預(yù)算管理(英文原文與中文譯文)

1、英文原文budget management1 introductionthe nhs reforms have had far reaching implications for clinicians of all grades and specialties. among other changes, it has been deliberate government policy that senior clinicians should have more direct management and budgetary responsibility within their own cl

2、inical areas. trust hospitals have developed a directorate based management structure and devolved budgets to clinical directors. a&e departments have either become directorates in their own right or associate directorates within larger directorates. a&e consultants who take on clinical directorship

3、 responsibilities will have more direct control of spending within their own department. at first this may seem intimidating, but the advantages of having control outweigh the disadvantages of more administrative activity.this article aims to give some guidelines to help make the task less daunting,

4、 as well as some tips based on personal experience. i do not intend to cover fund raising activity or the organization of postgraduate education and its funding. brief mention will be made of business planning at the end. and we have outlined what management budgeting is and how it differs from trad

5、itional budgetary control systems in health authorities; considered what it aims to achieve; and discussed the participation of clinicians in the management budgeting process and its likely impact on their methods of working.2 what is a budget?traditional budgetary control systems are based primaril

6、y on a structure of what are normally termed functional or departmental budgets. in this structure budgets are held by those people responsible for providing a service.there is normally no participation of clinical staff in this budgetary control structure other than the possibility that the budget

7、holders for pathology and radiology might be the consultants in charge. this seems strange given the considerable influence that clinicians have over the use of hospital resources.in any system of budgetary control a key principle is that individual budget holders should be held responsible only for

8、 those items of expenditure over which they can exert control. in health authorities this principle does not always apply. an extreme example of this concerns the pharmacy budget, where the pharmacist is often held responsible for drugs expenditure even though he has no direct control over the level

9、 of spending.although a budget is a sum of money given to you to run your service (including salaries and wages of all personnel) it is important to realize it is essentially a paper exercise similar to running your own bank account and receiving a bank statement. you will never actually see the mon

10、ey and the nitty-gritty of manipulating the account is done by your management colleagues and the finance department. your role as clinical director is to keep a watching brief on it and to make executive decisions as to how it isspent. there are three broad categories of budget:(1) steady state-you

11、 are allocated the same amount of money each year with an allowance for inflation. although it offers predictability for future planning it is inflexible and does not allow for surges in activity or unfunded government and trust lead initiatives. the majority of a&e departments receive their funding

12、 in this way.(2) activity based-the amount of money provided reflects the work done. it is accurate, flexible, and is the basis of much purchaser/provider contract activity. it is generally not available until the work has been completed and will vary from year to year.(3) lump sum-the government, r

13、egion, or trust releases a lump sum of money for a specific purpose (for example, to start triage or audit or to complete a waiting list initiative).this is unpredictable, often comes at short notice, and can rarely be used for long term planning.although the majority of a&e budgeting falls into the

14、 first category, lump sum money is available from time to time. an average department seeing 50 000 patients a year may hadean annual budget of approximately one million pounds. when taking on a budget ask these questions:(1) how big is it? who actually controls it?(2) do you really have control of

15、it or is it only theoretical, how often will you receive a statement? who do you speak to make changes with the budget? with whom and how do you negotiate within your institution?(3) ask to be taken through a budget statement and have a clear explanation of all terms, etc. it is normally delivered m

16、onthly and although it may look complicated it is easy to master and is really little different from your own bank statement.(4) go through it carefully as mistakes are an occasional occurrence (although they can be rectified retrospective through the finance department).(5) the financial year runs

17、from april to march. the theoretical aim is to make the books balance by the end of the financial year and not from month to month. short term overspends or under spends are not important.(6) a positive (+) sign means an overspend and a negative (-)sign means an under spend.(7) concentrate on the bi

18、g numbers; do not worry too much about little numbers although they do need to reanalyzed at some stage as savings can probably be made without affecting the quality of service.(8) devolve control of the nursing budget to your clinical nurse manager but be prepared to involve yourself in nursing act

