預(yù)算管理【外文翻譯】

1、原文： budget management introduction the nhs reforms have had far reaching implications for clinicians of all gradesand specialties. among other changes it has been deliberate government policy thatsenior clinicians should have more direct management and budgetary responsibilitywithin their own clinic

2、al areas. trust hospitals have developed a directorate basedmanagement structure and devolved budgets to clinical directors. aampe departmentshave either become directorates in their own right or associate directorates within largerdirectorates. aampe consultants who take on clinical directorship re

3、sponsibilities willhave more direct control of spending within their own department. at first this mayseem intimidating but the advantages of having control outweigh the disadvantages ofmore administrative activity. this article aims to give some guidelines to help make the task less daunting aswell

4、 as some tips based on personal experience. i do not intend to cover fund raisingactivity or the organization of postgraduate education and its funding. brief mentionwill be made of quotbusiness planningquot at the end. and we have outlined whatmanagement budgeting is and how it differs from traditi

5、onal budgetary control systemsin health authorities considered what it aims to achieve and discussed the participationof clinicians in the management budgeting process and its likely impact on theirmethods of working. what is a budget traditional budgetary control systems are based primarily on a st

6、ructure of whatare normally termed functional or departmental budgets. in this structure budgets areheld by those people responsible for providing a service. there is normally no participation of clinical staff in this budgetary controlstructure other than the possibility that the budget holders for

7、 pathology and radiologymight be the consultants in charge. this seems strange given the considerable influencethat clinicians have over the use of hospital resources. in any system of budgetary control a key principle is that individual budgetholders should be held responsible only for those items

8、of expenditure over which theycan exert control. in health authorities this principle does not always apply. an extremeexample of this concerns the pharmacy budget where the pharmacist is often heldresponsible for drugs expenditure even though he has no direct control over the level ofspending. alth

9、ough a budget is a sum of money given to you to run your service includingsalaries and wages of all personnel it is important to realize it is essentially a paperexercise similar to running your own bank account and receiving a bank statement. youwill never actually see the money and the nitty-gritt

10、y of manipulating the account isdone by your management colleagues and the finance department. your role as clinicaldirector 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 are allocated the same a

11、mount of money each year with anallowance for inflation. although it offers predictability for future planning it isinflexible and does not allow for surges in activity or unfunded government and trustlead initiatives. the majority of aampe departments receive their funding in this way. 2、activity b

12、ased-the amount of money provided reflects the work done. it isaccurate flexible and is the basis of much purchaser/provider contract activity. it isgenerally not available until the work has been completed and will vary from year toyear. 3、lump sum-the government region or trust releases a lump sum

13、 of money fora specific purpose for example to start triage or audit or to complete a waiting listinitiative.this is unpredictable often comes at short notice and can rarely be used forlong term planning. although the majority of aampe budgeting falls into the first category lump summoney is availab

14、le from time to time. an average department seeing 50 000 patients ayear may hadean annual budget of approximately one million pounds. when taking ona budget ask these questions: 1、how big is it who actually controls it 2、do you really have control of it or is it only theoretical how often will your

15、eceive a statement who do you speak to make changes with the budget with whomand how do you negotiate within your institution 3、ask to be taken through a budget statement and have a clear explanation of allterms etc. it is normally delivered monthly and although it may look complicated it iseasy to

16、master and is really little different from your own bank statement. 4、go through it carefully as mistakes are an occasional occurrence althoughthey can be rectified retrospective through the finance department. 5、the financial year runs from april to march. the theoretical aim is to make thebooks ba

17、lance by the end of the financial year and not from month to month. short termoverspends or under spends are not important. 6、a positive sign means an overspend and a negative -sign means an underspend. 7、concentrate on the big numbers do not worry too much about little numbersalthough they do need

18、to reanalyzed at some stage as savings can probably be madewithout affecting the quality of service. 8、devolve control of the nursing budget to your clinical nurse manager but beprepared to involve yourself in nursing activities for example the development ofnurse partitioning. 9、be prepared to nego

19、tiate with other directorates about certain items， similarissues arise with funding for anesthetic agents and blood products. 10、use creative accountancy. this is legitimate and will even receive the supportof your financial colleagues. a key principle of management budgets is that all users of serv

20、ices should beinformed of their costs. this is achieved by means of recharges made between thosebudget holders who supply services and those who use them. considering domestic andcleaning services again this would entail a recharge between that departments budgetand those of other departments and fa

21、cilities in the hospital. cleaning costs would thenappear on budget reports. in the case of say pathology services consultant budget holders would becharged according to the number and type of tests that they request. such rechargeswould be based on an agreed price list for tests rather than the act

