Core competence of midwives in township hospitals and its influencing factors-A cross-sectional study.

Objective: This study aimed to assess the core competence of midwives in township hospitals through a self-assessment questionnaire. The relationship between professional identity and core competence and the factors influencing midwives' core competence was also investigated. Method: Convenience sampling was conducted in 77 township hospitals in Ganzhou, Jiangxi Province, China, with 150 participants. The questionnaires were distributed online in November 2021. We conducted a descriptive data analysis, a correlation analysis of the two variables of professional identity and core competencies, and multivariate linear regression to analyse the influencing factors, including the sociodemographic information, the Midwife Core Competence Scale, and the Nurses' Professional Identity Scale scores. Results: The mean score for the core competence was 206.43 (±37.45) out of 270. The highest score was for pregnancy care (3.97 ± 0.70) and the lowest was for newborn care (3.72 ± 0.78). The independent sample t-test results and one-way analysis of variance showed that qualifications, midwifery training situation, and midwifery working years had differential effects on midwives' core competencies (P < 0.05). Multiple linear regression showed that qualifications, midwifery working years, and level of professional identity were influencing factors (P < 0.05). Conclusions: The core competencies of midwives in township hospitals were lower than those reported in other studies. Advancements in education, midwifery working years, and professional identity may increase midwives' core competencies.

The relationship between organisational support for career development, organisational commitment, and turnover intentions among healthcare workers in township hospitals of Henan, China.

BACKGROUND: Township hospitals in China face the challenge of shortage and turnover of healthcare workers. This study aims to evaluate the relationship between organisational support for career development (OSCD), organisational commitment, and turnover intentions among healthcare workers in township hospitals. METHODS: The data in this study were obtained from the Health Service Capacity Survey of Primary Health Institutions (2020), one of the special surveys of rural health poverty alleviation in Henan, China. The sample comprised 298 healthcare workers. Three standardised instruments were used: the turnover intention scale, OSCD scale, and organisational commitment scale. Descriptive statistics, One-way Analysis of Variance, Pearson correlation analysis, and the simple mediation model were used for data analysis. RESULTS: The results showed that the mean score of the healthcare workers' turnover intentions was 2.21 ± 0.77, which was low. The healthcare workers' turnover intentions had significant differences in gender, age, marital status, education, professional title, and organisational tenure. OSCD had no significant direct relationship with turnover intentions, while having a significant positive direct relationship with organisational commitment. Organisational commitment had a significant negative direct relationship with turnover intentions, and played a fully mediating role in the relationship between OSCD and turnover intentions. CONCLUSIONS: OSCD had an indirect negative effect on healthcare workers' turnover intentions in township hospitals through the full mediation of organisational commitment. The findings of this study suggest the importance of policymakers and organisation managers to improve OSCD practice and pay attention to 'humanistic management'. In addition, the formulation and implementation of talent retention policies should consider socio-demographic differences.

[Study of the Workload and Human Resources Demand of Basic Public Health Services in Township Hospitals of Sichuan Province].

OBJECTIVE: To understand the basic public health service (BPHS) tasks and workload of the township hospitals in Sichuan Province and to provide empirical evidence for improving the allocation of human resources (HR) and the quality of BPHS in township hospitals. METHODS: Retrospective survey was conducted to collect information regarding the actual working hours per unit time of service of BPHS. Information on the service volume and unit service time of BPHS tasks for 2018 was collected in 7 township hospitals in an economically developed area and an area of moderate economic development. Estimated HR required to cover the BPHS tasks was calculated based on the survey data of actual work time. RESULTS: The time required for the basic units of various BPHS tasks varied greatly. The top four most time-consuming services showing consistent results in the the two regions were health education, health supervision and coordination, management of children aged 0-6 and maternal care management. Institutions in the area of moderate economic development reported higher per capita service volume in the registration of children for vaccination, management of hypertension, and health supervision and coordination than those in the economically developed area, but lower service volume for other services. There is a shortage of full-time staffs in both areas. CONCLUSION: Differences in the service volume of BPHS exist in regions of different levels of economic development. The shortage in HR could be related to the lower quality and volume of the service. Comprehensive exploration of policies to recruit and retain competent personnel, the strengthening of grassroots professional training, and optimization of information technology will help improve the competence and quality of grassroots services.

A Comprehensive Evaluation of Township Hospitals in the Severely Cold Areas of China.

