County-level hospitals are the backbone of China's health care system, providing medical services to more than 70% of the Chinese population.
Recently, Academician Gao Runlin of Fuwai Hospital and Wu Yangfeng of Peking University Clinical Research Institute published research saying that medical quality management and target management in County-level hospitals in China have not been taken seriously.
For hospitals participating in the CPACS-3 study, the researchers applied the Hospital Management (HMP) scale to quantify the level of medical management in hospitals.
Based on data collected by questionnaires and hospital management documents, the scale covers 17 indicators across 4 dimensions of hospital management practices (target management, operations management, performance management, and talent management).
Indicators of quality of care include inpatient mortality and nosocomial infection rate. Hospital efficiency indicators include length of patient stay, number of bed turnovers per year, and bed occupancy rate. Hospital financial metrics include total annual hospital revenue and cost per hospital stay. All indicators reflect the hospital's annual data.
The study found that hospital management scores were not significantly correlated with quality and efficiency of care, but were associated with total income. However, after adjusting for factors such as economic region and number of beds, the correlation with total income disappears.
The researchers note that the findings show that hospitals in China seek financial returns through the services they provide.
As for why hospital management scores have nothing to do with medical quality and service efficiency, the researchers stress that there are reasons for the relatively small sample size, but the management of these hospitals does not really pay attention to medical quality is certainly another important reason.
The study found that only 37 percent of hospitals incorporate quality of care into management goals, and about half do not have detailed plans to improve quality of care.
In terms of operations management, about two-thirds of hospitals do not have a "continuous quality improvement" program. In terms of performance management, only 9% of hospitals have given severe penalties, such as dismissal and deduction of bonuses for employees who are not satisfied with performance. When it comes to talent management, less than half of hospitals reward talent.
The study found that all indicators of low scores in hospitals include goal balance, goal setting and goal sharing, continuous quality improvement, penalization of employees who do not perform well, rewarding talent, and so on. These indicators are all related to the quality of care.
Figure High and low HMP score hospital index score radar chart
Obviously, these indicators have been ignored in the current hospital management, but they are problems that all hospitals in China's current medical reform need to solve.
Researchers believe that for China's current healthcare reform to be successful, it must solve the micro-level problems in hospital management practices.
The researchers conducted two hospital management surveys of 101 county-level hospitals from 2013 to 2015. Three managers (hospital director, infirmary director and cardiology director) and a cardiologist were invited to participate in the survey.
A total of 95 hospitals participated in at least one survey and were included in the analysis. The hospital management score averaged 51.1 points, with the highest being 71.1 points and the lowest being 31.1 points.
Hospitals' overall average hospital management scores varied widely, with 84% scoring below 60. The average scores of the four dimensions of target management, operation management, performance management and talent management were 38.6, 56.4, 53.2 and 55.7, respectively.
The researchers suggest that the state introduce policies requiring each hospital to establish a continuous improvement system for medical quality with clear responsibilities and focus on target management.
In the study, goal management performed worst among the four dimensions of hospital management.
As a modern management concept, goal management refers to a management method in which all staff of the hospital actively participate, determine work goals from top to bottom, and ensure the realization of goals from bottom to top.
But the researchers weren't familiar with what their hospitals were targeting. The importance of quality of care in hospitals seems more like a well-known concept than a guide to action.
In the study, hospitals with higher management scores had higher total revenue, which was actually due to the larger number of services reflected in the hospital size, not the more efficient.
In the study, hospital management scores were not related to cost per hospital stay, which also suggests this.
来源：Zhu Y, Zhao Y, et al. The hospital management practices in Chinese county hospitals and its association with quality of care, efficiency and finance. BMC Health Serv Res. 2021, 21(1): 449.
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