Purpose Effective nurse-child communication is a fundamental aspect of delivering pediatric nursing care. Family caregivers' global ratings to hospital are considered a proxy-reported measure for assessing a child's inpatient stay experience. We investigate the associations between nurse-child communication and family caregivers' global ratings to hospital. Design and methods A retrospective analysis of a national child patient experience survey data was conducted. Patient experience with nurse-child communication and the family caregivers' global ratings of hospital were measured using the Child Hospital Consumer Assessment of Healthcare Providers and Systems. Hierarchical linear models were constructed to examine the association between nurse-child communication measures and family caregivers' global ratings to hospital. Results Data from 1010 patients at six National Regional Centers for Pediatric in China were collected. The overall rating of hospitals and the willingness to recommend the hospital showed increasing trends as the nurse-child communication score increased. How often nurses encourage children to ask questions was significantly associated with family caregivers' overall ratings of hospital and the family caregivers' willingness to recommend the hospital. Conclusions Effective communication by nurses with the child is associated with significantly higher global ratings to the hospital by family caregivers during inpatient care. Encouraging children to ask questions is a promising contributor to caregivers' global ratings to hospital. Practice implications Pediatric nurses should emphasis encouraging children to ask questions for effective communication in nursing practice. Future research is also needed to develop more targeted strategies to assist pediatric nurse to communicate with child better.

目的 分析北京地区急性白血病患者住院费用和费用结构变化趋势,为制订相关政策提供数据支撑.方法 采用2015-2019年北京地区77所二级和三级医院住院病案首页数据对急性白血病住院费用、费用结构进行描述性、差异性和趋势分析.结果 2015-2019年北京地区急性白血病住院次均费用呈增长趋势(P＜0.05),药耗费用占比则明显下降(P＜0.05).不同年龄组住院次均费用比较,差异有统计学意义(P＜0.05).急性白血病患者住院主要治疗方式为化疗,且不同年龄化疗患者的住院次均费用、次均药品费用比较,差异有统计学意义(P＜0.05).结论 北京地区急性白血病患者住院费用负担仍然较重,药品、耗材费用对住院负担贡献度高但呈下降趋势.需关注儿童、老年等重点人群的住院费用负担,结合儿童白血病特点对其付费标准进行单独测算.

目的 为提升新生儿DRG分组的准确性,分别应用出生体重与入院体重作为入组条件,寻找入组依据.方法 数据来源于某市2016年1月1日-2020年12月31日出生天数<29 d的新生儿病案首页数据,应用CN-DRG分组方案(2018版)进行DRG分组,采用SPSS 24.0软件进行统计分析.结果 新生儿出生体重与入院体重均完整者占新生儿首页数据的77.1％;对于新生儿体重密切相关DRG组别,将出生体重与入院体重分别作为入组条件,入组一致及差异分别占97.6％及2.4％;对于入组存在差异的1821例,按照出生体重与入院体重入组准确分别占83.1％及8.5％,新生儿平均出生天数分别为6.00 d、18.85 d;对于新生儿平均出生天数≤7 d按出生体重入组准确,平均出生天数>14 d按出生天数构成及伴随问题选择入组体重;新生儿出生天数为8 d～14 d,出生体重与入院体重入组无差异.线性回归分析显示,出生体重回归系数绝对值>入院体重回归系数绝对值.结论 新生儿出生体重对DRG分组影响大于入院体重.应关注早产儿出生体重与入院体重变化,提升病案首页新生儿出生体重与入院体重的完整性,将合理体重作为DRG分组依据.

Background Understanding the long-term inpatient service cost and utilization of psychiatric patients may provide insight into service demand for these patients and guide the design of targeted mental health programs. This study assesses 3-year hospitalization patterns and quantifies service utilization intensity of psychiatric patients in Beijing, China. Methods We identified patients admitted for one of three major psychiatric disorders (schizophrenia, bipolar and depressive disorders) between January 1 and December 31, 2013 in Beijing, China. Inpatient admissions during the following 3 years were extracted and analyzed using sequence analysis. Clinical characteristics, psychiatric and non-psychiatric service use of included patients were analyzed. Results The study included 3443 patients (7657 hospitalizations). The patient hospitalization sequences were grouped into 4 clusters: short stay ( N = 2741 (79.61% of patients), who had 126,911 or 26.82% of the hospital days within the sample), repeated long stay ( N = 404 (11.73%), 76,915 (16.26%) days), long-term stay ( N = 101 (2.93%), 59,909 (12.66%) days) and permanent stay ( N = 197 (5.72%), 209,402 (44.26%) days). Length and frequency of hospitalization, as well as readmission rates were significantly different across the 4 clusters. Over the 3-year period, hospitalization days per year decreased for patients in the short stay and repeated long stay clusters. Patients with schizophrenia (1705 (49.52%)) had 78.4% of cumulative psychiatric stays, with 11.14% of them in the permanent stay cluster. Among patients with depression, 23.11% had non-psychiatric hospitalizations, and on average 46.65% of their total inpatient expenses were for non-psychiatric care, the highest among three diagnostic groups. Conclusion Hospitalization patterns varied significantly among psychiatric patients and across diagnostic categories. The high psychiatric care service use of the long-term and permanent stay patients underlines the need for evidence-based interventions to reduce cost and improve care quality.

