This study investigates how hospital performance may be influenced by environmental ethics, measured by regional medical corruption cases. To address the endogeneity issue, we use corruption cases in non-medical sectors as instrumental variables for medical corruption in regions with hospital operations. Our analysis combines data on corruption investigations with hospital management and performance measures from the World Management Survey, covering more than 500 hospitals in China from 2014 to 2016. We found that a one-third increase in corruption cases in a region reduces management quality by 0.05 standard deviations, increases the complication rate by 3%, and increases the length of stay by 0.15 days. Subgroup analyses revealed that the negative effects of corruption are particularly pronounced for management quality in younger hospitals and for performance outcomes in older hospitals. Furthermore, we found that compared with corruption at the hospital-leader level, corruption among hospital staff has stronger negative effects on management quality and service outcomes. Our findings also show that corruption can distort the incentives and operational priorities within hospitals. Our work helps improve the understanding of the relationships between the ethical environment and hospital performance outcomes, offering insightful implications for better governance and policy settings in developing and transitional health systems.

Surveys are widely used to assess hospital management with the aim of understanding differences in management practices. However, survey measures with prior notice can make hospitals change their routine practices and are unable to reflect the actual hospital management level. The World Management Survey (WMS) methodology has been developed to ameliorate these issues. It uses a double-blinded method and open-ended question design. The Chinese Hospital Management Survey (CHMS) project is the first to adapt the WMS methodology in China, which it uses to measure hospital management level in 510 hospitals. This paper provides an instrument to better measure actual management practices, which makes it possible to compare the management level of hospitals in China and other countries.

Medical disputes can be viewed as a negative indicator of health care quality and patient satisfaction. However, dispute prevention from the perspective of systematic supervision is unexplored. This study examines hospital clustering based on diagnosis-related group (DRG) indicators and explores the association between hospital clusters and medical disputes. Health administrative data from Sichuan Province in 2017 were used. A twostep cluster analysis was performed to cluster hospitals based on DRG indicators. A multiple regression analysis was conducted to evaluate the relationship between clusters and the incidence/number of medical disputes. The 1660 hospitals were grouped into three DRG clusters: basic (62.5%, n = 1038), diverse (31.0%, n = 515), and lengthy (6.4%, n = 107). After adjusting for covariates, the diverse hospitals were associated with an increased probability of having medical disputes (OR 5.24, 95% CI 2.97–9.26), while the diverse and lengthy hospitals were associated with a greater number of medical disputes (IRR 10.67, 95% CI 6.58–17.32; IRR 4.06, 95% CI 1.22–13.54). Our findings highlighted that the cluster-level performance of hospitals can be monitored. Future studies could examine this relationship using a longitudinal design and explore ways to reduce medical disputes in hospitals.

This study investigated sociodemographic factors for immunization care use and the relationship between trust in physician (TIP) and immunization service use in older Chinese Americans. Data were collected through the Population Study of Chinese Elderly, including survey information of 3,157 older adults in the Greater Chicago area. Regression results showed that the odds of getting vaccinated were higher for those who were older, female, and had higher education and income. After adjusting for the covariates, higher TIP was associated with greater immunization service use. The highest tertile of TIP was associated with higher odds of using immunization service (OR 2.19, 95% CI [1.76, 2.72]), especially for flu and pneumonia vaccines. Findings suggests that immunization service use may be increased by improving TIP and promoting targeted health care management plans for racial/ethnic minorities, which is highly relevant to increase the vaccination rate and contain the pandemic as the COVID-19 vaccine is available.

OBJECTIVE Satisfaction with healthcare may be captured by surveys of patients and staff, or in extreme cases, the number and severity of medical disputes. This study tries to investigate the relationship between satisfaction and hospital management as well as the role of good management in preventing medical disputes ex ante. METHOD We investigate this relationship using information on management practices collected from 510 hospitals in mainland China using the World Management Survey questionnaire and combined with medical malpractice litigation data and patient/staff satisfaction surveys. Multiple regression models were used to analyse the relationship between hospital management scores and medical litigation outcomes as well as patient and staff satisfaction during 2014-2016. RESULTS An increase of one standard deviation in the management score was related to 13.1% (p < 0.10) lower incidence of medical disputes, 12.4% (p < 0.05) fewer medical litigations, and 51.3% (p < 0.10) less compensation. Better management quality of hospitals was associated with higher inpatient satisfaction (p < 0.05) and staff well-being (p < 0.01). CONCLUSION Improving hospital management could reduce hospital costs generated by lawsuits, reduce potential harm to patients, and improve patient and staff satisfaction, thus leading to a better patient-physician relationship.

BackgroundDoctor-patient relationship has become an intense concern in public health in recent years. Medical malpractice lawsuits have presented an increasing trend over past decade. This study aims to describe distributions of medical malpractice lawsuits across different provinces and to investigate its relationship to the growth of private hospitals.MethodsData was drawn from China Judgments Online, the China Health Statistic Yearbooks and China Statistical Yearbooks between January 1, 2010 to December 31, 2016. Private hospitals expansion was measured by the number and proportion of private hospitals, the ratio of outpatient visits from private to public hospitals and the ratio of discharges from private to public hospitals. Fixed-effects negative binomial regressions were utilized to estimate the association between the growth of private hospitals and the number of medical malpractice lawsuits.ResultsIn total, we identified a total of 18220 lawsuits relevant to medical malpractices across China between 2010 and 2016. The regression results revealed that more private hospitals, larger proportion of private hospitals and higher ratio of discharges from private to public hospitals were significantly associated with fewer medical malpractice lawsuits. An increase of 100 private hospitals in health care market was associated with a decrease in the number of medical malpractice lawsuits by 21%. The ratio of outpatient visits from private to public hospitals was not significantly associated with the number of malpractice lawsuits. ConclusionsThere was great disparities of incidences of medical malpractice lawsuits across different provinces. Greater expansion of private hospitals was associated with fewer medical malpractice lawsuits at province level. This negative association indicated that more private hospitals in health care market might provide more incentives for hospitals to contain the incidences of medical malpractice cases.

