Analyzing The Governance Structure Of Public Hospitals In Shanghai

[Background]As one of the central parts of healthcare reform in China, public hospital reform is to address the public complaints of the high cost and limited access to medical service. Improving the governance mode and reforming the operation mechanism in public hospitals are the keys of public hospital reform in China, but its process is difficult. As a large city and municipality directly under the central government, Shanghai has its particularities in public hospital reform. How to implement the public hospital reform in Shanghai on the basis of its situation is the urgent issue.[Purpose]This study aims at reviewing the governance theories and the reform experience in public hospital governance, describing the duties and powers of different governance structures of public hospitals in Shanghai, evaluating the performance of public hospitals with different governance modes in Shanghai in order to provide the information for policy making on public hospital reform in Shanghai and to provide the recommendations for nationwide public hospital reform.[Contents]The research content of this study includes:1. Review of the theories of governace modes in public hospitalsThe study systematically reviewed the governance theories, described the category and characteristics of the governance modes in public hospitals at home and abroad, and introduced the evolution process of governace modes in public hospitals of China.2. Empirical study of the governance modes in public hospitals of ShanghaiIn the empirical study, the author analyzed the external and internal environment that may influence the the governance structure of public hospitals in Shanghai, described the characteristics of different governance modes of public hospitals in Shanghai, and demonstrated the performance of the public hospitals with different modes. [Methods]1. Reference review and existing data collectionReference review in the study was made to get the information on the governance theories and on the related health policies of Ministry of Health of China and Shanghai government. Existing data were collected from the statistical yearbooks, the health statistical yearbooks of Shanghai, and Shanghai Municipal Health Bureau to get the data related to health care and the performace of public hospitals in Shanghai.2. Key informant interviewThirteen key informants from Shanghai Municipal Health Bureau, a district health bureau, Shanghai Shenkang Hospital Development Center and hospital managers were interviewed with semi-structure outlines, in order to get their viewpoints on the current governance modes of public hospitals and their advices about how to improve it.3. Questionnaire surveyThe abover informants were also asked to complete a questionnaire about the governance mode of public hospitals.4. Public hospital surveyIn addition, a hospital survey was made in nine public general hospitals, including three tertiary general hospitals subordinated to Shanghai Shenkang Hospital Development Center, two tertiary general hospitals subordinated to Minister of Health and four secondary general hospitals subordinated to district bureaus of Shanghai. The governance structures of these public hospitals represent the typical governance modes in Shanghai. The questionnaire contained the contents of the governance structure, duties and power, regulations and rules of public hospitals, the data on hospital manpower, medical care, education and research, performance in the years of2008and2010, and so others.5. Data analysesQualitative and quantitative analysis methods were used in the study. The statistical methods used in the study included mean, standard deviation, ANOVA, perentage, and χ2. All the quantitative data were analysed using SAS9.0.[Conclusions]1.They were the key in promoting the public hospital reform of improving the corporate governance mode in public hospitals and reforming the operation mechanism. The Primary task of the corporate governance mode in public hospitals were Clear defined goals,narrow scope,achievable targets and effective supervisory structure.In the study,we used PEST to analysis the External environment of Shanghai public hospital.The external environment had helped to promote the reform of public hospital.but there still had challenge.2.A variety of governance modes of public hospitals existed in Shanghai, including Shenkang mode, Fudan mode and the district management mode. Because of the difference in the governance power scope, the hospitals with Shenkang mode were more controlled by their governance body-Shanghai Shenkang Hospital Development Center, while the hospitals with Fudan mode were under weaker external control than the other two.3.The duties and power structure were different among three different governance modes.Although,Shanghai Municipal Health Bureau and district health bureau had the industry the management function, the duties of Shenkang were almost the same as and the duties of the district health bureau.the duties of fudan university only were determining the strategic planning and supervision of medical quality and safety.the director of hospital had the duty to determine the strategic planning, establish and perfect the system of hospital organization and manage the hospital.It was very important to research making the director of hospital to have the legal person status and power4.Overwhelming advantages had not been detected in any one of the three governace modes. It implies that not only the governance structure but also other factors affact the performance of public hospitals. Whatever the governance modes, the governance elements should be emphasized, such as duty, power, personnel quality, regulations, the linkage between each layer of the management structure, regulatory measurement and implement efforts.[Suggestions]The reform of the governance structure in public hospitals in Shanghai should be focused on the core elements of the governance structure of public hospitals rather than the superficial layout. It is very important to clarify the duties and powers of the owners, governers, and operators of public hospitals and to correlate the duties with powers. Four measurements are recommended to promote the reform on the governance structure of public hospitals. First of all, more financial input is indispensible for public hospitals to take social responsibilites. The governmental duties and powers of surpervising public hospitals in China should be integrated rather than dispersed in different departments of the government. Furthermore, it is needed to clarify the rights and obligations between the government and hospitals. Last but not the least, the presidents of public hospitals should be given more autonomy in decision making in operational management.