我国三级综合医院岗位评价模型研究
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摘要
医院是推进医疗卫生事业改革发展、维护人民健康的重要保障单位。医院的人事管理制度经过多年的发展和探索，取得了很多成果，但也存在人岗分离、等级不清、考核不明、分配不公、价值定位低等诸多问题。随着医药卫生体制改革的深化，医院人事制度的改革势在必行，逐步向“以岗位管理为核心的医院新型用人制度”方向发展。
岗位管理是医院实现人岗匹配、提高工作效率的有效途径。而岗位评价是岗位管理的基础，是人力资源管理和组织管理的基石，是薪酬管理和绩效考核的重要依据。通过实施科学的岗位评价可以系统地确定岗位之间相对价值，建立健全岗位结构、岗位责任、岗位薪酬和岗位绩效等制度。医院岗位评价的研究在国外已相对成熟，而我国还处于探索阶段，且存在诸多问题，如缺乏岗位分析环节和验证环节、岗位评价要素体系不健全、岗位评价流程不规范、评价结果应用不深入等。由于三级综合医院规模大、岗位多、岗位管理问题复杂度高，代表性强，影响性大，因此，针对三级综合医院岗位评价模型的研究具有行业典型意义和示范作用。
本研究旨在创新构建适合我国三级综合医院的岗位评价模型，运用模型准确评价医院各岗位价值，为医院岗位管理和薪酬管理提供依据。本论文的主要内容包括：
第1章绪论。从我国卫生事业单位人事制度改革历程着笔，介绍了本论文的研究背景及意义、国内外研究现状、研究对象与目的、研究框架与内容、研究思路与方法、主要工作及创新性。
第2章岗位评价的理论概述。阐述岗位的概念及其分类、岗位评价的概念、作用、理论基础。重点论述了岗位评价的方法和国内外常用的医院岗位评价模型。
第3章三级综合医院岗位评价模型的构建。运用文献分析法、问卷调查法、焦点访谈法和专家讨论法初选评价要素；运用Delphi专家咨询法和医院岗位评价要素问卷调查筛选评价要素；运用因子分析法确定评价要素维度；运用专家评分法和方差分析法确定要素分级；运用层次分析法确定要素权重；运用结构方程模型和克朗巴哈系数检验所构建的要素体系。最终，创新构建了5维度23要素的三级综合医院岗位评价模型。
第4章三级综合医院岗位评价模型的优化。在运用所构建的三级综合医院岗位评价模型进行预评价的基础上，采用问卷调查法和访谈法对样本岗位进行岗位分析并制定岗位说明书；运用模糊综合评价法和评分者权重法对样本岗位的评分进行统计分析；运用一元概化理论对评分者信度进行研究；最后，运用多元概化理论检验三级综合医院岗位评价模型，并对模型进行优化。
第5章三级综合医院岗位评价模型的应用。根据所构建的医院岗位评价模型在北京某三级综合医院进行应用，梳理了岗位评价的实施流程，并阐述了岗位评价结果在岗位分级和薪酬管理方面的具体应用。
第6章结论与建议。总结讨论研究结论，对三级综合医院岗位评价模型的构建和应用提出相关建议，并总结了本研究的局限性和医院岗位评价的研究展望。
本研究主要成果及结论有：
（1）构建了三级综合医院岗位评价模型。该模型要素体系共包含5个评价维度23个评价要素，不同的评价要素划分为不同的级别，分别为：维度一，岗位责任，包括：患者服务职责（8级）、质量安全职责（6级）、管理决策与实施职责（5级）、财务与资产管理职责（6级）、人员管理职责（6级）、信息资源管理职责（6级）、科学研究职责（6级）；维度二，能力要求，包括：沟通与人际关系能力（5级）、操作能力（5级）、分析与判断能力（4级）、应对突发事件能力（5级）、创新能力（5级）、计划与组织能力（5级）；维度三，知识技能，包括：专业技术知识（8级）、经验（7级）、培训（5级）；维度四，强度与环境，包括体力强度（5级）、脑力强度（5级）、心理与精神强度（4级）、工作环境（5级）；维度五，工作特性，包括：工作自主性（6级）、工作关联系（5级）、工作时间特性（5级）。同时，根据不同要素的级别制定了详细的分级标准。
该模型评价维度权重分别为：0.364、0.285、0.146、0.117、0.088；评价要素权重分别为：0.084、0.070、0.060、0.047、0.040、0.034、0.030、0.065、0.061、0.057、0.030、0.041、0.029、0.076、0.040、0.032、0.026、0.034、0.031、0.026、0.034、0.031、0.022。
（2）该模型有较好的效度。运用探索性因子分析，提取的五个公因子累计贡献率达到79.39%，公因子的特征根均大于1。运用结构方程模型分析，五因素模型的χ2/df小于5，RMSEA值是0.06，拟合指标GFI、NFI、IFI、TLI、CFI均接近0.90，五因素模型各项指标都达到了拟合水平，显著优于单因素模型。
（3）该模型有较好的信度和区分度。通过对医院岗位评价模型的多元概化理论研究表明：全域总分的概化系数较高（0.969），显著高于各因子的概化系数，且相对误差方差分量（1.171）和绝对误差方差分量（2.232）均不算大，这说明岗位评价模型的总体信度较好。同时，各变异分量中岗位因素造成的方差变异最大，说明由岗位因素引起的变异是最主要因素，这也可以说明本次岗位评价体系具有较好的区分度，能较好的区分岗位间的价值差异。最后，比较各因子分值比例及其所对应的全域方差的贡献率可知，知识技能、能力要求、岗位责任、强度与环境、工作特性五个维度对全域总分的贡献与它们的权重基本持平，这表明医院岗位评价模型在各维度的分值比例比较合适。
（4）基于一元概化理论的评分者信度研究表明，医院高层领导和人力资源专家的评分者信度较高。因此，在计算岗位评分时可给与较高的权重。另外，在评价者数量方面，8～10个评价人员就可以满足医院岗位评价的信度要求。