目的 探究精神疾病患者住院总费用的影响因素,为控制住院医疗费用和提高精神专科医院住院医疗结局质量提供参考.方法 利用单因素分析和多元线性回归分析,抓取北京市3家三级精神专科医院2016年1月1日-6月1日住院患者的病案首页数据进行统计分析.结果 共纳入6 529条患者入院记录,住院总费用中位数为17 772.7元.除患者社会人口学因素、住院天数和诊断类型外,患者共患躯体疾病、是否接受电休克疗法和就诊医院对住院总费用均有显著影响.结论 应重视精神疾病患者的共患躯体疾病预防和诊治,治疗方法和就诊医院的机构差异对住院总费用的影响值得进一步研究.

Background Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China. Methods Data on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics. Results The 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals ( p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04–1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56–0.91) and frequent readmissions (OR 0.60, 95%CI 0.40–0.91). Conclusion More than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.

AIMS To identify and group hospitalization trajectory of alcohol use disorder (AUD) patients and its associations with service utilization, healthcare quality and hospital-level variations. METHODS Inpatients with AUD as the primary diagnosis from 2012 to 2014 in Beijing, China, were identified. Their discharge medical records were extracted and analyzed using the sequence analysis and the cluster analysis. RESULTS Eight-hundred thirty-one patients were included, and their hospitalization patterns were grouped into four clusters: short stay (n = 565 (67.99%)), mean psychiatric length of stay in 3 years: (32.25 ± 18.69), repeated short stay (n = 211 (25.39%), 137.76 ± 88.8 days), repeated long stay (n = 41 (4.93%), 405.44 ± 146.54 days), permanent stay (n = 14 (1.68%), 818.14 ± 225.22 days). The latter two clusters (6.61% patients) used 37.26% of the total psychiatric hospital days and 33.65% of the total psychiatric hospitalization expenses. All the patients in the permanent stay cluster and 41.77% of the patients in the short stay cluster were readmitted at least once within 3 years. Two-hundred thirty-four patients (28.16%) were admitted at least once for non-psychiatric reasons, primarily for diseases of circulatory and digestive systems. Cluster composition varied significantly among different hospitals. CONCLUSION Hospitalization pattern of patients with AUD varies greatly, and while most (>2/3) hospitalizations were short stay, those with repeated long stay and permanent stay used more than one third of the hospital days and expenses. Our findings suggest interventions targeting at certain patients may be more effective in reducing resource utilization.

Objectives China launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients’ perspective. Design This nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China. Setting A total of 117 tertiary hospitals in mainland China. Participants 48 422 responses from outpatients and 35 957 responses from inpatients were included in this study. Primary outcome measure The scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating. Results More than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016–2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings. Conclusions The national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.

Objective To analyze the differences and influencing factors of inpatient satisfaction on hospitals of different types in different regions two years following implementation of the National Healthcare Improvement Initiative.Methods Data of hospitals and inpatient satisfaction survey results were collected from the a third-party evaluation of the National Healthcare Improvement Initiative, and analyzed in a two-step clustering model.This effort aims at learning the subjective feelings of inpatients and impacts of the objective indicators of medical resources allocation on inpatient satisfaction.The analysis helps identify indicators to be included into the clustering model and their correlation with such satisfaction.Results The two-step clustering rounded hospitals into four categories based on the inpatient overall satisfaction.Gaps were found among different categories of hospitals in terms of types of hospitals, location, affiliation and healthcare resources allocation.The inpatient overall satisfaction varied with these indictors.Among the category with the highest inpatient overall satisfaction, 100% were general hospitals, most of which in eastern area(52.38%),and local hospitals(50.00%).Hospitals in this category feature larger scales and stronger medical techniques.The category with the lowest inpatient overall satisfaction were mostly hospitals located in western regions(65.52%), maternal and child hospitals(41.38%)and local hospitals (89.65%).Most of these hospitals were large in scale, but their medical techniques and resources fell behind their eastern counterparts.The strongest correlation with inpatient overall satisfaction was medical behavior(r=0.95), while the weakest was the medical resources allocation(r<0.30).Conclusions There are gaps of inpatient overall satisfactions among different types of hospitals located in different regions. Patients′subjective perceptions and medical resources allocation affected their overall satisfactions.The non-medical services were important factors towards patient satisfaction.

