基于需求与能力管理的医院服务运作管理研究
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摘要
随着我国经济和社会的持续不断发展,群众对医疗保健的需求不断增长、对医院的期望也不断上升,由此带来医院管理内容、管理方法以及管理手段等一系列变化。目前,我国医院面临的急需要解决的难题就是,如何缓解老百姓“看病难、看病贵”、如何提高社会公众的看病就医满意度以及如何提高医院服务质量与管理效率等。本文从提高患者满意度和提高医院服务运作管理水平的角度出发,基于需求与能力管理对医院服务运作管理问题进行分析与研究。
本文的主要研究内容包括：(1)医院服务运作管理相关问题现状调研。分别进行了“医院预约挂号现状调研”、“患者时间与价格敏感度现状调研”这两个方面的现状调研；通过先后两次实地调研数据的采集与对应数据的分析,分别得出了相关的调研结论及相关对策建议。(2)一方面,针对现状调研中---“医院预约挂号现状调研”方面问题进行的相关研究,通过流程管理理论的引入,运用理论模型和数值模拟的方法,得到了医院预约挂号管理的策略。(3)另一方面,针对现状调研中---“患者时间与价格敏感度现状调研”方面问题进行的相关研究,通过需求管理理论的引入,运用理论模型分析的方法,得到了供需匹配下医院的需求与能力管理策略。(4)针对“患者时间与价格敏感度现状调研”方面问题、在需求管理策略研究内容的基础之上,从医院方(即供方)的角度出发,通过医院的主动需求管理对医疗资源设备分配进行相关研究。(5)针对“患者时间与价格敏感度现状调研”方面问题、在需求管理策略研究内容的基础之上,从患者需求(即需方)的角度出发,通过医院的主动需求管理对患者需求转移及医疗资源匹配进行的相关研究。
在本文的研究过程中,得到的主要研究结论如下：(1)一方面,虽然已经有大部分的患者了解并支持预约挂号,但是患者对于预约挂号的实际使用率却非常的低。针对“预约挂号现状调研”情况及结论,首先可以通过相关的研究来有力支撑预约挂号较现场挂号的优势,其次就应该通过现实的实际行动来推行预约挂号方式。另一方面,参与调研的绝大部分患者都是时间不敏感型与价格敏感型的,要进一步改进医院需求与资源匹配管理现状,首先可以通过相关的研究来支撑需求与资源相互匹配时较需求与资源严重不匹配的优势,其次就应该通过现实的实际行动(分别从供方与需方的角度),来逐步地推动医院就诊环节中需求与资源匹配的实际问题。(2)医院现场挂号系统存在一个最大可容纳患者数；预约挂号系统也存在一个最优预约量；影响最优预约量的因素可分为患者因素和医院因素。(3)通过医院需求管理排队模型的分析研究得到：系统能力相对弹性,资源的利用率提高；系统空闲概率变小,资源利用率提高；当需求随机性减小时,系统排队相对减少,资源利用率提高。(4)门诊患者的最优预订限额、紧急患者的资源保留水平都是可求解的；如果已接受的门诊患者预约数小于最优预订限额,则接受门诊患者新预约请求,反之拒绝；可通过相关影响因素来调节该最优预订限额。(5)采用挂号费优惠折扣可为患者节省大量的等待时间,并提高患者就医的满意度；在实行诊疗费用的折扣优惠之后,排队候诊的患者等候人数可基本趋于较平稳状态,可将一周之内的医生工作强度调节到一个较为平稳的状态；在实行护理床位费折扣优惠后,排队等候住院的患者数可得到较大幅度降低；既能够提高患者接受住院护理的满意度,同时又能够为护士资源的合理分配带来好处。
本文的创新点如下：(1)在第3章中对基于需求与能力管理的医院预约挂号管理策略进行了研究,提出了医院采用服务预订的方式,可以通过预约挂号的方式展开；构建了患者总挂号成本度量模型,通过模型分析与讨论得到：预约挂号系统存在一个最优预约量,任何一个大于或小于最优预约量的预约量都会增加患者总挂号成本,同时影响最优预约量的因素分别为患者因素和医院因素。(2)在第4章中对供需匹配下的医院需求与能力管理策略进行了研究,提出了医院需求管理阶段的划分与各阶段特征；以收益管理中供需匹配的核心思想,建立了医院服务运作系统的排队模型,通过对该模型指标体系的分析得到：要提高医院人员设备等医疗服务资源的利用率,可以通过以下两个方面进行：一是在一定范围内提高医院服务能力,二是通过医院需求管理来适当减少服务需求的随机性。(3)在第5章中基于需求与能力管理思想,从供方角度研究医疗设备资源的分配管理,建立了预订限额的医疗设备分配的决策树模型,通过研究医疗设备在普通门诊患者与紧急患者之间的能力分配问题,结果表明：门诊患者的最优预订限额、紧急患者的资源保留水平都是可求解的；如果已接受的门诊患者预约数小于最优预订限额,则接受门诊患者新预约请求,反之拒绝；此外,医院方还可以依据自身的实际情况,通过调整相关影响因素来提高或降低门诊患者的最优预订限额。(4)在第6章中基于需求与能力管理思想,从需方角度研究患者需求转移及医疗资源匹配管理,分别建立了患者挂号、诊疗、床位住院的三个不同环节的患者需求转移模型,模型分析结果表明：通过患者的需求转移,是能够实现充分利用医疗资源、提高服务质量与提高患者看病就医满意度的这样一个和谐统一的目标。
综合以上,本论文运用需求与能力管理理论与方法对医院服务运作管理进行研究,是希望通过收益管理的思路(包括：市场细分、差异化资源配置、提高服务效率)为缓解老百姓反映的“看病难、看病贵”等医疗服务问题提供一个新的研究视角。本文以现状调研中发现的问题为研究基础,针对“医院预约挂号现状调研”和“患者时间与价格敏感度现状调研”这两个问题开展研究。本文所得到的模型、方法、定理以及管理策略具有较强的创新性,并对现阶段我国医院的服务运作管理具有参考与应用价值。
