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

Abstract

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; however, its application requires further in-depth research and individualized approaches for different hospital environments in order to improve quality, effectiveness, and patient satisfaction to provide better healthcare services.