构建长期护理保险制度是应对人口老龄化的有效措施,研究通过对欧亚各个发达国家护理保险制度的产生背景、筹资方式、受益对象和法律保障等多个角度予以比较分析,并探讨国外长期护理保险制度管理经验,从而为我国长期护理保险体系的构建提供参考.

Objective To investigate medical staff performance salary satisfaction level of tertiary public hospitals in Heilongjiang Province,and to explore the problems existing in the performance salary and countermeasures.Methods Selecting 849 medical personnel in five tertiary public hospitals in Heilongjiang Province as the object of investigation,and using on-site survey.Results The total satisfaction degree of respondents is (2.92±0.89).And merit pay overall satisfaction of welfare satisfaction feeling dimension had the lowest levels,and the score is (2.78±0.02).Different degree,job category,work time (per week),performance wages ratio,category of performance wage satisfaction of medical staff is statistically significant (P＜0.05).Conclusion Performance-based payment reform should follow the principle of the combination of "social benefits" and "economic efficiency".Through weakening concept,improving the level of performance pay,perfecting performance appraisal system,fully stimulating staff work enthusiasm,work efficiency can be improved.

Quality is the key to healthcare success in the 21st century. Literature indicates that great chal-lenges exist in improving healthcare quality. We introduced some globally used care quality frameworks(Donabedi-an model,IOM six aims and OECD model). The approaches of quality indicator development fall into three broad categories:deductive approach (from concept to database), inductive approach (from database to concept) and joint use of both. The reliability, validity as well as the maintenance of quality indicators should be carefully as-sessed. The implementation of quality frameworks and indicator development approaches should depend on research purposes and local context.

Objective By investigating the current situation of the hospital safety performance,to understand and explore the factors which affecting the safety performance in the hospital,and to put forward hospital safety performance improvement strategies.Methods Adopting the method of random sampling to select medical personnel of 10 tertiary hospitals as the research object.Through simple regression analysis and multiple regression analysis and other methods,the paper analyzes the factors which influence hospital safety performance.Results (1) Safety training and accident analysis of two dimensions of positive reaction rate were lower than 75％;(2) The hospital safety culture and patient safety behavior has influence on the safety performance.Conclusion In order to enhance the level of the hospital safety performance management,it needs to strengthen the quality of medical personnel training,and at the same time to create a good cultural atmosphere,and to regulate the behavior of the safety of the medical staff.

Objective: To establish a proper evaluation system to evaluate the strategic extent of hospital human resource management. Methods: After building index system with two rounds of Delphi method, analytic hierarchy process (AHP) was used to determine the weight of these indicators.Results:The index system consists of 5 first-level indicators, 19 second-level indicators and 85 third-level indicators.And the weights of these indicators were also determined.Conclusion:The index system is reliable, and it' s of great importance to establish and im-prove evaluation system to hospital human resource management.

医院安全文化测评工具对于医疗机构的安全管理至关重要,目前世界范围的医院安全文化测评工具在测评维度和适用条件的差异性还未被深入认知.通过文献法和比较法,系统查阅国内外医院安全文化相关文献,对各主流医院安全文化的测评工具的研发过程、测评内容、应用现状以及优缺点进行深入比较剖析.医院安全文化测评工具在使用前对于维度和条目的修订应在紧密结合本国国情的基础上充分考虑相关领域专家意见,同时,对测评工具的信度和效度进行系统检测,并保证语言翻译的准确性.

To strengthen the construction of patient safety culture is the only way to improve safety management level of hospital patients, therefore, the accurate understanding of patient safety culture status quo of hospital is particularly important. HSOPSC ques-tionnaire was one of the world in the field of health representative and scientific nature of patient safety culture assessment tools, this paper introduced the origin, content and advantage HSOPSC questionnaire, to the application status in our country at present in the key analysis, and the matters needing attention in the process of further clarify its application, so as to our country's patient safety cul-ture assessment work provide certain reference and reference.

