Experience with multicampus hospital management
Yu Zhang1, Wu Shan2, Zhe
Han1, Weijiang Ye1, Ying
Zhou1, Min Xu1, Jianping
Wang1, Juan Zhang1, Wencai
Xu3, Hongbo Chen4, Hangping
Ge5, Shuo Zhang1*
1Department of Administration, First Affiliated
Hospital of Zhejiang Chinese Medical University, Hangzhou, China
2Department of Basic Medicine, Zhejiang Chinese
Medical University, Hangzhou, China
3Department of Finance, First Affiliated Hospital of
Zhejiang Chinese Medical University, Hangzhou, China
4Department
of Nephrology, First Affiliated Hospital of Zhejiang Chinese Medical
University, Hangzhou, China
5Department of Hematology, First Affiliated Hospital
of Zhejiang Chinese Medical University, No.54,youdian road ,Hangzhou,
China, 310006
*Corresponding author
E-mail: zhangshuotcm@163.com(SZ)
Ethics statement
Ethical approval is not required for the study.
Conflict of interest
The authors declare that they have no conflicts of interest.
Funding Statement
There is no funding for the study.
Authors’ contributions
All authors contributed to the study conception and design. Material
preparation, data collection and analysis were performed by the first,
second and third authors. The first draft of the manuscript was written
by the first author and all authors commented on previous versions of the
manuscript. All authors read and approved the final manuscript.
Data Availability
The data used to support the findings of this study are included within
the article.
Acknowledgments
We express gratitude to Yuanjuan Zhang, Liping Zhang, and all staff for
administrative. support during this work.
Abstract
With urbanization and economic development in China, medical needs in
urban areas continue to increase, but the building of public hospitals
is, however, restricted by available space. As a result, many hospitals
have set up multiple campuses, with associated issues such as lack of
experience in running a multicampus model, quality standardization, cost
control, and culture conflicts. We have four campuses with successful
operations. In this paper, we will share our management and operation
experiences, which may provide some insights for other hospital
managers.
Key words : public health, experience, health economics, health
services research
Introduction
Multicampus hospitals are hospitals with two or more campuses. They
share one legal entity, with unified financial management and the
deployment of various resources such as staff, technology, and
equipment. They are able to provide healthcare services at different
locations or in different cities. A survey showed that in urban areas,
95% of public hospitals had multiple campuses in
20141. We analyzed the
rationale for the emergence of multicampus hospitals, their development
and management challenges, and our own experience in order to provide
insights for other similar hospitals.
Materials
Rationale for the emergence of multicampus hospitals
First, most urban public hospitals in China are facing challenges
regarding the lack of space, insufficient governmental investment, and
high operational loads, necessitating a multicampus model.
Second, with continuous economic development, urban residents are
becoming more health conscious but often choose urban public hospitals
for more advanced medical technology, requiring multiple campuses to
serve those needs. Third, while equipped with new buildings and
equipment, rural hospitals lack experienced specialists. Thus, it makes
sense for rural hospitals to collaborate with urban public hospitals and
operate as a campus.
Development of multicampus hospitals in China
In the 1980s, medical co-ops were once piloted in
China2, where several
hospitals worked together to share medical technology but were otherwise
independent with respect to financial management and staff. In the
1990s, many hospitals began to collaborate by establishing and merging
management and setting up multicampus
hospitals3.
Now, multicampus hospitals are expanding at an accelerated
pace4.
Results and discussion
Challenges and solutions in multicampus hospital management
Quality standardization
For multicampus hospitals, inconsistent procedures may lead to different
quality of care. Difference in staff, technology, and equipment may also
contribute to differential quality, affecting patient
satisfaction5. Our
experience shows that when initiating a multicampus hospital, managers
often do not focus on inconsistent quality of care; however, any campus
with poor quality of care affects overall quality of care, and over
time, the issue becomes more challenging to address. Our solution is to
deploy an information system and train staff. All campuses should have
access to a unified, shared information system, including inpatient
records, outpatient records, imaging studies, and laboratory
tests. Moreover, the managers of each campus organize conferences as
well as conduct virtual workshops to enable multidisciplinary discussion
about difficult cases. For diagnosis and treatment, we believe it is
important to train staff with standard procedures and consult recognized
specialists across campuses to diagnose and treat difficult cases.