Background Medical litigation represents a growing cost to healthcare systems. Mediation, arbitration, and other alternative dispute resolution (ADR) methods are increasingly used to help solve the disputes and improve healthcare satisfaction. In China, the increasing number of medical disputes has contributed to concern for the safety of physicians and mistrust between physician and patients resulting in ADR processes being established in several provinces in recent years. Our aim was to describe and explain the impact of this new mediation process in the Chinese healthcare system. Methods Our study investigated mediation practices in China using case-level data from 5614 mediation records in Guangdong Province between 2013 and 2015. We investigated how the resolution success as well as the compensations are associated with the case characteristics using regression analysis. Results Among the cases analyzed, 1995 (41%) were solved with agreement through mediation, 1030 were closed by reconciliation, 559 were closed by referring to court and 1017 cases were withdrawn after mediation. Five hundred five Yinao cases were solved with the help of mediators on the spot. We find that mediation solved about 90% of medical disputes under present mechanisms, while more police support is needed to cope with Yinao . The average compensation of mediation is CNY60,200 and average length of mediation is 87 days. Longer time taken to reach resolution and more money claimed by patients are associated with lower resolution success rate ( p < 0.01) and higher compensation levels (p < 0.01). Conclusion Our results show the performance of mediation mechanisms in China to help solve medical disputes. ADR plays a role in reducing the need for initiating litigation and may ultimately increase satisfaction with the healthcare system.

目的 了解中国医院人才管理现状、存在的主要问题,分析其原因,并提出对策建议.方法 采用世界管理调查方法和问卷,通过电话对医护人员进行访谈.结果 中国医院人才管理得分较低,主要表现在调离表现欠佳的员工和挽留员工方面.中国医院在招聘编制内人才方面仍然面临着较大的约束.结论 中国医院在人才管理方面仍然存在较大的进步空间,医院在人才招聘、调离和激励方面需要有更大的自主权才能够更好的吸引和留住人才.建立能够综合反映医院人才管理客观实践和员工主观感受的指标体系能够帮助医院发现自身不足,更好地提升自身管理水平.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:调查中国医院治理现状,为公立医院改革,建立现代医院管理制度提供依据。方法:对医院高级管理者发放医院治理问卷,运用统计软件进行分析。结果:不同治理类型的医院在决策自主权存在较大的差异,自治型公立医院在决策自主权方面大多高于其他两组。公立医院院长主要由政府直接任命或者政府组织竞选产生,院长选拔最优先考虑的是卫生领域的领导经验和政治影响力。建议:增加医院多领域自主权,有助于调动医务人员和管理人员的积极性。中国医院院长选拔机制不能满足现代化医院管理的要求,需要职业化医院管理团队来对医院进行精细化管理。</span>

Objective To explore methods to measure the management level of Chinese hospitals in natural conditions of Chinese hospitals, for improvement of their operation efficiency. Methods The methodology of World Management Survey( WMS) was introduced, and the questionnaire was localized using expert consultation method. Double-blind telephone interviews were conducted to investigate the management level of Chinese hospitals in the four dimensions of standardized operation, performance monitoring, target setting and talent management. Results The management level of hospitals in China varied greatly from places. Among them, the hospital management scoring was found to range from 2. 50 to 2. 75 in most cases, averaging 2. 55. These hospitals scored relatively poor at the four specific management practices of hospital layout(2.48), performance communication(2.27), talents retention, and clarity and comparability of objectives(2. 45). Management level of a hospital was correlated to such factors as its history, ownership form, human capital and hospital size. Conclusions This study uses WMS methodology to quantify Chinese hospital management. The overall management level of Chinese hospitals is expected to improve with much gaps to cover. At this stage, it is imperative to solve the unbalanced and inadequate development of hospital management levels, among regions, hospital grades and forms of ownership.

To understand the management level and international positioning of Chinese hospitals, we devel-oped a comprehensive survey instrument of chinese hospital management survey following the well-adapted methodolo-gy of world management survey which has been widely used internationally. The survey was conducted on 20 manage-ment practices covering four major management dimensions including operations management, performance manage-ment, target management and talent management respectively. Based on the CHMS structure and setting, the four-di-mension and twenty-item management model was analyzed with construct validity test. From the test, the middle level managers were recruited from more than 400 chinese national representative hospitals. The results showed that the chi-square/degree of freedom (CMIN/DF) is 2. 209, and RMSEA (root mean square error approximate) is 0. 039, indicating a good model fitting. The further indications of model fit such as GFI, IFI and CFI were all above 0. 9 which is the typical benchmark for model acceptance. This study provides evidence for correspondence between con-ceptual and empirical hospital management and the insight of model fitting on the current data. The results conclude that CHMS has satisfied validation in Chinese hospital management practices, and can be used as an effective sur-vey method to assess the level of Chinese hospital management and to provide a general platform for international comparison.