（5）运用本模型在案例医院的评价结果表明，岗位价值按照高层管理岗位、中层管理岗位、基层管理岗位、一般员工岗位逐步递减；在同一层次上的岗位，临床科室的岗位价值大于医技科室和行政科室，后勤科室的岗位价值最小；临床科室里同等级别的医生岗位的价值大于护理岗位的价值。而具体的科室之间相同职务之间岗位价值的差异是由医院的具体实情和战略发展需要来决定的。
Hospitals can play very key role in the reformation and health-caring in China, in whichhuman resource management have been making some progress after years of working out.But there are still many problems such as: job and duty is separated, level is unclear,assessment is unclear, distributing is unfair and job-value is too low, existed in many ways.So, the reformation of hospital personnel system is necessary, and the hospitals go further forthe regulation of the Job-management centre with the development of reformation onmedical and healthcare system.
The best way to job-duty match and improve efficiency for the hospital is the jobmanagement. Job evaluation is the fundament of job management and human resourcemanagement, especially, basis of compensation management and performance evaluation. Itwould make clear to take value among jobs, establish and improve the system of jobstructure, obligation, wage and performance by scientific job evaluation. The research onhospital job evaluation is more mature in the developed countries, while is in the beginningof stages in China. The existing problems are lack of job analysis and inspection, theevaluation factor system is not perfect, the process is not standard, and the application ofresults is not in-depth. The level-three general hospital means big size, more jobs, highprofession, more complicated, strong representative and greater impact. Therefore, theresearch on the job evaluation model of level-three general hospital will play an importantrole.
The paper aims to construct a job evaluation model for the three-level general hospitalthrough systematic, scientific and innovational way, and expose the real value of jobs inhospitals, and provide the basis for job management and compensation management.
The framework and contain is as follow:
Chapter1Introduction It gives the background and meaning, the research status, theresearch object and purpose, the research frame and content, the research idea and method,the main work and innovation.
Chapter2The theory overview of job evaluation It explained the conception,function, theory foundation and principle theory, which apply in this paper. Specially, itintroduced the method and the typical hospital job evaluation model.