OBJECTIVE: The aims of this study are to establish an evaluation system and find the existing problems in the architectural design of township hospitals in the severely cold regions of China. BACKGROUND: Due to the geographical location and economic factors, development still has some key problems, such as inadequate construction, old facilities, and backward technology, which are more prominent in the severely cold regions. METHODS: First, evaluation factors have been selected and determined by literature review and on-site investigation. Evaluation rules have been determined using fuzzy membership function. Then, the analytic hierarchy process is used to determine the weights of the evaluation factors at all levels. Finally, take a township hospital as an example to calculate the comprehensive evaluation results. RESULTS: A comprehensive evaluation index system with 28 elements and 76 factors for the township hospitals in severely cold regions including the basic health service capacity, the emergency capacity, and the climate fitness. CONCLUSIONS: The establishment of the comprehensive evaluation system of township hospitals in severely cold areas in this study aims to find out the problems through the evaluation of the existing township hospitals in the severely cold areas and provide guidance for the transformation of existing township hospitals in the severely cold areas. By comparing the scheme evaluation for building hospitals, we shall look for the optimal solution to provide reference for future development in the construction of township hospitals.

Evaluating Patient Satisfaction in Township Hospitals in the Cold Regions of China.

OBJECTIVE: This study focused on township hospitals in the cold regions of China and aimed to evaluate patient satisfaction during the medical care process. This study also discusses the correlation between patient needs and satisfaction. BACKGROUND: Hospitals seek to improve patient satisfaction to provide better service. However, there is a lack of existing literature on grassroots medical institutions in towns and townships, especially in cold regions. Therefore, this study aimed to examine the correlation between patient needs and the satisfaction of township hospitals in the cold regions of China. METHODS: First, a hierarchical task analysis method was used to build the hierarchy for patient satisfaction demands. Patients from 15 township hospitals in cold areas were subjected to semistructured interviews, and a theoretical model was proposed using the grounded theory method. Finally, each open code index was evaluated, and 270 questionnaires were issued to evaluate patient satisfaction. RESULTS: The framework for patient satisfaction demands included five dimensions: tangibles, reliability, responsiveness, assurance, and empathy. A theoretical model for patient satisfaction demands was built, and four selective codes, including "Characteristic", "Perceived Quality", "Loyalty Intention", and "Environment Expectation", were extracted. The weights of these satisfaction-influencing factors were subsequently evaluated. CONCLUSIONS: This study summarizes the existing problems in a basic health service provision capacity, climate adaptability, lack of environmental design, and so on; proposes four influencing factors; establishes a patient satisfaction evaluation model; and obtains the weight of influence of each factor. These results will help provide accurate and effective suggestions for hospital management.

Factors Associated With Hospitalization Costs of Coronary Heart Disease in Township Hospitals in Rural China.

In large proportions of rural areas in many developing countries, health care delivery system is less developed and is less likely to be equipped to conduct sophisticated treatment for coronary heart disease (CHD) patients locally. This study aims at describing the status quo of and exploring factors associated with hospitalization costs of CHD in township hospitals where only drug therapy was available for CHD conditions. We collected data of inpatients with CHD from discharge records from 10 township hospitals in rural Liaoning from December 2013 to December 2014. We used multilevel linear regression to analyze the factors associated with CHD hospitalization costs. A total of 4635 inpatients were included in the analysis. We found that the average hospitalization costs were 6249.97 RMB (US$1012.47) with the average of 8.89 days of hospitalization in township hospitals in Liaoning. Age, gender, length of stay, the number of times of admissions, by which route was hospitalized, and type of CHD were all the factors significantly associated with hospitalization costs of CHD in township hospitals. The factors associated with hospitalization costs of CHD in township hospitals in rural China showed some different features from the existing studies. When the government designs the related policy, the policy makers need to consider the specific feature of hospitalization costs of CHD in township hospitals in rural areas.

Psychological violence against general practitioners and nurses in Chinese township hospitals: incidence and implications.

