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1、灾难医疗管理之组织灾难医疗管理之组织.人力管理及法律依据人力管理及法律依据王宗伦王宗伦 副教授副教授新光医院急诊科主任新光医院急诊科主任灾难医疗组织管理灾难医疗组织管理组织经营组织经营v经营观念经营观念v经营策略经营策略v组织管理组织管理v组织领导组织领导经营观念经营观念n健康的重要性健康的重要性n经营观念与管理哲学经营观念与管理哲学n环境的变迁二十一世纪医疗服务的趋势环境的变迁二十一世纪医疗服务的趋势n环境的变迁二十一世纪医疗政策的趋势环境的变迁二十一世纪医疗政策的趋势n医疗服务业的本质医疗服务业的本质n医疗机构的经营管理医疗机构的经营管理n市场与非市场的力量运作市场与非市场的力量运作n医疗
2、机构经营管理的未来展望医疗机构经营管理的未来展望健康的重要性健康的重要性n全民健康的观念全民健康的观念n健康的定义健康的定义n灾难对健康的冲击灾难对健康的冲击经营观念与管理哲学经营观念与管理哲学n经营观念经营观念n建立机构经营观念的目的建立机构经营观念的目的n社会责任的意义社会责任的意义n古典观点古典观点n社会经济观点社会经济观点n管理哲学管理哲学n管理的意义管理的意义n机构经营管理之理想方法机构经营管理之理想方法n机构经营管理之完整体系机构经营管理之完整体系环境变迁二十一世纪医疗环境变迁二十一世纪医疗服务的趋势服务的趋势n持续增加的医疗需求持续增加的医疗需求:灾难效应灾难效应n逐渐老化的人口
3、逐渐老化的人口:灾难冲击灾难冲击n人口比率快速高龄化人口比率快速高龄化n长期照护的需求与困境长期照护的需求与困境n门诊化趋势门诊化趋势:灾难准备灾难准备n门诊与住院医疗资源的配置门诊与住院医疗资源的配置n门诊服务的发展趋势门诊服务的发展趋势环境变迁二十一世纪医疗环境变迁二十一世纪医疗服务的趋势服务的趋势n管理性医疗管理性医疗n医疗科技浪潮医疗科技浪潮n区域医疗网络区域医疗网络n执业准则执业准则灾难医疗灾难医疗环境变迁二十一世纪医疗环境变迁二十一世纪医疗政策的趋势政策的趋势n新普遍主义的兴起新普遍主义的兴起n古典普遍主义与市场机制古典普遍主义与市场机制n新普遍主义新普遍主义n总体效率与个体效率的
4、探讨总体效率与个体效率的探讨n总体效率总体效率n个体效率个体效率n设置医疗优先顺序设置医疗优先顺序:灾难考量灾难考量n重新思考提供者的诱因重新思考提供者的诱因医疗服务业的本质医疗服务业的本质n服务业的共同本质服务业的共同本质n医疗服务业的特点医疗服务业的特点n医疗服务业的努力方向医疗服务业的努力方向n灾难效应肯定医疗服务的本质灾难效应肯定医疗服务的本质服务业的共同本质服务业的共同本质n机构组织是由白领阶级主导机构组织是由白领阶级主导n劳力密集劳力密集n服务的提供是直接与消费者交易的服务的提供是直接与消费者交易的型态型态n生产几乎是无形的产品，并且不容生产几乎是无形的产品，并且不容易评估其服务品
5、质的优劣易评估其服务品质的优劣医疗服务业的特点医疗服务业的特点n不确定性不确定性n信息不对称信息不对称医疗服务业的努力方向医疗服务业的努力方向n使服务从无形变成有形，让不可见变成使服务从无形变成有形，让不可见变成可见，建立品牌经营的观念可见，建立品牌经营的观念n融合医疗服务标准化与顾客个人化要素融合医疗服务标准化与顾客个人化要素n加强机构员工教育训练，以提高服务附加强机构员工教育训练，以提高服务附加价值加价值n医疗品质控制与管理医疗品质控制与管理n了解顾客对服务品质的期望了解顾客对服务品质的期望医疗机构的经营管理医疗机构的经营管理n医疗机构的经营型态医疗机构的经营型态n医疗服务的发展过程医疗服
6、务的发展过程n非营利组织（医疗机构）的经营管非营利组织（医疗机构）的经营管理理医疗机构的经营型态医疗机构的经营型态n公立医疗机构公立医疗机构n私立医疗机构私立医疗机构n非营利医疗机构非营利医疗机构n非营利机构的意义非营利机构的意义n非营利机构的基本观念非营利机构的基本观念医疗服务的发展过程医疗服务的发展过程n人民互助的阶段人民互助的阶段n慈善赞助的阶段慈善赞助的阶段n政府或财团资助的阶段政府或财团资助的阶段n竞争与市场的阶段竞争与市场的阶段非营利组织（医疗机构）的非营利组织（医疗机构）的经营管理经营管理n非营利组织的使命非营利组织的使命n追求经营的绩效追求经营的绩效n特别注重管理特别注重管理市
7、场与非市场的力量运作市场与非市场的力量运作n非市场力量介入的原因非市场力量介入的原因n了解非市场力量的重要性了解非市场力量的重要性n何谓非市场环境何谓非市场环境n市场与非市场的差异市场与非市场的差异n公私不同公私不同n参与者不同参与者不同n利害影响不同利害影响不同n决定关键不同决定关键不同n合法非法不同合法非法不同n绩效评估标准不同绩效评估标准不同市场与非市场的力量运作市场与非市场的力量运作n非市场的要素与策略非市场的要素与策略n医疗机构的非市场策略医疗机构的非市场策略医疗机构经营管理的未来展望医疗机构经营管理的未来展望n从医院管理到医疗管理从医院管理到医疗管理n策略焦点策略焦点n运行效率运行
8、效率n临床效益临床效益n网际网络的运用网际网络的运用911911美国恐怖攻击事件美国恐怖攻击事件FEMA Historyn nThe Federal Emergency Management Agency-an The Federal Emergency Management Agency-an The Federal Emergency Management Agency-an The Federal Emergency Management Agency-an independent agency reporting to the President and independent age
9、ncy reporting to the President and independent agency reporting to the President and independent agency reporting to the President and tasked with responding to,planning for,tasked with responding to,planning for,tasked with responding to,planning for,tasked with responding to,planning for,recoverin
10、g from and mitigating against disaster.recovering from and mitigating against disaster.recovering from and mitigating against disaster.recovering from and mitigating against disaster.n nthe Congressional Act of 1803:This act,generally the Congressional Act of 1803:This act,generally the Congressiona
11、l Act of 1803:This act,generally the Congressional Act of 1803:This act,generally considered the first piece of disaster considered the first piece of disaster considered the first piece of disaster considered the first piece of disaster legislation,provided assistance to a New legislation,provided
12、assistance to a New legislation,provided assistance to a New legislation,provided assistance to a New Hampshire town following an extensive fire.In the Hampshire town following an extensive fire.In the Hampshire town following an extensive fire.In the Hampshire town following an extensive fire.In th
