中国公立综合性医院战略定位类型、医院文化、医院绩效的关联机制研究
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摘要
[背景]
随着我国医疗卫生改革的不断深入,从医院文化入手,加强医院内涵建设,缓解医患矛盾,成为医院谋求自身长远发展的重要手段。“科学管理,文化先行”已然成为一种共识。而传统形成的医院文化,有优势文化和劣势文化,有强势文化和弱势文化。只有与医院战略相匹配、相和谐的医院文化,才能作为文化引擎推进医院战略目标的实现,引领医院走上可持续发展之路。因此,理清战略定位与医院文化的关联机制对医院战略管理具有重要意义。
医院文化的构建,是为医院战略目标服务,而最终落实在医院经营绩效上。国内外的研究表明,医院文化与医院绩效有关联,但具体而言,哪些医院文化维度对医院绩效的哪些方面产生影响?医院文化对医院绩效的影响是否受到其他因素的交互作用?明确医院文化对医院绩效的作用机制对提升医院绩效有积极意义。
[研究目的]
探索研究我国公立综合性医院战略定位、医院文化、医院绩效的关联性,试图构建以战略定位为导向、医院文化为纽带,医院绩效为结果的关联机制,为进一步推动公立医院发展提供理论参考。
[研究内容]
本研究的主要内容包括：
1、战略定位类型研究。本研究从战略内涵的构成要素手分析目前我国公立综合性医院的战略定位的类型及其特点。
2、医院文化研究。本研究在Denision组织文化模型的理论基础上,结合我国公立医院的组织特点,研制适用于我国公立综合性医院的组织文化测评量表,并通过实证研究对量表作信效度检验。此外,运用医院文化量表对我国不同地区、不同等级公立综合性医院的组织文化进行分析。
3、医院绩效研究。本研究基于平衡计分卡的理论框架,从学习与成长、内部经营流程、客户、财务四个方面对不同级别公立综合性医院的绩效现状进行分析。并对近10年来,医院在医疗项目、医疗质量、医学教育与科研、市场占有率等方面的业务发展进行分析。
4、三者关联性研究。分析不同战略定位类型的医院,其组织文化的优劣势与强弱势,其医院绩效现状和近10年来绩效发展状况的差异。分析同一战略定位类型下,不同医院文化维度对医院绩效不同方面的影响；分析相似的医院文化类型,不同战略定位类型医院,组织绩效的差异；从而研究三者的关联性。
[研究方法]
1、专家咨询。本研究组织了两次专家咨询,第一次对本研究初步设计的各类调查表进行评议；第二次对本研究初步构建的战略定位、医院文化和医院绩效的关联性进行评议。
2、省/直辖市医疗卫生状况调查。本研究查阅了2006-2008年的中国卫生统计年鉴,分别针对综合医院、卫生院和社区卫生服务中心,收集了被调查省/直辖市的医疗卫生数据,以均衡同类医院的绩效指标的地区差异。
3、医院调查。本研究收集了被调查医院2006-2008年的医院基本情况,包括床位、人员状况、固定资产、医疗服务状况、医学教育与科研、财务状况等,以此分析了解医院的绩效状况。
4、医院院级领导调查。本研究通过对每所被调查医院院级领导的调查(每所医院1名),收集近10年来医院发展规模、业务状况、总体战略定位和重大举措等信息,以此分析了解医院的战略定位类型。
5、医院职工调查。本研究通过匿名问卷调查,在被调查的二、三级医院中,中层及以上干部按照10%比例随机抽样(至少10名),一般医务人员按照实际在岗医师(士)、护师(士)、医技人员各10%比例随机抽样(至少30名)；在被调查的一级医院中,中层及以上干部按照50%比例随机抽样,一般医务人员中,随机抽取医师(士)10人、护师(士)5人、医技人员5人(不足20人的全部调查)。以此来了解医院文化现状和员工满意度。
6、病人满意度调查。本研究通过匿名问卷调查,对每所医院随机调查门诊、住院病人各50名。以了解病人对医务人员、医疗质量、医疗服务效率等的满意度评价。
7、主要数据分析方法
(1)聚类分析：主要运用R型聚类对战略定位的评判指标进行整合,运用Q型聚类对各调查医院的战略定位状况进行分类总结,以区分战略定位类型。
(2)量表信度、效度分析：本研究运用Cronbach'sα系数和折半系数分析总量表和各子量表的内部一致性。从内容效度、结构效度、交互效度对量表进行效度分析。结构效度分析主要运用结构方程模型(Structural equation modeling,SEM)的验证性因子分析(confirmatory factor analysis, CFA)对量表模型进行拟合优度检验。交互效度主要分析量表模型在不同样本间的测量恒等性。
(3)多层线性模型分析：本研究运用多层线性模型(Hierarchical Linear Modeling)分析不同战略定位、不同医院文化维度对员工满意度和病人满意度的影响,研究医院层、个人层变量对响应变量的影响,以及医院层变量与个人层变量间的交互作用。
[研究结论]
1、本研究从“战略内涵”入手,归纳总结出目前我国公立综合性医院战略定位类型5种。
2、基于Denison组织文化模型,结合我国公立综合性医院的特点,经过专家咨询、预调查初筛和正式调查的样本检验,最后形成了73题共13个文化维度的医院文化测评量表,实证调查结果显示,量表具有较好的信度和效度。
3、对东、中、西3个省/直辖市,9个地区共计87所医院的组织文化调查显示,分值最高是“制度规范”、“竞争意识”和“社会责任”；得分最低的是“授权”和“组织协调”。不同地区和不同级别医院间组织文化不存在显著差异。
4、研究显示,不同级别医院间,医护比、医师中研究生学历比例、医师中高级职称比例、手术前后诊断符合率、出入院诊断符合率、平均住院日等10项指标在不同医院级别间存在显著差异(p<0.05)。近10年来的医院发展状况显示,不同级别医院间,在“医疗项目种类”、“科研质量”、“科研项目数”、“住院医疗服务量”、“手术量”上存在显著差异(p<0.05)。
5、根据不同战略定位类型区分,医院近10年发展规模和业务状况存在显著差异(p<0.05)。Logistic分析显示,控制医院级别、地区和医院文化后,战略定位对医院机构层面绩效有明显作用；而控制医院级别、地区和医院战略定位后,医院文化对机构层面绩效影响有限。多层线性模型(HLM)分析显示,医院文化对员工工作、薪酬、组织氛围、近5年的医院发展的满意度以及医院未来发展的信心有显著的影响；医院“社会责任”和“竞争意识”文化对医疗服务态度、医疗质量、服务效率的病人满意度有显著正向影响。
[Background]
