Chinese Public Hospital Research Articles

Optimization Path for Management Decision-Making of Chinese Public Hospitals Under the Background of Big Data

This study examines how Big Data might improve Chinese public hospital management. A comprehensive study examines how data diversity, storage efficiency, analytics tools, and information system complexity affect decision-making. A carefully selected quantitative dataset from Chinese public hospitals is used in the study. Analyses use structured medical records, semi-structured billing data, and unstructured patient comments. The sample size of 115 was chosen for statistical robustness and multiple regression analysis best practices, which recommend 10-20 observations per predictor variable for estimate. Multiple linear regression analysis highlights amazing correlations and stresses data diversity, storage efficiency, analytics tools, and information system sophistication in decision efficiency. The study helps healthcare executives and regulators understand the complex relationship between regression coefficients and modified R-squared value. Also evaluated are Chinese public hospitals' strengths and weaknesses. Strengths include data integration, analytics, and advanced information systems. The report emphasizes data quality and cultural transformation, which impact Big Data and decision-making. The report emphasizes data consumption and advanced analytics to empower healthcare decision-makers. This research informs Chinese public hospital strategic reforms to improve resource allocation, patient care, and efficiency. This paper demonstrates how Big Data can impact healthcare decision-making. It enriches academic discourse and guides healthcare stakeholders through modern management with relevant insights and practical advice.

Analysis of the Current Situation in Chinese Public Hospital Based on AMO Theory

Public hospitals in China have a complicated internal structure with a sizable number of members and a strict management system. Human resource management plays an important part in the management of modern public hospitals, which also serves as the primary management component for efficient internal management. At the same time, in the context of strategic human resources management, the AMO theory has gradually entered the management of public hospitals. Based on a brief overview of human resource management in modern public hospitals, this study adopts the AMO theory (abilities, motivations, and opportunities) perspective in analysing the problems and challenges faced by the human resource management strategy in modern public hospitals, and exploring how human resource management in modern public hospitals should play an effective role based on the AMO theory. Based on a detailed and targeted analysis of the contents of the challenges, theoretical and practical support for the development of modern hospitals and the orderly conduct of internal management is provided.

Improving occupational health for health workers in a pilot hospital by application of the HealthWISE international tool: An interview and observation study in China.

For a safe and healthy workplace in the health sector, the International Labor Organization (ILO) and the World Health Organization (WHO) jointly developed HealthWISE, an international technical tool that helps health workers (HWs) to identify workplace hazards and apply low-cost solutions. This study sought to gather experiences and lessons from a Chinese pilot hospital for the scale-up application of HealthWISE. A qualitative study was undertaken at a Chinese public hospital with a ≥5-year application of HealthWISE through in-depth interviews with targeted HWs who participated in the Training-of-Trainer (TOT) workshops, and observations were gathered using evidence from photos and publications, then, thematic analysis was formulated. Driven by motivation, the participants learned from the HealthWISE TOT workshop alongside the favorite and worst parts of it. Positive changes and results of occupational health for HWs occurred after the workshop, the participants trained others and planned to implement HealthWISE within their responsibility. During the COVID-19 Pandemic, the Hospital acted the approaches of protecting the health, safety and well-being of HWs with significant results. Further suggestions on workshop and HealthWISE implementing as well as the national policies were collected. The study indicated the Hospital's experience of leadership and participation, supporting and facilitating, system establishment, and culture creation. The suggestion included keeping staff engaged under a positive safety and health culture, promoting recognition of HealthWISE among public health institutions nationwide, developing online courses for medical colleges, focusing on the alignment among various law systems, and adopting measures under the principle of the hierarchy of occupational hazards controls. This study has demonstrated the systematic improvement of occupational health for HWs by HealthWISE implementation in the Chinese hospital. The valuable experiences and lessons derived here can be shared with other hospitals in China and beyond, especially under the unprecedented challenges of the COVID-19 pandemic, to achieve the goals of safety, health, and well-being for HWs by building a resilient health system.

Patient-centred care and patient autonomy: doctors\u2019 views in Chinese hospitals

BackgroundPatient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care among doctors in the Chinese public hospitals.MethodsA quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China.ResultsIn total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes.ConclusionThe study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals.

