基于标杆管理的县级疾病预防控制中心绩效诊断与改进的关键技术研究
发布时间：2018-09-19 20:55
【摘要】：一、研究背景随着政府绩效管理理论与实践的推进,提供公共服务的疾病预防控制中心(以下简称“疾控中心”)的绩效管理,逐渐被各方重视。2008年12月,卫生部疾病预防控制局印发了《各级疾病预防控制中心基本职责》和《疾病预防控制工作绩效评估标准》(卫疾控发(2008)68号),在全国范围内拉开了疾控工作绩效考核的帷幕。然而,绩效考核仅仅是迈出了绩效管理的第一步,更为重要的是后续如何进行绩效诊断、利用绩效评结果,实现绩效的持续改进。如何使得疾控中心的绩效评估落到实处,如何既鼓励先进,又不打击后进机构的工作热情；如何避免在评估过程中盲目攀比和生搬硬套?这些都是目前疾控体系亟待回答的问题。县级疾控中心是我国疾病预防控制体系的“网底”,需要开展大量的具体工作,其绩效的改进将对整体疾控工作绩效的提高起到重要作用。标杆管理(Benchmarking),其实质是以提高组织绩效为首要目标,通过寻找和实施最佳实践,发现差距并不断创新与改进管理方式的过程。系统回顾当前的研究发现,标杆管理是绩效诊断与改进的可行途径。随着西方公共管理理念逐步被关注,标杆管理在我国医疗卫生领域中的应用主要集中在医疗机构,公共卫生机构应用较少。二、目标内容研究目标：以华东某省为例,借鉴标杆管理理念,在明确机构运行规律的基础上建立多维度标杆,从区域和机构层面对疾控中心进行绩效诊断与改进研究,并研制相应的方法学思路。研究内容：①探讨机构运作规律,’明确资源配置、能力建设和职能落实的关系。②通过确立多维度标杆,对华东某省县级疾控中心和典型机构进行绩效诊断与改进。③通过比较2010年和2012年华东某省县级疾控中心的绩效,明确绩效诊断与改进的效果。④总结绩效诊断与改进方法学思路,形成《县级疾控中心绩效诊断与改进指南》。三、材料方法(一)在“结构-过程-结果”方法指引下,运用2010年全国县级疾控中心绩效指标完成度以及人员、经费、房屋设备等数据,探讨县级疾控中心资源配置、能力建设和职能落实之间的关系。(二)运用规范差距分析法,对照2010年全国、东部地区及2009年华东某省县级疾病预防控制中心绩效指标完成度数据,明确2010年华东某省县级疾控中心面上情况和典型机构与多维度标杆的差距,进而进行绩效诊断与改进研究。(三)运用纵向历史比较法,比较2012年与2010年华东某省县级疾控中心绩效指标完成度和人员、经费、房屋设备等数据,明确两年来的绩效改进情况。四、研究结果(一)县级疾控中心运行规律探讨在对2010年华东某省县级疾控中心工作现况进行描述性分析的基础上,运用简单相关分析、主成分分析和回归分析等方法对筛选的资源配置、能力建设和职能落实等三方面的关键指标进行分析,结果表明县级疾控中心遵循“结构-过程-结果”的运行规律,人员数量、人员素质、经费投入、设备配置等资源配置情况在很大程度上影响着机构的职能落实。提示,运用标杆管理确定“最佳实践”时,应根据不同机构的资源配置水平,针对性的确定。(二)华东某省县级疾控中心绩效诊断与改进研究首先,确定多维度的标杆。①虚拟标杆：根据“结构-过程-结果”运行规律,将县级疾控中心按照资源配置水平聚类,以每一类机构前10%绩效完成度作为该类机构的虚拟标杆。②常规标杆：考虑我国行政区域划分及不同年度变化,形成常规标杆,包括横向标杆(全国县级水平、地区县级水平和标准水平)以及纵向标杆(历年最佳水平)。其次,借鉴雷达图对2010年华东某省县级疾控中心面上情况和典型机构进行多维度绩效诊断。①区域层面：2010年华东某省县级疾控中心绩效完成度高于全国县级均值、东部县级均值,但与全国/东部县级最高水平标杆、标准水平标杆以及虚拟标杆均有一定差距；②机构层面：2010年典型机构绩效完成情况高于全国县级均值、全国县级市均值、东部县级均值、东部县级市均值和2009年该级绩效完成度,但与虚拟标杆、标准水平和全国/东部县级最高水平标杆均有一定差距,最大的相差了12.6%。最后,从职能落实和能力建设两方面进行绩效改进研究,同样从区域和机构两个层面展开。职能落实方面,①区域层面：技术指导与应用研究,突发公共卫生事件应急处置和健康危害因素监测与控制职能需重点改进；②机构层面,技术指导与应用研究、疾病预防与控制、突发公共卫生事件应急处置职能需重点改进。能力建设方面,以突发公共卫生事件应急处置能力为例,①区域层面：模拟演练工作开展较好,但相关信息网络直报率、事件报告及时率、规范处置指数和应急物品储备齐全率有待加强；②机构层面,相关信息网络直报、事件报告及时、规范处置指数、预案体系完成和模拟演练能力完成较好,但应急物品储备齐全工作远远低于标准要求,需重视。(三)绩效诊断与改进实证效果评价比较2010-2012年华东某省县级疾控中心资源配置水平、能力建设及职能完成情况,发现资源配置水平和能力建设均有了很大的提升,但能力提升幅度高于资源配置水平,各项职能均有不同程度的提高,平均完成度从84.4%提升到92.2%。运用规范差距分析法比较发现,区域层面和机构层面与标杆的差距均减少,其中,①区域层面突发卫生事件应急处置、健康危害因素监测与控制、技术指导与应用研究职能减少幅度较大；②机构层面,总体绩效完成度与标杆差距减少幅度较大,但信息管理和健康危害因素监测与控制职能与标杆差距增加,需在今后工作中引起重视。(四)总结绩效诊断与改进方法学思路本部分尝试总结了一套县级疾控中心运用标杆管理理念绩效诊断与改进的方法学思路,主要包括明确多维度标杆、绩效诊断与改进以及持续的改进过程。在此基础上,形成《县级疾病预防控制中心绩效诊断书及绩效改进指南》模板。五、讨论本研究以探讨县级疾控中心绩效诊断与改进方法思路为目的,形成了《县级疾病预防控制中心绩效诊断书及绩效改进指南》模板,对于优化县级疾病预防控制工作、提升绩效提供了重要工具。①明确了县级疾控中心遵循“结构-过程-结果”运行规律,提示不能仅根据排名来评估绩效考核成绩,需根据资源配置水平,设立相应的虚拟标杆；②形成了多维度立体标杆,具体包括虚拟标杆和常规标杆,其中常规标杆包括横向标杆(全国县级水平、地区县级水平、标准水平)和纵向标杆；③形成了《县级疾病预防控制中心绩效诊断与改进指南》模板,该模板主要包括现况评价,绩效诊断、绩效改进以及具体指标完成情况,可以作为疾病预防控制提高绩效的有效工具。与此同时,本研究也存在以下待完善之处：①研究仅基于绩效考核信息平台的数据进行绩效诊断与改进,没有进一步结合区域或者机构的具体情况；②在绩效改进研究方面,仅通过与标准的差距比较明确了相对薄弱的各项职能,提供了需改进的方向,没有结合区域或机构的实际情况形成具体的改进策略；③研究着眼于从宏观层面提供绩效诊断与改进的方法学思路,形成的《县级疾病预防控制中心绩效诊断与改进指南》模板具有通用性,但如何在此基础上,形成个性化的诊断书与改进指南,还需要进一步深入探索,包括形成具体的绩效诊断与改进的操作流程等。
[Abstract]:First, with the advancement of the theory and practice of government performance management, the performance management of the Centers for Disease Control and Prevention (CDC), which provides public services, has been paid more and more attention. Work Performance Evaluation Criteria > (Health and Disease Control Facility (2008) 68) has opened the curtain of performance evaluation for disease control throughout the country. However, performance evaluation is only the first step in performance management. More important is how to make follow-up performance diagnosis, use the results of performance evaluation, and achieve continuous improvement of performance. How to encourage the advanced and not attack the work enthusiasm of the backward organizations? How to avoid blindly comparing and relocating rigidly in the evaluation process? These are the questions that need to be answered urgently in the current CDC system. Benchmarking, whose essence is to improve organizational performance as the primary goal, is a process of discovering gaps and constantly innovating and improving management methods by finding and implementing best practices. The application of benchmarking in the field of medical and health care in China is mainly concentrated in medical institutions, but less in public health institutions. 