Study On Strategy Of Public Health Functions Implementation Of Comprehensive State-run Hospitals Based On The Theory Of The Collaborative Management

ObjectiveBy investigating the current situation of the public health in thecomprehensive public hospitals of our country as well as the establishment of thepublic health departments, clarifying the function, rights and liabilities of the publichealth in public hospitals, probing the key problems and effects for the functions ofpublic health performed by the public hospitals, establishing the assessment on theoperating condition of the public health in public hospitals based on ’second-levelcomprehensive evaluation of public health in comprehensive public hospital’ model,in this research, effective suggestions for the purpose of promoting public healthand strengthening public health function are proposed, and the collaborativemanagement modes for the continuous service of comprehensive public hospitals areconstructed.Content and Methods(1) Literature review and information analysis: referring to the relevant domesticand foreign document on public health system liabilities and operating condition,investigating the existing problems for the performance of public health function inChina, analyzing the similarities and difference between the public health function and public care function, and studying the advantage and disadvantages of the publichealth functions performed by different entities.(2) Studying practical examples: We surveyed53hospitals in Hubei andGuangdong Province (26second-class hospitals,26first-class hospitals, a privatehospital),including1115medical personnel. Using the methods of collecting availabledata and statistical statement and questionnaire, we surveyed the developmentsituation of public health department and human resource situation of public healthmanagement departments in comprehensive public hospitals located among thesampling districts, understanding the operating modes and liabilities of the publichealth, investigating medical staff’s opinions, suggestions, and the awareness of onpublic health. Using the methods of semi-structured in-deep interview, we got theinformation of the benefits form public health work, the obstacles and the suggestionfor improvement. Using the methods of typical cases collecting, we explored the keyproblems influencing public health work and the viable model for China,(3) Quantitative analysis: Through statistics methods of description analysis, weanalyzed the awareness degree of the human resource in public health departments aswell as medical staff on the function and liabilities of public health. Through statisticsmethods of cluster analysis, based on the evaluation score of hospital management、infectious-disease control、Chronic no communicable disease management、materialand child hygiene、public health education and emergency rescue, we analyzed thehospitals and assessed the operation situation of their public health department,summarized the existing key problems faced during they performing their publichealth functions. Through Pearson Chi-Square test and Binary Logistic regression, weexplored and analyzed the key problems and influencing factors of public health work,which are the practical foundations for the relevant strategies research.(4) Qualitative analysis: applying stakeholder analysis, straightening out theinterest related degree, influence power, standpoint, and effect degree from politics among stakeholders involved by public health. Through balancing the benefits of allparties, the politics feasibility and sustainability are promoted. Applying the SWOTanalysis, through the data from investigation, the advantages, disadvantages,opportunities, and threat of the public health operating modes are analyzed.Findings and ConclusionsFindings:(1)The study found that there are institutional rift between public health andclinical in public hospital, and lack of effective two-way communication andcollaboration mechanism.(2) In the case where the liabilities of public health staff overlap, one person issupposed to be in charge of multi-liabilities, i.e. public health specialists areinsufficient. After the establishment of public health administrative offices, the onesthose related to the original public health are supposed to be integrated.(3) The public health departments are averaged assigned3.35people, withfemale accounting for a higher percentage; for age structure, the employee in publichealth department is older, with an average of43.1, there is the phenomenon of aging;for the type of occupation, physician occupies a smaller percentage, while nurse andclinician account for the majority, resulting in the deficient occupation diversity; foreducation level, junior college and undergraduate are the majority, highly educatedspecialists are less(7.1%); the training receiving can’t meet the demand of work.(4) Through questionnaire survey and statistical analysis,98%of medical staffagree with hospital undertaking public health responsibilities, and it is generallyrecognized that there should be a separate department undertaking the liabilities;90.8%of medical staff are aware of the existence and function of the public healthdepartment.(5)Compare the difference of public health work effect of hospitals in twoprovinces, through Chi-Square Test analysis, despite the difference in public health service operating modes of hospitals in Hubei and Guangzhou provinces, there exist aslight discrepancy of medical staff awareness of public health mechanism, on aspectsof infectious-disease control(χ~2=1.6，P>0.05), sterilization and hospital infectioncontrol(χ~2=2.5，P>0.05), health emergency disposal(χ~2=3.5，P>0.05).The publichealth department in Hubei province mainly concentrates on the clinical medical staffwho own a much better awareness of public health liability than those in Guangdongprovince(χ~2=81.2，P<0.01).