Objective:To analyze the hot spots and frontiers of medical quality and safety management since the new medical reform, and to provide reference for the continuous improvement of medical quality and safety management.Methods:Chinese literatures related to medical quality and medical safety management in CNKI database from April 2009 to December 2022 were retrieved, and the included literatures were processed and analyzed by CiteSpace software and Excel software.Results:1 921 literatures related to medical quality management and 2 497 literatures related to medical safety management were included. The publication trend showed a " double peak", showing a downward trend. The research hotspots in literature related to medical quality and safety management in China since the new medical reform have focused on practice exploration and influencing factors. The trend of future research is to closely follow the background of the times in medical quality and safety management research and intelligent medical quality and safety management evaluation system research.Conclusions:In the future, research on medical quality and safety management should be more in line with the changes of medical reform policies, focus on high-quality development to deepen the research on micro issues, promote information construction to continuously improve the indicator evaluation system, so as to promote the sustainable and high-quality development of medical quality and safety management in China.

Objective:To construct a theoretical model of medical quality and safety management based on the current situation of medical quality and safety management mode in China, providing reference for continuous improvement of medical quality and safety management.Methods:The CNKI database was used as the data source to search literature, with a high citation index H=38 as the judgment standard, the core literature related to the quality and safety management in China was selected. Based on the structure-process-outcome (SPO) model, Nvivo qualitative analysis software was used to code and analyze the included literature, sort out the relevant elements of China′s medical quality and safety management, and clarify the logical relationship between the elements, forming a generalized SPO model of China′s medical quality and safety management.Results:Through a systematic summary and review of relevant literature, a generalized SPO model for medical quality and safety management was proposed, including 5 structural elements (organizational structure, personnel management, resource management, informatization, management standards), 2 process elements (management methods, service processes), and 3 outcome elements (patient outcomes, employee outcomes, organizational results). The logical relationships between and within the three major elements were constructed.Conclusions:To improve the level of medical quality and safety management in China, the structural dimension should be focused on clarifying the responsibilities of the main body of quality management, establishing an independent and perfect quality control department, strengthening the investment and construction of information technology, and promoting the implementation of the medical quality management standard; the process dimension should be focused on promoting the rational application of quality management tools; and the outcome dimension should be focused on strengthening the management of patient safety and improving the individual satisfaction.

Objective:To systematically construct the foreign medical quality and safety management model by searching the English literature related to medical quality and safety management, so as to provide reference for improving the level of medical quality and safety management in China.Methods:The Web of Science database was used as the data source, the English literature related to medical quality and safety management in foreign countries was screened following the PRISMA guidelines, and the content of the screened literature was analyzed using qualitative text analysis based on the Structure Process System Outcome (SPSO) theoretical model.Results:In this study, a total of 37 articles were screened, 5 first-level themes of structure, process, system, outcome and continuous quality improvement were identified, 16 second-level themes were found, and their functional relationships were established. A theoretical model of the SPSO-Extension (SPSO-E) for medical quality and safety management was constructed, added new elements of the external environment, organizational outcome and employee outcome, and refined the continuous quality improvement into three segments of quality checking, problem handling and quality consolidation.Conclusions:In order to improve medical quality and safety management in China, the internal management model of the hospital should be dynamically adjusted according to the changes of external environment, and the result dimension should pay attention to the improvement of organization′s operational effectiveness and the physiological and psychological aspects of the staff. The final management results have a feedback effect on the hospital′s resource allocation, service delivery, organizational arrangements and cultural construction, promoting continuous improvement and enhancement of the hospital′s quality.

Objective:To construct future-oriented theoretical management model for medical quality and patient safety.Methods:Procedure grounded theory was applied to code data including 30 expert interview records from July 2021 to June 2022 and the qualitative analysis results of 71 core literatures in Chinese and English, and then the theoretical model was constructed.Results:After three-level coding, 555 reference points, 249 initial concepts, 41 categories, 27 main categories and 7 core categories related to medical quality and safety management were sorted out, and the theoretical model of SQ (I-SPORT) matrix for medical quality and safety management was constructed. This model extended the traditional dimension in quality and safety management.Conclusions:Regarding medical quality and safety management, on one hand, should focus on the systematic improvement of structure, process, results, reengineering, education and training in terms of management functions; on the other hand, it is necessary to improve the organization, employees, resources, technology and tools, and patient experience in terms of management elements.

