Study On Definition Of Social Responsibility And Dynamic Mechanism Of Public Hospitals

[Purpose]The study tried to explore social responsibility of public hospitals in the framework of social responsibility and find out effective means to rectify the certain anomie behaviors of public hospitals.The purpose of this study were as following.Firstly,we tried to define the nature and types of social responsibility of public hospitals.Secondly,we constructed the social responsibility dynamic model of public hospitals.Thirdly,we explored the status of social responsibility performance and driving force in tertiary public hospitals.Finally,we put forward the pathways to optimize social responsibility in public hospitals.[Methods]1.Literature research.Journals and papers were collected mainly through CNKI,Wanfang database,VIP,web of Science,Pubmed and other databases in both Chinese and English;yearbooks,policy information,statistical reports were collected through national bureau of statistics and health departments at all levels.2.Field investigation method(1)Semi-structured interviews.We invited 10 interviewees,including head of the administrative department,dean of tertiary public hospitals and primary medical institutions,as well as scholars to join in the study.The topics of interview referred to whether the public hospital should undertake the social responsibility,and the source of social responsibility of the public hospitals.(2)Expert consultation.10 experts scored the ability and willingness of tertiary public hospitals to fulfill social responsibility,and finally determined the types of social responsibility of public hospitals.(3)Questionnaire survey.One was the survey of 106 medical staff in a hospital affiliated to Guangzhou Medical University.The survey content was the score of the motivation of public hospitals to fulfill social responsibility.The second was a patient survey.A total of 561 outpatients and inpatients were randomly selected from two tertiary hospitals.The survey included medical experience,whether they encountered unnecessary tests or expensive drugs during the process of medical treatment;cognition and evaluation of excessive medical treatment.(4)Typical case analysis: three affiliated hospitals of a medical university were selected to collect the materials for completing governmental mandatory tasks,medical education,scientific research and other positive external activities.3.Second-hand data analysis.Longitudinal and cross-sectional data such as China Health Statistics Yearbook,National Medical Service and Quality Safety Report and Statistical Bulletin over the years were selected for analysis the trend of government investment in public hospitals and the medical service quality of public hospitals.4.The data analysis method.We applied Nvivo12 software for processing the qualitative data in this paper,and the main method was content analysis and grounded theory coding.SPSS19.0 was used for statistical analysis dealing with quantitative data.General descriptive statistics,principal component analysis and binary Logistic regression analysis were used in this study.[Results]1.The grounded theory result was as following.The essence of public hospitals was that the government ran medical institutions to provide medical services,which was one of the forms for the government to fulfill its responsibility in the medical field.The social responsibility of public hospital's was to assume its role responsibility.2.According to should-capacity-willingness three-dimensional model,the social responsibility of public hospitals should also consider capacity boundaries and willingness of hospitals to undertake.Therefore,on the basis of social responsibility(role/should),according to the standard of the capability and willingness rating?3,this paper divided the social responsibility of public hospitals into four categories containing capacity-support,willingness-support,fully-support and non-support.3.According to the internal and external driving forces and explicit/implicit binding force formed by social responsibility,the motivation of public hospitals to fulfill social responsibility came from four aspects.17 driving factors of social responsibility of public hospitals were summarized,and principal component analysis was conducted on the driving score data of 106 medical personnel.A total of 7 common factors were extracted.Results showed that the factors of the public hospital social responsibility were mainly composed of two sets of variables.External variables covered government investment and government guidance,laws and regulations,health policy,public supervision and professional supervision,patients' selection and satisfaction evaluation,as well as pressure from other hospitals.The internal motivation mainly included the characteristics of the medical service and the attributes of public hospitals,the moral motivation of hospital managers and staff,the image and brand of hospitals and the sustainable development of hospitals.4.The results of the empirical study on the tertiary public hospitals showed that the capacity-support social responsibility performed well.Willingness-support social responsibility was not satisfactory.Except for the excellent performance in medical research,the number of outpatient service provided by tertiary public hospitals has been on the rise,which was inconsistent with the policy of hierarchical diagnosis and treatment.Moreover,compared with tertiary private hospitals,the service quality of tertiary public hospitals has no obvious advantage.Questionnaire survey results of patients showed that excessive medical treatment was common in both outpatient and inpatient treatment activities,which indirectly confirmed the poor performance of non-supportive responsibility in controlling medical expenses.[Conclusions]1.The essence of public hospitals was the extension of government responsibility.With natural "altruism" and social benefits,which determines that the social responsibility of public hospitals was inseparable from its role positioning.However,the social responsibility of public hospitals was also limited by the capability and willingness of public hospitals to fulfill their responsibilities.Therefore,different types of social responsibility of public hospitals were formed,and the motivation of different types of social responsibility were different.2.Due to the increase of government investment and its clear guidance,as well as orientation of performance appraisal for personnel training and medical research,tertiary public hospitals performed well in fulfilling capacity-support social responsibility.However,because of insufficient supervision of medical insurance institutions,the superficial supervision from professional association and patients,the quality of medical service in tertiary public hospitals was not superior.In addition,because of the lack of awareness in image management and the weak moral motivation of hospital managers/staff,there was not enough intrinsic motivation for tertiary public hospitals to fulfill their social responsibilities.3.The optimization of social responsibility of public hospitals depended on promotion of internal and external forces.In terms of external force,a clear contract should be established between the government and public hospitals,as well as a sound "public contract" should be established with medical insurance institutions.Furthermore,public social information disclosure and supervision should be promoted.In terms of internal force,firstly we should balance the power structure of hospital internal governance.Secondly,reasonable performance assessment and incentive mechanism should be established.Stakeholders should form synergy to promote public hospitals to fulfill social responsibilities.[Innovation and Deficiency]Innovation1.Discussion the nature of social responsibility of public hospitals.This study started with the exploration of the nature of social responsibility.On the basis of in-depth interviews with experts,the grounded theory was adopted to refine the essence of social responsibility of public hospitals.2.We built public hospitals social responsibility model.We divided public hospitals responsibility into four types containing capability-support,willingness-support,fully-support and non-support.This classification provided a perspective for clarifying the boundary of social responsibility and motivation for implementation.3.Constructing the social responsibility dynamic model of public hospitals.The social responsibility dynamic factors of public hospitals were mainly composed of internal and external variables.According to the explicit binding force/implicit binding force and internal motivation,this paper analyzed the status of social responsibility fulfillment of public hospitals in China,and provided reference for the implementation of social responsibility of public hospitals.Deficiency1.This study classified the social responsibility of public hospitals according to the should-capability-willingness three-dimensional model,which had a strong researcher's perspective and needed further demonstration in the next study.2.This study discussed the implementation mechanism of social responsibility in public hospitals,analyzed the driving factors of social responsibility in public hospitals and expounds their interaction mechanism.However,due to the lack of public information data on social responsibility of public hospitals in China,it was difficult to dig into the detailed mechanism of action.