1、Chinas Proposed Changes in Hospital Management Education and Practice as Derived from North American Successes-來自北美洲的成功經(jīng)驗(yàn),Howard W. Houser, Ph.D. Professor Emeritus and Former Associate Dean Department of Health Services Administration The University of Alabama at Birmingham April 26, 2013 Beijing,

2、China , 系主任,教授 2013年4月26日 中國(guó)北京,My Background我的背景,I have 54 years of hospital management and hospital management education experience in the USA 在美國(guó)，我有54年的醫(yī)院管理和醫(yī)院管理教育經(jīng)驗(yàn) I have 29 years of hospital and health administration education experience in China 在中國(guó)，我有29年的醫(yī)院管理和衛(wèi)生管理教育經(jīng)歷 Hospital management educ

3、ation and practice in China is one of those projects 中國(guó)醫(yī)院管理教育與實(shí)踐是其中之一,My USA Experience and Background我在美國(guó)的經(jīng)驗(yàn)和背景,Earned both Masters and Ph.D. degrees in Hospital and Health Administration 擁有醫(yī)院和衛(wèi)生管理的碩士和博士學(xué)位 Worked in 6 different hospitals early in career 在早期職業(yè)生涯中曾為6所不同的醫(yī)院工作過 Routine access to more t

4、han 150 hospitals in academic career 在學(xué)術(shù)生涯中與150多所醫(yī)院保持頻繁的日常聯(lián)系 Three years active duty as officer in U.S. Air Force Medical Service School preparing all levels of health workers for Air Force hospitals 曾作為現(xiàn)役軍官在美國(guó)空軍醫(yī)療服務(wù)學(xué)校服役3年，為空軍醫(yī)院培養(yǎng)不同層次的管理人員。,My USA Experience and Background我在美國(guó)的經(jīng)驗(yàn)和背景,Began full time

5、teaching in 1970 從1970年起開始全職教書 Have served as program and school developer, program director, department chair and associate dean 曾擔(dān)任醫(yī)院管理系和衛(wèi)生管理專業(yè)學(xué)院的創(chuàng)始人，項(xiàng)目總監(jiān)，系主任和副院長(zhǎng) Now work part time on special projects 現(xiàn)在為一些感興趣的項(xiàng)目兼職工作,My China Experience and Background我在中國(guó)的經(jīng)驗(yàn)和背景,China Ministry of Health and U.S. P

6、roject HOPE as Leader of Hospital and Health Administration Development Project May-October, 1984 1984年5月-10月，作為中國(guó)衛(wèi)生部和美國(guó)聯(lián)合項(xiàng)目的“HOPE基金會(huì)”中“醫(yī)院和衛(wèi)生管理發(fā)展”項(xiàng)目主管人 Based at Xian Medical University and extending to Beijing Medical University, Zhejiang Medical University, and Shanghai Second Medical University 當(dāng)時(shí)

7、曾主要工作于西安醫(yī)科大學(xué)，也曾參與北京醫(yī)科大學(xué)、浙江醫(yī)科大學(xué)和上海第二醫(yī)科大學(xué)的工作 Focused on undergraduate and graduate hospital/health administration and continuing education 主要關(guān)注醫(yī)院及衛(wèi)生管理本課及研究生教育和繼續(xù)教育,The History of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,Prior to 1930- Doctors, Nurses, or Businessmen bec

8、ame hospital presidents Hospitals not complicated 1930年以前，醫(yī)生、護(hù)士和經(jīng)商人士都可以成為醫(yī)院的院長(zhǎng),醫(yī)院并不復(fù)雜 The 1st Generation -1933&34- Two masters programs launched at Northwestern University and University of Chicago 1933-1934-第一代：美國(guó)西北大學(xué)和芝加哥大學(xué)成立了兩個(gè)醫(yī)院管理碩士點(diǎn) Chicago is headquarters for both American Medical Association a

9、nd American Hospital Association 芝加哥是美國(guó)醫(yī)療協(xié)會(huì)和美國(guó)醫(yī)院協(xié)會(huì)的總部,The History of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,Led by Physician Leaders and Academic Leaders in Economics and Finance 由醫(yī)生領(lǐng)袖和經(jīng)濟(jì)與財(cái)務(wù)學(xué)科的領(lǐng)袖來領(lǐng)導(dǎo) Selected the Masters Degree as the terminal degree for practice 選擇碩

10、士學(xué)位作為這個(gè)醫(yī)院管理實(shí)踐學(xué)位的學(xué)位終點(diǎn) One year of academic work and one year of guided practice. 第一年是學(xué)術(shù)課程， 第二年是有針對(duì)性的實(shí)踐 Other similar programs followed on the West and East coasts of U.S. 另外一個(gè)相似的碩士點(diǎn)隨后在美國(guó)的西海岸和東海岸建立,The History of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,Most educational

