Hospital investigation report

# Report # Introduction Township hospitals are an important link in the construction of rural health service system. The following is the survey report of the health center, welcome to read!

A survey report of a health center

The situation of township hospitals is directly related to the quality of medical care and the health of rural people. Township hospitals are an important link in the construction of rural health service system. In order to fully understand the current situation of military township hospitals, understand the existing problems and factors restricting the development of hospitals, I recently conducted an investigation on the construction of military township hospitals with this problem, analyzed the crux problems restricting the development of primary medical care, and sought solutions. Through discussion, visiting, consulting relevant materials and on-the-spot understanding, the basic situation of military township hospitals was investigated, and the investigation situation was summarized as follows: 1. Basic situation of military township hospitals construction.

Junsai Township is located in the southeast of * * County, 98km away from the county seat, and it is the junction of * * County, * * County and * * County. Within the township 186. 18km2, the forest coverage rate is 4 1%, the altitude is 2978m, and the lowest altitude is 530m, so the climate is quite different.

The township has jurisdiction over 6 village committees, 43 natural villages and 69 villagers' groups. The population of Han, Wa, Lahu, Lisu and De 'ang ethnic minorities is 1 1, and the minority population accounts for 44% of the total population. It is a nationality township in * * county, too. 20 19 rural population 12880, per capita net income of 4069 yuan.

There are 7 medical institutions in the township, including hospitals 1 and 6 village clinics. The hospital covers an area of 10 mu, with a building area of 3,348 ㎡ (including the comprehensive business building area of 1564㎡), of which the dangerous building area of 1264㎡ accounts for 37% of the building area. There are 34 employees in the hospital (including regular employees 12 and temporary workers 22), 3 practicing doctors, 4 practicing assistant doctors and professional nurses 1 person.

There are 6 village clinics in the township, with a construction area of 60m2 (including 2 brick-concrete structures and 4 brick-wood structures). At present, there are 0/0 village doctors, including 6 male village doctors, 4 female village doctors (2 missing), 4 village doctors with high school education or above and 6 village doctors with junior high school education or below.

Second, the difficulties and problems in the development process

1, the staffing is insufficient (approved staffing 12, actual staffing 12), the phenomenon of professional and technical personnel taking part-time jobs is prominent, and the work efficiency is low. The health center has hired 22 temporary workers to fill the shortage of jobs to meet the needs of work.

2. The funding gap for the construction of the comprehensive business building is too large. The main project investment is 2.86 million yuan, and the auxiliary project investment is about 320,000 yuan. At present, the funds in place are 6.5438+0.9 million yuan, including 6.5438+0.3 million yuan for projects and 6.5438+0.2 million yuan for county-level funds. Due to the limited income-generating capacity of health centers and economic difficulties, a large number of temporary workers have to be paid every month.

3. The hospital sends many people to study every year, but the shortage of talents still exists in the short term, especially the lack of academic leaders with strong professional ability.

4. The infrastructure is backward, and there is a serious shortage of studios and wards. The workshop is 663.84 square meters, including dangerous building 138 square meters and staff dormitory (dangerous building) 1 120.6 square meters. With the completion of the new comprehensive building, the problem of room shortage will be solved.

5. Due to the lack of medical and health investment for many years, the foundation of hospitals is weak, and it is impossible to invest more money to update medical equipment in time, resulting in hospitals with only basic medical equipment, which is outdated and crude. Compared with hospitals at the same level, the medical equipment used in hospitals is relatively backward and insufficient, which can no longer meet the medical needs.

6. The quality of filing and management of basic public health services needs to be further improved, especially the health management of pregnant women, children and chronic diseases needs to be strengthened. Diabetes and hypertension are difficult to treat. First, doctors in hospitals and clinics have poor professional skills and irregular treatment. Second, the varieties of drugs for treating diabetes and hypertension are relatively insufficient; Third, patients' awareness of taking the initiative to receive physical examination and treatment is not strong; Fourth, influenced by local customs and habits, it is difficult to interfere with healthy eating habits. Due to the influence of traffic, it is difficult for the elderly living in mountainous areas to have the opportunity to receive comprehensive health examination in health centers, thus affecting the improvement of system management rate.

