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    醫院績效考核及績效工資分配辦法實施細則

    時間:2013-03-12 15:26:26  來源:  作者:
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    醫院績效考核及績效工資分配辦法實施細則
    國有醫院運行機制改革的主要內容之一是分配制度的改革。隨著國家公務員工資體制的改革,事業單位的工資改革已擺到我們面前,而改革的主要內容是績效工資。如何在醫院復雜的人力資源分類狀態下設計一套符合市場經濟規律,又體現公立醫院社會事業屬性特點的績效工資方案十分重要。湖南省郴州市第一人民醫院經過近十年的探索,根據醫院不同系列、不同崗位設計的績效工資方案,極大地激發了員工的創造性和積極性,推動了醫院的快速發展。現介紹如下:
    一、各類人員薪酬權重系數的設計
      權重系數是指用于指導制定各類人員所有分配到的薪酬總額之間的比例參考數值。確定各類人員的權重系數供設計各類人員薪酬總額標準時作參考。目前國家對醫院各類員工之間的分配差距并無明確規范,也無量化標準,但設計時要體現向高風險、高技術、高強度勞動和貢獻大的崗位傾斜,并且與管理要素、技術要素分配相結合。在實際操作過程中,參照以下原則進行:1、根據地方政府文件規定;2、根據地方勞動部門發布的各類人員工資指導意見;3、根據醫院的實際情況:員工的承受能力、醫院的改革成本、領導的期望目標等。(見表一、二)
    二、臨床科主任年薪設計
      年薪制是一種有效的激勵管理者的薪酬形式之一,是一種將目標任務、權力、利益、風險融合在一起的分配模式。由于它有預先設定的目標壓力,又有達到目標后的利益,同時承擔風險,管理者就能有計劃、有措施地為完成目標任務發揮所能,并能有效地運用職權,最大限度地激發管理者的積極性。
      醫院是以臨床和醫技科室為核算單位。而臨床科室更具有相對獨立性和主動性,對臨床科室管理者實行年薪制,推動臨床科室全面發展,推動臨床科室兩個效益增加,就可全面帶動醫技科室和醫院其他部門發展。
      年薪是由兩部分組成,即基本年薪和風險年薪。二者所占比例根據醫院對科室管理者的要求而定,年薪定的高,風險年薪也高;年薪定的保守,風險年薪也相應比例低些。一般基本年薪不少于員工的平均年收入,最高的基本年薪一般不超過年薪總額的1/2。風險年薪根據業績考核才能得到,屬于不定收入。
      為了增加風險,還可以要求管理者交納一定的風險金,風險金也隨考核上下浮動。
      湖南省郴州市第一人民醫院臨床科主任基本年薪與風險年薪各占50%,基本年薪按月分發,風險年薪考核后根據結果上下浮動。其計算方式為:X1/2W[1/2W1/2WK100%]X為實際所得年薪、W為設定的年薪、K為考核值,設定為100%。當K值為100%時,實際年薪為設定年薪,當K值大于100%時,實際年薪高于設定年薪,當K值少于100%時,實際年薪低于設定年薪:(見表三)
      臨床科室還交納相當于年薪設定額度50%的風險金,風險金不計利息,按考核K值上下浮動。例:K值為115%,風險金上浮15%K值為82%,風險金下浮18%
      三、臨床醫生績效工資設計
      醫生是醫院生存和發展的主要生產者,優秀的醫療人才是醫院的重要資源。醫生的分配是醫院績效考核的核心內容,目前國有醫院醫生的工資體系基本上是根據學歷、職稱和工齡來確定,與醫生的實際職責、風險、技術、業績和貢獻關系不大,難以起到激勵作用。設計一個好的醫生績效工資體系應達到以下目的:
      1、激勵和回報醫生完成醫院的戰略目標;2、確保和提高醫療質量;3、吸引和留住優秀人才;4、增強團隊精神;5、培養醫生的責任心。
      郴州市第一人民醫院臨床醫生的績效工資沒有統一的方案和標準,而是根據各臨床科室的特點和管理者個人管理方式來設計各自的方案,舉例如下:心血管內科績效分配方案
      1、實行百分制考核。其中經濟收入占70%,服務質量占10%,勞動紀律占10%,醫療質量占10%(主要在病歷、診斷、治療、用藥合理性等方面);2、每做一例介入手術加1分;3、不管病床的醫生(學科帶頭人)績效系數為1.5,住院醫生系數為1.2,輪科醫生系數為1.0