With the continual development of economy and society, the requirement to hospital has been growing rapidly, therefore, the service function and task of hospital have been extended gradually, and there have been a series of changes on hospital's management contents, methods and means. Now the important problem that hospital is facing is how to solve the problem of common people called "seeing a doctor is difficult, seeing a doctor is expensive", how to improve the satisfaction degree from patient to hospital service, and how to enhance hospital service efficiency and quality, In this paper, in order to increase patient's satisfaction degree to hospital service and also improve hospital's service operation management, demand and ability management theory based model and method are studied.
The main content of this dissertation is as the following,(a) Basing on the summary of relative reference, domestic and foreign research on the demand and ability management and hospital service operation management problem is summarized. In order to well know the real situation of hospital service operation management, the facts of appointment®istration management, and also supply-demand match, are investigated and analyzed,(b) Demand and ability management theory based methods and models for hospital service operation management are studied, which includes hospital demand management, medical resource optimal management and business flow optimal management, furthermore, the models suitable to hospital service operation management are analyzed,(c) Demand and ability management theory based appointment®istration management method and medical equipment resource optimal management method are studied,(d) Demand and ability management theory based patient demand transfer management method and medical resource optimal management method are studied. Firstly, with queue theory's application, patient demand transfer management is studied with model establishment and simulation analysis. Secondly, with queue theory's application, the diagnosis and treat demand of patient, and also hospital management strategy for doctors, are discussed with model establishment and simulation analysis. Thirdly, also with queuing theory's application, in-patient's demand and hospital management strategy for nurses, are discussed with model establishment and simulation analysis.
