Because of a measure introduced by the hospital, Li Jiajing, a doctor at a public tertiary hospital in Hunan Province, is worried about the future.
According to the regulations of the hospital, zero tolerance is implemented for complaints, and where there is a complaint, each time the party and the middle-level cadres of the department to which they belong are fined 200 yuan, and if the relevant departments investigate and verify that it is a valid complaint, each time the party and the middle-level cadres of the department are punished 500 yuan each.
"Now many hospitals stipulate that if there is a complaint, there will be no fines first, and our hospitals are: if the implementation is a valid complaint, then increase the punishment." Li Jiajing complained to us, which made people very helpless, very chilling,
Courtesy of Li Jiajing
Before discussing whether this provision is reasonable, we find that more and more hospitals are beginning to pay attention to the reception and handling of medical complaints, and link it with the relevant assessment of medical staff.
This may send a signal that it is time for doctors to change their attitude towards service.
High-pressure policies with repressive employees
"Whenever there is a complaint, the administrative department takes it for granted that the medical staff is at fault, and it is ruthless to deal with, and even unreasonable in many cases." Li Jiajing felt very aggrieved.
Li Jiajing found it difficult to accept that as long as a complaint was received, the medical department would leave a "case file" for the doctor concerned, and deduct money and points in performance appraisal, professional title promotion, evaluation and evaluation.
Under high pressure, Li Jiajing began to become cautious: "For example, some patients insist on their unreasonable requirements, and doctors may not dare to insist on their correct opinions from a medical point of view." Because I'm afraid he'll complain to you."
The court's complaints were announced from October 18 to November 29
Gao Chao, a lawyer at Beijing Huawei Law Firm, pointed out that the provision of "deducting money as soon as a complaint" is the hospital's internal system, and the deduction is a bonus, which "is usually not illegal, mainly related to the internal administrative level of the hospital".
Wu Xiaomai, vice president of Enze Hospital of Taizhou Enze Medical Center (Group), believes that this "simple and rough" management method is not scientific and counterproductive to the original intention of attaching importance to medical complaints.
"The purpose of handling medical complaints is not to impose fines, in fact, this way of handling is not conducive to hospitals finding real problems and solving problems." Wu Xiaomai thinks.
Duan Tao, former president of Shanghai First Maternal and Child Health Hospital and founder of Springfield Medical Management, also disagreed with the method of fines: "It will only bring depression to employees."
How can repressed employees provide better care to patients?
How complaints relate to doctors
In 2019, the National Health Commission promulgated the Measures for the Administration of Complaints by Medical Institutions, which stipulates that medical institutions should standardize the management of complaints, regularly count complaints, and combine statistical results with year-end assessments, regular assessments of physicians, medical ethics evaluations, and evaluations.
Since then, more and more hospitals have issued relevant regulations. Wu Xiaomai said that Taizhou Enze Medical Center (Group) Enze Hospital implements a safety medical points and professional ethics points management system, with a total score of 12 points, which is related to annual assessment and professional title promotion.
If the doctor violates the "18 Core Medical Systems", points will be deducted, but for complaints related to service attitude, the hospital will feedback the patient's appeal to the doctor concerned, conduct verbal reminders, and follow up continuously.
In Wu Xiaomai's hospital, few doctors have been punished for complaints related to service attitudes, generally focusing on communication education, "let alone deducting money". If the doctor's complaints exceed multiple times in succession, it will enter the process of discussion and analysis, deduction of points, etc. In Enze Hospital, when receiving patient complaints, the first thing to investigate and collect evidence, if it is an objective fact, the incident will be reported to the safety and quality committee for discussion and analysis, and then make a handling opinion.
Correct handling of medical complaints is a powerful means to improve patient satisfaction and improve medical services. Whether it is the relentless "leave a complaint at the bottom of the case" or the gentle points system, more and more hospitals directly link medical complaints to doctor management.
However, in addition to policy incentives, what makes hospitals have to pay attention to the quality of medical services is another incentive, which may be the pressure of market competition.
"Now public hospitals are beginning to lack patients." Duan Tao said.
Big hospitals also need to "solicit customers"
The COVID-19 pandemic has pressed the "accelerator button" for the new construction and expansion of public hospitals.
In March 2021, during the two sessions of the National People's Congress, the National Health Commission mentioned in response to the "Proposal on Effectively Relaxing the Restrictions on the Number and Scale of Public Hospitals" put forward by the deputies to the National People's Congress that it is necessary to reasonably adjust the bed allocation standards of public hospitals, support some strong public hospitals to moderately build and develop multi-hospital areas on the basis of controlling the scale of individual bodies, and quickly convert functions in the event of a major epidemic.
Under the impact of the COVID-19 pandemic, the status of public hospitals has been further consolidated, coinciding with the opening year of the 14th Five-Year Plan, and public hospitals have begun a new round of construction.