      舉例:某月心血管內科的醫生績效可供分配的總額為15000元,共5名醫生參與分配,其中學科帶頭人1名、住院醫生3名、輪科醫生1名。其中A醫生的收入為78000元,介入手術8例,B醫生的收入為58000元,介入手術6例,C醫生收入為49000元,介入手術2例,D醫生收入12000元。計算如下:
      ①學科帶頭人的績效:醫生總系數1.53×1.21.06.1,每1.0系數的績效為15000÷6.12459元,學科帶頭人的績效為2459×1.53688元;
      ②一般醫生的績效總額為:15000368811312元;
      ③分數考核:經濟分以最高收入醫生為70分,其他醫生以此醫生的收入為基礎按比例計算。
      A醫生的分數為:70(經濟)+10(服務質量)+10(勞動紀律)+8(醫療質量)+8(介入手術)=106分;
      B醫生的分數:58000/78000×7010108686.05分;
      C醫生的分數:49000/78000×7010108273.97分;
      D醫生的分數:12000/78000×701010838.77分;
      醫生總分數:10686.0573.9738.77304.79分;
      平均每分為:11312/304.7937.11元;
      經計算:A醫生106分×37.113934元;B醫生為3194元;C醫生為2754元;D醫生為1439元。
      眼科醫生績效舉例
      某副主任醫生某月的績效工資計算:
      ①本科檢查收入(眼科檢查、治療加上視光檢查)按4%比例計入個人所得;(6160.5元+1179元)×4%293.58元;②住院病人開單并自己執行操作收入按5%比例計入個人所得;(14272.94元+1120元)×5%769.65元;③醫護共同收入(算50%),按4.88%比例計入個人所得;655元×50%×4.88%÷6(醫生人數)=2.66元;④外科室劃歸本科的收入按7%比例計入個人所得;781.26×7%54.69元;⑤手術收入:397.82元;⑥門診手術收入:2306.33元;⑦病歷扣款:35元;⑧藥品比例超標扣款:95.08元;⑨各項考核扣分:1.87分;⑩收治入院病人32人獎320元;
      個人績效:(293.58796.652.6654.64397.822303.333595.08)×(1001.87%3204436.42元。
      普外科醫生績效舉例
      普外科共有醫生6名(主任除外),分為2個醫療小組,本月醫生績效共15000元。A組本月急診手術欠費5000元,收入140000元,共出院病人39個,退回紅包4個,甲級病歷獎勵800元,病歷中度缺陷扣100元;B組本月擇期手術欠費3000元,收入120000元,共出院病人33個,收到表揚信1封,退回紅包2個,甲級病歷獎勵600元,病歷中度缺陷扣50元。
      A組和B組組長的計算步驟如下:
      1.欠費計算:
      A組扣5000×20%=1000元;
    人力資源管理2007年第1國有醫院績效工資的設計與考核
            
                       1頁當前第1
        B組扣3000×40%=1200元;
      2.晚夜班補助:
       60×10+60×5=900元;
      3.表揚信、退回紅包獎勵:
       7×20%=140元;
      4.可分配的總績效額:
       15000-900-140-800-600+150+1000+1200=14910
      5.醫生總系數:
       1.4×2+1.2×2+1.0+0.8=71.0的系數為:14910÷7=2130元;主治醫生的績效為:2556元;住院醫師的績效為:2130元;輪科醫生的績效為:1704元;組長的績效總額:2130×1.4×2=5964元;
      6.A組組長的考核打分為:140000÷500+39=319分;B組組長的考核打分為:120000÷500+33=273分;設500元收入為1分,每出院1個病人為1分;組長的總分為:319+273=592分;平均每分為:5964÷592=10.07元;A組組長的績效為:319×10.07=3214元;B組組長的績效為:273×10.07=2750元;
      7.各項獎懲在每位醫生的績效上進行獎勵和扣款。
    麻醉科醫生績效考核方案
