Establish and Evaluate the Effectiveness of the Performance Bonus Appraisal System for Physicians in a Mainland Public Hospital

In recent years, mainland China's public hospitals have begun to reform performance-based wages by the policy. Taiwan's five major public hospitals have had a long-standing practice of physician bonuses, and the system is relatively stable and mature. This research aims to study whether the Performance Bonus Appraisal System (PBAS) for physicians in Taiwan's public hospitals be adopted by mainland China's public hospitals by considering the characteristics of local conditions. The researchers adjusted and developed the PBAS model for physicians in mainland public hospitals based on the clinical work, performance management practical experience in Taiwan's public hospitals, and literature survey, and conducted in-depth research on a mainland public hospital. We designed a structured questionnaire with 20 questions in four dimensions (three items on "strategy," eight on "process," four on "communication," and five on "decision-making"), which were modified by an expert validity test. We tested with the expert reliability Cronbach's α = 0.92. The effectiveness was discussed according to the pre- and post-test results (30 months). The overall test shows that supervisors are higher than non-supervisors; there is no significant difference in the service years levels. The gap between medical units in the post-test is smaller than in the pre-test, and the physicians' service quantity reflects the urgent, severe, difficult, complex, and risky works, which leads to a significant drop in the scores of the second-line clinical units. Overall, the process design of the new PBAS effectively enhances the procedural and responsibility of the process dimension. The supervisor's appraisal training, the disclosure of methods, and the establishment of a communication platform significantly improves feedback, leadership, and management in the communication dimension compared to the old system. The personnel system of public hospitals in mainland China is different from that in Taiwan. This study is expected to provide references and applications for medical managers and physician performance supervisors.

關鍵字

mainland China's public hospital ； physician performance ； performance bonus ； performance appraisal ； performance indicator

並列摘要

近年來大陸公立醫院被政策性要求績效工資改革，臺灣五大公立醫院體系醫師獎金行之有年，制度相對穩定成熟。「臺灣公立醫院醫師的績效獎金評核制度（Performance Bonus Appraisal System, PBAS）能否在大陸發展出因地制宜的模式？」為本研究之動機。研究者依據臺灣公立醫院臨床工作、績效管理實務經驗與文獻探討，調整並發展出大陸公立醫院醫師的PBAS模式，並針對大陸公立Y醫院進行深入研究，設計結構式問卷四大構面20題（策略面三題、程序結構面八題、溝通面四題與決策意見面五題），經專家效度檢定修改、專家信度Cronbach's α 0.92後施測，依據前測與後測結果（間隔30個月）進行成效探討。整體結果顯示，主管均高於非主管；服務年資層無顯著性差異；醫療單元間在後測較前測差距縮小；醫師服務量計算反映急、重、難、雜與風險，導致臨床二線單元分數顯著下降。整體而言，醫師的新PBAS流程設計有效地提升流程結構面的權責性，主管評核培訓、辦法公開，並建立溝通平臺，導致溝通構面的意見回饋、領導與管理兩項明顯提升。大陸公立醫院的人事制度與臺灣還是有背景環境下的差異，本研究期望能提供醫務管理人員與醫師績效主管參考與運用。

並列關鍵字

大陸公立醫院；醫師績效；績效獎金；績效評核；評核指標

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