7. In the actual operation process, the contradiction between basic public health services and human resources has become increasingly obvious, which is mainly manifested in the following three aspects: first, there is a shortage of hospital staff, there is no formal full-time staff management in public health, disease prevention and maternal and child health care, and the situation of regular and part-time staff is special, so it is necessary to hire temporary workers to manage this work, coupled with the low salary of temporary workers (1300-65430), and second, the history of village doctors is generally low. At present, a certain number of rural doctors have only primary school education. This part of village doctors have less literacy, limited acceptance and great difficulty in work, which leads to low quality of work and service; Third, the village clinics are understaffed, especially those where ethnic minorities live in mountainous areas. There is a shortage of local talents, and professional and technical personnel outside are unwilling to go or can't stay. This situation is still unresolved, which affects the overall quality of work.

8. "Pay more attention to medical treatment than prevention". For a long time, the phenomenon of "attaching importance to medical treatment but neglecting prevention" in township hospitals is very serious. At present, the number of prevention and care personnel in township hospitals is too small, and their quality is low, which greatly reduces the effect of prevention and care work in township hospitals. Providing public health services should be the focus of township hospitals. However, due to the current system, the county, township and village health institutions that originally cooperated with each other in functions have gradually changed into comprehensive competition. In this case, because public health service can not bring obvious benefits, it is gradually weakened, which leads to the continuous development of township health "emphasizing medicine and neglecting prevention".

As a "sandwich layer", township hospitals are inferior to village clinics in terms of convenience and service price in the medical field, and the medical level is difficult to compare with urban hospitals, so they are gradually lagging behind in the competition. In recent years, with the government's increasing attention to rural health work, some policies that benefit township hospitals have been introduced one after another, improving the hardware facilities of township hospitals. The "new rural cooperative medical system" is inclined to township hospitals in reimbursement. In addition, the development of the "18th National Health Work" has also brought development opportunities for it. However, these policies only "resurrected" the township hospitals to maintain their normal operation, and did not make substantial contributions to the return of township hospitals to their original positions. Most township hospitals are still marching on the old road of "attaching importance to medical treatment and neglecting prevention".

Three. Suggestions on the next work of township hospitals in military competition

1, continue to strengthen personnel training, according to the actual needs of the hospital, arrange personnel to further study in higher medical institutions in a targeted manner, and strive to complete the training of all hospital staff in 2-3 years, and 90% of the staff in village clinics will go to the hospital for rotation training, so that all front-line departments will have a subject leader, and the comprehensive service capacity of the hospital will reach a higher level.

2. Complete the comprehensive building construction project and put it into use as soon as possible in the near future. Strive to achieve standardized and standardized operation and strive to develop into a grade hospital.

3, continue to strengthen basic public health services, focusing on strengthening the service management level of special groups, to ensure that the quality of dynamic management of pregnant women, children aged 0-6, elderly people over 65, hypertension and diabetes has been greatly improved. Strengthen the management of high-risk pregnant women, 100% will bring high-risk pregnant women into the system, 100% will realize hospital delivery and put an end to maternal death.

4. Strengthen health education and publicity, change the way of publicity, and improve the awareness rate of people's health knowledge.

5. Strengthen the standardized management of paper files and electronic files, and at the same time strengthen the input management of electronic files of village doctors, so that village doctors can fully master computer operation technology and make the dynamic management records of special people electronic and normal.

6, strengthen the project fund management, to ensure earmarking, every work of village doctors must be audited and verified before compensation funds can be issued, and distributed to village doctors on time to ensure the efficient operation of public health work.

7, continue to strengthen the standardization of village clinics, improve the service level of village doctors, improve the medical environment of village clinics, improve the comfort of people seeking medical treatment, and meet the medical needs of the people.

