Research On The Level Of Technical Post Of Surgeons Based On Resource-Based Relative Value Scale (RBRVS)

[Purpose]Based on the analysis and evaluation of the technical positions of clinical surgeons,the key factors of job grade grading are constructed,and the expert posting method and questionnaire survey method are used to construct the physician grade rank model,to determine the grading criteria based on RBRVS,and then build a hierarchical classification model.Finally,the grounded theory is used to optimize the model,and to provide the theory and method support for the clinical management of clinical surgeons in large hospitals.[Method](1)Literature research.Through the CNKI,Wanfang,VIP and other Chinese database,PubMed,EMbase,SCI / SSCI and other foreign language database,as well as international health agency website,including the World Health Organization and Internet network resources,to search some literature of RBRVS,CanMEDS,job analysis,job evaluation,job grade.We can clear job grade grading elements on the basis of induction and summary analysis.(2)Spot investigation method.Through the preliminary work to determine the questionnaire on the Shenzhen Municipal Public Hospital of the clinical surgeon survey,we investigated 51 surgeons in 4 hospitals.The survey investigated some post grading factors that were considered to be more important and critical in the mind of clinical surgeons.(3)Expert consultation method.Select nearly 20 relevant experts to participate in the consultation through the combination of on-spot consultation and letters.The primary factor were scored from the importance,operability and quantification of the factors of surgeon post rank,and the grading elements were screened and increased according to the expert score.The results of the questionnaire were used to determine the factors of clinical surgeon technical post grade.(4)Individual depth interview.Through the individual depth interview with nearly 20 experts,to consult the experts on the construction of the model and standard application of the views,and to build the concept of model optimization framework in the use of grounded theory.[Results](1)Through the literature research and expert discussion method,using the RBRVS theory,combining the CanMEDS and NHS post evaluation theory,We preliminarily determines the conceptual framework for grading of doctors’ posts,then determines the clinical operation skill,the operation complexity and other 26 post level classification factors of clinical surgeons,which includes three categories: Indicators of clinical specialist,the scientific research type teaching,and the clinical skills.And then we discuss the key elements of Index system in this paper.(2)We use expert consultation on the importance,quantification,and effectiveness of indicators to cut out the four indexes such as property and assets management responsibility,determine the final 22 indicators and the hierarchical model of indicators.Surgery done coefficient,preoperative complications correction factor,work coordination,patient satisfaction and the degree are divided into four grades;postoperative complications correction factor,service responsibility for patients,analytical skills and judgement,communication and interpersonal skills are divided into 5 levels;human resource management is divided into 6;clinical skills,clinical teaching status,the number of scientific research projects,scientific research output,work experience and the responsibilities of management and decision,training and continuing education are divided into seven;complexity of operation,post-operative surgical work amount,teaching work,research awards,professional influence at home and abroad are divided into 8.(3)We determine the technology level hierarchical model of clinical surgeons,calculate the weight coefficient of each index,and quantify indexes based on their significance.Based on RBRVS,We use expert discussion,literature analysis,critical incident method and so on to determine the classification standard of all key elements.Finally,the level classification model of the surgeon’s technical post is constructed.(4)Technical post level classification model on Clinical surgeons should focus on“stability”“quantitative” "operational" "relevance" "timing" five dimensions in the process of application,and then extract 25 primary concept category such as personnel relationship and physicians connotation.Finally,build concept framework of model optimization on the clinical surgeons’ technical post level classification.[Conclusions]Evaluation model based on the title of clinical surgical personnel has many disadvantages,while technical post level classification research on clinical surgeons based on RBRVS is a kind of innovation of medical institutions post management mechanism.It integrates many theories such as NHS post evaluation and CanMEDS to construct the technology level classification model on clinical surgeons,which contains clinical specialized subject,scientific research and teaching and non-clinical skills three categories of 22 indicators.We divide different indicators for the hierarchy,and determine the weight coefficient and classification standard of index,which are helpful to quantify the comprehensive skills of surgeons.The model can guide clinical surgical post management of large medical institutions,promote the comprehensive development of clinicians,improve the surgeon’s assessment of current predicament,and can be conducive to the human resources management and the reform of post management of modern hospital.[Innovation and deficiency]The main innovation point of this research:(1)Based on theoretical analysis,we construct technology level classification model on clinical surgeons using RBRVS.Through quantitative thinking of RBRVS,innovatively make post management a quantitative examination,which can provide theoretical basis for clinical surgeons on Post management and performance evaluation.(2)This study divides clinical surgeons into clinical specialist type and scientific research and teaching one,and distinguishes the two types to divide clinical technical indicator into clinical specialist and research teaching indicators.The deficiency of this study:(1)Technical post classification model on clinical surgeons is based on the literature analysis method,expert discussion and critical incident method to determine,so as that classification standard may still rough,need further research to enhance the precision.(2)The optimization model originally designed is simulated optimization using quantitative data,which is unable to collect quantitative data due to some objective reasons.this study collect suggestions on model optimization through expert interview method to and construct the model optimization framework using grounded theory.Limited to the time and ability,I can only put forward the preliminary optimization idea.