Objectives: To discuss the relationship of behavioral intention among nursing job satisfaction, occupational values and patient safety. Methods: The questionnaires are investigated with nursing job satisfaction scale, nursing occupational values scale, nursing patient safety behavior scale. Results: There is a positive correlation among nursing job satisfaction, occupational values and patient safety. Nursing occupational values has a mediating role between job satisfaction and patient safety behavior. Conclusions: Hospital managers should pay attention to the management of nursing personnel’s safety behavior, which is beneficial to improve medical care quality and ensure patient safety.

Objectives:To analyze patient safety influence factors and its mechanism in emergency department to provide reference on preventing medical defaults and protecting patient safety. Methods:With a cross-sectional design, 506 healthcare workers were participated in this study. In depth interview was used as a reference. Factor analysis and SEM were used to evaluate the strength and relationship between factors. Results:In the well simulate equation, the strength of the factors is:Rescue Ability>Safety Management Perception>Career Perception>Medical Error Report System>Knowledge and Skill Training. Conclusion:These five factors could provide scientific evidence to make countermeasures towards medical error and improve patient safety.

目的 编制和修订出适用于我国医疗环境的病人安全文化与安全绩效相关性测评问卷.方法 基于文献法和专家咨询法形成初始问卷,采用问卷调查法对其结果进行信度与效度检验.结果 问卷由15个维度构成,其总体信度Cronbach's α为0.919,各维度Cronbach's α系数为0.531～ 0.949,因子分析结果共提取出15个公因子,累计贡献率为80.164.结论 所编制的病人安全文化与安全绩效相关性问卷信度和效度良好,可以用于病人安全文化与安全绩效的相关性研究.

剖宫产术是目前常见的创伤性手术之一，具有损伤性大和风险性高等特点，手术中任何环节处置不当都会为母婴安全带来严重威胁。本研究以失效模式与效果分析法为理论基础，以术前、术中和术后为划分依据，通过对剖宫产术流程的详细分析，界定剖宫产术的主要风险因素，识别剖宫产术各种风险因素的危害程度，以制定针对性改进策略，规避高危险因素，防范剖宫产术不良事件的发生，保障孕产妇及婴儿生命安全。

目的 构建医院感染管理安全评价指标体系,为医疗安全管理提供测评工具.方法 运用德尔菲法筛选并确定各项评价指标,建立医院感染管理安全评价体系.结果 经过两轮德尔菲法专家咨询,构建“医院感染管理安全评价指标体系”,包括一级指标3个,二级指标17个,三级指标54个.结论 所构建的指标体系具有较高的信度、效度,相关部门可作为评价医院感染管理的工具.

目的：观察社区康复路径在脑卒中患者家庭康复中的应用效果，探讨脑卒中患者家庭康复的规范化护理模式。方法将60例社区脑卒中患者随机分为对照组和实验组，对照组采用传统康复治疗及护理方法，实验组采用社区康复路径护理模式。分别在干预1个月后及3个月后采用Brunnstrom、FMA、BI、照顾者的照顾能力等量表，对患者康复情况进行康复效果评价。结果两组患者及家庭照顾者各项评分无显著性差异（P＞0．05），1个月后及3个月后各项评分有显著差异（P＜0．05）。结论按临床护理路径脑卒中病人家庭实施康复护理，可以提高脑卒中患者的疗效，促进患者家庭健康。

Objective To analyze ICU nursing job information in 3A comprehensive hospital,to clarify ICU nursing personnel qualification requirements,and to provide reference and basis for scientific management of ICU nurses.Method Using O*NET work context,skill and ability questionnaires to conduct a questionnaire survey on 125 nurses in ICU.Result The score of each dimension of work context,skill and ability questionnaires were all higher than 3 points,among them,interpersonal relationships,basic skills and cognitive abilities are the highest dimensions.Conclusion Job descriptions should be established to meet the ICU nursing job characteristics,to ensure that the ICU nursing personnel selection according to the post requirements,and to improve the hospital and patients' safety.