13、e century that followed,ad hoc legislation was century that followed,ad hoc legislation was century that followed,ad hoc legislation was century that followed,ad hoc legislation was passed more than 100 times in response to passed more than 100 times in response to passed more than 100 times in resp
14、onse to passed more than 100 times in response to hurricanes,earthquakes,floods and other natural hurricanes,earthquakes,floods and other natural hurricanes,earthquakes,floods and other natural hurricanes,earthquakes,floods and other natural disasters.disasters.disasters.disasters.FEMA Historyn nBy
15、the 1930s,when the federal approach to By the 1930s,when the federal approach to By the 1930s,when the federal approach to By the 1930s,when the federal approach to problems became popular,the problems became popular,the problems became popular,the problems became popular,the Reconstruction Finance
16、Corporation was Reconstruction Finance Corporation was Reconstruction Finance Corporation was Reconstruction Finance Corporation was given authority to make disaster loans for given authority to make disaster loans for given authority to make disaster loans for given authority to make disaster loans
17、 for repair and reconstruction of certain repair and reconstruction of certain repair and reconstruction of certain repair and reconstruction of certain public facilities following an earthquake,public facilities following an earthquake,public facilities following an earthquake,public facilities fol
18、lowing an earthquake,and later,other types of disasters.and later,other types of disasters.and later,other types of disasters.and later,other types of disasters.n nIn 1934,the Bureau of Public Roads was In 1934,the Bureau of Public Roads was In 1934,the Bureau of Public Roads was In 1934,the Bureau
19、of Public Roads was given authority to provide funding for given authority to provide funding for given authority to provide funding for given authority to provide funding for highways and bridges damaged by natural highways and bridges damaged by natural highways and bridges damaged by natural high
20、ways and bridges damaged by natural disasters.disasters.disasters.disasters.FEMA Historyn nThe Flood Control Act,which gave the The Flood Control Act,which gave the The Flood Control Act,which gave the The Flood Control Act,which gave the U.S.Army Corps of Engineers greater U.S.Army Corps of Enginee
21、rs greater U.S.Army Corps of Engineers greater U.S.Army Corps of Engineers greater authority to implement flood control authority to implement flood control authority to implement flood control authority to implement flood control projects,was also passed.This projects,was also passed.This projects,
22、was also passed.This projects,was also passed.This piecemeal approach to disaster piecemeal approach to disaster piecemeal approach to disaster piecemeal approach to disaster assistance was problematic and it assistance was problematic and it assistance was problematic and it assistance was problema
23、tic and it prompted legislation that required prompted legislation that required prompted legislation that required prompted legislation that required greater cooperation between federal greater cooperation between federal greater cooperation between federal greater cooperation between federal agenc
24、ies and authorized the President agencies and authorized the President agencies and authorized the President agencies and authorized the President to coordinate these activities.to coordinate these activities.to coordinate these activities.to coordinate these activities.FEMA Historyn nThe 1960s and
25、early 1970s brought The 1960s and early 1970s brought The 1960s and early 1970s brought The 1960s and early 1970s brought massive disasters requiring major massive disasters requiring major massive disasters requiring major massive disasters requiring major federal response and recovery operations f
