A Study On Achievement Administration Of Large Scale General Hospital

ObjectiveThe study on public hospital performance is to discuss management of hospital performance by analyzing factors that influence hospital performance, and the responsiveness from the perspectives of patients in clinic visit and hospitalized and health staff. The study also analysis what factors affect those medical staffs' satisfaction with their work and income. Finally, a policy suggestion on further improving hospital management efficiency is put forward to enhance professionals working enthusiasm and the total achievements of a hospital so as to increase the corefore for hospital competition.Methods1. The study uses field investigation and panel discussion to evaluate hospitalperformance. A specific survey on four tertiary hospitals affiliated themselves to three medical universities and Shanghai municipality was conducted. Data were collected in each hospital from 1999 to 2002 about service quality and effectiveness, financial condition and study/creative ability. Through analysis on ten comprehensive hospitals, twenty district center hospitals and fourteen community hospitals of Shanghai municipality, a "Star System" was brought forward in hospital performance evaluation.2. A pilot study on the responsiveness of outpatients and inpatients in tertiary hospitals, special tertiary hospitals, secondary hospitals, community hospitals and rural township health centers was held. Questionnaires include basic information for informants and perspective of responsiveness' aspects. Using eight elements of responsiveness provided by WHO, we designed respective questionnaire for inpatient, outpatient and health workers based on the study results.3. A specific survey was conducted in four tertiary hospitals affiliated themselves to three medical universities and Shanghai municipality, four secondary hospitals and four community hospitals in district or county in Shanghai. 872 outpatients, 637 inpatients and 1134 health workers were randomly selected to face-to-face inquiry. Likert scale (always, often, sometime, never) is used, and evaluated on total lever of eight elements (very good, good, moderate, bad, very bad) in analysis.4. By means of quantitative and qualitative studies, surveys and interviews were conducted for the medical staffs, patients and community residents. Eight hundred and nine medical staffs, 365 patients and 300 community residents participated in the survey. Keeping the fundamental information of subjectss in mind, the questionnaires were given to the medical staffs in four aspects: hospital culture and features, values, working conditions and economic incentive situation and incentive method. As for the medical service clients and community residents, three aspects were considered. They are reasons of choosing the hospital, familiarity with medical staffs and views on the incentive mechanism.Results1. The results from service quality and effectiveness, financial condition and study/creative ability showed that sample hospitals have higher efficiency, however they should pay more attention on the financial operation. Through two rounds of expert consultation, the author selected 31 indicators to evaluate hospital performance based on weighted. The results showed that evaluation method had the characteristics of stability, reliability and availability.2. The pilot study showed that most patients could get prompt attention. They thought that they had treatment autonomy, the proportion of free choice on doctors or nurses was increased. Most of patients would talk their confidential medical history to doctors freely, and they could get rational explanation from doctors. The health reform in Shanghai has paid attention on patient's responsiveness, and got better efficiency.3. The results of responsiveness study showed that most important parts of responsiveness were dignity, autonomy and confidential. Sex, age, education and professional title were potential factors effect on perspective of responsiveness. Most doctors and nurses regarding responsiveness were very good or good. Total score of doctors and nurses was 8.247, more higher than that of outpatient and inpatient 8.095 and 7.858 respectively. But the assessment score of autonomy and choice of doctors were lower. We should increase to provide patient-orientation information.4. The percentage of the medical staffs that were satisfied and greatly satisfied with present work was merely 41.7% (great satisfaction accounted for 3.1%).The key factors affecting the satisfaction were the hospital management, the professional skills and career develop opportunities, gender and age of medical staffs and the level of financial income. Medical staffs realized the most important three incentive factors were, namely, economic income, training and skill-enhancing opportunities and the promotion chances. Only did 22.13% medical staffs show satisfaction and great satisfaction with the present income. The determined factors were age, working lifetime and remuneration system. Most medical staffs expect their income at least above 6,000 Yuan per month, however, the actual and expected incomes were differently according to their gender, age, title and degree. The actual and expected incomes of surgeon were higher than those of physicians. The factors of organization,culture, management and working environment were attributed to the incentives of medical staffs in their working.Through the surveys and interviews with the service clients and the community residents, it was learned that besides certain requirements for the medical service quality and attitude, there were also other reasons for choosing the hospitals, such as dignity and environment. About 27% of the medical service clients and 38% of the community residents have had the experiences of giving the doctors under-the-table fees. It was suggested that hospitals need to further improve their remuneration mechanism, increase doctor's income, legalize the grey income and firmly get rid of the under-the-table charges.Policy suggestionsThe suggestions include calculating readmission rates to evaluate hospital performance index and further improvement. Star system could be adopted in hospital performance evaluation. Using the responsiveness contends of the patient satisfaction to increase the coreforce for hospital competition.