In December 2019, with the support of the hospital leadership, I was fortunate to participate in the 24th phase of the Beijing HuatongGuokang Charity Foundation (BHGF) platform to go to the University of Siena University for further education. With the care and attention of the staff of the Foundation and the International Exchange Office of the University of Siena, I successfully completed the three-month study and exchange. During the course of further studies, a severe outbreak of pneumonia caused by a new type of coronavirus occurred in our country. Although studying overseas, we are concerned about the safetyofhe motherland; we will pay attention to the epidemic of the disease daily and safeguard the dignity and image of the motherland in terms of speech and behavior.
During the study, I haveattended the academic lecture , which included Italy's public health system construction, European and Chinese medical research project, Italian nursing education path and nurses on-the-job education situation, Siena university hospital on the links and content of fine management, people with mental illness management mode, management style and psychological problems of hospital management insurance measures, the hospital clinical risk management and dealing with medical disputes, neonatal intestinal nutrition related knowledge; Completed more than 10 sessions of self-study, covering clinical risk management, volunteer activity projects, pain management, nosocomial infection management, art participation in psychological intervention of cancer patients, outpatient and emergency setting and operation, outpatient management of chronic diseases, and training of social health workers. In addition, I served as an intern for 3 months under the guidance of Dr.Bellini and Dolatela in the fragility and chronic disease in elderly people unit, and got a preliminary understanding of the methods and procedures of chronic patient management in Siena hospital, Italy. In addition, under the careful arrangement of teachers from the international exchange department of Siena university hospital, I also visited the municipal office of Siena, the old hospital, the bank of the mountains, the public library, the archives, the block museum, the public pharmacy and other historical and cultural institutions, to better understand the situation of Italy and the city of Siena. Now the specific report of the three months 'learning experience is as follows:
Firstly, different national conditions decide medical service system, the correct health concept and the death education to form the Italian good medical service cultural environment: Italy is a developed capitalist countries, the medical service system in 2018, the WHO ranked ninth in the world, ranked in the medical service quality in the world.Siena is an Italian literary revival origin, in Tuscany district, living in the city for 3 months, go deep into the ancient history and culture, through close contact with the locals, Ihave understandtheir health care system and operation process. The city has a long history, a small population, mainly Catholic and Christian; They know respect, will take the initiative to express respect for strangers; For more than 500 years, Siena city has preserved its 17 block autonomous culture and the culture of horse racing festival, which have satisfied the happiness of local people's life. They will face the disease correctly, thinking that the disease is the body in a certain period of time in a certain state; They would face death correctly, believing that death is an inevitable process of life. During the Renaissance, a large number of frescoes focused on war and death. Therefore, in the process of medical treatment, they will express their respect for doctors, their adherence to the appointment and referral system, and their understanding of the medical insurance policy adopted by the state to determine the proportion of medical expenses paid based on income.
Compared with China, as a developing socialist country, has been expanding its infrastructure in an all-round way with rapid economic growth in recent years. In terms of transportation, communication, logistics, payment and artificial intelligence construction, China is far stronger than Italy. With the rapid rise of the country, people's demand for happiness is constantly rising, which determines that Chinese people have higher and higher demand for health and medical experience. However, because of China's large population and lack of quality medical resources, the difficulty of medical reform is much higher than that of Italy. As a staff member involved in the urban medical reform, I deeply feel that I have a heavy responsibility. We need to think seriously about how to integrate good health education and death education in Italy into the work of China's medical reform. The construction of humanities is the most difficult, but also the most important, which is the first point that I feel deeply in the three months of study.
Secondly, the national health service system and the system construction, combined with the regional autonomous management, form good grading diagnosis: Italian medical system by the central government, regional medical organizations (AOU, equivalent to a tertiary hospital, only in a city, with medical school directly to regional management) and the local health bureau (AUSL, equal to one, 2 class hospital). Primary and secondary hospitals are responsible for the diagnosis and treatment of common diseases, while tertiary hospitals mainly provide medical services that cannot be provided by local hospitals. Hospitals at all levels have their own strengths and cooperate with each other to avoid repeated purchase of large medical equipment and waste of resources. Italy is divided into 20 regions with medical autonomy. The Tuscany region, where Siena is located, advocates the medical mode of "resource sharing and technical cooperation", and makes overall arrangements and regulation within the scope of the region. For example, the medical services offered by university hospitals are different. The university hospital of Siena carries out heart, lung and kidney transplants, while the liver transplant is located in Pisa, which can meet the demand and save medical resources. Italy's medical investment is big, the country takes local economy, population and other conditions as reference, allocates certain fund to big area, big area allocates each local medical bureau according to the circumstance, by local medical bureau allocates and manages. The country passes investigation statistic, regulation each single disease kind needs medical treatment to invest on average, how much of the fund that allocates a hospital is the number that receives according to the hospital treats each disease kind to decide.