Chapter3To construct the job evaluation model for the three-level general hospital It had preliminary screened the evaluation factors by analyzing of the reference,questionnaire survey method, focus group interview and expert discussion method. It hadconfirmed the evaluation factors by Delphi and questionnaire of hospital job evaluationfactors. It had identified the evaluation dimensions by factor analysis. It had divided factorsgrade by expert marking method and analysis of variance. It had confirmed the weight offactors by analytic hierarchy process. It had tested the hospital job evaluation model bystructural equation model and Cronbach's α. Finally, it had constructed the job evaluationmodel for the three-level general hospital which includes five dimensions and twenty-threefactors.
Chapter4Optimization of the job evaluation model for the three-level generalhospital In the basis of pre-evaluate, it had researched job analysis and job description byquestionnaire method and interview method. It had statistical analyzed the result by fuzzyintegrated evaluation and evaluator weight method. It had researched the rater relability ofjob evaluation by univariate generalizability theory.It had verificated the job evaluationmodel by multivariate generalizability theory and further optimization of the model.
Chapter5Application of the job evaluation model for the three-level general hospitalThe job evaluation model was applied in a three-level general hospital of Beijing.
Chapter6Discuss and suggestion It had summarized the research conclusion, andput forward the helpful suggestion on the construction and application of the job evaluationmodel for three-level general hospital. At the same time, it had given the limitation andexpectation of the research.
The main result and conclusion is as follow:
(1) It had built the job evaluation model for the three-level general hospital, whichincluding five dimensions and twenty three factors. At the same time, different factors weredivided into different levels. The dimensions and factors are as follow: dimension one is jobresponsibility, which including patient care (eight levels),quality safety (sixlevels),management decision and Implementation (five levels),financial and assetmanagement (six levels), personnel management (six levels),information resourcesmanagement (six levels) and research and development (six levels). Dimension two iscapacity requirements, which including: communicational and relationship skills (five levels),physical skills (five levels), analytical and judgment skills (four levels), emergency responseskills (five levels), innovation skills (five levels), planning and organization skills (fivelevels).Dimension three is knowledge requirements, which including: professional knowledge (eight levels), experience (seven levels), training (five levels).Dimension four iseffort and environmental, which including: physical effort (five levels), mental effort (fivelevels),emotional effort (four levels),working conditions (five levels).Dimension five ischaracter of job, which including: freedom to act(six levels), working relevance(five levels),timing feather(five levels).
It had confirmed the weight of the dimension and the factor,the weight of thedimension is as follow:0.36、0.285、0.146、0.117、0.088；the weight of the factor is as follow:0.084、0.070、0.060、0.047、0.040、0.034、0.030、0.065、0.061、0.057、0.030、0.041、0.029、0.076、0.040、0.032、0.026、0.034、0.031、0.026、0.034、0.031、0.022。
(2) The job evaluation model has good validity. The result of factor analysis shown thatthe five common factors can contribute to reach at79.39%, and all of the characteristic rootsare bigger than one. The result of structural equation model shown thatχ2/df of fivefactors is smaller than five, RMSEA is0.06, fit index GFI、NFI、IFI、TLI、CFI is around0.90，all the targets in five factors had almost reach similar level, so it is favorite the singlefactor method.
(3) The job evaluation model has good reliability and distinction. The result ofmultivariate generalizability theory shown that the generalizability coefficient of compositeuniverse score (0.969) is significantly higher than each factor of generalizability coefficients,and the variance component of relative error (1.171)and absolute error(2.232) are not large,so the job evaluation model have good overall reliability. At the same time, the variationcomponent of job factors caused is the largest, so the job factor is the most important factor,and the job evaluation model has good distinction. Finally, the factor scores and thecontribution of composite universe score is basic agreement, so the score of each dimensionis reasonable in hospital job evaluation model.
(4) The result of univariate generalizability theory shown that the senior leaders and thehuman resources experts had higher evaluator reliability than middle leaders in hospital jobevaluation, so it can give higher weight in calculation of job evaluation scores. In addition,from eight to ten evaluators can meet the reliability requirement of job evaluation inhospitals.