19、ivities (for example, the development of nurse partitioning).(9) be prepared to negotiate with other directorates about certain items, similar issues arise with funding for anesthetic agents and blood products.(10) use creative accountancy. this is legitimate and will even receive the support of you

20、r financial colleagues.a key principle of management budgets is that all users of services should be informed of their costs. this is achieved by means of recharges made between those budget holders who supply services and those who use them. considering domestic and cleaning services again, this wo

21、uld entail a recharge between that departments budget and those of other departments and facilities in the hospital. cleaning costs would then appear on budget reports.in the case of, say, pathology services, consultant budget holders would be charged according to the number and type of tests that t

22、hey request. such recharges would be based on an agreed price list for tests rather than the actual cost of performing each individual one. this would have the effect of protecting the consultants who use pathology services from bearing the costs of any inefficiencies in the laboratories.it is beyon

23、d the scope of this article to describe in detail the revised procedures for setting budgets that would apply in a system of management budgeting. two features of importance should, however, be noted.the first is that all budget holders, including clinicians, would be invited to discuss possible cha

24、nges in their budgets. such discussions would consider options for service developments if additional resources became available and options for retrenchment should this become necessary as a consequence of reductions in resources. also included would bean assessment of alternative ways of using exi

25、sting resources to achieve greater efficiency. these reallocations might be made within a specific budget or might mean the movement of resources from one budget to another.linked to these discussions would be several financial incentives intended to encourage good budgetary control. typically, thes

26、e would permit budget holders to retain a proportion of any planned underpinnings to use in improving the services that they provide.3 who needs budgets?modern companies reject centralization, inflexible planning, and command and control. so why do they cling to a process that reinforces those thing

27、s? budgeting, as most corporations practice it, should be abolished. that may sound like a radical proposition, but it would be merely the culmination of long-running efforts to transform organizations from centralized hierarchies into devolved networks that allow for nimble adjustments to market co

28、nditions. most of the other building blocks are in place. companies have invested huge sums in it networks, process reengineering, and a range of management tools including eva (economic value added), balanced scorecards, and activity accounting. but they have been unable to establish a new order be

29、cause the budget and the command and control culture that it supports remain predominant.in extreme cases, use of the budget to force performance improvements may lead to a breakdown in corporate ethics. people who worked at worldcom, now bankrupt and under criminal investigation, said ceo bernard e

30、berts rigid demands were an overwhelming fact of life there. “you would have a budget, and he would mandate that you had to be 2% under budget,” said a person who worked at worldcom, according to an article in financial times last year. “nothing else was acceptable.” worldcom, enron, barings bank, a

31、nd other failed companies had tight budgetary control processes that funneled information only to those with a “need to know.”in short, the same companies that vow to stay close to the customer, so that they can respond quickly to precious intelligence about market shifts, cling tenaciously to budge

32、ting-a process that disembowels the front line, discourages information sharing, and slows the response to market developments until its too late.a number of companies have recognized the full extent of the damage done by budgeting. they have rejected the reliance on obsolete data and the protracted

33、, self-interested wrangling over what the data indicate about the future. and they have rejected the foregone conclusions embedded in traditional budgets-conclusions that render pointless the interpretation and circulation of current market information, the stock-in-trade of the knowledge-based, net

34、worked company.4 business planningthis is a new concept in the nhs but is well recognized in private industry. you will probably be asked to write on each year, a task which is not as tedious as it may sound. a good plan will help:(1) priorities future activity(2) predict financial needs(3) develop

35、departmental team spirit(4) convince others of your “vision” and enlist their cooperation(5) give support in times of change and uncertainty.method:the following is a useful structure for developing your plan:(1) identify all the activity of your department.(2) do you wish to stop any activity?(3) d

36、o you wish to continue any activity unchanged?(4) do you wish to continue any activity with minor change?(5) is there anything you wish to radically change?(6) is there anything you wish to introduce which is considered radical or innovative?tips:(1) involve your medical and nursing colleagues; many