      個人月工作量總分由麻醉方式、麻醉時間、特殊情況加分以及麻醉質量評分四部分組成:
      1、麻醉方式評分:全麻插管:5/臺;靜脈全麻:4/臺;椎管內麻醉:3/臺;神經阻滯麻醉:2/臺;基礎麻醉:1/臺;麻醉時間評分:1/臺。
      四、醫技科室人員績效設計
      醫技科室人員包括醫技檢查科室、功能檢查科室及門診有關科室,其工作的自主性相對較弱,工作量受到臨床工作的牽制,收費無自主性,采用計件式績效工資比較符合其工作性質。計件式方法一般是根據工作量的實際價值采取直接按比例提成的辦法,但許多工作量的大小并不與其收費價值成比例,因此可以采取工作量化記分方式進行績效考核,再將分數轉化為金額。舉例如下:
     B超室績效考核方案
      1、日常工作計分說明:門診B0.5/人次;常規彩超1/人次;腔內彩超1.5/人次;彩超系統產檢2/人次;心臟彩超2/人次;床旁彩超5/人次;介入超聲操作(活檢及治療)10/人次;中、晚班1/人次;
      2、中、晚夜連班補助:初級50/天;中級70/天;副高90/天;
      3、科室個人分配計算方法:①計算個人考核分,包括日常工作計分,中、晚夜班計分,外出學習及獎懲計分等;②計算支出部分工資,包括科室基本工資,中、晚班補助及進修培訓人員工資等;③考核工資等于醫院總分配金額減去支出部分工資,其中30%為職稱考核工資,按不同職稱系數考核分配(系數:初級1.0、中級1.21.3、副高1.4 、正高1.8 ),不同職稱需完成相應的會診及教學等任務,70%用于日常工作計分分配;④個人最終分配組成:基本工資+30%職稱考核工資+70%日常計分工資+中、晚夜班+其它等。
     放射科績效考核方案
      1、固定部分
      ①放射接觸工齡:年限≤3年,200/月;3年<年限≤10年,300/月;10年<年限≤20年,400/月;年限> 20年,500/月;
      ②經管費:即參與本組內管理人員,主要分配做計件工資計算、膠片等材料申領與發放等,診斷與技術組各兩人,每人100/月;
      ③教學費:診斷與技術組各300元,主要從事本組人員的教學,科研工作和集體閱片等;
      ④特殊補貼:對從事放射工作35年以上工作人員,每人每月另補100元,對登記室人員從事核對報告簽名及片號檢查,每月補100元;
      ⑤白班:即白天上班從事具體工作人員按20/天發放;
      ⑥晚夜班:由大科發放。
      2、計件工資
      ①診斷組:A 每閱片一份,按1分計算(包括多部位);B 特殊檢查:食管吞鋇,4/人次;鋇餐造影,6/人次;鋇灌腸造影,8/人次;全程鋇餐,8/人次;子宮輸卵管造影,6/人次;竇道及瘺管造影,6/人次;其他檢查參考以上。
      ②技術組:A 每暴光1次,按1分計算;B 每洗或打印膠片1張,按1分計算;C 特殊:靜脈腎盂造影,6/人次;子宮輸卵造影復查, 3/人次;其他特殊檢查參考以上; D 床旁片,按以上3倍計算。
       檢驗科績效考核方案
      1、人員組合:
      分成五個小組:生化組、免疫組、臨床組、血庫組、門診120化驗組。小組長待遇為全科平均數的120%。
      2、以工作量為計件工資的依據。每天工作實行百分制。
      生化室:雜項化驗1/項,電解質1.5/項,凝血止血3/項,血氣化驗1/項,門診標本化驗1/項,上機操作0.4/測試。分別乘以工作量,得出每天的分數;
      免疫組:乙肝全套(2.2/個),乙肝表面抗原1.0/個,丙肝化驗1.0/個,分別乘以工作量,得出每天的分數;
      臨床組:分為體液(小便常規1/個,大便常規0.5/個,ESR和各種常規及各種染色等1/個),血常規上機(301×個數),網織紅2/個,血型化驗(503×個數),得出每天的分數;
      3、醫療質量:根據檢驗科質量缺陷管理方案扣分;
      4、勞動紀律:根據醫院勞動紀律管理考核辦法每缺一次扣50元;
      5、科研教學:每講課一次獎勵50元;
      舉例:何章勇(初級職稱、參加工作2.5年)20069月份的考核,出勤25天;生化室上班1158.6分,門診化驗室上班2天得分322.2分,在臨床室上班5天得分699.5分,在免疫室上班7天得分1147.9分,血庫1天得分161分,9天的晚、夜、夜休得分1693.5分;
