美国梅奥诊所经营多年“长盛不衰”究竟有什么秘诀?

2017-08-03 佚名 医院管理论坛报

梅奥经营多年还能够在美国激烈的医疗市场中脱颖而出,到底有什么秘诀呢?

到过梅奥诊所的每一个人都会感到它与其他美国医院相比存在的巨大差异。究竟梅奥为何如此特殊?这也是笔者一直尝试解答的问题。到梅奥诊所进修过之后,笔者找到了答案:绝佳的团队合作让庞大如航空母舰般的组织架构反而变得扁平,这可能得益于多年的医院文化积淀。文化赋予了梅奥一种得天独厚的巨大优势,从而在美国激烈的医疗市场中脱颖而出。

家庭般的工作氛围

团队合作首先建立在顺畅沟通的基础上。在梅奥手术室,虽然每个人都很忙碌,但是笔者最常听到的话是“我有什么能帮助你的吗?”“你觉得我这样做有什么问题吗?”如果小儿麻醉诱导时需要人帮忙扎液,只要开口就会有人来。如果一个医生看到别人准备做神经阻滞而自己又暂时没什么事,可能会主动帮忙把超声机推过来。互帮互助、开放自由的沟通环境围绕在每个人身边。

作为一个外来的访问者,如果手术间护士看到你,会主动打招呼“到这边来看手术会看得清楚一些”,或者在进行激光手术时直接递来一副“激光防护眼镜”——带着友善的微笑,而非训斥责备的目光。在这种氛围中,帮助人的人不会有任何的居高临下,被帮助的人也不会觉得被冒犯。而这种家庭般的氛围和朋友般的关系,不仅仅体现在人和人交谈的语言中,而是随处可见。

由于梅奥手术间亚专业高度细分,很多麻醉医生和手术室护士长期固定搭配,在手术间的公告牌上随处可见张贴的“周末活动通知”,每个人自愿报名并选择自己愿意带来的饮食种类,医生护士们似乎到了周末仍然愿意相聚在一起。每条手术间走廊里,都可以看到“Thankyouboard”,来来往往的人们可以把自己感谢的话写在上面,令人意外的是更新频率很高。在梅奥,工作和生活的界限似乎在变得模糊。

在这样的环境中工作,梅奥人可以做到全情投入,很少抱怨。即使是在手术室这样高强度工作的环境中,也很少能听到人在抱怨,更很少听到人们在谈论手术几点能结束,后面还有几台。

精准的工作流程

手术室内的工作流程和环节众多,涉及人员方方面面,而梅奥因为开展了很多质量改进项目,流程只多不少。例如,当麻醉医生在手术中需要查血气时,不仅从来不需要自己亲自用血气机,更不用自己亲自送标本,连患者信息都不用自己填写标记——手术间内为每个病人自动生成一个独特的条码标签,贴在血气样本上,而每个手术间内都有一个按钮式传呼机,呼叫麻醉二线、送标本、送血气等都有专人完成,只要在传呼机上按下相关按钮就行。

而为了便于PACU护士更好管理患者,需要麻醉医生在手术结束前为每个患者分配一个“危重度评分(Acuityscore)”,不同的分数对应不同的床护比和PACU物资配置。诸如此类的细节很多,尽管工作环节多了,但梅奥的手术间运营非常有序,衔接紧密,这和每个组织工作人员的团队合作和密切配合是分不开的,每个组织就好像钟表的齿轮一样紧密衔接,每个齿轮都精密准确,而高凝聚力的团队合作精神就是齿轮间的润滑剂。

充足的人员配备

梅奥能打造这样强大的文化,也并非一朝一夕,背后隐藏着很多管理密码。医护人员配备充足和对其充分尊重是重要一环。梅奥的手术间分为中部、北部和儿科,其中在centraldivision,虽然只有五十几个手术间,却有120多个麻醉医生。充足的人员是避免医护人员过度疲劳的保障,是塑造文化执行纪律等一切的基础。科室专门设置了机动人员负责替午饭、替休息、晚间手术接班。当人疲于奔命的时候,是无论如何也无法集中精力学习和提供高质量服务的。

在这样充足的人员条件下,每个人都可以全身心集中在当时负责的患者身上。而充足的人员又来源于医院的吸引力——专业度、文化、品牌,二者相辅相成。值得一提的是,梅奥是美国医院中为数不多的为医生提供年薪制的医院,医生的价值与工作量无关,这也是梅奥较为独特的地方之一。

梅奥的仪器设备和药品可谓达到了最顶配,一些仪器或药品并不是美国的每个医院都有,但是只要认为对患者有利,梅奥医生都可以向医院提出,最终都会使用在临床当中,这样也保障了梅奥能一直走在医学发展的最前沿。

基于数据的循证医学研究

现在,循证医学已经成为医疗领域的一个重要方向。美国的众多医院行医模式都是遵循循证医学证据的,但是在大型教学医院里,往往审批层级众多、效率低下,导致一些最新的临床研究结果和证据无法很快地传导到临床医疗中。

而在梅奥,医生们的循证医学证据遵循的证据往往在不断更新,比如产科延迟脐带夹闭,氟哌利多的使用,内收肌管阻滞的大规模应用等。并且,梅奥的医生们在将新的诊疗手段应用到临床后,会积极收集临床数据,来观察疗效是否确实更好。很多临床问题,都有自己医院的独特数据,而收集这个数据并不是为了做科研发文章的需要,而主要是为了改进临床工作。

美国信息系统的特点是,信息输入时往往并不是完全格式化的,但是后期会有人去利用机器学习的方法来研究和分析大数据,为临床所用。

梅奥有一支庞大高效且多专业融合的数据分析部门,专门针对医疗信息系统里面收集的海量信息进行分析,旨在改善临床流程和结局。研究团队成员有医师、流行病学家、统计学人员、IT人员等,学科充分交叉和相互补充。随着HIT系统源源不断的产生大量数据,这样的一支队伍是不可或缺的,这也保证了梅奥能够做到基于数据的临床持续改进。

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    2017-08-03 thlabcde

    好东西学习了!

    0

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    2017-08-03 惠映实验室

    学习了,谢谢

    0

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    2017-08-03 131****1460

    学习了受益匪浅

    0

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