The National Health and Health Commission first proposed to standardize the establishment of branch campuses, and the development of one hospital and multiple districts needs to overcome three major difficulties

In recent years, China's public hospitals have developed rapidly in multiple hospitals
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Well-known domestic hospitals such as Wuhan Tongji Hospital, Shanghai Renji Hospital, and Huashan Hospital Affiliated to Fudan University are all multi-campus development
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However, whether it is a trusteeship cooperative hospital, medical group development, or self-built new hospital and other multi-district models, they are generally faced with management difficulties and development bottlenecks, calling for policy regulation and guidance
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As a representative of the 13th National People's Congress, Zhou Chongchen, president of Henan Children's Hospital, told the health community that one of the themes of the proposal he submitted at the National Two Sessions in 2022 involved the operation and management of one hospital and multiple districts
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In February 2022, the National Health and Medical Commission issued the "Guiding Principles for the Planning of Medical Institutions (2021-2025)" (hereinafter referred to as the "Guiding Principles"), which for the first time proposed at the national level to regulate the establishment of branch campuses in public hospitals.
The center, the national regional medical center, etc.
gave loose conditions, and also announced the end of the era of one hospital, multiple districts, and barbaric development
.
?In the national document, the "Guiding Principles" clearly put forward the definition of branch area for the first time, and put forward strict and clear requirements on the basic conditions for applying for setting up a branch area of ​​a public hospital, the development stage of a public hospital, and the size of beds in the branch area.
request
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? Fu Qiang, deputy director of the National Health Commission's Health Development Research Center, said
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?Under the new reform environment and development background, one hospital and multiple districts will enter a new stage of quantitative change to qualitative change, and will also face new challenges
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? Zhou Chongchen wrote in the proposal
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First and foremost, how can the management of multiple campuses be more unified? How can cost control be more efficient? How to achieve homogenization of medical services? Regarding one hospital and multiple districts, there is currently no unified development model in China, and there is no fixed answer to the problems encountered in the development process.
Hospital managers can only cross the river by feeling the stones
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It is worth noting that, different from the old way of "making it bigger first and then becoming stronger", the "Guiding Principles" further clarified that "making it stronger first and then bigger", leading the connotative development of public hospitals
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?The state should issue as soon as possible a guiding document on the management of one hospital and multiple districts, and further guide and standardize the management system, operation mechanism, institutional setup, and practice management of one hospital and multiple districts
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? Zhou Chongchen said
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After the epidemic, "one hospital with multiple districts" is the time.
One hospital with multiple districts can be traced back to the 1980s when large hospitals supported grassroots construction work in remote areas
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Subsequently, with the acceleration of urbanization and the successive incentives of corporate hospital restructuring, hierarchical diagnosis and treatment, and medical alliances, large hospitals have expanded and subsidized high-quality medical resources in the form of sub-centers, branches, and sub-districts
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According to the data, 22 of the top 30 public hospitals in the "2019 Chinese Hospital Rankings" released by the Institute of Hospital Management of Fudan University have set up branch campuses
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While promoting the balanced allocation of medical resources, it has also spawned concerns from the outside world about the staking of large hospitals
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?Because the state has no guiding opinions on one hospital and multiple districts, in the context of restricting the development scale of public hospitals, many hospitals also have many concerns when establishing branch hospitals
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? Zhou Chongchen told the health community
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Under such circumstances, there is a lot of chaos in the disorderly development of one hospital and multiple districts
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?Some hospitals set up branches in different places just to give a name and hang a brand.