With the development of Chinese health care reform, starting from organizational culture construction to enhance hospital inner sustainable improvement and alleviate doctor-patient conflict, it has already become an important way for governmental hospitals to pursue their own long-term development. "Scientific management, culture goes first" has become a common consensus. While traditional hospital cultures include superiority cultures and inferior ones, pre-eminent cultures and minority ones. Only the culture that matches the hospital strategy harmoniously can lead the hospital to the road of sustainable development and promote the hospital to realize the hospital's strategic goals. Therefore, it is very significant to clarify the correlative mechanism of hospital strategy orientation and organizational culture.
Constructing hospital culture is to serve hospital strategic objectives, but it is ultimately reflected by hospital performances. The domestic and international researches indicated that hospital culture is associated with hospital performance. But specifically, which hospital culture dimensions have influenced on hospital performances? Is there any interaction among hospital culture and other factors which have impact on hospital performance? It has a positive significance to specify the mechanism of how hospital culture effect hospital performances.
[Purpose]
The purpose of this study is to investigate the correlative mechanism among hospital strategy orientation, organizational culture and hospital performances of governmental hospitals in China. We intended to provide a theoretical reference for promoting the development of public hospital modern management.
[Contents]
1. We studied on the types of hospital strategy orientation on base of the main component parts of the strategy content and analyzed the characteristics of different type according to the current situation of governmental hospital strategy orientation.
2. Based on the corporate culture model of Denison, combining features of governmental hospitals in our country, we developed the hospital culture scale which applied to the governmental general hospitals of our country. We tested the validity and reliability of the scale through empirical research data and used the scale to analyze the characteristics of the governmental general hospitals of different levels or in different regions of China.
3. Upon the theoretical model of the Balanced Score Card, we investigated the governmental hospital performances of different levels through analyzing the four aspects involving learning and growth, internal operational process, customers and financing situation. Moreover, we also studied the development and improvement of hospital performances including hospital medical services, health care quality, medical education and researching, market share increase and so on in the past 10 years.
4. We analyzed the difference of the hospital culture, of the current hospital performances and the development of hospital performances among the various types of hospital strategic orientation. Under the same strategic orientation, we investigated whether different hospital culture dimension has various impact on diverse aspect of hospital performances. And with the similar hospital culture, we studied whether different hospital strategic orientation would lead different hospital performances.
