Chinese Public Hospitals' Practices of Total Quality Management in the COVID-19 Pandemic: A Field Research

With China's economic rise, Chinese public hospitals face many challenges, including uneven distribution of healthcare resources, fierce competition among hospitals, uneven quality of healthcare services, and poor patient experience. At the same time, Chinese public hospitals face challenges due to the widespread impact of the new pneumonia in several countries and industries. Total Quality Management (TQM) has been widely used in various countries and industries, and Chinese public hospitals have also learned from TQM to improve their management. Systematic methods for continuous improvement of TQM include 6S on-site management, Six Sigma management, and QC teams. In this context, 6S on-site management plays a crucial role in ensuring the safe operation of hospitals and other aspects. This study examined three hospitals: a tertiary general hospital (China National Regional Medical Center), a secondary general hospital, and a secondary Chinese medicine hospital. Two hospitals implemented 6S management before and after one year during the 2019 coronavirus disease pandemic, and the other hospital implemented 6S management before and after one year during the non-pandemic period. A questionnaire survey was also conducted for one hospital before and after implementing 6S on-site management. Changes in healthcare quality indicators, economic indicators, and hospital satisfaction were investigated in the three hospitals before and after the pandemic and before and after 6S on-site management. SPSS 21.0 statistical software was used to analyze the patient group data quantitatively, and the measurement data were expressed as mean ± standard deviation. Comparisons between two groups were made using paired t-tests, and comparisons between multiple groups were made using one-way ANOVA with hypothesis testing. P-values less than 0.05 were considered statistically significant differences. The questionnaire was pre-experimental. Questionnaire reliability was analyzed using Cronbach's alpha coefficient method to test the reliability of each variable. As part of TQM practices, implementing 6S management has brought about systematic improvements in efficiency, organization, cleanliness, and standardization, all of which have contributed to improving the quality of services in Chinese public hospitals. 6S on-site management had a significant and varying degree of positive impact on healthcare quality, economic indicators, and satisfaction at different levels of hospitals. In terms of medical quality, for example, delayed visit cases increased, hospital infection indicators improved, and antimicrobial drug utilization decreased. Concerning economic indicators, there was a significant increase in outpatient revenues, outpatient visits, visits, and operating income. Regarding satisfaction, the results varied among hospitals. Hospital A significantly increased patient, doctor, and nurse satisfaction after implementing 6S. However, purely analyzing the quality of care, economic indicators, and hospital satisfaction decreased after the outbreak of the COVID-19 pandemic. Even during the epidemic, positive increases in hospital indicators were still observed before and after the implementation of 6S site management. In summary, 6S site management has a positive effect on public hospitals in China and can ameliorate the negative effects of the epidemic

伴随中国经济的崛起，我国公立医院面临诸多挑战：医疗资源分布不均、医院间竞争激烈、医疗服务质量参差不齐，以及患者体验不佳。与此同时，受新型冠状病毒肺炎在多国及多行业的广泛影响，公立医院亦面临额外挑战。全面质量管理（Total Quality Management, TQM）已在全球多国及各行业得到广泛应用，我国公立医院也借鉴TQM理念以优化自身管理。TQM持续改进的系统性方法包括6S现场管理、六西格玛管理以及质量控制（Quality Control, QC）小组。在此背景下，6S现场管理对于保障医院安全运营等方面发挥着至关重要的作用。

本研究选取三家医院作为研究对象：分别为三级综合医院（国家区域医疗中心，China National Regional Medical Center）、二级综合医院以及二级中医医院。其中两家医院在2019冠状病毒病（COVID-19）疫情期间开展6S管理，研究周期为实施前后各一年；剩余一家医院则在非疫情时段开展6S管理，同样以实施前后一年为研究周期。另有一家医院在实施6S现场管理前后开展了问卷调查。

本研究针对三家医院，分别对比疫情前后及6S现场管理实施前后的医疗质量指标、经济指标与医院满意度变化情况。采用SPSS 21.0统计软件对患者组数据进行定量分析，计量数据以均数±标准差表示。两组间比较采用配对t检验，多组间比较则采用单因素方差分析（one-way ANOVA）结合假设检验，以P值<0.05作为差异具有统计学意义的判定标准。

本问卷为预试验问卷。采用克朗巴哈α系数（Cronbach's alpha coefficient）法对问卷各变量进行信度分析，以检验问卷可靠性。作为全面质量管理实践的组成部分，实施6S管理可在效率、组织、整洁度与标准化层面实现系统性优化，进而助力我国公立医院服务质量的提升。6S现场管理对不同层级医院的医疗质量、经济指标及满意度均产生了显著且程度各异的积极影响。例如在医疗质量方面，延误就诊病例数有所上升，医院感染指标得到改善，抗菌药物使用率有所下降。就经济指标而言，门诊收入、门诊诊疗人次、诊疗人次与营业收入均实现显著提升。在满意度层面，不同医院的改善效果存在差异：甲医院在实施6S管理后，患者、医师及护士满意度均显著提升。但单纯从新冠疫情暴发后的情况来看，医疗质量、经济指标及医院满意度均有所下滑。即便在疫情期间，实施6S现场管理前后的医院各项指标仍呈现正向提升态势。综上，6S现场管理对我国公立医院具有积极作用，可有效缓解疫情带来的负面影响。