Research on the Construction of Comprehensive Evaluation Index

System of Private Hospitals

Jingying Gao and Dan Chen

School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China

Corresponding author

Keywords: Private Hospitals, Evaluation Index System, Medical Quality, Competitiveness, Index Screening Model.

Abstract: Comprehensively considering the Donabedian model and the concept of core competitiveness, this study uses

the index screening model, literature research method, and Delphi method to establish a comprehensive

evaluation index system for private hospitals that is consistent with the current stage of development in China.

Calculate the index weight and determine the evaluation criteria. The index system includes 4 first-level

indexes, 9 second-level indexes, and 25 third-level indexes, including not only the medical quality evaluation

of private hospitals themselves as medical institutions, but also the core competitiveness evaluation of private

hospitals with the basic characteristics of enterprises. In the hope of promoting the sustainable and high-

quality development of private hospitals.

1 INTRODUCTION

With the continuous improvement of the people's

pursuit of medical quality, how can private hospitals

adapt to the requirements of medical and health

services in the new era, how to achieve healthy and

rapid development, the deep-seated problems arising

from this urgent need for us to explore. In recent

years, the support that nation gives to private hospital

has increased every year. However, the development

of the private hospital is still relatively difficult,

comparing with the public hospital which has long

history and strong government investment (Zeng

2018). Private hospitals need competitiveness for

better development. Consequently, the evaluation of

private hospitals should include not only the medical

quality evaluation of private hospitals themselves as

medical institutions but also the core competitiveness

evaluation of private hospitals with the basic

characteristics of enterprises. Under the background

of the “Healthy China” strategy, the construction of

comprehensive evaluation index system of private

hospitals is worth further study.

1.1 Medical Quality Evaluation

The main purpose of medical quality evaluation is to

help each medical institution accurately understand

the current situation and changing trend of its own

medical quality management, especially the gap

between it and the leading units of medical quality, so

that it can realize the loopholes and deficiencies in the

hospital quality management and carry out the

corresponding measures (Jiao 2015).

The Donabedian model was proposed by Avedis

Donabedian, the father of American medical quality

management, in 1968. It measures medical quality

with three dimensions of “structure-process-result”

(Ayanian 2016). Since then, it has been widely used

in the field of medical quality research and practice,

and this evaluation framework has been formed, that

is, the medical quality is divided into three parts:

basic condition quality, work link quality and end-of-

service quality. Jiao, X. et al. use the literature study,

focus group method, Delphi method, and balanced

score card theory to develop a set of indexes for

assessing medical quality of tertiary hospital (Jiao

2015). Wang, H. S. et al. use IOM model and

Donabedian model, the inductive method and

deductive method. A comprehensive evaluation

index system of medical quality in modern hospitals

in China is constructed (Wang 2019).

1.2 Core Competitiveness Evaluation

With the increase of medical service providers and

the development of economy and society, the

742

Gao, J. and Chen, D.

Research on the Construction of Comprehensive Evaluation Index System of Private Hospitals.

DOI: 10.5220/0011286400003440

In Proceedings of the International Conference on Big Data Economy and Digital Management (BDEDM 2022), pages 742-748

ISBN: 978-989-758-593-7

competition of medical service market is becoming

more and more intense. The people have higher and

higher requirements for the quality of medical

services. The development of private hospitals

increasingly requires core competitiveness. The core

competitiveness of an enterprise refers to the unique

and inimitable ability of an enterprise that can support

its competitive advantage (Qian 2018).

Han, Q. X. et al. start from the concept of hospital

core competitiveness, and construct an evaluation

index system for the core competitiveness of Chinese

hospitals, including social reputation, health

resources and hospital development potential (Han

2015). Gong, H. X. et al. use the entropy TOPSIS

method, taking nine cities in Pearl River Delta as

research objectives to construct an evaluation index

system of private hospitals competitiveness, and

determine the index weight (Gong 2016). Jia, Y. et al.

use the range transformation method, entropy value

method, and TOPSIS method to standardize index,

determine index weight and evaluate the

competitiveness of ten private hospitals in Dalian (Jia

2016). Qian, Y. Y. Z. uses the literature analysis and

Delphi method to construct the evaluation system of

private hospital core competitiveness, through AHP

to determine the weight of each index. And it

establishes the fuzzy matrix judgment model to

evaluate the core competitiveness of three private

hospitals in WE area (Qian 2018).

In summary, the existing researches mainly use

the literature method and Delphi method construct the

private hospital medical quality or core

competitiveness evaluation index system, by using

entropy TOPSIS method to determine the index

weight and evaluate the competitiveness, the

countermeasures are put forward. However, most

studies only take individual private hospitals as

research objects, only evaluate medical quality, or

only evaluate core competitiveness. A unified,

scientific, and effective comprehensive evaluation

index system for private hospitals has not yet been

formed.