37、 heads contribute many ideas(2) use brainstorming(3) dont forget to involve your clerical staff-they will seething from a very different angle and can contribute excellent ideas(4) include everything in the first draft (it can be pruned later)(5) if you think an innovative idea is worth pursuing try

38、 not to be put off by caution keep pursuing it(6) the actual format of the plan should follow that usedwithin your trust.5 summarythe nhs as a whole is constrained to operate with finite resources. furthermore, each individual district, as a consequence of the cash limit system, has a fixed sum of m

39、oney available to it each year for the provision of services. these financial facts of life must be recognized by all those who use the service or work in it. from the point of view of the district they lead to two apparently contradictory obligations-namely, to provide the pattern of services that

40、best meets the changing needs of the community as a whole; and to do so within a fixed financial allocation. the provision of services that meet the needs of the community requires constant appraisal of the way that resources are used. this may indicate that growth in a certain area of activity is r

41、equired. cash limits, however, imply that growth in one area can only be achieved either through contraction in another or by an overall improvement in efficiency. management budgeting provides the means to examine and tackle these issues and thus can help to reconcile the conflicting demands that c

42、onfront districts.budgetary responsibility gives you more control. take time to master the fine detail, ask questions of your management and finance colleagues about anything you do not understand (you will not lose face), and develop the skills of lateral thinking and creative accountancy. even if

43、your budget is repeatedly overspent do not take it personally, ensure that management are aware of it and have a goodnights sleep. do not worry about it.中文譯文預(yù)算管理1介紹國民保健制度的改革措施已經(jīng)對所有職業(yè)和專業(yè)醫(yī)生產(chǎn)生了深遠(yuǎn)的影響。在其他方面，它已蓄意被政府的政策改變，資深醫(yī)生在自己的臨床領(lǐng)域應(yīng)該有更多的直接管理和預(yù)算責(zé)任。醫(yī)院已經(jīng)開發(fā)出一種信任的預(yù)算管理體制和權(quán)力下放的臨床董事。急癥室要么成為擁有自己權(quán)利的董事，要么成為聯(lián)營公司里更大

44、的董事。急癥室顧問對臨床采取控制的職責(zé)將更直接地體現(xiàn)在他們自己的支出部門。起初，這看起來嚇人，但似乎有控制帶來的優(yōu)點遠(yuǎn)遠(yuǎn)大于更多的管理活動所帶來的弊端。本文旨在提供一些指引，以幫助更好的完成任務(wù)，以及提供一些基于個人的經(jīng)驗的技巧。我不打算在籌集資金活動或組織研究生教育資金方面展開討論，只是在最后簡要提及“業(yè)務(wù)規(guī)劃”。另外會提出什么是管理預(yù)算以及在衛(wèi)生當(dāng)局它是如何不同于傳統(tǒng)的預(yù)算控制系統(tǒng)；指出它旨在實現(xiàn)的目標(biāo)；及探討了臨床醫(yī)師參與管理預(yù)算編制過程及其可能影響他們的方法工作。2什么是預(yù)算傳統(tǒng)的預(yù)算控制系統(tǒng)建立的主要是根據(jù)一個什么樣的功能或結(jié)構(gòu)，通常被稱為部門預(yù)算。在這種結(jié)構(gòu)中的預(yù)算分別由這些人負(fù)責(zé)

45、提供某種服務(wù)。在預(yù)算控制結(jié)構(gòu)以外，通常沒有臨床工作人員的參與的可能性，病理學(xué)和放射學(xué)的預(yù)算是歸持有人的顧問公司負(fù)責(zé)。這似乎起了相當(dāng)陌生影響，臨床醫(yī)師可以使用醫(yī)院資源。在任何預(yù)算控制系統(tǒng)里的一個關(guān)鍵原則是，個別預(yù)算持有人應(yīng)只負(fù)責(zé)以上這些項目的開支，他們可以對這些項目施加控制。衛(wèi)生當(dāng)局對這個原則并不總是適用。一個極端的例子，這涉及到制藥預(yù)算，在那里藥劑師通常只是負(fù)責(zé)藥品的支出，盡管他沒有對消費(fèi)水平有直接的控制。雖然預(yù)算就是給你一筆錢讓你來管理服務(wù)(包括薪金和所有人員的工資)。但重要的是要認(rèn)識到它本質(zhì)上就類似于紙上談兵，來經(jīng)營自己的銀行帳戶和接受銀行對帳單。你永遠(yuǎn)不會真正看到金錢和事實的真相，操縱帳