Objective To analysis the influencing factors in costs of treating adults and children,and then to compare the difference of influencing factors between adults and children . Methods Using the medical record hompage data during, we built two hierarchical linear models to analysis the influencing factors in costs by 42 conditions with matching diagnosis related groups for adults and children. Results Gender, outway and the number of diagnoses had statistical significant to adults, where the contrary result to children; Hospital types had statistical significant to children, where the contrary to adults. The most significant factor influenced adults and children were "medicine & material expenses" (β adults=22754.94,βchildren=8815.84, all P＜0.001). There were higher in sequence of influencing factors than adults by children in the number of operations and age . Conclusion Influencing factors on costs between adults and children were differen. Currently Cost structure was inappropriate for it couldn't reflect the acctual medical resources needs for children. Shortening length of stay will improve resources use. Intensive study should be taken to age subdivision cause of the stronger correlation to children than adults in explaining hospital costs.

Hyperthyroidism refers to a clinical state that results from inappropriately hight hyroid hormone levels in the tissues [1] .Ⅰ-131 therapy plays a critical role and provides a remarkable curative effect in targeting thyroid diseases. Thyroid cells can take up isotope I-131, which emits not only beta rays but also

Objective To understand the current situation of inpatients′perceptions of doctor-patient relationship and its influencing factors, and to make policy recommendations for further targeted healthcare improvement.Methods Based on the survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we analyzed the inpatients′perceptions of doctor-patient relationship.SPSS 22.0 software was used to conduct Kruskal-Wallis test and Dunn-Bonferroni test,and SAS 9.4 was used to conduct multivariate logistic regression to analyze the influencing factors of inpatients′perceptions of doctor-patient relationship.Results The mean perception score of the inpatients pertaining to doctor-patient relationship was 4.34 ±0.84,and the median was 5.00.The perception score of the male inpatients pertaining to doctor-patient relationship was significantly higher than that of the female respondents(P<0.05),that of the inpatients who had fixed physicians or general practitioners before visiting was higher than that of the inpatients who did not have(P <0.05).The overall satisfaction of inpatients during hospitalization(P <0.01, OR =2.73)and doctors′satisfaction to have enough communication time with patients(P <0.01, OR =1.84)were the most significant protection factors to inpatients′perceptions of doctor-patient relationship.The process and structure evaluation results of hospitals in harmonization of doctor-patient relationship was a significant risk factor.Inpatients who had fixed physicians or general practitioners before visiting(P<0.01, OR=1.31)was another statistically significant positive influencing factor of inpatients′perceptions of doctor-patient relationship.Conclusions It is imperative to strengthen communications between doctors and patients and to improve healthcare service, in order to raise patients′satisfactions for a harmonized doctor-patient relationship.In addition to establish a working mechanism for medical disputes as a post-incident strategy, hospitals are recommended to take proactive and preventive measures.In addition,measures like integration of family doctor system and medical alliance system,as well as encouraging patients to contract their family doctors will help to harmonize the doctor-patient relationship.

