Practical Study On County-leve Public Hospital Reform By A Model Of Discipline Co-construction

BackgroundTo implement Hierarchical Medical Model has become a consensus in the process of the current health reform. In 2015, the state issued Guidance on promoting the construction of Hierarchical Medical Model.which emphasizes on improving the ability of primary health care services and claims to establish a hierarchical medical system in line with national conditions gradually with the purpose of gradually improving the hierarchical medical policy system, basically forming the mechanism of cooperation within medical and health institutions, orderly and effectively sinking high-quality medical resources as well as standardizing medical order by 2017. In addition, The Guidance aimed at fully enhancing the hierarchical medical ability, gradually improving the security mechanism, and forming the hierarchical medical model which contain primary diagnosis, dual referral, acute and chronic treatment and upper and lower linkage,which conform to the national conditions by 2020. Under the premise of voluntary participation of the masses, in addition to price adjustment and Medicare payment policy guidance, truly sinking the quality medical resources and improving the ability of grass-roots hospitals to solve common diseases are the keys to the implementation of hierarchical treatment model.The Guidance requires that the treatment rate of country public hospitals increased to 90% and basically achieved the goal of taking serious disease within County. In current status,the effect of the construction of primary medical institutions and the contingent of general medical personnel which is not obvious in short-term, county public hospital which is the leader and net top of county medical service system is the key to fulfill the goal. Additionally, fully enhancing the comprehensive ability requires county public hospitals to determine hospital scale reasonably based on the factors such as service population, disease spectrum, medical service demand and so on, to strengthen the clinical specialty construction, effectively enhance the ability to solve practical problems in clinical specialties so as to reduce the loss of patients.Medical University contains the function of teaching, scientific research, scientific and technological development, medical service which plays an irreplaceable role in the national economy, especially in the regional economic development system engineering. In recent years, medical university of our country is also undertaking the function of social service, but failed to meet the expectations of the society.University and its affiliated hospital function as a combination of personnel training, scientific research, social services and cultural heritage should fully use its advantages to better sever the local economic and social development.Specifically, under the background of vigorous promotion of hierarchical medical model and county public hospital reform, how to integrate advantages of university affiliated hospital and extend high-quality medical resources to the grassroots are the problems that faced by the medical university administrators.ObjectiveThis research is based on the case study of discipline co-construction between the affiliated hospital and the newly hand-over county-level public hospital (namely Conghua Center Hospital) of Southern Medical University. The purpose of this article is to analyze the progress and effect of the model of discipline co-construction, point out the problem and insufficient, find out the key chains and factors that influence the promotion of discipline co-construction and extension of resources as well as put forward countermeasure and suggestions for the improvement and perfection.Methods1. Literature analysisAdopting the non structural and non quantitative literature,systematically retrieval and collect all kinds of paper such as books, journal articles, dissertations and statistical reports about the management system and integration model of University Affiliated Hospital both at home and abroad,the typical practice of the University and its affiliated hospital to the county hospital to summarizes the main ideas in the literature, providing theoretical basis for this study.2. Statistical analysisCollecting the critical data of the volume of medical services,medical service ability,discipline,personnel structure,changes of medical expenses,pathogenic loss situation of the county-level public hospital(Conghua Central Hospital) in recent years.The descriptive statistical analysis was conducted to compare the changes of related indexes before and after the hospital reformation so as to describe the progress and effect of the implementation of discipline co-construction mode.3. Semi-structured interviewsSelect a total of 29 related personnel to carry out semi-structured interviews, which includes closely related university leaders, leaders of university departments, hospital leadership of discipline co-construction,academic leaders, discipline co-construction experts, leadership of the recipient hospital, heads of department and medical staffs to deeply understand their attitude, progress and effect, problems and counter measures towards discipline co-construction.Appendix of the interview outline.4. Theoretical analysisOn the basis of previous field investigation and semi-structural interview, this paper adopts stakeholder analysis to analyze the stakeholders of discipline co-construction, clarify the main