| With the national "12th Five-Year Plan" and a new round of the health service reform, the regional health planning to solve social and expensive, medical care issues important pawn. Guidance has been published by Office of the State Council in2000, pointing on the urban medical and health system, to encourage the various medical institutions to merge, build medical service groups.The Hospital Group is the implementation of unified management by the same responsible person or group, liking the hospital medical services of groups, at the cradle of the United States in the early19th century. In China’s early days, hospital bed space shortage motivated the merger of small hospitals into higher level hospitals, as the form of the enlightenment of grouping mode in China. With the construction of an integrated health care services and health network in1993and2000, regional medical services information sharing platform, the Medical Group’s operating mode is becoming more and more unified, there has been more than100medical groups nationwide unified Regional health information organization (RHIO) mode in the United States. Some groups, such as the Mayo Clinic Group has become the giant of the American medical field. In1996, mature Medical Group, named the Nanjing Gu Lou Medical Group opened a chapter of the Chinese mode Hospital Group, followed by the different forms of hospital groups being established:the health of the Commonwealth in2009, and Obstetrics and Gynecology Hospital Association in 2010. Through the continuous accumulation of experience and management models, to date, the country has close to100run as the organization of the hospitals group, assembly. After20years reform and development, China’s hospitals Group has been changing the health care market structure, about one hundred groups in various forms has been established, becoming a big aircraft carrier in the medical market.This study, in the Group of61hospital management model Analysis, excludes the "branch" and "yard house" out of the "hospital group", with other grouping mode’s organizations included in a total of61hospital group in China, since1987. In addition, this research area hospital group concept with reference to regional planning program:set the center on or near the biggest or finest General Hospital, in the193km diameter range. This assembling of medical institutions of property rights, namely, can be described as a regional hospital group.Regional Hospital Group, a combination of Regional Health Planning and Hospital Grouping mode has respective advantages of the regional health planning that only based on health needs and health resources in the region, local materials, and the capacity of health services. Regional Hospital Group enhances the overall health level by integrating health resources within the region, through a unified brand and quality management and liquidity of the exchanges and cooperation, so that medical resources are best allocated in the region. And the Grouping mode pay more attention to the management of Group as a whole, through intra-group members to take a unified supervision, medical care, research, teaching, and logistics management flexibility to reconcile, so that each part of the intra-group are in top working condition.Existing domestic Hospital Group governance model can be categorized as the hospital group of integrated mode, cooperative mode, and hybrid mode; hospital group can be divided into three compositions:large and medium-sized hospital group, leveling Regional Medical Group, and cross-cutting health care groups. Integrated hospital group concentrates the asset ownership of different members, bringing management integration and brand homogeneity into one. In this kind of group, health care, training and research management, all manages by the management center, reflecting the only vertical management hierarchical structure. The internal medical quality, medical technology and staff development can be integrated driven by the group. Laddered Medical Group is composed by a comprehensive hospital, second-level hospitals, specialist hospitals, and the primary hospitals in communities. The comprehensive hospital would be set as the center hospital of the hospital group. Management center in the center hospital manages follow-level personnel in economics, researching management, applicable to the regional laddered health planning in China.Foreign concepts of the hospital group are same as the ones in our country. However, foreign countries have established a relatively complete set of regional health system. They could use the meaning legal and administrative modes in the guide the interaction of the hospitals at the levels of longitudinal, horizontally, and set the collaboration of training system, promoting overall balanced development of organic combination in the different levels of medical institutions. It could ensure that all level hospital’s medical quality and the capacity for sustainable development are identical. In addition, by setting constraints to the development of capital in major medical institutions, concentrated only on medical needs of the market and the need for effective expansion of health care resources, and strictly limiting the size and location of health facilities, foreign modes could prevent excessively expansion of hospitals in region, and reduce the waste of medical resources, especially for health protection field. Therefore, it could be helpful by actively reference the foreign medical groups operating experiences in order to conduct the integrated Hospital Group construction in China.In the analysis of Regional Hospital Group’s constructive feasibility, this study found civil constructing strengths:hospital classification system has been established, demand for urban sanitation is higher than supply, and community-based clinics in the health care market in China has a great advantage. However, the lacking of interaction between different levels of hospitals within the region, bottleneck of the rapid expansion of large hospitals, and sharply compression of small hospitals’ interests greatly restricts the regional healthy development. Development of hospital group requires the use of the favorable orientation of the new health policy, referring the foreign advanced mode, fully using positive state of our existing regional health planning. The changing of existed hospital running mode from blindly development into the development of community oriented health service mode would be needed in the future.Combined of the analysis and research above, this topic is defined for Chinese laddered Regional Hospital Group. And by analyzing the examples of classical grouping mode, it would give a complete package for the details of its operations.Laddered regional hospital group directly reference to the standards of corporate governance structure of public hospitals, the implementation of separate management from operation. And during the transitional period of the Hospital Group, it recommends to use of a mixed group management model, layer by layer, to promote the growing of regional hospitals to the same center of gravity. By the Board of Directors resolution, the mode recommended by the study uses of