Moreover, it is useful to implement a rotation system so that
specialists see patients at different campuses, conduct ward rounds, and
perform operations. The rotation will also help residents and attending
physicians to improve and standardize their quality of care.
Cost control
Multicampus hospitals face higher operation costs due to increased work
processes, humanpower, and equipment relative to single-campus
hospitals. Moreover, cost accounting is more complex while sharing staff
and equipment. We must address the complexity of cost
accounting while controlling costs. Our solution is the differential
deployment of departments and staff at each campus. For our hospital,
the Riverside Campus is the only general hospital in the region and is
equipped with mostly general practitioners. In addition, the campus has
an emergency room and a trauma ward because it is next to highways. The
West Lake Campus, on the other hand, is equipped with physicians
specializing in traditional Chinese medicine, acupuncture, and Chinese
massage (Tuina). Moreover, the same department may focus on different
diseases across campuses. For example, the Department of Hematology
specializes in hematological malignancies at the West Lake Campus but
common and non-malignant hematological diseases at the Riverside Campus.
The department for rare diseases only has outpatient physicians and
consultation physicians. This prevents waste and unnecessary
competition6.
All medical products, supplies, equipment, and hospital operating items
are purchased from government-designated websites, ensuring the lowest
prices for similar products online. We only have a few hospital managers
and support staff, assigned with specific tasks. The director is
responsible for overall management in order to reduce levels of
management.
Cultural conflicts
Different campuses may have different cultures or even culture conflicts
due to different department deployment, locations, and time of set up,
which affects operation
efficiency7.
Building a common culture takes time and is a complex process, where
patient-centered attitude plays an important role, as this will
gradually align behavior and cultural norms. Moreover, we encourage
hospitals to establish a timely feedback mechanism to identify cultural
differences through patients’ evaluation of employees and employees’
mutual evaluation and then minimize these differences through various
methods.
Discussions
The central campus of our hospital, a general university affiliated
hospital, was established in 1931 to provide healthcare services in the
community. In 2001, Hangzhou Economic and Technological Development Area
Hospital became a eastern campus of our hospital, heralding in the first
multicampus model in China. The revenue from this campus has been
growing 10% or more each year. We have two additional campuses,
including the western campus, which specializes in rehabilitation, and
the southern campus, which provides general treatment. In summary, we
hope our experience in addressing some common issues in hospital
management will provide insights to other multicampus hospitals.
References
1. shao gang Li, jin Wu, huizi Gao. The management mode and
countermeasure analysis of multi-area hospital. Chinese Remedies &
Clinics. 2017;17(08):1223-5.
2. Li H, Zheng s, Zheng s. Investigation on the status of hospital
branch construction in China. Practical Journal of Clinical Medicine.
2014;11(03):224-8.
3. Sun x, Ou c. Analysis of the formation of Chinese hospital groups.
hospital administration journal of Chinese people’s liberation army.
2008;15(11):1060-1.
4. Jia T, Yuan h. Analysis of the management difficulties and its
countermeasures on multi-campuses hospitals. Chinese Hospitals.
2014;18(08):28-30.
5. Li Z, Xu Y. The Consideration of the Relationship between Physician
and Patient after the Extension of Hospital. medicine and philosophy.
2005;26(04):39-40+2.
6. Gong X, Li J. Discussion on the integration of hospital culture under
the merger of medical institutions. Changing Medicine.
2014;43(04):504-5.
7. Lei Y, Sun L. Research on the Construction of Subject Groups in
General Hospital. hospital administration journal of Chinese people’s
liberation army. 2008;15(07):649-51.