2. Objectives: Taking a province in East China as an example, using benchmarking management concept for reference, to clarify the operational rules of institutions. On the basis of this, a multi-dimensional benchmark is established to study the performance diagnosis and improvement of CDC at regional and institutional levels, and corresponding methodological ideas are developed. Performance diagnosis and improvement are carried out by the control center and typical institutions. 3. By comparing the performance of a county-level CDC in East China in 2010 and 2012, the effect of performance diagnosis and improvement is clarified. 4. Summarizing the Methodological Thinking of performance diagnosis and improvement, forming < County-level CDC Performance Diagnosis and Improvement Guide >. 3. Material method (1) in the "structure-past" Under the guidance of the "process-result" method, the relationship among resource allocation, capacity building and function implementation of county-level CDC was explored by using the data of performance indicators, personnel, funds and housing equipment of the county-level CDC in 2010. (2) The standardized gap analysis method was used to compare the performance indicators of the county-level CDC in 2010 with that of the whole country, the eastern region and a county in East China in 2009. The data of performance indicators of CDC at different levels were collected to clarify the situation of CDC at county level in East China in 2010 and the gap between typical institutions and multi-dimensional benchmarking, and then to conduct performance diagnosis and improvement research. (3) The performance indicators of CDC at county level in East China in 2012 and 2010 were compared by longitudinal historical comparison method. Fourth, the results of the study (1) on the basis of descriptive analysis of the work status of a county-level CDC in East China in 2010, using simple correlation analysis, principal component analysis and regression analysis to screen. The key indicators of resource allocation, capacity building and function implementation are analyzed. The results show that CDC at county level follows the operation law of "structure-process-result". The allocation of resources, such as the number of personnel, personnel quality, funds input and equipment allocation, greatly affects the implementation of the functions of the organization. To determine the "best practice" of pole management, it is necessary to determine the performance diagnosis and improvement of CDC at the county level according to the resource allocation level of different organizations. (2) First of all, the multi-dimensional benchmarking should be determined. The first 10% performance completion of each type of organization is used as the virtual benchmarking. 2. Conventional benchmarking: Considering the division of administrative regions and the changes of different years, the conventional benchmarking is formed, including horizontal benchmarking (national County level, regional county level and standard level) and vertical benchmarking (the best level in previous years). Datu made a multi-dimensional performance diagnosis of the situation and typical institutions in a county-level CDC in East China in 2010. There is a certain gap; 2) Institutional level: the performance of typical institutions in 2010 is higher than the national average at the county level, the national average at the county level, the eastern average at the county level, the eastern average at the county level, and the eastern average at the county level in 2009, but with the virtual benchmark, the standard level and the highest national/eastern county level benchmark there is a certain gap, the biggest difference. Finally, performance improvement research was carried out from two aspects of function implementation and capacity building, and also from two levels of region and organization. Function implementation: 1. Regional level: technical guidance and application research, emergency response to public health emergencies and health hazards monitoring and control functions need to focus on improvement; 2. Institutional level; In terms of capacity-building, taking the emergency response capability of public health emergencies as an example, 1. Regional level: simulation drill work is well carried out, but the relevant information network direct reporting rate, event reporting and timely rate, standardized handling index. At the institutional level, the