Degeling P J
Centre for Hospital Management and Information Systems Research, University of New South Wales, Sydney, Australia.
Aust Health Rev. 1993;16(2):160-8.
Current efforts to realign authority relationships within hospitals are important, but not sufficient. The rules which underpin the autonomy of medicine and those which are required for constituting management in clinical settings are not 'things' which can be decreed in and out of existence either by altering the lines on a hospital organisation chart, or by improving hospital information systems and allocating managerial responsibility to some clinicians. Accordingly, the ultimate success of the current hospital reform program will depend on the willingness of players in health policy circles to broaden their reform agenda to encompass issues which go well beyond factors internal to the organisation of hospitals. Included here are initiatives in areas such as hospital casemix funding and budgeting; clinical protocols; establishing linkages between the managerial and clinical roles of clinician managers; and recasting the employment of hospital medical staff.
当前在医院内部重新调整权力关系的努力很重要，但还不够。支撑医学自主性的规则以及临床环境中构成管理所需的规则，不是通过改变医院组织结构图上的线条，或者通过改进医院信息系统并将管理职责分配给一些临床医生就能随意决定其存废的“事物”。因此，当前医院改革项目的最终成功将取决于卫生政策领域的参与者是否愿意扩大其改革议程，以涵盖远远超出医院组织内部因素的问题。这包括医院病例组合资金和预算编制、临床方案、建立临床医生管理者的管理和临床角色之间的联系以及重塑医院医务人员的聘用等方面的举措。