26、ederal response and recovery operations federal response and recovery operations federal response and recovery operations by the Federal Disaster Assistance by the Federal Disaster Assistance by the Federal Disaster Assistance by the Federal Disaster Assistance Administration,established within the
27、Administration,established within the Administration,established within the Administration,established within the Department of Housing and Urban Department of Housing and Urban Department of Housing and Urban Department of Housing and Urban Development(HUD).Development(HUD).Development(HUD).Develop
28、ment(HUD).FEMA Historyn nHurricane Carla struck in 1962,Hurricane Betsy in Hurricane Carla struck in 1962,Hurricane Betsy in Hurricane Carla struck in 1962,Hurricane Betsy in Hurricane Carla struck in 1962,Hurricane Betsy in 1965,Hurricane Camille in 1969 and Hurricane Agnes in 1965,Hurricane Camill
29、e in 1969 and Hurricane Agnes in 1965,Hurricane Camille in 1969 and Hurricane Agnes in 1965,Hurricane Camille in 1969 and Hurricane Agnes in 1972.The Alaskan Earthquake hit in 1964 and the San 1972.The Alaskan Earthquake hit in 1964 and the San 1972.The Alaskan Earthquake hit in 1964 and the San 197
30、2.The Alaskan Earthquake hit in 1964 and the San Fernando Earthquake rocked Southern California in Fernando Earthquake rocked Southern California in Fernando Earthquake rocked Southern California in Fernando Earthquake rocked Southern California in 1971.These events served to focus attention on the
31、1971.These events served to focus attention on the 1971.These events served to focus attention on the 1971.These events served to focus attention on the issue of natural disasters and brought about increased issue of natural disasters and brought about increased issue of natural disasters and brough
32、t about increased issue of natural disasters and brought about increased legislation.legislation.legislation.legislation.n nIn 1968,the National Flood Insurance Act offered new In 1968,the National Flood Insurance Act offered new In 1968,the National Flood Insurance Act offered new In 1968,the Natio
33、nal Flood Insurance Act offered new flood protection to homeowners,and in 1974 the flood protection to homeowners,and in 1974 the flood protection to homeowners,and in 1974 the flood protection to homeowners,and in 1974 the Disaster Relief Act firmly established the process of Disaster Relief Act fi
34、rmly established the process of Disaster Relief Act firmly established the process of Disaster Relief Act firmly established the process of Presidential disaster declarations.Presidential disaster declarations.Presidential disaster declarations.Presidential disaster declarations.FEMA Historyn nPresi
35、dent Carters 1979 executive order merged many of President Carters 1979 executive order merged many of President Carters 1979 executive order merged many of President Carters 1979 executive order merged many of the separate disaster-related responsibilities into a the separate disaster-related respo
36、nsibilities into a the separate disaster-related responsibilities into a the separate disaster-related responsibilities into a new Federal Emergency Management Agency(FEMA).Among new Federal Emergency Management Agency(FEMA).Among new Federal Emergency Management Agency(FEMA).Among new Federal Emerg
37、ency Management Agency(FEMA).Among other agencies,FEMA absorbed:the Federal Insurance other agencies,FEMA absorbed:the Federal Insurance other agencies,FEMA absorbed:the Federal Insurance other agencies,FEMA absorbed:the Federal Insurance Administration,the National Fire Prevention and Administratio
