Waldman J Deane, Smith Howard L, Hood Jacqueline N
Ro Anderson Graduate Schools of Management, School of Medicine, University of New Mexico, USA.
Hosp Top. 2003 Winter;81(1):5-14. doi: 10.1080/00185860309598010.
The U.S. healthcare system requires radical, not incremental, change. Management issues in healthcare delivery are fundamentally different from those in the business world. Systems thinking forces a focus on corporate culture, about which there is little hard data. The use of cost/benefit analysis suffers from the lack of any accepted measure of long-term "benefit." The authors make four observations: (1) corporate culture is both part of the cause and part of the cure for healthcare; (2) long-term financial and functional measures are necessary to make evidence-based decisions; (3) valid, nationwide data must be developed regarding the corporate culture of medicine; and (4) direct (unmodified) application of management theory or practices will not achieve sustainable improvements.
美国医疗保健系统需要的是彻底变革，而非渐进式变革。医疗服务中的管理问题与商业领域的管理问题有着本质区别。系统思维促使人们关注企业文化，而关于企业文化的硬数据却很少。成本效益分析的运用因缺乏任何公认的长期“效益”衡量标准而受到影响。作者提出了四点看法：（1）企业文化既是医疗问题的部分成因，也是解决办法的一部分；（2）做出基于证据的决策需要长期的财务和功能衡量标准；（3）必须收集有关医学企业文化的有效全国性数据；（4）直接（未经修改）应用管理理论或实践无法实现可持续的改善。