46、戶是通過你的管理和財務(wù)部的同事來完成的。你作為臨床主任的作用是保持看簡介并作出如何花費(fèi)的行政決定。共有三種主要的預(yù)算大類：(1) 穩(wěn)態(tài)，你分配相同數(shù)額的錢每年都有因通貨膨脹引起的津貼。雖然未來的規(guī)劃提供了可預(yù)測性但缺乏靈活性，但不允許在今后的活動中或在政府的領(lǐng)導(dǎo)下倡議無資金激增。大部分部門接受以這種方式提供資金。(2) 活動的基礎(chǔ)，所提供的資金數(shù)額反映所做的工作。這是許多購買者或供應(yīng)商合同的準(zhǔn)確的，靈活的，基本活動。一般而言，它是直到工作已經(jīng)完成后才使用的，并將于每年有所不同。(3) 分政府、地區(qū)包干，或信托發(fā)行的用于特定目的的一筆錢(例如，以開始分流或?qū)徲嫗橐罁?jù)來完成候補(bǔ)名單的倡議)。這是不

47、可預(yù)測的，往往在短時間內(nèi)很少被用于長遠(yuǎn)的規(guī)劃。盡管大多數(shù)預(yù)算多數(shù)屬于第一大類，但包干資金可以一次性供應(yīng)。一個平均每年癥治50000名患者的部門的年度預(yù)算大約有100萬英鎊。當(dāng)實行預(yù)算時會有這么幾個問題：(1) 預(yù)算有多大？究竟是誰控制它？(2) 你是真的對它有控制，還是只是理論上的？你隔多久會收到一份聲明？你說的話能改變預(yù)算嗎？你會和誰在你的機(jī)構(gòu)內(nèi)進(jìn)行協(xié)商？(3) 聲明需要通過預(yù)算報表，對所有條款做出明確說明，這是每個月的正常交付，盡管它看起來很復(fù)雜，但它是很容易掌握的，和你自己的銀行聲明只有一點點的不同。(4) 通過小心翼翼的預(yù)算能使錯誤只會偶然發(fā)生(雖然他們可以通過財務(wù)部門進(jìn)行回顧性分析)

48、。(5) 財政年度從三月算到四月。理論目的是使年底收支平衡,財政按年度預(yù)算，而不是按月。短期的超支與否并不重要。(6) 正(+)符號的含義是超支而負(fù)(-)符號是指未用盡。(7) 集中精力在大數(shù)目，關(guān)于小數(shù)目不要太擔(dān)心，盡管他們確實需要在某個階段分析如何節(jié)省開支同時又不影響服務(wù)質(zhì)量。(8) 控制下放臨床護(hù)理預(yù)算，給你的護(hù)士經(jīng)理，但也要準(zhǔn)備自己參與護(hù)理活動(例如，護(hù)士發(fā)展)。(9) 準(zhǔn)備與其他董事談判某些項目，如麻醉劑和血液制品類似的問題。(10) 創(chuàng)造性應(yīng)用會計。這是合法的，并會得到你財務(wù)同事的支持。預(yù)算管理的一個重要原則是，所有用戶的服務(wù)都應(yīng)該被告知他們的成本。這是實現(xiàn)預(yù)算持有人之間的溝通方式

