Background County hospitals as the backbone of the China’s healthcare system are providing services for over 70% of the total population. However, the hospital management practice (HMP) and its links with quality of care, efficiency and finance in these hospitals are unknown. Methods We did two cross-sectional surveys of HMP in 2013 and 2015 among 101 county hospitals across rural China. Three managing roles (hospital director, director of medical affairs office and director of cardiology) and a cardiologist were invited to the surveys. A novel HMP rating scale, with 100 as full score, was used to measure the HMP in 17 indicators under four dimensions (target, operation, performance, and talent management) for each hospital. We analyzed the association of HMP score with variables on quality of care, efficiency and finance using linear mixed models with and without adjustment for potential confounders. Findings A total of 95 hospitals participated in at least one survey and were included in the analysis. The overall mean HMP score varied dramatically across the hospitals and 84% of them scored less than 60. The dimension mean HMP score was 38.6 (target), 56.4 (operation), 53.2 (performance) and 55.7 (talent), respectively. The pattern of indicator mean HMP score, however, was almost identical between hospitals with high and low overall HMP score, showing the same ‘strength’ (staff satisfaction, staff performance appraisal, ‘hard wares’, patient-centered services, etc.) and ‘weakness’ (target balance, target setting, continuous quality improvement, penalties on staff with dissatisfied performance, etc.). The associations of overall mean HMP score with quality of care and efficiency variables and cost per hospitalization was not statistically significant. The statistical significance in the association with hospital annual total income disappeared after adjusting for region, teaching status, number of competitors, number of staff and number of beds in use. Conclusion The HMP in Chinese county hospitals scores low in general and was not significantly associated with hospital care quality, efficiency and finance. The current healthcare reform in China should address the micro level issues in hospital management practices.
Background: Lacking methods to quantify the inter-hospital variance in hospital management practice (HMP) is a bottle neck for research on HMP and quality of care. This study aims to quantify the inter-hospital variance in HMP by developing a novel rating scale of HMP and evaluating its feasibility, reliability and validity. Methods: Based on the theory of hospital management, we developed a HMP rating scale with 4 dimensions: Target, operations, performance and talent management. We used questionnaires to collect relevant information from the hospital director, the medical affairs director, the head of the department of cardiology, and a cardiologist. And we also requested a list of administration documents. For validation of the scale, we applied it to 101 hospitals that had participated in the Third Phase of the Clinical Pathways in Acute Coronary Syndromes Study (CPACS-3) in 2013 and repeated it in 2014. Results: The HMP rating scale includes 17 indicators and 47 sub-indicators in the four dimensions; 85% and 97% of hospitals responded to the first and second survey respectively. A high degree of the test-retest reliability for the overall score (ICC = 0.8) was found between the two time points. Both split-half and Cronbach'α coefficient of the overall score exceeded 0.85. Cumulative percentage of variance in all dimensions was above 60%, and factors extracted in each dimension were highly consistent with the designed indicators and sub-indicators. The overall HMP score was different between hospital groups with different revenues, patients' hospital stays, and number of clinical pathways (All p values < .01). Conclusions:The HMP rating scale was demonstrated reliable, valid, and responsive, but future studies with larger sample size in different settings are needed to confirm the study findings.
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