[Methods]
1. In this study, we organized expert consultation meetings for twice. The first time, we invited eight experts who were health administrators, hospital managers, specialists and scholars in health management field to comment all the kinds of questionnaire drafts. The second time, we invited ten hospital senior managers and scholars in relevant areas to review the initially constructed correlative mechanism among hospital strategic orientation, organizational culture and performances.
2. According to the general hospitals, health centers and community health service centers, the study reviewed the 2006-2008 Chinese Health Statistics Yearbooks, collected series of healthcare data of the surveyed provinces / municipalities so as to balance regional differences of the same level hospital performances.
3. This study collected the basic information of those investigated hospitals from the year 2006 to 2008, including beds, personnel situation, fixed assets, healthcare service status, medical education and researching, financing situation and so on, in order to analyze the status of hospitals'performances.
4. For every investigated hospital, one of leaders was surveyed to collect such information as the scale of hospital development, business situation, the general strategic orientation and main significant actions during the past 10 years. Upon these information, we explored to generalize the types of the governmental hospital strategic orientation.
5. With the anonymous questionnaire, we surveyed hospital staff to get the information about the status of hospital culture and staff satisfaction. Among the second and tertiary governmental hospitals, we randomly sampled 10% of managers (at least 10 managers),10% of on-the-job physicians, nurses and medical technicians (at least 30 persons). Among the primary hospitals, we randomly sampled 50% of managers,10 of physicians,5 of nurses and 5 of medical technicians (if the number of all staff is less than 20, all the persons were surveyed.).
6. In this investigation,50 outpatients and 50 inpatients were randomly surveyed for each hospital with the anonymous questionnaire to collect the information on patient satisfaction on medical services of healthcare providers, healthcare quality and efficiency, etc.
7. Analysis methods:
(1) Cluster Analysis:R-type analysis was employed to integrate the evaluation indicators of the strategic positioning; Q-type analysis was used to classify and sum up the strategic position status of the investigated hospitals, in order to distinguish the types of strategic positioning.
(2) Scale Reliability and Validity Test: This study calculated the Cronbach's a coefficient and the split-half reliability coefficient to analyze internal consistency of total scale and subscales. Validity analysis of the scale was conducted with three aspects which involved content validity, construct validity and interactive validity. For construct validity analysis, confirmatory factor analysis (CFA) was used to calculate the goodness-of-fit test for the scale model. Interactive validity was used to test for partial invariance of scale model among different samples. The study used software AMOS17.0 for scale modeling construction and testing.
(3) Hierarchical Linear Model was used to analyze the impacts of different hospital strategic orientation, different hospitals culture on staff satisfaction and patient satisfaction. And we also studied the impacts of hospital level explanatory variables and personal level explanatory variables on response variables, and analyzed the interaction between the hospital level and individual level explanatory variables.
[Findings]
1. Based on the main component factors of strategy content, the study have summarized 5 types of the current strategy positioning of governmental general hospitals using cluster analysis.
2. Upon the organizational culture model of Denison, combining with the features of governmental general hospitals in China, we have developed a hospital culture scale with totally 13 dimensions and 73 questions through expert consultation, pretest survey and formal investigation in three provinces / municipalities. The investigation indicated that the scale had good reliability and validity.
3. Findings showed that the three culture dimensions of‘system culture’,‘sense of competition’and‘sense of social responsibility’scored highest; the culture dimensions of‘authorization’,‘coordination of organization’scored lowest. There is no significant difference on hospital culture among different regions and different levels.
4. Findings showed that there were significant differences on the doctor-nurse ratio, the proportion of physicians with postgraduate degree, the proportion of physicians with junior or senior job titles, the conformity rate of the admission and discharge diagnosis, the average length of stay and other 10 indicators among different levels of hospitals (p<0.05). Over the past 10 years, the hospital development displayed there were significant differences on‘types of healthcare services’,‘researching quality’,‘number of research projects’,‘volume of Hospital medical services’,‘volume of surgery’among different levels of hospitals(p<0.05).
5. The size expansion and the development of healthcare services in various hospitals with different type of strategic positioning were significantly different during past 10 years (p<0.05). Hierarchical Linear Model analysis showed that diverse hospital culture dimension had a distinct significant impact on staff job satisfaction, payment satisfaction, satisfaction on organizational climate, satisfaction on the hospital development of the past five years, and staff confidence on hospital future. We also found that for the hospitals with higher'sense of social responsibility' and‘sense of competition’, the patient satisfaction on medical services of healthcare providers, on healthcare quality, on medical service efficiency were better.
