Guiding Opinions of the General Office of the State Council on Establishing a Modern Hospital Management System

· Document Number：No. 67 [2017] of the General Office of the State Council

· Area of Law： Health and Sanitation

· Level of Authority： Regulatory Documents of the State Council

· Date issued：07-14-2017

· Effective Date：07-14-2017

· Status： Effective

· Issuing Authority： General Office of the State Council

Guiding Opinions of the General Office of the State Council on Establishing a Modern Hospital Management System
(No. 67 [2017] of the General Office of the State Council)
The people's governments of all provinces, autonomous regions, and municipalities directly under the Central Government; all ministries and commissions of the State Council; and all institutions directly under the State Council:
The modern hospital management system is an important part of the basic medical care and health system with Chinese characteristics. For purposes of developing a modern hospital management system, the following opinions are hereby offered with the approval of the State Council:
I. General requirements
(1) Guiding ideology. We shall comprehensively implement the spirit of the 18th CPC National Congress, the Third, Fourth, Fifth and Sixth Plenary Sessions of the 18th CPC Central Committee and the National Hygiene and Health Conference, carry out in depth the spirit of a series of important speeches and new concepts, thoughts and strategies of managing state affairs of General Secretary Xi Jinping, conscientiously implement the decisions and arrangements of the CPC Central Committee and the State Council, advance the overall layout for "economic, political, cultural, social, and ecological progress" in an overall manner and the Four-Pronged Comprehensive Strategy in a coordinated manner, firmly develop and implement the concept of innovative, coordinated, green, open and shared development, adhere to the leadership of the CPC, correct hygiene and health work policies, and the hygiene and health development path with Chinese characteristics, constantly improve the quality of medical service, make efforts to realize the organic unity of social benefits and operation efficiency, fully motivate medical personnel, implement democratic management and scientific decision making, enhance the leading and catalyzing role of public hospitals, improve the diversified hospital operation pattern, accelerate the supply-side structural reform of medical service, realize the modernization of the hospital governance system and management capability, and lay a solid foundation for advancing the building of a healthy China.
(2) Basic principles.
Adhering to centering on people's health. People's health shall be given a strategic position of prior development, fairness, accessibility, and benefits for the people shall be set as the start point and foothold, people's health shall be protected in an all-around, whole-cycle manner, people's health and wellbeing shall be improved, and people's fulfillment in relation to the reform shall be enhanced.
Adhering to the public-welfare nature of public hospitals. The responsibility of party committees and the government for leading, guaranteeing, administering and supervising public hospitals shall be implemented, social benefits shall come first, attention shall be paid to health fairness, and inclusiveness shall be enhanced. The combination of government leadership and the use of the role of market mechanism shall be adhered to, and diversified, differentiated and personalized health demand shall be met.
Adhering to the separation of the government and public institutions and of administration and operation. Government functions shall be transformed at a faster pace, the reform of simplification of administrative procedures, delegation of powers, combination of decentralization and control, and optimization of services shall be deepened, the duty of establishment and supervision of the government as the capital contributor of public hospitals and the limits of powers of autonomous operation and management of public hospitals as public institutions shall be reasonably defined, and ownership and the right of operation shall be separated. The competent departments at all levels shall innovate on administration means, make a shift from direct administration of public hospitals to industrial administration, and enhance the development of policies, regulations, industrial plans, standards, and specifications and the duty of supervision of and guidance to hospitals.
Adhering to guidance by category and encouraging exploration and innovation. The innovation spirit of the local governments shall be respected, and all regions shall be encouraged to, according to the reform direction and principles as determined by the Central Government, based on the nature, function orientation, grade, size and other various situations of hospitals, adopt measures suitable to local conditions, make breakthroughs and innovation, and establish a modern hospital management system in line with the actual circumstances.
(3) Main objectives. By 2020, a new public hospital operation mechanism maintaining public welfare, stimulating, and guaranteeing sustainability and a governance mechanism featuring coordination, checks and balance, and mutual promotion of decision making, execution, and supervision will have been basically formed, the sound development of privately-run hospitals shall be prompted, the management of various hospitals at all levels shall be promoted in being regulated, lean and scientific, and a modern hospital management system featuring well-defined power and responsibility, scientific management, complete governance, efficient operation and effective supervision shall be basically developed.