relevant information network direct reporting, timely event reporting, standardized disposal index, the completion of the plan system and the ability to simulate the exercise are better, but the emergency supplies reserve is far below the standard requirements, which needs to be paid attention to. (3) Performance diagnosis and improvement of empirical evaluation of 20. From October to 2012, the level of resource allocation, capacity building and function completion of a county-level CDC in East China showed that the level of resource allocation and capacity building had been greatly improved, but the extent of capacity improvement was higher than the level of resource allocation, and all functions had been improved to varying degrees, with the average completion degree increased from 84.4% to 92.2%. The analysis results show that the gap between regional and institutional levels and benchmarking has been reduced, among which: (1) the regional level emergency response to health emergencies, health hazards monitoring and control, technical guidance and application research functions have been greatly reduced; (2) at the institutional level, the overall performance completion and benchmarking gap has been greatly reduced, but information (4) Summarizing the Methodological Thinking of performance diagnosis and improvement, this part attempts to summarize a set of Methodological Thinking of performance diagnosis and improvement of county CDC using benchmarking management concept, mainly including clear multi-dimensional benchmarking. Performance diagnosis and improvement and continuous improvement process. On this basis, the "county CDC performance diagnosis and performance improvement guide" template was formed. 5. The purpose of this study was to explore the county CDC performance diagnosis and improvement methods, and the "county CDC performance diagnosis and performance improvement guide" was formed. Improvement Guide > Template provides an important tool for optimizing county-level disease prevention and control work and improving performance. Multidimensional three-dimensional benchmarking, including virtual benchmarking and conventional benchmarking, including horizontal benchmarking (national County level, regional County level, standard level) and vertical benchmarking; (3) Formed a < County CDC performance diagnosis and Improvement Guide > template, the template mainly includes status evaluation, performance diagnosis, performance At the same time, this study also has the following aspects to be improved: 1. The research only based on the performance evaluation information platform data for performance diagnosis and improvement, not further combined with the specific situation of the region or institution; 2. In the performance of the organization; In the aspect of improvement research, only by comparing with the standard gap, the relatively weak functions are clarified, the direction for improvement is provided, and the specific improvement strategy is not formed according to the actual situation of the region or organization; 3. The research focuses on providing the Methodological Thinking of performance diagnosis and improvement from the macro level, and the formation of < county level disease prevention and control Performance Diagnosis and Improvement Guidelines > Template is universal, but how to form a personalized diagnosis book and improvement guide on this basis, we need to further explore, including the formation of specific performance diagnosis and improvement of the operation process.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.21
[Abstract]:First, with the advancement of the theory and practice of government performance management, the performance management of the Centers for Disease Control and Prevention (CDC), which provides public services, has been paid more and more attention. Work Performance Evaluation Criteria > (Health and Disease Control Facility (2008) 68) has opened the curtain of performance evaluation for disease control throughout the country. However, performance evaluation is only the first step in performance management. More important is how to make follow-up performance diagnosis, use the results of performance evaluation, and achieve continuous improvement of performance. How to encourage the advanced and not attack the work enthusiasm of the backward organizations? How to avoid blindly comparing and relocating rigidly in the evaluation process? These are the questions that need to be answered urgently in the current CDC system. Benchmarking, whose essence is to improve organizational performance as the primary goal, is a process of discovering gaps and constantly innovating and improving management methods by finding and implementing best practices. The application of benchmarking in the field of medical and health care in China is mainly concentrated in medical institutions, but less in public health institutions. 