(5) The result of job evaluation in case hospital indicated that the job value is gradualdecline according the sequence of senior manager, middle manager, basic manager andgeneral staff. On the same level, the value of the clinical post is greater than the medicaltechnology post and the administrative post, the value of the logistics post is relatively small, and the value of the doctor is greater than the nurse in clinical department. In addition, thereason for the difference in same kind of post which in different department is hospitalstrategy and development needs.
岗位管理是医院实现人岗匹配、提高工作效率的有效途径。而岗位评价是岗位管理的基础，是人力资源管理和组织管理的基石，是薪酬管理和绩效考核的重要依据。通过实施科学的岗位评价可以系统地确定岗位之间相对价值，建立健全岗位结构、岗位责任、岗位薪酬和岗位绩效等制度。医院岗位评价的研究在国外已相对成熟，而我国还处于探索阶段，且存在诸多问题，如缺乏岗位分析环节和验证环节、岗位评价要素体系不健全、岗位评价流程不规范、评价结果应用不深入等。由于三级综合医院规模大、岗位多、岗位管理问题复杂度高，代表性强，影响性大，因此，针对三级综合医院岗位评价模型的研究具有行业典型意义和示范作用。
本研究旨在创新构建适合我国三级综合医院的岗位评价模型，运用模型准确评价医院各岗位价值，为医院岗位管理和薪酬管理提供依据。本论文的主要内容包括：
第1章绪论。从我国卫生事业单位人事制度改革历程着笔，介绍了本论文的研究背景及意义、国内外研究现状、研究对象与目的、研究框架与内容、研究思路与方法、主要工作及创新性。
第2章岗位评价的理论概述。阐述岗位的概念及其分类、岗位评价的概念、作用、理论基础。重点论述了岗位评价的方法和国内外常用的医院岗位评价模型。
第3章三级综合医院岗位评价模型的构建。运用文献分析法、问卷调查法、焦点访谈法和专家讨论法初选评价要素；运用Delphi专家咨询法和医院岗位评价要素问卷调查筛选评价要素；运用因子分析法确定评价要素维度；运用专家评分法和方差分析法确定要素分级；运用层次分析法确定要素权重；运用结构方程模型和克朗巴哈系数检验所构建的要素体系。最终，创新构建了5维度23要素的三级综合医院岗位评价模型。
第4章三级综合医院岗位评价模型的优化。在运用所构建的三级综合医院岗位评价模型进行预评价的基础上，采用问卷调查法和访谈法对样本岗位进行岗位分析并制定岗位说明书；运用模糊综合评价法和评分者权重法对样本岗位的评分进行统计分析；运用一元概化理论对评分者信度进行研究；最后，运用多元概化理论检验三级综合医院岗位评价模型，并对模型进行优化。
第5章三级综合医院岗位评价模型的应用。根据所构建的医院岗位评价模型在北京某三级综合医院进行应用，梳理了岗位评价的实施流程，并阐述了岗位评价结果在岗位分级和薪酬管理方面的具体应用。
第6章结论与建议。总结讨论研究结论，对三级综合医院岗位评价模型的构建和应用提出相关建议，并总结了本研究的局限性和医院岗位评价的研究展望。
本研究主要成果及结论有：
（1）构建了三级综合医院岗位评价模型。该模型要素体系共包含5个评价维度23个评价要素，不同的评价要素划分为不同的级别，分别为：维度一，岗位责任，包括：患者服务职责（8级）、质量安全职责（6级）、管理决策与实施职责（5级）、财务与资产管理职责（6级）、人员管理职责（6级）、信息资源管理职责（6级）、科学研究职责（6级）；维度二，能力要求，包括：沟通与人际关系能力（5级）、操作能力（5级）、分析与判断能力（4级）、应对突发事件能力（5级）、创新能力（5级）、计划与组织能力（5级）；维度三，知识技能，包括：专业技术知识（8级）、经验（7级）、培训（5级）；维度四，强度与环境，包括体力强度（5级）、脑力强度（5级）、心理与精神强度（4级）、工作环境（5级）；维度五，工作特性，包括：工作自主性（6级）、工作关联系（5级）、工作时间特性（5级）。同时，根据不同要素的级别制定了详细的分级标准。
该模型评价维度权重分别为：0.364、0.285、0.146、0.117、0.088；评价要素权重分别为：0.084、0.070、0.060、0.047、0.040、0.034、0.030、0.065、0.061、0.057、0.030、0.041、0.029、0.076、0.040、0.032、0.026、0.034、0.031、0.026、0.034、0.031、0.022。
（2）该模型有较好的效度。运用探索性因子分析，提取的五个公因子累计贡献率达到79.39%，公因子的特征根均大于1。运用结构方程模型分析，五因素模型的χ2/df小于5，RMSEA值是0.06，拟合指标GFI、NFI、IFI、TLI、CFI均接近0.90，五因素模型各项指标都达到了拟合水平，显著优于单因素模型。
（3）该模型有较好的信度和区分度。通过对医院岗位评价模型的多元概化理论研究表明：全域总分的概化系数较高（0.969），显著高于各因子的概化系数，且相对误差方差分量（1.171）和绝对误差方差分量（2.232）均不算大，这说明岗位评价模型的总体信度较好。同时，各变异分量中岗位因素造成的方差变异最大，说明由岗位因素引起的变异是最主要因素，这也可以说明本次岗位评价体系具有较好的区分度，能较好的区分岗位间的价值差异。最后，比较各因子分值比例及其所对应的全域方差的贡献率可知，知识技能、能力要求、岗位责任、强度与环境、工作特性五个维度对全域总分的贡献与它们的权重基本持平，这表明医院岗位评价模型在各维度的分值比例比较合适。
（4）基于一元概化理论的评分者信度研究表明，医院高层领导和人力资源专家的评分者信度较高。因此，在计算岗位评分时可给与较高的权重。另外，在评价者数量方面，8～10个评价人员就可以满足医院岗位评价的信度要求。
（5）运用本模型在案例医院的评价结果表明，岗位价值按照高层管理岗位、中层管理岗位、基层管理岗位、一般员工岗位逐步递减；在同一层次上的岗位，临床科室的岗位价值大于医技科室和行政科室，后勤科室的岗位价值最小；临床科室里同等级别的医生岗位的价值大于护理岗位的价值。而具体的科室之间相同职务之间岗位价值的差异是由医院的具体实情和战略发展需要来决定的。