目的 构建ICU护理人员岗位胜任特征模型,为专科护理人员甄选、培训和绩效考核提供科学依据.方法 根据文献分析和专家咨询结果,建立ICU护理人员岗位胜任特征词典,利用行为事件访谈法对26名ICU护理人员进行访谈,采用自编问卷调查200名ICU护理人员,对各胜任特征项目重要程度进行态度评价.结果 所建立的ICU护理人员岗位胜任特征模型共包含15项鉴别胜任特征和7项基准胜任特征,归类一致性系数0.839.结论 所构建的ICU护理人员岗位胜任特征模型具有较好的信度和效度.

目的 帮助医院明确剖宫产手术中的高风险环节及关键流程,切实做好产科安全管理.方法 通过FMEA法与文献研究、头脑风暴、问卷调查及专家咨询相结合的方式,对剖宫产诊疗流程中的风险进行识别.结果 共识别出剖宫产诊疗流程中10项高风险环节,即产后出血、知情同意效果不佳、会诊不及时、羊水栓塞、切口感染、尿路感染、会诊诊断及治疗错误、术前宣教效果不佳、麻醉失误、检查结果有误.结论 FMEA法是一项有效的医疗风险识别工具,能够前瞻性地检测出剖宫产高风险环节,并有针对性地实施干预.

目的 探讨结肠癌根治术的高危风险以及引起风险的主要原因,提出有效的干预策略.方法 应用失效模式与效应分析法对结肠癌根治术进行风险识别研究.结果 分析得出结肠癌根治术共计8项流程、26项失效环节,排在前10位的高危风险分别为:观察患者药物反应失误、设备仪器准备不充分、检查时间过长、术前宣教不佳、麻醉前核对失误、手术时间过长、排药错误、术后注意事项告知有误、护士术后核对失误、手术者术后核对失误.结论 FMEA法可以有效地识别高危风险,据此有针对性地制定措施、采取策略,能够最终从源头上避免风险的发生.

Objectives: Through general evaluation of risk identification tools to get rank of applicability in healthcare to give some support on identifying medical risks, reducing medical harm and protecting patient safety. Methods:With a systematically review and expert consultation, 24 tools were selected. Delphi method was used to evaluate each tool in three dimensions:importance, feasibility and effectiveness. Results:The coordination of experts comes convergence after two rounds Delphi consultation. The top five tools are Case Analysis, Experience-based Judgment, Expert Investigation,Root Cause Analysis,Flow-Chart Method. Conclusions:The five identification tools could give some references on the hospital risk management.

在阐述研究型教学模式内涵的基础上,探讨了研究型教学模式在基础性、综合性以及创新性科研三个环节上的实践与具体做法,并针对当前卫生管理专业人才培养模式与教学体制等方面提出了建议,以支持研究型教学的顺利开展。

目的：通过对哈尔滨市10家医院医疗风险管理现状调查，掌握医院医疗风险管理情况，找出存在的问题，提出改进对策，为医院制定科学、完善的医疗风险管理体系提供参考。方法：运用文献法、访谈法、特尔菲法、头脑风暴法等方法；应用SPSS、EXCEL统计软件对数据进行统计学处理。结果：三级医院在风险管理体系相比于二级医院更为完善；两级医院在医护人员独立工作能力，医疗药品和设备的准入，医疗风险信息系统使用，医护人员培训满意度等方面均具有较大差异；大多数医护人员愿意主动报告医疗纠纷；医患沟通效果较好，科室之间沟通协作也比较好。结论：目标医院基本上建立了医疗风险管理体系，但是在功能上、风险管理措施的制定及落实上尚不完善，医疗风险管理人员的专业素质有待提高，医院医疗风险管理意识尚需加强。