Study On Public Hospitals’s Social Responsibility Based On The Interests Chain

Medical care and health cause is an important link of “people’s livelihood” orsocial security field, the development level of which is remarked by thefairness and accessibility of medical service. Public hospitals invested by thegovernments are the main medical service providers in most of the world’scountries including China. The word “public” in “public hospitals”determines its public benefit characteristic but it is not the entire reason forits existence. Through the studies on the nature of public hospitals and theexploration of the value creation law of hospitals, benefit protection andinfluencing factors should be made to establish a complete set of theoreticalsystem for public hospitals’ social responsibility based on interests-chainhypothesis. In this way, stakeholders of public hospitals will be motivated toinvest more resources, create more value and make the country and the publicbenefit. Meanwhile, it can explain current obstacles facing China’s publichospitals in the operation process, and solve social problems caused byshortcomings of medial system. In the end, it is helpful to the improvementof the country’s medical care and health cause.Public hospitals, as part of society, need to fulfill their obligations forsociety and shoulder corresponding social responsibilities for its stakeholderssuch as government investor, patients, medical staff and communities.Nevertheless, domestic study on public hospitals’ social responsibility is still at its budding stage with different opinions on its intension and extension,which still lacks of systemic and empirical studies.This paper starts from those fundamental questions, while puts an focuson the following issues:First, why do public hospitals need to shoulder social responsibility?Second, who is the objective of public hospitals’ social responsibility?Third, how do public hospitals realize their social responsibility?Forth, how to evaluate the social responsibility?Main research contents of the chapters are as follows:This paper starting with the above-mentioned four questions, based onthe adequate study of previous researches in this area, takes advantages ofeconomic theory and models as well as the empirical research in managementstudies, also borrowed the successful experiences of Singapore publichospitals reform, which builds up a complete set of theoretical system onpublic hospitals’ social responsibility.Main conclusions and innovative opinions obtained by this paper:1. Establish a theoretical system of public hospitals’ social responsibilitybased on interests-chain.With rigorous progressive logic, this paper has completely andcomprehensively established and proved the innovative “theoretical systemof public hospitals’ social responsibility based on interests-chain. The mainidea of the theoretical system is: public hospitals integrate and provide resources of stakeholders to create interest and value for society; improvedgovernance structure can reasonably distribute these interests for stakeholderswhile performance of social responsibility means protection of the interestwhich stakeholders deserve. This serves as a motivation for stakeholders tocreate greater interest so as to promote maximization of hospitals’ valuecreation, rationalization and maximization of stakeholders’ interestdistribution and further realize social responsibility.2. Determine public hospitals’ stakeholders with scientific methodsThis paper maintains that public hospitals’ stakeholders refer to objectsor beneficiaries of public hospitals’ social responsibility and are key roles inthe hospitals’ governance structure. Hospitals shoulder social responsibility,which means the realization of stakeholders’ interest claims and protection ofstakeholders’ interest protection. This paper starts with resource dependenceand resource structure theories, analyzes the particularity of public hospitals’stakeholders, clarifies for the first time the core position of seniormanagement teams and doctors of hospitals who possess knowledge andwisdom resources, and goes beyond the traditional view of the government orinvestors’ dominant roles in hospitals. Besides, it divides the government’sall functional departments into two stakeholders of “investors” and“regulatory departments of the industry” for the first time and pave atheoretical way for hospitals’ management offices. Based on questionnairesurvey and expert consultation, it determines public hospitals’ four corestakeholders, five expected stakeholders and two potential stakeholders withMitchell attribute analysis method. 