1、 华中科技大学博士学位论文公立医院人力资本投资的风险管理及控制策略研究姓名：高红霞申请学位级别：博士专业：社会医学与卫生事业管理指导教师：方鹏骞20080501华中科技大学博士学位论文公立医院人力资本投资的风险管理及控制策略研究博士研究生：高红霞导 师：方鹏骞 教授中文摘要研究目的公立医院作为卫生领域组织的典型代表，凸显人力资本价值、实现公立医院价值最大化的支撑基础是医院人力重要地位。连续、高效、敏捷本投资具有风险性甚至高风险于国内特别是卫生领域人力资选择公立医院为研究对象，期理论体系，分析导致人力资本本投资风险的理论模型，设计资本价值最大化，因此人力资本投资在医院经营中占有的公立医院人力资本
2、投资能力成为其生命线。但人力资性，已被国内外人力资本投资的理论和实践所验证。鉴本投资风险研究相对薄弱，尚不能构成完整体系，本文望通过系统研究，完善和拓展公立医院人力资本投资的投资风险的关键环节和影响因素，构建公立医院人力资具有可操作性的医院人力资本投资风险分散模式，以期推进当前医院人力资本投资风险的研究与实践。研究方法本研究主要采取了理论探讨与实证研究相结合、定性和定量相结合的研究方法。首先运用通过内容分析和二次论、人力资本产权理论、风险分析方法开展文献资料分析工作，吸收人力资本管理理管理理论等理论基础，对公立医院人力资本投资的相关理论进行分析。设计研究方案，在全国范围内按照经济水平抽取 12
3、家公立医院（二级6家）作为现场调查对象，对其人事部主任、中层管理者和副高级508位进行问卷调查 ,对医院的关键知情人进行半结构化访谈。EpiData3.1进行数据录入，运用 SPSS12.0进行统计分析，包括描述性分Logstic回归分析、因子分析、层次分析和模糊综合 评判医院和三级医院各以上职称员工共 现场收集的资料利用析、卡方检验、非参数检验、等；对研究中专家咨询、访谈等资料进行定性分析。-1-华中科技大学博士学位论文研究结果1.基本概念的界定借鉴国内外其他领域人力资本投资的研究成果，对公立医院人力资本、公立医院人力资本投资、公立医院人力环节、人才资本引进投资环节资本投资风险等概念进行界定
4、。从人力资本投资预决策、开发与培训投资环节、配置投资环节、使用投资环节（包括维持使用投资）构建公立医院人力资本投资的理论模型。2.公立医院人力资本投资风险的理论分析提出从外部环境和医院内部管理两大角度对公立医院人力资本投资风险进行划分。外部环境风险包括一般环治经济社会环境风险属于较小资本集中投资优势，但同时医具体竞争环境中，当地的经济境风险和具体竞争环境风险，其中一般环境中的宏观政概率风险；宏观行业环境风险中公立医院既具备了人力院人力资本的配置、使用和流失存在潜在威胁因素。在技术环境、医疗服务市场竞争、竞争对手间人力资本争夺等直接影响了公立医院人力资本投资效果。医院内部环节管理风险根据产生主体
5、的不同分为管理者行为风险和被管理者反应行为风险，在此基础上根据理模型。公立医院人力资本投资论分析结果初步设计了公立医院人力资本投资风险环节风险原因包括人力资本投资的特征原因、人力资本产权特征、不完全信息和不对称信息特征、人的异质性特征等等。3.公立医院人力资本投资内部管理风险的实证研究结果人力资本投资管理过程在不同级别医院之间呈现差异。对医院所处的具体外部环失风险越低，反之则离开本单位的倾向越强烈。不同级度的完善程度不同，三级医院的各项制度建设情况要好境越满意，医院的人力资本流别的医院内部人力资源管理制于二级医院，包括医院人力资本引进计划（2 8.723 P0.01）、医院科室环境建设（ p0
6、.05）、取得工作成果情况（2 36.174 p0.01）等等。二级医院对薪酬待遇 4.746p0.05）要好于三级医院。间呈现差异。临床科室的各项制度建设 4.986 P0.01）、培训制度（ p0.05）、培 训计划 (2 2 14.330p0.01)、职业生涯管理情况（ 0.029p0.05）、激励奖惩情况（ p0.05 ）等等。满意程度（ p0.01）、职业生涯管理实施情况（人力资本投资管理过程在不同科室性质之2情况要好于行政科室，包括人力资本引进计划制定（2-2-华中科技大学博士学位论文人力资本投资管理在普通员工和中层管理满意情况、对薪酬制度、福利 待遇满意情况、考核制度合理程度、科
7、室团队凝聚力评价要低于中层管理者（ p0.01）；中层管理者对医院发展信心大于普通员工（者之间呈现差异。普通员工对当前收入p0.05）；普通员工因为身体状况影响工作可能性要高于中层管理者（医院管理者行为中发现的问题：科室主任p0.05）。人事决策权较小；员工对医院战略目标认同度较差；培训对象因素未培训对象的适应性被摆在后位理和工作分析等管理尚需提高等等。通过公立医院人力资本流失风险引起管理者的重视，被培训者本人的需求、培训内容与；培训考核制度尚未建立；培训效果较差；职业生涯管Logistic回归分析，发现人力资本载体对薪酬福利制度满意情况（ OR 0.515, P 0.007）、对医院文化建设
