I 摘要 近些年来，随着规模扩大，医疗技术的发展，带来的也是医疗耗材市场的繁 荣。在医疗耗材取消零加成之前，耗材无疑是医院巨大的创收来源。近几年国家 对医用耗材管控力度不断加强，开始逐步对耗材加强管控。随着医院医疗改革不 断深入，医疗耗材的“零加成”时代来领了，医疗耗材在医院的角色也发生改变， 从之前医院的利润中心转变成为医院巨大的成本负担。为了减少医疗耗材带来的 成本压力，医院对耗材的粗放型管理必须向精细化管理转型。只有在保证医疗正 常进行前提下有效控制好运营成本，才能在未来的医院改革中持续有竞争力，不 被淘汰。以前的粗放型耗材管理模式，显然已经不适用于现代化医院的发展模式， 耗材精细化管理之路成为必然。本文基于精细化管理理论，分析了MR医院医疗 耗材管理现状，从中发现问题，并提出优化方案，对降低运营成本，提高医院竞 争力有一定的意义。 本研究通过阅读大量相关的国内外文献，并对器械科仓库人员、供应商、财 务科、临床科室医务人员和手术室二级库进行实地访谈调查。在此基础上对MR 医院现有耗材流程和管理模式进行分析，发现在采购、库存、配送、消耗监管环 节都存在着问题。对采购环节供应商管理混乱，监管不严的问题，我们提出了监 管评价体系和供应商证照资质管理。对于库存管理粗放化，制定采购计划凭借经 验的问题，通过信息化建设，对所有耗材扫码上架、出库，实现对耗材全程管理； 通过临床科室二级库信息平台对接，做到了有效的监管耗材库存，对院内剩余库 存做到精确计数；同时设定订货点，当耗材库存达到订货点进行采购，提高了耗 材周转，减少了积压。对于领用配送繁琐，医务人员工作负担重的问题，采取向 临床科室和手术室二级库实行主动配送和定制配送模式，减少了配送中出现的错 误，也减少了临床科室和二级库耗材积压和过多导致的失效，使得耗材周转率进 一步提高。 耗材精细化管理降低了医院运营成本，对其他医院的耗材管理有一定的借鉴 价值。 关键词：耗材管理；SPD医疗供应链；医用耗材；精细化管理 Abstract II Abstract Inrecentyears,withtherapiddevelopmentofChina'seconomy,hospitalshave enteredaneraofexpansion.Withtheexpansionofthescaleandthedevelopmentof medicaltechnology,theprosperityofthemedicalconsumablesmarketisalsobrought about.Beforethecancellationofzero-plusmedicalconsumables,consumableswill undoubtedlybeahugesourceofrevenueforhospitals.Beforethecancellationofzero- plusmedicalconsumables,consumableswillundoubtedlybeahugesourceofrevenue forhospitals.Inrecentyears,themanagementofmedicalconsumablesismoreand morestrict.Withthecontinuousadvancementofmedicalreforminpublichospitals, medicalconsumableshaveenteredtheeraofzeroaddition,andtheroleofmedical consumablesinhospitalshasalsochanged,fromtheformerprofitcenterofhospitalsto ahugecostburdenofhospitals.Inordertoreducethecostpressurecausedbymedical consumables,theextensivemanagementofhospitalconsumablesmustbetransformed tofinemanagement.Onlybyeffectivelycontrollingtheoperatingcostsunderthe premiseofensuringthenormaloperationofmedicaltreatmentcanpublichospitals continuetobecompetitiveandnotbeeliminatedinthefuturereform.Theformer extensiveconsumablesmanagementmodeisobviouslynotsuitableforthedevelopment modeofmodernhospitals,andthewayofconsumablesfinemanagementbecomes inevitable.Basedonthetheoryoffinemanagement,thisthesisanalyzesthecurrent situationofmedicalconsumablesmanagementinMRhospital,findsouttheproblems, andputsforwardtheoptimizationplan,whichisofcertainsignificancetoreducethe operatingcostandimprovethecompetitivenessofthehospital. Inthisstudy,alargenumberofrelevantdomesticandforeignliteratureswereread, reviewed,andfieldinterviewswereconductedamongwarehousepersonnel,suppliers, medicalpersonnelinthefinancialdepartment,clinicaldepartmentandthesecond-level warehouseintheoperating.Onthisbasis,theexistingconsumableprocessand managementmodeofMRHospitalareanalyzed,anditisfoundthatthereareproblems inprocurement,inventory,distributionandconsumptionsupervision.Intermsof chaoticsuppliermanagementandlaxsupervision,weputforwardthesupervision evaluationsystemandsuppliercertificationandqualificationmanagement.Withregard toextensiveinventorymanagementandtheproblemofmakingpurchaseplanbasedon Abstract III experience,wecanscanthecodeforallconsumablestobeputonshelvesandoutof storagethroughinformationconstruction,soastorealizethewholemanagementof consumables;Throughthedockingofthesecondarydatabaseinformationplatformof clinicaldepartments,theinventoryofconsumablescanbeeffectivelysupervisedandthe remaininginventoryinthehospitalcanbeaccuratelycounted.Atthesametime,the orderingpointissettopurchasewhentheinventoryofconsumablesreachesthe orderingpoint,whichimprovestheturnoverofconsumablesandreducesthebacklog. Asforthecomplicatedreceivinganddistributionandheavyworkloadofmedicalstaff, themodeofactivedistributionandcustomizeddistributionisadoptedfortheclinical departmentsandthesecond-levelwarehouseintheoperatingroom,whichreducesthe errorsindistributionandtheoverstockandoverfailureofconsumablesintheclinical departmentsandthesecond-levelwarehouse,andfurtherimprovestheconsumables turnoverrate. Thefinemanagementofconsumablesreducestheoperatingcostofhospitalsand improvestheefficiency.Ithascertainreferencevalueforotherhospitals'consumables management. Keywords:consumablesmanagement;SPDmodel;medicalconsumables;refined management 目录 IV 目录 摘要................................................................................................................................I Abstract..........................................................................................................................II 第1章绪论..........................................................................................................1 1.1研究背景和意义..............................................................................................1 1.1.1研究背景................................................................................................1 1.1.2研究意义................................................................................................2 1.2国内外研究综述...............................................................................................3 1.2.1关于库存管理的研究.............................................................................3 1.2.2关于医疗供应链研究.............................................................................5 1.2.3关于信息化建设研究.............................................................................6 1.2.4简要述评.................................................................................................7 1.3研究内容与框架...............................................................................................8 1.3.1研究内容.................................................................................................8 1.3.2研究框架.................................................................................................8 1.4研究方法...........................................................................................................9 1.5创新点...............................................................................................................9 第2章医用耗材精细化管理相关概念和理论基础................................................11 2.1相关概念界定.................................................................................................11 2.1.1医用耗材的概念...................................................................................11 2.1.2零库存管理的内涵...............................................................................11 2.1.3精细化管理内涵...................................................................................11 2.2相关基础理论.................................................................................................12 2.2.1精细化管理理论...................................................................................12 2.2.2医疗供应链管理（SPD）理论..........................................................12 2.2.3库存理论..............................................................................................14 2.2.4供应商管理理论...................................................................................15 2.3本章小结.........................................................................................................16 第3章MR医院耗材管理