8. Efforts should be made to standardize the construction of health centers, improve their comprehensive service capacity and competitiveness, and expand medical coverage, from the current service population of 6.5438+0.3 million to the population of the surrounding three counties, and strive to increase medical income to 3-4 million yuan within two years, so as to build health centers into garden-style health centers that the masses are satisfied with.

Fourthly, some thoughts on speeding up the construction of township hospitals.

(1) Define the functional orientation.

It is an important duty of the government to establish and improve the health service network at the county, township and village levels. In this three-level health service network, township hospitals are "hubs". It focuses on public health, provides comprehensive prevention, health care and basic medical services, and undertakes public health management functions within its jurisdiction. Over the years, due to people's misunderstanding of the functional orientation of township hospitals, they even operate them as productive enterprises, resulting in a difficult situation of less hospital investment, poor working conditions and more loss of health technicians. To speed up the construction of township hospitals and change the present situation, we must first further clarify the functional orientation of township hospitals, change concepts, increase investment, regard the work of township hospitals as an important basic work of the government, give full play to its pivotal role in the rural three-level medical and health network, and realize the goal of "common diseases do not leave the countryside".

(2) Increase investment, strengthen infrastructure construction and deepen internal management.

At present, there are some problems in health centers, such as outdated medical equipment and lack of medical equipment, which need to further increase government investment. It is necessary to deepen the internal management of township hospitals, gradually improve the internal management mechanism, and improve the medical quality and service level of township hospitals through scientific management. Through the introduction of relevant policies to mobilize the enthusiasm of the majority of health technicians in township hospitals and promote the work of township hospitals. It is necessary to further establish and improve the management rules and regulations of township hospitals, and promote the development of township hospitals in a scientific, institutionalized and standardized direction. How to organically combine the construction of township hospitals with the development of "new rural cooperative medical system" and "public health service" is an important topic to accelerate the construction of township hospitals at present.

(3) formulate policies and take measures to stabilize the rural health technical team, attract outstanding talents and improve the overall quality of the team.

1, formulate relevant policies to encourage medical staff to work at the grassroots level. The government allocates a certain amount of special funds every year to solve the basic problems such as insurance and wages of health technicians in township hospitals, so that they can work with peace of mind; Formulate and introduce corresponding preferential policies to attract more outstanding health talents, enrich the staff of primary health centers and improve the overall quality.

Article 2 Investigation Report of Health Center

I. Basic information There are 8 township hospitals and 2 branches in the county, including 3 central hospitals, with an approved establishment of 136 and 95 employees. Due to the lack of professionals, some township hospitals have nine self-employed people. All 79 administrative villages in the county have established standardized village clinics, 7 1 village clinics are equipped with qualified village doctors, and 8 village clinics are not equipped with village doctors.

After the reform of primary health care, township hospitals are positioned as public welfare institutions, which are the hub of rural health service network, and directly undertake tasks such as preventive health care, health supervision, basic medical care and health management in rural areas. In recent years, the county party committee and government have attached great importance to the construction of township hospitals, and the infrastructure construction of township hospitals has been significantly improved, and the comprehensive service capacity has been further improved, showing a good development trend.

The service capacity has been continuously enhanced. First, the medical environment has been improved. Through the basic medical reform and standardized construction of township hospitals, the business premises of township hospitals have been basically guaranteed. The second is to expand service projects. Most towns and villages can basically carry out B-ultrasound, electrocardiogram and X-ray diagnosis technology to facilitate rural residents to seek medical treatment. The third is to improve service capabilities. A number of health professionals have been recruited to work in township hospitals, which has enriched the business strength of township hospitals. The overall quality of grassroots medical staff has been further improved through county-level hospitals supporting township hospitals and sending key personnel of township hospitals to participate in public health project training and further study. In recent years, * * * has 12 people participated in the education and training of general practitioners, 19 people participated in the standardized training of residents, 78 people participated in the training of related public health projects, and 39 people participated in the training of management projects of provincial and municipal township hospitals. The fourth is to facilitate the masses to seek medical treatment. Township hospitals and village clinics have opened the new rural cooperative medical clinic as a whole, with centralized drug procurement and zero-difference sales; Strictly implement the charging standards for medical services set by provinces and cities; Actively carry out basic medical services. Compared with before the medical reform, the price of drugs dropped significantly and the number of outpatients increased significantly. For example, the price of drugs dropped by more than 37.8%, the number of outpatient visits increased by 12.79%, and the average outpatient expenses and the average hospitalization expenses decreased by 28.6% and 36.7% respectively, effectively alleviating the people's "difficulty in seeing a doctor" and "high cost of seeing a doctor".

