According to the 2022 National Bulletin on the Development of Ageing released at the end of 2023, by the end of 2022, 8,627 general hospitals and 19,494 primary medical and health institutions had been established in the country. From now on, the Health Newspaper will open a column of "Paying Attention to the Construction of Age-friendly Medical Institutions" to explore the experience of creating age-friendly medical institutions, discuss the connotation of age-friendly services, and provide inspiration for promoting medical institutions to fully implement preferential policies for medical services for the elderly and build a more age-friendly health service system.
According to the Notice on Carrying out the Construction of Age-Friendly Medical Institutions issued by the National Health Commission and the State Administration of Traditional Chinese Medicine on December 1, 2020, the construction of age-friendly medical institutions includes four aspects: age-friendly culture, management, service and environment, and the specific implementation plan shall be independently formulated by the health administrative departments at all levels and the competent departments of traditional Chinese medicine. After being given a strong degree of flexibility, each locality refines the construction standards and optimizes the evaluation methods in combination with its own reality. More and more medical institutions are joining the "age-friendly" queue in guidance and incentives.
Dispel the concerns of "not wanting to create" and "not daring to create".
In 2021, the Hebei Provincial Health Commission and the Hebei Provincial Administration of Traditional Chinese Medicine issued the Implementation Plan for the Construction of Age-Friendly Medical Institutions in Hebei Province, which was evaluated from four aspects: age-friendly culture (20 points), management (15 points), service (40 points), and environment (25 points). If the total score of the evaluation of the declared medical institutions is not less than 85 points (the total score of the evaluation of primary medical and health institutions is not less than 80 points), and the scores of the four individual evaluations are not less than 80% of the full score of the item (the single evaluation score of the primary medical and health institutions is not less than 75% of the full score of the item), it can be rated as an age-friendly medical institution in Hebei Province.
"At the beginning of the work, there were only more than 90 medical institutions in the city that were willing to declare, accounting for less than 20%. Cheng Junliang, a third-level researcher of the Health Commission of Shijiazhuang City, Hebei Province, pointed out. During his visit and investigation, he learned that some hospital managers were full of concerns: some said that the department directors were all technical talents and only cared about "taking care of the disease"; some said that participating in the creation could not produce economic benefits, and they were forced to have more than enough energy due to operational pressure; and some said that the creation work was complicated and they felt that they had no way to start......
"To sum up, part of it is that it is not wanted to create, and part of it is that it is not daring to create. This shows that the awareness of medical institutions on the importance and necessity of establishment work needs to be improved. Cheng Junliang said that in view of this, Shijiazhuang City will include the relevant indicators of the construction of age-friendly medical institutions into the "Healthy Shijiazhuang" action, as well as the key work of the Municipal Health Commission, requiring "focusing on municipal hospitals and setting an example". "In the mobilization, it has been emphasized many times that it is difficult to achieve a famous hospital by only talking about technology and not service, let alone reflecting the public welfare attributes of public hospitals, and unable to meet the needs of the times in the context of an aging population. Cheng Junliang said.
During this period, the Shijiazhuang Municipal Health Commission invited 8 experts in the health of the elderly at the provincial and municipal levels to select medical institutions at different levels to conduct on-site pre-assessment around the evaluation criteria of four aspects of age-friendly culture, management, service and environment, so as to standardize the archives created by age-friendly medical institutions, unify the on-site review standards of the expert group, and provide a template for other medical institutions to carry out the creation work.
"Among them, the evaluation content of age-friendly services is different from that of primary medical and health institutions and other medical institutions. Cheng Junliang introduced, the primary medical and health institutions are closest to the community, and the evaluation focuses on guiding them to optimize the medical service process, establish a green channel for elderly patients to seek medical treatment, standardize the health management for the elderly in the jurisdiction and provide home medical care services for the disabled elderly in need;
"Through high-level promotion and classified guidance, some hospital managers have dispelled their concerns and changed their attitudes, saying, 'Report first, try it'. Cheng Junliang said that in the past three years, 459 medical institutions in Shijiazhuang have been built into age-friendly medical institutions, accounting for more than 92%.
"The construction standards of age-friendly medical institutions are not static, it changes with people's expectations, and in the future, it is necessary to truly incorporate the creation of work into the overall construction of medical institutions, and timely feedback and correction should be given to the suggestions and problems pointed out by the public. Cheng Junliang emphasized.
It is necessary to "hold hands" and "look back"
Beijing is a pioneer in the construction of age-friendly medical institutions. As early as 2017, the city has established a working mechanism for voluntary declaration, district-level assessment, city-level review, and comprehensive evaluation. In 2018, four of the first 20 age-friendly hospitals in Beijing were from Dongcheng District, Beijing. One of them, Beijing Longfu Hospital, plays an important leading and promoting role as the carrier of the Dongcheng District Elderly Health and Medical Care Service Guidance Center.
