Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China

Teaching Hospital Governance Model for Service Quality Performance: Case Study of Indonesian Central General Hospital

This study aims to investigate the effect of teaching hospital management practices on the quality performance of health services by involving elements such as hospital accreditation standards, quality management, and JCI Academic Hospital-specific standards that are indirectly connected. This study chose a survey-based quantitative approach to clinical professional students in vertical teaching hospitals under the direct management of the Ministry of Health of the Republic of Indonesia. Six proposed hypotheses were tested by Partial Least Square-Structural Equation Modeling (PLS-SEM) analysis. The test results showed a positive influence between hospital teaching governance and hospital accreditation compliance, quality assurance and JCI Academic Hospital standards. Third, compliance with teaching hospital standards was also found to have a significant positive effect on the performance of teaching hospital service quality. Understanding the role of governance in encouraging the performance of teaching hospital service quality can help develop effective managerial strategies in achieving complete service quality for patients and clinical profession participants. This research resulted in contributions to existing practices and literature as governance modeling in dual quality standards charged to teaching hospitals.

Medical Malpractice Litigation After Spine Surgery in Beijing Between 2013 and 2018

OBJECTIVE

The aim of this study was to analyze the characteristics of alleged medical malpractice litigation involving spine surgery in Beijing between 2013 and 2018.

METHODS

Two online legal databases, Wusong and Weike, were queried for court verdicts involving spine surgery from January 2013 to December 2018 in Beijing. For all included cases, data pertaining to defendants, plaintiffs, case outcomes, allegations, and verdicts were abstracted, and descriptive analyses were performed.

RESULTS

A total of 186 legal cases were identified, and 122 cases were excluded because of irrelevance or insufficient information. Of the patients in the 64 cases included in this investigation, 40.6% were male. The mean age of the plaintiffs was 53.2 ± 18.6 years. The most common complaint addressed in this study is inadequate consent (53.1%; n = 34), followed by additional surgery required (40.2%; n = 26), being unsatisfied with the outcome of surgery (17.6%; n = 11), postoperative paralysis (15.6%; n = 10), and postoperative infection (15.6%; n = 10). The most common primary disease among all the cases is lumbar spinal stenosis (28.1%; n = 18), followed by spinal tumor (18.8%; n = 12), cervical spondylosis (17.2%; n = 11), vertebral fracture (14.1%; n = 9), deformity (12.5%; n = 8), and others (9.3%; n = 6). Spine surgeons successfully defended themselves in 13 cases (20.3%), which resulted in no indemnity payment. The remaining 51 cases (79.7%) were closed with an average verdict payout of U.S. $22,597, which was significantly lower than the average compensation claimed by the plaintiff (U.S. $11,3762) (P < 0.05).

CONCLUSIONS

This study comprehensively summarized the medical alleged malpractice litigation after spine surgery in Beijing. Given the rapid growth rate of spine surgery and the burden of related alleged medical malpractice litigation, it is valuable for spine surgeons to understand the potential legal impact of spine surgery. The most common complaint addressed in this study is inadequate consent. The findings in the present study highlight that in China, spine surgeons should pay more attention to communication with patients and perform spine surgery based on abnormal imaging as opposed to what the history and physical examination dictate, which can help reduce the litigation rate and improve the patient experience.

The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China

BACKGROUND

Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals.

METHODS

A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively.

RESULTS

The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions.

CONCLUSION

The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.

Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey

BACKGROUND

The Chinese healthcare system is affected by frequent disputes between physicians and patients. Although recent reforms have contributed towards improving the patient-physician relationship, distrust in physicians is still high. Communication skills (CS) training of physicians holds the key to improving patient confidence and diffusing stressful situations. This survey reports on the status of CS training in medical education in China, and the experiences and attitudes of physicians towards CS training.