BACKGROUND: International reports indicating that around 10-50% of health care staff are exposed to violence every year; in certain settings, this rate might reach over 85%. Evidence has shown that people who experience psychological violence are seven times as likely to be victims of physical violence. Although there have been numerous studies on WPV in general hospitals, there is no consensus regarding the current status of psychological violence directed at health care workers in township hospitals in China. The purpose of this study was to estimate the prevalence and the risk factors of psychological violence in Chinese township hospitals. METHODS: A retrospective cross-sectional survey of township hospitals general practitioners and general nurses was conducted in Heilongjiang Province, China.Descriptive analyses and binary logistic regression analysis were used to estimated the prevalence and the risk factors of psychological violence. RESULTS: Regardless of whether the assessment period was the past 12 months, past 36 months, or during their entire career,GPs and nurses reported that verbal abuse was the most common type of psychological violence (28.05, 30.28, 38.69 and 40.45%, 43.86, 54.02%).The main perpetrator was patients' relatives. Most participants responded to violence with "pretend nothing happened", 55.63% of GPs and 62.64% of nurses reported that the perpetrator received no punishment. Around 47.62% of respondents reported that their workplace had no procedures for reporting violence. When workplaces did have a reporting system, 57.73% knew how to use them. Only 36.98% had training in managing aggression and violence. General nurses, individuals 35 years or younger, those with higher professional titles and who work in shifts are at greater risk of psychological violence. CONCLUSIONS: Our results indicate a high prevalence of psychological violence in Chinese township hospitals, which can no longer be ignored. Effective measures should be taken to prevent and respond to workplace violence(WPV), especially psychological violence. TRIAL REGISTRATION: (Project Identification Code: HMUIRB20160014), Registered May 10, 2016.

Status analysis of the emergency ability of the pediatrics in township hospitals / 中国小儿急救医学

Objective@#To understand the present situation of the emergency ability of the pediatrics in township hospital of Hunan province, and to provide the basis for improving the treatment of critical diseases and strengthening the medical quality in basic hospital.@*Methods@#Status survey, expert consultation, on-spot examination, and questionnaire were conducted.One representative of the 1 217 township hospitals participating in the appropriate health technologies for pediatric emergency was sent to a face-to-face survey by investigators.@*Results@#In 1 217 township hospitals, only 965 pediatricians had been certified.Among them, 58 township hospitals did not purchase the first aid equipment in the scope of the survey, and 211 township hospitals were not equipped with first aid drug.Less than 30% of township hospitals had tracheotomy kits, cardiac defibrillator and first aid equipment such as neonatal incubator, newborn radiation table and infusion pump.Among the trained 1 095 general practitioners, only 305(27.85%) understood the basic first-aid knowledge of this training in pediatrics; 258(258/1 217, 21.20%) township hospitals could not carry out 7 pediatric emergency projects of this survey.The proportion of the capable of carrying out rescue treatment including acute respiratory failure (191/1 217, 15.69%), heart failure (201/1 217, 16.52%) and shock(227/1 217, 18.65%) in township hospitals were less than 30%.@*Conclusion@#The primary hospital is the basis for the treatment of critical diseases in pediatrics, but the level of diagnosis and treatment and basic equipment need to be further strengthened.The urgent task is to strengthen the training of medical and nursing staff in the treatment of critical diseases in pediatrics.

Efficiency and productivity measurement of rural township hospitals in China: a bootstrapping data envelopment analysis.

OBJECTIVE: Township hospitals (THs) are important components of the three-tier rural healthcare system of China. However, the efficiency and productivity of THs have been questioned since the healthcare reform was implemented in 2009. The objective of this study is to analyse the efficiency and productivity changes in THs before and after the reform process. SETTING AND PARTICIPANTS: A total of 48 sample THs were selected from the Xiaogan Prefecture in Hubei Province from 2008 to 2014. OUTCOME MEASURES: First, bootstrapping data envelopment analysis (DEA) was performed to estimate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of the sample THs during the period. Second, the bootstrapping Malmquist productivity index was used to calculate the productivity changes over time. RESULTS: The average TE, PTE and SE of the sample THs over the 7-year period were 0.5147, 0.6373 and 0.7080, respectively. The average TE and PTE increased from 2008 to 2012 but declined considerably after 2012. In general, the sample THs experienced a negative shift in productivity from 2008 to 2014. The negative change was 2.14%, which was attributed to a 23.89% decrease in technological changes (TC). The sample THs experienced a positive productivity shift from 2008 to 2012 but experienced deterioration from 2012 to 2014. CONCLUSIONS: There was considerable space for TE improvement in the sample THs since the average TE was relatively low. From 2008 to 2014, the sample THs experienced a decrease in productivity, and the adverse alteration in TC should be emphasised. In the context of healthcare reform, the factors that influence TE and productivity of THs are complex. Results suggest that numerous quantitative and qualitative studies are necessary to explore the reasons for the changes in TE and productivity.

Concern about Workplace Violence and Its Risk Factors in Chinese Township Hospitals: A Cross-Sectional Study.