49、清楚的了解是誰提供的服務(wù)以及是誰在使用它們。再次考慮到清潔服務(wù)，這將導(dǎo)致該部門之間和其他部門以及醫(yī)院設(shè)施的預(yù)算充值。清潔費(fèi)用然后才出現(xiàn)在預(yù)算報告里。比如說，病理服務(wù)，顧問的預(yù)算根據(jù)持有人收取的數(shù)量和類型來滿足他們的測試要求。這種方式將基于每個個體測試商定的價格清單，而不是實際成本。這將有效的保護(hù)那些在實驗室使用病理顧問服務(wù)的降低效率成本。它詳細(xì)地描述了超出本文范圍以外的設(shè)置預(yù)算修訂的程序，將適用于預(yù)算編制的管理制度。有兩個重要的特征應(yīng)該指出并加以說明。首先，所有預(yù)算的持有人包括醫(yī)生，將被邀請參加討論其預(yù)算中可能出現(xiàn)的變化。這樣的討論會考慮選項的服務(wù)發(fā)展，如果更多資源成為可及期權(quán)那么選擇裁員就會

50、成為資源減少一個必然的后果。評估還包括利用現(xiàn)有資源的替代方式來實現(xiàn)更高的效率。這些可能是重新分配作出的具體預(yù)算或可能意味著資源從一個預(yù)算流動到另一個。另外這些討論旨在鼓勵數(shù)家金融企業(yè)養(yǎng)成良好的激勵措施和預(yù)算控制制度。通常，這些將使預(yù)算持有人的任何計劃都保留贏余使用比例，改善他們提供的服務(wù)。3誰需要預(yù)算現(xiàn)代公司拒絕集中的，缺乏彈性的規(guī)劃、指揮和控制。既然如此，為什么他們堅持要強(qiáng)化這些東西呢？預(yù)算，由于大多數(shù)公司的做法，應(yīng)該予以取消。這聽起來像一個激進(jìn)的主張，但它僅僅是一個開始，努力從中央轉(zhuǎn)變到下放網(wǎng)絡(luò)的層次結(jié)構(gòu)來運(yùn)行，提供靈活的市場情況以調(diào)整機(jī)構(gòu)。大多數(shù)其他積木公司所面臨的困境：公司已投資大量資

51、金在網(wǎng)絡(luò)和流程再造，以及一系列管理工具，包括eva(經(jīng)濟(jì)增加值)，平衡記分卡和活動會計核算。但是他們一直都無法建立新秩序，因為預(yù)算指揮和控制了文化，它的支持仍然占主導(dǎo)地位。在極端的情況下，使用預(yù)算受力性能改進(jìn)可能導(dǎo)致企業(yè)道德倫理崩潰。在世界通訊這樣的公司工作的人現(xiàn)在都破產(chǎn)了，并接受刑事調(diào)查，首席執(zhí)行官伯納德埃貝斯說的剛性需求，是對生活有壓倒性的事實，“你應(yīng)該有一個預(yù)算，它將規(guī)定你必須控制預(yù)算在2%以內(nèi)?！币粋€在世通公司工作的人表示根據(jù)去年的金融時報，“沒有什么是可以接受的?！笔劳?，安然，巴林銀行和其他公司都沒有嚴(yán)格的預(yù)算控制，因此那些漏斗狀的信息對他們來說僅僅只是“有必要知道”而已。總之，同一

52、公司發(fā)誓要貼近客戶，使他們能夠快速響應(yīng)市場變化得到珍貴的情報，頑強(qiáng)地保持預(yù)算這個過程阻礙信息共享，并減緩市場的發(fā)展，直至發(fā)展為時已晚。許多公司已經(jīng)認(rèn)識到了預(yù)算編制完成的損害程度。他們已經(jīng)拒絕了依賴過時的數(shù)據(jù)，長期的爭吵數(shù)據(jù)預(yù)示這怎樣的未來。而且他們已經(jīng)放棄了傳統(tǒng)的嵌入式的結(jié)論預(yù)算，拒絕了毫無意義的解釋和呈現(xiàn)當(dāng)前市場信息的流通，以知識為基礎(chǔ)的貿(mào)易網(wǎng)絡(luò)公司。4業(yè)務(wù)規(guī)劃這是國民保健制度的一個新概念，但在私營工業(yè)能得到公認(rèn)。你可能會被要求寫一整年，這項任務(wù)并不像它聽起來的那樣乏味。一個好的計劃將幫助：(1) 優(yōu)先考慮未來活動(2) 預(yù)測財務(wù)需求(3) 開發(fā)部門的團(tuán)隊合作精神(4) 用你的“遠(yuǎn)見”說服別