This study hopes to promote the sustainable and

high-quality development of private hospitals by

establishing a comprehensive evaluation index

system for private hospitals in line with China's

current development, including not only the medical

quality evaluation, but also the core competitiveness

evaluation.

2 RESEARCH METHODS

2.1 Basic Model Selection

Figure 1: Index screening model.

This research uses the relatively common index

screening model, see Figure 1. This model is suitable

for a large number of indexes that already exist before

the system is built, but the indexes are scattered and

disordered. It is necessary to collect indexes and then

classify and filter them. After the system is formed,

its scientificity and practicability are evaluated.

Attention must be paid to the availability, specificity

and reliability of index screening. The finalized index

needs to be clearly defined and describe how the

index is calculated.

2.2 Literature Research Method

Collect the academic papers related to the evaluation

indexes of private hospitals, and select them

according to the inclusion-exclusion criteria and

research purpose. Establish the frequency table of

each level index of the index system. According to

the frequency table, the indexes with higher

frequency are selected for preliminary screening, and

the initial framework of the index system is formed.

2.3 Delphi Method

According to the results of literature screening, five

people including relevant university scholars, private

hospital operators, and medical institution managers

are organized to carry out expert consultation, to

remove unreasonable indexes and add missing

important indexes, improving the scientificity and

practicability of the index system. To make the expert

consultation results more scientific, we evaluate each

index from three aspects: importance, operability,

and sensitivity.

3 RESULTS

3.1 Establish Evaluation Index System

First, collect academic papers related to the

evaluation indexes of private hospitals. Most of the

literature is retrieved from the China Biomedical

Literature Database (CBMdisc), China National

Research on the Construction of Comprehensive Evaluation Index System of Private Hospitals

743

Knowledge Infrastructure (CNKI), Database of

Chinese sci-tech periodicals (VIP), and WanFang

Database. Other information is retrieved from the

website of the National Health Commission of the

PRC, the website platforms of provincial health

departments, and related foreign websites.

Carry out a fuzzy search with the theme of

“competitiveness of private hospitals, performance of

private hospitals, and quality of private hospitals”,

and then limit the titles or abstracts or keywords to

contain “index” or “evaluation index system” for

fuzzy search. By manually reading the titles and

abstracts, filter out the literature related to the

evaluation index system of private hospitals in the

past 5 years and download the full text. 306 articles

are obtained. Conduct preliminary screening based on

inclusion-exclusion criteria and research purpose,

and then the articles are browsed and discussed, and

finally 57 articles involving the evaluation indexes

are selected.

Second, create a literature information extraction

table. Collect the basic characteristics of literature,

including research time, research source, research

object, research category, and research fund source.

Based on further screening of the literature, the

relevant contents of the evaluation index system of

private hospitals in the literature are collected,

including index types, methods, and dimensions of

establishing the evaluation system.

Third, establish the frequency table of indexes at

all levels of the index system. There are 5 first-level

indexes and 119 third-level indexes. The indexes with

higher frequency are selected, and then compared

with policy documents and discussed, 4 first-level

indexes and 72 third-level indexes are reserved. The

initial framework of the index system is formed.

Fourth, conduct expert consultation on the index

system. According to the initial framework of the

index system, an expert consultation form is formed,

and the expert consultation questionnaire is

distributed to relevant university scholars, private

hospital operators, and medical institution managers

to collect relevant results.

Finally, according to the results of expert

consultation, calculate the mean value, standard

deviation, and coefficient of variation of the indexes.

After two rounds of discussions, combined with the

actual work development and recent development

goals. The comprehensive evaluation index system of

private hospitals includes 4 first-level indexes, 9

second-level indexes, and 25 third-level indexes.

3.2 Calculate the Weight

3.2.1 Degree of Expert Authority

The degree of expert authority of the expert

consultation is detailed in Table 1. The calculation

formula is Cr=(Ca+Cs)/2, in which Ca and Cs are

calculated by assigning points. The authority

coefficients of the four first-level indexes are all

greater than 0.70, which indicates the higher degree

of authority of the expert.

Table 1: Degree of expert authority score table.

Judgment

coefficient

(Ca)

Familiarity

coefficient

(Cs)

Authority

coefficient

(Cr)

Social reputation 0.82

0.74

0.78

Medical service

capacity

0.88

Financial

operations and

management

capability

0.90

0.80 0.85

Development

potential

0.84

0.70 0.77

3.2.2 Weight Calculation Results

The results of the weight calculation are shown in

Table 2.

3.2.3 Determine the Evaluation Criteria

First, the index base is established on the basis of

reading literature and relevant national policy

documents. And the preliminary evaluation index

system is determined through expert consultation.