随着我国医疗卫生改革的不断深入,从医院文化入手,加强医院内涵建设,缓解医患矛盾,成为医院谋求自身长远发展的重要手段。“科学管理,文化先行”已然成为一种共识。而传统形成的医院文化,有优势文化和劣势文化,有强势文化和弱势文化。只有与医院战略相匹配、相和谐的医院文化,才能作为文化引擎推进医院战略目标的实现,引领医院走上可持续发展之路。因此,理清战略定位与医院文化的关联机制对医院战略管理具有重要意义。
医院文化的构建,是为医院战略目标服务,而最终落实在医院经营绩效上。国内外的研究表明,医院文化与医院绩效有关联,但具体而言,哪些医院文化维度对医院绩效的哪些方面产生影响?医院文化对医院绩效的影响是否受到其他因素的交互作用?明确医院文化对医院绩效的作用机制对提升医院绩效有积极意义。
[研究目的]
探索研究我国公立综合性医院战略定位、医院文化、医院绩效的关联性,试图构建以战略定位为导向、医院文化为纽带,医院绩效为结果的关联机制,为进一步推动公立医院发展提供理论参考。
[研究内容]
本研究的主要内容包括：
1、战略定位类型研究。本研究从战略内涵的构成要素手分析目前我国公立综合性医院的战略定位的类型及其特点。
2、医院文化研究。本研究在Denision组织文化模型的理论基础上,结合我国公立医院的组织特点,研制适用于我国公立综合性医院的组织文化测评量表,并通过实证研究对量表作信效度检验。此外,运用医院文化量表对我国不同地区、不同等级公立综合性医院的组织文化进行分析。
3、医院绩效研究。本研究基于平衡计分卡的理论框架,从学习与成长、内部经营流程、客户、财务四个方面对不同级别公立综合性医院的绩效现状进行分析。并对近10年来,医院在医疗项目、医疗质量、医学教育与科研、市场占有率等方面的业务发展进行分析。
4、三者关联性研究。分析不同战略定位类型的医院,其组织文化的优劣势与强弱势,其医院绩效现状和近10年来绩效发展状况的差异。分析同一战略定位类型下,不同医院文化维度对医院绩效不同方面的影响；分析相似的医院文化类型,不同战略定位类型医院,组织绩效的差异；从而研究三者的关联性。
[研究方法]
1、专家咨询。本研究组织了两次专家咨询,第一次对本研究初步设计的各类调查表进行评议；第二次对本研究初步构建的战略定位、医院文化和医院绩效的关联性进行评议。
2、省/直辖市医疗卫生状况调查。本研究查阅了2006-2008年的中国卫生统计年鉴,分别针对综合医院、卫生院和社区卫生服务中心,收集了被调查省/直辖市的医疗卫生数据,以均衡同类医院的绩效指标的地区差异。
3、医院调查。本研究收集了被调查医院2006-2008年的医院基本情况,包括床位、人员状况、固定资产、医疗服务状况、医学教育与科研、财务状况等,以此分析了解医院的绩效状况。
4、医院院级领导调查。本研究通过对每所被调查医院院级领导的调查(每所医院1名),收集近10年来医院发展规模、业务状况、总体战略定位和重大举措等信息,以此分析了解医院的战略定位类型。
5、医院职工调查。本研究通过匿名问卷调查,在被调查的二、三级医院中,中层及以上干部按照10%比例随机抽样(至少10名),一般医务人员按照实际在岗医师(士)、护师(士)、医技人员各10%比例随机抽样(至少30名)；在被调查的一级医院中,中层及以上干部按照50%比例随机抽样,一般医务人员中,随机抽取医师(士)10人、护师(士)5人、医技人员5人(不足20人的全部调查)。以此来了解医院文化现状和员工满意度。
6、病人满意度调查。本研究通过匿名问卷调查,对每所医院随机调查门诊、住院病人各50名。以了解病人对医务人员、医疗质量、医疗服务效率等的满意度评价。
7、主要数据分析方法
(1)聚类分析：主要运用R型聚类对战略定位的评判指标进行整合,运用Q型聚类对各调查医院的战略定位状况进行分类总结,以区分战略定位类型。
(2)量表信度、效度分析：本研究运用Cronbach'sα系数和折半系数分析总量表和各子量表的内部一致性。从内容效度、结构效度、交互效度对量表进行效度分析。结构效度分析主要运用结构方程模型(Structural equation modeling,SEM)的验证性因子分析(confirmatory factor analysis, CFA)对量表模型进行拟合优度检验。交互效度主要分析量表模型在不同样本间的测量恒等性。
(3)多层线性模型分析：本研究运用多层线性模型(Hierarchical Linear Modeling)分析不同战略定位、不同医院文化维度对员工满意度和病人满意度的影响,研究医院层、个人层变量对响应变量的影响,以及医院层变量与个人层变量间的交互作用。
[研究结论]
1、本研究从“战略内涵”入手,归纳总结出目前我国公立综合性医院战略定位类型5种。
2、基于Denison组织文化模型,结合我国公立综合性医院的特点,经过专家咨询、预调查初筛和正式调查的样本检验,最后形成了73题共13个文化维度的医院文化测评量表,实证调查结果显示,量表具有较好的信度和效度。
3、对东、中、西3个省/直辖市,9个地区共计87所医院的组织文化调查显示,分值最高是“制度规范”、“竞争意识”和“社会责任”；得分最低的是“授权”和“组织协调”。不同地区和不同级别医院间组织文化不存在显著差异。
4、研究显示,不同级别医院间,医护比、医师中研究生学历比例、医师中高级职称比例、手术前后诊断符合率、出入院诊断符合率、平均住院日等10项指标在不同医院级别间存在显著差异(p<0.05)。近10年来的医院发展状况显示,不同级别医院间,在“医疗项目种类”、“科研质量”、“科研项目数”、“住院医疗服务量”、“手术量”上存在显著差异(p<0.05)。
5、根据不同战略定位类型区分,医院近10年发展规模和业务状况存在显著差异(p<0.05)。Logistic分析显示,控制医院级别、地区和医院文化后,战略定位对医院机构层面绩效有明显作用；而控制医院级别、地区和医院战略定位后,医院文化对机构层面绩效影响有限。多层线性模型(HLM)分析显示,医院文化对员工工作、薪酬、组织氛围、近5年的医院发展的满意度以及医院未来发展的信心有显著的影响；医院“社会责任”和“竞争意识”文化对医疗服务态度、医疗质量、服务效率的病人满意度有显著正向影响。
[Background]