II. Improving the hospital management system
(1) Developing hospital bylaws. Various hospitals at all levels shall develop bylaws. Hospital bylaws shall include nature of the hospital, object of hospital operation, function orientation, direction of hospital operation, management system, funding source, organizational structure, decision-making mechanism, management rules, supervision mechanism, culture building, party building, people's group building, the rights and obligations of the founders, hospital, and employees, and other content. A hospital shall be guided by its bylaws, establish and improve internal management bodies, management rules, procedure rules, and work procedure, among others, regulate its internal governance structure and power operation rules, and raise its operation efficiency. In developing its bylaws, a public hospital shall specify the position and role of the party organization in its internal governance structure.
(2) Improving the hospital decision making mechanism. The president shall be fully responsible for medical care, teaching, scientific research and administration. The president's executive meeting shall be the administration and business discussion and decision making body of a public hospital and make decisions on the discussed and researched matters. In relation to the decision making procedure, the development plan of the public hospital, "major issues, major personnel appointments and dismissals" and other major matters, and important issues involving the vital interests of medical personnel shall be researched, discussed and consented to by the party organization's meeting of the hospital, so as to ensure that the intent of the party organization is fully reflected in the decisions. Experts shall be allowed to fully play their roles, and specialized committees of medical quality safety management and pharmaceutical affairs management, among others, shall be set up to undertake technological consultation and feasibility discussion of specialized, technologically-demanding decision making matters. A hospital whose assets are diversified or which has been entrusted to an administrator, or a medical consortium, among others, may establish a board of directors. Party leadership shall be integrated into the governance structure of a public hospital, the members of the leadership of the party organization of the hospital shall enter the management of the hospital or the board of directors, and a party member of the management of the hospital or among the internal directors of the board of directors shall generally enter the leadership of the party organization of the hospital.
(3) Improving the democratic management system. The democratic management system with the employee representatives' assembly as the basic form shall be improved. A trade unions shall organize employees to participate in the democratic decision making, democratic management and democratic supervision of the hospital in accordance with the law. A hospital shall fully obtain the opinion of its employees in researching important issues relating to operation, management and development and may call a meeting involving the vital interests of employees only if a representative of the trade union attends it. The public disclosure of hospital affairs shall be advanced, and employees and the people's right to know, to participate, to expression and supervision shall be implemented.
(4) Improving the medical quality safety management system. The president shall be the primary person responsible for lawful practicing and medical quality safety of a hospital, and the presidency and department-level medical quality safety responsibility system shall be implemented. A medical quality management and control working system participated in by all the employees and covering the whole process of clinical medical service shall be established, and the essential medical quality safety systems such as responsibility for first diagnosis, three-level rounds, nursing by grade, operation management by grade, antibacterial agents management by grade, and clinical blood use safety. The hospital infection management system and the medical quality internal publication system, among others, shall be strictly implemented. The management of the quality safety of key departments, areas, parts and technologies shall be strengthened, and reasonable examination, medication and treatment shall be advanced.
(5) Improving the human resources management system. The management systems of employment, jobs, titles, practicing physicians, nurses, and revenue distribution, among others, shall be established and improved. Employees, whether or not on the staff, shall be taken into account in job establishment, revenue distribution, title assessment, management use and other aspects. A public hospital shall make autonomous distribution to the extent of the confirmed total account of the remunerations, reflect job differences, take account of disciplinary balance, and ensure more pay for more work and better performance. According to relevant provisions, a hospital may explore and implement the objective-oriented annual salary system and offer remunerations by agreement. The remunerations of medical personnel shall not be connected with the revenues from drugs, hygienic materials, examination, test and other business.
(6) Improving the financial asset management system. Financial income and expenditure, budget and final accounting, accounting, cost management, price management, and asset management shall be included in the unified administration of the finance department of a hospital. A comprehensive budget management, cost management, financial report, third-party audit and public information disclosure mechanism shall be established and improved to ensure the compliance of economic activities with the laws and regulations and the increase in the benefits of the use of money and assets. A public hospital, as a budget entity, shall include all its income and expenditure in the departmental budget for unified administration, enhance cost accounting and control, and gradually implement all-round cost accounting. A grade-three public hospital shall establish an office of chief accountant charged with overall management of its economic work, and any other hospital with good conditions shall advance the building of the chief accountant system according to the actual circumstances. The internal audit supervision of public hospitals shall be strengthened, and the audit of certified public accountants shall be promoted.
(7) Improving the performance appraisal system. The departments and medical personnel of a hospital shall be subject to its performance appraisal by the government or its founder, and medical personnel of various jobs and at all levels shall be appraised by category. A performance appraisal indicator system shall be established and improved, and job duty fulfillment, workload, service quality, code of conduct, medical quality safety, medical expense control, medical ethics, patients' satisfaction, and other indicators shall be highlighted centering on hospital operation direction, social benefits, medical service, economic management, talent fostering and training, sustainable development and other aspects. The establishment of revenue indicators for medical personnel shall be forbidden. Appraisal results shall be connected with the employment, promotion, and remunerations of medical personnel.