Second, the weighted average method is used to

calculate the weight of each index. The importance

score of each index is multiplied by the authority

coefficient of each expert to get the weighted score.

Then calculate the weighted average of each index,

and get the actual score after a series of mathematical

conversion calculations.

Finally, with reference to the relevant criteria in

the policy document and the actual situation, the

detailed scoring criteria for each index are calculated.

See Table 3.

The national standards are derived from “Private

Hospital Evaluation Standards Implementation Rules

(2016 Edition)”.

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Table 2: Comprehensive evaluation index system of private hospitals.

First-level

index

Point

value

Second-level

index

Point

value

Third-level index Weight

Combined

weight

Point

value

Social

reputation

(0.2172)

Patient

satisfaction

(1)

Annual patient satisfaction 0.5218 0.1133 11

Secondary visit rate 0.4782 0.1039 11

Medical

service

capacity

(0.3424)

Human

resources

(0.1124)

Proportion of personnel with senior

titles

0.0606 0.0207 2

Percentage of personnel with post-

graduate education or above

0.0518 0.0177 2

Medical

quality

(0.4381)

Prescription pass rate 0.0648 0.0222 2

Effective rate of treatment 0.0662 0.0227 3

Success rate of rescuing critically ill

patients

0.0648 0.0222 2

Accuracy of dispensing drugs 0.0619 0.0212 2

Diagnosis coincidence rate 0.0634 0.0217 2

Large equipment positive detection

rate

0.0522 0.0179 2

Incidence of medical errors 0.0648 0.0222 2

Medical

safety

(0.3258)

Annual number of medical

malpractices

0.0662 0.0227 2

Incidence of medical disputes 0.0648 0.0222 2

Infection rate of aseptic surgical

incision

0.0662 0.0227 2

Annual adverse event reporting rate 0.0621 0.0213 2

Incidence of nosocomial infection 0.0665 0.0228 3

Medical

service

efficiency

(0.1237)

Bed utilization 0.0662 0.0227 2

Average hospitalization days 0.0575 0.0197 2

Financial

operations

and

management

capability

(0.2019)

Income and

expenditure

structure

(0.7296)

Proportion of drug income 0.2507 0.0506 5

Percentage of inspection and test

income

0.2348 0.0474 5

Percentage of management fee 0.2441 0.0493 5

Debt paying

ability

(0.2704)

5 Hospital asset-liability ratio 0.2704 0.0546 5

Development

potential

(0.2362)

Personnel

training

(0.6657)

Passing rate of “three-basic and

three-strict” examinations for

medical personnel

0.3692 0.0872 9

Proportion of staff going on further

training

0.2965 0.0700 7

Development

and

innovation

(0.3343)

Number of new technologies or

special therapy items

0.3343 0.0790 8

Total 100

100

Research on the Construction of Comprehensive Evaluation Index System of Private Hospitals

745

Table 3: Evaluation criteria for comprehensive evaluation index system of private hospitals.

Third-level index Evaluation criteria

National

standard

Annual patient satisfaction

α≥85%, 11points; 80%≤α<85%, 8points; 75%≤α<80%,

5points; 70%≤α<75%, 2points; α<70%, 0points

≥85%

Secondary visit rate

α≥80%, 11points; 75%≤α<80%, 8points; 70%≤α<75%,

5points; 65%≤α<70%, 2points; α<65%, 0points

Proportion of personnel with senior titles α≥15%, 2points; 5%≤α<15%, 1points; α<5%, 0points /

Percentage of personnel with post-graduate

education or above

α≥15%, 2points; 5%≤α<15%, 1points; α<5%, 0points /

Prescription pass rate α≥95%, 2points; 90%≤α<95%, 1points; α<90%, 0points ≥95%

Effective rate of treatment

α≥90%, 3points; 85%≤α<90%, 2points;

80%≤α<85%, 1points; α<80%, 0points

≥90%

Success rate of rescuing critically ill patients α≥80%, 2points; 75%≤α<80%, 1points; α<75%, 0points ≥80%

Accuracy of dispensing drugs α≥95%, 2points; 90%≤α<95%, 1points; α<90%, 0points /

Diagnosis coincidence rate α≥60%, 2points; 55%≤α<60%, 1points; α<55%, 0points ≥60%

Large equipment positive detection rate α≥50%, 2points; 45%≤α<50%, 1points; α<45%, 0points ≥50%

Incidence of medical errors α≤0.5%, 2points; 0.5%<α≤1.5%, 1points; α>1.5%, 0points /

Annual number of medical malpractices α=0, 2points; 0<α≤5, 1points; α>5, 0points 0

Incidence of medical disputes

α≤0.05%, 2points; 0.05%<α≤0.15%, 1points;