11、 materials prepared by practitioners and regular faculty 大多數(shù)教育材料是為開業(yè)醫(yī)師和大學(xué)教員準(zhǔn)備的 Education was prescriptive in nature- How things ought to be 這個(gè)教育的指導(dǎo)性屬性是事情應(yīng)該是怎樣的 The 2nd Generation, 1940s and 50s- used same model, many in public universities in the Midwest e.g. Michigan, Minnesota, Iowa 1940年-1950年，第二

12、代：應(yīng)用同樣的模式；大多數(shù)在中西部的公立大學(xué)，比如密歇根、明尼蘇達(dá)、愛荷華等大學(xué) Most second generation leaders were mentored by the original 1930s leaders 大多數(shù)第二代管理者師從于30年代的第一批管理者,The History of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,My alma mater, University of Iowa department founded in 1950 by Gerhard

13、Hartman a 1934 Graduate of the University of Chicago Department 我的母校，愛荷華大學(xué)的該專業(yè)由哈特曼教授成立于1950年，他1934年畢業(yè)于芝加哥大學(xué)的衛(wèi)管專業(yè)。 Became clear that the education was necessary, the new model for hospital management, and it would grow and become permanent 在明確了這種教育是非常有必要之后，一個(gè)新的醫(yī)院管理模式就開始發(fā)展并且成為持久的模式 Many graduates rose

14、 to top positions in hospitals within 7-10 years 很多畢業(yè)生在7-10年的時(shí)間里成長(zhǎng)為醫(yī)院的高層管理者,The History of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,The 3rd Generation- 1960s &70s- Started in areas of U.S. and Canada where there were no programs 1960-1970年，第三代：在美國(guó)和加拿大的部分地區(qū)開始，這些地方之前并沒有

15、專門的項(xiàng)目 Example 1965- University of Alabama started at Birmingham Medical Center, this School of Health Administration, now has become School of Health Professions 1965年的例子-阿拉巴馬大學(xué)伯明翰醫(yī)學(xué)中心成立了衛(wèi)生管理學(xué)院，就是現(xiàn)在的衛(wèi)生管理專業(yè)學(xué)院 Leaders were mostly mentored by 2nd generation program leaders 這一代的領(lǐng)導(dǎo)者們多數(shù)從師于第二代的領(lǐng)導(dǎo)者,The Hist

16、ory of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,Curriculum extended to two academic years and year of guided practice 課程包括2年學(xué)習(xí)和1年指導(dǎo)性的實(shí)踐 Many programs removed year of guided practice from the degree and made it totally post degree experience while many , including UAB

17、did not 因?yàn)榭紤]學(xué)制太長(zhǎng)很多碩士點(diǎn)去掉了一年實(shí)踐課程。 但很多碩士點(diǎn)沒有這樣做， UAB 選擇了后者，即保留一年的實(shí)習(xí)。 Canada followed U.S. pattern 加拿大仿照了美國(guó)模式,The History of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,Many, even most, 4th generation programs have not yet sought or achieved accreditation 大多數(shù)第4代碩士點(diǎn)還沒有被發(fā)掘，或者說還

18、沒有取得評(píng)審認(rèn)證的專業(yè) Programs from all generations are housed in Schools of Public Health, Business, Graduate Schools, Schools of Medicine, and Schools of Health Professions 每一代的醫(yī)院管理碩士點(diǎn)都建立于公共衛(wèi)生學(xué)院、工商管理學(xué)院、研究生學(xué)院、醫(yī)學(xué)院或衛(wèi)生專業(yè)學(xué)院。 Doctoral study incorporated specific to this discipline since the 1950s 1950年代，博士學(xué)位學(xué)習(xí)開始加

19、入到這個(gè)專業(yè),The History of Hospital and Health Management Education in North America北美洲醫(yī)院和衛(wèi)生管理教育的歷史,Develops educators, researchers and leaders for key medical institutions 為主要醫(yī)療機(jī)構(gòu)培養(yǎng)教師、研究者和管理者 Bachelors Undergraduate evolved independently in many smaller schools with no graduate programs 在一些小的學(xué)校，只有學(xué)士學(xué)位而沒

20、有研究生學(xué)位 Today many 2nd and 3rd generation departments have bachelor, masters and doctoral programs in the same department. UAB does 在今天，很多第2、3代的學(xué)院有學(xué)士、碩士和博士點(diǎn)。UAB也是這樣。 The masters degree is still the standard of practice for top general hospital management. 碩士學(xué)位依然是綜合醫(yī)院高級(jí)管理的標(biāo)準(zhǔn)配置,A Review of Hospital Man

