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Evaluation of Work Efficiency and Medical Quality for a Hospital on the PPP Model in China with Benchmarking and GRA

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Evaluation of Work Efficiency and Medical Quality for a Hospital on the PPP Model in China with Benchmarking and GRA Available online at www.researchinformation.co.uk Research The Journal of Grey System Information Volume 27 No.1, 2015 Evaluation of Work Efficiency and Medical Quality for a Hospital on the PPP Model in China with Benchmarking and GRA Xiaoning Li1, Xinbo Liao1,2∗, Xuerui Tan3, Kai Zheng4, Xiaoping Xu5, Xiaojun Chen3 1. School of Public Health, Sun Yat-sen University, Guangzhou 510080, P.R. China (The first author now is working at Clinical Services Department, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, P.R. China.) 2. Department of Health of Guangdong Province, Guangzhou 510060, P.R. China 3. The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, P.R. China 4. School of Public Health, Jilin Medical College, Jilin 132013, P.R. China 5 .The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, P.R. China Abstract Work efficiency and medical quality are two main hospital performance indicators in "Indicators of medical quality management and control on the third level large general hospital (2011 edition)” issued by National Ministry of Health. Benchmarking and grey relational analysis (GRA) are put into use to construct accessing model to evaluate work efficiency and medical quality for a hospital on public private partnership (PPP) model (Chaonan Minsheng Hospital of Guangdong Province) between 2007 to 2011，a total of 10 indicators. Evaluating results of work efficiency and medical quality for a hospital on the PPP model could be obtained and discussed. The predicting trend of future development and suggestions for better development of a hospital on the PPP model may provide some useful information for the government of Chaonan district, The First Affiliated Hospital of SUMC and investor. And then, it does good to the management and development of the hospitals on PPP model. Keyword: Grey Relational Analysis; Benchmarking; Evaluation; Work Efficiency; Medical Quality; Hospital on PPP Model 1. Introduction “Public private partnerships (PPP) refers to a long-term, contractually regulated co-operation between the public and private sector for the efficient fulfillment of public tasks in combining the necessary resources (e.g. know-how, operational funds, capital, personnel) of the partners and distributing existing Hospital project risks appropriately according to the risk management competence of the Grey Evaluation ∗ Corresponding author: Xinbo Liao, Department of Health of Guangdong Province, Guangzhou 70 510060, P.R. China; Email:[email protected] Xiaoning Li et al/ The Journal of Grey System 2015 (27) project partners”[1]. Sharing risks and responsibility, improving efficiency, reducing cost, introducing competition, etc., are advantages of PPP [1-3]. The purpose of PPP is to transfer tasks and responsibility for the provision of infrastructure to the private sector, for gaining high efficiency, cost reliability and financial security [1]. Hyun Sook Lee [4] believed that applying PPP was the guarantee of position of exceptional comparative advantage of international expertise in the field of healthcare. A PPP can combine the strengths of private actors and the role of public actors to create an enabling environment for delivering high quality health infrastructure and services [5]. The appealing of program and goals of PPP to the motivations of the partners are critical factors for successful partnerships [6]. Good communication and relationships, support from authorities, perseverance and commitment were identified facilitators for PPP. Lack of leadership, skills and attitude (non-compliance, negative attitudes) were identified barriers towards PPP [7]. Carlos Oliveira Cruz and Rui Cunha Marques found that the main advantage of a PPP project for health care is to introduce the private sector’s commercial and profit-oriented approach to the delivery of an expensive public service [8]. Policies of “Notice for guidance of trial reform on public hospital” and “Guidance of further encouraging and leading private capital to set up medical institutions” issued by Chinese government are advocate private capital to set up medical institutions, in order to increase health resources and improve medical service efficiency and quality. Under these reform policies for private capital, Chaonan Minsheng Hospital of Guangdong Province was established by the government of Chaonan district, Shantou city, Guangdong Province, The First Affiliated Hospital of Shantou University Medical College (SUMC) and investor, becoming an earlier hospital on public private partnership (PPP) model [9]. Cheng Zhe and Wang Shou Qing constructed a development model of