the access system to analyze the different levels of the hospital’s medical staff, equipment, consumption, management, and environmental access system according to the different levels of hospital standards. Set the geographically or regionally center of the circle as the central hospital’s place, following with the secondary and primary hospitals within a very radius range. By3-5years of continuous preparation, candidate hospitals would be finally absorbed into the group.The grouping mode would also establish a distribution method for supplies, programs and rules according to the needs of intra-group supplies technical principles. By analyze different of services and demand of the members in hospital group, physical resources and technical resources could be rationally allocated. Intellectual property rights, except the conventional medical technology that should be encourage to be duplicated by members of the regional hospital, would like to become the technical features of different members in the group, and then establish a mutual aid-competition relationship between different hospitals in the group.To establish a rational, efficient health care system of the three-level ladder, the group firstly set the finest hospitals as the central hospital, followed with other comprehensive hospitals and specialist hospitals as second levels, and the grass-roots hospitals, including community health service stations and community hospitals, for the third level. Central hospital has no right for the controlling of other levels, but would be encouraged to make the interaction and cooperation of the medical, teaching, scientific research, a longitudinal cross-level management by the competent department for co-ordination hospitals within the Group, though boundary has been set by geographical isolation to distinguish between the different members of the Group. Lateral columns would be established, forming in the horizontal two-way relationship of mutual aid-the competition, and the complementary strengths by the referral mechanisms, consultation mechanisms, training mechanisms and multi-center research cooperation in information, knowledge and human cooperation. Through respectively strengths of different members, and the establishing of special brand by different group member, it could form an interactive mechanism of competition between hospitals, and then strive to attract more patient sources. Ensure not only the Group’s internal tension and also cohesion. Through human resource flow, the physical material flow and intangible assets flow, it could ensure flexibility in the use of internal resources.The implementation of consistency management model, unified within the Group, financial, materials management, strict management system, would assure that the medical treatment, teaching, research and other work could be set at the same basis, and same level of assessment and development. Guard of the interests of different members in the Group could maintain healthy competition within the group. Coordination, stable and sustainable development would be developed by mutual assistance within the chain of Co-ordination Group.Unified medical quality assurance group should be established to implement the supervision and management methods to provide consistent medical services. The sharing of Group brands and professions’practice transferring would enhance the confidence of the patients in second and primary hospital, and reasonably triage patients. By implementing the integration of scientific research, the hospital Group research could include the atmosphere of the three levels:the top researchers would like to overcome larger topic to declare, middle-level, municipal overcome following funds, and underlying, researchers, students, residents, staff composition, carry out data collection, and the specific operation work. Three-level complement each other and live in the formation of a capacity for sustainable development of the team. Implement the laddered human resources training mode to promote the mining of talent, training and sublimation. Senior, intermediate, junior researchers connect seamlessly, complementarity and with mutual assistance. By introduce these methods, personnel training would be able to continue rolling to the chain form, ensuring the successful completion of the Group’s operational, and finally laying a good foundation for the sustainable development of the hospital. Combine the clinical pathways in the vertical and horizontal direction by netting the variation, establishing a new path of mutual links to form the icon of the clinical pathway. Hierarchically, underlying diseases level implement clinical pathway widely. The mid-level specified in the professional path. Complicate patients are inputted into the custom path to the specific diseases. Variation of low-level hospital’s path transferred to the higher-level hospital. Finally, an integrated referral path system would be found more reasonably, justifiably, and operably in whole framework of the hospital group.61groups’unified quality management and their integrity mode has been compared by Fisher exact probability, only20of them (accounting for33%) using integrated management method, and in the sum of20Medical Group that implement the integrated management model, only8(40%) using of an unified quality management system. Other than integrated mode’s groups,4in41hospital groups implement the unified quality management (p=0.013). It indicates that all groups in China has not been emphasized on the unified standardize medical quality monitoring. Those un-integrated mode’s groups should focus more on the united unified quality management. At the same time, by the contrast of hospital group health cooperative model and the Group’s governance models, it integrated that the integrated hospital group pays more attention to the help of medical technology, medical standards, training from higher level hospital to the primary ones.Fisher exact probability test has been made to compare the numbers divided by hospitals assistance mode and the integrity mode in61hospital groups. Analyzing17integrated groups (85.00%) and36un-integrated groups (87.80%) that implement assistance methods (P=0.761), there are no significant difference between the number divided by hospitals assistance mode and the integrity mode. It indicated that un-integrated hospital groups also focus on the help and training from the top level hospitals to its subordinations.In study, comparison of the number of second level hospital with third-level hospital in the totally61hospital groups has been made. The outcome indicates that existed hospital groups has no unified plan for the number of non-Central Hospital, especially for the grassroots hospitals, being different in each group. Therefore, the integrated management model should become the most important target in future’s study. Further study of the unified management mode of the hospital groups should be the main goal in the hospital group’s research. And the optimized geographic patterns of civil regional hospital group would be done according to the further tests of China’s hospitals geographic distribution. |
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