| [Background]With the development of Chinese health care reform, starting from organizational culture construction to enhance hospital inner sustainable improvement and alleviate doctor-patient conflict, it has already become an important way for governmental hospitals to pursue their own long-term development. "Scientific management, culture goes first" has become a common consensus. While traditional hospital cultures include superiority cultures and inferior ones, pre-eminent cultures and minority ones. Only the culture that matches the hospital strategy harmoniously can lead the hospital to the road of sustainable development and promote the hospital to realize the hospital's strategic goals. Therefore, it is very significant to clarify the correlative mechanism of hospital strategy orientation and organizational culture.Constructing hospital culture is to serve hospital strategic objectives, but it is ultimately reflected by hospital performances. The domestic and international researches indicated that hospital culture is associated with hospital performance. But specifically, which hospital culture dimensions have influenced on hospital performances? Is there any interaction among hospital culture and other factors which have impact on hospital performance? It has a positive significance to specify the mechanism of how hospital culture effect hospital performances.[Purpose]The purpose of this study is to investigate the correlative mechanism among hospital strategy orientation, organizational culture and hospital performances of governmental hospitals in China. We intended to provide a theoretical reference for promoting the development of public hospital modern management.[Contents]1. We studied on the types of hospital strategy orientation on base of the main component parts of the strategy content and analyzed the characteristics of different type according to the current situation of governmental hospital strategy orientation.2. Based on the corporate culture model of Denison, combining features of governmental hospitals in our country, we developed the hospital culture scale which applied to the governmental general hospitals of our country. We tested the validity and reliability of the scale through empirical research data and used the scale to analyze the characteristics of the governmental general hospitals of different levels or in different regions of China.3. Upon the theoretical model of the Balanced Score Card, we investigated the governmental hospital performances of different levels through analyzing the four aspects involving learning and growth, internal operational process, customers and financing situation. Moreover, we also studied the development and improvement of hospital performances including hospital medical services, health care quality, medical education and researching, market share increase and so on in the past 10 years.4. We analyzed the difference of the hospital culture, of the current hospital performances and the development of hospital performances among the various types of hospital strategic orientation. Under the same strategic orientation, we investigated whether different hospital culture dimension has various impact on diverse aspect of hospital performances. And with the similar hospital culture, we studied whether different hospital strategic orientation would lead different hospital performances.[Methods]1. In this study, we organized expert consultation meetings for twice. The first time, we invited eight experts who were health administrators, hospital managers, specialists and scholars in health management field to comment all the kinds of questionnaire drafts. The second time, we invited ten hospital senior managers and scholars in relevant areas to review the initially constructed correlative mechanism among hospital strategic orientation, organizational culture and performances.2. According to the general hospitals, health centers and community health service centers, the study reviewed the 2006-2008 Chinese Health Statistics Yearbooks, collected series of healthcare data of the surveyed provinces / municipalities so as to balance regional differences of the same level hospital performances.3. This study collected the basic information of those investigated hospitals from the year 2006 to 2008, including beds, personnel situation, fixed assets, healthcare service status, medical education and researching, financing situation and so on, in order to analyze the status of hospitals'performances.4. For every investigated hospital, one of leaders was surveyed to collect such information as the scale of hospital development, business situation, the general strategic orientation and main significant actions during the past 10 years. Upon these information, we explored to generalize the types of the governmental hospital strategic orientation.5. With the anonymous questionnaire, we surveyed hospital staff to get the information about the status of hospital culture and staff satisfaction. Among the second and tertiary governmental hospitals, we randomly sampled 10% of managers (at least 10 managers),10% of on-the-job physicians, nurses and medical technicians (at least 30 persons). Among the primary hospitals, we randomly sampled 50% of managers,10 of physicians,5 of nurses and 5 of medical technicians (if the number of all staff is less than 20, all the persons were surveyed.).6. In this investigation,50 outpatients and 50 inpatients were randomly surveyed for each hospital with the anonymous questionnaire to collect the information on patient satisfaction on medical services of healthcare providers, healthcare quality and efficiency, etc.7. Analysis methods:(1) Cluster Analysis:R-type analysis was employed to integrate the evaluation indicators of the strategic positioning; Q-type analysis was used to classify and sum up the strategic position status of the investigated hospitals, in order to distinguish the types of strategic positioning.(2) Scale Reliability and Validity Test: This study calculated the Cronbach's a coefficient and the split-half reliability coefficient to analyze internal consistency of total scale and subscales. Validity analysis of the scale was conducted with three aspects which involved content validity, construct validity and interactive validity. For construct validity analysis, confirmatory factor analysis (CFA) was used to calculate the goodness-of-fit test for the scale model. Interactive validity was used to test for partial invariance of scale model among different samples. The study used software AMOS17.0 for scale modeling construction and testing.(3) Hierarchical Linear Model was used to analyze the impacts of different hospital strategic orientation, different hospitals culture on staff satisfaction and patient satisfaction. And we also studied the impacts of hospital level explanatory variables and personal level explanatory variables on response variables, and analyzed the interaction between the hospital level and individual level explanatory variables.[Findings]1. Based on the main component factors of strategy content, the study have summarized 5 types of the current strategy positioning of governmental general hospitals using cluster analysis.2. Upon the organizational culture model of Denison, combining with the features of governmental general hospitals in China, we have developed a hospital culture scale with totally 13 dimensions and 73 questions through expert consultation, pretest survey and formal investigation in three provinces / municipalities. The investigation indicated that the scale had good reliability and validity.3. Findings showed that the three culture dimensions of'system culture','sense of competition'and'sense of social responsibility'scored highest; the culture dimensions of'authorization','coordination of organization'scored lowest. There is no significant difference on hospital culture among different regions and different levels.4. Findings showed that there were significant differences on the doctor-nurse ratio, the proportion of physicians with postgraduate degree, the proportion of physicians with junior or senior job titles, the conformity rate of the admission and discharge diagnosis, the average length of stay and other 10 indicators among different levels of hospitals (p<0.05). Over the past 10 years, the hospital development displayed there were significant differences on'types of healthcare services','researching quality','number of research projects','volume of Hospital medical services','volume of surgery'among different levels of hospitals(p<0.05).5. The size expansion and the development of healthcare services in various hospitals with different type of strategic positioning were significantly different during past 10 years (p<0.05). Hierarchical Linear Model analysis showed that diverse hospital culture dimension had a distinct significant impact on staff job satisfaction, payment satisfaction, satisfaction on organizational climate, satisfaction on the hospital development of the past five years, and staff confidence on hospital future. We also found that for the hospitals with higher'sense of social responsibility' and'sense of competition', the patient satisfaction on medical services of healthcare providers, on healthcare quality, on medical service efficiency were better.
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