METHODS

A cross-sectional survey was conducted at medical institutions across China. A questionnaire developed for this study included the status of CS training, current aspects of patient-physician relationships, perceived own CS and patient-centeredness with Likert-scaled items from 1 (most negative) to 6 (most positive). Physicians' attitude towards CS training was measured with the Communication Skills Attitude Scale (CSAS) and its subscales PAS (Positive Attitude Scale) and NAS (Negative Attitude Scale). Data were analyzed descriptively and for group differences between the hospital level and operating vs. non-operating physicians. Binary logistic regression analysis was done to find associations explaining the occurrence of verbal and physical attacks and the role of CS attitudes.

RESULTS

Out of 1080 questionnaires, 772 physicians met inclusion criteria. A total of 466/772 participants (60.4%) had received at least one CS training during their career. The participants rated the current situation related to patient-physician relationship in China as highly stressful (mean = 4.52, SD = 1.26, 95% CI: 4.43-4.60), experiencing verbal attacks in the past three years once a year in 372/772 cases (48.2%) and physical attacks 111/772 times (14.4%). The mean PAS was 62.96 (SD = 7.63, 95% CI: 62.41-63.47). Being female was associated with increased risk of verbal attacks (OR = 1.51, 95% CI: 1.01-2.25) while working in a tertiary hospital and showing high levels of PAS decreased this risk (OR = 0.62, 95% CI: 0.43-0.89, and OR = 0.95, 95% CI: 0.93-0.98). Having received a previous CS training decreased the odds of physical attacks (OR = 0.54, 95% CI: 0.35-0.83).

CONCLUSIONS

A majority of Chinese physicians showed a high positive attitude towards CS training, were trained in CS and would value further training. Our results highlight that CS training is likely to promote patient-centered communication and reduce attacks against physicians. Both of these effects are to improve the patient-physician-relationship in the long run. More CS training should be offered to Chinese physicians, especially at secondary- and primary-care hospitals, where such practices remain infrequent.

Impact of hospital readiness on patient safety incidents during the COVID-19 pandemic in Indonesia: health worker perceptions

OBJECTIVES

This study examined the impact of hospital readiness on patient safety from the healthcare workers' perspective.

DESIGN

The study employed a mixed-methods explanatory sequential design, with the quantitative phase taking precedence. We conducted an online survey of 235 healthcare workers at COVID-19 referral hospitals, followed by an interview with 11 participants from various hospital types.

SETTING

COVID-19 referral hospitals in Indonesia.

PARTICIPANTS

Health workers working at COVID-19 referral hospitals.

MEASURES

Hospital ownership; hospital accreditation status; hospital readiness including incident management system, surge capacity, infection control and prevention, and human resource management; patient safety incident.

RESULTS

According to the survey, 66.4% of the participants worked at a hospital owned by the provincial or district government, and 69.4% worked at a hospital which had received an excellent status accreditation. More than 80% of the hospitals scored well in the categories of the incident management system (86%), surge capacity (80.9%), infection control and prevention (97.9%), and human resource management (84.7%). However, only 50.6% of the hospitals scored well in managing patient safety incidents. Hospital ownership, accreditation status and hospital readiness all have an impact on patient safety incidents, which were reported in all types of hospitals by both studies.

CONCLUSIONS

This study provides significant results for Indonesia in terms of hospital preparedness and patient safety for the COVID-19 pandemic. The accreditation and ownership status of the hospital have aided hospital readiness. Despite the fact that no hospital in the world was prepared for the COVID-19 pandemic, hospital readiness has improved a year later; however, patient safety has not improved. Patient safety incidents occurred regardless of hospital status, with the most common occurrence being delayed treatment. Administrative errors were also recorded in COVID-19 field hospitals that were not accredited. Future research should focus on improving pandemic care quality and implementing initiatives that are applicable to all types of hospitals.

Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019

Background

Hospital and ICU structural factors are key factors affecting the quality of care as well as ICU patient outcomes. However, the data from China are scarce. This study was designed to investigate how differences in patient outcomes are associated with differences in hospital and ICU structure variables in China throughout 2019.

