In recent years, the development of public hospitals has been facing continuous changes in the internal and external environment, and is under tremendous operational pressure. Performance management is a hot topic in the field of healthcare management. On the whole, most of the existing studies focus on performance appraisal and performance evaluation, and there is a lack of systematic research on performance management planning, implementation, appraisal and feedback.
Taking a large general hospital as an example, this study analyzes the current situation and existing problems of hospital performance management, and discusses the goals, principles and ideas for future performance management improvement. In this study, a combination of questionnaire survey and interview was adopted, and 909 valid questionnaires were collected from all staff of the case hospital (see Table 1).
The questionnaire has a total of 33 questions, which focuses on the elaboration of the current situation and problems, so as to form the next optimization direction of performance management. A total of 27 employees were selected for one-on-one interviews using stratified random sampling (see Table 2).
The interview outline consists of 12 questions, all of which are open-ended questions, which are targeted supplements based on the results of the questionnaire, focusing on cause analysis and solicitation of suggestions.
Five-level integrated performance appraisal management system
The result?
The case hospital is a large tertiary general hospital, which has fully implemented the new version of the "Hospital Financial System" and the "Hospital Accounting System" since July 2011, and formulated a new performance distribution plan. In 2013, the hospital completed the performance appraisal reform and formed a comprehensive evaluation and distribution system guided by budget and leveraged by post performance.
In 2018, the hospital once again upgraded its performance management model (hereinafter referred to as the "2018 version"), taking collectivization and networking as the management framework, the overall goal and development strategy of the hospital as the guideline, innovating the performance appraisal mechanism and optimizing the income distribution rules.
The 2018 version divides the performance appraisal into 4 units: operating beds, non-operating beds, other and some outpatient clinics, and medical and technical departments, and divides the staff of the hospital into 9 grades such as physicians (internal medicine and surgery), nursing, medical technology, and management according to the nature of the post.
Through the 2018 version of the performance management upgrade, the hospital has gradually built a five-level integrated performance appraisal management system of "hospital group, each hospital area and trusteeship medical alliance, discipline (subspecialty)-diagnosis and treatment group, department director, and individual physician", which is decomposed layer by layer and implemented step by step, forming an open and growth-oriented performance appraisal management model.
The survey found that the staff of the hospital in the case hospital as a whole had a good cognitive foundation for hospital performance management, and believed that the performance appraisal results did not stay in the evaluation, but became a necessary input for salary distribution, and the hospital performance management has achieved certain results in promoting the development of the hospital and stimulating the enthusiasm of employees.
However, at the same time, there are still some employees who have doubts and dissatisfaction with performance management, especially in terms of incentive effect, fairness and reasonableness, and income satisfaction.
For example, nearly one-fifth of employees believe that performance management does not motivate them to improve the quality and efficiency of medical services and take the initiative to take responsibility for work and responsibility.
In some grades, about 30% of employees believe that the performance management system is not fair and reasonable;
There are still 30% of employees who are not satisfied with their income in the past three years.
Combined with the results of questionnaire survey and interview, this study sorted out the problems existing in hospital performance management and discussed the possible reasons from four aspects: performance planning, performance appraisal, performance communication and feedback, and application of assessment results.
The results show that although the performance management of the case hospital is leading in terms of theoretical construction and practical design, there are still problems that need continuous improvement, such as insufficient systematic construction of performance planning, insufficient reflection of individual job responsibilities and labor value in performance appraisal, lack of guidance and analysis in performance communication and feedback, and high expectations of employees for the proportion of performance pay in the application of appraisal results.
Performance planning, appraisal, communication feedback, and application of results
How do they interlock?
1. Performance planning link
The process of designing and developing a hospital performance plan usually involves breaking down strategic objectives, defining key success factors, building a performance indicator system, and determining the weight of indicators.
At present, the staff of the case hospital have a high degree of understanding of the strategic objectives and performance management system, and are more aware of the performance appraisal index system of the hospital and department, but the survey results show that about one-third of the medical technicians and clinical surgeons in the medical technology department are dissatisfied with the performance management plan (see Figure 1).
For example, the importance evaluation of "service capability and level" in each performance unit is second only to "medical quality and safety", but in the current performance appraisal index system, the weight ranking of this dimension is relatively low. This means that some important performance appraisal dimensions may not be given due weight, which affects the scientificity and fairness of the performance plan.