constraints of the discipline co-construction model further,and then use SWOT analysis method to Analyze the strengths, weaknesses, internal strengths and external opportunities and challenges of discipline co-construction mode,so as to lay the foundation for the final countermeasures.Results1.After handed over to the university and the comprehensive reform of discipline co-construction, Conghua central hospital has improved significantly. Management level has gradually improved; the setting of clinical departments and medical equipment has become more complete; the personnel structure has constantly optimized; the ability of medical service and science and education system have steadily improved; medical cost has better controlled; hospital income and expenditure structure has become more reasonable; pathogenic loss has significantly reduced; cooperation between region medical institutions has become more closely;medical equipment has become more complete; the advantages of university resources sinking grassroots effect is obvious, the overall strength of the hospital rapidly, taking serious diseases within the county effect previews.2.The Department of internal medicine, general surgery, cardiovascular medicine, obstetrics and gynecology department and other key construction departments of Conghua Central Hospital develop rapidly,Significant changes in performance and gradually become the hospital’s advantage specialist, which leads to a substantial reduction of the patient resource loss.3.The number of patients in Conghua Central Hospital transferred to the central city hospital reduced significantly. Support hospitals affiliated to the university got the priority referral right of difficult and critical patients in Conghua District,thus the Conghua source number of receiving area is not affected and the cause structural of the support hospital did not affected significantly.4.Respondents approved the discipline co-construction model.considered that the model promotes the rapid sinking of the University and its large affiliated hospital quality resources, the rapid increase of the county hospital service capacity; promote the collaborative development between the Affiliated Hospital, to activate the vitality of school talent team, give full play to the potential of talents; promote the cooperation of the hospital and the hospital at or above the county level, helps to reduce the risks of patient blind transfer and costs of diagnosis, conducive to the formation of the hierarchical medical system.Respondents have also presented the problems according to the situation, such as the lack of clear development plans and coherence in the implementation of the discipline co-construction and so on.5.There were still many uncertainties after analysis the stakeholders of the discipline co-construction model of:(1) medical university was not clear about the independent legal status of the affiliated hospital management system;the overall planning of the discipline co-construction was not complete to the university and lack of effective measures to protect the interests of the support hospitals; (2) understanding and attitude towards the discipline co-construction of main leaders and academic leaders in support hospital were not unified; (3) the personal management capabilities and business capabilities, academic status and personal charm of the academic leaders and experts of the discipline co-construction had a great impact on the effectiveness of the department building; (4) the attitude of discipline co-construction and integration ability of resources of the recipient hospital,the speed of development of the department and the relationship with the support hospital were not entirely consistent; (5) government needs to further improve the relevant supporting support of the specific measures about sinking high-quality medical resources,the county-level public hospital reform,hierarchical medical model and so on.Conclusions1.Discipline construction model is conducive to:(1) Promote a comprehensive university and its large affiliated hospital resources extends to the county hospital enhance the capacity of county public hospital comprehensive service; (2) Conducive to the promotion of University Hospital between the groups of the collaborative development, enhance the affiliated hospital to upgrade the overall strength; (3) Build the hospital and the county hospital between division and cooperation mechanism, and promote reconstruction of the classification system of diagnosis and treatment.2. The medical university how to dominate,the interest distribution mechanism between the support hospitals and the recipient hospital,collaborative development mechanism of the discipline co-construction model and government’s support and protection of the relevant policies towards to the construction of public hospitals at the county level and Hierarchical medial system are the factors restricting the construction of disciplines co-construction model.Subject to build a model still needs to be further explored.3.Suggestions:(1) Government should give full play to the role of the university in health care reform,especially the role of social services and personnel training and actively promote the completely hand-over of the conditional hospital to the university; (2) Universities should focus on building a long-term mechanism of discipline co-construction mode; (3) To actively explore the construction of the discipline construction model to promote the hierarchical medical system.