(8) Improving the talent fostering and training management system. The standardized training for residents and for diplomates and the continuing medical education system shall be implemented to effectively foster medical students. The building of key clinical specialties and disciplines shall be strengthened, and the core competitiveness of hospitals shall be improved. An urban doctor shall serve at a basic-level medical institution or one paired up for assistance for no less than one year accumulatively before being promoted to attending physician or deputy chief physician. A large-sized urban hospital shall vigorously foster talents for the basic level and remote and poverty-stricken areas.
(9) Improving the scientific research management system. Clinical medicine research shall be strengthened, the innovation on, breakthroughs in and application of diagnosis and treatment technologies shall be accelerated, appropriate technologies shall be vigorously promoted and popularized, the drug clinical trials and research shall be strengthened and regulated, and the level of medical technologies shall be raised. The integration of basic disciplines with clinical disciplines and aided diagnosis and treatment disciplines shall be strengthened. Scientific research project management, quality management, scientific research rewards, intellectual property right protection, achievements conversion and promotion, and other systems shall be established and improved.
(10) Improving the logistics management system. The compilation of the hospital development and building plans and early project discussion shall be enhanced, and the basic construction project legal person responsibility system, bidding system, contract management system, project supervision system, and permanent quality responsibility system, among others, shall be implemented. Appropriate medical equipment shall be reasonably allocated, and a management system covering the whole life cycle from procurement, use, maintenance, and disposition shall be established. A hospital "logistics one-stop" service mode shall be explored, and the society-based logistics service for hospitals shall be advanced.
(11) Improving the information management system. The building of the standardization and regulation of the hospital information system shall be enhanced to effectively connect to systems of medical insurance, budget management, and electronic drug supervision, among others. The functions including medical service management, medical quality safety, drugs and consumable items management, performance appraisal, financial operation, cost accounting, internal audit, and integrity risk prevention and control shall be improved. The management of the building of hospital networks and information security shall be strengthened, and the patient personal information protection system and technological measures shall be improved.
(12) Strengthening hospital culture building. Correct hospital operation concept shall be developed, and the professional spirit of "respecting and blessing life, saving the injured and dying, willing to be devoted, and showing unlimited love" shall be advocated. The service purposes shall be followed, the awareness of service shall be raised, service quality shall be improved, and the service for people's health shall be provided wholeheartedly. The building of the hospital spiritual civilization shall be advanced, and the core socialist values education shall be conducted, so as to form good medical ethics. The physical and psychological health of medical personnel shall be taken good care of, and their work, achievements, diligence and contribution shall be respected, in order to enhance their sense of honor resulting from their career. A team of medical personnel skilled at medical techniques, of noble medical ethics, and prudential in work shall be built to shape the integrity of the industry.
(13) Fully providing public convenience and benefit service. Each grade-three public hospital shall participate in the building of medical consortium and play a leading role. Medical service shall be further improved, hospitalization process shall be optimized, the facilities in diagnosis areas shall be reasonably distributed, appointment for diagnosis and treatment shall be scientifically implemented, and daytime operation, long-distance medical care, multidisciplinary joint diagnosis and treatment mode shall be promoted. Emergency diagnosis and treatment forces shall be strengthened, and green passages before and in the hospitals shall remain unimpeded. Hospitalization guidance, settlement at diagnosis, examination and test results push-off, settlement of hospitalization at different locations and other information-driven public convenience service shall be provided. Quality nursing service shall be offered, and the service of social workers and volunteers shall be strengthened. The development of a mechanism integrating mediation at hospital, people's mediation, judicial mediation, and medical risk apportion mechanism shall be advanced, medical disputes shall be properly resolved, and a harmonious physician-patient relationship shall be created.