Workplace violence in Chinese township hospitals is a major public health problem. We identified the risk factors of healthcare workers' worry about experiencing workplace violence in 90 Chinese township hospitals and determined specific measures for differing stages of violence (based on crisis management theory). Participants were 440 general practitioners and 398 general nurses from Heilongjiang Province, China (response rate 84.6%). One hundred and six (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Regarding psychological violence, the most common type reported was verbal abuse (46.0%). While most (85.2%) respondents had some degree of worry about suffering violence, 22.1% were worried or very worried. Ordinal regression analysis revealed that being ≤35 years of age, having a lower educational level, having less work experience, and working night shifts were all associated with worry about workplace violence. Furthermore, those without experience of such violence were more likely to worry about it. Respondents' suggested measures for controlling violence included "widening channels on medical dispute solutions," "improving doctor-patient communication," and "advocating for respect for medical workers via the media." Results suggest the target factors for reducing healthcare workers' worry by according to the type of education and training and possible measures for limiting workplace violence in township hospitals.

Prescribing Patterns in Outpatient Clinics of Township Hospitals in China: A Comparative Study before and after the 2009 Health System Reform.

OBJECTIVE: China introduced a series of health reforms in 2009, including a national essential medicines policy and a medical insurance system for primary care institutions. This study aimed to determine the changing prescribing patterns associated with those reforms in township hospitals. METHODS: A multi-stage stratified random cluster sampling method was adopted to identify 29 township hospitals from six counties in three provinces. A total of 2899 prescriptions were collected from the participating township hospitals using a systematic random sampling strategy. Seven prescribing indicators were calculated and compared between 2008 and 2013, assessing use of medicines (antibiotics and adrenal corticosteroids) and polypharmacy, administration route of medicines (injections), and affordability of medicines. RESULTS: Significant changes in prescribing patterns were found. The average number of medicines and costs per-prescription dropped by about 50%. The percentage of prescriptions requiring antibiotics declined from 54% to 38%. The percentage of prescriptions requiring adrenal corticosteroid declined from 14% to 4%. The percentage of prescriptions requiring injections declined from 54% to 25%. Despite similar changing patterns, significant regional differences were observed. CONCLUSIONS: Significant changes in prescribing patterns are evident in township hospitals in China. Overprescription of antibiotics, injections and adrenal corticosteroids has been reduced. However, salient regional disparities still exist. Further studies are needed to determine potential shifts in the risk of the inappropriate use of medicines from primary care settings to metropolitan hospitals.

Factors Associated with the Competencies of Public Health Workers in Township Hospitals: A Cross-Sectional Survey in Chongqing Municipality, China.

PURPOSE: This study aimed to explore the competencies of public health workers (PHWs) of township hospitals in Chongqing Municipality (China), and determine the related impact factors of the competencies of PHWs; METHODS: A cross-sectional research was conducted on 314 PHWs from 27 township hospitals in three districts in Chongqing Municipality (China), from June to August 2014. A self-assessment questionnaire was established on the basis of literature reviews and a competency dictionary. The differences in competencies among the three districts were determined by adopting the chi-square test, t-test, analysis of variance (ANOVA) method, and the impact factors of the competencies of PHWs were determined by adopting stepwise regression analysis. RESULTS: (1) RESULTS of the demographic characteristics of PHWs in three sample districts of Chongqing Municipality showed that a significant difference in age of PHWs (p = 0.021 < 0.05) and the majors of PHWs (p = 0.045 < 0.05); (2) In terms of the self-evaluation competency results of PHWs in township hospitals, seven among the 11 aspects were found to have significant differences in the three districts by the ANOVA test; (3) By adopting the t-test and ANOVA method, results of the relationship between the characteristics of PHWs and their competency scores showed that significant differences were found in the economic level (p = 0.000 < 0.05), age (p = 0.000 < 0.05), years of working (p = 0.000 < 0.05) and title of PHWs (p = 0.000 < 0.05); (4) Stepwise regression analysis was used to determine the impact factors of the competencies of PHWs in township hospitals, including the economic level (p = 0.000 < 0.001), years of working (p = 0.000 < 0.001), title (p = 0.001 < 0.005), and public health major (p = 0.007 < 0.01). CONCLUSIONS: The competencies of the township hospital staff in Chongqing Municipality (China), are generally insufficient, therefore, regulating the medical education and training skills of PHWs is crucial to improve the competencies of PHWs in the township hospitals of Chongqing Municipality. The results of this study can be mirrored in other areas of China.

Organizational barriers associated with the implementation of national essential medicines policy: A cross-sectional study of township hospitals in China.