8、满意情况（OR 0.437, P 0.007）、离开本地区倾向（OR 6.260,P 0.000）是人力资本流失风险的主要影响因素。合同的约束力、最高学历等因素对人力资本流失影响有待进一步研究。4.公立医院人力资本投资风险模型研究结果通过管理者行为和被管理者反应行为的因子分析发现，在中层管理者行为中，医决策权归属以及人力资本信息风险是最容易导致人力资管理者反应行为中，医院内部制度与环境满意度、医院人力资本重视度、单位倦怠、工作倦怠、主动流失、人12个潜在因子进行工个人因素、科室因素、医院因素和医院地区因素，由院制度建设、医院实力、人事本投资风险的影响因子。在被的地区环境、中高层管理者对力资本与
9、岗位的匹配性、人力资本培训需求是主要影响因子。对这深层次分析，归结为四类：员此构建了公立医院人力资本投资主要风险管理模型。5.公立医院人力资本投资管理风险评价结果本研究通过德尔菲法和层次分析法构建公指标，并运用模糊综合评价法对二级医院和三级医院、以及各环节风险水平和总体风险水平进行评价。结果发现，三级医院、二级医院在外部环立医院人力资本投资管理风险三级评价12家医院的人力资本投资境风险、人力资本引进风险、开发与培训风险环节的风险程度较小，策投资管理环节风险程度较大风险水平；但通过加权平均法在人力资本配置与使用环节管理风险程度中等，在预决。两个级别医院的总体风险水平均为风险较小稍偏中等发现三级医
10、院总体风险水平要稍高于二级医院；不同级别医院在人力资本流失环节风险程度不一。-3-华中科技大学博士学位论文从各家医院环节风险情况看，在外部环境管理风险方面，医院的风险程度不一；每家医院在人力资本预决策投对人力资源管理制度建设的重险程度较小。利用加权平均法资环节风险普遍较大；在配置与使用环节上，由于医院视，因此表现出由于管理不善而导致的人力资本投资风，对每家医院总体风险进行综合评价，结果为尽管各家医院人力资本投资管理风险总体显示风险较小，但基本上都稍偏风险中等水平。对策建议：1.公立医院人力资本投资风险的风险管理。提出从风险环节与因素识别机制、风险审计机制、风险评估机制、资本投资风险管理机制。风
11、险防范机制、风险控制机制构建完整的公立医院人力综合本文的研究内容和研究结果，本研究提出公立医院人力资本投资风险识别主要包括：（ 1）风险类型的识别，包括外部环境风险和内部管理风险；管理者行为风险和被管理者行为风险。（2）风险产生环节的识别，从医院内部看，风险产生环节包括预决策环节、人力资本引进环节、人力资本开发与培训环节、配置与使用环节；从人力资本载体看，主要包括代理风险和流失风险。（3）风险因素的识别，从管理者行为风险看，医院人力资本投资风人力资本流失风险看，主要风处的地区环境、医院级别等。险的产生与医院内部管理制度的健全程度息息相关；从险因素包括薪酬福利制度、医院文化建设情况、医院所在医院
12、人力资本投资风险审计中，审计者应根据医院识别的风险来源、风险环节和风险因素进行逐一审计，看风险控制措施。投资活动对这些风险是否跟踪识别，是否采取了相应的在风险防范机制中，其中内部管理风险防范目的，外部环境风险防范应重点进行环境分析和竞争对手分析。2.公立医院人力资本运营与风险防范。人 力资本运营机制从人力资本投资预决策力资本培训开发机制、人力资本使用机制进行构建。在范主要通过医院人力资本运营以达到防机制、人力资本引进机制、人预决策机制中，要建立和完善资规划、关注人力资本承载力人力资本引进需求分析、制定资本引进结果评估。在培训与医院人力资本投资集体决策制度、做好医院人力资本投、明确医院战略目标；
13、在人力资本引进机制中，应做好与本院发展规划相符合的人力资本引进计划、进行人力开发机制中，设计完善的医院培训管理体系。从体系流-4-华中科技大学博士学位论文程看，应包括培训计划制定、培训需求分析、培训对象确定、培训内容和方式的选择、培训效果评估。在人力资本使合理配置、推行员工职业生涯境建设。用机制中，重点做好工作分析、人力资本数量和质量的规划管理、重视健康维持投资、重视医院文化和医院环3.从人力资本产权角度进行人力资本投资风险防范。本研究提出主要从人力资本产权化的薪酬激励机制设计、行风险防范。约束措施与风险防范、心理契约与风险防范三个方面进在人力资本产权化的薪酬激励机制设计中应包括薪酬激励、福利
14、激励、职业发展资本使用效率和稳定性的主要因素之一，因此医院应设1）薪资政策要保持对外的竞争性； 2）薪资水平要结合激励等；薪酬福利是影响人力计科学合理的薪资激励方案。医院实际； 3）薪资要重视员工的福利愿望；表现、贡献等因素确定不同的数额，实行差别化薪资；在约束机制中，除考核机制外，还应包括4)按表现支付薪资，按岗位、责任、日常5）关注激励的公平性问题。管理者行为约束、员工行为约束和契约66.1%人认为合同并不能构成约 束其离开单位的有效约束；同时考虑到调查结果显示手段，由此提示契约约束并不是防范医院人力资本流失风险的最终策略，提出将心理契约、事业感情投资、人际关系投资作为风险防范的重要途径。
15、关键词：公立医院 人力资本投资风险因素与环节风险管理-5-华中科技大学博士学位论文The research on risk management of human capitalinvestment in Public hospitalD. Candidate： Gao Hong-xiaSupervisor： Prof. Fang PengqianAbstract Objectives：As the typical representative of the health organization, the foundation to realize thehuman capital valu
