医疗工艺设计“三段论”

工艺设计是前期策划的重要内容在美国,医院前期策划的整个过程非常复杂,一个500㎡的医院项目,其前期策划对于医疗顾问来说需要1～1.5年的时间。前期策划的重要工作是工艺设计,可以说,前期策划的很多工作都是为工艺设计服务的。前期策划的流程之所以如此复杂,其出发点是要设计师广泛地了解相关的项目、条件,准确界定项     

前期策划，医院如何考虑，怎样入手？

建设一个项目对一个单位来讲，所产生的影响至少有几十年，对于建什么功能。先建什么后建什么。要达到什么样的目标，要建设什么样的标准，通过什么样的步骤和措施来实施。都要结合自身的特点和基础条件。进行必要的前期策划，以便系统的研究论证。而做好前期策划，首先就要做好医院的规划设计，只有科学的规划设计。才能提升医疗建筑的可持续发展能力。     

机电工程师的使命

建筑物内,机电专业有关的设施都是直接或间接为人服务的,对建筑的使用体验和效果起着重要的作用.在医疗建筑内更是如此,机电设施可以直接影响医学治疗的效果,是医疗安全的保证. 建筑工程机电工程师是指从事供配电、暖通空调、给水排水、动力工程及相关业务活动的高级专业技术人员.按我国现行注册工程师的设置和考试规定,与建筑有关的机电...     

基于医疗工程辅助设计平台的综合医院前期策划探究

通过对既有综合医院建筑数据进行统计、整理、分析,借助计算机软件技术、云端服务、统计学理论等手段,形成基于数据可视化、多方协同的医疗工程辅助设计数据平台,以弥补综合医院前期策划的不足。从项目管理、规范查询、辅助设计三大功能模块出发,为医院建筑设计相关从业人员提供直观的数字及图形参考,提高多方沟通和工作效率。     

高端医疗服务机构设计动态——高端医疗服务机构建筑设计现状及重点

日前，中国的高端医疗服务主要通过三个渠道进行：高端全科医院（诊所）、高端专科医院（诊所）和公立医院的高端服务部门。由于机构性质不同，高端医疗服务机构的规模和服务类型也有很大差异，所以建筑呈现出了多样化的特点。同时，由于服务对象的特殊性，其建筑具有与一般医疗机构的建筑不同的要求。本期特别策划，将为您展示高端医疗服务机构的建筑特点以及设计过程中的重点和独特之处。     

高端医疗服务机构设计动态

目前,中国的高端医疗服务主要通过三个渠道进行:高端全科医院(诊所)、高端专科医院(诊所)和公立医院的高端服务部门。由于机构性质不同,高端医疗服务机构的规模和服务类型也有很大差异,所以建筑呈现出了多样化的特点。同时,由于服务对象的特殊性,其建筑具有与一般医疗机构的建筑不同的要求。本期特别策划,将为您展示高端医疗服务机构的建筑特点以及设计过程中的重点和独特之处。     

关于召开“第四届现代医用工程技术与管理大会”的通知

<正>各级医院及有关单位:医院建设是集城市规划、城市设计、项目策划、土地利用规划、医疗空间规划、工艺流程设计、建筑工程设计、机电工程设计、绿色建筑(节能降耗)、医疗设施设计、医疗设备配置、室内设计、景观设     

医院建筑规划与设计的理性思考

通过对医院基建项目可行性研究及前期策划准备工作，探讨医院建筑规划、设计与建设 的科学性、经济性、实用性。医院建筑规划、设计与建设应“以病人为中心、以员工为本”，实施“人性 化”规划、设计与建设，符合医疗流程，满足医院对安全与感染的控制和管理。     

高端医疗服务机构生态设计

高端医疗服务机构为了提升其品质以及患者就医时的舒适度,人均能耗及资源占用都比普通医院高,如何实现这类建筑的生态化就更值得设计人员深思。特别需要指出的是,高端医疗设施的生态设计不应仅仅局限于"节能"设计,还要综合考虑建筑对人的健康、心理方面的影响,以及环保材料的应用和医院污物垃圾处理生态化。院区规划设计的生态策略*尊重当地气候特点和基地的现状高端医疗服务机构在规划中,需充分考虑当地气候特点。通过对基地自然环境的调研和分析,     