21、agement Practice in the USA美國(guó)醫(yī)院管理回顧,They rely instead on graduation from accredited programs and professional organizational achievement credentials 而是依靠評(píng)審認(rèn)證的學(xué)位畢業(yè)證書和專業(yè)機(jī)構(gòu)文憑 This was probably a mistake because there is no law to prevent anyone from becoming a hospital president who does not have the p

22、rofessional degree 這可能是一個(gè)失誤，因?yàn)闆]有法律可以阻止一個(gè)沒有專業(yè)學(xué)位的 人來擔(dān)任醫(yī)院的董事長(zhǎng) Most hospitals and systems seek and staff only with professional degree holders 大多數(shù)醫(yī)院和醫(yī)療系統(tǒng)尋找和雇傭這些專業(yè)學(xué)位的人,What Subject Matter Do These Graduates Learn?這些研究生學(xué)什么？,Health Systems Development, Organization, and Management 衛(wèi)生系統(tǒng)發(fā)展、組織和管理 Hospital and

23、 other Health Organization Development, Organization Theory, Governance, Structure, and System Relationships 醫(yī)院和其他衛(wèi)生組織發(fā)展、組織理論、管理、結(jié)構(gòu)和系統(tǒng)關(guān)系 Health Care Economics and Health Care Finance and Accounting 衛(wèi)生經(jīng)濟(jì)、財(cái)務(wù)管理和會(huì)計(jì)學(xué) Hospital and Health Related Human Resources Management 醫(yī)院和與衛(wèi)生相關(guān)的人力資源管理,What Subject Matt

24、er Do These Graduates Learn?這些研究生學(xué)什么？,Epidemiology and Medical and Surgical Practice content 流行病學(xué)、醫(yī)療和外科實(shí)踐內(nèi)容 Statistics and Quantitative Methods for Health Administration Practice 衛(wèi)生統(tǒng)計(jì)學(xué)和計(jì)量學(xué) Health Care Marketing and Competition 衛(wèi)生市場(chǎng)和競(jìng)爭(zhēng) Health Information Technology and Health Informatics 衛(wèi)生信息技術(shù)和衛(wèi)生信息學(xué)

25、,What Subject Matter Do These Graduates Learn?這些研究生學(xué)什么？,Methods of System and Organization Improvement 系統(tǒng)和組織改善方法 Quality Systems and Accountability 質(zhì)量體系和問責(zé)制 Leadership Skills, Critical Thinking, Problem Solving, Teamwork 領(lǐng)導(dǎo)力、批判性思維、問題解決和團(tuán)隊(duì)合作,What Subject Matter Do These Graduates Learn?這些研究生學(xué)什么？,Heal

26、th Policy- What should we do and how should we do it 衛(wèi)生政策-我們應(yīng)該做什么和應(yīng)該怎么做 Health Law- Federal and State Government Laws and Regulations, Contracts , Liability and Negligence 衛(wèi)生法律-聯(lián)邦和州政府的法律和規(guī)定、合約、責(zé)任和過失處理 Integrative course to apply all knowledge learned 綜合課程保證所有知識(shí)的應(yīng)用 Elective courses to specialize 專門化的

27、選修課,Why Executive Models?為什么要采用高級(jí)管理人員模式,Many Universities, including my own, UAB, operate executive format masters and doctoral degrees 很多大學(xué)，包括UAB，開展了針對(duì)高級(jí)管理人員的碩士和博士課程 Most participants are those who hold hospital management jobs but with no formal job related education 大多數(shù)的學(xué)習(xí)者從事醫(yī)院管理但是并沒有學(xué)過相關(guān)的管理課程 La

28、rge numbers of these students are doctors and other health professionals 大多數(shù)學(xué)生是醫(yī)生或者其他醫(yī)學(xué)專業(yè)人員 They learn the same content in the same amount of time while continuing working 他們用同樣的實(shí)踐學(xué)習(xí)相同的課程，同時(shí)也兼顧工作,Some Conclusions about the USA Experience美國(guó)經(jīng)驗(yàn)小結(jié),The Masters degree in hospital and health care managemen

29、t has become the standard for hospital and medical center operations in the U.S. 醫(yī)管或衛(wèi)管碩士學(xué)位成為美國(guó)醫(yī)院和醫(yī)療中心運(yùn)營(yíng)的標(biāo)準(zhǔn) There are more than 90 accredited masters programs producing more than 2000 graduates each year 每年有超過90家認(rèn)證的碩士項(xiàng)目提供2000多名畢業(yè)生 Hospital and Health Care Management are very popular choices among U.S

30、. college graduates 在美國(guó)的大學(xué)和研究生院專業(yè)中，醫(yī)院和衛(wèi)生管理是非常搶手 的選擇 Many of the 1st, 2nd, and 3rd generation are now deceased or retired 很多第1-3代的畢業(yè)生開始逐漸退休了,Why In the 21st Century China Should Be Ready to Adopt Modern Health Management Education and Practice為什么21世紀(jì)的中國(guó)應(yīng)該準(zhǔn)備好接受現(xiàn)代醫(yī)院管理教育和實(shí)踐,The 1980s experiment we ran w

