Study On The Influencing Factors Of Public Hospital Comprehensive Performance Based On Interpretative Structural Modeling

Public hospital reform is one of the important themes in the field of health care around the world,and it is also a world-class problem.At present,there are many problems in the management system and operation mechanism on the domestic public hospitals,resulting in the problems of difficult and expensive to see a doctor,the worsening doctor-patient relationship,low social satisfaction,which seriously hinders the sustainable development of public hospitals.According to the fact that the comprehensive performance of public hospitals is not high as a whole,the paper focuses on the influencing factors of the comprehensive performance of public hospitals,mining the surface,middle and deep influencing factors,in order to improve the comprehensive performance of public hospitals,and provide a theoretical basis and reference for deepening the reform of public hospitals and health policy formulation.Firstly,the paper determines the several influencing factors on the comprehensive performance of public hospitals with literature analysis and expert consultation method.And then with interpretative structural modeling method,the paper divides the influencing factors into three levels:surface,middle and deep according to the relationship between the factors;Secondly,the paper studies the impact of deep factors on the comprehensive performance of public hospitals with data envelope analysis;Thirdly,the paper studies the impact of secondary deep factors on the comprehensive performance of public hospitals with structural equation model;Finally,the paper studies the impact of surface and middle factors on the comprehensive performance of public hospitals with system dynamics approach.Through research,the paper establishes the interpretative structural model of the impact factors on the comprehensive performance of public hospitals.Among them,the surface factors include working pressure,hospital culture,hospital corporate governance,incentive and restraint mechanism,hospital strategy,hospital environment,hospital market competition,health personnel quality and ability,and social preferences for medical treatment.The middle factors include government supervision,social supervision,financial investment,hospital level and scale,and hospital category.The deep factors include government policy orientation and regional economy.The results on the impact of deep factor(Regional Economy)on the comprehensive performance of public hospitals show that after excluding the extreme case,regional economy has a significant effect on the comprehensive performance of public hospitals,but there is no significant effect on the economic benefit.The results on the impact of secondary deep factor(Government Policy Orientation)on the comprehensive performance of public hospitals show that public hospitals implementing government orientation is helpful to improve the comprehensive performance.And the impact on the social benefits from high to low is in order:generation and dissemination of policy information,management behavior adjustment.The impact on the economic benefits from high to low is in order:social benefits,generation and dissemination of policy information,dynamic capabilities,management behavior adjustment.In the study of the impact of surface and middle factors on the comprehensive performance of public hospitals,the paper establishes the theory model of system dynamics for the impact factors of the comprehensive performance of public hospitals,which further clarifies 16 main theoretical paths on the surface and middle factors affecting the comprehensive performance of public hospitals.From the influencing factors,the paper puts forward the several countermeasures and suggestions to improve the comprehensive performance of public hospitals,which is divided into five main parts:the first is to effectively use the local resources and play area advantages.The second is to emphasize the role of the government policy orientation and reasonably promote the reform of public hospitals,including to set up a policy study group,and actively implement the government policy orientation;to emphasize on policy orientation implementation,and strengthen multilateral supervision.The third is to make full use of its characteristics and guarantee the healthy development of public hospitals,including to clear public hospital grade and scale,and innovate development road;to clear type of public hospitals,and create competitive specialty.The fourth is to strengthen the internal construction of public hospitals and strive to enhance the dynamic capabilities,including to shape excellent hospital culture,and standardize hospital strategy management;to explore suitable corporate governance model,and establish a modern hospital management system;to strengthen the health personnel performance appraisal,and establish a fair and reasonable incentive and restraint mechanism;to strengthen the sense of learning,and improve health personnel quality and ability;to improve the hospital working environment,and cautiously care for health personnel job stress.The fifth is to strengthen the government responsibility,and actively promote the policy orientation,including to promote grading treatment,and reasonably guide social preferences for medical treatment;to promote social medical,and create a fair hospital competition environment;to strengthen the financial investment management,and establish a scientific and reasonable compensation mechanism in public hospitals.