Association of sleep disturbance with shift work, occupational stress, and musculoskeletal pain in Chinese public hospital emergency workers: A multicentre cross-sectional study

ABSTRACT Poor sleep, which is reportedly prevalent among healthcare professionals, could lead to various detrimental consequences. This study aimed to investigate the sleep quality of individuals working in emergency departments of public hospitals in China and explore the potential factors influencing sleep disturbance. A self-administered questionnaire was completed by 7688 emergency workers from 147 public hospitals in Shandong, China. Log-binomial regression analysis was performed to explore the relationship of sleep disturbance with possible influencing factors, including individual and work characteristics, occupational stress, shift work, and musculoskeletal pain. The participants’ mean Pittsburgh Sleep Quality Index score was 9.6 ± 4.8, with 5341 (69.5%, 68.2–70.7%) of them experiencing sleep disturbance. The sleep quality was poorer in doctors (10.2 ± 5.1, 71.0%, 69.0–73.0%) than in nurses (9.2 ± 4.5, 68.6%, 67.0–70.1%), and poorer in those working in secondary (9.9 ± 4.5, 70.2%, 68.0–72.3%) and tertiary (12.2 ± 4.9, 77.5%, 75.3–79.7%) hospitals than in primary hospitals (8.0 ± 4.1, 64.6%, 62.6–66.6%). High prevalence of sleep disturbance was significantly associated with shift work, occupational stress, musculoskeletal pain, fewer breaks in a work shift, and less exercise during leisure time, after adjusting for confounding variables. Sleep disturbance occurred in emergency workers in the following order: two-shift rotation > three-shift rotation > permanent night shift > permanent day shift. Emergency workers in public hospitals in China had poor sleep quality and commonly experienced musculoskeletal pain. Urgent and comprehensive measures are needed to combat these issues.

Impact on decision making framework for medicine purchasing in Chinese public hospital decision-making: determining the value of five dipeptidyl peptidase 4 (DPP-4) inhibitors

BackgroundMedicine purchasing in Chinese public hospitals is decided by the hospital Pharmacy Management Committee (PMC), that is complex, subjective and requires efficient approaches to ensure transparency and consistency for the factors being considered. This study aimed to use the Evidence and Value: Impact on Decision Making (EVIDEM) framework to assess medicine in these hospitals. In this study anti-diabetic drugs DPP-4 inhibitors, which work by inhibiting the activation of the Dipeptidyl Peptidase 4 (DPP-4) inhibitors, were appraised.MethodsFollowing EVIDEM methodology (EVIDEM-10th), we convened an appraisal group and asked each individual to express their perspectives by assigning weights to each criterion. A systematic literature search for information of each criterion of five DPP-4 inhibitors was completed. Then the appraisal group scored for each criterion of the five DPP-4 inhibitors. The estimated value of the five DPP-4 inhibitors was obtained by Multi-Criteria Decision Analysis (MCDA) which combined individual weighting of each criterion with individual scoring for each intervention in each criterion.ResultsBy assigning weights, the most important criterion was the quality of evidence (4.01±0.52), and that the comparative cost consequences-non-medical cost was the least important criterion (2.87±1.03). Criteria included disease severity, size of the affected population, comparative effectiveness, type of therapeutic/preventive benefit and cost of intervention, all of which were assigned the same weight of 3.58. After MCDA, the overall value orders for each DPP-4 inhibitor included Sitagliptin (0.45), Linagliptin (0.44), Vildagliptin (0.43), Alogliptin (0.42) and Saxagliptin (0.40).ConclusionsBased on EVIDEM framework and MCDA, we found that overall value of five DPP-4 inhibitors was similar. It is feasible to use the EVIDEM framework and MCDA in purchasing medicine for Chinese public hospitals.

High-performance work systems, multiple commitments, and knowledge exchange and combination among Chinese public hospital nurses.

AimThis research explores and examines the differentiated mediation roles of multi‐foci commitment in the relationship between HPWS and knowledge exchange and combination among Chinese hospital nurses.DesignThis study employs a quantitative research approach and survey design.MethodsIndividual‐level time‐lagged data were collected from 845 nurses in public hospitals in China using online questionnaires. Aside from personal information, the items in the questionnaires were adopted from mature scales in previous research.ResultsThe results of multiple regression analysis demonstrate that nurses’ professional and affective commitments partially mediate the relationship between HPWS and KEC. Nurses’ continuance commitment does not play a mediation role in HPWS‐KEC relationship, although HPWS positively influences nurse continuance commitment, which then weakly and positively impacts KEC.