Objective:To analyze the current situation of research on the moral culture construction of the healthcare industry in China, and provide reference for further promoting such construction.Methods:Relevant literature on the moral culture construction of the healthcare industry published from 2012 to April 18, 2022 were retrieved on CNKI, and bibliometric analysis was made on the temporal distribution, sources, institutional cooperation, keyword clustering, etc. of the literature through CiteSpace 5.8.R3 software.Results:A total of 126 effective documents were included, and the highest number of published articles was 23 in 2018. The top 5 journals were all non-core journals with a total of 45 articles(35.71%). The number of papers issued by 11 research institutions was 2, and the other 102 were all 1. The overall density of the knowledge map network of research institutions was 0. The top three keywords in terms of frequency were " moral culture construction" , " hospital" and " medical ethics" , of which the heart rate was>0.1.The results of cluster analysis of subject research showed that the research subjects of the moral culture construction of the healthcare industry mainly focus on the construction of hospital moral culture and medical ethics. Most of the research subjects focused on hospitals, and focus on the construction of public hospitals′ moral culture. The research content was related to medical ethics, party conduct, and doctor-patient relationship.Conclusions:Medical and health institutions should pay more attention to the construction and research of moral culture, expand the depth of research, enhance the influence of this research field, and pay attention to the construction of moral culture of healthcare institutions outside hospitals.

Establishing and perfecting the modern hospital management system is an important guarantee to promote the high-quality development of public hospitals. It is a significant and challenging task that how to integrate particular " CPC′s building" with " corporate governance structure" for improving the modern governance system of public hospitals in China. On the basis of bibliometrics and content analysis and with the practical experience of public hospitals in China, the authors summarized the logical relationship between modern management system and the framework of corporate governance system, initially constructed the innovative mode of " corporate governance" with the core of " party building" , and then reshaped the corporate governance structure of public hospitals in China. The results could provide reference for strengthening the party construction, establishing modern management system, and improving the corporate governance of public hospitals in China.

Objective:To measure the cost efficiency and its components of 141 public tertiary hospitals of China and measure the influencing factors.Methods:COST, CCR and BCC model of DEA were used to measure the cost efficiency, allocative efficiency, technical efficiency, pure technical efficiency and scale efficiency.Results:In 2018, the values of cost efficiency, allocative efficiency, technical efficiency, pure technical efficiency, scale efficiency of the sample hospitals were 0.632, 0.929, 0.675, 0.732 and 0.917 respectively. 10(7.09%)sample hospitals were in the state of constant returns to scale, 41(29.08%)sample hospitals were in a state of decreasing returns to scale, while 90(63.83%)sample hospitals were in a state of increasing returns to scale. The regional GDP per capita and the bed utilization rate, average hospitalization days, average charge per output of hospital had significant impacts on the cost efficiency.Conclusions:Technical efficiency is the main factor affecting cost efficiency, and pure technical efficiency is the key factor for technical efficiency. Continuously improving the internal management level of the hospital is the main and necessary approach to enhance the technical efficiency of public tertiary hospitals. Internal factors have greater impacts on the efficiency of the sample hospitals. Reducing the average length of stay, increasing the utilization rate of beds and reducing the average charge level per outpatient can improve the cost efficiency of the hospitals.