People, property and materials are not unified, medical business is not coordinated, and homogenization is impossible to talk about
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?Professor Luo Li, Secretary of the Party Committee of the School of Public Health of Fudan University and Deputy Director of the Institute of Hospital Management of Fudan University, told the health community that this not only fails to meet the original intention of the medical reform for rational allocation of medical and health resources, but also may damage the brand and reputation of the main hospital
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Luo Li is a member of the National Health and Health Standards Committee Health Information Standards Professional Committee, an expert of the National Health and Health Committee's Disease Prevention and Control Expert Advisory Committee, and a member of the National Health and Health Committee's hierarchical diagnosis and treatment and medical consortium construction expert group
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Change comes after the COVID-19 pandemic
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?For a period of time, the state hoped to regulate the development of public hospitals, especially to moderately control the scale expansion, so as to make room for the development of private hospitals
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? Luo Li said, however, an epidemic has made the country realize again the importance of vigorously developing public hospitals
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So, how do public hospitals develop? ?The space for the expansion of the scale of the monomer is limited, and the group->
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?According to Luo Li, it is necessary to give full play to the regional leading role of high-level hospitals, rationally distribute branch areas, and allocate advantageous specialties in branch areas, so that the distribution of high-quality medical resources is more balanced, and the common people have higher access to high-quality medical resources.
Only in line with the medical reform the essence of
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In addition, during the epidemic, Wuhan Tongji, Wuhan Union and other multi-district hospitals requisitioned separate campuses and converted them into designated hospitals for patient admission, which played a unique role in epidemic prevention and control
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? This may be the next development direction of general hospitals
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?A remark by Jiao Yahui, then deputy director of the Medical Administration and Hospital Administration Bureau of the National Health and Health Commission, in an interview with the media in May 2020 was regarded as the first signal of the National Health and Health Commission's public support for the construction of one hospital and multiple districts
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Subsequently, the Fifth Plenary Session of the 19th Central Committee of the Communist Party of China held in October 2020 pointed out that accelerating the expansion of high-quality medical resources and the balanced regional layout were interpreted by the outside world as the official guidelines for the development of multiple districts in one hospital
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Soon, at the National Medical Management Work Conference held in February 2021, it was clearly pointed out that the research and introduction of policies to guide the development of large public hospitals in one hospital and multiple districts should not only control the scale expansion of individual institutions, but also guide the expansion and doubling of high-quality medical resources.
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Coordinated development of regional layout - the state supports the development model of public hospitals with single and multiple hospital districts is more clear
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Four months later, the "Opinions on Promoting the High-Quality Development of Public Hospitals" was issued, which clearly stated that some strong public hospitals should be supported to moderately build and develop multi-hospital areas on the basis of controlling the scale of individual hospitals, and rapidly change their functions in the event of a major epidemic.
——This is the first time that a document at the national level proposes to support one hospital and multiple districts
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At the end of January 2022, the National Health and Health Commission issued the "Guiding Principles for the Establishment of Medical Institutions (2021-2025)" (hereinafter referred to as the "Guiding Principles"), which clarified the concept of branch campuses for the first time, and set the conditions for the construction of branch campuses.
standard
etc.
Since then, the construction of one hospital and multiple districts has "national standards", and has entered a new era of standardized management
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Only a strong enough hospital has the qualification to become a big hospital.
As the first regulation to regulate the development of hospitals in multiple districts, the "Guiding Principles" proposes in Chapter 6 to regulate the establishment of branch districts in public hospitals.
Strict and clear requirements are put forward for the development stage and the scale of beds
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First of all, what is a branch district? This concept has been widely discussed by many hospital managers who eat crabs, and even the construction of tight medical alliances has been included in its scope
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This "Guiding Principles" gives a clear definition: a public hospital is a branch of a hospital with a certain bed size that is established at other addresses other than the original campus (main campus) by means of new establishment or mergers and acquisitions, etc.

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There are two key points, one is that it has a certain scale of beds, and the other is that it belongs to a non-independent legal person
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This means that primary medical service extension points, outpatient departments, and health check-up centers without beds organized by public hospitals, as well as cooperative institutions with independent legal persons, such as medical consortia, hospital trusteeship, cooperative organization, agreement cooperation, and counterpart support, etc.
And the districts that have not reached a certain bed size are not classified as branch districts
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Based on this, the "Guiding Principles" clearly pointed out that all assets such as people, money, and property in the branch campus belong to the main campus
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?Only by establishing the connection of property rights and implementing the unified management of people, finances and materials, can the motivation of the main hospital be truly stimulated and the branch area be run well
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?Luo Li told the health community that practice has repeatedly proved that branch construction without property rights, people, money and things are not unified, and most of them are nothing in the end.