The reform of medical insurance payment methods and the "national examination" have put forward higher requirements for hospital operation and management, and the performance plan, as a management tool, needs to adapt to new environmental changes, and there are inevitably deficiencies in the implementation process.
At the same time, it is difficult to scientifically translate policy requirements into guidance for individual behavior. Taking the assessment of "the proportion of medical service income in medical income" emphasized by the state in recent years as an example, this indicator aims to reasonably reflect the value of medical personnel's technical labor, which is essentially not only to control the irrational use of drugs and consumables, but also to create space for the reform of the salary system. In practice, although this indicator is improving year by year at the hospital and department levels, medical staff have not really felt the positive feedback from the policy.
2. Performance appraisal
In performance appraisal, the hospital scientifically measures and evaluates the effectiveness of behavioral activities, and its key action is "comparison", and the premise of "comparison" is the selection of assessment indicators and the determination of assessment standards.
The survey found that although the logic of the monthly, quarterly and annual performance appraisal of hospitals is consistent, there are still objections to whether they can fully reflect the responsibilities and labor value of individual positions.
Nearly 50% of employees expressed uncertainty or denial about whether performance appraisal reflects personal value, especially among medical technicians, clinical physicians and clinical surgeons in medical technology departments (see Figure 2).
In addition, some employees believe that the performance system lacks a scientific evaluation and feedback mechanism, although it is in place to consult before determining the indicator system, but the construction of evaluation methods and effect feedback mechanisms needs to be further strengthened after the indicator system is determined.
The index system and weight distribution of performance appraisal are often formulated according to the strategic objectives and performance management requirements of the hospital, but in practice, due to the differences in job responsibilities and the characteristics of employees' work, the performance appraisal index system and weight distribution are not accurate enough, which cannot accurately reflect the workload and difficulty of the individual, so that some employees think that the performance appraisal results cannot objectively measure the value of labor.
At the same time, the lack of a closed-loop evaluation and feedback mechanism makes it difficult for employees to understand their performance in a timely manner, which in turn affects their work enthusiasm.
3. Performance communication and feedback
Performance communication and feedback run through the whole process of performance management, which requires continuous communication between managers and employees on performance goals, measurement standards, and application of performance results. In practice, performance communication and feedback often only stay at the stage of compiling performance plans and soliciting opinions, and it is difficult for employees' feedback on performance to be systematically sorted out in the later stage.
According to the survey, nearly 30% of the employees in the case hospital did not know that the hospital provided a way to appeal for performance (see Figure 3), and 29 people did not know what other channels of communication and feedback the hospital provided in addition to the performance result appeal.
Second, there is a lack of performance coaching analysis. 5.50% of employees have complained about the performance appraisal results in the last year, and 1.76% of them are not satisfied with the results.
It can be seen that although the hospital has established performance communication and feedback channels, such as questionnaires, emails, OA feedback, symposiums, etc., and carried out corresponding communication and feedback work, there are certain problems in publicity, and the awareness rate and feedback rate of this mechanism have gradually decreased over time.
In this regard, managers need to recognize the importance of performance communication and feedback, enhance publicity and provide clearer and more open performance communication channels. At the same time, employees should also have the courage to find and face problems, and put forward valuable suggestions through feedback links, so as to make management measures more targeted and operable.
4. Application of assessment results
First of all, employees do not have a sufficient understanding of performance-based pay and fixed salary.
According to the Notice on Printing and Distributing the Evaluation Indicators for the High-quality Development of Public Hospitals (Trial) in July 2022, the evaluation of the "proportion of fixed salary" is proposed in the performance appraisal of hospitals.
The survey results show that in addition to the two grades of logistics support and subject director, other employees choose more fixed salary proportions of 50%, 40% or even 30%.
Secondly, the staff is not satisfied with the secondary allocation of the department.
The survey found that 20.24% of the employees clearly expressed dissatisfaction with the second-level allocation results of the department, mainly concentrated in the imaging medical technology department, medical technician and clinical internal medicine physician in the medical technology department.
From the perspective of external factors, on the one hand, the impact of the medical reform policy, the salary of medical staff is no longer linked to the income of drugs, inspections and other businesses, on the other hand, it is to strictly control excessive diagnosis and treatment, and implement mutual recognition of inspection and test results of medical institutions.