This study identifies potential organizational barriers associated with the implementation of the Chinese National Essential Medicines Policy (NEMP) in rural primary health care institutions. We used a multistage sampling strategy to select 90 township hospitals from six provinces, two from each of eastern, middle, and western China. Data relating to eight core NEMP indicators and institutional characteristics were collected from January to September 2011, using a questionnaire. Prescription-associated indicators were calculated from 9000 outpatient prescriptions selected at random. We categorized the eight NEMP indicators using an exploratory factor analysis, and performed linear regressions to determine the association between the factor scores and institution-level characteristics. The results identified three main factors. Overall, low levels of expenditure of medicines (F1) and poor performance in rational use of medicines (F2) were evident. The availability of medicines (F3) varied significantly across both hospitals and regions. Factor scores had no significant relationship with hospital size (in terms of number of beds and health workers); however, they were associated with revenue and structure of the hospital, patient service load, and support for health workers. Regression analyses showed that public finance per health worker was negatively associated with the availability of medicines (p < 0.05), remuneration of prescribers was positively associated with higher performance in the rational use of medicines (p < 0.05), and drug sales were negatively associated with higher levels of drug expenditure (p < 0.01). In conclusion, irrational use of medicines remains a serious issue, although the financial barriers for gaining access to essential medicines may be less for prescribers and consumers. Limited public finance from local governments may reduce medicine stock lines of township hospitals and lead them to seek alternative sources of income, jeopardizing their capacity to meet the needs of local consumers.

Evaluation of medical service efficiency before and since the implementation of the essential medicine system at township hospitals in Shandong province / 中华医院管理杂志

Objective To evaluate the township hospitals'medical service efficiency in Shandong province,and to provide references for the development in township hospitals under the background of the essential medicine system.Methods The method of data envelopment analysis(DEA)was used to analyze the township hospitals' medical service efficiency in Shandong province before and since the implementation of the essential medicine system.Results For the township hospitals in Shandong province in general,their relative efficiency ratio of the medical service efficiency dropped from 66.67% to 53.33% since the implementation of the essential medicine system.In terms of the input and output,the non-DEA effective township hospitals are found with insufficient output as measured by the output indicator,while some input indicators input were found as excessive.Conclusion The low scale efficiency has become the main factor for the low service efficiency of such hospitals since the implementation of the essential medicine system in Shandong province.In order to improve the medical service efficiency,it is important to continue to improve the essential medicine system,increase the medical staff's incentives, improve the fiscal compensation policy,and keep the policy continuity.

Research on the Allocation of the Health Workforce in Primary Medical Institutions in Rural China：Based on Data of township hospitals from 29 provinces / 中国卫生经济

The health workforce plays an important role in the development of township hospitals. It builds up the comprehensive evaluation index system as the first time, based on data of township hospitals from 29 provinces, to evaluate the allocation of the health workforce in primary medical institutions in rural China. The empirical results show that the core workforce allocation of Chinese township hospitals has largely focused on the local health status, which shows good fairness of allocation. Meanwhile, the equity level of the core workforce allocation is not far behind the overall fairness level, and both are slightly higher than the critical value. The core workforce allocation is in good consistency with the local level of economic development.

Functional orientation of township hospitals in developed areas in China / 中华医院管理杂志

Objective To explore the functional orientation of township hospitals in developed areas to achieve goals of the ongoing health reform.Methods Two rounds of Delphi consultation was made among 18 experts from around the country to learn the degree of importance of every function.Results The experts' average seniority of service in their fields was 23.28±10.41 years.The positivity coefficients of the two-round consultation were 100％.Kendall' S coefficients of the two-round consultation were 0.226 and 0.265 (p＜0.01).These data are of statistical importance,suggesting consensus among these experts and the consultation meeting the needs of forecast.In these consultation,seven class-1 functions and and 27 class-2 functions were determined.Medical services and public health services account for similar proportion of work of township hospitals.Conclusion The functional orientation was feasible and forward looking,for reference of township hospitals in developed areas.

Investigation and analysis of the current state of development in township hospitals in Wenzhou City / 中华医院管理杂志

An analysis on the human resources, equipments and budgets of the township hospitals in Wenzhou City discovered the following setbacks: Changeable management system, poor positioning of their functionality, difficulty to play their roles, insufficient funding, inadequate infrastructure, slow development, lack of medical technicians, low level of medical services, and lack of development momentum. Based on these findings, the author proposed the following to upgrade their functionality and promote their development: Clearly positioning their functionality, improving the financial assurance mechanism, deepening system reforms in these hospitals, and further clarifying job divisions.