The 2nd round of the third-party evaluation of the National Healthcare Improvement Initiative was made during Dec 2016 and Jan 2017.The methods, organization and implementation of the survey and the technical roadmap were the same as those of the 1st round of evaluation.The total number of respondents was 94 218,including 19 773 doctors,24 315 nurses,29 105 outpatients and 21 025 inpatients. 142 typical cases were collected from sample hospitals.The key findings showed that, the National Healthcare Improvement Initiative has been implemented quite well in the 2nd year, achievements and challenges exist side by side.The overall satisfaction rate of both outpatients and inpatients was good, both were about 90%.Further improvement is expected.Hospital staff have been actively involved in this Initiative,but they are not satisfied with their working environments and compensations.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的了解中国改善医疗服务行动实施2年来妇幼医疗机构住院患者的总体满意度及其影响因素,为促进妇幼机构提升服务水平和提高服务质量提出改进建议。方法收集2015年和2016年"全国改善医疗服务行动"第三方评估中全国33家妇幼医疗机构9 802例住院患者满意度调查结果和医疗机构年度卫生统计数据,采用多水平线性模型分析妇幼医疗机构住院患者满意度的影响因素。结果中国妇幼医疗机构住院患者总体满意度为（4.59±0.63）分,15个核心指标中,满意度最高的为"护士态度和善"[（4.70±0.58）分]和"医生耐心询问病情"[（4.70±0.56）分],满意度最低的为"我表扬和投诉医护人员的渠道畅通"[（3.11±2.16）分];对中国妇幼医疗机构住院患者总体满意度影响最大的为"本次住院费用明白、合理"（β=0.174 3,t=24.53,P &lt;0.001）,其次是"我感受到了医护人员给予我的尊重和安慰"（β=0.123 0,t=11.15,P &lt;0.001）,"医生耐心询问病情"和"护士态度和善"均是影响中国妇幼医疗机构住院患者总体满意度的重要指标（均P &lt;0.001）。结论医疗费用仍是妇幼医疗机构住院患者主要关注的内容,而医护人员的服务意识越来越成为患者住院体验的重要因素,优化医疗资源配置和加强护理服务是进一步改善住院医疗服务的重点。</span>

Background A longer time in consultation with doctors in ambulatory care has been associated with better quality of care. Patient experience is of great concern to policy makers and is linked with health-care quality. However, the relationship between consultation length and patient experience remains unclear. We aimed to investigate the effect of consultation length on patient experience, based on analysis of a cross-sectional nationwide patient survey data in China. Methods We obtained patient survey data from a stratified nationwide survey sample that covered 136 tertiary hospitals in China. Patient-estimated consultation length and associated patient experience data were collected by questionnaire after each patient attended a face-to-face consultation with a doctor. The consultation experience was rated on a 5-point scale. We applied a two-piecewise linear regression model to examine the saturation effect of the consultation length on patient experience (consultation score), using a smoothing function, while age, sex, education, and profession were adjusted in the model, then estimated the turning point that gave the maximum model likelihood by using trial and error. Findings Between Dec 18, 2017, and Dec 30, 2017, 27 721 patients, aged 15–85 years, were eligible and selected for inclusion. The median patient-reported duration of face-to-face ambulatory care consultation was 10 min (IQR 5–12), and the mean score of the consultation experience rated by the patient was 4·25 (SD 0·83; 95% CI 4·24–4·26) on the 5-point scale. After adjusting for potential confounders including age, sex, education, and profession, there was a non-linear relationship between consultation length and measure of patient experience after smooth curve fitting. A turning point at 8 min was identified in the modelling process. Below this point, there was a higher probability of rating a consultation score above average with longer consultation length (odds ratio [OR] 1·28, 95% CI 1·26–1·30, p<0·001). After this point, the OR changed to 1·03 (95% CI 1·02–1·04, p<0·001). There was a significant difference in patient experience measure before and after this consultation length turning point (p<0·001). Interpretation Consultation length was associated with a measure of patient experience in a non-linear pattern. Longer consultations might not be required to achieve better patient experience, but an adequate consultation should not be shorter than 8 min. Future research about the appropriateness of consultation length for varies ambulatory care institutions would be of benefit. Funding National Natural Science Foundation of China (71532014), National Health Commission of China

BackgroundNumerous studies indicate that the doctor–patient relationship in China is facing serious challenges. What are the major factors affecting their relationship? Does the media play a role in forming people's opinions? This study examines the impact of China Central Television's report of Chinese doctors getting kickbacks from pharmaceutical companies on perceptions of the doctor–patient relationship. We measure the impacts on both patients and doctors.MethodsThis study draws data from a national survey in 2017, which included satisfaction surveys among patients and doctors in 136 public tertiary hospitals. We used Likert five-point scales to measure perceptions (presented in centesimal scores) pertaining to the doctor–patient relationship. We used the propensity-score matching method to match the respondents before and after the news report (0000 h on Dec 25, 2016, as the critical midpoint of the 2017 survey), and estimated the differences in the perceptions before and after the widely cited news report. STATA 14·0 was used to conduct descriptive, propensity-score matching (nearest neighbor 1:1 matching with replacement) and logistic regress analysis. The level of statistical significance was set at 0·05.Findings9138 ambulatory patients, 5140 inpatients, and 5942 doctors surveyed before the news report, were matched with 6372 ambulatory patients, 3701 inpatients, and 1662 doctors surveyed after the news report by performing propensity-score matching. The positive perceptions of the inpatients pertaining to the doctor–patient relationship after the news report was 0·58 points lower (p=0·03, 95% CI −1·11 to −0·05), and that of doctors was 4·62 points lower (p=0·00, 95% CI −5·44 to −3·81) than those before the news report.InterpretationNo matter how widely the problem actually exists in China, national media reporting of “bad news” seems to negatively affect the perception of doctor–patient relationships among both patients and doctors. In this information age, strategies to improve the doctor–patient relationship might need to include media management.FundingNational Health and Family Planning Commission of China.

