Reform of public hospitals and the main role of medical staffs
Authors: Peiying Zhang
Journal: Cell Biochemistry and Biophysics (2014)
Discipline: BIOLOGY & BIOCHEMISTRY
Keywords: reforms; public hospital system; China; motivation; mobilization
Affiliations: Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China, .

Abstract:  The success of reforms to the public hospital system in China depends on the motivation and mobilization of medical staffs. Several factors are known to influence the motivation of health workers, including remuneration, acquisition of power and reputation, the ability to care for others, and the level of satisfaction. Obtaining recognition turns out to be a central factor in affecting motivation, while power and reputation fuel the health workers' enthusiasm. Providing caring for others and level of satisfaction safeguards the enthusiasm of medical staffs. We found that the motivation of medical staffs was enhanced through institutionalized programs that reward, empower, and promote the reputation of individuals, and other factors. Through the implementation of these programs, the medical staffs of Xuzhou Central Hospital have been successfully mobilized, resulting in an improvement in performance securing the healthy growth of the hospital, which ultimately translated to better health care delivery for the people in the region. 

Retracted: No

PubPeer comments:
 Please compare with [Zhang (2015)] ,  Public Hospital Reform and the Principal Roles of Medical Staff , in the same journal. Evidently the editors of  Cell Biochemistry and Biophysics thought that *one* paper cheerleading for a restructuring of Chinese public hospitals was not enough, and two were required. They interpret the remit of the journal very broadly. The two papers overlap more than I would have expected. This paper:  **Enhancing the Motivation of Health Workers in Our Hospital** Healthcare system reform has always been a great concern of the Party and State leaders of China. Premier Jiabao Wen reiterated that hospital reform must encourage health workers at a meeting with stakeholdersu2014individuals and rural physicians, and Mr. Keqiang Li stated that the strengths of health workers should be fully developed within the health care reform. Encouraging the working environment should be created to facilitate health workersu2019 practice and attract outstanding medical talent, enabling health workers to participate in the health care reform with greater enthusiasm and energy [4]. The Health Minister, Mr. Zhu Chen proposed that enhancing health workersu2019 motivation can be realized, on the one hand, through increasing salaries, and on the other hand, through improving the social recognition. Thus, the enhancement of health workersu2019 motivation is converted into health benefits for the people [5]. Here, we share some specific practices in our hospital.  **Distribution of Benefits**  In 1999, reforms in the personnel system and its distribution in our hospital were first implemented in the Jiangsu Province. A system of full employment and management was established. After the reform, performance appraisals that fully recognize the value of the technical expertise, focusing on widening the income gap, skewing the salary distribution to persons in key positions and high-tech talents were implemented. In recent years, two measures have been implemented to further improve the operational efficiency to adapt to the reform policy. One such measure is to abolish the 10 % commission from drug sales, control the profits from drug sales, and identify the departments and medical groups where the profit from drug sales is excessive. Other measures to enhance the evaluation and supervision of average hospital stays and preoperative bed occupation include a cumulative point-assessment system to monitor the medical groups who did not meet the standards. The assessment system is based on a proportional increase in wages for time worked. After one year of implementation, physiciansu2019 salaries rose substantially. Meanwhile, a series of interventions have been implemented in the employment systems such as job evaluations and a promotion system to maintain and encourage health workersu2019 enthusiasm. ---------------------------------------------------------- The 2015 version:  **Our Explorations and Practices in Mobilizing Staff Enthusiasm**  Healthcare system reform has always been a serious source of concern for Chinau2019s top leaders since it has a huge impact on peopleu2019s life. Premier Wen Jiabao said u201chealthcare reform must be an inspiring initiative for the medical staffu201d when he approved the healthcare reform plan on behalf of the State Council. Incumbent Premier Li Keqiang said, during a meeting with representatives of outstanding health institutions, advanced individuals and excellent rural doctors, that u201cwe should make the utmost efforts to let medical staff play major roles in the reform and development of the healthcare industry, create favorable work environments so that they can perform their duties without concern, extraordinary people aspire to work as a doctor, and they can devote themselves to the industry with strong enthusiasm and high spiritu201d [4]. Chen Zhu, the former health minister, said medical staffu2019s enthusiasm should be elevated by increasing their income and lifting their social recognition, and higher enthusiasm can be translated into greater health benefit to the Chinese people [5].  **Benefit Distribution**  In 1999, Xuzhou Center Hospital became the first in the Jiangsu healthcare system to overhaul the personnel system and income distribution mechanism. Under the reform plans, all positions are no longer permanently secure, and a job management system has been put into place. The revamped performance evaluation system has fully recognized the value of medical staffu2019s professional techniques and skills, widened the income difference between ordinary staffs and those at key positions and with strong practical credentials. In order to further increase the hospitalu2019s operating efficiency, we have taken two steps in recent years. The first is to forgo 10 % revenue from drug sales, controlling the proportion of drug sale revenue to the total revenue and imposing double penalties on departments and clinic rooms that fail to keep the proportion below certain levels. The second is to intensify evaluations on how many days hospitalized patients spent in the hospital before they are discharged. The evaluationu2019s aim is to uphold the principle that people who do more work and do better quality work will earn more. As a result, doctors have seen their income growing considerably in the past year.  In order to motivate our staff, the hospital rolled out a series of regulations and policies on issues of great importance to their vital interest, like employment, professional title appraisal, and career promotion. , 
 Both versions would ideally be illustrated with the classic paintings of Soviet Realist Art.  Medical Staff of Xuzhou Hospital declare their enthusiasm for Zhang Administration Reform .  ,