随着我国医药卫生体制改革的不断深入，公立医院改革已全面推开，公立医院对外 面临着民营医院和其他大型公立医院的竞争威胁，对内面临资金紧 张和人才流失的压 力。公立医院只有不断提高医疗服务质量，提升患者满意度，才能在激烈的竞争环境中 得以生存发展。在诸多影响医疗服务质量的因素中，非医疗技术因素的 影响作用越来越 大。因为患者在医院就诊的整个过程中有80%的时间都是花费在非医疗技术服务流程中， 非医疗技术服务工作效率不高，直接影响患者对医院服务质量满意度的评 价，最终将影 响医院的竞争能力和可持续发展能力。 本文围绕某三级甲等公立医院A医院的非医疗技术服务流程进行分析研究，将非医 疗技术服务流程分为诊前、诊中、诊后服 务流程。运用价值链理论找出流程中重复的、 不增值的、无效的以及耗费时间长的环节，明确需要优化的关键环节。采用鱼骨图法对 非医疗技术服务流程存在问题的原因进行分 析，运用帕累托（80：20原理）确定主要原 因。采用ECRS法对诊前、诊中、诊后的服务流程进行优化，消除浪费环节，合并重复 环节，重排不合理环节，简化冗繁环节。为确保 实施效果，在组织领导、制度建设、信 息技术支持、人员等各方面提出保障措施。 通过非医疗技术服务流程的优化实施，在有效缩短患者就医时间，为患者提供更好 的医疗服务 ，提高患者满意度的同时，还可以在医院规模不扩大，医疗投入不大幅增加 的情况下，通过对医院现有资源的合理调配，提高医院的运行效率，提高医院的核心竞 争力和经济效 益，满足社会各类医疗服务需求。 关键词：公立医院；非医疗技术服务；流程优化 II STUDYONPROCESSOPTIMIZATIONOF NON-MEDICALTECHNICALSERVICEINAHOSPITAL ABSTRACT Withthedeepeningofthemedicalandhealthsystemreforminourcountry,thereformof publichospitalshasbeenpushedforwardinanall-roundway,Publichospitalsarefacingthe competitionthreatfromprivatehospitalsandotherlargepublichospitalsexternally,andthe pressureofcapitalshortageandbraindraininternally.Onlybyconstantlyimprovingthe qualityofmedicalservicesandimprovingpatientsatisfactioncanpublichospitalssurviveand developinthefiercecompetitionenvironment.Amongthefactorsthataffectthequalityof medicalservice,non- medicaltechnologyfactorsplayanincreasinglyimportantrole.Because patientsspend80%oftheirtimeinthehospitalinnon-medicaltechnicalservices,thelow efficiencyofnon-medicaltechnicalservicesdirectlyaffectstheevaluationofpatients' satisfactionwithhospitalservicequality.Ultimately,itwillaffectthecompetitivenessand sustainabledevelopmentofhospitals. Thepaperfocusesontheanalysisandresearchonthenon-medicaltechnicalservice processofAhospital,atertiaryfirst-classpublichospital,thenon-medicaltechnicalservice flowisdividedintopre-diagnosis,in-diagnosisandpost-diagnosisserviceflow.Itusesthe valuechaintheorytofindouttherepetitive,non-value-added,ineffectiveandtime- consuming linksintheprocess,andtoclarifythekeylinksthatneedtobeoptimized.Thefish-bone diagramwasusedtoanalyzethecausesoftheproblemsintheaboveprocess,andPareto (80:20principle)wasappliedtodeterminethemaincauses.ECRSmethodisusedtooptimize theserviceprocessofpre-diagnosis,in-diagnosisandpost-diagnosis,eliminatewastelinks, mergeduplicatelinks,rearrangeunreasonablelinksandsimplifyredundantlinks.Finally,it putsforwardtheguaranteemeasuresofoptimizingtheprocessfromfouraspects: organizationguarantee,systemguarantee,informationtechnologyguaranteeandpersonnel guarantee. III Throughtheoptimizationandimplementationofthenon- medicaltechnicalservice process,whileeffectivelyshorteningthepatient'smedicaltreatmenttime,providingbetter medicalservicesforpatientsandimprovingpatientsatisfaction,withoutexpandingthescale ofhospitalsandincreasingmedicalinvestmentsubstantially.Itcanalsoimprovethe operationalefficiencyandcorecompetitivenessofthehospitalthroughtherationalallocation ofexistingresourcesinthehospital,soastoachievethewin- wingoalofeconomicandsocial benefits. KEYWORDS:PublicHospitals;Non-medicalTechnicalServices;Process Optimization IV 目录 摘 要.........................................................................................................................................I ABSTRACT....................................................................................................................................II 第一章绪 论.............................................................................................................................1 1.1研究背景与意 义.........................................................................................................1 1.1.1研究背 景.........................................................................................................1 1.1.2研究意 义.........................................................................................................2 1.2研究内容与目 标.........................................................................................................2 1.2.1研究内 容.........................................................................................................2 1.2.2研究目 标.........................................................................................................3 1.3研究方法和研究框 架.................................................................................................4 1.3.1研究方 法.........................................................................................................4 1.3.2技术路线 图.....................................................................................................4 1.4研究创新 点.................................................................................................................5 第二章国内外研究现 状.........................................................................................................7 2.1非医疗技术服务研究现 状.........................................................................................7 2.2非医疗技术服务流程优化研究现 状.........................................................................8 2.3研究述 评.....................................................................................................................9 第三章A医院非医疗技术服务流程现状分 析....................................................................11 3.1A医院基本情 况........................................................................................................11 3.2A医院业务概 况........................................................................................................12 3.3A医院非医疗技术服务流程现状调 查....................................................................14 3.3.1非医疗技术服务流程调查过程及调查情 况...............................................14 3.3.2非医疗技术服务流程的划分及现状分析...................................................15 3.4本章小 结...................................................................................................................20 第四章A医院非医疗技术服务流程问题及原 因分析........................................................22 4.1非医疗技术服务流程问题分 析...............................................................................22 4.1.1诊前非医疗技术服务流程价值链分 析.......................................................22 4.1.2门诊和住院诊中非医疗技术服务流程价值链分析...................................25 4.1.3诊后非 医疗技术服务流程价值链分析.......................................................26 V 4.2A医院非医疗技术服务流程存在问题的原因分 析................................................28 4.2.1诊前非医疗技术服务流程原因分析...........................................................28 4.2.2诊 中非医疗技术服务流程原因分析...........................................................32 4.2.3诊后非医疗技术服务流程原因分 析...........................................................35 4.3本章小 结...................................................................................................................41 第五章A医院非医疗技术服务流程的优化及 其实施效果................................................42 5.1优化的目标和原 则...................................................................................................42 5.1.1优化目 标..........