meetings, report the handling of medical safety incidents and medical disputes, and sum up experience. 20 1 1 year is a crucial year for hospital development. Orthopedics is determined to do a good job in medical quality and medical safety management, enhance teaching and scientific research capabilities, strengthen "three basics" training, and successfully complete various medical tasks.