On the afternoon of January 3, the 2018 National Working Conference on Improving Medical Services was held in Beijing. Vice Premier Liu Yandong made important instructions, fully affirming the important role that the implementation of the Action Plan for Further Improvement of Medical Services will play in optimizing medical service processes, innovating medical service models, improving medical quality and safety, and improving the public’s experience of medical treatment. It is hoped that the national health and family planning system will thoroughly implement the spirit of the 19th National Congress of the Communist Party of China, be guided by Xi Jinping’s thoughts on socialism with Chinese characteristics in the new era, adhere to the people-centered approach, and focus on meeting the new requirements of the people for medical and health services in the new era, and improve convenience for the people. Measures, the use of scientific and technological means to support, promote the improvement of medical services to a new level, to enhance the sense of gain, happiness, and security of the people, and to make new contributions to building a well-off society in an all-round way. The meeting carefully studied the spirit of the important instructions of Vice Premier Liu Yandong, comprehensively summarized the improvement of medical services from 2015 to 2017, and studied and deployed relevant work arrangements from 2018 to 2020.

Li Bin, director of the National Health and Family Planning Commission and party secretary, pointed out in his speech that through three years of hard work, significant results have been achieved in improving medical services. Information technologies such as appointments for diagnosis and treatment and mobile payment have been widely used, and medical treatment has been "three long and one short". The situation has been effectively alleviated. The application of innovative service models such as day service and clinical path has been accelerated, and the quality and efficiency of medical services have been rapidly improved. Through the development of the service capacity of county hospitals and the establishment of a remote service system, the acceleration of the sinking of high-quality medical resources is promoted, the accessibility of medical services is further improved, and the public's sense of access to medical treatment is effectively improved.

Li Bin emphasized that it is necessary to accurately grasp the main contradictions and changes in Chinese society in the new era to meet the people's higher-level and more diversified health and health service needs. We must adhere to the people-centered development principle and make full use of new technologies and concepts to promote the high-quality development of medical services. We must always adhere to the simultaneous advancement of reforms and improvements, so that the advancement of comprehensive medical reforms will become a new driving force for improving medical services.

Li Bin requested that the improvement of medical services from 2018 to 2020, on the one hand, must establish and improve five working systems, including appointment diagnosis and treatment, and telemedicine , to form a long-term mechanism. On the other hand, it is necessary to innovate and develop medical services in 10 areas including the promotion of multidisciplinary diagnosis and treatment models, promote the high-quality development of medical services, and continuously improve the public's experience of seeking medical treatment. At the same time, local health and family planning administrative departments should strengthen organization and leadership, fully mobilize the enthusiasm of medical staff, do a good job in policy guarantees and increase publicity to establish models, so as to provide support and guarantee for improving medical services.

Wang Hesheng, deputy director of the National Health and Family Planning Commission and director of the Medical Reform Office of the State Council, presided over the meeting and announced the 2015~2017 advanced model notification documents for improving medical services, and reported to 290 high-quality medical service demonstration hospitals such as Beijing Chaoyang Hospital, and the Stroke Center of Xuanwu Hospital of Capital Medical University 228 high-quality medical service demonstration departments, and 234 high-quality medical service demonstration individuals including Li Yan from Beijing You'an Hospital gave notifications to 8 units including the Liaoning Health and Family Planning Commission, and 15 hospitals including Peking Union Medical College Hospital, which actively organized publicity reports Be promoted by the report.

At the meeting, 6 units including Jiangsu Provincial Health and Family Planning Commission made typical exchange speeches. Peking Union Medical College School of Public Health and National Health and Family Planning Commission Medical Management Service Guidance Center introduced the third-party effect evaluation of improving medical services and online hospital satisfaction survey Happening. The third-party evaluation and satisfaction survey results show that the satisfaction of outpatients and inpatients in tertiary hospitals in my country has been increasing year by year, and the improvement of medical services in three years has achieved positive results.