OBJECTIVE:To provide reference for setting reasonable medicines insurance payment price in China.METHODS:We retrieved and analyzed academic articles formally published at home and abroad,official websites and government documents,summarized.medicines insurance payment pricing mechanism as well as fair solutions to high-cost medicines,so as to put forward the suggestions to formulate reasonable medicines pricing policy in China.RESULTS&CONCLUSIONS:The international medicines payment prices are usually determined by internal reference pricing method,incremental cost-effectiveness evaluation method and external reference pricing method.The sustainable and fair accessibility of high-cost medicines are promoted by fair medicines pricing program,medicines patent pool,open source medicines discovery znitiative and so on.After the goal of universal health care has been achieved in china,reasonable medical insurance payment price should be explored and formulated.It is necessary to adopt,intemal reference pricing method to determine the payment standard of completitive eneric products,external reference pricing method or incremental cost-effectiveness evaluation method to determine the reference price for price negotiation of the innovative patented medicines;the concept of fair pricing for high-cost medicines.

Objective To investigate inpatient satisfaction for the past year following the implementation of China Healthcare Improvement Initiative.Methods Structured questionnaire was used to interview 19 938 inpatients immediately before discharge from 136 tertiary hospitals across 31 provinces in China,with 19 938 valid questionnaires recovered.Results Inpatients' overall satisfaction rate was 93.1 ± 5.7 (95％ CI 92.1-94.1).Patients were least satisfied with hospital food.The satisfaction of sample inpatients with high proportion of out-of-pocket payment is lower than that with low out-of-pocket payment(P＜0.05).The proportion of out-of-pocket payment was negatively correlated with satisfaction rate." Medical technology"," Kindness" and " Advanced equipment" are the most concerns for inpatients.Conclusions Healthcare affordability and amenity services deserve higher attention of the hospitals in addition to their medical services.The level of out-of-pocket payment and health insurance security is critical to inpatients satisfaction.Improving health insurance security will greatly contribute to raising inpatients satisfaction.

A systematic study and analysis were made about the inpatient survey methodologies and key findings in typical countries,by means of peer review journals,reviews and professional website information of these countries on their medical service improvement and patient evaluation systems.This was followed by a comparison of above information with the 2015 national inpatient satisfaction survey in China.As found in the study,national inpatient surveys of the five countries share similar measurement methods,yet with different sample sources,sample size,survey timing,and organization forms,indicating that the inpatient satisfaction in China was not poorer than other countries.Non-medical services in China have rooms of improvement,this is also the case in other studied countries.The authors propose appropriate changes in the organization forms,stratified sampling,and expanded sample size.

ObjectiveThis study aims to develop understanding of Chinese patient satisfaction with tertiary hospitals.DesignThe study draws on data collected from the 2015 China National Patient Survey. A Likert five-point scale was used to formulate the questionnaires. Descriptive analysis and logistic regression analysis were conducted.SettingA structured questionnaire was used by 1432 interviewers to interview 27 475 outpatients and 19 938 inpatients in 136 tertiary hospitals from 31 provinces.ParticipantsOutpatients in the dispensing area and inpatients in the discharging area were randomly interviewed.Main Outcome Measure(s)Key domains of the questionnaire include the layout of service functions, environment maintenance, process management, quality of care, humane care and the patient-doctor relationship. Within each domain, several indicators were set, and each indicator was given a statement.ResultsThe overall satisfaction scores are 4.42 ± 0.68 and 4.67 ± 0.62 for outpatient and inpatient, respectively. The domains with highest satisfaction are 'diagnosis and treatment' for outpatient and 'nursing care' for inpatient. Outpatients were least satisfied with long waiting time, while inpatients were least satisfied with the food. The strongest predictor of overall satisfaction appears to be 'patient-doctor relationship' for both outpatients (OR = 3.53, 95% CI: 3.17-3.92) and inpatients (OR = 7.34, 95% CI: 5.55-9.70).ConclusionsChinese hospitals need to pay more attention to offering more humane care to patients, hospital environment and process management improvement, reducing waiting times for seeing doctors and outpatient testing, and improving amenity services such as better food in the wards.