private capital delivering medical institutions, which provided practical reference for the participants [10]. Work efficiency and medical quality are the two main hospital performance indicators in "indicators of medical quality management and control on the third level large general hospital (2011 edition)” issued by the National Ministry of Health in China. Work efficiency and medical quality are also proposed in “guideline of evaluation on hospital management (2008 edition)” issued by the National Ministry of Health in China. Work efficiency and medical quality are important indicators to evaluate management and operations. Indicators of work efficiency include average hospitalization days, working days per bed, bed utilization rate and hospital beds turnover and indicators of medical quality include coincidence rate of pathologic examination and clinical diagnosis, rescuing critically ill patients on emergency, successful rate of rescuing critically ill patients on emergency, rescuing critically ill inpatients, successful rate of rescuing critically ill inpatients, class-I healing rate of aseptic incision and so on, which are proposed in "indicators of medical quality management and control on the third level large general hospital (2011 edition)” issued by the National Ministry of Health in China. 2. Theory of GRA GRA was proposed by Deng Julong in the 1980s [11-13], which plays an important part in many areas. The foundational thought of GRA is judging the Hospital closeness for the relationship of sequences from the similar level of geometry of the Grey sequence curve-the closer the curve is the bigger the degree of interaction between [13,14] Evaluation corresponding sequences, conversely, the further the smaller . GRA has been 71 Xiaoning Li et al/ The Journal of Grey System 2015 (27) widely applied in many fields. In recent years, GRA is often applied in healthcare industry. In the aspect of hospital evaluation and analysis, GRA is applied to evaluate the financial burden of patients for a hospital on the PPP model [9], resource configuration and service ability for a hospital on the PPP model [16], medical quality [17], drug price regulation of public hospitals[18]，develop an evaluation method for selecting the optimal medical tourism alliance [19] ， concentration of medical resources [20], demand forecast for emergency resources [21] and so on. In the aspect of relevant influential factors analysis for the hospital, GRA is put into use in influential factors the hospital medical expenditure [22], influential factors of inpatient medical expense for angina patients [23], main factors influencing business income in the hospital [24], influential factors for Chinese medicine [25], sexual satisfaction and hemoglobin in essential hypertensive patients [26] , main influential factors of setting up opening hospital beds for departments [27], relevant factors of general income in the hospital [28], influence factors of average hospitalization days [29] and so on. GRA is also applied in public health service [30], such as influential factors of inpatients' cost in new rural cooperative medical scheme [31] and influential factors of new rural cooperative medical scheme [32], influential factors of community health services [33,34], occupational health supervision and quality evaluation [35,36] improving service quality of nursing homes [37] and so on. GRA is suitable for evaluating the work efficiency and medical quality for a hospital on the PPP model since it has no special requirements for sample count and data distribution. Deng’s correlation degree is a method of GRA, which was first proposed by professor of Julong Deng and developed by Sifeng Liu. The bigger the value for correlation degree, the correlation between reference sequence and comparison sequence is closer. [14, 15] Deng’s correlation degree is selected to access work efficiency and medical quality of a hospital on the PPP model in this study. A hospital on the PPP model is a completely new hospital model comparing with traditional public hospitals and private hospitals. We wonder whether work efficiency and medical quality of a hospital on the PPP model are better or worse than traditional public hospitals and private hospitals. The purpose of this study is to evaluate work efficiency and medical quality of a hospital on the PPP model. The reasons why we choose GRA for analysis are that Chaonan Minsheng Hospital of Guangdong Province opened in 2006, and does not have much in terms of historical data for use with statistical and other mathematical methods[9,16]. However, GRA has the right function of solving the problems of uncertainty information involving multiple attributes, small sample size and non-normal distribution[14,38]. The evaluating results may provide some useful information for the government of Chaonan district, The First Affiliated Hospital of
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