Health News: Shanghai General Hospital Drives Management Upgrades by “Three Carriages”
“The purpose of hospital management is to give full play to the overall operation function and get the best comprehensive benefit.” As an internal medicine expert who devoted the first half of his life to the theory of organism, Shanghai General Hospital’s President Wang Xingpeng has been wondering whether the hospital can also be considered as an organism in management. In practice, the hospital's quality and technology system, personnel growth system and performance incentive system built for improving the quality of medical service have become the "three carriages" for driving management upgrades.
From “Large and Inclusive” to “Strong and Intensive”
In Wang Xingpeng's opinion, it is tertiary hospitals’ future task to improve their clinical and scientific research capabilities, consolidate and implement functional positioning. This requires hospitals to consider their actual situations, adjust their functional structures, highlight their advantages in certain fields, turning from "large and inclusive" to "strong and intensive".
To promote the discipline construction centered on the diagnosis and treatment of complicated difficult diseases and emergency severe diseases, the hospital decided to build an advantageous discipline group aiming at sub-speciality construction. For example, the Clinical Center for Urology focuses on urologic oncology, urinary calculus, prostate and urinary control, kidney transplantation and andrology to develop sub-specialities; the Clinical Center for Ophthalmology focuses on fundus and retina, cataract, optometry/refractive/ophthalmology to develop sub-specialities. In addition, the hospital has also established a Clinical Center for Trauma First Aid based on its strength in the field of trauma first aid and location advantage, built a professional trauma sequential therapy team integrating specialities for trauma treatment, such as trauma orthopedics, craniocerebral trauma, hand trauma, trauma psychology and trauma rehabilitation.
Improving medical quality is the core of hospital management, so we must be strict, precise and meticulous. The Hospital General Office’s Director Liu Jun said in 2015 the hospital began to build a nosocomial infection prevention and control system including the quality control system, training system, assessment system and support system, preliminarily realized real-time data generation, dynamic regulation and better team construction, to effectively ensure clinical safety.
Clinical pharmacists in many places are still in the stage of taking part in ward rounds, reviewing doctor's advice, writing medication history, commenting on prescriptions. In comparison, Shanghai General Hospital’s clinical pharmacists have turned from visiting the clinic to working in the clinic. 42 full-time clinical pharmacists have move from the clinical pharmacy to the clinical ward, participating in the clinic’s outpatient and inpatient services all day long in an all-round manner. According to the hospital’s Clinical Pharmacy Director Fan Guorong, the hospital uses the nurse management model to manage clinical pharmacists and carries out dual command by the clinical department and pharmacy department. Based on the pharmacist station in the clinic, the hospital has also established clinical pharmacist service teams for oncology, pediatrics, transplantation, chronic disease management, antibacterial drug management based on disease categories. At present, the hospital's clinical pharmacist service coverage has increased from 16.1% to 61.3%. The level of rational use of antimicrobials has been significantly improved. Patient satisfaction is as high as 98.5%.
Activate the Hospital’s Talent Pool
According to Wang Xingpeng, classified personnel training, classified assessment, classified planning and development and classified promotion are like four cornerstones of the hospital’s personnel management. None can be dispensed with. To give full scope to their talents, every doctor in the hospital can choose a career development type and plan their own development paths according to their own career interests, advantages, specialities and development direction of the department. Through perfecting the on-the-job training and assessment system, the hospital builds promotion channels for personnel at all levels, presents each doctor with an optimal growth road map, thus stimulating everyone's motivation.
According to Hu Yingping, director of the hospital's Human Resources Department, to optimize the hospital’s personnel structure and curb the phenomena of “more attention to scientific research, less attention to clinical practice and teaching”, the hospital classified the orientations of personnel development into interdisciplinary, clinical, research and teaching, requiring each department to allocate personnel in the ratio of 5:3:1:1. The objective of interdisciplinary personnel training is to train pacesetters in specific disciplines. The objective of clinical personnel training is to train medical backbones for specific disciplines and sub-specialities. The objective of research personnel training is to train academic leaders. Accordingly, the hospital has also defined the competence criteria for each post.
To put the hospital’s HR strategy into practice, we need to make the rules and regulations grow teeth. According to Wang Xingpeng, affected by the life tenure system, it’s a one-way road for doctors concerning professional and technical posts, only up not down, only in not out. As a result, doctors who have been promoted lack drive, while remarkable young doctors lack the opportunity for promotion. After deliberation and trials, in 2015, Shanghai General Hospital officially launched the real hospital-wide competition for appointments.