16、e and the hospital value maximum is human capital value. So the humancapital investment played an important role in hospital management. But it is confirmedby theory and practice that there is high risk in the human capital investment at home andabroad. In view of the research of human capital inves
17、tment in health field is relativelyweak, the article system research public hospital to improve theoretical system of publichospital human capital investment, analyze the key risk unit and influencing factors, andconstruct theoretical model of risk management of public hospital investment. Hope topr
18、omote the research and practice.Methods：The article applies to theory discussion and demonstration research, combining withQualitative and quantitative study on human capital investment risk in public hospital. Atfirst, author carry on content analysis and secondary analysis on the basis of collecti
19、ng agreat amount of documents. Combining theories such as human capital management,human capital property right, risk management and so on. Secondly the author designs theresearch approach. Objective to investigate the risk influencing factors of human capitalinvestment, a procedure of stratified cl
20、uster random sampling was conducted in nationbased on geographical location and economical condition, including 6 secondary hospitalsand 6 tertiary hospitals. The subject are personnel manager, midlevel manager and senioremployees a total of 508. All data are processed by SPSS for Windows 12.00. Sta
21、tisticalAnalysis methods include Descriptive Statistics, nonparametric test, chi-squared analysis,factor analysis, the Analysis Hierarchy Process and Fuzzy Comprehensive Evaluation. Atlast the article analysis the results of experts consultation, nominal group discussion, and-6-华中科技大学博士学位论文the inter
22、view results.Results and Conclusions：1. The basic concepts are defined. The article use for reference from results of humancapital investment in other field at home and abroad, including Human capital of publichospital, human capital investment of public hospital and human capital investment risk of
