Abstract

1 Objectives and Significance

“Decision of the central committee of the communist party of China about some major issues in building a harmonious socialist society”stressed that“focusing on solving the interests problems people most concerned a-bout, the most direct and the most realistic”, “to stimulate social vitality”and“adhere to public welfare nature of public medical health”, “Strengthen public service function of public hospital”, to promote the harmonious society construction.At present, it is difficult to let current public hospital return to the“public welfare”as well as the prominent social problem of Chinese doctor-patient contradiction, which undoubtedly becomes a major theoretical and realistic proposition in the field of medical and health services, focusing on the promotion of public hospital social governance system and governance capacity, and building a harmonious relationship between doctors and patients to promote the building of a harmonious society in China.Based on the perspective of stimulating the demand side of the medical service to promote the social evaluation supervision and governance, this paper identifies and defines the concept and connotation of the public hospital's social responsibility and social evaluation in China at the present stage.The theoretical model, realization path and strategy of public hospital social evaluation and governance were systematically constructed and put forward.The results of the study would help to improve the interpretation of social evaluation and governance elements on the mechanism of fulfilling the social responsibilities of public hospital, and explore new governance ideas to solve the major problem of poor social effect of the government and the health administrative departments managing the public hospital.It also has important significance to enrich and promote health management science.

2 Methods

2.1 Theoretical research

On the basis of literature research and logical reasoning, this paper defines the concept and connotation of public welfare, social responsibility and social evaluation of public hospitals in China, and puts forward to construct the theoretical model of social evaluation and governance of public hospital.

2.1 Empirical research

The questionnaire, interviews, Delphi method, mathematical statistics and so on were used.2595 public hospital stakeholders were surveyed, who were randomly selected from the government and relevant departments, provincial and municipal hospital, provincial and municipal physician associations, provincial and municipal TV stations and newspapers, provincial and municipal people's Congress and CPPCC members, urban and rural residents in Zhejiang Province in the east of China, Hubei Province in the central of China and Shaanxi Province in the west of China.A thorough investigation and empirical analysis of 960 outpatients and inpatients as well as 480 medical staff were carried out in 8 provincial and municipal tertiary comprehensive hospitals in the three provinces.

3 Main Research Contents and Results

3.1 Research on social evaluation and governance theory of public hospital

The research found that, from the perspective of social system, comparing the concept expression of“social responsibility”on the demand side of public hospital with the concept of“public welfare”“social function”“social duties”and“social responsibility”on the common supply side of literature,“duties”reflects government's guarantee and regulation responsibilities for public hospital's social position or function, “responsibility”reflects social responsibility the public hospital should bear or carry on.This concept inter-pretation is more easily to be understood, interacted and accepted by the social system.

The social duties of public hospital refers that on the basis of the government's effective security, management, supervision and guidance on public hospital's sustainable development, in order to meet the specific social needs, the responsibility of public hospital should include maintaining public health, ensuring the quality and accessibility of basic medical services, fulfilling government mandatory task and other aspects of improving social benefits.Social evaluation of public hospital is a participatory governance mechanism and method which is based on social governance theory in the field of public health services to stimulate and mobilize the social forces.It refers to authorize inspection, assessment, release, feedback, and urge the governance of public hospital to return to public welfare and assume its due social responsibilities and values from the angle of social multi-participation subject of“the third sector”with certain authority and influence.

3.2 Study about the cognition, attitude and influencing factors of stakeholders on social evaluation and governance of public hospital

The study has found that patients and their families have the lowest awareness rate of public hospital social evaluation（55.41%）, followed by are the social public（63.29%）, public media（74.45%）, the next are the government-related civil servants（84.34%）and medical workers（84.55%）, the social professional organization workers have the highest awareness rate（88.66%）.The enthusiasm or willingness rate of public hospital stakeholders participating in social evaluation and governance is as high as 94.0%, however, the participate optimism of the demand side such as patients and their families（96.8%）, the social public（96.8%）, the social professional organization（94.9）and public media representatives（96.2%）and so on, are significantly higher than other two kinds of the stakeholders of the supply side.The belief of patients and their families（91.7%）, public media（88.6%）and the public representatives（85.4%）, that social system participating in social evaluation and governance of public hospital is necessary, is significantly higher than that of the government-related civil servants（77.8%）, the social professional organization（69.4%）and medical workers（60.4%）.Education level, age and working time are the main common factors that affect different stakeholders'cognition and attitude toward social evaluation and governance of public hospital.

3.3 Study on the public's willingness and formation mechanism of participating in social evaluation and governance of public hospital

The study has found that the public's and content willingness rates of participating in social evaluation and governance of public hospital are all a-bout 73%, but the cognitive level is relatively low.The public's participation willingness is positively related to the ladder of“pay attention to public information”take the initiative to reflect the views to influence the public decision making”actively participate in planning, negotiation and cooperation decision-making”from low to high participation.Based on the planned behavior theory, the path coefficients of participation attitude, subjective norm and perceptual behavior control three elements to participation way willingness are in turn 0.542、-0.189 and 0.335（P values were ＜0.001）.The path coefficients to participation content willingness are in turn 0.572、-0.136 and 0.295（P values were ＜0.001）.There is a positive pairwise correlation among participation attitude, subjective norm and perceptual behavior control.The path coefficients of the public cognition on social evaluation and governance of public hospital to participation attitude, subjective norm and perceptual behavior control are in turn 0.565,0.484, and 0.417.All have significant significance（p values were＜0.001）.The indirect effect of cognition on participation way willingness through participation attitude, subjective norm and perceived behavioral control are in turn 0.291, -0.093, and 0.135.The in-direct effect on participation content willingness are in turn 0.303, -0.067, and 0.117.Cognition has a direct positive impact on participation attitude, subjective norm and perceptual behavior control, though it has no direct impact on the public's participation willingness, it can produce indirect promoting effect on willingness through participation attitude, subjective norm and perceptual behavior control.