In this title conferment and appointment reform, the ceiling that worried the hospital’s young backbones was broken. Young doctors with titles of senior professional posts who didn’t get the appointments before got development space this time. Among the 23 doctors with titles of senior professional posts, 21 got the appointments. Among the 68 doctors with titles of senior professional associate posts, 64 got the appointments. Appointments come with titles. In Shanghai General Hospital, this is no longer empty talk.
The reform also put an end to research-based promotion. The hospital’s surgeon Mr. Shen got his title of a senior professional post in 2004. However, in 2014 he was demoted to associate chief because he didn’t perform enough operations. In the following 2 years, he adjusted his priorities. His operations and workload almost increased by 50%. In the 2nd round of title conferment and appointments, he returned to his post as chief again. Mr. Shen told the reporter: “to be a chief surgeon and leader, research alone is not enough. Clinical ability is also a gold standard for competence assessment.”
Performance Assessment Must Be in Tune with the Medical Reform’s Orientation
The internal performance assessment must be in tune with the medical reform’s policy orientation and linked to the hospital’s management objectives. This is the tone set by Wang Xingpeng for the hospital’s internal assessment scheme.
To tie the staff’s incomes with the hospital’s public benefit indicators and embody the performance-based distribution principle of “more pay for more work, better pay for better work”, Shanghai General Hospital gave a lot of thought to the design of its internal assessment scheme. According to Xia Wei, Director of the hospital’s Performance and Cost Department, patient satisfaction, workload, service quality, degree of difficulty, clinical research output and teaching quality, cost control and medical expense control are all factors that require attention in hospital performance management. Structural adjustment and disease management should be reflected in the assessment, involving the adjustments to the disease structure, patient structure and cost structure, focusing on efficiency and quality indicators. The hospital also set post pay coefficients according to factors such as the job responsibility, contribution, degree of difficulty and labor intensity, to embody the assessment principle of “one post, one pay”.
Wang Xingpeng stresses that the internal performance assessment not only should focus on technical level, service quantity and efficiency, but also should be based on the average value of hospitals at the same level in the city, focus on the consumption of drugs and materials in each disease group in the surgery department, striving to save medical resources and reduce the burden of patients. In recent years, the hospital's hospitalization expenses and drug proportion are at a low level among the city's general hospitals.
Shanghai General Hospital also includes all revenues and expenditures in its overall budget management and strengthens economic analysis to know exactly where the money goes. The hospital actively guides the departments to strengthen their cost consciousness and integrates cost assessment into the performance assessment system, to link the hospital’s medical costs to the interests of each employee, thereby increasing employees’ awareness of economy, trying to achieve the benign development pattern in which medical income growth is lower than business growth, medical cost growth is lower than medical revenue growth, striving to achieve the maximum return with the minimum consumption.
By Han Lu, Reporter with Health News
One Thousand Threads Pulled by One Needle
The establishment of a modern hospital management system covers both the government governance system at the macro level and the hospital management system at the micro level. Strengthening hospitals’ internal management is the "last kilometer" for promoting the modern hospital management system. In Shanghai General Hospital, a systematic, standardized and comprehensive management reform oriented to serving patients has truly connected the claims of all stakeholders to a single point. It not only let the macro orientation and hospital development resonate at the same frequency, but also let more reform dividends fall on its employees and patients.
Only when hospitals do not lack safety nets, can patients feel safe. A hospital’s internal management system, as the code of conduct and guidance for the medical personnel, is the guarantee and foundation of the steady improvement of medical quality and patient safety. Through Shanghai General Hospital’s exploration, we can see hospitals should always attach great importance to the construction of a quality management system and strive to improve their technical level, consolidate their medical quality and ensure the safety of patients. At the same time, hospitals should strive to become patient-friendly hospitals, integrate the idea that “life is precious, patients come first” into hospital construction, process design and all kinds of work, and constantly improve patients’ medical experience, so that patients can always feel the hospitals’ goodwill.
Improving patients’ sense of gain by enhancing doctors’ sense of achievement is a way must be passed by hospitals to promote internal management reform. Shanghai General Hospital’s practice gives us a hint: only if we face squarely and attach importance to incentives for the medical staff, find the key to talent recognition, selection, training, use and retention, mobilize manpower and make each "cell" fully release their energy, can we yield twice the result with half the effort and unite the hospital as one. More importantly, hospital administrators must not allow the internal management system to become vanity. We should regard performance assessment as an important tool and open the income gap through strict performance assessment, so that the hospital’s management objectives can be broken down layer by layer and the pressure of reform can be transmitted layer by layer.
Shanghai General Hospital’s unceasing exploration and practice of the idea of hospital systematic management is admirable. We also expect more hospital administrators to summarize their experience and lessons in practice, constantly improve and find a universal practical way for hospital management that accommodates the interests of all parties.