| BackgroundSince the founding of the people’s Republic of China,China has gradually established a county,township and village level prevention and health care network.At the end of the 1980s,with the medical and health institutions gradually closing to the market,township hospitals were in a difficult situation.In order to meet the health needs of rural residents,a number of policies were issued to support the development of township health centers.In 2018,Shandong Province selected "business deans" for poverty alleviation key towns and weak township health centers,aiming to improve the low management level and weak service ability of township health centers,and provide diversified and high-level health services for the common people.As one of the ten new measures of "promoting health care reform and serving people’s health" in 2020,the policy effect of "business president" selection and appointment system in Shandong Province is in urgent need of evaluation.Analyzing the operation mechanism and influencing factors of the selection and appointment system is more conducive to promoting the improvement and perfection of the work system.ObjectiveThrough the current situation investigation of the work performance of the"Business Dean" during his tenure,the promotion effect of the selection work on township health centers was evaluated.In addition,this paper explored the operating mechanism of the selection work,analyze the problems and obstacles in the implementation of the policy for the selection of "Business Deans".This not only provided relevant policy suggestions for the selection work,but also provided reference for comprehensively improving the management ability and service level of township health centers.MethodIn this study,through literature review,combing the relevant policy documents of the selection work,combined with the needs of policy assessment,the questionnaire and structured interview questionnaire were developed.The first batch of "Business Dean" were surveyed online in the form of electronic questionnaires.A total of 51 structural electronic questionnaires and 43 valid questionnaires were distributed;59 "business deans" electronic questionnaires and 59 valid questionnaires;858 staff electronic questionnaires were distributed.By means of structured interview,face-to-face interviews were conducted among 10 "Business Dean",10 directors of township health centers,20 staff members of township health centers and 20 patients.The statistical analysis was completed by SPSS 25.0.Descriptive statistics were used to analyze the basic situation of township health centers,the basic situation of the selected personnel,and the key tasks of the selected work.Based on the structure process result theory and path analysis,this paper constructs the function path and operation mechanism of "Business Dean" selection.Through in-depth interviews and policy analysis,this paper analyzes the highlights and existing problems of "Business Dean" selection,and provides empirical data for the research.ResultThe results of this study are mainly divided into four parts:the basic situation,work development,effect analysis and path analysis of the pilot township health centers.1.In Shandong Province,the pilot township health centers are located at the bottom of per capita GDP,and the rural population of Heze and Linyi is relatively large.The average number of emergency patients in the township hospitals in the pilot area was 43900,and bed turnover rate was 54.13%,while the average level of township hospitals in Shandong was(44800,61.43%).As of July 2020,about 94.7%of township hospitals have standardized the clinical diagnosis and treatment system,followed by the management of medical staff(18%),and the contracted service of family doctors(16%).In addition,a total of 83 characteristic specialties were established in 43 township health centers,of which TCM Department accounted for 18%,followed by rehabilitation department,accounting for 16%.560 business backbones were trained,84 two-way referral channels were established,and the number of referral was more than 7000.2.The results showed that the total income,outpatient income,the number of outpatients and emergency patients,and residents’satisfaction of township health centers were improved(Statistics were:0.104,0.361,0.095,0.873;P<0.05).3.Path analysis showed that the number of registered medical staff had a positive impact on the training of professional backbone in the key tasks of selection,and the direct impact values of nurses and clinicians were 0.32 and 0.33 respectively(P<0.05).The level of institutions has an indirect effect on the cultivation of business backbones,and its indirect effect value is 0.30.The population density,working years,professional title and management experience of "Business Dean,in township health centers had a positive impact on the number of characteristic specialties,and the effect values were 0.18,0.16,0.24 and 0.18 respectively(P<0.05).The path coefficients were 0.32 and 0.75(P<0.05).There was a negative correlation between the establishment of two-way referral channel and the number of inpatients in township hospitals,and the direct effect value was-0.14.The effect of establishing management system on Residents’ satisfaction was positive correlation,and the direct effect value was 0.47(P<0.05).4.The results of stakeholder analysis show that in the matrix analysis of the degree of interest relevance and policy influence,the administrative departments of health,township hospitals and business presidents have strong interest relevance and policy influence,while the selected units have weak interest relevance but strong policy influence.In the matrix analysis of the degree of interest correlation and implementation intention,the health administrative departments,township hospitals and residents have strong implementation intention,while the business presidents and the selected units have weak implementation intention.Conclusion and SuggestionConclusion:The selection and dispatch of "Business Dean" has clear objectives,accurate positioning and support at both ends,outstanding work focus,establishment of system and optimization of management,improvement of the medical environment of health centers,and enhancement of residents’ satisfaction.The establishment of characteristic specialty and the cultivation of professional backbone play an important role in improving the service ability and economic level of health centers.In summary,it is a feasible,reasonable and effective poverty alleviation policy to the selection and dispatch of "Business Dean".However,during the selection period,the incentive guarantee measures and assessment mechanism are not perfect.Suggestion:Considering the current situation of the selection and assignment work and the current national policies,it is suggested to improve the selection and dispatch work of "business presidents" from the following four aspects:improving the incentive mechanism and stimulating the enthusiasm of the policy implementation subject.It is suggested to provide support from supervision,management,and policy to further optimize the selection work. |
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