23、public hospital etc. The author construct theory model from five taches on managementrisk in hospital: prediction and decision risk, recruitment risk, development and trainingrisk, distribution and use risk.2.The theory analysis of human capital investment of public hospital. The authorthinks the in
24、vestment risk should be divided into 2 ways: environment risk andmanagement risk. The former include general environment risk and concreteenvironmental. The environment risk of politics, economy and society is small probability.The industry environment endow with public hospital some superiority on
25、human capitalinvestment, but there are potential threat through distribution, use and loss of humancapital. In addition, there are a series of factors in concrete environmental, such as thelocal economy and technology environment, the competition within medical servicemarket, the contest of human ca
26、pital within competitor etc. It affects the effect of humancapital investment inevitably.According to the difference of risk subject, the management risk in public hospitalcould be divided into 2 sections, the behavior risk of manager and the reaction behaviorrisk of being managed. The main reason o
27、f human capital investment include the characterof human capital investment, the character of human capital property right, incompleteinformation and asymmetric information among the investmeng, human heterogeneity etc.3. The demonstration research of the public hospitals management risk of humancap
28、ital investment.The management of investment presentes differences along withdifferent level of hospital. The higher satisfaction with local environment of hospital, thelower risk of human capital loss. It is different about the policy of human resourcesmanagement in different level of hospital. In
29、general, perfect degree of HRM in the tertiaryhospitals is better than the secondary hospitals, including the human capitals recruitmentplan（ 2 8.723 P0.01） , the hospitals environment（ p0.05） etc. But insecondary hospitals, the satisfaction with salary（ p0.01） , career management（2-7-华中科技大学博士学位论文4.