2. Objectives: Taking a province in East China as an example, using benchmarking management concept for reference, to clarify the operational rules of institutions. On the basis of this, a multi-dimensional benchmark is established to study the performance diagnosis and improvement of CDC at regional and institutional levels, and corresponding methodological ideas are developed. Performance diagnosis and improvement are carried out by the control center and typical institutions. 3. By comparing the performance of a county-level CDC in East China in 2010 and 2012, the effect of performance diagnosis and improvement is clarified. 4. Summarizing the Methodological Thinking of performance diagnosis and improvement, forming < County-level CDC Performance Diagnosis and Improvement Guide >. 3. Material method (1) in the "structure-past" Under the guidance of the "process-result" method, the relationship among resource allocation, capacity building and function implementation of county-level CDC was explored by using the data of performance indicators, personnel, funds and housing equipment of the county-level CDC in 2010. (2) The standardized gap analysis method was used to compare the performance indicators of the county-level CDC in 2010 with that of the whole country, the eastern region and a county in East China in 2009. The data of performance indicators of CDC at different levels were collected to clarify the situation of CDC at county level in East China in 2010 and the gap between typical institutions and multi-dimensional benchmarking, and then to conduct performance diagnosis and improvement research. (3) The performance indicators of CDC at county level in East China in 2012 and 2010 were compared by longitudinal historical comparison method. Fourth, the results of the study (1) on the basis of descriptive analysis of the work status of a county-level CDC in East China in 2010, using simple correlation analysis, principal component analysis and regression analysis to screen. The key indicators of resource allocation, capacity building and function implementation are analyzed. The results show that CDC at county level follows the operation law of "structure-process-result". The allocation of resources, such as the number of personnel, personnel quality, funds input and equipment allocation, greatly affects the implementation of the functions of the organization. To determine the "best practice" of pole management, it is necessary to determine the performance diagnosis and improvement of CDC at the county level according to the resource allocation level of different organizations. (2) First of all, the multi-dimensional benchmarking should be determined. The first 10% performance completion of each type of organization is used as the virtual benchmarking. 2. Conventional benchmarking: Considering the division of administrative regions and the changes of different years, the conventional benchmarking is formed, including horizontal benchmarking (national County level, regional county level and standard level) and vertical benchmarking (the best level in previous years). Datu made a multi-dimensional performance diagnosis of the situation and typical institutions in a county-level CDC in East China in 2010. There is a certain gap; 2) Institutional level: the performance of typical institutions in 2010 is higher than the national average at the county level, the national average at the county level, the eastern average at the county level, the eastern average at the county level, and the eastern average at the county level in 2009, but with the virtual benchmark, the standard level and the highest national/eastern county level benchmark there is a certain gap, the biggest difference. Finally, performance improvement research was