38、n,the National Fire Prevention and Administration,the National Fire Prevention and Administration,the National Fire Prevention and Control Administration,the National Weather Service Control Administration,the National Weather Service Control Administration,the National Weather Service Control Admin
39、istration,the National Weather Service Community Preparedness Program,the Federal Community Preparedness Program,the Federal Community Preparedness Program,the Federal Community Preparedness Program,the Federal Preparedness Agency of the General Services Preparedness Agency of the General Services P
40、reparedness Agency of the General Services Preparedness Agency of the General Services Administration and the Federal Disaster Assistance Administration and the Federal Disaster Assistance Administration and the Federal Disaster Assistance Administration and the Federal Disaster Assistance Administr
41、ation activities from HUD.Civil defense Administration activities from HUD.Civil defense Administration activities from HUD.Civil defense Administration activities from HUD.Civil defense responsibilities were also transferred to the new responsibilities were also transferred to the new responsibilit
42、ies were also transferred to the new responsibilities were also transferred to the new agency from the Defense Departments Defense Civil agency from the Defense Departments Defense Civil agency from the Defense Departments Defense Civil agency from the Defense Departments Defense Civil Preparedness
43、Agency.Preparedness Agency.Preparedness Agency.Preparedness Agency.FEMA Historyn nJohn Macy was named as FEMAs first John Macy was named as FEMAs first John Macy was named as FEMAs first John Macy was named as FEMAs first director.Macy emphasized the similarities director.Macy emphasized the similar
44、ities director.Macy emphasized the similarities director.Macy emphasized the similarities between natural hazards preparedness and between natural hazards preparedness and between natural hazards preparedness and between natural hazards preparedness and the civil defense activities.FEMA began the ci
45、vil defense activities.FEMA began the civil defense activities.FEMA began the civil defense activities.FEMA began development of an Integrated Emergency development of an Integrated Emergency development of an Integrated Emergency development of an Integrated Emergency Management System with an all-
46、hazards Management System with an all-hazards Management System with an all-hazards Management System with an all-hazards approach that included direction,control approach that included direction,control approach that included direction,control approach that included direction,control and warning sy
47、stems which are common to the and warning systems which are common to the and warning systems which are common to the and warning systems which are common to the full range of emergencies from small full range of emergencies from small full range of emergencies from small full range of emergencies f
48、rom small isolated events to the ultimate emergency-isolated events to the ultimate emergency-isolated events to the ultimate emergency-isolated events to the ultimate emergency-war.war.war.war.FEMA Historyn nThe new agency was faced with many unusual challenges The new agency was faced with many un
49、usual challenges The new agency was faced with many unusual challenges The new agency was faced with many unusual challenges in its first few years that emphasized how complex in its first few years that emphasized how complex in its first few years that emphasized how complex in its first few years
50、 that emphasized how complex emergency management can be.Early disasters and emergency management can be.Early disasters and emergency management can be.Early disasters and emergency management can be.Early disasters and emergencies included the contamination of Love Canal,emergencies included the c