深化医院改革坚持改革创新

一、深化医院改革,坚持观念创新 (一)要树立竞争观念:随着社会主义市场经济体制的逐步确立,医疗卫生事业竞争也日趋激烈,从而使医院管理者直到普通医务人员都必须彻底转变观念.在保障广大群众对医疗服务具有自主选择权的前提下,通过质优价廉的医疗服务来赢得病人,占据医疗市场更多的份额.我院就此进一步改善门诊就诊、检查、治疗环境和住院诊疗设施,建立健全"以病人为中心"医疗优质服务体系,使病人享受到优质、高效、经济、文明、便捷的医疗服务,病人就诊人数大幅度增加.今年以来,门诊病人比去年同期增加了10.6%,住院病人比去年同期增加了25%.     

Meeting patient expectations: healthcare professionals and service re-engineering.

A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.     

东营市人民医院急诊急救中心暨内科病房综合楼工程设计

文章通过规划设计、单体设计、特色设计等,详细介绍了东营市人民医院新建急诊急救中心暨内科病房楼工程的设计和建设过程。该工程集急诊、部分门诊、医技、病房及保健等多功能于一体,可供基建工程管理者参考。     

An agent-based simulation model to study accountable care organizations

Creating accountable care organizations (ACOs) has been widely discussed as a strategy to control rapidly rising healthcare costs and improve quality of care; however, building an effective ACO is a complex process involving multiple stakeholders (payers, providers, patients) with their own interests. Also, implementation of an ACO is costly in terms of time and money. Immature design could cause safety hazards. Therefore, there is a need for analytical model-based decision-support tools that can predict the outcomes of different strategies to facilitate ACO design and implementation. In this study, an agent-based simulation model was developed to study ACOs that considers payers, healthcare providers, and patients as agents under the shared saving payment model of care for congestive heart failure (CHF), one of the most expensive causes of sometimes preventable hospitalizations. The agent-based simulation model has identified the critical determinants for the payment model design that can motivate provider behavior changes to achieve maximum financial and quality outcomes of an ACO. The results show nonlinear provider behavior change patterns corresponding to changes in payment model designs. The outcomes vary by providers with different quality or financial priorities, and are most sensitive to the cost-effectiveness of CHF interventions that an ACO implements. This study demonstrates an increasingly important method to construct a healthcare system analytics model that can help inform health policy and healthcare management decisions. The study also points out that the likely success of an ACO is interdependent with payment model design, provider characteristics, and cost and effectiveness of healthcare interventions.     

A novel open-source web-based platform promoting collaboration of healthcare professionals and biostatisticians: a design science approach

Collaboration among clinicians and statisticians is relatively poor, with many cases leading to poor quality research, reflected by low level of evidence studies published in the literature, thus affecting the overall quality of healthcare. We have developed a novel open-source web-based platform aiming in reinforcing the clinician-statistician relationship, using an iterative design research process by involving all end-users. Evaluation of this platform by healthcare professionals and biostatisticians was highly positive, as we first identified the pitfalls of their relationship and overcame them through the use of this platform. We are hoping that this will strengthen the clinician-statistician relationship in the short term and ultimately improve the quality of research and hence the quality of healthcare in the long term.     

基本卫生技术包应用研究概述

影响卫生服务提供绩效的主要因素之一是服务提供的过程（即临床诊疗流程）及所需的各类卫生技术（包括人力资源、设备、设施、药品等）.基本卫生技术包（EHTP）是一种优化临床诊疗流程和卫生技术配置的管理工具,可通过这种核心技术,对卫生技术实施优化干预,以促进和改善服务提供的绩效.作者介绍了基本卫生技术包的方法学原理、技术路线、研究设计和其在单病种质量管理中应用的可行性,以便为决策者提供循证依据,将有限的卫生技术投入到最具成本效果的服务项目上.     