22、ual cost of performingeach individual one. this would have the effect of protecting the consultants who usepathology services from bearing the costs of any inefficiencies in the laboratories. it is beyond the scope of this article to describe in detail the revised procedures forsetting budgets that

23、would apply in a system of management budgeting. two features ofimportance should however be noted. the first is that all budget holders including clinicians：would be invited todiscuss possible changes in their budgets. such discussions would consider options forservice developments if additional re

24、sources became available and options forretrenchment should this become necessary as a consequence of reductions in resources.also included would bean assessment of alternative ways of using existing resources toachieve greater efficiency. these reallocations might be made within a specific budgetor

25、 might mean the movement of resources from one budget to another. linked to these discussions would be several financial incentives intended toencourage good budgetary control. typically these would permit budget holders toretain a proportion of any planned underpinnings to use in improving the serv

26、ices thatthey provide. who needs budgets modern companies reject centralization inflexible planning and command andcontrol. so why do they cling to a process that reinforces those things budgeting asmost corporations practice it should be abolished. that may sound like a radicalproposition but it wo

27、uld be merely the culmination of long-running efforts to transformorganizations from centralized hierarchies into devolved networks that allow fornimble adjustments to market conditions. most of the other building blocks are in place.companies have invested huge sums in it networks process reenginee

28、ring and a rangeof management tools including eva economic value added balanced scorecardsand activity accounting. but they have been unable to establish a new order because thebudget and the command and control culture that it supports remain predominant. in extreme cases use of the budget to force

29、 performance improvements may leadto a breakdown in corporate ethics. people who worked at worldcom now bankruptand under criminal investigation said ceo bernard eberts rigid demands were anoverwhelming fact of life there. quotyou would have a budget and he would mandate thatyou had to be 2 under bu

30、dgetquot said a person who worked at worldcom according toan article in financial times last year. quotnothing else was acceptable.quot worldcomenron barings bank and other failed companies had tight budgetary control processesthat funneled information only to those with a quotneed to know.quot in s

31、hort the same companies that vow to stay close to the customer so that theycan respond quickly to precious intelligence about market shifts cling tenaciously tobudgeting-a process that disembowels the front line discourages information sharingand slows the response to market developments until its t

32、oo late. a number of companies have recognized the full extent of the damage done bybudgeting. they have rejected the reliance on obsolete data and the protractedself-interested wrangling over what the data indicate about the future. and they haverejected the foregone conclusions embedded in traditi

33、onal budgets-conclusions thatrender pointless the interpretation and circulation of current market information thestock-in-trade of the knowledge-based networked company. business planning this is a new concept in the nhs but is well recognized in private industry. youwill probably be asked to write

34、 on each year a task which is not as tedious as it maysound. a good plan will help: 1、priorities future activity 2、predict financial needs 3、develop departmental team spirit 4、convince others of your quotvisionquot and enlist their cooperation 5、give support in times of change and uncertainty. metho

35、d： 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、do 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 chan

36、ge 6 、 is there anything you wish to introduce which is considered radical orinnovative tips： 1、involve your medical and nursing colleagues many heads contribute manyideas 2、use brainstorming 3、dont forget to involve your clerical staff-they will seething from a verydifferent angle and can contribut

37、e 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 not to be put off by cautionkeep pursuing it 6、the actual format of the plan should follow that usedwithin your trust. summary the nhs as a whole is constrained to

38、 operate with finite resources. furthermoreeach individual district as a consequence of the cash limit system has a fixed sum ofmoney available to it each year for the provision of services. these financial facts oflife must be recognized by all those who use the service or work in it. from the poin

39、t ofview of the district they lead to two apparently contradictory obligations-namely toprovide the pattern of services that best meets the changing needs of the community asa whole and to do so within a fixed financial allocation. the provision of services thatmeet the needs of the community requir

40、es constant appraisal of the way that resourcesare used. this may indicate that growth in a certain area of activity is required. cashlimits however imply that growth in one area can only be achieved either throughcontraction in another or by an overall improvement in efficiency. managementbudgeting

41、 provides the means to examine and tackle these issues and thus can help toreconcile the conflicting demands that confront districts. budgetary responsibility gives you more control. take time to master the finedetail ask questions of your management and finance colleagues about anything you donot u

42、nderstand you will not lose face and develop the skills of lateral thinking andcreative accountancy. even if your budget is repeatedly overspent do not take itpersonally ensure that management are aware of it and have a goodnights sleep. do notworry about it.source: geoffrey hughes2007.“the budget management” the hospital budgetmanagement.no.10.pp.156-166.譯文： 預(yù)算管理 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