According to the incomplete statistics of the Halls think tank, since 2020, nearly 102 tertiary public hospitals in nearly 20 regions across the country have started a wave of branch construction, with 128,000 new beds and an investment amount of up to 180 billion yuan.
At the same time, henan province, Tianjin city, Xi'an city, Jinan city and other places of the official successively announced the next few years in the province and city of large hospital construction plans, proposed to add the number of tertiary hospitals and the number of standing beds.
Contrary to the high-profile construction tide, public hospital operations are under greater pressure.
The epidemic has restricted the flow of patients, during this period, the outpatient volume, bed utilization rate and turnover rate, business income and other general declines in public hospitals, according to the data of more than 300 medical institutions in 26 provinces and cities surveyed by Guangzhou Elebi, 94.1% of hospitals experienced a year-on-year decline in cash flow during the epidemic, of which 76.6% of hospitals fell by more than 20%.
There are more and more hospitals and fewer patients, which makes public hospitals face the challenge of "customer acquisition". From any point of view, serving existing customers is the best way to obtain customers. Therefore, in the general environment, hospitals are paying more and more attention to the handling of medical complaints and the improvement of patient satisfaction.
These trends are a wake-up call for doctors: it's time to change their attitude towards service.
"Don't be high above you"
The era of "what doctors provide, patients must accept" is passing.
Our interviews and surveys found that most medical complaints are related to service attitudes. The publicity that Li Jiajing showed us showed us showed that 5 of the 8 cases were related to service attitudes or doctor-patient communication; in Enze Hospital, Taizhou Enze Medical Center (Group), in the first half of 2021, the service center received about 20 medical complaints, most of which were related to doctor-patient communication; so did Beijing Tsinghua Changgeng Hospital, which is affiliated with Tsinghua University, and Qin Tao, the doctor-patient relationship office of the hospital, told the health community that a large part of the medical complaints he handled were related to patient medical experience.
Data suggest that patient demand is challenging hospitals' attitudes to service.
In such an environment, Duan Tao believes that the doctor's "superiority" is no longer possible, respect is mutual, and doctors can no longer carry "Party A thinking" when providing medical services.
"The doctor's verbal expression is related to his own professional quality, and is linked to his professional ability and self-confidence." For example, Wu Xiaomai said that the larger the expert, the better the service attitude.
The healthcare industry's campaign to improve service quality has been many years behind other industries. Under the market competition, all walks of life hope to use better services to attract and retain consumers, and enterprises that are known for their services such as Haidilao are growing rapidly.
Li Jiajing does not believe that the services of places such as Haidilao can be equivalent to medical services. "The former is a place of consumption and service for the Eight Classics. Medical staff are faced with excessive clinical workload + complex assessment indicators + suffering from various unequal treatment + high standards of medical ethics requirements + patients in various pathological conditions." Li Jiajing said that in this state of work, medical staff will inevitably have "bad tone and bad mood", "but this is only a few cases".
So, how to resolve the dissatisfaction and grievances of doctors?
Behind the complaints, there are hidden problems in the medical profession
More important than the doctor's improvement of behavior is the improvement of medical management methods.
"The doctor sees 80 to 90 outpatient clinics in the morning, how do you ask him to meet all the needs of patients?" 」 Duan Tao summed up with years of management experience in the top three public hospitals that what is measured is assessed, and the behavior of medical staff is guided by various assessment indicators of the hospital, so hospital managers cannot "both ... And ...", to find a balance between "fast, good, cheap", to develop a reasonable assessment standard.
"There are no pointless complaints, and there are no invalid complaints." Wu Xiaomai hopes that hospitals will use the handling of medical complaints as an opportunity to improve problems in systems or processes.
Wu Xiaomai believes that behind all complaints about service attitudes, there must be hidden problems in the medical profession, "patients lack professional judgment, and can only complain from the attitude".
What the hospital has to do is to find the problems in the medical system or process behind it, and then improve and establish new systems and processes.
Gao Chao also believes that active investigation and careful handling of complaints, finding the best solution to the problem, improving medical efficiency and promoting medical fairness are the fundamental purposes of the government to promote "handling complaints as soon as they are received".
Duan Tao will stimulate the good qualities and potential of employees as the most important management work of hospital managers.
This requires managers to be patient, and it is impossible to rely on simple and crude means of fines.
Without satisfied employees, there are no satisfied patients, Duan Tao mentioned that the real problem for hospital managers to solve is to make employees agree with the core values of the hospital and hospital culture, "when every employee can take patients seriously from the heart, it is the best state of an organization."
*Note: Li Jiajing is a pseudonym in the text
Written by | The health community
Written by | Yang Ruijing
Edit | Swagpp