Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

Based on the management by objectives and developmental performance appraisal,Shanghai Tenth People's Hospital explored the performance appraisal scheme for attending,including disease-specific complexity,disease-specific difficulty,clinical risk-taking and comprehensive quality.Assessment and feedback work was imple-mented by the medical management department,which format a set of independent budget of the physician perfor-mance assessment system.It introduced incentive measures to encourage attending to treat difficult and critical cases,provided high quality medical services,and eventually enhance hospital management effectiveness to attending.

The cross regional loose medical alliance is an important carrier in the current integrated development process of medical services in the Yangtze River Delta region. Smith policy implementation process model was used to analyze the development difficulties of cross regional loose medical alliances from idealized policies, policy implementation institutions, policy target groups, and policy implementation environment. Such medical alliances were formed under the background of integrated development in the Yangtze River Delta, with Shanghai′s tertiary public hospitals as leading units and medical institutions in Jiangsu, Zhejiang, and Anhui provinces as member units. Analysis showed that the policies for such medical alliances development had not yet clearly defined the organizational management mode, operational mechanism, and implementation path, and the corporate governance structure of medical alliance was immature; The policy implementation agencies were relatively lagging behind in the support of special funds and the formulation of related supporting policies; Participation of policy target groups was insufficient and their incentive mechanisms was imperfect; There were problems in the policy implementation environment, namely inconsistent medical and health service regulations and systems in different regions, different health financing capabilities of local governments, insufficient coordination of medical institution management concepts, and a lack of unified standards in information systems. Based on the above difficulties, this study proposed to strengthen the development planning and layout of cross regional loose medical alliances, and improve the corporate governance structure; To strengthen the government′s main responsibility and improving policy implementation capabilities; To improve the internal cooperation and operation mechanism of cross regional loose medical alliances, and enhance the sense of identity of the target group; To optimize the policy implementation environment and implement various support measures, so as to provide references for further promoting the coordinated development of high-quality medical resources in the Yangtze River Delta region.

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.