The main conclusions of this dissertation are as the following,(a) Most of the outpatients have known there is appointment method for them, but appointment method's using rate is very low in fact. The outpatient appointments method can be an important chance to solve the "seeing a doctor is difficult, seeing a doctor is expensive" problem. However, to solve this problem in root, it would need government, patient, and hospital's working together, at the same time, hospital should endeavor for satisfying patient and offering them more convenience,(b) There is a maximum acceptance patients'number in hospital registration system, and hospital should control patients'number less than the maximum number, otherwise the waiting time of patient would be longer and longer. There is an optimal appointment patients'number in hospital registration system, and any other appointment number would increase the cost of patients'registration. There are two effect factors of optimal appointment patients'number, which are patients'factor and hospital's factor. The former is the waiting time value of patients, which is positive correlative to the number, and the latter is negative correlative to the number, which are handling charge, service windows for registration, service speed and working time for registration, one of the hospital's factors which is the patients'total number, is positive correlative to the number. These two effect factors could advance or reduce the optimal appointment patients' number, so hospital should be taken them into account,(c) Patient's optimal appointment limitation number and emergency patient's resource keeping level are existed and the relevant expression equation can be constructed. If patient number is less than the limitation, a new appointment should be accepted, otherwise should be refused. The cost of increasing a patient's checking was negative correlative to the limitation number, and the cost of refuse a patient, the profit of accept a patient; the cost of medical treatment leave unused was positive correlative to the limitation number,(d) The registration charge's change can save the waiting time, and improve the satisfaction of patient. After the management of patient's requirement transfer, total patient number distribution can be balanced instead of fluctuating in one week, which is beneficial to hospital management,(e) The diagnosis and treatment charge's change can decrease the waiting number of patient who desires to get medical treatment. After changing the charge, doctor's workload can be balanced instead of fluctuating in one week, which is beneficial to hospital's doctor resource management,(f) The change of inpatient treatment charge can decrease the waiting number of patient who desires to get treatment as inpatient. After changing the charge, nurse's workload can be balanced instead of fluctuating in one week, which is beneficial to hospital's nurse resource management.
The innovation points of the dissertation are as the following,(a) In chapter3, the patient's appointment registration management policy based on Demand and Ability Management was researched, after the service booking introduced from revenue management into hospital service operation management, the cost measurement model was developed, and got:There is a maximum acceptance patients'number in hospital registration system, and any other appointment number would increase the cost of patients' registration. There are two effect factors of optimal appointment patients'number, which are patients'factor and hospital's factor,(b) In chapter4, the hospital's demand and ability management policy based on supply&demand matching was researched, after the supply match with demand introduced from revenue management into hospital service operation management, the service operation model was developed, and got:we could from two aspects to advance the using efficiency, one was advancing the hospital's service ability in some scope, the other was reducing the service demand randomicity.(c) In chapter5, basing on demand and ability management was introduced into capability management method and decision-tree model, patient optimal appointment limitation decision-tree model was constructed, and got:the expression equations for outpatient optimal appointment limitation number and emergent patient resource keeping level are formed. If patient number is less than the limitation, a new appointment should be accepted, otherwise should be refused. The correlative effect factor can be advanced or reduced to the limitation number from the hospital fact,(d) In chapter6, basing on demand and ability management was introduced into capability management method and queuing model, the indicators for hospital registration queuing system, hospital doctor treatment queuing system and hospital inpatient queuing system are formed, furthermore, patient total wait time cost measurement model, changed registration charge based patient requirement transfer model, changed diagnosis&treat charge based patient demand transfer model and changed inpatient medical nursing charge based patient demand transfer model are established. With simulation for the above model, some methods and strategies are put forward, which are for patient cost minimization, patient seeing-doctor requirement transfer, patient medical treatment requirement transfer and relevant doctor resource matching, and inpatient requirement transfer and relevant nurse resource matching. The above methods and strategies are effective to increase hospital service efficiency and patient seeing-doctor satisfaction degree.