31、as too early and no one understood its importance 1980年代的經(jīng)驗(yàn)太早了，那時(shí)沒人明白它的重要性 Today you have seen your hospitals become more and more complicated to operate, technology growing exponentially and patient expectations growing more demanding 你已經(jīng)可以看到今天你的醫(yī)院運(yùn)營(yíng)變得越來越復(fù)雜，指數(shù)性技術(shù)增長(zhǎng)和病人越來越高的期望,Why In the 21st Century

32、 China Should Be Ready to Adopt Modern Health Management Education and Practice為什么21世紀(jì)的中國(guó)應(yīng)該準(zhǔn)備好接受現(xiàn)代醫(yī)院管理教育和實(shí)踐,Health care finance becomes more complex and difficult each day 衛(wèi)生財(cái)務(wù)每一天都變得復(fù)雜和困難 Private hospitals are growing and competing in every city in China 中國(guó)每個(gè)城市，私立醫(yī)院都在成長(zhǎng)和爭(zhēng)得一席之地 There is a strong need

33、 for change and positive reform 變革和積極改革的強(qiáng)烈需要,Why Does China Need These Types of Graduates?為什么中國(guó)需要這種研究生,Living in an ever expanding digital age. The delivery of health services will always be digitally dependent because of our need for medical records and research 處在一個(gè)前所未有的數(shù)字膨脹時(shí)代。衛(wèi)生服務(wù)的發(fā)展一直是數(shù)據(jù)依賴，因?yàn)槲覀冃?/p>

34、要醫(yī)療記錄和研究 Coping with endless technology progress, changes, and upgrades. Modern medicine and health care is heavily technology dependent. Our technology does not wear out, it becomes obsolete and is replaced 應(yīng)對(duì)無止境的技術(shù)進(jìn)步、改革和升級(jí)換代。現(xiàn)代醫(yī)學(xué)和衛(wèi)生服務(wù)嚴(yán)重地依賴于技術(shù)。我們的技術(shù)不會(huì)停止進(jìn)步，它不斷被廢棄和然后被替代。,Why Does China Need These Typ

35、es of Graduates?為什么中國(guó)需要這種研究生,Dealing with ever more complex systems of health care finance. Health care finance and budgeting is among the most complex of any industry and is continually changing 應(yīng)對(duì)衛(wèi)生財(cái)務(wù)系統(tǒng)的復(fù)雜性。衛(wèi)生財(cái)務(wù)和預(yù)算比任何一個(gè)產(chǎn)業(yè)都要復(fù)雜，并且在不斷的變化。 Delivering quality health services to 1.3 + billion citizens i

36、n the 21st century. We all know how to do it, but must organize, finance, and provide the health professionals and health organizations to do it 為13億多人提供醫(yī)療衛(wèi)生服務(wù)。我們都知道怎樣做，但是如何組織財(cái)務(wù)、提供衛(wèi)生服務(wù)的專家和衛(wèi)生機(jī)構(gòu)來做。,Why Does China Need These Types of Graduates?為什么中國(guó)需要這種研究生,Responding to the internal and joint venture p

37、rivate hospital systems. They already know about the benefits of employing these people and seek them in foreign countries. They will need many more native Chinese graduates 應(yīng)對(duì)國(guó)內(nèi)的和合資的私立醫(yī)院。他們已經(jīng)懂得雇傭醫(yī)管專業(yè)的人并從國(guó)外發(fā)掘這些人才，并從中得到了好處。他們需要更多的本土醫(yī)管專業(yè)畢業(yè)生。 Responding to the International Pursuit of Quality and Reduc

38、tion of Medical Errors. Modern systems with well educated administrators establish and operate these processes best 應(yīng)對(duì)國(guó)際上對(duì)醫(yī)療質(zhì)量的追求和降低醫(yī)療事故。擁有這些良好專業(yè)教育背景人才的現(xiàn)代系統(tǒng)可以最佳的建立和運(yùn)營(yíng)。,Why Does China Need These Types of Graduates?為什么中國(guó)需要這種研究生,Finally- Because it will improve overall the efficiency, effectiveness, and cost control of Chinas health delivery system 最后，因?yàn)樗梢源龠M(jìn)改善整個(gè)中國(guó)醫(yī)療衛(wèi)生系統(tǒng)的效率、效益和成本管控。,What If They Existed Today?如果他們現(xiàn)在就已經(jīng)出現(xiàn)了呢？,Every hospital president in this room could use well at least one of these graduates 在這個(gè)房間里的每一個(gè)醫(yī)院院長(zhǎng)都可以良好使用至少一個(gè)這樣的畢業(yè)生。 Very large hospitals could use wel