An evolutionary approach to the architecture of effective healthcare delivery systems

PURPOSE: Aims to show that material flow concepts developed and successfully applied to commercial products and services can form equally well the architectural infrastructure of effective healthcare delivery systems. DESIGN/METHODOLOGY/APPROACH: The methodology is based on the "power of analogy" which demonstrates that healthcare pipelines may be classified via the Time-Space Matrix. FINDINGS: A small number (circa 4) of substantially different healthcare delivery pipelines will cover the vast majority of patient needs and simultaneously create adequate added value from their perspective. RESEARCH LIMITATIONS/IMPLICATIONS: The emphasis is firmly placed on total process mapping and analysis via established identification techniques. Healthcare delivery pipelines must be properly engineered and matched to life cycle phase if the service is to be effective. PRACTICAL IMPLICATIONS: This small family of healthcare delivery pipelines needs to be designed via adherence to very specific-to-purpose principles. These vary from "lean production" through to "agile delivery". ORIGINALITY/VALUE: The proposition for a strategic approach to healthcare delivery pipeline design is novel and positions much currently isolated research into a comprehensive organisational framework. It therefore provides a synthesis of the needs of global healthcare.     

Management challenges and markets

The scarcity of resources in healthcare systems has general causes and country-specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely on. Cost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each country.     

The Contribution of Conceptual Independence to IT Infrastructure Flexibility: The Case of openEHR

In the Netherlands demands on IT support in healthcare organizations are increasing. New visions on healthcare focus on patient-centered healthcare, where mutual consultation among healthcare professionals in the network becomes a standard process. Recent governmental regulations prescribe that patients must be able to access personal health records. IT flexibility is needed to allow organizations to meet new demands. In this study we focus on Conceptual Independence (CI) because CI, as a design principle, can improve the adaptability of Information Systems (IS). Software with CI operates on flexible data models that are independent of the CI based application. Therefore, it is claimed that a standalone IS becomes more flexible with CI. We extend the claim by demonstrating that CI affects the flexibility of the entire IT infrastructure. We investigate which dimensions of IT flexibility are responsible for the improvement. Multi-case study research has been performed following a mixed-methods approach in 10 mental healthcare organizations. Five have implemented openEHR, a proxy for CI, and five have not. Data has been collected with a questionnaire of IT infrastructure flexibility and semi-structured interviews. The data synthesis shows a positive effect of CI on IT flexibility, as CI increases the adaptability of IS, transparency and standardization of the IT infrastructure.     

Healthcare Reform and Disease Management in Italy

The 1999 reform of the Italian healthcare system has softened the effects of the 1992 shift to market mechanisms and competition within healthcare by promoting cooperation and partnerships among providers and Local Health Units (LHUs). In addition, it has facilitated the completion of transfering organizational and financial responsibility to the regional governments.Such health policy developments require both the introduction of administrative tools, which stimulates integration, and the design of a coherent policy for quality of care. A 3-fold integration between healthcare and social services has been promoted to tackle the introduction of administrative tools: institutional integration between municipalities and LHUs, managerial integration at the district level for the provision of primary care and non-hospital care, and professional integration between healthcare professionals. A similar approach has characterized the policy for quality of care: an essential benefit package is to be identified as a guarantee to all citizens, practice guidelines will be developed and implemented and an accreditation process is underway.Implementation issues aside, effective introduction of the suggested tools requires careful planning and organization of the system and, above all, coordinated interventions at the 3 levels of healthcare provision (i.e. the macro, intermediary and micro levels).     

A method to simulate incentives for cost containment under various cost sharing designs: an application to a first-euro deductible and a doughnut hole

Many health insurance schemes include deductibles to provide consumers with cost containment incentives (CCI) and to counteract moral hazard. Policymakers are faced with choices on the implementation of a specific cost sharing design. One of the guiding principles in this decision process could be which design leads to the strongest CCI. Despite the vast amount of literature on the effects of cost sharing, the relative effects of specific cost sharing designs—e.g., a traditional deductible versus a doughnut hole—will mostly be absent for a certain context. This papers aims at developing a simulation model to approximate the relative effects of different deductible modalities on the CCI. We argue that the CCI depends on the probability that healthcare expenses end up in the deductible range and the expected healthcare expenses given that they end up in the deductible range. Our empirical application shows that different deductible modalities result in different CCIs and that the CCI under a certain modality differs across risk-groups.