摘要
医院物资是医院开展医疗活动所必需的物质条件,对物资的科学管理,是提高经营管理水平,获取最佳经济效果的一个有效途径和重要手段。如今,供应链、物流、零库存管理等理念已经引入医院物资管理,但是我国医院物流和供应链还处于起步和探索阶段,因此,对医院物资进行系统化和集成化的管理,优化物资管理流程,降低物资的采购与管理成本,是一个具有理论意义和实践意义的课题。
本文首先对国内外医院物资管理的发展与研究现状进行了综述,指出我国医院在物资管理研究方面与国外相比仍有较大的差距。我国医院物资管理尚未建立集成化的管理模式,仅注重研究物资在医院内部的流转,忽略了与供应商的外部关系,以定性研究为主,缺乏定量化的现代管理技术和方法。基于此,本文的研究主要从以下四个方面展开:
1.在供应链和集成管理思想下,构建了医院物资集成化管理模式,从物流过程、管理职能和实现步骤三个维度详细阐述了该模型的思想和方法。对医院物资集成化管理模式的实施框架、特点和保证该模式实现的关键技术进行了详细说明。
2.在集成化管理模式下对医院物资物流过程再造实现医院内部基础管理集成。分析了传统的医院物资采购方式、管理流程及存在的问题,将JIT和供应链管理的思想引入医院物资管理中,通过业务流程再造,建立基于JIT和零库存理念的医院物资一体化物流过程,并指出了物流过程再造的步骤和实施要点。
3.将总拥有成本的理念应用于医院物资的成本管理对再造后的物流过程进行评价。针对上一章提出的基于JIT的医院物资物流过程,应用总拥有成本法分析了医院物资物流过程的成本项目及成本动因,建立了医院物资的TCO模型,并用作业成本法计算总拥有成本,最后在某医院高值耗材管理中进行了实证分析,取得了良好的效果。
4.医院物资集成化管理模式的实现要求医院与供应商建立战略联盟关系,这是医院外部集成化的体现。通过比较总拥有成本和交易成本的相同点和区别,扩展了总拥有成本的定义,对战略联盟降低总拥有成本进行了理论分析,并以总拥有成本为效用函数的医院和供应商演化博弈过程验证了这一结论。最后分析了供应链联盟的自组织演化过程,为促进医院与供应商建立并维持联盟的主动性提出了相应的激励措施。
Hospital Materials are necessary conditions for carrying out medical treatment and other activities. Scientific management of materials is an important and effective means for improving capital efficiency and management level and obtaining the best economic results. With the new medical reform, the concepts of "supply chain integration", "zero inventory management" and "hospital logistics extension" etc. are introduced into pharmaceutical circulation field. Our hospital logistics and supply chain management is still in its exploratory stage, the subject of providing systematic, scientific and integrated management for procurement of hospital materials, optimizing management processes, reducing waste and overstock items and decreasing the procurement and management costs, is of theoretical and practical importance.
The integrated management model of domestic hospital materials management has not been established and the attention focuses on the flow of materials within the hospital while the relationship between hospitals and suppliers is ignored. Related researches are mainly qualitative and the objective of cost management is chiefly about minimizing the inventory cost. The analysis, evaluation and control of hospital supply chain cost are rarely considered. For all the above reasons, this thesis mainly studies the following aspects:
1. The integration mode of hospital materials management is established within the framework of supply chain management and the ideas and methods,the mode is elaborated from logistics process, functional management and implementation steps. The implementation,characters and key technologies of the integrated supply chain management are also analyzed in detail.
2. The logistics process dimension of the integration mode of hospital materials management is studied, the purchasing methods,processes and related problems of traditional procurement management are analyzed, and JIT method and supply chain management are introduced into management of hospital materials. The integrated logistics process based on the theory of JIT and zero inventory is established by business process reengineering, the steps and key points of implementation are provided.
3. Functional management dimension of the integrated mode of hospital supply chain management is studied, and as an evaluation method,the idea of total cost of ownership is applied to the purchase cost of hospital materials management. The procurement cost items of hospital materials and the cost drivers are analyzed, a TCO model is established and the total cost of ownership of purchasing materials is calculated via the method of activity-based costing. The method is also applied in high-value consumable management in case hospital.
4. Supply chain strategic alliance is a new mode of business cooperation in integrated supply chain management. The conclusion that transaction costs and the total cost of ownership between hospitals and suppliers can be reduced with the strategic alliance is validated on the base of evolutionary game theory. The evolution mechanisms of strategic alliances for hospital supply chain is analyzed via self-organization theory and the incentives for members of supply chain alliance are proposed to improve incentives on supply chain strategic alliance.
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