The Research On The Professionalization Of Hospital Director In Public Hostipal In China

ObjectivesPromoting the specialized and professionalized construction of hospital director is not only an important guarantee for the maintenance of public welfare in public hospitals, but also an important thrust of the deep reform in public hospitals. In intense medical market competition, the importance of hospital director of the public hospitals is increasingly prominent as key factors by grasping the mainstream of market competition and the activities directly involved in the operation and management. Hospital director's professionalism will have a direct impact on the economic and social benefits of the public hospitals, and even affect the future and destiny of the public hospitals. Professionalization of hospital director in Chinese Public hospitals becomes an inevitable choice. The practical experiences of the developed countries show the feasibility of the professionalization of hospital director, which we could learn for our practice. In this dissertation, the professionalization of hospital director of public hospitals was researched. Through research, it was expected to improve the theoretical system, analyze the macro-political environment of the reform in-depth, refine and dig the key sectors and factors which may block the reform. Meanwhile, it was expected to propose competency model of professionalized hospital director to build the institutional arrangements and support environment for the reform of the professionalization of hospital director of public hospitals, which conform China's national conditions, meet the reform needs of the professionalization.Methods:Theory discussion and demonstration research are the main methods in this article, combining with qualitative and quantitative study. At first, basing on a'great amount of documents, the article carries on documentary analysis, and combined many theories such as career theory, social role theory, governance theory etc to analysis the theories of professionalization reform of hospital director in public hospital. Secondly the author designs the research programme, did investigatigationg in 19 hospitals in Shandong province. Sample volume including 82 hospital directors and 595 middle managers.All data were input by SPSS 13.00. The article used some statistical analysis methods such as descriptive statistics, chi-squared analysis and logistic analysis. At last the article analysis the results of Key informan interview, also including some policy documents, gray literature, etc.Results1. Definition of professionalization of public hospital directorThe professionalization of the public hospital director is a combination of process and results. From the processes, reform of professionalization means reform of all angles of the career concept, career system, occupational environment, and professional team building, etc. to provide the driving force. From the results, professionalization means professionalized hospital director is accepted by law as an independent social career, and achieved gradually improved market of professionalize hospital, professionalization of hospital director's value-orientation, professionalized quality, market-oriented configuration, non-official identity, and social recognition.2. Categorization and design of social role of the professionalized hospital director The role of professional hospital director is usually from the interactive relationship with public hospitals, government departments, other social organizations, and the public. As a role model which can adapt to social expectations, role categorization must combine with the macro, meso and micro perspective, to define and identify the expected connotation of the new role from multi-dimensional relation, such as government and society, hospitals and individuals, etc. From the entire design, professionalized hospital director takes management as life-long career, which has strict market entry and exit rules, obtain the right to use the hospital legal property, manage hospital as the legal status of the operator, achieve economic efficiency of hospital and social objective through using his professional management skills.3. Analysis results of PEST1) Level of policy environment:The policy-oriented professionalization of public hospital in China shows a developmental from a general professionalized management of public health and hospital to the definite hospital director professionalization. The national relevant documents and policies provided policy guarantee for the reform. But the regardless of management and service, the traditional cadre and personnel system, the administration of public hospitals and the executive level of hospital director, etc. becomes political obstacles.2) Level of economic environment:Professionalization of hospital director can be promoted by market economic system environment, health market competition, etc., but the imperfections of professional managers market, and the intervention of managers market by government administrative may limit the progress of the reform.3) Level of social environment:Although the social acceptance of the professionalized hospital director is gradually increased, and the human environment of professionalization of hospital director is gradually established, the thinking of traditional hospital director still exists, and to some extent hindered the reform.4) Level of technical environment:It provided reference for China's reform by other industry professionalization reform and the practice of foreign hospital director professionalization, but it still lacks uniform requirements for professionalized hospital director in terms of access, selection and appointment, evaluation, exit mechanism, etc., currently.4. Analysis of individual factors in the reform of professionalization of public hospital