3. Design a complete mechanism for profit distribution in publichospitals or namely the stakeholders’ co-governance mechanism.This paper uses the game theory method to establish a mathematicalmodel of core stakeholders’ interest game, and infers that public hospitals’internal core stakeholders can only guarantee their interests by cooperativegame. At the same time, this paper infers the importance of the informationtransparence of the hospital through the game model between hospitals andpatients. Based on this inference, the paper discusses and designs a jointgovernance theory and model on the part of public hospitals’ stakeholders.Meanwhile, it studies the best choice for public hospitals’ governance frominternal and external aspects. Internal aspects include public hospitals’investor system, public hospitals’ property right reform, and presidentresponsible system structure led by the board of directors with participationof the public as well as way of doctor representatives’ participation. Externalaspects focus on government regulation and compensation behavior,regulated market behavior and oriented patient behavior of seeing doctors.This paper studies the government’s reasonable regulation of public hospitalsand the reform direction of public hospitals based on four real-life casesdrawn from the author’s personal questionnaire surveys and visits.4. Provide a new definition of the concept of public hospitals’ socialresponsibility and design a scientific evaluation index systemThis paper, based on full studies on previous scholars’ opinions, worksout the definition and connotations of public hospitals’ responsibility whichcomply with the paper’s logic, that is, through transparent, legal and moralpractice, public hospital shoulders the responsibility for the influence brought to its shareholders by its decision and practice. It mainly includes fouraspects, namely, profitability, law, morality, and benevolent responsibility.Meanwhile, it makes an explicit elaboration of four responsibilitiescorresponding to each stakeholder for the first time. This paper also adoptsscientific and appropriate methods such as expert consultation, practicalmeasurement with survey samples and standard reliability and validityanalysis of multivariate statistics to work out a complete, operable andinstructive public hospitals’ social responsibility evaluation index systembased on stakeholders. This is what the previous scholars haven’t touchedupon.5. Conduct a large-sample survey on public hospitals’ socialresponsibility status in China and analyze influencing factorsThis paper conducts a large-sample survey on public hospitals’ socialresponsibility status in China with the author’s self-designed public hospitals’social responsibility evaluation index system, and verifies the correctness ofthe theoretical system through empirical study. Besides, it goes deep into thediscussion of problems existing in public hospitals’ performance of socialresponsibility and causes as well, and provides circumstantial evidence forhospitals’ internal causes for Chinese public’s problem of “difficult access toquality medical services and expensive medical bills”. However, there’smuch left to be desired in such aspects as the delicacy management whichimproves hospitals’ operation efficiency, reform in separated governance ofownership and power of operation, protection of doctors’ rights and interestsand transparency of hospitals’ information. Corresponding stakeholders aredissatisfied with these problems so the transfer of the dissatisfaction exacerbates the problem of “difficult access to quality medical services andexpensive medical bills” for the public.This paper proposes the following countermeasures and suggestions onChina’s health system reform, based on the theoretical exploration andempirical researches,(1) Accelerate the establishment of hospitals’ investors organizationwhich represents the government, and standardize the government’s andhospitals’ investors system. The organization should be at the same level withlocal health department (bureau) and a statutory organization of the samenature with corporate interest’s legal representative. It exercises the power ofinvestors, is entitled to interest it deserves and meanwhile shoulderscorresponding responsibility.(2) Speed up the formulation of “Law of Public Medical Organizations”,clarify the legal rights, position and responsibility of public hospitals,improve the governance structure and let the hospital management teamspossess full operation right with reasonable supervision. Besides,stakeholders should participate in the governance so that their rights andinterests which they deserve can be protected.(3) Restructure current organizations of public hospitals, highlight theposition and interest of doctors in the hospital; ensure doctors can participatein the decision-making process of the hospitals’ key events throughmechanism design such as medical committee; meanwhile dramaticallyincrease the salary and welfare treatment of public hospitals’ doctors throughthe reform of hospitals’ charging structure. (4) Incorporate social responsibility into core work and strategy ofpublic hospitals with evaluation by a third-party evaluation organization;include social responsibility index in the public hospitals’ performance,evaluation, assessment or target management system so as to strengthenhospitals’ and medical care and health practitioners’ sense of socialresponsibility and encourage hospitals to release social responsibility reporton a regular basis.(5) Strengthen civic education and improve the doctor-patientrelationship. Health authorities need to make publicity with various kinds ofmedia, and let people set up right health care awareness and enrich medicalknowledge, maintain right behaviors of seeing doctors, show respect formedical personnel and be responsible for their own health.(6) Take measures to enhance the information transparency of publichospitals; advocate the set-up of public relations department in large hospitals,and implement the policy of making government affairs public so as toenable the public learn about the hospitals’ development, operation status andgenuine medical level through various ways, and obtain supports fromstakeholders.