[Improving Medical Services·Three-year Observation] Changes are happening quietly in major hospitals

In recent years, the expansion and quality improvement of my country's medical insurance system has released a large number of medical needs, but the subsequent difficulties in diversion of people and complex procedures have caused people to criticize the medical environment, service attitudes, and service procedures of large hospitals. . On December 13, 2014, General Secretary Xi Jinping pointed out during an inspection in Zhenjiang City, Jiangsu Province that the people’s desire for equalization of medical services is very urgent. Some major hospitals in big cities are always in a “wartime state” and they are overcrowded and must be resolved. Okay this question.

In order to improve this situation, in January 2015, the National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine launched a three-year "Action Plan for Further Improvement of Medical Services" across the country, focusing on urging large tertiary hospitals in cities to improve their medical service processes. Innovate measures to facilitate the people to see a doctor. When the first phase of the action plan comes to an end, do the people feel more about the medical services? What changes did it bring to the industry? In the future, how will the improvement and perfection of medical services meet the needs of the times and benefit the people seeking medical care?

Patient experience becomes a luxury

One Friday morning, Xu Hua (pseudonym) woke up early and went to the local prestigious large-scale women's and children's specialist hospital for treatment. "I arrived at the hospital at 8 o'clock and queued for 20 minutes. It was number 66."

After waiting for about an hour and a half, it was Xu Hua's turn to see a doctor. As soon as she walked into the clinic, she found that it was full of patients, each with a blue disposable treatment sheet in his hand, waiting for a more private examination. The so-called "examination room" is just an area enclosed by a curtain in the middle of the consulting room. The curtain is sometimes not tightened, and the inspection scene inside is unobstructed. Xu Hua handed the doctor the results of the examination. The doctor did not lift his head, and asked 3 questions loudly, many of which were personal. As he asked, he asked his assistant to open a checklist, and then directed to Xu Hua and said, "Go get a blood test for hormones, do a B-ultrasound, and come again."

When he arrived in the B-ultrasound room, Xu Hua was told by the staff that the appointment was full and he would come back another day. She went to the examination room to line up for almost an hour, and was told that she needed an empty stomach for the blood draw, and stopped taking it after 10:30 in the morning. Depressed and furious, Xu Hua turned back to the doctor's office to ask about the next treatment process, and was told by the doctor that he would need to re-register for the next visit. "After spending more than 3 hours in the hospital, the doctor spoke to me for no more than 30 seconds; none of the two doctors' assistants explained to me that the examination might not be possible; the registration fee was 26 yuan, just for such a few nonsense. A few checklists that can’t be done?” Xu Hua couldn’t help but questioned the doctor. The doctor said, “Why didn’t you look at it? I’ve given you the checklist.”

去年年初，本报记者曾赴北京市多家三甲医院实地体验，发现几乎没有一家医院的厕所提供手纸。

有人指出，公立医院长期处于垄断地位，在外无压力、内无动力的情况下，患者体验感自然成了奢侈品。但另一方面，权威资料显示，近几年来，我国医疗机构提供的医疗服务量较2010年前实现了量级增长。2014年，全国总诊疗人次达76亿人次，出院人数2亿多人，年诊疗量和住院量较2009年分别增长42.1%和54.6%，与此相对应的卫生技术人员仅增加了38%。近两年，全国医疗卫生机构医疗服务量增速总体放缓，但三级医院的服务量增幅却依然保持在高位。2015年和2016年，三级医院总诊疗人次和入院人数与上一年相比分别增长7.1%和8.6%、8.7%和12.5%。

“在国外看一次门诊要10分钟～15分钟，诊治结束后有个拥抱，但我们这里门诊看病就像‘流水线’，医生不是不想沟通，而是没有时间和能力。”一位三级医院医生无奈地说。

站在患方角度看问题

国家卫生计生委曾对医疗服务领域群众感受强烈的突出问题进行过专门调查，发现老百姓对大医院的不满主要表现在就诊环境、医院标识、服务态度、服务流程、隐私保护、信息透明、急诊服务、纠纷投诉等领域。

于是，2015年年初，国家卫生计生委、国家中医药管理局在全国医疗系统启动了为期3年的“进一步改善医疗服务行动计划”，每年提出10余条当年的重点工作，明确长短期指标要求，旨在实现“便捷、安全、有效、明白就医，努力构建和谐医患关系。”

