School of Public Health, Shanghai JiaoTong University School of Medicine, No. 227 South Chonqing Rd, Huangpu District, Shanghai, P.R. China.
Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, No. 227 South Chonqing Rd, Huangpu District, Shanghai, P. R. China.
BMC Health Serv Res. 2023 Jul 19;23(1):775. doi: 10.1186/s12913-023-09772-2.
Efforts to measure performance and identify its driving factors among clinicians are needed for building a high-quality clinician workforce. The availability of data is the most challenging thing. This paper presented a summary performance measure for clinicians and its application on examining factors that influence performance using routine patient-based records.
Perfomance indicators and difficulty score were extracted from electronic medical records (EMRs). Difficulty adjustment and standardized processing were used to obtain indicators which were comparable between specialties. Principal component analysis (PCA) was used to estimate the summary performance measure. The performance measure was then used to examine the influence of person-job fit and burnout through a mediator effect model and cluster analysis.
A valid sample of 404 clinicians were included in this study, and 244 of them had valid response in the questionnaire. PCA explained 79.37% of the total variance presented by the four adjusted performance indicators. Non-performance attributes and performance driving factors help distinguish different clusters of clinicians. Burnout mediates the relationship between person-job fit and performance in a specific group of clinicians (β = 0.120, p = 0.008).
We demonstrated the analytical steps to estimate clinicians' performance and its practical application using EMRs. Our findings provide insight into personnel classified management. Such practice can be applied in countries where electronic medical record systems are relatively less developed to continuously improve the application of performance management.
为建立高质量的临床医生队伍，需要努力衡量临床医生的绩效并确定其驱动因素。数据的可用性是最具挑战性的事情。本文提出了一种临床医生综合绩效衡量标准，并应用于使用常规基于患者的记录检查影响绩效的因素。
从电子病历（EMR）中提取绩效指标和难度得分。通过难度调整和标准化处理，获得了各专业之间具有可比性的指标。主成分分析（PCA）用于估计综合绩效衡量标准。然后，通过中介效应模型和聚类分析，使用绩效衡量标准来检查人与工作匹配度和倦怠感的影响。
本研究纳入了 404 名合格的临床医生，其中 244 名在问卷调查中有有效回复。PCA 解释了四个调整后绩效指标总方差的 79.37%。非绩效属性和绩效驱动因素有助于区分不同的临床医生群体。在特定组别的临床医生中，倦怠感在人与工作匹配度和绩效之间起到中介作用（β=0.120，p=0.008）。
我们展示了使用 EMR 估计临床医生绩效的分析步骤及其实际应用。我们的研究结果为人员分类管理提供了新的思路。这种做法可以应用于电子病历系统相对不发达的国家，以不断改进绩效管理的应用。