The infrastructure has improved significantly. Over the past few years, 2.2 million yuan has been invested to complete the housing reform and expansion project of Qidu town and Dayan town health centers, with an investment of 1.75 million yuan to start the construction of revolving houses in township health centers, and 2.5 million yuan is under construction in Xianyu town and Lilac town central health centers, which will be started soon 1.25 million yuan. At the same time, it also invested 400,000 yuan to purchase X-ray machines, B-ultrasound machines, electrocardiogram machines, urine analyzers and other medical equipment for township hospitals. Infrastructure construction has improved the working and living conditions of township hospitals.

Public health services have been carried out steadily. Through the reform of primary health care, township health centers have adjusted their work functions in time according to the requirements of the reform plan of township health centers, and changed the past business model of "paying more attention to medical care than prevention". In addition to providing people with "safe, effective, convenient and cheap" basic medical services, they also vigorously carry out various public health services such as establishing personal health records, carrying out health education, implementing vaccination, and cooperating with emergencies. By the end of 20 19, 67,832 electronic files had been established, with a filing rate of 72.9%, including 8,776 elderly people over 65 years old, 9,896 patients with hypertension, 595 patients with diabetes and 0/00 patients with severe mental illness. The health and safety level of farmers has been gradually improved.

Second, the existing problems

The construction of talent team needs to be strengthened urgently. First, because the working environment is relatively difficult and the salary is low, the newly graduated students are unwilling to work in health centers, and the recruitment indicators are often not in place. At the same time, the problem of aging team and lack of successors is more prominent. Second, the brain drain phenomenon is serious. In the three years since the reform of primary health care, * * * has openly recruited 52 professional and technical personnel (mostly from village clinics), but 7 of them voluntarily gave up or resigned. Third, there is a shortage of professional and technical personnel. At present, there are 95 on-the-job staff in township hospitals in the county, including 6 with bachelor's degree, accounting for 6.3% of the total number, 42 with junior college degree, accounting for 44.2% of the total number, and 47 with secondary school education or below, accounting for 49.5% of the total number. Due to the unreasonable academic structure, the overall quality of technical personnel in township hospitals is not high, and the level of diagnosis and treatment is difficult to improve.

The distribution system is not dynamic enough, and the connotation of medical reform is not fully reflected. In the past, hospitals were put on the market, and the salaries of medical staff were directly linked to economic benefits. After the medical reform, township hospitals are positioned as public welfare institutions. In the case of very tight financial resources, the county government has increased its investment in hospitals, ensuring the operation of hospitals and the treatment of personnel. However, after the reform, the hospital's service consciousness and concept consciousness still need to be changed, especially the performance distribution of "internal vitality" is not very encouraging. For a long time, employees have formed the concept that file salary (basic salary, subsidy, performance salary) is regarded as due remuneration. There is a concept of average distribution in the performance appraisal distribution of township hospitals, and the income gap between employees is not big. In addition, medical staff are on duty at night and work overtime on holidays without pay, so the enthusiasm and initiative of a small number of clinical medical staff are not high. Due to the heavy responsibility of occupational risks, high demands of patients, shirking patients, inefficiency and other undesirable phenomena occur from time to time.