Exploring the doctor-patient relationship as a challenge job demand: application of the job demands–resources model in a Chinese public hospital

ABSTRACT In the increasingly commercialized healthcare environment in China, doctor-patient relationship (DPR) is a job demand for doctors that is linked to various motivational outcomes. Drawing on the Job Demands–Resources (JD-R) model, and the conservation of resources theory, we develop a preliminary conceptual model that links Leader Member Exchange (LMX) as a job resource, and DPR as a challenge job demand, to the levels of work engagement and turnover intentions of doctors working in this healthcare environment. Using two-wave data collected from 381 doctors in a public hospital, we found support for the hypothesized model. Results of a series of SEM analyses revealed that LMX was positively related to DPR and work engagement, while DPR partially mediates the path from LMX to work engagement. In addition, LMX is negatively related to turnover intentions through DPR and subsequently work engagement. Theoretically, this study contributes to the development of the JD-R model by investigating the concept of challenge job demand, and its role in the motivational process, with new evidence from healthcare occupations in China. Practically, this study contributes to the limited number of studies on managing the changing nature of the DPR in China, and in seeking potential solutions based on established organizational constructs.

Patient satisfaction with non-clinical nursing care provided by the nursing assistant under different management models in Chinese public tertiary hospital

BackgroundThere are disparities of in-hospital non-clinical nursing care delivered by the nursing assistant under different management models in China. This study aimed to identify the best management model of the nursing assistant from the patient perspective. MethodsThis is a cross-sectional study. The inpatient satisfaction with in-hospital non-clinical nursing care delivered by the nursing assistant under different management models was measured and analyzed based on a national inpatient survey Likert the 5-point scale questionnaire conducted in 144 public tertiary hospitals across 31 provinces of China. The study conducted univariate analysis and binary Logistic regression analysis to examine which management model of the nursing assistant and any other key determinants would lead to a positive satisfaction rating by the inpatient who experienced non-clinical nursing care. FindingsThe overall satisfaction rating of 6211 inpatients received non-clinical nursing care was 4.73 out of 5, among which 96.09% of the responded inpatients had a positive satisfaction rating. By controlling of the other variables, the likelihood of having a positive inpatient satisfaction rating of non-clinical nursing care delivered by the nursing assistant under the direct commercial company management model, the self-employed model, the commercial company and hospital joint management model accounted for only 14.8%, 20.3% and 35.7% of the nursing assistant under the direct hospital management model. ConclusionsThe direct hospital management model of the nursing assistant might be the best one to deliver the non-clinical nursing care that mostly satisfied the inpatient of Chinese public hospitals.

Association of Hospital-Level Differences in Care With Outcomes Among Patients With Acute ST-Segment Elevation Myocardial Infarction in China

The incidence of acute myocardial infarction has increased over the past decades in China, and management challenges include an unbalanced economy, disparate resources, and variable access to medical care across the nation. To examine the variations in care and outcomes of patients with ST-segment elevation myocardial infarction among 3 levels of hospitals in the typical Chinese public hospital model. This cross-sectional study used data from the China Acute Myocardial Infarction Registry to compare the differences in care and outcomes among patients at 108 hospitals from 31 provinces and municipalities throughout mainland China. Participants included patients with ST-segment elevation myocardial infarction directly admitted to hospitals between January 2013 and September 2014. Data analyses were performed from June 2015 to June 2019. Care in province-level, prefecture-level, or county-level hospitals in China. The primary outcome was in-hospital mortality. Secondary outcomes included presentation, treatments, and major complications. A total of 12 695 patients (9593 men [75.6%]; median [interquartile range] age, 63 [54-72] years) were included; 3985 were at province-level hospitals, 6731 were at prefecture-level hospitals, and 1979 were at county-level hospitals. Compared with patients admitted to province-level hospitals, those admitted to prefecture-level and county-level hospitals were older (median [interquartile range] age, 61 [52-70] years vs 63 [54-72] years and 65 [57-75] years) and more likely to be women (815 women [20.5%] vs 1620 women [24.1%] and 667 women [33.7%]). Patients in prefecture-level and county-level hospitals were less likely to use ambulances compared with patients at province-level hospitals (11.6% [95% CI, 10.8%-12.4%] and 12.0% [95% CI, 10.6%-13.5%] vs 19.4% [95% CI, 18.1%-20.7%]; P < .001) and were less likely to experience early presentation, with onset-to-arrival times less than 12 hours for 75.3% (95% CI, 73.9%-76.6%) of patients at province-level hospitals, 70.8% (95% CI, 69.7%-71.9%) of patients at prefecture-level hospitals, and 69.8% (95% CI, 67.7%-71.8%) of patients at county-level hospitals (P < .001). The rates of reperfusion therapy were significantly lower in low-level hospitals (54.3% [95% CI, 53.1%-55.5%] for prefecture-level hospitals and 45.8% [95% CI, 43.6%-48.1%] for county-level hospitals) compared with province-level hospitals (69.4% [95% CI, 67.9%-70.8%]; P < .001). There was a progressively higher rate of in-hospital mortality at the 3 levels of hospitals: 3.1% (95% CI, 2.6%-3.7%) for province-level hospitals, 5.3% (95% CI, 4.8%-5.9%) for prefecture-level hospitals, and 10.2% (95% CI, 8.9%-11.7%) for county-level hospitals (P for trend < .001). After adjustment for patient characteristics, presentation, hospital facility, and treatments, the odds of death remained higher in prefecture-level (odds ratio, 1.39 [95% CI, 1.06-1.84]) and county-level (odds ratio, 1.43 [95% CI, 0.97-2.11]) hospitals compared with province-level hospitals (P for trend = .04). These findings suggest that there are significant variations in care and outcomes of patients among the 3 levels of hospitals in China. More efforts should be made to address the identified gaps, particularly in the prefecture-level and county-level hospitals. This work can inform national quality improvements efforts in China and in other developing countries.

