预算管理【外文翻译】 .doc

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 clinical 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 responsibilities 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 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 traditional 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 structure 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 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 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. although 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-gritty 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 amount 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 based-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 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 available 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 youreceive 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 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 balance 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 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 negotiate 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 services 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 facilities 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 actual 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 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 resources 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 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 services 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 would 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 reengineering 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 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 budgetquot 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 short 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 too 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 traditional 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 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. 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、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 change 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 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 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 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 point 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 requires 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 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 understand 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.译文： 预算管理 介绍 国民保健制度的改革措施已经对所有职业和专业医生产生了深远的影响。在其他方面，它已蓄意被政府的政策改变，资深医生在自己的临床领域应该有更多的直接管理和预算责任。医院已经开发出一种信任的预算管理体制和权力下放的临床董事。急症室要么成为拥有自己权利的董事，要么成为联营公司里更