(6)The criteria of assessment to public health operation was established and theitemized and general evaluation on sampling hospitals was launched. Through clusteranalysis, the evaluated hospitals are grouped to four main headings(the first group arehospitals with poor scores in all aspect, the second group are hospitals poor ininfectious-disease control and health emergency disposal, the third group are hospitalswith better scores in all aspect, the fourth group are hospitals better in organizationmanagement and infectious-disease control but others score medium). Throughanalysis of variance test, it is found in this research that there exist a strikingdiscrepancy among the management of organization(F=78.374， P<0.01), theinfectious disease prevent and control(F=28.94，P<0.01), launching health education(F=7.765， P<0.01), and handling health emergency(F=5.643, P<0.01) and thatmedical healthcare organization expands the work on chronic non-infectious disease（F=2.079， P>0.05） and gradually standardizes the material and childhygiene(F=2.231，P>0.05). The binary logistic stepwise regression analysis wasapplied. After four-step regression analysis, it is found out that the influencing factoron the medical staff awareness of the public health knowledge was merely associatedwith the perception of public health management function(OR=10.23, P<0.01) insteadof medical staff education level, public health training and working life.(7)This research indicates that, medical institutions are supposed to be mainlyresponsible for the following public health responsibilities: Providing basic medical services, Health emergency, prevention and treatment of infectious diseases, maternaland child health, chronic non-communicable diseases, health education andpromotion.(8)The four network management mechanism of hospital Public Health Includingexecutive management, the Hospital Management Committee of Public Health,Division of Public Health and public health administrator.Conclusions:Through on-site qualitative and quantitative investigation, the followingproblems are found out if public health work can be carried out synergistically bydisease prevention and control institutions and medical institution:(1) the executivelevel fails to pay adequate attention to public health;(2) public health lacks in fundingsupport from government;(3) the coordination mechanism between the clinicaldepartments and public health departments is not explicit;(4) public health lacks instimulus mechanism;(5) health education requires further improvement;(6) a lack ofpublic health specialists;(7) irrational public health personnel structure;(8) privatehospital is deficient in undertaking the public health responsibility.Hospitals must structure coordination mechanism for public health work withother institutions:(1) structure collaborative elements, including collaborativeorganization, collaboration frequency, the contents of collaboration, and collaborativemechanism;(2) structure the collaborative system of hospital public health four levelsnetwork, including the levels of administration, public health management council,public health department and public health administrators in clinical departments.Through the collaborative system of this four levels network, public health andclinical care can be organic bonded and develop synergistically. Suggestions(1) clarify the reimbursement mechanism of public health and clinical carecollaborative work system;(2) treat public health and clinic healthcare alike and raisethe social awareness on public health;(3) constructing the talent exchange mechanismbetween public health and clinical care, improving the professional quality of publichealth staff;(4) emphasize the tertiary disease prevention idea and strengthen thehealth education;(5) establish the performance appraisal and supervise mechanism forcollaborative work of public health and clinical care;(6) improve mechanismestablishment and public health should be included within the scope of medicalmanagement;(7) establish public health four-level network management mechanism,strengthen the structure coordination mechanism of public health and clinical care;(8)improve the public health quality for each district.InnovationFrom the unique viewing angle of synergetic development of public health servicesand clinical services in hospitals, by investigating the current situation of the publichealth in the comprehensive public hospitals of our country as well as theestablishment of the public health departments, clarifying the function, rights andliabilities of the public health in public hospitals, probing the key problems andeffects for the functions of public health performed by the public hospitals,establishing the assessment on the operating condition of the public health in publichospitals through five aspects of organization management, infectious-disease control,chronic non-infectious disease management, health education and promotion, andhealth emergency rescue, constructing the synergetic management modes of publichealth for the continuous service of comprehensive public hospitals.This study and paper based on the project “Assessment on the operational status of public health department in hospitals in Wuhan” undertaken by Professor FangPengqian.