A Call for Leadership and Management Competency Development for Directors of Medical Services-Evidence from the Chinese Public Hospital System.

Background: A competent medical leadership and management workforce is key to the effectiveness and efficiency of health service provision and to leading and managing the health system reform agenda in China. However, the traditional recruitment and promotion approach of relying on clinical performance and seniority provides limited incentive for competency development and improvement. Methods: A three-component survey including the use of a validated management competency assessment tool was conducted with Directors of Medical Services (n = 143) and Deputy Directors of Medical Services (n = 152) from three categories of hospital in Jinan, Shandong Province, China. Results: The survey identified the inadequacy of formal and informal management training received by hospital medical leaders before commencing their management positions and confirms that the low self-perceived competency level across two medical management level and three hospitals was beyond acceptable. The study also indicates that the informal and formal education provided to Chinese medical leaders have not been effective in developing the required management competencies. Conclusions: The study suggests two system level approaches (health and higher education systems) and one organization level approach to formulate overall medical leadership and management workforce development strategies to encourages continuous management competency development and self-improvement among clinical leaders in China.

Effect of public hospital managers\u2019 risk and gain perception on their attitude towards physician dual practice: a cross-national study in 31 provinces of China

BackgroundThis study aims to explore the effect of public hospital managers’ risk and gain perception on their attitude towards physician dual practice (PDP).MethodsA cross-sectional study enrolling 1513 managers from public hospitals in the East, Middle and West of China was conducted. Generalized linear mixed models (GLMM) were used to identify the determinants of managers’ support for PDP.ResultsThe rate of managers’ support for allowing PDP or implementing PDP with restriction, was 94.3% (95% CI: 0.93, 0.95). The mean score of managers’ risk perception was 67.7 ± 14.46, and the mean score of managers’ gain perception was 24.0 ± 5.56. After controlling for individual and institutional characteristics, the GLMM presented the score for risk perception increased 1 score and the rate of managers’ support for PDP decreased by 5% (OR = 0.95, 95% CI: 0.93, 0.97); while the score for gain perception increased 1 score and the rate of managers’ support increased by 18% (OR = 1.18, 95% CI: 1.12, 1.24).ConclusionsOur data demonstrate that the majority of Chinese public hospital managers are in favor of allowing or implementing PDP with restrictions. Although gain perception is comparatively weaker than risk perception, a stronger influence in determining public hospital managers’ support for PDP is demonstrated.

Impact of a management innovation on professional subcultures – the case of a balanced scorecard implementation in a Chinese hospital

Purpose The balanced scorecard (BSC) has been a popular management innovation in health care. Implementing an innovation like the BSC can change the professional subcultures of a hospital. The purpose of this paper is to measure subcultures to establish the level of change during the implementation of a management innovation in a single Chinese public hospital. Design/methodology/approach Four surveys were administered to the staff of a single hospital, and a 100,000-word research diary was compiled from observation of the research process. A longitudinal case study design was administered from 2006 to 2009. The competing values tool was administered twice to assess organizational cultural change. Findings There was a change in the culture of different professional groups. The group with the strongest dominating culture type, which relies on cohesion, morale and employee participation in decision-making, shows the most positive change in cultural types during the BSC implementation process. Management innovations such as the BSC can create more balance in each professional group. Practical implications The successful implementation of a management innovation in a hospital requires the managers to consider meeting the demand of medical professional groups and achieve desired culture type change, which in turn may help to achieve the expected results. Originality/value This paper provides support to the finding that groups with a dominant group culture are more receptive to change and implementing a management innovation can influence professional group’s culture. It also provides evidence that the implementation of BSC can create more balance in each professional group’s culture. Although these findings come from health care, it may have relevance to other contexts in China.

