Hospital organizational environment and staff satisfaction in China: A large-scale survey

What Makes a Hospital Excellent? A Qualitative Study on the Organization and Management of Five Leading Public Hospitals in China

Purpose

To summarize the organizational and management experiences and explore the organizational theoretical model of five leading public hospitals in China.

Patients and Methods

Purposive sampling was used to select five leading hospitals in different regions of China under the National Health Commission and Provincial Health Commission as study hospitals for the study. From August 2021 to March 2022, 8 leaders and 39 managers from these hospitals were surveyed using semi-structured interviews. The data and information were analyzed in four dimensions using thematic analysis and grounded theory, focused on summarizing the experiences and practices of China's leading hospitals in organizational system, culture, operations and performance management, and employee development. This study complied with the COREQ guidelines for reporting qualitative research.

Results

An organizational system model of the characteristics of hospital excellence was developed using four core attributes: organizational system, organizational culture, operations and performance management, and employee development; the model was named the System-Culture-Operation-Performance-Employee (SCOPE) model. Organization and management among leaders and managers in China's leading hospitals are based on the SCOPE process, resulting in employees' well-being, patients' positive outcomes, and organizational excellence. In terms of hospital culture, while adhering to the Hippocratic Oath, the hospital is deeply influenced by traditional Chinese culture, which emphasizes "benevolence" and "love", leading all staff to adhere to "patient-centered care and service." In terms of operations management, a separate operations management department is responsible for hospital operations and performance assessment. As for employee development, the staff's sense of reverence for their profession is emphasized and a reasonable salary system and good practice environment are established to promote staff motivation.

Conclusion

The SCOPE model reveals the perspectives of leaders and managers in China's leading hospitals regarding organization and management under a Chinese cultural background. These findings can complement the existing literature on hospital management systems.

Slack resources and individual performance of clinicians: the mediating role of job satisfaction and empirical evidence from public hospitals in Beijing, China

BACKGROUND

Clinicians in Chinese public hospitals face a complex and severe clinical practice environment, and the individual performance of clinicians is key to improving the output of the healthcare industry. This study aims to explore the mechanism of slack resources in improving individual performance of clinicians and the role of job satisfaction in this process, while the study framework is based on the widely applied Job-Demands Resources theory.

METHODS

Based on the study framework composed of slack resources, individual performance, and job satisfaction, hypotheses have been put forward, and questionnaires have been distributed to representative clinicians in tertiary public hospitals. Finally, 318 valid data collected from clinicians have been obtained. To verify the hypotheses, multiple linear regression models have been established to explore the relationship between variables, and the three-stage regression models have been used to verify the presence of mediating role.

RESULTS

All four hypotheses proposed in this study have been proved to be held. Clinicians' job satisfaction has played a mediating role in the impact of slack resources and its three dimensions on individual performance. Among them, there has been a complete mediating role for staff slack, while time and space dimensions have played a partial mediating role in the impact of slack resources on individual performance.

CONCLUSIONS

In public hospitals in environments where behavior is subject to significant government interference, it is necessary and feasible to retain appropriate slack resources to improve individual performance. From the perspective of resources management in hospitals, it is necessary for public hospitals to implement a strategy of reserving an appropriate portion of time, staff and space in order to have the conditions to improve clinicians' satisfaction. The existence of slack resources in public hospitals can improve the job satisfaction of clinicians, and then improve the individual performance through the process.

Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework

Background

Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. In this study, we used kangaroo mother care (KMC) as an example of an evidence-based neonatal intervention recently introduced in selected Chinese hospitals, to identify the factors that influenced its successful implementation. We also explored the utility of the PARIHS framework in China and investigated how important each of its constructs (evidence, context and facilitation) and sub-elements were perceived to be to successful implementation of EBIs in a Chinese setting.

Method

We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants.

Results

Using KMC as an example, our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level.

Conclusion

Based on our findings examining KMC implementation as a case example, the PARIHS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07493-6.

Prevalence of Percutaneous Injuries and Associated Factors Among a Sample of Midwives in Hunan Province, China

Background: Percutaneous injuries and blood-borne-related infections pose occupational hazards to healthcare professionals. However, the prevalence and associated factors for these hazards among midwives in Hunan Province, China are poorly documented. Methods: A cross-sectional study was conducted among a sample of 1,282 eligible midwives in the cities of Yongzhou, Chenzhou, Hengyang, and Changsha in Hunan Province, China, from January 2017 to July 2017. The association of selected independent variables with percutaneous injuries was investigated using binary logistic regression. Results: 992 participants responded (77.3%), and within the previous 12 months, 15.7% experienced percutaneous injuries. In multivariate analysis, hospital size, age, length of employment as a midwife, weekly working hours, and three aspects of Hospital Safety Climate Scale were associated with percutaneous injuries. The risk of percutaneous injuries among the midwives working in hospitals with ≤399 beds was higher than that among those working in hospitals with ≥400 beds by nearly 3 times. Furthermore, the percutaneous injury prevalence of midwives decreased as age increased. Moreover, the probability of percutaneous injuries among the midwives with weekly working hours of >40 was 4.35 times higher compared with that among midwives with weekly working hours of ≤40. Conclusion/Application to practice: The prevalence of percutaneous injuries among midwives in the study hospitals was substantial. Our results further proved that risk mitigation strategies tailored to midwives are needed to reduce this risk. These strategies include ensuring a positive organizational climate, providing highly safe devices, and reducing the workload.

Satisfaction survey among primary health care outpatients in the backward region: an empirical study from rural Western China

BACKGROUND

With a growing health demand, patient satisfaction analysis is essential for evaluating the accessibility and performance of medical services. Previous studies had explored the Chinese outpatient satisfaction and influencing factors in developed areas and tertiary hospitals. Considering the lower education level, less income, and heavier economic burden, it was necessary to conduct a region-specific questionnaire survey for the outpatient's satisfaction in rural Western China.

OBJECTIVE

To analyze the satisfaction of primary outpatient service in rural Western China, and explore the factors affecting outpatients' satisfaction.

METHODS

Questionnaire composed of nine 5-Likert items was applied to survey outpatient satisfaction among randomly selected samples in 11 provinces of Western China. Exploratory factor analysis (EFA) was conducted to study the factor structure of questionnaire. Stepwise multiple linear regression analysis was performed to study the influencing factors.

RESULTS

A total of 2,754 outpatients completed the questionnaire, the response rate was 88.7%. Respondents were most satisfied with medical staff service attitude (3.71±0.83) and least satisfied with medical cost (2.97±0.83). A 3-factor solution was adopted in EFA to explain the overall satisfaction. Factors identified were "Service attitude", "Facility and professional skills", and "Patients' cost". And, the questionnaire was proved to have good reliability and acceptable internal consistency. The stepwise multiple linear regression analysis results presented that factors, including sample hospital type (P<0.05), age (P<0.001), education level (P<0.05), occupation (P<0.01), monthly income (P<0.05), and chronic disease conditions (P<0.01) were significantly associated with the dimensional or overall satisfaction.

CONCLUSION

The primary health care outpatient satisfaction in rural Western China is lower than developed areas and tertiary hospitals. Care providers in backward regions should pay more attention to patients' demographic characteristics and health status, to meet outpatients' actual demand. Efficient hospital management methods, modern technology, and staff training are needed to improve the service quality and care efficiency.