Research on the method of measuring performance pay of family doctor teams based on hierarchical analysis and key performance indicator design
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摘要:
目的 基于家庭医生团队工作内容及特质，使用层次分析法和关键业绩指标法结合构建家庭医生团队绩效薪酬测算方法。 方法 首先深度访谈了解目前家庭医生团队岗位工作内容，梳理设定家庭医生团队下签约服务标化工作项目。以层次分析法计算标化工作项目的相对权重，计算标化工作项目的薪酬值，构建数量指标；使用集中式专家会议研讨法，根据家庭医生团队绩效薪酬的政策文件和实践基础，设定家庭医生签约服务关键业绩指标，构建质量指标；两者结合构建家庭医生团队绩效薪酬测算方法。基于实际业务数据开展新老方案比对测算及验证。 结果 家庭医生团队岗位的服务数量的标化工作项目共计199项；家庭医生团队工作平均相对标化值为6.47±3.32，其中单个项目相对标化值最高为“家庭病床出诊”，最低为“公益性计划生育咨询”。家庭医生签约服务绩效质量指标体系包括3个维度、5个一级指标和6个二级指标，并设定对应的考核方法，以已有的全科医疗工作数量的3 748条数据作为基础数据测算，按照原方案标化值测算其绩效薪酬总额为397 958元，按照优化调整后的测算结果为405 315.4元(家庭医生签约服务费除外)，整体较原方案增长约1.85%，进行DF检验，P＜0.05，满足数据平滑性要求，可以确保新标化工作值及测算方案过渡。 结论 基于层次分析和关键业绩指标的团队绩效薪酬测算方法，能够有效衔接旧有的按医疗收入提成的绩效方案，促进签约服务落实。 Abstract:Objective To construct a method of measuring performance pay of family doctor teams using analytic hierarchy process and key performance indicator based on the content and characteristics of the work of the family doctor team. Methods Firstly, in-depth interviews were conducted to understand the work content of the current family doctor team, and standardized work items for contracted services under the family doctor team were sorted out. The relative weights of the standardized work items were calculated using the hierarchical analysis method, the salary values of the standardized work items were calculated and quantitative indicators were constructed. Secondly, centralized meetings and discussions were used to set key performance indicators for family doctor signing services based on policy documents and practice base, and quality indicators were constructed. A performance compensation calculation method for family doctor teams was constructed using combining the two. Based on actual business data, the new and old plans were comparatively calculated and verified. Results There were 199 standardized work items for the number of services of family doctor team positions. The average relative standardized value was 6.47±3.32, with the highest relative standardized value for a single project being "home bed visits" and the lowest being "public welfare family planning consultation". The performance and quality indicator system for family doctor contract services included 3 dimensions, 5 first level indicators, and 6 second level indicators, and corresponding assessment methods were set. Based on the existing 3 748 pieces of general medical work data as the basic data, the total performance-based compensation was calculated to be 397 958 yuan according to the standardized value of the original plan. After optimization and adjustment, the calculation result was 405 315.4 yuan (excluding family doctor contract service fees), which was an overall increase of about 1.85% compared to