Medical disputes and patient satisfaction in China: How does hospital management matter?

What is the relationship between hospital management practices and quality of care? A systematic review of the global evidence

There is a widely held view that good management improves organizational performance. However, hospitals are complex organizations, and the relationship between management practices and health service delivery is not straightforward. We conducted a global, systematic literature review of the quantitative evidence on the link between the adoption of management practices and quality of care in hospitals. We searched in PubMed, EMBASE, EconLit, Global Health, and Web of Science on 16 October 2024, without language or country restrictions. We included empirical studies from 1 January 2000 onwards, examining the quantitative association between hospital management practices and quality of care. Outcomes included structural quality (availability of resources such as drugs and equipment), clinical quality (adherence to guidelines), health outcomes, and patient satisfaction or experience with care. In every study, each tested association was categorized as significantly positive (at the 5% level), null, or significantly negative. The study was registered with PROSPERO (CRD42022301462). Of 11 731 articles, 25 studies met the inclusion criteria and had an acceptable risk of bias. Studies were equally distributed between high-income and low- and middle-income countries, with 22 cross-sectional and three intervention studies. Of 111 associations, 55 (49.5%) were significantly positive, one (1%) was significantly negative, and 55 (49.5%) were null. Among the associations tested, the majority were significantly positive for structural quality (79%), clinical quality (60%), and health outcomes (57%), while most associations between hospital management and patient satisfaction (80%) were null. The findings are mixed, with a similar proportion of positive and null associations between management practices and quality of care across studies. The evidence is limited by the risk of bias introduced by nonrandomized study designs. Evidence of positive associations in some settings warrants further investigation of the association through intervention studies or natural experiments. This could leverage methodological developments in quantitatively measuring management, highlighted by this review.

Effects of separating drug sales from treatment on medical disputes

For decades, the patient-physician conflict has been a persistent issue globally, particularly in China, where the situation has been deteriorating. To curb the inappropriate financial incentives of physicians, eliminate the practice of over-prescription, and improve the strained patient-physician relationship, the Chinese government has been implementing Separating Drug Sales from Treatment (SDST) in public hospitals since 2012. In this paper, we exploit the staggered difference-in-differences method and event study approach to examine the effects of SDST on medical disputes, based on administrative hospital-level annual data from 2011 to 2018 in G province. We find that SDST significantly decreases the number of total medical disputes by 10.0%, through reducing the over-prescription and medical malpractice, and improving hospital management practices and operational efficiency. This paper argues that removing the link between drug prescription and hospital revenue contributes to realigning physicians' financial incentives and thus building a healthy patient-physician relationship.

How Does Management Matter for Hospital Performance? Evidence From the Global Hospital Management Survey in China

BACKGROUND

Improving healthcare productivity and efficiency through effective management practice is crucial in the healthcare sector. However, the evidence on how management practices affect hospital performance is mixed and limited in the public health system. The objectives of this study are (1) locating Chinese public hospitals' management ability in the global health system community, and (2) investigating how public hospital's management practice is correlated to the objective and subjective performances.

METHODS

Using the World Management Survey (WMS) methodology, the national Global Hospital Management Survey-China (GHMS-China) was conducted from 2014 to 2016 to measure Chinese hospitals' management practices. This study utilized a national representative hospital sample from the GHMS-China and used multi-variable linear regression model to examine the association between hospital performance and management practices. This study mainly focused on the clinical outcomes for acute myocardial infarction (AMI), heart failure (HF), pneumonia children (PC), and coronary artery bypass grafting (CABG), as well as satisfaction measurements including staff turnover and subjective ratings from patient and staff.

RESULTS

Hospitals with higher management scores have significantly lower mortality rates on AMI, lower complication rates on CABG and shorter average length of stay (LoS) for PC patients. Hospital management and subjective performance also shows a positive correlation, with a significant increase of inpatient satisfaction rating by 0.72 scores (95% CI: 0.28,1.16; P=0.001). This relationship is more pronounced in hospitals with larger bed capacities, greater competition, more autonomy, and in sub-sample group of hospitals with superior management practice. The potential mechanisms through which hospital management can foster performance include attracting more talented clinical staffs, providing more valuable and continuous training opportunities, as well as providing more standardized clinical care service.