With the development of Chinese health care reform, starting from organizational culture construction to enhance hospital inner sustainable improvement and alleviate doctor-patient conflict, it has already become an important way for governmental hospitals to pursue their own long-term development. "Scientific management, culture goes first" has become a common consensus. While traditional hospital cultures include superiority cultures and inferior ones, pre-eminent cultures and minority ones. Only the culture that matches the hospital strategy harmoniously can lead the hospital to the road of sustainable development and promote the hospital to realize the hospital's strategic goals. Therefore, it is very significant to clarify the correlative mechanism of hospital strategy orientation and organizational culture.
Constructing hospital culture is to serve hospital strategic objectives, but it is ultimately reflected by hospital performances. The domestic and international researches indicated that hospital culture is associated with hospital performance. But specifically, which hospital culture dimensions have influenced on hospital performances? Is there any interaction among hospital culture and other factors which have impact on hospital performance? It has a positive significance to specify the mechanism of how hospital culture effect hospital performances.
[Purpose]
The purpose of this study is to investigate the correlative mechanism among hospital strategy orientation, organizational culture and hospital performances of governmental hospitals in China. We intended to provide a theoretical reference for promoting the development of public hospital modern management.
[Contents]
1. We studied on the types of hospital strategy orientation on base of the main component parts of the strategy content and analyzed the characteristics of different type according to the current situation of governmental hospital strategy orientation.
2. Based on the corporate culture model of Denison, combining features of governmental hospitals in our country, we developed the hospital culture scale which applied to the governmental general hospitals of our country. We tested the validity and reliability of the scale through empirical research data and used the scale to analyze the characteristics of the governmental general hospitals of different levels or in different regions of China.
3. Upon the theoretical model of the Balanced Score Card, we investigated the governmental hospital performances of different levels through analyzing the four aspects involving learning and growth, internal operational process, customers and financing situation. Moreover, we also studied the development and improvement of hospital performances including hospital medical services, health care quality, medical education and researching, market share increase and so on in the past 10 years.
4. We analyzed the difference of the hospital culture, of the current hospital performances and the development of hospital performances among the various types of hospital strategic orientation. Under the same strategic orientation, we investigated whether different hospital culture dimension has various impact on diverse aspect of hospital performances. And with the similar hospital culture, we studied whether different hospital strategic orientation would lead different hospital performances.