In this paper, demand and ability management based hospital service operation management method is analyzed and studied. The whole research work is based on fact survey, indicator system set-up, model and method formation, and simulation analysis etc. The models, method and management strategy constructed and put forward in this paper are valuable to hospital service operation management practice.
本文的主要研究内容包括：(1)医院服务运作管理相关问题现状调研。分别进行了“医院预约挂号现状调研”、“患者时间与价格敏感度现状调研”这两个方面的现状调研；通过先后两次实地调研数据的采集与对应数据的分析,分别得出了相关的调研结论及相关对策建议。(2)一方面,针对现状调研中---“医院预约挂号现状调研”方面问题进行的相关研究,通过流程管理理论的引入,运用理论模型和数值模拟的方法,得到了医院预约挂号管理的策略。(3)另一方面,针对现状调研中---“患者时间与价格敏感度现状调研”方面问题进行的相关研究,通过需求管理理论的引入,运用理论模型分析的方法,得到了供需匹配下医院的需求与能力管理策略。(4)针对“患者时间与价格敏感度现状调研”方面问题、在需求管理策略研究内容的基础之上,从医院方(即供方)的角度出发,通过医院的主动需求管理对医疗资源设备分配进行相关研究。(5)针对“患者时间与价格敏感度现状调研”方面问题、在需求管理策略研究内容的基础之上,从患者需求(即需方)的角度出发,通过医院的主动需求管理对患者需求转移及医疗资源匹配进行的相关研究。
在本文的研究过程中,得到的主要研究结论如下：(1)一方面,虽然已经有大部分的患者了解并支持预约挂号,但是患者对于预约挂号的实际使用率却非常的低。针对“预约挂号现状调研”情况及结论,首先可以通过相关的研究来有力支撑预约挂号较现场挂号的优势,其次就应该通过现实的实际行动来推行预约挂号方式。另一方面,参与调研的绝大部分患者都是时间不敏感型与价格敏感型的,要进一步改进医院需求与资源匹配管理现状,首先可以通过相关的研究来支撑需求与资源相互匹配时较需求与资源严重不匹配的优势,其次就应该通过现实的实际行动(分别从供方与需方的角度),来逐步地推动医院就诊环节中需求与资源匹配的实际问题。(2)医院现场挂号系统存在一个最大可容纳患者数；预约挂号系统也存在一个最优预约量；影响最优预约量的因素可分为患者因素和医院因素。(3)通过医院需求管理排队模型的分析研究得到：系统能力相对弹性,资源的利用率提高；系统空闲概率变小,资源利用率提高；当需求随机性减小时,系统排队相对减少,资源利用率提高。(4)门诊患者的最优预订限额、紧急患者的资源保留水平都是可求解的；如果已接受的门诊患者预约数小于最优预订限额,则接受门诊患者新预约请求,反之拒绝；可通过相关影响因素来调节该最优预订限额。(5)采用挂号费优惠折扣可为患者节省大量的等待时间,并提高患者就医的满意度；在实行诊疗费用的折扣优惠之后,排队候诊的患者等候人数可基本趋于较平稳状态,可将一周之内的医生工作强度调节到一个较为平稳的状态；在实行护理床位费折扣优惠后,排队等候住院的患者数可得到较大幅度降低；既能够提高患者接受住院护理的满意度,同时又能够为护士资源的合理分配带来好处。
本文的创新点如下：(1)在第3章中对基于需求与能力管理的医院预约挂号管理策略进行了研究,提出了医院采用服务预订的方式,可以通过预约挂号的方式展开；构建了患者总挂号成本度量模型,通过模型分析与讨论得到：预约挂号系统存在一个最优预约量,任何一个大于或小于最优预约量的预约量都会增加患者总挂号成本,同时影响最优预约量的因素分别为患者因素和医院因素。(2)在第4章中对供需匹配下的医院需求与能力管理策略进行了研究,提出了医院需求管理阶段的划分与各阶段特征；以收益管理中供需匹配的核心思想,建立了医院服务运作系统的排队模型,通过对该模型指标体系的分析得到：要提高医院人员设备等医疗服务资源的利用率,可以通过以下两个方面进行：一是在一定范围内提高医院服务能力,二是通过医院需求管理来适当减少服务需求的随机性。(3)在第5章中基于需求与能力管理思想,从供方角度研究医疗设备资源的分配管理,建立了预订限额的医疗设备分配的决策树模型,通过研究医疗设备在普通门诊患者与紧急患者之间的能力分配问题,结果表明：门诊患者的最优预订限额、紧急患者的资源保留水平都是可求解的；如果已接受的门诊患者预约数小于最优预订限额,则接受门诊患者新预约请求,反之拒绝；此外,医院方还可以依据自身的实际情况,通过调整相关影响因素来提高或降低门诊患者的最优预订限额。(4)在第6章中基于需求与能力管理思想,从需方角度研究患者需求转移及医疗资源匹配管理,分别建立了患者挂号、诊疗、床位住院的三个不同环节的患者需求转移模型,模型分析结果表明：通过患者的需求转移,是能够实现充分利用医疗资源、提高服务质量与提高患者看病就医满意度的这样一个和谐统一的目标。
综合以上,本论文运用需求与能力管理理论与方法对医院服务运作管理进行研究,是希望通过收益管理的思路(包括：市场细分、差异化资源配置、提高服务效率)为缓解老百姓反映的“看病难、看病贵”等医疗服务问题提供一个新的研究视角。本文以现状调研中发现的问题为研究基础,针对“医院预约挂号现状调研”和“患者时间与价格敏感度现状调研”这两个问题开展研究。本文所得到的模型、方法、定理以及管理策略具有较强的创新性,并对现阶段我国医院的服务运作管理具有参考与应用价值。
