In 2005, the innovative management mode of "doctors follow patients" in orthopedics department of Huaxi Hospital performed strongly. This year, the number of orthopedic operations exceeded 4000 for the first time, reaching a record of 4020 cases, accounting for almost one tenth of the total surgical operations in our hospital (44 1 1). This data fully proves that the medical service model of "doctors follow patients" pioneered by orthopedics is indeed a powerful measure to effectively use resources, promote the development of disciplines and enhance the strength of departments.
"We have arranged for you. Please come to the hospital within five days, and you can have surgery within three days. " Holding a notice of orthopedic hospitalization in his hand, Lao Li was quite emotional.
Lao Li is an ordinary worker in a factory in Chengdu. Just over forty, he unfortunately suffered from lumbar disc herniation. In recent days, he was in great pain and finally forced Lao Li, who had been hesitant, to make up his mind to come to the hospital for surgery. When I came to the hospital, Lao Li muttered, I don't know when it will be my turn to be hospitalized! Based on experience, Lao Li feels that it is not easy to be hospitalized in a big hospital like Huaxi Hospital. Today, however, Lao Li got an unexpected answer.
What makes Lao Li think it is difficult to stay in hospital so easily? It is a project called "Hospital Management Process Optimization Project-a new model of doctors' professional classification of diseases and doctors' follow-up of patients" initiated by the Department of Orthopaedics of West China Hospital from 65438 to 0999. Referring to the motivation of this reform, Minister Liao of the Propaganda Department said with emotion: "In recent years, patients choose doctors all over the country, but there is no convincing evidence to prove its effect; There are also great difficulties at the operational level. So we decided to boldly try the ward management mode of "doctors follow patients". This new model mainly includes two aspects: open bed management and doctors' professional subdivision into diseases.
Open bed management
Speaking of bed management, Minister Liao talked about the disadvantages of the "territorial" management model of doctor beds currently used in China. "In some hospitals with many patients and difficulties in hospitalization, some doctors' beds are very tight, but at the same time, other doctors' beds are empty. The bed turnover rate in the department is low, and the limited resources are not reasonably and fully utilized, which makes the ability of medical staff not fully exerted, patients are dissatisfied, and doctors are busy, which ultimately affects the development of the department. " Minister Liao said, "Even now, most hospitals in China still implement the doctor's territorial bed management system, that is, each medical team doctor is responsible for managing about 5~ 15 beds. No matter how many patients there are, some doctors can only live in their own beds, and some doctors have few patients, but even if the beds he manages are always empty, other doctors can't occupy his beds. Of course, in some cases, some doctors can bend the rules and lend their beds to others, which is also based on personal friendship. "
The purpose of implementing the new model in orthopedics of Huaxi Hospital is to change this territorial bed management into open bed management, so that doctors can follow patients instead of beds. Orthopedics doctors treat patients in outpatient clinics, and doctors can write hospitalization bills for patients who are suitable for hospitalization. Because of the open bed management, patients can move in as long as there are empty beds in the department when they go through the admission formalities. Moreover, after the patient is hospitalized, the orthopedic head nurse will classify the patient according to the condition. As long as they are patients with thoracic vertebrae, no matter which bed they live in or which doctor is admitted to the hospital, they will be managed by doctors in the thoracic vertebrae professional group.
Implementing open bed management is tantamount to breaking the iron rice bowl for doctors who are used to territorial management. So at the beginning of implementation, the difficulty can be imagined. Minister Liao said: "At first, no one was willing to give up power, and they were very excited. Especially those doctors with fewer patients are even less motivated. " In order to cooperate with the implementation of this model, orthopedic cadres first emphasize the change of service concept in departments, and strive to make department staff establish a new service consciousness. Gradually, doctors realize that only by establishing a platform for sickbeds and displaying doctors' abilities can we better promote the improvement of service and medical quality. Therefore, we can abandon the original fixed beds and adapt to the new open bed management model.
Specialty is subdivided into diseases.
In order to effectively implement the model of "doctors follow patients", it is very important to subdivide doctors' specialties into diseases. For example, the original spinal surgery is now divided into three parts: cervical vertebra, thoracic vertebra and lumbar vertebra, and each part is specially responsible by a group of doctors. Minister Liao said that the biggest difficulty in implementing "doctors follow patients" lies in the subdivision of doctors' sub-specialties.
First of all, we should choose a professional category. The determination of the types and modes of orthopedic sub-specialties is an important link related to the benign and parallel development of each sub-specialty in the future. The Department of Orthopaedics, West China Hospital has made accurate statistics and analysis on the number of patients and the amount of operations for each single disease in recent three years. Combined with the existing number of doctors, seniority, professional title, number of beds, difficulty of operation of various diseases, recovery rate, prognosis and other factors, we discussed and brewed repeatedly and held general practice meetings many times. Through voting at the meeting, opinions were solicited at the meeting, and the opinions of the general practitioners reached a high degree of unity, and were finally determined as spinal surgery, upper limb trauma and hand microsurgery, and lower limb trauma.
