The Research Of Performance Management Scheme Of The Rural Township Health Institutions

Objectives After five years of deepening the health care system reform, the government investment in primary health care institutions increased continuously, which guaranteed the development of the primary health care services. However, both quality of service and working enthusiasm dropped in some degree after reform in township-village health institutions(THI), even causing phenomena like "Eating from the same pot---egalitarian practice where one gets the same payment regardless of work done" and "Raise Dawdler---one gets paid without working" in some places. To improve quality of service in THI, it is necessary to conduct problem-oriented performance management and establish pay for performance incentive mechanism. Successful implementation of performance management in THI would improve their basic services as well as optimize their functions in the three-tertiary health care network and provide theoretical reference for the government management. These would facilitate the sustainable development of rural health services, and ultimately improve peasantry health.Methods Both quantitative and qualitative studies were applied in the research. Field investigations were carried out in47THI in Jieshou, Huaiyin and Hanjiang. Data were collected in four aspects:general management, basic medical service, public health service and social evaluation. Data Envelopment Analysis (DEA) was used to study institutions’ efficiency to understand the current status and find major performance problems in health institutions. Then DEA results were then compared with performance indicators. Cumulative odds logistic model was also used to analyze the main factors affecting residents’satisfactions with basic medical service and public health service. The basic theoretical framework of this study was established by literature review. Through expert consultation and in-depth interviews, the performance management scheme with sustainable performance improvement as its goal was designed oriented by performance problems.Results The main performance problems:in general management, systematic and effective performance management scheme was needed and the workforce construction needs strengthening in three cities (districts). In terms of basic health service, problems existed such as high outpatient antibiotic prescription and intravenous administration ratio, poor service specification and theoretical knowledge among medical staff and low efficiency. In public health service, the management work of children and maternal care was relatively poor and registered prevalence rates of chronic diseases were relatively low. Residents’satisfaction with basic medical service was low. The results of DEA showed that health institutions in Jieshou and Huaiyin had low efficiency while some institution had insufficient output. In order to improve organizational efficiency and performance level, main interventions were needed in the following aspects:the chronic diseases screening in Jieshou, the efficiency of basic health services and management of patients with severe mental illness in Huaiyin, the basic medical service standards and management of elderly in Hanjiang. The lack of health personnel and the low quality of personnel were the factors that affected performance. Factors affecting residents’ satisfaction with basic medical services including over ten thousand yuan on medical equipment for each hospital bed and outpatient antibiotic prescription ratio; factors like standard management rate of the65years and above and registered prevalence rate of hypertension affected residents’ satisfaction with public health service. Conclusions In designing performance management scheme:problem-orientation is the core of performance management. The key first step is to find the performance problems and take them into consideration through the whole process of scheme design. Performance issues have timeliness. Sustainable performance improvement is the goal of performance management. Targeted and practical performance improvement measures should be developed and skills training should be undertaken to improve performance. Effective incentives are an important guarantee for sustainable performance improvement. To ensure the smooth implementation of the performance management program, policy support must be completed with multi-sectoral cooperation mechanism. The funds should be guaranteed, and incentive mechanism should be enhanced. Two-way communication of performance should be emphasized with the establishment of open communication channels. Managers need to change management philosophy and complement the supporting management system. A perfect information system should also be constructed to transform performance management to a scientific and information-based style.