With the continual development of economy and society, the requirement to hospital has been growing rapidly, therefore, the service function and task of hospital have been extended gradually, and there have been a series of changes on hospital's management contents, methods and means. Now the important problem that hospital is facing is how to solve the problem of common people called "seeing a doctor is difficult, seeing a doctor is expensive", how to improve the satisfaction degree from patient to hospital service, and how to enhance hospital service efficiency and quality, In this paper, in order to increase patient's satisfaction degree to hospital service and also improve hospital's service operation management, demand and ability management theory based model and method are studied.
The main content of this dissertation is as the following,(a) Basing on the summary of relative reference, domestic and foreign research on the demand and ability management and hospital service operation management problem is summarized. In order to well know the real situation of hospital service operation management, the facts of appointment®istration management, and also supply-demand match, are investigated and analyzed,(b) Demand and ability management theory based methods and models for hospital service operation management are studied, which includes hospital demand management, medical resource optimal management and business flow optimal management, furthermore, the models suitable to hospital service operation management are analyzed,(c) Demand and ability management theory based appointment®istration management method and medical equipment resource optimal management method are studied,(d) Demand and ability management theory based patient demand transfer management method and medical resource optimal management method are studied. Firstly, with queue theory's application, patient demand transfer management is studied with model establishment and simulation analysis. Secondly, with queue theory's application, the diagnosis and treat demand of patient, and also hospital management strategy for doctors, are discussed with model establishment and simulation analysis. Thirdly, also with queuing theory's application, in-patient's demand and hospital management strategy for nurses, are discussed with model establishment and simulation analysis.