III. Establishing and improving a whole-hospital governance system
(1) Specifying the function of the government to found public hospitals. Multiple modalities to effectively realize the separation of the operation and founding of public hospitals shall be vigorously explored, and the duty of the government to found hospitals shall be fulfilled in an overall manner. The government shall exercise the right to founding, development, major decision making, and enjoyment of assets, among others, in relation to public hospitals and deliberate the bylaws, development plans, major project implementation and income and expenditure budgets, among others, of public hospitals. Regional hygiene plans and medical institution establishment plans shall be made, and the number and size of comprehensive public hospitals shall be reasonably controlled. The policy for the investment in public hospitals complying with regional hygiene plans shall be comprehensively implemented, the policy for investing more in traditional Chinese medicine hospitals including ethnic hospitals shall be detailed and implemented, and the long-term debt of public hospitals meeting conditions shall be gradually repaid and resolved. A medical service price dynamic adjustment mechanism based on the changes of cost and revenue structure shall be gradually developed. Within the total number of the existing staff of the local governments, the total number of the staff of public hospitals shall be determined and subjected to the filing system. A leader of a public hospital shall be selected according to the provisions for the administration of the leaders of public hospitals issued by the Organization Department of the CPC Central Committee. The administrative levels of public hospitals shall be gradually canceled, and the persons in charge of the competent health and family planning departments at all levels (including the competent traditional Chinese medicine and herbs departments, and the same applies hereinafter) shall not concurrently assume the leadership jobs of any public hospital. A remuneration system suitable for the characteristics of the medical care industry shall be developed, and the value of the technology service of medical personnel shall be reflected. An appraisal and assessment mechanism oriented on public welfare shall be established, the appraisal of the performance of public hospitals and the appraisal of the annual and term objective responsibilities of the presidents shall be regularly organized, and the appraisal results shall be connected with fiscal subsidies, reimbursement of medical insurance, and the total amount of performance-related pay remunerations and the remunerations, appointment and removal, punishment and reward of the presidents, among others.
(2) Specifying the function of the government to supervise hospitals. A comprehensive supervision system shall be developed, the supervision of the medical quality safety, medical expenses and the acts such as inflated prescription, insurance fraud, and drug commission of various hospitals at all levels shall be strengthened in priority, and a "blacklist" system shall be established, to form a whole-industry, diversified permanent supervision mechanism. An accountability system shall be developed with respect to acts of arbitrary charges and adverse practicing having a major bearing on society, those causing major medical accidents or major safety accidents, cases of seriously breaching the laws and disciplines, and acts seriously contrary to the integrity building. The function of the competent health and family planning departments to supervise medical service shall be enhanced, and the institution, personnel, technology and equipment access and leaving mechanism shall be improved. The reform of the reimbursement method of medical insurance shall be deepened, medical insurance shall be allowed to fully play the role in adjusting, controlling, guiding, supervising, and restricting medical service acts and expenses, and medical insurance's supervision of medical institutions shall be extended to the medical service acts of medical personnel. The bed number, construction standards and purchase of large medical equipment of public hospitals shall be controlled more strictly, construction by borrowing and luxurious decoration shall be prohibited, and beds shall be reduced where exceeding the number quota. The size of special-need service of public hospitals shall be controlled, and the proportion of special-need service offered shall not exceed 10%. The accounting and auditing supervision of the economic operation and financial activities of public hospitals shall be enhanced. The category-based management system of for-profit and non-profit privately-run hospitals shall be improved, and the supervision of the ownership, financial operation, and balance use, among others, of non-profit privately-run hospitals and the management and control of for-profit privately-run hospitals shall be strengthened.
(3) Implementing the operation and management autonomy of public hospitals. A public hospital shall undertake operation and management and provide medical service in accordance with the laws and regulations and exercise the operation and management autonomy including internal personnel management, organizational structure, employment of middle-level officials, employment and talent introduction, internal performance appraisal and remuneration distribution, and annual budget implementation. The employment autonomy of public hospitals shall be ensured, medical personnel shall be autonomously and publicly employed from society according to the need of business and within the total number of the staff, and sought-after, high-level talents may be hired by observation according to provisions. The employment of public hospitals in poverty-stricken, remote areas shall be further improved, employment conditions shall be reasonably established, employment means and methods shall be bettered, and incentive and guarantee measures shall be completed.
(4) Strengthening social supervision and industrial self-discipline. The public disclosure of the information of hospitals shall be strengthened, and the information as to quality safety, price, medical expenses, financial conditions, and performance appraisal, among others, shall be publicly disclosed in priority. The role of industrial associations, societies and other social organizations in the building of industrial self-discipline and professional ethics shall be strengthened, and hospitals shall be guided in operating in accordance with the law and competing in a fair and orderly manner. The medical quality, technology, safety and service appraisal and certification systems shall be reformed and improved. A third-party appraisal system shall be explored and established.
