Jiefang Daily: Shanghai General Hospital’s 3 Years of Exploration: From Training Assessment to Title Conferment and Appointment, Bold Reforms Trigger Vigor——Breaking the Ceiling to Let Good Doctors Stand Out (Aug. 23, 2017)

One Friday, at 18 o 'clock, at Shanghai General Hospitals’ Urinary Surgery Department, Han Bangmin, who just returned from the operating room to his office excitedly discussed the operation with his colleagues. “In addition to the routine communication every Tuesday, I usually read periodicals for a while as long as I have time at home after work. With new prospects, now I feel that I’m full of energy in both clinical work and scientific research.” As Deputy Director of the Clinical Center and Chief of Prostate at the Urinary Surgery Department, born in the 1970s, he was in good spirits, “the ceiling above my ahead is being broken gradually.”

“What is the biggest problem in career growth? You can't find your goals and you can't see your future.” Three years ago, Wang Xingpeng, the hospital’s president who often heard such complaints from young doctors, decided to start an ice-breaking reform. “The growth and development of medical personnel have its special rules. As a large general tertiary Grade-A hospital, we have the mission and obligation to explore the rules and build a personnel ecosystem in line with the characteristics of the current era.”

Apart from recognizing talents, selecting talents, using talents, we must train and retain talents. Three years of exploration have shown initial results now. At Shanghai General Hospital, a series of bold reforms, such as classified training, comprehensive assessment, untying title conferment and appointment, are activating the pool of spring water in this public hospital.

Talent Training: Classified Training by “Adding”

In 2006, Han Bangmin graduated with a doctor’s degree. Last year, he became the new Chief of Prostate at Shanghai General Hospitals’ Urinary Surgery Department. He admitted that in the past he could not imagine that he could become chief of a sub-speciality and doctoral advisor so soon. “There are so many outstanding seniors in the hospital. What young doctors could do before was wait patiently.”

In Sept. 2014, “Shanghai General Hospital’s Personnel Development Plan for 2014-2018” was introduced. Seizing this opportunity, Han Bangmin stood out and was formally appointed to a senior post. “For medical personnel, professional titles are not only linked to pay. More importantly, it is a necessary indicator to in competition for management posts, the title of doctoral advisor and bidding for projects.”

In recent years, Shanghai General Hospital has reached a consensus: the hospital must strive for medical personnel increments, instead of robbing the stock; as a large public hospital, it should shoulder the long-term responsibility of personnel training. A common plan in public hospitals was injected with many new meanings by Shanghai General Hospital. There’s one word at the heart of the 8,000-word personnel development plan: classified, i.e. classified training, classified assessment, classified management, classified promotion. For example, for personnel in different promotion channels, the hospital has developed a total of 25 in-hospital training programs in 4 categories to stimulate the enthusiasm of the staff in corresponding positions, such as the Excellent Young Personnel Training Program, Excellent Doctor Training Program, Short-Term Overseas Training Program for Directors, etc. After the introduction of the plan, the number of participants in overseas training has tripled. Since 2015, more than 200 people in the hospital have participated in the long-term overseas training program. This is top-notch among Shanghai’s municipal public hospitals. Considering the development of the pediatric department, emergency department and other departments in short supply, the hospital also formulated the Training Program for Personnel in Short Supply and so on. The implementation of the plan has promoted the rapid growth of excellent young and middle-aged medical personnel in the hospital. In one year, the hospital’s employees were successively selected for the Recruitment Program for Young Professionals, Shanghai Leading Talents Program, Shanghai Huangpu River Talents Program, etc.

Talent Recognition: Comprehensive Assessment Through “Multiple Channels”

In many public hospitals, doctors good at clinical work are not necessarily good at research, while doctors good at research are not necessarily good at clinical work. It is often said that the former will be at a disadvantage when competing for titles.

Chen Feng 'e, a chief ophthalmologist with 32 years of work experience, is one of them. She is recognized as a clinical backbone in the hospital. She has performed lots of difficult operations for diseases such as retinal detachment. The monthly average number of outpatients is 300-400. There’s almost no complaint throughout the year.

“There are different paths in the hospital’s personnel development plan. I chose the clinical type. If we were in an assessment system that stresses scientific research and academic work, there would be no path suitable for people like me, a senior not good at doing research or writing papers in such an important department as ophthalmology.” She exclaimed.