53、人和爭取他們的合作(5) 給予變革以及不確定的時期支持。方法：以下是對發(fā)展你的計劃有用的結(jié)構(gòu)框架：(1) 確定所有你的部門的活動。(2) 你希望停止任何活動嗎？(3) 你想任何活動都繼續(xù)保持不變嗎？(4) 你想任何活動有輕微的改變嗎？(5) 你有什么是希望從根本上改變的？(6) 你有什么是希望引進(jìn)被認(rèn)為是激進(jìn)的或創(chuàng)新的？提示：(1) 涉及到你醫(yī)療和護(hù)理的同事，許多人就能貢獻(xiàn)很多想法(2) 采用頭腦風(fēng)暴(3) 不要忘記你的文書人員的參與，他們能從一個非常不同的角度看事情，可以提出優(yōu)秀的想法(4) 初稿涵蓋所有內(nèi)容(它可以在日后被修剪)(5) 如果你認(rèn)為一個創(chuàng)新的想法是值得追求的盡量不要謹(jǐn)慎,積極

54、地繼續(xù)追求它(6) 該計劃應(yīng)按照你確認(rèn)的實際使用的格式。5總結(jié)作為一個整體的國民保健服務(wù)是約束經(jīng)營的有限資源。此外，每個地區(qū)，作為一個現(xiàn)金限額制度的后果，有固定數(shù)額的錢提供給它作為每一年提供的服務(wù)。這些現(xiàn)實的財務(wù)事實必須由所有人使用服務(wù)或工作。從區(qū)的角度來看，它們將導(dǎo)致兩個明顯矛盾，即提供最好的服務(wù)模式，以及滿足不斷變化的整個社會的需要；這樣做有一個固定的財政撥款和完善的服務(wù)，來滿足時代的需要,提供給社會不斷評估的方式以使用資源。這可能表明，對在一定范圍內(nèi)的增長要求的庫存現(xiàn)金限額，然而，一個地區(qū)的增長只能通過其他地區(qū)的收縮或整體改善效率來實現(xiàn)。預(yù)算管理提供了手段，來研究和處理這些問題，從而有助

55、于調(diào)和一些地區(qū)之間相互沖突的需求。預(yù)算責(zé)任給你更多的控制。需要花時間掌握細(xì)節(jié)，向你的經(jīng)理和你財務(wù)部的同事咨詢一切你不知道的問題(你不會丟臉)，發(fā)展技能的橫向思維和創(chuàng)造性的會計思路。即使你的預(yù)算一再超支不必太在乎，確保管理層意識到這一點，并擁有良好的睡眠，不要太擔(dān)心。 膄葿羆袆荿蒞羅羈膂蚄羅膀莈蝕羄芃芀薆羃羂蒆蒂羂肅艿螁羈膇蒄蚆肀艿芇薂聿罿蒂蒈蚆肁芅莄蚅芄蒁螃蚄羃莄蠆蚃肅蕿薅蚃膈莂蒁螞芀膅螀蟻羀莀蚆螀肂膃薂蝿膄莈蒈螈襖膁蒄螇肆蕆螂螇腿芀蚈螆芁蒅薄螅羈羋蒀螄肅蒃莆袃膅芆蚅袂裊蒂薁袁羇芄薇袁腿薀蒃袀節(jié)莃螁衿羈膆蚇袈肄莁薃袇膆膄葿羆袆荿蒞羅羈膂蚄羅膀莈蝕羄芃芀薆羃羂蒆蒂羂肅艿螁羈膇蒄蚆肀艿芇薂聿罿蒂蒈

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