      20069月份總得分:158.5322.2699.51147.91611693.54182.7
      基礎工資:200(基本)+100(初級)+03年內無工齡工資)=300元;
      本月講課一次獎50元,無檢驗質量扣分,無違反勞動紀律。科室0.76/分;
      總績效:3004182.7×0.76503529元。
       五、護士長的薪酬設計
      護士長的薪酬設計既要考慮各科的效益不同要有差別,又要考慮全院這個崗位上的整體平衡。
      月工資由崗位工資和績效工資構成:1、崗位工資護士長均定為1300元/月;2、績效工資50%根據工作量分配,50%考核工作質量后分配。
      具體辦法:
      護士長薪酬總額=科主任平均年薪×40%;每位護士長績效工資總額=護土長月工資總額-1300元;
      護士長計分方法:
      1、所在科室一個月內病危病人每例每天計1分;2、所在科室一個月內I級護理:病人每例每天計1分;3、所在科室一個月內出院病人每例次計1分;
      計算每分值:全院護士長績效工資總額50%÷全院護士長累計得分總數=元/分,另50%績效工資考核工作質量采取倒扣辦法。
      舉例:某院病區護士長22人,個人薪酬總額為4.6萬元/年,月工資=4.6萬×80%÷12=3066元。
      基礎工資1300元,績效工資可供分配的為3066-1300=1766元,其中50%即883元作為工作量考核后分配,另883元作為工作質量考核后分配。
      計算出分值:某月全院出院人數2302人次,全院危重病人、I級護理病人共2410天,883元×22人÷(2302+2410=4.12元。
      該月某科室出院110人,危重病人、I級護理病人共253天,護士長計分253+110=363分。
      該科護士長工作量收入=363×4.12=149556元。
      如果該護士長工作質量考核沒有扣分,她該月工資=1300+883+ 149556=367856元。
      年底考核工資:護士長薪酬總額20%放在年底,經考核后發放。其方法為:
      1、與所在科室經濟效益掛鉤,占50%;參照所在科室科主任考核中的全年經濟效益得分;年底考核工資總額50%/全院病區科主任經濟效益得分;總和×護士長所在科室經濟效益得分。
      2、各級人員對護士長的滿意度掛鉤,占50%;本科主任滿意度40%;護理部工作人員滿意度10%;所在科室護士滿意度30%;其他部門滿意度20%
      六、護士的績效工資設計
      病房護士有多個崗位,以夜班崗位最為辛苦,一般夜班工作人員只有1-2人,要承擔全部科室的治療、觀察任務,除身體上時差影響外,還需要具備豐富的經驗,承擔較重的壓力和責任。因此在確定績效時應為最高的崗位。其他崗位中護理組長也屬比較重要的崗位,一般要求有經驗的專科護士承擔,負責一個小組病人的護理管理工作,也是分配考慮的重點。護士工作由于其創造性和自主能力不強,主要是完成醫生醫囑工作和日常的護理任務,嚴格三查七對,對執行特別重要,因此她們的績效設計以崗位系數為主,在確定供分配的績效額度后,根據上班的系數計算。             例如:某月某科護士供分配的績效工資總額為12446元,護士甲(組長)該月上班24天,組長崗位系數是1.0,她的得分為24×1.024分;護士乙上晚班3個,得分為3×1.54.5,晝班4個,4×2.510分,其他班:7×0.74.97×0.96.33×1.03分,該月共計28.7分;該科所有護士累計總分為335.4分,每分價值:12446÷335.435.44元;甲護士:35.44×24850.56元;乙護士:35.44×28.71017.22元。
      非病區護士的分配根據具體科室不同采取不同的量化計分法。例如手術室護士績效考核方案:
      手術分計分:洗手巡回(小手術2/臺,中手術4/臺,大手術6/臺);手術時間3/小時,超過4小時每小時遞增1分,1個病人做兩臺手術按手術高的一個類型計分,無洗手護士的巡回加1分;小于3歲小兒加1分,搶救病人加2分,腔鏡手術加2分,體循加4分,感染手術處理加1分。晚班40分,中班10分,白班(含休息班)20分,每人完成154小時,超時每小時加3分,不夠每小時減3分。
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