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The second question that needs to be answered is, what kind of hospital can develop multiple campuses? Luo Li pointed out that the "Guiding Principles" gave a clear answer: it must be stronger first and then bigger - only the hospitals with sufficient strength are qualified to be bigger
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The so-called “strong” means that the bed utilization rate continues to exceed 90%, the average hospital stay is in the top 10% of the same type of hospitals in the country, and the CMI value ranks in the top 10% of the same type of hospitals in the province.
Years A+ or above, and there have been no major medical safety incidents and serious epidemic problems in the past three years
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Only when they become stronger and meet these conditions, can public hospitals apply for new branch areas
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In addition, the "Guiding Principles" pioneered a number of mathematical models, and proposed the bed demand coefficient R, which is used to assess whether a branch should be established in the current development stage of a public hospital.
Comprehensive evaluation of hospitalization rate and bed weight corresponding to service radius
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The "Guiding Principles" clarifies that only if R≥1.
3 (indicating that the hospital treats a large number of patients from other cities, has obvious regional radiation capacity, and the existing number of beds is difficult to meet the needs of patients for medical treatment), and has a certain staff reserve, can the branch area be developed according to the situation
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?Introduced the construction standard of a fixed proportion of non-local patients (R≥1.
3), reflecting the principle of "only a stronger hospital can make a bigger hospital" in the new era
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? said Rowley
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This also means that the branch area is not built if you want, but has a higher threshold
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The "Guiding Principles" also constrains the construction of branches across provinces, specifying that the construction project units of national medical centers, national regional medical centers and national regional medical centers, and project units undertaking the task of relieving non-capital functions of medical and health care in Beijing are excluded.
In addition, other medical institutions cannot set up branches across provinces
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The "Guiding Principles" also set specific targets for the development of one hospital and multiple districts: By the end of 2025, there should be no more than 3 branch districts in public hospitals; the number of beds in new branch districts should not be lower than the minimum number of second-level hospitals of the same type Requirements, not higher than the highest standard of beds in general hospitals at the same level; the total number of beds in each branch district does not exceed 80% of the number of beds in the main hospital area by the end of 2020
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?The setting of these construction indicators is to hope that the hospital can truly strengthen the branch area, and truly achieve a more balanced distribution of high-quality medical resources
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? Luo Li said, rather than blindly developing the number, leading to the dilution and dilution of high-quality medical resources
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The development of one hospital and multiple districts needs to overcome three major difficulties.
If we want to achieve the above goals, we must have superb management and operation level, which is a great test of the wisdom of hospital managers
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According to a survey, the public has certain concerns about the construction of branches in large hospitals.
About 43% of the respondents believe that: ? Some branch doctors and equipment are of average level, making it difficult to attract patients to seek medical treatment
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? There is a relationship between the service quality of one hospital and multiple districts
? How to ensure that patients can experience the same efficient and high-quality service and quality in different hospital districts, so as to maintain the connotation of the hospital brand, is the focus and difficulty of multi-district hospital construction
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? Zhou Chongchen said that in order to achieve this goal, at least three major difficulties need to be overcome: The first major difficulty is the doubling of the difficulty of management
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The multi-district management of one hospital is a systematic project.
With the increase of the hospital area and scale, the difficulty of management will increase exponentially
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How to build an efficient and refined management system is a prerequisite for the development of one hospital and multiple districts
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Zhou Chongchen believes that this requires the full implementation and implementation of the dean's responsibility system under the leadership of the party committee, and each hospital district is led by a unified party committee
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It is also necessary to integrate and coordinate the vertical management of the main campus and the horizontal management of the branch.

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Henan Children's Hospital has been exploring the development of multiple hospital districts since 2011.
Under the new background of the construction of national regional medical centers, it has gradually formed Zhengdong Hospital (core hospital), East Third Street, South and West.
One hospital and four The new pattern of district development, the integration of hospital districts, standardized management, homogenization of services, maximization of benefits, four modernizations, management, and district, departmental system and management modes have significantly improved hospital management efficiency and effectively solved the problem.