The “clinical type” mentioned by Chen Feng’e is one of the four categories in Shanghai General Hospital’s personnel training and assessment mechanism, i.e. interdisciplinary, clinical, research and teaching, which have been adopted to replace the “sweeping approach” and correct the current bias in favor of research in large hospitals’ internal assessment systems. "We turned the assessment system from a ruler into a multidimensional channel. Our doctors can choose their space for improvement according to their abilities and interests.” Said Hu Yingping, director of the hospital's Human Resources Department. The “clinical type” chosen by Chen Feng’e trains medical backbones and experts in specific disciplines and sub-specialities. The “interdisciplinary type” trains pacesetters and leaders in specific disciplines. The “research type” trains academic pacesetters and leaders. The “teaching type” trains backbones in medical education.

Now, with a sense of gain from the reform, Chen Feng’e is demanding more of herself. “Though I have chosen the clinical type, I will continue to summarize my clinical experience and teach it to young doctors.”

Talent Selection: “Seismic Divorce” of Title Conferment from Appointment

The title conferment plus appointment reform is the last and most important link in the hospital’s personnel development framework. In many large general hospitals, some old employees become “invisible” after getting their titles and treatment, and some even perform only several operations a year. On the other hand, new employees pouring in every year hit the ceiling of professional titles because of the limited number of posts. The divorce of title conferment from appointment activated a pool of spring water.

At the hospital’s staff congress three years ago, “Shanghai General Hospital’s Appointment Methods for Medical Professional and Technical Posts (Trial)” was passed by obtaining 91.96% of votes. According to the “Appointment Methods”, the hospital will determine the number of posts and form a reasonable personnel structure according to the number of available posts approved by relevant departments, the hospital’s authorized size and the proportions of professional and technical posts. At the heart of this is the divroce of title conferment from appointment: even if you have a senior title, you may not be appointed to a senior post.

After two rounds of title conferment and appointment, some people’s titles changed, while others returned to their former posts with encouragement. 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 and didn’t pass the expert review. In the following 2 years, his operations and workload almost increased by 50%. In the 2^nd round of title conferment and appointments at the end of last year, he returned to his post as chief again.

When personal enthusiasm for work is stimulated, the hospital’s learning and collaboration atmosphere takes on a new look. In the past, everyone was busy and had no time to attend the training class for applying for the National Natural Science Foundation’s projects; today, the seats are not enough. In the past, it wasn’t part of the job to teach interns; today, everyone teaches step by step. In this positive atmosphere, Shanghai General Hospital’s clinical and scientific research performance is remarkable. In 2016, it got 57 projects from the National Natural Science Foundation, ranking 21^st among all hospitals in China. In the first half of this year, the number of level-4 operations (major operations) performed by the hospital ranked first in the city. The hospital’s CMI has been going up year by year. The number of patients of 9 major diseases treated by the hospital ranked top 3 in the city.

How can this “seismic” reform make people convinced? The hospital's Human Resources Department showed the reporter a huge and fine personnel assessment big data information system. The system includes four categories, medical treatment, scientific research, education and medical ethics. In medical treatment, there are 17 items. To avoid subjective interference, all data are from the EMR system, medical case system, anesthesia information system, nosocomial infection system and so on, to ensure the data are authentic, reliable and documented.

A public hospital’s public welfare functions and competitive edges are not incompatible. To a public hospital, reforms need to be calibrated. In the next stage, Shanghai General Hospital will develop an internal performance assessment system, to copy and popularize its innovative model of classified personnel training. “What we want to do is to grasp the endogenous law of personnel growth and development and use a good system to train a group of good doctors who can stand the test.”

 By Huang Yangzi, Reporter with Jiefang Daily

Review

Elaboration for a Great Cause

Wang Renwei

This year, the reform of public hospitals has been deepened.

A hospital’s central resources are its doctors. Therefore, how to mobilize the enthusiasm of medical staff under the premise of emphasizing public welfare has always been the top priority in the series of public hospital reform plans by relevant state departments.

It is no doubt that in current public hospitals as public institutions, medical personnel management still has the problem of being extensive rather than subtle. How to let more good doctors come out through the reform and exploration of systems and mechanisms? This is a great cause. However, there aren’t many hospitals carrying out a real personnel reform.

After three years of reform and exploration, Shanghai General Hospital has submitted a praiseworthy answer sheet in this regard. They are praiseworthy not only for their courage to reform, but also for their elaboration. Such elaboration first is reflected in the system design. They have a whole set of systems suitable for the current rules of medical personnel growth in training, assessment and appointment. Second, they use IT to formulate scientific and comprehensive implementation rules. In their four indicators, medical treatment alone has 17 items.

We cannot say Shanghai General Hospital’s reform is already perfect. We introduce some of their experience because we hope more public hospitals can make breakthroughs in this aspect. A hospital is really activated only when its talent pool is activated.