3.4 Research on the choice and component architecture of social evaluation and governance subject of public hospital

The study has found that the“support-process-outcome”three dimensional content index system of social evaluation and governance of public hos-pital has difference with its fit configuration of taking“multiple-independ-ent-professional-authority-initiative”as the principle and suitability ranking of the consistent governance subject.Whether it is support, process or result dimensions, they should be led by social professional organizations as well as organizing the implementation of evaluation and governance.In the support dimension which consists of resource guarantee input and management institution, the public, medical workers, public media should be activated and mobilized to participate actively and collaboratively, and the government and related department civil servants should give cooperated.In the process dimension of the fulfillment of the responsibilities of the basic medical and health services provided by public hospital to the society, government-related civil servants, patients and their families, the social public representatives to participate collaboratively, medical workers and public media are needed to participate collaboratively and cooperatively.In the outcome dimension which consists of both doctor and patient satisfaction, the public, the government-related civil servants, public media representatives participate actively and collaboratively, medical workers, patients and their families participate collaboratively and cooperatively.It better meets China's current reality to establish the multiple combination evaluation subject and mechanism which is dominated by the third-party professional organization agent independently commissioned by the government, introduce the multi-participation of patients and their families, urban and rural residents, social observers, the public and public media representatives, and where the government and related departments and public hospital give coordination and collaborative cooperation.

3.5 Study about the index system of social evaluation and governance of public hospital

This study follows the social evaluation and governance theory and logic considerations of constant improvement of public hospital's effective performance of social responsibility, promoting return to public welfare, maintaining sustainable and healthy development, constructs the support dimension including three secondary indicators such as the resource guarantee input of the government to public hospital（weight of 0.162）, management and supervision institution（weight of 0.084）, and the public's support（weight of 0.073）, the process dimension including five secondary indicators such as quality of basic health care services（weight of 0.098）, medical costs and the cost control（weight of 0.086）, the government mandatory task（weight of 0. 057）, medical talent education training and scientific research（weight of 0. 064）, and social public welfare activities（weight of 0.017）, the outcome dimension including two secondary indicators such as patient satisfaction（weight of 0.186）, and medical staff satisfaction（weight of 0.174）, as well as 32 threelevel index system such as the proportion of government financial investment in public hospital to total hospital income（%）etc.Compared with the domestic research in the same field, with particular emphasis on the per-spective of synergistic governance from the social system, creatively supplement and inspect the elements of the resource guarantee and supervision of the government on public hospital, the participation supporting effect of the public and social system and medical staff satisfaction etc, as well as forming a constantly meeting the closed-loop governance loop of the happening of citizen medical needs and interest demands to“support-process-outcome”three-dimensional layers of progressive, related interaction and mutual influence.

3.6 An empirical study about the core index of social evaluation and governance of public hospital-doctor-patient satisfaction

Firstly, the study has found that patient and medical staff satisfaction as well as the synergistically satisfaction is the core index to measure the effect of social evaluation and governance of public hospital to fulfill social respon-sibilities, strengthen organization and management, and improve service quality.Secondly, at present, both the researches of doctor-patient satisfaction and the practices of assessment are based on the satisfaction theory of traditional customers or staff.It regards patients and medical staff as rational economic men to design the satisfaction assessment, on the one hand the traditional theory neglects the irrational factors including cognition, compre-hend of information, emotional psychological, social, medical and public opinion environment with medical service information asymmetry and its impact on the degree of satisfaction.On the other hand, the studies on medical staff satisfaction are often limited to inspect the factors of working environment, working conditions, organization management, and career develop-ment.They neglected inspecting the social factors such as patients'rational respect work recognition, trust relationship to medical staff, and the current medical system, public opinion environment, together with their effects on satisfaction.The scientific, objectivity and reliability of doctor-patient satis-faction assessment are to be discussed.Thirdly, basing on the above studies, targeted constructing and empirically testing to put forward assessment scale and correction model which consists of patient satisfaction including“service environment, service fees, service technology, service attitude, service efficiency”five dimensions and total 20 items.And medical staff satisfaction include“working itself, working pressure, interpersonal relationship, working conditions, working reward, organization management”six dimensions and total 20 items.

3.7 Strategies and policy recommendations on social evaluation and governance of public hospital

The study has put forward ten suggestions.Firstly, the new system to drive the government's public governance on public hospital should be innovated.Secondly, the social evaluation and governance mechanism of public hospital which is agented by the social professional organization commissioned by the government should be established. Thirdly, the social professional organizations third-party evaluation agencies should be vigorously cultivated and developed.Fourthly, the professional standards and credibility of the social professional organizations third-party evaluation agencies should be improved.Fifthly, the citizens'sprint together with the consciousness and ability of participating in the social governance should be cultivated.Sixthly, social citizens, the public and public media and other social systems to participate in the evaluation and governance path should be stimulated and activated.Seventhly, a social multi-subject cooperative evaluation and governance model of public hospital based on stakeholders should be established.Eighthly, the social evaluation index system guided by public hospital's fulfilling social responsibility and governance effect should be constructed and improved.Ninthly, the methods and conditions of social evaluation and governance of public hospital with the combination of direct evaluation and indirect evaluation should be formulated.Tenthly, the results release, appeal and application system of social evaluation and governance of public hospital should be established.

Keywords:Public hospitals; Social governance; Social evaluation; Social responsibility; Doctor-patient satisfaction