The bottleneck in the development of multiple campuses
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?In order to realize the management of each hospital area, some members of the leadership team of the main hospital area should concurrently serve as the executive dean of the branch area
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? Zhou Chongchen said, and asked them to work in the branch area at least 1 day a week
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In order to find problems in multiple hospital districts in time and solve them quickly, Henan Children's Hospital has established a "supervision system" many years ago, that is, the leaders of administrative functional departments shall supervise all hospital districts every day to find problems and report them in the hospital.
Report at the morning meeting
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? At the meeting, who is in charge of this problem and who will take it away, and solve it promptly and quickly
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? Zhou Chongchen said that after the problem is solved, the organization will look back and check the implementation
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The second major difficulty is the increased difficulty in cost control
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After the new campus is completed, it needs a lot of resource support, especially human resource support, and the cost is quite high, which brings many challenges to the development of the branch campus
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In order to ensure the quality of medical services, the cost of medical staff must not be saved
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It is very necessary to follow the principles of simplicity and efficiency, build a flat administrative management framework, and effectively control operating costs
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According to Zhou Chongchen, in order to control operating costs, Henan Provincial Children's Hospital adopts a departmental system for management in its branch areas, and only sets up a general department, a medical department, and a security department.
Each department is equipped with 2-3 management personnel.
A post with multiple responsibilities
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?With less than 10 people, the daily operation and management of the branch area is solved, which greatly saves labor costs and reduces the operation burden of the branch area.

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? Zhou Chongchen said that if the majority system is not implemented, the management team will need at least dozens of people if it is set up according to the functional departments of the main campus
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The third major difficulty is how to ensure the homogeneity of medical services in various hospital districts
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?The first two issues involve the management and operation of hospitals, while the homogenization of medical care is directly related to the goals and effectiveness of the development of one hospital and multiple districts, and is the key point
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? said Rowley
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The premise of ensuring the quality of medical care is first of all a clear branch location
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?You must first confirm that there is a population sufficient to support regular operations within the radiation range of the sub-hospital area, and there must be a basic number of patients, and then use the dominant specialties to attract patients from a wider range, so that the sub-hospital area can truly be achieved.
Continue to operate and continue to grow
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? Rowley thinks so
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On the basis of a clear positioning, it is necessary to have a high-quality medical and nursing team
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?In order to ensure the service quality, after the completion of the new hospital area, according to the actual situation of the hospital area, the disciplines (specialties) are optimized and adjusted, and the entire disciplines in a certain hospital area can be moved
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? According to Zhou Chongchen, in order to support the development of the branch, he directly moved a ward from another hospital to the new one
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? Directly dispatching outstanding medical staff from the main hospital to the branch is the most direct way to ensure the quality of medical care in the branch, provided that there are enough talents in the main hospital, so that one will not lose sight of the other
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? Luo Li said, this requires the hospital to prepare the relevant talents in advance
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However, some industry experts also pointed out that the other side of the coin is whether the main hospital area and the branch area can be converted, and it is also worth exploring - when the branch area is running smoothly, so that the comprehensive service capacity can replace the original main hospital area, whether it can be considered The branch district is adjusted to the main district? After the medical personnel reorganization system is in place, various guarantees such as medical technology, administration, and logistics will be homogeneous through the transfer center, logistics support center, and telemedicine.

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Regarding one hospital and multiple districts, there is currently no unified model in China.
The managers of various hospitals are mostly "crossing the river by feeling the stones", and the solutions to the above problems are somewhat different
.
? Hope that the state can select and launch a batch of development cases of one hospital and multiple districts, excavate and summarize their successful measures, and increase experience promotion and exchange
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? Zhou Chongchen wrote in the proposal
.
He believes that what is more important is that the state should speed up the issuance of guidance documents on the management of one hospital and multiple districts, and further guide and standardize the management system, operation mechanism, institutional setup, and practice management of one hospital and multiple districts.
Follow and have rules to follow, can one hospital and multiple districts truly achieve high-quality development
?