[Methods]
1. In this study, we organized expert consultation meetings for twice. The first time, we invited eight experts who were health administrators, hospital managers, specialists and scholars in health management field to comment all the kinds of questionnaire drafts. The second time, we invited ten hospital senior managers and scholars in relevant areas to review the initially constructed correlative mechanism among hospital strategic orientation, organizational culture and performances.
2. According to the general hospitals, health centers and community health service centers, the study reviewed the 2006-2008 Chinese Health Statistics Yearbooks, collected series of healthcare data of the surveyed provinces / municipalities so as to balance regional differences of the same level hospital performances.
3. This study collected the basic information of those investigated hospitals from the year 2006 to 2008, including beds, personnel situation, fixed assets, healthcare service status, medical education and researching, financing situation and so on, in order to analyze the status of hospitals'performances.
4. For every investigated hospital, one of leaders was surveyed to collect such information as the scale of hospital development, business situation, the general strategic orientation and main significant actions during the past 10 years. Upon these information, we explored to generalize the types of the governmental hospital strategic orientation.
5. With the anonymous questionnaire, we surveyed hospital staff to get the information about the status of hospital culture and staff satisfaction. Among the second and tertiary governmental hospitals, we randomly sampled 10% of managers (at least 10 managers),10% of on-the-job physicians, nurses and medical technicians (at least 30 persons). Among the primary hospitals, we randomly sampled 50% of managers,10 of physicians,5 of nurses and 5 of medical technicians (if the number of all staff is less than 20, all the persons were surveyed.).
6. In this investigation,50 outpatients and 50 inpatients were randomly surveyed for each hospital with the anonymous questionnaire to collect the information on patient satisfaction on medical services of healthcare providers, healthcare quality and efficiency, etc.
7. Analysis methods:
(1) Cluster Analysis:R-type analysis was employed to integrate the evaluation indicators of the strategic positioning; Q-type analysis was used to classify and sum up the strategic position status of the investigated hospitals, in order to distinguish the types of strategic positioning.
(2) Scale Reliability and Validity Test: This study calculated the Cronbach's a coefficient and the split-half reliability coefficient to analyze internal consistency of total scale and subscales. Validity analysis of the scale was conducted with three aspects which involved content validity, construct validity and interactive validity. For construct validity analysis, confirmatory factor analysis (CFA) was used to calculate the goodness-of-fit test for the scale model. Interactive validity was used to test for partial invariance of scale model among different samples. The study used software AMOS17.0 for scale modeling construction and testing.
(3) Hierarchical Linear Model was used to analyze the impacts of different hospital strategic orientation, different hospitals culture on staff satisfaction and patient satisfaction. And we also studied the impacts of hospital level explanatory variables and personal level explanatory variables on response variables, and analyzed the interaction between the hospital level and individual level explanatory variables.
[Findings]
1. Based on the main component factors of strategy content, the study have summarized 5 types of the current strategy positioning of governmental general hospitals using cluster analysis.
2. Upon the organizational culture model of Denison, combining with the features of governmental general hospitals in China, we have developed a hospital culture scale with totally 13 dimensions and 73 questions through expert consultation, pretest survey and formal investigation in three provinces / municipalities. The investigation indicated that the scale had good reliability and validity.
3. Findings showed that the three culture dimensions of‘system culture’,‘sense of competition’and‘sense of social responsibility’scored highest; the culture dimensions of‘authorization’,‘coordination of organization’scored lowest. There is no significant difference on hospital culture among different regions and different levels.
4. Findings showed that there were significant differences on the doctor-nurse ratio, the proportion of physicians with postgraduate degree, the proportion of physicians with junior or senior job titles, the conformity rate of the admission and discharge diagnosis, the average length of stay and other 10 indicators among different levels of hospitals (p<0.05). Over the past 10 years, the hospital development displayed there were significant differences on‘types of healthcare services’,‘researching quality’,‘number of research projects’,‘volume of Hospital medical services’,‘volume of surgery’among different levels of hospitals(p<0.05).
5. The size expansion and the development of healthcare services in various hospitals with different type of strategic positioning were significantly different during past 10 years (p<0.05). Hierarchical Linear Model analysis showed that diverse hospital culture dimension had a distinct significant impact on staff job satisfaction, payment satisfaction, satisfaction on organizational climate, satisfaction on the hospital development of the past five years, and staff confidence on hospital future. We also found that for the hospitals with higher'sense of social responsibility' and‘sense of competition’, the patient satisfaction on medical services of healthcare providers, on healthcare quality, on medical service efficiency were better.
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