Objective:With Diagnosis related groups(DRG)indicator introduced into the hospital efficiency evaluation, to analyze the adjustment effect of DRG on the efficiency value, and to compare the similarities and differences between the DEA efficiency value and the DRG efficiency indicator.Methods:The DRG pilot data in 2017 and 2018 of tertiary hospitals in Hubei province and related data from other reports were collected. Indicators including the actual number of beds, the number of employees, the actual total bed days occupied, and medical income were used as input indicators, and total admissions, number of discharges, weight of DRG and number of DRG groups were used as output indicators. 7 models were constructed using different indicator combinations. The efficiency of the hospital was calculated by the Bootstrap-DEA efficiency evaluation method. The relationship between hospital attributes and efficiency was analyzed by a generalized linear model.Results:There was an abnormal phenomenon that the higher the hospital level, the lower the efficiency in the efficiency value calculated by the traditional method. The efficiency values of county hospitals, city hospitals and provincial hospitals were 0.83, 0.74 and 0.71, respectively( P<0.01). DRG weight and group number were used as output for DEA analysis, and the efficiency values of county hospitals, city hospitals, and provincial hospitals were 0.95, 0.95 and 0.96( P=0.20)respectively. The DRG efficiency indications of county hospitals, city hospitals and provincial hospitals were 1.42, 1.11, 1.00 respectively( P<0.01). The higher the level, the lower the efficiency, while the efficiency values calculated by DEA were 0.84, 0.82, 0.86, respectively( P=0.58). Conclusions:The efficiency value calculated by the traditional method presents a systematic bias, which could be corrected effectively when DEA analysis using DRG weights is used as output indicator. The results developed new ideas of efficiency analysis for hospitals practicing DRG management.

Objective:To quantitatively measure the level of hospital human resources management of public hospitals in China with D-CHMS.Methods:From January through December of 2019, the Development Chinese Hospital Management Survey(D-CHMS)was used in field survey of relevant personnel of 36 tertiary general hospitals and 27 secondary general hospitals, with 10 persons chosen from each hospital. Survey data were subject to descriptive analysis and t test, for quantitative measurement of the human resources management level of these sample hospitals. Results:The level of human resources management in Chinese public hospitals was on the low side, as seven secondary dimensions scored 2.94 in average. To name a few, talents retention and talents recruitment scored the lowest, being (2.13±0.29) and (2.90±0.63) respectively. Tertiary hospitals presented an obviously better performance than secondary hospitals in incentives for best performers, talents retention and recruitment. Human resources management level of hospitals in China′s west regions scored the highest, followed by those in the east regions.Conclusions:Public hospitals in China, especially secondary hospitals were expected to enhance their human resources management. Approaches recommended include building a talent pool, developing a series of preferential policies, building development platforms, optimizing performance appraisal, motivating remuneration schemes, and offering unique employee value propositions, which serve to recruit and retain talents.

Objective:To develop a new kind of efficiency-based hospital ranking based on existing major hospital rankings with reference to hospital input data.Methods:DEA method was called into play and built five models for hospital ranking according to the efficiency value so calculated. The hospital beds available and the number of employees of 59 general hospitals in 2018 were used as the input indicators, and China′s Best Hospitals ranking by Fudan University′s Hospital Management Institute(Fudan ranking)and the total scoring and individual items evaluation from China Hospital STEM ranking by the Medical Information Institute of the Chinese Academy of Medical Sciences were used as the output indicators.Results:The correlation coefficients between hospital beds and the scores from Fudan-rankings and STEM-ranking were 0.08 and 0.09 respectively( P>0.05), and the correlation coefficients between personnel and scores from the two rankings were 0.34 and 0.39 respectively( P<0.01). The correlation coefficients of the efficiency values of the five super-efficiency DEA models and the beds were 0.37, -0.61, -0.71, -0.61 and-0.61 respectively( P<0.01), and the correlation coefficients of personnel were-0.17, -0.37, -0.60, -0.39 and -0.39( P<0.01)respectively. Compared with the original ranking, the ranking of the efficiency value of the super-efficiency DEA model found the average ranking of hospitals in Beijing and Shanghai rose by 6.38 places, and the ranking of hospitals in non-Beijing and Shanghai areas dropped by 4.37 places on average. The difference was statistically significant( P=0.02), and other differences in the ranking of different types hospitals were not statistically significant. Conclusions:Thanks to the super-efficiency DEA efficiency value which is added with such input indicators as hospital beds and personnel, the ranking becomes more scientific and comprehensive. The research results can provide references for more rational patient flow and encourage hospitals onto a more healthy development pathway.