Managing patients’ no-show behaviour to improve the sustainability of hospital appointment systems: Exploring the conscious and unconscious determinants of no-show behaviour

A hospital appointment system promotes information exchange between hospitals and patients. Because patients’ no-show behaviour wastes medical resources and compromises the sustainability of medical services, it is of utmost importance to expound no-show behaviour and its determinants. From a multi-stage perspective, we identify channel convenience, waiting time, and expected technical quality as conscious determinants and no-show habit as an unconscious determinant and propose a model for analysing patients’ no-show behaviour. The proposed hypotheses are examined with data collected from a Chinese tertiary care public hospital’s appointment system by binary logistic regression. The results show that channel convenience and expected technical quality are negatively related to no-show behaviour whereas the effects of waiting time and no-show habit on no-show behaviour are significantly positive. Meanwhile, the relationship between no-show habit and no-show behaviour is stronger for shorter waiting time or higher levels of channel convenience and expected technical quality. Our findings have implications for managing patients’ no-show behaviour, improving hospital appointment system management, and providing sustainable medical services.

Data-Driven Models for Capacity Allocation of Inpatient Beds in a Chinese Public Hospital.

Hospital beds are a critical but limited resource shared between distinct classes of elective patients. Urgent elective patients are more sensitive to delays and should be treated immediately, whereas regular patients can wait for an extended time. Public hospitals in countries like China need to maximize their revenue and at the same time equitably allocate their limited bed capacity between distinct patient classes. Consequently, hospital bed managers are under great pressure to optimally allocate the available bed capacity to all classes of patients, particularly considering random patient arrivals and the length of patient stay. To address the difficulties, we propose data-driven stochastic optimization models that can directly utilize historical observations and feature data of capacity and demand. First, we propose a single-period model assuming known capacity; since it recovers and improves the current decision-making process, it may be deployed immediately. We develop a nonparametric kernel optimization method and demonstrate that an optimal allocation can be effectively obtained with one year's data. Next, we consider the dynamic transition of system state and extend the study to a multiperiod model that allows random capacity; this further brings in substantial improvement. Sensitivity analysis also offers interesting managerial insights. For example, it is optimal to allocate more beds to urgent patients on Mondays and Thursdays than on other weekdays; this is in sharp contrast to the current myopic practice.

Inpatient bed allocation policy under uncertain capacity

This paper concerns the problem of inpatient bed allocation for two classes of patients (scheduled and non-scheduled) when there is uncertainty about daily available capacity. In the afternoon of each day, patients from the scheduled class, also called backlogged elective admissions, are selected from a waiting list, for the admission on the next day. The non-scheduled class, also called emergent admissions, are new requests that arise randomly each day with emergent needs. The capacity of available beds for a medical specialty to provide hospitalization services is uncertain when backlogged elective patients are chosen. Admitting too many of elective patients may result in exceeding a day’s capacity, which can potentially necessitate “overflowing” or “postponing” some emergent requests that should be performed as soon as possible. Therefore, the problem faced by the medical specialty facility at the decision-making point of each day is how many of the backlogged elective patients can be admitted. We formulate this problem as a Markov decision process (MDP) and study the structural properties of the model to characterize the nature of the optimal policy. We propose easy-to-implement policies (the fixed quota policy and the best fixed quota policy), which perform well under fitted distributions. By reporting numerical analyses using real data from a Chinese public hospital, we finally compare the improvements that our proposed solutions could bring to the hospital with the existing practices under several different cost structures.

Resource Crafting: Is It Really 'Resource' Crafting-Or Just Crafting?