From the perspective of internal factors, the secondary distribution of departments combines incentive indicators and assessment indicators such as the number of inspections and treatments, and it is difficult to clearly judge whether the reasons behind dissatisfaction can indeed be solved by the setting and weight adjustment of the allocation indicators. Therefore, in the future, it is necessary to further analyze and optimize information tools.
In addition, it is believed that the proportion of performance appraisal results affecting individual remuneration and evaluation and promotion is low, indicating that the existing application scenarios of performance appraisal results need to be enriched and improved.
Objectives and principles for hospital performance management improvement
What is it?
At present, there are three main reasons for the need for improvement in hospital performance management.
First of all, the impact of the external policy environment on hospitals is becoming increasingly significant, and specific requirements and monitoring indicators are put forward for the high-quality development of hospitals.
Secondly, the rapid development of the hospital in recent years requires the adoption of a more scientific management model and more efficient management methods to meet the constantly updated management requirements.
Finally, the demands and satisfaction of employees are also something that managers need to consider.
Therefore, the goal of hospital performance management improvement is to improve the hospital assessment and incentive mechanism, more reasonably reflect the labor value of personnel in various positions, mobilize the enthusiasm of employees, improve patient satisfaction, establish a modern hospital management system, and help achieve the strategic goals of the hospital.
Hospital performance management improvement is a complex, comprehensive, and incremental project that requires the following principles.
First, the principle of people-oriented and goal-oriented, continuously optimize the performance appraisal index system, combined with the leverage of income distribution, to stimulate the enthusiasm and creativity of all employees.
The second is to take into account the principle of overall planning and dynamic adjustment, fully implement the relevant policy requirements, take into account the income distribution relationship between public hospitals, public health institutions and primary medical and health institutions, and dynamically adjust the salary level of public hospitals and optimize the salary structure of public hospitals on the basis of ensuring the benign operation of medical institutions, the affordability of basic medical insurance expenditures, the overall burden of the masses and the continuous improvement of medical service levels.
The third is the principle of fair and reasonable, distribution according to work, guided by the value of knowledge, the distribution of labor, knowledge, technology, management and other elements according to contributions, highlighting key elements such as workload, service quality, medical ethics and medical style, reflecting more work and more rewards, excellent performance and good pay.
Hospital performance management improvements
What should I do?
The overall idea of hospital performance management improvement is to identify the problems that need to be solved urgently in hospital performance management from a global perspective and in comparison with the new requirements put forward by the reform of multiple payment methods, and trace and locate them in all aspects of performance management.
(1) Strengthen synergy and fully understand the national policy orientation and specific requirements.
In recent years, the introduction of national policies has formed a synergy. The "Opinions on Promoting the High-quality Development of Public Hospitals" proposes six paths to promote hospital quality reform and efficiency reform, and releases the corresponding index system. (For specific indicators, please refer to the "Operation Manual for the Evaluation Indicators for the High-quality Development of Public Hospitals (Trial) (2022 Edition)" issued by the National Health Commission)
The real management effect can not only rely on the fine management of functional departments, but through a series of guidance, requirements and process optimization, to enhance the management awareness of the whole hospital, affect the behavior of clinical departments, essentially mobilize and enhance the enthusiasm of employees, and promote the innovation and development of medical services.
(2) Focus on rationality and focus on the achievement of the hospital's strategic goals and planning.
Hospital performance management is a people-centered system engineering, and the scientific, systematic and standardized management foundation is the foundation and premise.
Therefore, the hospital performance management improvement plan should start with the hospital's strategic planning, with the help of the performance appraisal mechanism and bonus distribution, focusing on promoting the development of the discipline and focusing on providing better medical services for patients.
The performance appraisal of the hospital takes the treatment group as the unit, and the bonus accounting and distribution takes the subspecialty as the unit, and guides and encourages the construction of disciplines and improves the level of medical services through the reasonable distribution mechanism associated with the performance appraisal results.
At the same time, each discipline can confirm the bonus distribution of the sub-specialties under the discipline and make a second overall distribution, so as to better motivate and enhance the cohesion and motivation of the discipline.
(3) Reflect the scientificity, human resources and operation departments work together.
After the hospital performance management improvement plan is proposed, it is necessary to continue to conduct a more in-depth systematic and scientific evaluation with the effective cooperation of human resources, finance and operation management departments.
Based on talent insights, the finance and operation management department helps the human resources department improve organizational performance and do a good job of auxiliary and staff work, including human resources inventory, human resources supply and demand balance analysis, human resource efficiency analysis, and doctor portraits.