directorAs the main sources of professionalized hospital director hospital director and middle managers team has some problems in their academic and degree. Many hospital director still stay in the experienced management levels,87.1% of respondents' management knowledge and skills derived from their work experiences, and they received training in an average of 2.06 times at their present management. Because hospital directors lack of professional management knowledge and skills, the affected degree of the reform of professionalization was 68.28 points.68 percent of those polled said that professionalization reform was necessary, but the lower scored the feasibility of reform (mean 57.96), of which under 60 points accounted for 64.2%. Regression analysis on the willingness of the professionalization showed that major personal influence factors including hospital level where the survey work at (OR=1.662, P=0.016), gender (OR=0.632, P=0.020), age (OR=0.632, P=0.020), judgment on the necessity of implementing the professionalize hospital director in China (OR=0.680, P=0.005), Personal judgment on the feasibility of reform (OR=1.663, P=0.000), extent of personal interest in full-time management (OR=0.370, P=0.000), and judgment on the suitability of their own personal capacity and personality meet to professionalized hospital director (OR=0.364, P=0.000).5. Analysis of structural factors in the reform of professionalization of public hospital directorIn this dissertation, structural factors are divided into three levels, government, markets and hospitals. In various enumerated structural factors which may impact the reform of the public hospital director professionalization, the average score of evaluation of impact extent was higher than 60 points. The average score of evaluation of the lack of management level and skill, as well as the lack of the health management personnel was relatively low. The current selection and appointment system on hospital director and the lack of the employing autonomy in hospitals get the highest score. The score of evaluation of the middle-level cadre impact on structural factors is higher than the hospital director. The regardless of management and service in hospitals and health administration departments has larger impact on the reform.30.5 percent of the anthropogenic impact has more than 80 points.6. Construction of the competency model framework of professionalized public hospital directorIn this study, the competency model framework of professionalized hospital director was constructed from two dimensions in reference competence and identifying competency. Reference competency includes four levels, essential management knowledge and skills, accumulation of professional experience, job input, and professionalism. Identifying competency includes three levels, the maintain ability of societies and groups, the ability of obtaining organizational goals, and special personality traits for excellent managers. In each level, it also contains a number of evaluated indexes.Suggestions:This dissertation systematically proposed the institutional arrangements and the support environment for our country's professionalization of public hospital director. Institution is the rules of conduct, and it is the formal constraints in more extent. In institution construction, those informal constraints can also be included in the areas of institution construction. Therefore, to achieve the reform of professionalized of the public hospital director, it should be done:1. Construction of institutional category system of professionalized public hospital director consists of three layers:the core is the institution device, followed by institutional arrangements, the most external institutional environment and institutional basis. It has mutual influence between the three levels. 2. Institutional basis of the professionalization reform of public hospital director includes political and economic foundation for professionalization reform, legal governance structure in public hospitals, related laws and regulations and market-oriented managers.3. Institutional arrangements for professionalized public hospital director:as a specific of professionalize system Institutional arrangements needs the supporting by the informal system in the implementation. Formal institutional arrangements include selection, evaluation, motivations and supervision system for professionalized hospital director. Informal institutional arrangements include creating a favorable public opinion, and building professionalized incentives organizational culture.4. Construction of supporting environment for professionalized of public hospital director:The construction of institution environment should proceed to the construction of institutional environment, social needs environment, legal environment, social security environment, occupational people birth environment, social credit environment and hospital professionalize environment.Innovation(1)Because there is lack of systematical research on the professionalization of public hospital director, so this article utllizes the theory of career theory, social role theory, and governance theory etc, based on the perspective of the hospital management innovation to make a systematical analysis. Definites of professionalization of public hospital director, discovers the different core work on different stage, digs the affect factors about individual and structure, and constructs the competency model framework of professionalized public hospital director.(2)The research bases on China state, it provides policy and practical support of how to guide the innovation of professionalization of public hospital director. Especially the research outcome of competency model and policy arrangement.Besides that, the article categorizes and design of social role of the professionalized hospital director.