| In January 2015,the NHFPC issued the ‘Action Plan for the Further Improvement of Medical Services’.The ‘Plan’ not only put forward a series of requirements for the hospital outpatient service and management in detail,but also set a timetable for the hospital outpatient departments（OPDs） to improve.Learning from the 2015 Work Report of the NHFPC,our colleagues did a very job at improving the outpatient appointment and reducing the waiting time in OPDs.However,the author found out that the ‘3-Longs,1-Short’ situation is still in existence,with uneven distribution of workload and low satisfaction of patients in hospital OPDs through observation.Under the background of improving outpatient service nationwide,the author tries to find out the reason why the efficiency of outpatient service cannot be improved after completion of many advances.Aiming at the situation of using and managing outpatient resources in hospital,way of clinical diagnosis and treatment were discussed.With the theory of ‘business process reengineering’,‘clinical pathway theory’ and ‘demand theory’ as the theoretical basis,through the observation of outpatient service flow of D hospital in Shanghai and the collection and analysis of outpatient service and related data,the author brought out the outpatient process reengineering program.In the meantime,the effect and significance of outpatient process reengineering were discussed through interviews with medical workers and questionnaires for outpatients.The author found that there are three problems in the process of hospital outpatient service,including the overall,structural and procedural problems.The main problem is the uneven distribution of the patient population,the blind pursuit of experts and high-level outpatient clinic affects the hospital clinic of optimal allocation of resources,diagnosis and treatment process and the higher degree of time-consuming uncertainty.By discussing the causes of the current problems,the author believes that the lack of unified standards for diagnosis and treatment,ambiguity in the setting of outpatient level,the first-come-first-served basis of the people was difficult to correct in a short term,the doctor discipline of out-patient is lack of scientific management,all these made the reform has been unable to break through the core difficulties of the important factors.This paper proposes to try to use the ‘clinical pathway’ as the outpatient procedure standard to achieve the homogeneous diagnosis and treatment of outpatient service,and optimize the efficiency of medical resources utilization.From the definition of health,by expanding the scope of emergency services,patients with subjective urgent needs will be included in the emergency scope,and the role of the emergency department changed as a diagnostic function unit in the daily medical activities,so as to improve the efficiency of the first-level triage of the hospital.Setting grades of the outpatient,to achieve the hospital classification diagnosis and treatment and referral system to improve the accuracy of the treatment population.In addition,the author made clear the prerequisite for outpatient appointment,that is,the definitive nature of outpatient capacity.Based on the calculation of outpatient workload,according to the clinical pathway of the allocation of out-patient resources,making the separated outpatient units to be effectively integrated,and to make more accurate booking,patients’ treatment be more efficient.With the certainty to replace the uncertainty in the existing outpatient process,to complete the outpatient process reengineering.The research of this article has carried on the beneficial thinking and the exploration for the hospital implement to the ‘Action Plan of Further Improvement of the Medical Service’.The ‘Plan’ to improve patient services and clinical pathways were promoted an organic integration,to achieve the mutually reinforcing effects,but also a future to the further enhancement of the operation and management of the hospital outpatient. |
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