The main conclusions of this dissertation are as the following,(a) Most of the outpatients have known there is appointment method for them, but appointment method's using rate is very low in fact. The outpatient appointments method can be an important chance to solve the "seeing a doctor is difficult, seeing a doctor is expensive" problem. However, to solve this problem in root, it would need government, patient, and hospital's working together, at the same time, hospital should endeavor for satisfying patient and offering them more convenience,(b) There is a maximum acceptance patients'number in hospital registration system, and hospital should control patients'number less than the maximum number, otherwise the waiting time of patient would be longer and longer. There is an optimal appointment patients'number in hospital registration system, and any other appointment number would increase the cost of patients'registration. There are two effect factors of optimal appointment patients'number, which are patients'factor and hospital's factor. The former is the waiting time value of patients, which is positive correlative to the number, and the latter is negative correlative to the number, which are handling charge, service windows for registration, service speed and working time for registration, one of the hospital's factors which is the patients'total number, is positive correlative to the number. These two effect factors could advance or reduce the optimal appointment patients' number, so hospital should be taken them into account,(c) Patient's optimal appointment limitation number and emergency patient's resource keeping level are existed and the relevant expression equation can be constructed. If patient number is less than the limitation, a new appointment should be accepted, otherwise should be refused. The cost of increasing a patient's checking was negative correlative to the limitation number, and the cost of refuse a patient, the profit of accept a patient; the cost of medical treatment leave unused was positive correlative to the limitation number,(d) The registration charge's change can save the waiting time, and improve the satisfaction of patient. After the management of patient's requirement transfer, total patient number distribution can be balanced instead of fluctuating in one week, which is beneficial to hospital management,(e) The diagnosis and treatment charge's change can decrease the waiting number of patient who desires to get medical treatment. After changing the charge, doctor's workload can be balanced instead of fluctuating in one week, which is beneficial to hospital's doctor resource management,(f) The change of inpatient treatment charge can decrease the waiting number of patient who desires to get treatment as inpatient. After changing the charge, nurse's workload can be balanced instead of fluctuating in one week, which is beneficial to hospital's nurse resource management.
The innovation points of the dissertation are as the following,(a) In chapter3, the patient's appointment registration management policy based on Demand and Ability Management was researched, after the service booking introduced from revenue management into hospital service operation management, the cost measurement model was developed, and got:There is a maximum acceptance patients'number in hospital registration system, and any other appointment number would increase the cost of patients' registration. There are two effect factors of optimal appointment patients'number, which are patients'factor and hospital's factor,(b) In chapter4, the hospital's demand and ability management policy based on supply&demand matching was researched, after the supply match with demand introduced from revenue management into hospital service operation management, the service operation model was developed, and got:we could from two aspects to advance the using efficiency, one was advancing the hospital's service ability in some scope, the other was reducing the service demand randomicity.(c) In chapter5, basing on demand and ability management was introduced into capability management method and decision-tree model, patient optimal appointment limitation decision-tree model was constructed, and got:the expression equations for outpatient optimal appointment limitation number and emergent patient resource keeping level are formed. If patient number is less than the limitation, a new appointment should be accepted, otherwise should be refused. The correlative effect factor can be advanced or reduced to the limitation number from the hospital fact,(d) In chapter6, basing on demand and ability management was introduced into capability management method and queuing model, the indicators for hospital registration queuing system, hospital doctor treatment queuing system and hospital inpatient queuing system are formed, furthermore, patient total wait time cost measurement model, changed registration charge based patient requirement transfer model, changed diagnosis&treat charge based patient demand transfer model and changed inpatient medical nursing charge based patient demand transfer model are established. With simulation for the above model, some methods and strategies are put forward, which are for patient cost minimization, patient seeing-doctor requirement transfer, patient medical treatment requirement transfer and relevant doctor resource matching, and inpatient requirement transfer and relevant nurse resource matching. The above methods and strategies are effective to increase hospital service efficiency and patient seeing-doctor satisfaction degree.
In this paper, demand and ability management based hospital service operation management method is analyzed and studied. The whole research work is based on fact survey, indicator system set-up, model and method formation, and simulation analysis etc. The models, method and management strategy constructed and put forward in this paper are valuable to hospital service operation management practice.
引文
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