The China Public Hospital Reform Course was jointly delivered by World Bank and Ministry of Health in Wuhu, China from May 7 to 11, 2012 to assist Chinese policymakers and practitioners to understand the root causes for the current situation in public hospitals and strategically evaluate alternative solutions to major problems.
About 170 government participants from the pilot cities and pilot provinces in China attended the training. Among them were high level policymakers including deputy mayors in charge of health sector reform, heads of health sector reform commissions, and Health Bureau directors. These officials attended in the first two days which were designed to target the senior policy makers. Hospital directors and managers, and middle-level city, county and provincial health bureau officials constituted the majority of the audience.
12 international and national faculty delivered presentations on various hospital-related topics in 16 sessions during five days including an evening video session. Given the audience, the complexity of issues involving hospitals and the fact that public hospital reform is a major pillar of government policy, the course evolved into more a policy workshop than a traditional training event. By presenting basic concepts, strategies, and alternative solutions, and by illustrating domestic and international experiences, the course sought to improve the capacity of the course participants to better assess their current situation, evaluate the possible solutions and craft strategies based on lessons learned from China and the world.
The course combined traditional presentations by faculty members, video presentations of international cases with interactive sessions. One interactive session allowed the participants to assess and compare the degree of functionality of a set of hospital system governance arrangements and mechanisms applied in the international cases and China in terms of the incentives and accountabilities they provide to hospital managers and staff to influence their behaviors.
Each group first selected the two most problematic elements of governance they are facing in their hospitals. Based on learning from international and Chinese cases, the group then developed feasible institutional arrangements and mechanisms that can be used to strengthen public hospital governance that would align hospital behaviors with government objectives while improving efficiency, quality and patient satisfaction.
Each group presented their main conclusions the next morning, and all course participants were invited to evaluate the group work on a scoring sheet. The quantitative results drawn from the daily evaluations completed by participants demonstrated remarkably high ratings on all sessions with respect to content and speakers; all received at least 4.5 on a 1-5 scale. The overall course evaluation ratings were above average (3.5 - 4.1) for usefulness and relevance of the course, effectiveness of capacity building, and content and training methods collected upon course conclusion.
In terms of lessons learned, many attendees came to the course with the expectations that they would find solutions to their specific problems that they would be able to immediately implement upon their return home. Future courses would need to adjust the design to allow ample time for problem-solving sessions.