30、746 p0.05） is better than the tertiary hospitals.The management of investment presentes differences along with different department.In general, the system of HRM in clinical department is better than the administrate office,including the human capital s recruitment plan（ 2 4.986 P0.01） , training sy
31、stem（ p0.05） , training plan(p0.05） , and so on.2 14.330 p0.01), career management（ 2 0.029The management of investment presentes differences along with midlevel managerand senior employees. The satisfaction of enior employees with salary, ExaminationSystem , confidence in hospital development is lo
32、wer than midlevel manager（ p0.01） .Logistic regression analysis of loss risk of human capital investment showed that thesatisfaction of salary（ OR 0.437, P0.01） , hospital culture（ OR 0.437, P P0.01）and want to leave area（ OR 6.260, P P0.01） are the main factors.4.The factor analysis result through
33、the behavior of manager show that the hospitalmanagement system, the hospital strength, the decision right of personnel, and theinformation risk of human capital are the main impact factors of investment risk. AndThe factor analysis result through the reaction behavior of being managed show thatther
34、e are 8 factors: the satisfaction with hospital system and environment, the localenvironment, the job burnout and so on.The article goes on to study 14 factors and find that it can be divided into 4 class: theindividual factor of employee, the department factor, the hospital factor and the local fac
35、tor.The theory model of main investment risk is designed on this basis.5. The article construct risk rate index of human capital investment through the Delphimethod and AHP. Evaluate the investment tache risk and the whole investment risk in thetertiary hospitals, the secondary hospitals and in each
36、 hospital with Fuzzy ComprehensiveEvaluation. It shows that the risk level is low in environment risk, recruitment risk,development and training risk. The distribution and use risk is midding, and the predictionand decision risk is high. The whole risk in public hospital is low, but the tertiary hos
37、pitalsinvestment risk is higher than the secondary hospitals. There is difference of loss risk in thetertiary hospitals and secondary hospitals. The evaluation of each hospital shows that thelevel of environment risk is different, but the prediction and decision risk is high in eachhospital. The dis
38、tribution and use risk is low as a result of the perfect HRM system.-8-华中科技大学博士学位论文Suggestions:1.The risk management of human capital investment in public hospital. The articledefine the system of risk management, including the system of risk identification, thesystem of risk auditing, the system of
39、 risk evaluation, the system of risk prevention and thesystem of risk control.Upon the research contents and results, the Key Point of risk identification containsthree parts: the first, the recognition of risk classification. Such as environment risk andmanagement risk, the behavior risk of manager
40、 and the reaction behavior risk of beingmanaged etc. The second, the recognition of risk unit. The author construct model of riskunit from five taches on management risk in hospital: prediction and decision risk,recruitment risk, development and training risk, distribution and use risk. The third, t
41、herecognition of risk factors. The investment risk is closely linked with management systemin hospital. And among the possible factors of human capital loss, there are four mainfactors: the system of salary welfare, the hospital culture, the exterior environment ofhospital and the level of hospital.
42、In the process of risk audit, the auditor should audit risk source, risk unit and riskfactor one by one, in order to make sure that hospital manager have take action totrack,identify these potential risk.In the system of risk prevetion, we should take different way between managementrisk with enviro
43、nment risk.The emphases in risk prevetion of hospital environment isenvironment analysis and competitor analysis. But the management risk prevention recursto human capital operation.2. The article put forward human capital operation to control investment risk. Thesystem of human capital operation in
44、cludes four parts: the system of prediction anddecision, the system of recruitment, the system of development and training, and thesystem of using. In first part, the establishment and improvement of collectivedecision-making system, human capital investment planning, hospital stratagem is mostimpor
45、tant. In the system of development and training, the manager should put attention totraining plan, the analysis of training demand, the trainings content and method, theevaluation of training effect etc. In the last part, manager should focus on job analysis,career management, health investment and
46、hospital culture.-9-华中科技大学博士学位论文3.The author put forward the innovaion of human capital property right to preventinvestment risk in public hospital: the Motivation Mechanism, the Mechanism ofpsychological contract and the restriction mechanism.Three contents, the salary prompting, the walfare prompt
47、ing and the careerdevelopment prompting, are the most important among the salary and welfare systembased on human capital property right. Upon the results above, the salary and welfare isone of the main factor affects the human capitals efficiency and stability, so the hospitalshould design science
48、and rational project on salary. The first, the salary project shouldkeep rivalrousness with society and competitor. The second, the salary should consider thecondition of the hospital financing. The fourth, the salary should pay attention to thewalfare mind of employee. The last, the level of salary
49、 should relate with position, duty etc.The last, the equity of promotin also cannt be ignored.Restriction system takes important role in the risk prevention of human capitalinvestment risk. Except assessing system, there are behaviour restriction of manager andbeing, contract restriction. The results of investigation tell us that contract is not aneffective way to prevent human capital loss risk, abo