One of the important responsibilities of the guidance center is to provide "one-to-one" guidance for the participating medical institutions to adapt to the evaluation experts of the city's age-friendly medical institutions. Zhao Shichu, an expert in the evaluation of municipal age-friendly medical institutions and vice president of Beijing Longfu Hospital, often receives calls from participating medical institutions, including those who consult the comprehensive assessment indicators of the elderly and those who consult the setting up of palliative care wards.
Whenever she has time, Zhao Shichu will also visit the field, and the ingenuity of some participating medical institutions has also inspired her a lot. "I was very impressed by the fact that a primary medical and health institution has set up diagnosis and treatment zones decorated with different colors for patients of different ages, which is very clear. For example, the color of the elderly patient area is calm and restrained, which weakens the attributes of some hospitals and is very humane. Zhao Shichu said that this is also the creation of Dongcheng District advocated "to bring the new with the old, to promote the old with the new".
In the "retrospective" of the construction of age-friendly medical institutions in the jurisdiction, Zhao Shichu paid great attention to collecting common problems. "Although many primary medical and health institutions have established age-friendly medical institutions, there is a talent gap in rehabilitation and nursing, which hinders the provision of age-friendly services. Zhao Shichu said.
Case discussion and difficult consultation in Beijing Longfu Hospital are open to grassroots medical staff in the medical alliance to help them improve their diagnosis and treatment skills. "In the next step, we plan to establish a long-term and short-term rotation training mechanism, and grassroots medical staff can participate through the 'order' method. For example, if grassroots nurses want to master the deep venipuncture technique at this stage, they can choose this one separately, and when they encounter deep venipuncture operations, they can come to observe and learn, without having to take off work for too long to avoid the contradiction between work and learning. Zhao Shichu said.
"Qualified" reflects accessibility, and "excellent" highlights leadership
"The construction of age-friendly medical institutions covers a wide range of areas, and we adhere to the combination of universal construction and key demonstration to ensure that the construction standards are implemented. Wu Wei, director of the Aging and Health Division of the Jiangsu Provincial Health Commission, introduced that the creation of age-friendly medical institutions in the province was launched in 2021 and is divided into two grades: qualified and excellent. "The purpose of this is to fully mobilize the enthusiasm of the participating medical institutions, which not only reflects the accessibility of universal creation, but also highlights the leading nature of key construction. Wu Wei said.
According to the Standards for the Construction of Age-Friendly Medical Institutions in Jiangsu Province (Trial), if the total evaluation score of the declared medical institutions is not less than 60 points, and the scores of the four individual evaluations are not less than 60% of the total score of this item, they can be rated as age-friendly medical institutions, and if they reach more than 80 points, they can be recommended as excellent grades of age-friendly medical institutions.
In Nantong City, Jiangsu Province, which has entered a deeply aging society, all general hospitals, rehabilitation hospitals, nursing homes and primary medical and health institutions that provide health services for the elderly have been included in the scope of construction. The city's health commission regularly carries out special supervision and training on the promotion of the construction of age-friendly medical institutions in various counties (cities and districts).
After several trainings, Gong Yachi, director of the Geriatrics Department of the Third People's Hospital of Nantong City, as the specific executor of the hospital's establishment work, has a thorough understanding of the construction standards. "Environmental renovation seems simple, but it is not easy to score, like installing elevator handrails, only three sides can get 1 point. Gong Yachi said.
In 2021, the Third People's Hospital of Nantong successfully passed the qualification rating evaluation of age-friendly medical institutions, but due to the lack of high overall score ranking, it missed out on excellence. Analyzing the reasons for the loss of points, Gong Yachi believes that the hardware facilities of the hospital are relatively complete, but there is still room for improvement in age-friendly management and services. To this end, the hospital has explored the establishment of technical specifications and continuous improvement mechanisms with the characteristics of geriatric services, involving a number of services such as comprehensive geriatric assessment, multidisciplinary integrated management of geriatrics, geriatric syndrome and geriatric care problem assessment and intervention, and finally advanced to an excellent grade in the 2023 review.
Gong Yachi was deeply touched by this, and was promoted from qualified to excellent, and the scoring point was to deepen the service connotation. "For example, if the multidisciplinary integrated management service is only directly copied from the multidisciplinary diagnosis and treatment model of tumors, it is difficult to score, and it is necessary to grasp the characteristics of multi-disease coexistence and multi-drug sharing of elderly patients, adjust the participating disciplines in a targeted manner, and optimize the collaboration mode. Gong Yachi explained.
Nantong City will give a reward of 100,000 yuan to each medical institution that has achieved remarkable results. In Gong Yachi's view, although this reward is not enough to cover the cost of creation, actively participating in the creation of age-friendly medical institutions has a significant role in improving patient satisfaction and hospital reputation, especially in the context of the accelerated aging of the population, in the long run, the benefits are much higher than the investment.
Text: Health News reporter Zhao Xingyue Correspondent Jiang Xiao Li Bingbing Editor: Guan Zhongyao
Proofreader: Li Shiyao
Review: Qin Mingrui, Xu Bingnan