How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application.

BACKGROUND: Surgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services. METHODS: A literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China. RESULTS: Based on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution. CONCLUSIONS: Our evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Better clinical benefits and potential cost saving of an enhanced recovery pathways for laparoscopic adrenalectomy.

BACKGROUND: Enhanced recovery pathways (ERPs) have been demonstrated to be clinically and economically effective for colorectal surgery. However, data are lacking to support the cost-effectiveness of ERPs for laparoscopic adrenalectomy, as well as potential economic loss. This study aims to determine the cost-effectiveness of ERPs vs. conventional care (CC) for patients undergoing laparoscopic adrenalectomy. METHODS: A single centered retrospective case-control study was performed. Patients undergoing laparoscopic adrenalectomy from January 2018 to June 2021 were enrolled. One inpatient ward used ERPs, whereas the other did not. Case control was used for matching (53 patients for each group). Postoperative outcomes were recorded up to 30 days after surgery. ERPs-specific costs were integrated into the model. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration, which were reported in Renminbi. A bootstrap independent t-test was used for comparison. RESULTS: The two groups were matched in terms of demographics and surgical details. Hospital stay was significantly shorter in the ERPs group (2.54 days, P<0.001). The rate of complications was lower in the ERPs group (1 vs. 7 patients, P=0.031), there was no severe complications or morbidity. ERPs-specific costs were ¥656 per patient. The self-payment cost difference per patient between the two groups was ¥3,154.52 in favor of the ERPs group, but this was not statistically significant (P=0.113). The mean direct saving per patient in the ERPs group was ¥8,326.00, the total costs saving including indirect and potential overhead per patient was ¥18,247.60. CONCLUSIONS: Enhanced recovery is cost-effective compared with conventional perioperative management for laparoscopic adrenalectomy. Savings were noted in disposable materials, medicine and medical services, radiology and laboratory costs, with no increase in morbidity or duration.

Key factors influencing the effectiveness of hospital quality management tools: using the quality control circle as an example-a cross-sectional study.

OBJECTIVE: To identify the key factors influencing the effectiveness of hospital quality management tools and analyse the mechanisms needed for long-term scientific hospital management. METHODS: In this cross-sectional study, a large number of participants in quality control circle (QCC) activities were investigated on site. Data were collected by the questionnaire during the sixth National Hospital Quality Control Circle Competition in Shandong, China, in October 2018. A total of 1500 participants were randomly selected, in which 1316 questionnaires were completed, yielding an overall response rate of 87.73%, and 1181 questionnaires were valid. We performed a stepwise regression analysis to identify the independent variables with explanatory ability. Then the total mean score of the organisational, group, and individual factors were introduced layer by layer, and a regression model with four levels was established. RESULTS: The application effectiveness of QCC activities can be divided into three dimensions: individual factors, group factors and organisational factors. Utility perception was the most important individual factor. Inappropriate incentives and rewards had a negative effect on both organisational effectiveness and individual effectiveness. The attitude and ability of the circle monitor and counsellors, the specificity of the goals were the key group factors. Of the organisational factors, activity orientation had the greatest impact. Among the three dimensions, individual factors had the most significant influence on the effectiveness of QCCs, followed by group factors, then by organisational factors. CONCLUSION: These results suggest that addressing the concerns of the leaders and implementing a safeguard system that protects the QCC tool from neglect or failure, that strengthening team building and using team rewards or non-material incentives to enhance enthusiasm, and that mobilising the enthusiasm of the circle members and even the whole hospital for using quality management tools are essential.