CONCLUSION

Better management practice is correlated to superior hospital performance in Chinese Public Health Service System. Future studies with religious and causality study design are warranted.

An Analysis of Inpatient Satisfaction with Trust-related Factors of Public Secondary and Tertiary Hospitals in China

BACKGROUND AND OBJECTIVES

Patient satisfaction surveys are implemented as an essential quality improvement tool in healthcare markets. This study investigates patient satisfaction in public secondary and tertiary hospitals and identifies factors contributing to inpatient satisfaction, particularly trust-related factors, to eventually improve the quality of care in the healthcare system.

METHODS

A population-based cross-sectional survey was conducted between February and April 2021 in 31 Chinese provinces. Telephone interviews with computer assistance were used to gather data. Spearman Rank Correlation was used to analyze satisfaction with hospitalization services between secondary and tertiary hospitals. Multiple Linear Regression was used to determine the influencing factors of overall patient satisfaction.

RESULTS

Inpatients reported more satisfaction with inpatient care when doctors treated them respectfully (p < 0.01). Inpatients with higher self-identified social class reported higher satisfaction (p < 0.01). Inpatients who trust in most people in society (p < 0.01) and trust in the Chinese healthcare system (p < 0.01) reported higher satisfaction. Female inpatients reported higher overall satisfaction (p < 0.01).

CONCLUSIONS

The study of Chinese inpatients in secondary and tertiary hospitals highlighted the importance of respect from doctors, their self-identified social class, and their trust in influencing satisfaction during their hospital stay and called for additional research into policy measures.

Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China

BACKGROUND

Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR.

METHODS

This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021.

RESULTS

COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures (P < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions (R=-0.082, P < 0.05); trial procedures were significantly negatively correlated with years (R=-0.484, P < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes (R = 0.098-0.294, P < 0.001) and negatively correlated with trial procedures (R=-0.090, P < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD (P < 0.05).

CONCLUSIONS

Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.

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.

Socioeconomic inequality in public satisfaction with the healthcare system in China: a quantile regression analysis

Background

As China pursues better social equality and improvement in public services (healthcare), public satisfaction has been considered as a key performance indicator. There is a great need to better understand the disparities and inequalities in the public satisfaction with its healthcare system.

Methods

Based on Chinese General Social Survey (CGSS) 2015 ( a set of nationally representative survey data, the most recent wave containing information about public satisfaction with the healthcare system), this study utilizes the quantile regression method to analyze how the public satisfaction at high or low quantile of the score distribution varies according to the socio-economic status and healthcare system performance indicators, especially in rural areas.

Results

This study found that, at the highest percentile, better Self-Reported-Health (SRH) is associated significantly with a lower satisfaction score (coefficient -4.10, P < 0.01). High socioeconomic status (especially "above average" group) has higher satisfaction scores at both mean (coefficient 3.74, P<0.01) and median (coefficient 3.83, P<0.01). This effect is also significant across the lower quantiles of the satisfaction levels. West and Middle region (the less developed regions) tended to be more satisfied, whereas those in Northeast reported a large negative effect (coefficient -7.07, P < 0.01) at the median. While rural residents generally reported higher levels of satisfaction, rural residents’ preference regarding hospital beds and primary care access seems generally to be opposite to that of urban residents.

Conclusion

Our findings suggest that the ongoing healthcare reform needs to integrate more preventive care to meet the healthy residents’ expectation and demands. More attention should be guided to the vulnerable healthcare system in the Northeast region, which has a stagnant local economy. Outcome-based quality care is especially preferred in rural healthcare, in addition to improvement of utilization and access. In addition, the “pro-rich” inequality is an ongoing concern about the system.

A taxonomy of Chinese hospitals and application to medical dispute resolutions

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.