The distribution of essential drugs is not standardized and it is difficult to meet the basic medical needs. First, there are fewer kinds of essential drugs. Second, the commonly used basic drugs online cannot be delivered in time, especially the most basic drugs with low profits, which are not delivered at all by distribution enterprises, resulting in a small number of drugs in township hospitals, which is difficult to meet the basic medical needs.

Third, some suggestions.

Build a strong team and comprehensively improve the level of medical services. First, pay equal attention to the introduction and supplement of health professionals, further simplify the recruitment procedures, shorten the recruitment cycle, and create conditions for the introduction of talents. The second is to establish and improve the education and training mechanism for medical staff, regularly educate and train medical staff on medical and health business knowledge and medical skills, and effectively improve their professional quality. The third is to strengthen the construction of medical ethics, constantly improve the awareness of medical staff to serve the masses, strengthen the humanistic education of medical staff, strengthen the supervision system and measures, and constantly improve the professional ethics of medical staff.

Clarify the performance distribution method step by step. According to the annual objectives and tasks, work quantity, quality and people's satisfaction, etc. , determine the distribution mode of performance pay, broaden the level of income distribution, reflect more pay for more work, and truly realize the high or low treatment of employees. For example, township health centers can consider implementing the incentive policy that 30% of the funds after the balance of payments are included in the year-end incentive performance appraisal, and medical staff are on duty at night and work overtime on holidays to ensure that performance pay is more scientific and reasonable.

Article 3 Hospital investigation report

Township hospitals are the hub of rural tertiary health network, which undertake the functions of rural preventive health care, basic medical care and public health management, and play an active role in facilitating farmers' medical treatment and ensuring their health. According to the development status, difficulties and problems faced by township hospitals, our bureau conducted a detailed investigation on the infrastructure, medical conditions, service capacity and service functions of township hospitals (including central hospitals). First, the status quo of rural health

1, infrastructure and equipment configuration

The average business space of township hospitals (including central hospitals) in our district is about 3,956 ㎡, with 5/kloc-0 beds, equipped with X-ray machines, biochemical analyzers, gastric lavage machines, ventilators, anesthesia machines, comprehensive operating tables, electrocardiographs and other equipment. Three central hospitals are equipped with ordinary ct. Some township hospitals are lower than this configuration, and some equipment is aging, which can only basically meet the medical needs of local farmers.

2. Development of health services

The central health center has basically set up 12 business departments, including internal medicine, obstetrics and gynecology, surgery, ENT, Chinese medicine, emergency department, pediatrics and preventive health care. However, the business departments of town and street health centers are lower than this setting, and the average outpatient (emergency) visits in 20xx are 42 164, the discharge visits are 949, and the operating table 134. The housing, department construction and staffing of public health services basically meet the requirements of the Ministry of Health; Obviously, basic medical services and public health services are at a low level.

3. Health manpower situation

As a result, the staff of township hospitals (including central hospitals) in our district are aging, and there is a phenomenon of broken files. Most of the medical staff in township hospitals are mainly Chinese medicine, and there is a serious shortage of talents, especially clinical graduates with high academic qualifications and high professional titles. The average number of middle-level professional titles does not exceed 10, and most of them are junior. The introduction and cultivation of talents has become an obstacle to the development of township hospitals.

Second, the problems in rural health

One of the crux: "can't afford to lose"

Unreasonable setting of medical institutions leads to the contradiction between limited health resources and unreasonable resource allocation, resulting in waste of health resources; Township hospitals are not simple medical institutions. In addition to providing basic medical services for rural people, it also undertakes many rural public health functions, such as maternal and child health care, daily epidemic prevention, popularization of health knowledge and handling public health emergencies. Therefore, township hospitals cannot compare with general clinics and pharmacies.

The second crux: "Who will raise it?"