“对医疗服务的改善优化，许多医院一直都在做。国家的行动将医院行为变为全国统一行动，引导整个行业站在患者角度考虑和解决问题。”中国医科大学附属盛京医院院长郭启勇说。

北京协和医院院长助理秦明伟说，协和医院历来有持续改进和自我提升的文化和传统，这种工作方法和医院文化无论是对医疗服务的改善优化，还是对临床、教学、科研水平提升，都是关键性的基础和前提。“医院应该把改善医疗服务行动，当成建设和持续改进医院文化的重大机会。”北京协和医学院公共卫生学院院长刘远立教授说。

三级医院抓重点任务

记者在盛京医院儿科VIP诊区采访时看见，原来光秃冰凉的金属候诊椅上，有了色彩鲜艳的椅垫和椅背。该院医务部副主任肖丽介绍，“暖椅工程”创意并非今年才有，但想办好这件事却并不容易，“要让椅垫冬暖夏凉、容易清理，材质上就排除了一大批；形态上，软的容易损坏，不做固定的又容易丢失。除此之外，还要考虑颜色、款式等。”肖丽说，如今这一小小的改变，收获了患者许多“赞”。

上海市儿童医院从流程优化上找到了改善服务的“切口”。该院通过对信息数据的分析，提出凡符合“血常规”“尿常规”“粪便常规”适应证的患儿，可自主选择“诊前化验”服务，直接带着检查结果看医生。新流程不仅缩短患儿在院等候时间约30分钟，也提高了接诊医生的工作效率。如今，86%的普内科患儿在就医高峰期选择“诊前化验”。

近几年，越来越多的医院开始利用信息化手段改善服务。温州医科大学附属第一医院设计了具有自主知识产权的多功能自助服务系统，全院260台自助服务机可以办理就诊卡、预约、预存、缴费、化验单打印等；江苏省无锡市人民医院与相关企业紧密合作，逐步开发应用了智能输液监测、生命体征动态采集、智能床位监测、婴儿防盗等系统，让患者的获得感和安全度“双提升”……

记者从国家卫生计生委获悉，截至目前，我国所有三级医院均利用互联网技术实施预约诊疗，1300多家医院提供了移动结算方式，近1500家三级医院建立了信息库，为患者提供信息查询和推送服务，国家级贫困县实现远程医疗全覆盖。

北京协和医学院所做的第三方评估显示，“行动计划”90%的重点任务已经在三级医院得到落实，医疗服务流程更趋合理，2016年门诊患者全程候诊时间较2015年缩短了8分钟。

越来越多的医院和管理者开始有了“主动改”的动力。“时代在发展，老百姓的就医需求也在变。在医疗行业竞争激烈的年代，看好病和体验感并列为一级痛点。在各行各业、各家同行都在不断自我提升的年代，谁不变，谁就必然会被时代所淘汰。”大连医科大学附属第二医院副院长刘志宇说。

【改善医疗服务·三年观察】医疗生产力在不断变革

随着时间推移，许多医院对改善医疗服务的理解更加深刻，工作切入点也从最初的便民措施和流程调整，逐渐深入医疗服务模式的改变和创新，通过供给侧改革和生产力变革，不断提升患者满意度。

“提速挖潜”用好优质资源

记者在上海交通大学医学院附属仁济医院日间手术病房见到文芳（化名）时，她正等待手术。前两天，文芳在仁济医院急诊时被诊断为急性胆囊炎，经评估符合实施日间手术的标准。医生告诉她，选择这一术式比传统手术能节省4天时间，费用也会少些，于是她决定试试。当晚，手术后的文芳顺利出院，回家康复。

发展日间手术，成为仁济医院提高医院运行效率、拓展优质医疗资源服务可及性的重要“抓手”。2016年，该院用仅占6.22%的手术床位完成了日间手术30844人次，占择期手术40.1%，平均住院日也从2005年的12.41天陡降至2016年的6.12天。