The classification system of Italy is to build a family doctor clinic, community health service as the foundation, the hospital medical health system framework for the security, family doctors, which played a key role in the medical service system in Italy, is responsible for the diagnosis and treatment of common diseases, prescribe laboratory examination and imaging examination for patients and hospital prescription, etc., and is responsible for the contact of specialized subject doctor, etc. Family doctors are general practitioners (GP) who have received six years of university medical education plus three years of professional training. Residents are free to choose a family doctor. The income of a family doctor is linked to the number of patients signed up, and to ensure the quality of service, each family doctor can sign up no more than 1,500 people. The family doctor is responsible for the promotion of health care knowledge, and communicates with patients and wins the trust of patients. Patients can only go to the hospital for treatment through the referral recommendation letter from the family doctor, and the family doctor will track and assist them in the whole process. The management clinic of chronic diseases of the elderly I work in adopts the management mode of treatment and treatment by appointment. The patients are recommended by the family doctor, who adjusts the treatment plan according to the condition, and then the family doctor continues to track the treatment effect. In this way, patients can be treated effectively, and comprehensive treatment resources of the hospital can be applied to complicated and severe patients. For patients with chronic diseases, more of them are left at home for long-term treatment and monitoring, which saves social medical resources and achieves good management effect.
Compared with China, due to the large population, there is a relative lack of high-quality medical resources, and the medical insurance system has not been established for a long time, and the insurance operation mode is not perfect. This means that public hospitals can not only obtain the national medical insurance fees to meet the hospital operation and development; However, patients are not restricted by graded diagnosis and treatment, so they can choose hospitals at will. As a result, there are many large specialized hospitals for simple diseases, and it is difficult to implement graded diagnosis and treatment, which further leads to uneven utilization of medical resources. However, the medical insurance of patients adopts the method of "partial reimbursementcombinepatient conceit" to form a purchasing relationship for medical service behaviors, which easily leads to the loss of trust between patients and doctors. However, the pace of China's medical reform has never stopped. Now, it will shift from "disease" to "health" as the center, which is the direction of China's medical reform and has certain foresight. During this study, I experienced the severe outbreak of pneumonia caused by the new coronavirus in China, the relevant measures of the public health emergency plan launched in Italy, and also paid full attention to the joint prevention and control response mechanism of the epidemic in China. I think, this event must be for a big test of the centers for disease control work in our country, will inevitably bring a new revolution, I believe that after returning home, how to make full use of hospital comprehensive resources to carry out the disease prevention and control work also will be the top priority of our work, this is me this three months to learn deeply understand to the second point.
Third point, hospital management embody humanistic, pragmatic, careful and thoughtful, comprehensive services for patients and hospital staff: Siena university hospital medical service, around the patient, people-oriented, service in order to achieve optimal effect. Medical service in the whole link in Italy, from the company of volunteers service to the diagnosis and treatment in the process of the doctor's careful communication, from a helicopter fast pre-hospital detailed guide to the patient discharged from hospital, all link embodies the "supremacy of life, the patient first" service concept, patients will receive full respect and care for, will also feedback the greatest respect to medical staff, to form the benign cycle of the doctor-patient relationship.
The management of Siena university hospital is based on the working characteristics of medical staff, communication links between doctors and nurses, which are pragmatic, pragmatic and lean, with the purpose of maximizing work efficiency. Siena university hospital ICU unit, for example, fully embodies the characteristics of information system construction, all the work through the information system, achieves the purpose of the comprehensive and objective record, and save the transition, doctors and nurses communication and record time repeatedly, repeatedly and classification work real-time remind clearly, make it easy for doctors and nurses can work, and to participate in the execution through information system can effectively reduce the risk of clinical medical, avoid error executing treatment to patients. Perfect information system design makes the whole work become smooth and simple, grasp the key points of the work, eliminate unnecessary every link, so that doctors and nurses can work easily and effectively.