the original plan. Perform DF test showed P < 0.05, which meted the requirements for data smoothness and could ensure the transition of new standardized work values and calculation schemes. Conclusion The method of measuring performance pay of family doctor teams based on analytic hierarchy process and key performance indicators can effectively connect old performance plans and promote the implementation of contract signing services. -
Key words:
- Family doctor /
- Signing services /
- Performance /
- Distribution
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表 1 判断矩阵标度及其含义
Table 1. Scale and meaning of judgement matrix
标度 含义 1 表示2个项目相比，消耗相同的资源 3 表示2个项目相比，前者比后者消耗稍多的资源成本 5 表示2个项目相比，前者比后者明显消耗更多的资源成本 7 表示2个项目相比，前者比后者强烈消耗更多的资源成本 9 表示2个项目相比，前者比后者极端消耗更多的资源成本 2，4，6，8 表示上述相邻判断的中间值 
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表 2 家庭医生团队工作部分项目与相对标化值示例
Table 2. Examples of part items and relative standardized value for family doctor team work
工作板块 工作项目 相对标化值 公共卫生 肿瘤患者访视与康复指导 2.0 公共卫生 HIV/AIDS高危人群干预 3.0 公共卫生 VCT咨询 3.0 公共卫生 高血压新建卡 10.0 公共卫生 公益性计划生育咨询 1.0 基本医疗 拔甲治疗 4.0 基本医疗 电子生物反馈疗法 2.0 基本医疗 灌肠 1.0 康复服务(含中医) 刺络拔罐(每次最高) 3.2 康复服务(含中医) 康复评定 5.3 护理服务 肌肉注射 2.1 护理服务 导尿 2.4 家庭医生健康管理 家庭病床出诊 14.0 家庭医生健康管理 签约居民电子健康档案更新 8.0
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表 3 家庭医生团队服务签约服务关键业绩指标及评价标准
Table 3. Key performance indicators and evaluation criteria for family doctor contract services
维度 一级指标 二级指标 分值 指标定义 评分标准 签约覆盖 签约情况(30分) 重点人群签约数维持情况 20 做实家庭医生签约，确保重点人群签约覆盖，重点人群签约数变化值=当年签约重点人数-上一年签约重点人数 重点人群签约数变化值≥-15得20分，-25≤n＜-15得19分；-35≤n＜-25得18分；-45≤n＜-35得17分；-55≤n＜-45得16分；n＜-55得15分 重点人群签约 10 确保做实家庭医生签约，提升对辖区重点人群签约的贡献，公式：签约重点居民人数/辖区核定重点人群数×100% 重点人群签约贡献度≥1.50%得10分，1.25%~1.50%得9分，1.00%~1.25%得8分，0.75%~1.00%得7分，0.50%~0.75%得6分，＜0.50%得5分 有效服务 组合内就诊(20分) 签约居民组合内就诊率 20 签约居民当年度在签约医疗机构组合内就诊占签约居民总就诊次数比例，公式：签约居民在签约医疗机构组合内门诊人次数/签约居民当年度门诊总人次数 组合内就诊率≥80%得20分、75%~79%得19分、70%~74%得18分、65%~69%得17分、60%~64%得16分、40%~60%得14分、＜40%得10分 社区就诊(20分) 签约居民社区就诊率 20 签约居民当年度在签约社区卫生服务中心就诊占签约居民总就诊次数比例，公式：签约居民在签约社区卫生服务中心门诊人次数/签约居民当年度门诊总人次数 社区就诊率≥60%以上得20分、55%~59%得19分、50%~54%得18分、45%~49%得17分、40%~44%得16分、20%~40%得14分、＜20%得10分 服务满意度(10分) 满意度评分 10 签约居民当年度对签约家庭医生满意度评价结果 分数=10分×满意度(%) 有效控费 医保费用(20分) 签约居民年人均医保费用 20 签约居民当年度在各级医疗机构人均年医保费用(以签约半年以上的参保人员作为统计目标人群)，公式：签约居民年医保费用/签约居民数量评分依据 签约居民当年度在各级医疗机构人均年医保费用高于市签约居民面上水平得15分、≤平均水平得20分
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Table 4. Performance payment calculation for family physicians
薪酬来源 计算方法 质量考核依据 标化工作项目部分 按199个标化工作项目的完成数量进行计算，具体测算为：∑(单个项目标化值×当年度标化薪酬×完成次数) 进行两级质量考核模式，其中70%根据中心医务科、公共卫生科原有的服务质量评价进行质量考核；30%根据家庭医生团队服务签约服务关键业绩指标及评价标准，计算得分，按照计算得分/100×100%进行质量考核 家庭医生签约服务费部分 按上海市签约服务费用管理规定，根据团队签约服务的人员基数，家庭医生签约服务经费中不少于70%用于团队的薪酬发放。具体测算为：团队签约服务人数×10元/(人·月)×70%。 家庭医生团队服务签约服务关键业绩指标及评价标准，计算得分，按照计算得分/100×100%进行质量考核
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