This study aims to provide an integrated perspective on job crafting and its antecedents through the exploration of the joint effects of individual-level and team-level job crafting on employee work engagement. Drawing on conservation of resources (COR) theory, we propose that engaging in job crafting behaviors is promoted by the presence of job-related resources. In turn, job crafting is expected to result in higher levels of work engagement. We expect this reasoning to hold for the individual as well as the team/collective levels. The hypotheses were tested using data from 287 medical professionals from 21 hospital units of a Chinese public hospital. Findings from two-level Bayesian structural equation modeling supported the idea that at the individual level, individual job crafting behaviors partially mediated the relationship from individual resources to individual work engagement. Further, collective crafting mediated the relationship from team resources to individual work engagement. In addition, a positive cross-level relation between collective crafting and individual crafting was found. We conclude that stimulated by resources, both job crafting processes at the individual-level and team-level can promote individual work engagement in Chinese employees.

A hybrid multi-criteria decision making model for elective admission control in a Chinese public hospital

In healthcare service systems, patients are not always served in the order they arrive, but are ranked with respect to their relative “importance” and “urgency” to the service system. We consider such a system where elective admission requests backlogged on a list wait to be assigned inpatient beds. To consolidate the performance of Classified Diagnose and Treatment in China, determining an optimal admission priority assignment policy for all waiting patients is vital. It is a complicated multi-criteria decision making (MCDM) problem involving both qualitative and quantitative criteria. Evaluating the admission priority of each patient is based on vague information or uncertain data in which significant dependence and feedback between the evaluation dimensions and criteria may exist. This paper applies a hybrid MCDM model that integrates the 2-tuple DEMATEL technique and the fuzzy VIKOR method to the elective admission control problem. It makes use of the modified 2-tuple DEMATEL to determine the relative weights of the evaluation criteria and the fuzzy VIKOR method to assess the alternatives (waiting patients) over the criteria. An empirical case in West China Hospital is presented to demonstrate the applicability of the proposed approach. Sensitivity analysis of the results by the proposed hybrid MCDM model and comparative analysis with other different approaches are presented. The results show that the proposed model is effective and provides insightful implications for hospital managers to refer.

Prioritizing the elective surgery patient admission in a Chinese public tertiary hospital using the hesitant fuzzy linguistic ORESTE method

In public health systems around the world, there are not enough medical resources to provide elective (e.g., scheduled or non-emergency) services for all patients immediately. One feasible solution is to prioritize patients by taking into account a variety of factors, such as disease severity, waiting time, and disease types. This is a typical Multiple Criteria Decision Making (MCDM) problem. To solve this problem, in this paper, we first conduct an investigation on the admission process, and obtain 16 indicators affecting patients’ admission, which form a criteria system. Since there is much vague and uncertain information which can be depicted by the hesitant fuzzy linguistic term set effectively for these indicators, we then apply a powerful MCDM method, named the hesitant fuzzy linguistic ORESTE, to prioritize the elective surgery patient admission in a Chinese public tertiary hospital, the West China Hospital. Robust results are obtained by performing a sensitivity analysis with six scenarios. We also compare the results with those derived by other HFL-MCDM methods. It is illustrated that the hesitant fuzzy linguistic ORESTE can help hospitals flexibly manage the patient admissions.

Establishing Appropriate Agency Relationships for Providers in China.

Physicians play multiple roles in a health system. They typically serve simultaneously as the agent for patients, for insurers, for their own medical practices, and for the hospital facilities where they practice. Theoretical and empirical results have demonstrated that financial relations among these different stakeholders can affect clinical outcomes as well as the efficiency and quality of care. What are the physicians’ roles as the agents of Chinese patients? The marketization approach of China’s economic reforms since 1978 has made hospitals and physicians profit-driven. Such profit-driven behavior and the financial tie between hospitals and physicians have in turn made physicians more the agents of hospitals rather than of their patients. While this commentary acknowledges physicians’ ethics and their dedication to their patients, it argues that the current physician agency relation in China has created barriers to achieving some of the central goals of current provider-side health care reform efforts. In addition to eliminating existing perverse financial incentives for both hospitals and physicians, the need for which is already agreed upon by numerous scholars, we argue that the success of the ongoing Chinese public hospital reform and of overall health care reform also relies on establishing appropriate physician-hospital agency relations. This commentary proposes 2 essential steps to establish such physician-hospital agency relations: (1) minimize financial ties between senior physicians and tertiary-level public hospitals by establishing a separate reimbursement system for senior physicians, and (2) establishing a comprehensive physician professionalism system underwritten by the Chinese government, professional physician associations, and major health care facilities as well as by physician leadership representatives. Neither of these suggestions is addressed adequately in current health care reform activities.