Hospitals can play very key role in the reformation and health-caring in China, in whichhuman resource management have been making some progress after years of working out.But there are still many problems such as: job and duty is separated, level is unclear,assessment is unclear, distributing is unfair and job-value is too low, existed in many ways.So, the reformation of hospital personnel system is necessary, and the hospitals go further forthe regulation of the Job-management centre with the development of reformation onmedical and healthcare system.
The best way to job-duty match and improve efficiency for the hospital is the jobmanagement. Job evaluation is the fundament of job management and human resourcemanagement, especially, basis of compensation management and performance evaluation. Itwould make clear to take value among jobs, establish and improve the system of jobstructure, obligation, wage and performance by scientific job evaluation. The research onhospital job evaluation is more mature in the developed countries, while is in the beginningof stages in China. The existing problems are lack of job analysis and inspection, theevaluation factor system is not perfect, the process is not standard, and the application ofresults is not in-depth. The level-three general hospital means big size, more jobs, highprofession, more complicated, strong representative and greater impact. Therefore, theresearch on the job evaluation model of level-three general hospital will play an importantrole.
The paper aims to construct a job evaluation model for the three-level general hospitalthrough systematic, scientific and innovational way, and expose the real value of jobs inhospitals, and provide the basis for job management and compensation management.
The framework and contain is as follow:
Chapter1Introduction It gives the background and meaning, the research status, theresearch object and purpose, the research frame and content, the research idea and method,the main work and innovation.
Chapter2The theory overview of job evaluation It explained the conception,function, theory foundation and principle theory, which apply in this paper. Specially, itintroduced the method and the typical hospital job evaluation model.
Chapter3To construct the job evaluation model for the three-level general hospital It had preliminary screened the evaluation factors by analyzing of the reference,questionnaire survey method, focus group interview and expert discussion method. It hadconfirmed the evaluation factors by Delphi and questionnaire of hospital job evaluationfactors. It had identified the evaluation dimensions by factor analysis. It had divided factorsgrade by expert marking method and analysis of variance. It had confirmed the weight offactors by analytic hierarchy process. It had tested the hospital job evaluation model bystructural equation model and Cronbach's α. Finally, it had constructed the job evaluationmodel for the three-level general hospital which includes five dimensions and twenty-threefactors.