carried out from two aspects of function implementation and capacity building, and also from two levels of region and organization. Function implementation: 1. Regional level: technical guidance and application research, emergency response to public health emergencies and health hazards monitoring and control functions need to focus on improvement; 2. Institutional level; In terms of capacity-building, taking the emergency response capability of public health emergencies as an example, 1. Regional level: simulation drill work is well carried out, but the relevant information network direct reporting rate, event reporting and timely rate, standardized handling index. At the institutional level, the relevant information network direct reporting, timely event reporting, standardized disposal index, the completion of the plan system and the ability to simulate the exercise are better, but the emergency supplies reserve is far below the standard requirements, which needs to be paid attention to. (3) Performance diagnosis and improvement of empirical evaluation of 20. From October to 2012, the level of resource allocation, capacity building and function completion of a county-level CDC in East China showed that the level of resource allocation and capacity building had been greatly improved, but the extent of capacity improvement was higher than the level of resource allocation, and all functions had been improved to varying degrees, with the average completion degree increased from 84.4% to 92.2%. The analysis results show that the gap between regional and institutional levels and benchmarking has been reduced, among which: (1) the regional level emergency response to health emergencies, health hazards monitoring and control, technical guidance and application research functions have been greatly reduced; (2) at the institutional level, the overall performance completion and benchmarking gap has been greatly reduced, but information (4) Summarizing the Methodological Thinking of performance diagnosis and improvement, this part attempts to summarize a set of Methodological Thinking of performance diagnosis and improvement of county CDC using benchmarking management concept, mainly including clear multi-dimensional benchmarking. Performance diagnosis and improvement and continuous improvement process. On this basis, the "county CDC performance diagnosis and performance improvement guide" template was formed. 5. The purpose of this study was to explore the county CDC performance diagnosis and improvement methods, and the "county CDC performance diagnosis and performance improvement guide" was formed. Improvement Guide > Template provides an important tool for optimizing county-level disease prevention and control work and improving performance. Multidimensional three-dimensional benchmarking, including virtual benchmarking and conventional benchmarking, including horizontal benchmarking (national County level, regional County level, standard level) and vertical benchmarking; (3) Formed a < County CDC performance diagnosis and Improvement Guide > template, the template mainly includes status evaluation, performance diagnosis, performance At the same time, this study also has the following aspects to be improved: 1. The research only based on the performance evaluation information platform data for performance diagnosis and improvement, not further combined with the specific situation of the region or institution; 2. In the performance of the organization; In the aspect of improvement research, only by comparing with the standard gap, the relatively weak functions are clarified, the direction for improvement is provided, and the specific improvement strategy is not formed according to the actual situation of the region or organization; 3. The research focuses on providing the Methodological Thinking of performance diagnosis and improvement from the macro level, and the formation of < county level disease prevention and control Performance Diagnosis and Improvement Guidelines > Template is universal, but how to form a personalized diagnosis book and improvement guide on this basis, we need to further explore, including the formation of specific performance diagnosis and improvement of the operation process.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.21
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