Secondly, the choice and division of individual sub-majors. The Orthopedics Department of West China Hospital first held a meeting of the department management group, unified the internal opinions of the leading group, decided to promote the personnel arrangement in an orderly manner by stages, and formulated the basic principles of "full democratic mode discussion, fair and just professional selection, department leaders taking the lead in losses, unified management of economic income, and distribution according to basic+performance+inclined policy". In view of the large gap in the foundation and development of each sub-major, the department proposed that the members of the leading group should try their best to enter the sub-major with poor foundation and late start, and the selection should be based on the principle of "fairness, justice and openness, as far as possible in line with their own wishes, and appropriate deployment in the department". For relatively biased specialties, the distribution system is tilted from the beginning.
The selection of individual sub-specialties of orthopedics in Huaxi Hospital is as follows: among the original personnel of orthopedics, because the old experts have worked for decades and performed thousands of operations, they are very proficient in each sub-specialty, and the departments follow the principle of two-way selection for the old experts and choose a sub-specialty by themselves. On this basis, some young potential doctors are responsible for some sub-majors that some old experts are unwilling to choose, and they will open up these fields in order to make breakthroughs; Party member took the lead in studying a major that no one really wanted to choose. For the second generation of talents in the department, those doctoral and master's majors were divided from the time they chose their tutors. Because the selection of tutors is voluntary, it will be easier to be admitted to the hospital after graduation. Minister Liao said that hospitals will not restrict the development of young talents. Some doctors and masters have popular majors, but because there are many people doing this major and the competition is fierce, the hospital encourages them to develop into relatively partial majors. If you are a doctoral student majoring in thoracic vertebrae, you can also choose ankle joint and other majors to do papers and topics, because these majors have fewer people, wider roads and better development space. If you do well, it is easy to make achievements and improve your academic status.
the crown of the year
The implementation of "patients choose doctors" has optimized the management process of inpatients. The hospital can arrange the patient's admission time according to the needs of the surgical plan, shorten the waiting time of the patient after admission, and shorten the waiting time and hospitalization time of the patient through reasonable arrangement of preoperative examination. Minister Liao said: "The orthopedic doctors in our hospital are generally very busy. Before, there was no scientific plan to admit patients to hospital, which led to many patients waiting in line for surgery for a long time after hospitalization, which not only occupied the hospital bed but also wasted the patient's time and expenses. It's different now. The hospital can arrange the admission and operation time of patients according to the patient's disease, the number of patients with the disease, the number of doctors with the disease and the use of beds. " Now, if there are patients who need ankle surgery in the Department of Orthopaedics of West China Hospital, the department can calculate when it is the turn of new ankle patients to have surgery according to the existing number of ankle patients, the number of ankle doctors and the daily operation volume of this disease, and then arrange some examinations according to the operation needs, and complete them in the outpatient clinic while the patients are waiting for admission, so as to further determine the admission time of patients, thus achieving the purpose of shortening the waiting time for surgery after admission.
The professional subdivision has also improved the doctor-patient communication ability and innovative consciousness of medical staff. In this regard, Minister Liao made a detailed analysis: since the professional breakdown, doctors have only operated on a certain disease, and the number of operations has increased. They can also devote all their time and energy to deeper research on this disease, and medical technology has quickly reached the national leading level. With the advantages and foundation of the treatment of this disease, when doctors communicate with patients, they can confidently tell patients how many cases I have done in this area, how many cases other authoritative people in the country have done, how much progress I can make in this area at home and abroad, and what I can't do. In this way, the patient's mind will be very clear and he will trust the doctor more. Moreover, after a period of professional subdivision, doctors in various professional groups have formulated their own professional diagnosis and treatment paths according to practical experience, which can effectively standardize doctors' personal behavior.
Minister Liao said that after the optimization of the management process of orthopedic inpatients, the efficiency indicators of clinical work in the department have been greatly improved; At the same time, practice makes perfect, which promotes the continuous improvement of doctors' level and quickly reaches the domestic advanced level; The waiting time of patients outside the hospital is greatly reduced, the loss of patients is reduced, the number of patients admitted to hospital and the number of operating tables are increased, the utilization rate of beds is obviously improved, and the average hospitalization days of patients and the average cost of single diseases are greatly reduced. For example, the average cost of arthroscopic surgery dropped from 5346 yuan to 3426 yuan, and the average cost of joint replacement surgery dropped from 40960 yuan to 32980 yuan. At the same time, due to the improvement of medical quality and good communication between doctors and patients, patients' satisfaction has been improved. Before 1999, this department had 16 complaints, but there was no complaint in 2004, which is a miracle for a department with nearly 200 beds and such a heavy workload.
"The premise of the division of departments and the development of doctors in the direction of single disease specialization is that there are enough patients in this department, and the doctors in this department are rich in resources and have high medical level. Therefore, this model is only suitable for large general hospitals and specialized hospitals, and small general hospitals should not imitate it. " Talking about the feasibility of promoting this model in other hospitals, Minister Liao said frankly.