Benchmarking Comparison Between Zhejiang Province and American Hospitals

Abstract

Clinical engineering (CE) has evolved rapidly over the last 30 years in China. Among the 34 provincial-level administrative units within China, the Zhejiang province is 1 of the most advanced in terms of healthcare technology maintenance and management. To determine Zhejiang’s current stage of development and opportunities for further improvement, a comparison of the performance of its CE departments was made against hospitals in the United States. Data were collected from 22 Zhejiang hospitals and compared with those from 270 acute-care hospitals in the United States collected by Truven Health Analytics. To provide a background for CE benchmarking, comparisons were first made between China and the United States and then between hospitals in Zhejiang and the United States. CE benchmarking comparison was made in 3 categories: (a) operational, (b) financial, and (c) productivity. Within the operational category, the total annual amounts of repairs and scheduled maintenance events were compared versus total equipment amount. Within the financial category, the total CE expense was compared versus total number of operating beds, total equipment amount, total equipment acquisition cost, and total hospital operating expense. Within the productivity category, the total CE full-time equivalent was compared versus total number of operating beds and total equipment amount. These comparisons showed that (1) although the equipment inventory in Zhejiang tends to be much smaller than in the United States for hospitals of comparable amount of operating beds, the amounts of repairs and scheduled maintenance events per total equipment amount are similar; (2) the total CE expense, although apparently lower in Zhejiang than in the United States versus total operating beds, is comparable versus total equipment amount. The cost of service ratio is much lower in Zhejiang than in the United States, but the total CE expense is comparable versus total hospital operating expense; and (3) the CE full-time equivalent is significantly lower in Zhejiang than in the United States versus total amount of operating beds but much higher versus total equipment amount. The fact that repairs and scheduled maintenance are similar in Zhejiang and the United States shows that CE leaders are managing equipment in a comparable manner. Most of the differences found in the comparisons were traced to a few factors. First, the average length of stay in China is substantially higher than in the United States, which explains why hospitals in Zhejiang tend to have more operating beds but fewer pieces of equipment. Second, labor cost is significantly lower in China than in the United States, thus allowing Zhejiang hospitals to employ more workers than their American counterparts. Third, there is significantly difference in the cost of living between China and the United States. Fourth, healthcare is financed in different ways in these 2 countries. Finally, being public entities, Chinese hospitals are managed and operated in a different manner than American hospitals are, which are mostly private, albeit nonprofit, organizations. For example, most CE departments in Chinese hospitals are also directly responsible for medical equipment procurement. Nonetheless, it is interesting to note that hospitals in both areas spend roughly 1% of their total operating expenditure for CE. These results suggest that CE in Zhejiang is comparable with that in the United States in terms of managerial excellence, but there could be some room for improvement in financial management, technical expertise, and productivity.