Shi Jingyu, Sun Xinyue, Meng Kai
Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China.
Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
BMJ Open. 2021 Jan 6;11(1):e042447. doi: 10.1136/bmjopen-2020-042447.
Since China launched its nationwide systemic healthcare reform in 2009, policies such as the elimination of drug markups and the reform of medical insurance payments have forced some hospitals into a crisis threatening their survival. Both public and private hospitals have been building and strengthening their capacity to achieve sustainable development. However, the existing research has not provided a comprehensive evaluation tool required to support this effort. Therefore, this study develops an organisational capability evaluation index system to help public and private hospitals assess their current conditions.
The Delphi method was used to construct a hospital organisational capability evaluation index system in conjunction with the boundary value method and an analytic hierarchical process. Then, a questionnaire survey was administered in 55 hospitals (32 non-profit and 23 for-profit hospitals), and Cronbach's α and a factor analysis were used to verify the index system's reliability and validity.
A literature review and semistructured interviews with 23 hospital managers and scholars clarified the definition of hospital organisational capability and formed an indicator pool. Additionally, 20 hospital directors were selected from public and private hospitals to participate in two rounds of the Delphi consultation.
The Delphi consultation resulted in an index system including 12 primary and 40 secondary indicators demonstrated to be reliable and valid. The three indicators with the largest weights were 'regulation capability' (0.251), 'decision-making capability' (0.121) and 'executive capability' (0.105).
This study constructed an index system based on theoretical and practical considerations, and is expected to be applied to quantitatively evaluate the organisational capability of both public and private hospitals in China, and support their adaptation to external environmental changes.
自2009年中国在全国范围内启动系统性医疗改革以来，取消药品加成和医疗保险支付改革等政策使一些医院陷入了威胁其生存的危机。公立医院和私立医院都在建设并加强自身能力以实现可持续发展。然而，现有研究尚未提供支持这项工作所需的全面评估工具。因此，本研究构建了一个组织能力评估指标体系，以帮助公立医院和私立医院评估自身现状。
采用德尔菲法，结合边界值法和层次分析法构建医院组织能力评估指标体系。然后，对55家医院（32家非营利性医院和23家营利性医院）进行问卷调查，并使用克朗巴哈α系数和因子分析来验证指标体系的可靠性和有效性。
通过文献综述以及对23位医院管理人员和学者进行半结构化访谈，明确了医院组织能力的定义并形成了指标池。此外，从公立医院和私立医院中选取20位医院院长参与两轮德尔菲咨询。
德尔菲咨询得出一个包含12个一级指标和40个二级指标的指标体系，该体系经证明具有可靠性和有效性。权重最大的三个指标分别是“规制能力”（0.251）、“决策能力”（0.121）和“执行能力”（0.105）。
本研究基于理论和实践考量构建了一个指标体系，有望用于定量评估中国公立医院和私立医院的组织能力，并支持它们适应外部环境变化。