In comparison with the medical service and management of hospitals in China, in recent years, the government has introduced many new models in the service and management of hospitals through themed activities such as "hospital management year" and "further improvement of medical service action". It is mainly reflected in the extensive application of modern information, the simplification and improvement of medical service process, the expansion of medical and health service and the improvement of health education model, etc., which have greatly improved the service capacity and level of the hospital. However, there are still many problems in the evaluation of hospital service improvement, which is still far from western advanced countries. For example, the hospital volunteer program already exists in many hospitals in China, but the connotation construction is far less than in Italy. Doctors and nurses in the hospital are practicing the service concept of "patient-centered", but the medical insurance policy, the related system and process of national standardized hospital management have not kept up with this service concept, and the purchase relationship between patients and hospitals is the key reason for the formation of a good humanistic doctor-patient environment. Again, for example, a hospital information system construction is still stay in the hospital independent development and operation, the patient health information cannot be Shared state, many hospital doctor workstation, nurse workstation, medical information system, such as workstations are set up separately, lack of necessary connection between each other, can't be linked together, thus lead to the orders, not in time to change the prescription did not update in time, failed to pass the information system of prevention and control of risk control and so on, lead to doctors and nurses to waste a lot of time on the exchange, succession, etc. And because there is no corresponding system to remind and monitor, treatment is not on time phenomenon also often occur. It is far less difficult and efficient to get work done through personal memory and scheduling than through direct involvement with information systems. So, compared to Italy is both rigorous and easily working atmosphere of hospital, our hospital management reform in the future work, how should continue around the "patient" and "staff" two major groups to optimize and improve the relevant systems and procedures, that is we shouldresolve in the future, this is I in the three months to learn deeply realized that the third point.
Fourth point, diagnosis and treatment time, fully communication careful treatment, evaluation of comprehensive reach the designated position, make everychronicpatients get the best management scheme:the chronicmanagement experts make an appointment every morning for about 3-4 patients; Communication time per patient was approximately 1 hour; There is a full understanding of the patient and detailed communication. The treatment procedures are as follows: Communication with patients and asked recently feel and symptoms, as well as psychological feelings, query the patient medical records for which the patient is (read theinformation system ) - understanding the patient's recent check the necessary information, complete assessment (MMSE scale simple mental state examination, Montreal cognitive assessment, mini getting state evaluation mental state assessment, such as GDS depression scale assessment, etc.), adjust the treatment plan (including drug, examination, diet and exercise program, etc.), understand the patient's health care costs, According to the situation, treatment order, referral order (follow-up management of the plan submitted to the family doctor), medication order, etc., signed and sealed -- informed consent should be signed for all patients to receive treatment -- appointment for the next visit (15 days, 1 month, 3 months, 6 months). During the treatment, most of the time is spent communicating and chatting with patients, which is what we often call "talk therapy". The whole process of diagnosis and treatment is full of humanistic care and mutual respect. Patients have great trust in doctors and follow the medical plan to a high degree. Accompanying family members can participate in the whole process of communication, flowing between each other with deep love and emotion. Let a person feel, whether the doctor or the patient, in the state is relaxed and happy. Patients will think that their illness is a state of the body, to adjust as much as possible. Therefore, they call this“visits.”
Comparing our country, because of the largechronicpatient base, community health care is still in preliminary development stage, also failed to effectively implement the classification diagnosis and treatment, often appear level 3 general hospital and the hospital patient cluster, doctors use time is very limited in each patient, can complete the patient's medication and check the disposal, don't have the time to perfect the patient assessment. Under the condition of our hospital, we began to independent research and development in 2018 chronic disease management information systems, designed to do the group management of hypertension patients by information system, but two years to run down, but encountered a patient base is too big, too little hospital staff, combined with the community health service management disconnect specific difficulties, such as how to search for, find a path, is suitable to China's national conditions, the management effect and quality can be effectively close to European countries, this is the home to do the main work, and I am the primary purpose of the study. Through learning, how can nurses fully participate in the management of patients with chronic diseases, participate in the evaluation of patients, and work effectively with doctors to manage patients with chronic diseases? With this idea to carry out the work, perhaps is to do a lot of slow disease patient management work an effective path, worth exploring!
Three months of the study ended,it brought me not only the expansion of knowledge, broaden horizons, start thinking, what's more, is to exercise myself in a foreign country life and the ability to learn, to improve the English listening comprehension and expression ability, and cultivate the friendship with Italian teachers. These experiences will benefit me for a lifetime! Finally, I would like to thank the hospital leaders, teachers of the foundation and foreign teachers of Siena international exchange office for their support and help. Return to the motherland, I will learn to use! Back in March, the country is still covered by the outbreak ofcoronavirus-infected pneumonia. On the battlefield faced by the medical staff, I will go forward with you without hesitation and contribute my own strength to cheer for the motherland! Cheers forWuhan! Cheer for home!