IV. Strengthening the building of the party in hospitals
(1) Fully using the role of the party committees of public hospitals as leadership cores. The party committee of a public hospital shall ensure the effective political, ideological and organizational leadership of the work of the hospital, control the direction, manage the big picture, and guarantee the implementation. Controlling the direction is mainly to voluntarily remain highly in line with the CPC Central Committee with comrade Xi Jinping as the core in relation to ideology, politics and action, to comprehensively carry out the theories, paths, guidelines and policies of the party, to guide and supervise the hospital to observe the laws and regulations issued by the state, to maintain the lawful rights and interests of all parties, and to ensure the correctness of the direction of the reform and development of the hospital. Managing the big picture is mainly to adhering to act while adhering to the big picture, to make arrangements for the whole picture, to discuss major issues, to grasp the key points, to advance all the work of the hospital in an overall manner, such as reform and development, medical service, and medical ethics and integrity, and to make efforts to build a modern hospital reassuring patients, with which the people are satisfied. Guaranteeing the implementation is mainly to manage officials, to gather talents, to build and lead the team, to focus on the basic level, to lay foundations, to discuss and decide the establishment of the internal bodies of the hospital and the selection and appointment of the persons in charge of them, to lead spiritual civilization building and ideological and political work, to lead the people's groups and organizations and the employee representatives' assembly, to effectively conduct the work as to intellectuals and united front, to enhance the building of party integrity, and to ensure the 100% implementation of the party's hygiene and health work guidelines, policies and arrangements at the hospital.
(2) Comprehensively strengthening the building of the party at the basic level in hospitals. It shall be adhered to that the building of the party at public hospitals is closely integrated with the building of a modern hospital management system, and concurrent planning and advancement shall be made. The party building work leadership system and working mechanism shall be strengthened and improved, a hospital party building work body shall be reasonably established, party building work forces shall be sufficiently and effectively assigned, a scientific, effective party building work appraisal and assessment system shall be developed, the primary responsibility for the management of the party shall be further implemented, the full party organization and party work coverage shall be advanced, the branch party committees of the internal bodies of hospitals shall be established and improved, the secretaries of the branches shall be selected from the best and effectively assigned, the role of the branches as political cores shall be fully used, and the branches shall be developed to strong battle citadels. The organic integration of party organizations' activities and business work shall be adhered to, and the innovation on activities, ideological and political work, and vehicles shall be advanced vigorously, so as to prevent "mere formality." The Several Rules concerning the Political Life in the Party under New Conditions and the Regulation of the Communist Party of China on Internal Supervision shall be conscientiously implemented, the regularly and institutionally "studying the party chart and a series of speeches and acting as a qualified party member" shall be advanced, and the systems such as "the general meeting of the party members of branch committee, the meeting of the members of branch committee, the meeting of small party groups and party courses," democratic life meeting, organizational life meeting, and party theme day shall be strictly carried out. Party member recruitment and party member education shall be strictly managed, and party members shall be guided in fully playing the role as pioneers and role models.
(3) Strengthening the building of the party organizations of privately-run hospitals. The party organizations of privately-run hospitals shall be built more vigorously, and in approving the establishment of a privately-run hospital, concurrent planning on the construction of the party, concurrent establishment of party organization and concurrent conduct of the party work shall be adhered to. Territorial jurisdiction and competent department administration shall be integrated, a privately-run hospital party building work management system shall be established and improved, and the subordinate relationship of party organizations shall be regulated. The party organizations of privately-run hospitals shall closely center on the basic tasks assigned by the party constitution to basic-level party organizations, conduct work based on the actual circumstances, and operate and develop hospitals according to the requirements of the party.
V. Organization and implementation
(1) Strengthening organization and implementation. All regions shall set the development of a modern hospital management system as important content to deepen medical reform, make implementation plans, specify objectives, tasks and division of responsibilities, and improve the implementation and supervision system. The health and family planning departments and other departments at all levels shall adapt to the new requirements and situation of the building of a modern hospital management system, delegate relevant powers in a timely manner according to the division of functions, adjust relevant policies, strengthen interim and ex-post supervision, optimize the process of government service, and join work advancement forces.
(2) Summarizing and promoting experience. The competent health and family planning departments at all levels shall closely follow the work progress in conjunction with relevant departments, strengthen survey and guidance, and research and solve the new situations and problems appearing in the reform in a timely manner. The typical experience of all regions in the development of a modern hospital management system shall be mined, summarized, refined and promoted, and mature experience shall be make into policies in a timely manner, so as to promote the constant improvement of the modern hospital management system.
(3) Effectively giving publicity. Correct public opinion orientation shall be adhered to, social concerns shall be responded to in a timely manner, and social expectations shall be reasonably guided, in order to create a good public opinion environment for the development of a modern hospital management system. Publicity guidance shall be strengthened, the general public shall be guided in developing a scientific, rational and orderly hospitalization concept, and a good atmosphere in which whole society respects health and hygiene shall be created.
General Office of the State Council
July 14, 2017