Financial support is limited, governments at all levels do not attach importance to health work, and the central government's health policy is not implemented enough. As a result, the investment in township hospitals is not large, and some funds have shrunk; However, the expenses borne by township hospitals are large, and the amount of various insurances that employees need to pay is large, and the funds of retired employees and on-the-job employees are tight; Who will pay for the renewal of medical equipment, the improvement of medical environment, the training of medical personnel and the daily operating expenses of the hospital? Now hospitals are required to make zero profits from drugs, and it is not allowed to support doctors with drugs. Who will support the hospital?

The third crux: "No one"

Most township hospitals are understaffed, and only a few hospitals simply send their staff out to study, let alone improve or develop new business. This situation of "unable to get out" and "unable to get in" has led to some newly purchased government equipment being neglected. Life is hard, the conditions are simple, and even the normal salary can't be kept. How can we attract talents under such circumstances? Can you retain talents?

Third, facing opportunities.

1, the national rural health work conference proposed that people's governments at all levels should increase investment year by year, and the growth rate should not be lower than the growth rate of recurrent fiscal expenditure in the same period. From 20xx~20xx, the annual increase of health expenditure at all levels will be mainly used to develop rural health undertakings. By 20xx, the reconstruction and construction tasks of county-level medical institutions, county preventive health care institutions and township (town) hospitals will be basically completed. However, relying on the national debt funds and the Red Cross assistance funds, our district has carried out housing renovation and equipment purchase for some township hospitals in our district.

2. With the gradual increase of farmers' health investment and the gradual improvement of the new rural cooperative medical system, this work has brought new opportunities to township hospitals in our district. Judging from the development of the new rural cooperative system, the business volume of township hospitals in our district has increased significantly; With the gradual increase of financial investment in health at all levels, the medical needs of farmers will increase significantly.

Fourth, suggestions and countermeasures for the long-term development of township health undertakings.

1, we should make full use of national debt construction funds.

With the implementation of the national debt project and the increase of policy support for rural health work in China, some rural health centers with development potential will be built and equipped one after another in the future. The construction of health centers should be based on the long-term, moderately control the scale of development, avoid the waste of investment and equipment, strive to create fine products, and develop characteristic hospitals and specialties.

2. Enhance the health care function.

For hospitals that cannot survive, maintain or limit their medical scale, tilt limited resources and funds to preventive health care, and highlight the function of preventive health care. Idle houses and newly expanded houses are directly used for township preventive health care, with emphasis on township vaccination clinics. Personnel with certain professional expertise are enriched into the preventive health care team, and their basic medical services are undertaken by powerful hospitals nearby.

3. Integrate health service functions and expand service scope.

Clarify the functional orientation of health service networks at all levels and give full play to the overall functions of rural health networks. Establish the position of township health institutions organized by the government as operational guidance centers for rural preventive health care and medical services, and clarify their responsibilities in rural preventive health care, basic medical care, first aid and primary health care personnel training and operational guidance. Township hospitals mainly provide public health services, comprehensive preventive health care and basic medical services, and are entrusted by county-level health administrative departments to undertake health management functions. Township hospitals should reform their operating mechanism, explore new service modes, establish rural community health service center system with state support, vigorously promote the implementation of rural health regional planning, establish rural community health service network, and effectively provide basic health services for farmers.

4. Increase investment and implement the national rural health economic policy.

In addition to actively introducing and striving for national and provincial financial input, with the development of economy, local governments should increase investment in rural health and earnestly fulfill their responsibilities, especially to fully implement the matching fund policy required by the state to avoid aggravating the increase of bad debts in township hospitals. Through the way of government transfer payment, the bad debts that have been formed in township hospitals have been cancelled, and the burden that has been formed in the historical development of township hospitals has been effectively reduced.

It is a complex and arduous task to solve the problems existing in township hospitals, which requires the joint efforts of all parties. It is necessary to clarify the functional orientation of township hospitals in the three-level health network and fully understand the basic role of township hospitals in solving the problem of "difficult and expensive medical treatment" for farmers. Constantly straighten out the management system, establish the public welfare nature of township hospitals, reduce market-oriented operation, and give play to the role of township hospitals in ensuring farmers' basic medical and public health services.