α>0.15%, 0points

≤0.05%

Infection rate of aseptic surgical incision α≤0.5%, 2points; 0.5%<α≤2%, 1points; α>2%, 0points ≤0.5%

Annual adverse event reporting rate α=100%, 2points; 90%≤α<100%, 1points; α<90%, 0points 100%

Incidence of nosocomial infection

α≤8%, 3points; 8%<α≤9%, 2points;

9%<α≤10%, 1points; α>10%, 0points

≤8%

Bed utilization α≥80%, 2points; 75%≤α<80%, 1points; α<75%, 0points ≥80%

Average hospitalization days

α≤10days, 2points; 10days<α≤15days, 1points;

α>15days, 0points

≤10days

Proportion of drug income α≤45%, 5points; 45%<α≤50%, 3points; α>50%, 0points ≤45%

Percentage of inspection and test income α≤19%, 5points; 19%<α≤23%, 3points; α>23%, 0points /

Percentage of management fee α≤10%, 5points; 10%<α≤30%, 3points; α>30%, 0points /

Hospital asset-liability ratio α≤55%, 5points; 55%<α≤65%, 3points; α>65%, 0points /

Passing rate of “three-basic and three-strict”

examinations for medical personnel

α=100%, 9points; 95%≤α<100%, 7points; 90%≤α<95%,

5points; 85%≤α<90%, 3points; α<85%, 0points

100%

Proportion of staff going on further training

α≥15%, 7points; 10%≤α<15%, 5points;

5%≤α<10%, 3points; α<5%, 0points

Number of new technologies or special

therapy items

α≥15, 8points; 10≤α<15, 5points;

5≤α<10, 2points; α<5, 0points

4 CONCLUSIONS

The results of this study show that among the first-

level indexes, the top three scores are: medical

service capacity (34), development potential (24),

social reputation (22). Among the second-level

indexes, the top three scores are patient satisfaction

(22), personnel training (16), medical quality (15),

and income and expenditure structure (15). Among

the third-level indexes, in terms of social reputation,

the highest combined weight is annual patient

satisfaction (0.1133). In terms of medical service

capability, the highest combined weight is the incidence of

nosocomial infection (0.0228). In terms of financial

operations and management capability, the highest

combined weight is the hospital asset-liability ratio

(0.0546). In terms of development potential, the highest

combined weight is the passing rate of “three-basic and

three-strict” examinations for medical personnel (0.0872).

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4.1 Enhance Patient Satisfaction

Private hospitals should strengthen infrastructure

construction and improve hospital environment,

facilities and sanitation. Standardize the service

attitude of medical personnel, and severely punish

phenomena such as indiscriminate charges. Optimize

the medical treatment process, improve the

appointment diagnosis and treatment services, and

widely carry out convenient services. Continuously

improve the quality of medical care, improve medical

technology, meet the needs of the people for medical

services, and build a harmonious doctor-patient

relationship, thereby enhancing patient satisfaction.

4.2 Implement Infection Management

Private hospitals should strengthen nosocomial

infection management. In view of the current

situation of epidemic prevention and control, private

hospitals should implement the prevention of people

and objects, the prevention of internal and external,

and the prevention of doctors and patients. Integrate

the concept of “three defenses” into diagnosis and

treatment activities to reduce the risk of infection in

private hospitals (Wang 2021). Adhere to strict

management to ensure medical safety, formulate and

improve a series of medical rules and regulations.

4.3 Optimize Asset Management

Private hospitals should optimize the hospital's asset

management, strengthen the analysis and allocation

of assets, and especially improve the management of

fixed assets. Formulate regulations on the

management of fixed assets and strictly implement

the asset budget (Li 2019). The scale and increase or

decrease of liabilities should be adapted to the

hospital's demand for funds and solvency. A financial

risk management and early warning mechanism

should be established to dynamically monitor

hospital assets and debt data to avoid potential risks

(Zhou 2020).

4.4 Strengthen Talent Team Building

Private hospitals should reasonably excavate,

develop and cultivate reserve talents. Attach great

importance to the introduction and training of talents,

attract talents through favorable treatment and perfect

promotion system. Improve incentive measures,

mobilize the enthusiasm of medical personnel to

participate in scientific research work, and stimulate

innovation vitality. Organize regular training and

assessment. Strengthen the training of “three-basic

and three-strict” for medical personnel, improve the

level and quality of medical personnel. Thereby

improving the quantity, efficiency and quality of

medical services.

ACKNOWLEDGEMENT

This paper is one of the phased achievements of the

project “Research on the Evaluation Index System of

Private Hospitals in China” commissioned by the

Social Medical Management Branch of the Chinese

Association of Chinese Medicine.

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