Methods

This was a multicenter observational study. Data from a total of 2820 hospitals were collected using the National Clinical Improvement System Data that reports ICU information in China. Data collection consisted of a) information on the hospital and ICU structural factors, including the hospital type, number of beds, staffing, among others, and b) ICU patient outcomes, including the mortality rate as well as the incidence of ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs). Generalized linear mixed models were used to analyse the association between hospital and ICU structural factors and patient outcomes.

Results

The median ICU patient mortality was 8.02% (3.78%, 14.35%), and the incidences of VAP, CRBSI, and CAUTI were 5.58 (1.55, 11.67) per 1000 ventilator days, 0.63 (0, 2.01) per 1000 catheter days, and 1.42 (0.37, 3.40) per 1000 catheter days, respectively. Mortality was significantly lower in public hospitals (β =  − 0.018 (− 0.031, − 0.005), p = 0.006), hospitals with an ICU-to-hospital bed percentage of more than 2% (β =  − 0.027 (− 0.034, -0.019), p < 0.001) and higher in hospitals with a bed-to-nurse ratio of more than 0.5:1 (β = 0.009 (0.001, 0.017), p = 0.027). The incidence of VAP was lower in public hospitals (β =  − 0.036 (− 0.054, − 0.018), p < 0.001). The incidence of CRBSIs was lower in public hospitals (β =  − 0.008 (− 0.014, − 0.002), p = 0.011) and higher in secondary hospitals (β = 0.005 (0.001, 0.009), p = 0.010), while the incidence of CAUTIs was higher in secondary hospitals (β = 0.010 (0.002, 0.018), p = 0.015).

Conclusion

This study highlights the association between specific ICU structural factors and patient outcomes. Modifying structural factors is a potential opportunity that could improve patient outcomes in ICUs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-03892-7.

Estimating the Impacts of Hospitals' Organisational and Geographical Characteristics on the Adoption of Health Information Technology in Mongolian Hospitals

Background

The adoption of health information technology (HIT) is an important measure for improving healthcare quality and safety, which is affected by many hospital factors, but it has not yet been estimated in the Mongolian hospital sectors. This study examines how hospitals' organisational and geographical characteristics influence the adoption of HIT in Mongolian tertiary and secondary care hospitals.

Methods

А cross-sectional study involving the executive directors and medical equipment engineers was conducted in 39 hospitals. Data acquired from questionnaires are (1) hospitals' organisational and geographical characteristics, including bed-size capacity, ownership type, status, and location of the hospitals, and (2) the adoption rate of HIT, and its categories are based on the Health Information and Management Systems Society's classification (2002). The dependent variable was measured as numbers and the rate of HIT programs adopted clinical, administrative, and strategic information technologies (IT). A regression analysis was used to estimate the factors of impact on the adoption of clinical, administrative, and strategic IT.

Results

We found a concerning relationship between the characteristics and adoption of HITs. On average, the number of HIT programs adopted was 18, covering nine clinical IT programs, six administrative IT programs, and three strategic IT programs. The adoption rate of overall HIT was 33.29% in the hospitals. In regression analysis, the organisational and geographical characteristics' impact and HIT adoption of hospitals was positively associated with large bed-size (clinical IT: β = 0.256, P < 0.001; administrative IT: β = 0.3654, P < 0.001; strategic IT: β = 0.0006, P < 0.001), for-profit (strategic IT: β = 0.1995, P < 0.01), teaching (clinical IT: β = 0.2560, P < 0.05; administrative IT: β = 0.1985, P < 0.05; strategic IT: β = 0.2236, P < 0.01), and urban location (clinical IT: β = 0.2840, P < 0.001, administrative IT: β = 0.2256, P < 0.01; strategic IT: β = 0.2256, P < 0.001).

Conclusion

Our study found that the HIT adoption rate in Mongolia is poor, and its adoption is mainly positively associated with bed-size capacity, status, and location of the hospitals. Also, we found that the ownership type is partially affected HIT adoption.