Chapter4Optimization of the job evaluation model for the three-level generalhospital In the basis of pre-evaluate, it had researched job analysis and job description byquestionnaire method and interview method. It had statistical analyzed the result by fuzzyintegrated evaluation and evaluator weight method. It had researched the rater relability ofjob evaluation by univariate generalizability theory.It had verificated the job evaluationmodel by multivariate generalizability theory and further optimization of the model.
Chapter5Application of the job evaluation model for the three-level general hospitalThe job evaluation model was applied in a three-level general hospital of Beijing.
Chapter6Discuss and suggestion It had summarized the research conclusion, andput forward the helpful suggestion on the construction and application of the job evaluationmodel for three-level general hospital. At the same time, it had given the limitation andexpectation of the research.
The main result and conclusion is as follow:
(1) It had built the job evaluation model for the three-level general hospital, whichincluding five dimensions and twenty three factors. At the same time, different factors weredivided into different levels. The dimensions and factors are as follow: dimension one is jobresponsibility, which including patient care (eight levels),quality safety (sixlevels),management decision and Implementation (five levels),financial and assetmanagement (six levels), personnel management (six levels),information resourcesmanagement (six levels) and research and development (six levels). Dimension two iscapacity requirements, which including: communicational and relationship skills (five levels),physical skills (five levels), analytical and judgment skills (four levels), emergency responseskills (five levels), innovation skills (five levels), planning and organization skills (fivelevels).Dimension three is knowledge requirements, which including: professional knowledge (eight levels), experience (seven levels), training (five levels).Dimension four iseffort and environmental, which including: physical effort (five levels), mental effort (fivelevels),emotional effort (four levels),working conditions (five levels).Dimension five ischaracter of job, which including: freedom to act(six levels), working relevance(five levels),timing feather(five levels).
It had confirmed the weight of the dimension and the factor,the weight of thedimension is as follow:0.36、0.285、0.146、0.117、0.088；the weight of the factor is as follow:0.084、0.070、0.060、0.047、0.040、0.034、0.030、0.065、0.061、0.057、0.030、0.041、0.029、0.076、0.040、0.032、0.026、0.034、0.031、0.026、0.034、0.031、0.022。
(2) The job evaluation model has good validity. The result of factor analysis shown thatthe five common factors can contribute to reach at79.39%, and all of the characteristic rootsare bigger than one. The result of structural equation model shown thatχ2/df of fivefactors is smaller than five, RMSEA is0.06, fit index GFI、NFI、IFI、TLI、CFI is around0.90，all the targets in five factors had almost reach similar level, so it is favorite the singlefactor method.
(3) The job evaluation model has good reliability and distinction. The result ofmultivariate generalizability theory shown that the generalizability coefficient of compositeuniverse score (0.969) is significantly higher than each factor of generalizability coefficients,and the variance component of relative error (1.171)and absolute error(2.232) are not large,so the job evaluation model have good overall reliability. At the same time, the variationcomponent of job factors caused is the largest, so the job factor is the most important factor,and the job evaluation model has good distinction. Finally, the factor scores and thecontribution of composite universe score is basic agreement, so the score of each dimensionis reasonable in hospital job evaluation model.
(4) The result of univariate generalizability theory shown that the senior leaders and thehuman resources experts had higher evaluator reliability than middle leaders in hospital jobevaluation, so it can give higher weight in calculation of job evaluation scores. In addition,from eight to ten evaluators can meet the reliability requirement of job evaluation inhospitals.
(5) The result of job evaluation in case hospital indicated that the job value is gradualdecline according the sequence of senior manager, middle manager, basic manager andgeneral staff. On the same level, the value of the clinical post is greater than the medicaltechnology post and the administrative post, the value of the logistics post is relatively small, and the value of the doctor is greater than the nurse in clinical department. In addition, thereason for the difference in same kind of post which in different department is hospitalstrategy and development needs.
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