Gao Jiechun’s Answers to 5 Questions on China’s Hospital Rankings

On November 11, 2017, the annual “China’s Hospital Ranking” and “Chinese Hospital Specialist Reputation Ranking” were released by Fudan University in Shanghai, drawing widely concern from the medical industry and beyond. 

For eight years, the ranking has long been “a dish” for the medical industry served by the Hospital Management Institute, Fudan University in every November. Whether the dish is a gluttonous meal or just an appetizer, it has become accustomed throughout the industry and is increasingly recognized. For hospitals, the rankings are benchmark and motivation for discipline construction; for patients, it is helpful to find appropriate medical treatment facilities.

On the day of the ranking publication, CN-Healthcare talked with professor Gao Jiechun, the director of the Hospital Management Institute, Fudan University and the “operator” of the China’s hospital ranking. 

Gao Jiechun

There are many disputes about the rankings, but the sixty-year-old medical management veteran said he would not take them to heart. The list was just a reference. However, dozens of hospital deans were sitting in the first three rows of the venue. In face of the ranking, they might be far less calm than Gao has imagined.

Question 1: Why create China’s hospital rankings?

Gao decided to create a China’s hospital rankings, starting with a “complex”.

Twenty years ago, he went to Philadelphia Children’s Hospital as a visiting scholar. One day, people in the entire hospital were watching a hospital ranking list. Suddenly, he remembered that China did not have a highly recognized hospital ranking. This leads to two phenomena: first, the hospital managers and academic leaders lack a benchmark for discipline construction; second, each hospital has no reference nor comparison and generally feels good about itself.

Since the creation of the ranking list, hospitals are able to find the gaps compared with their peers, with the catch-up direction and goals. In the opinion of Gao, the rankings have created a “no-go-back” atmosphere for the hospital and formed a relatively common hospital management tool, which coincides with the initial intention of creating the ranking: setting the industry benchmark and becoming the reference for discipline construction of all hospitals.

Question 2: Why not use more dimensions to evaluate hospitals?

Gao is not reluctant to include the hospital health insurance data into the ranking system. However, up to now, China’s medical insurance has not yet reached the national network. As an independent third party institution, Fudan University Hospital Management Institute is not able to obtain the comprehensive data.

The hospital rankings published by Peking University sets the first page of medical records as one of the evaluation dimensions. But Gao believes that the reliability of the first page of medical records in China needs to be improved and the front page of all army hospitals cannot be made public. Therefore, this dimension can only be given up. Obviously, the premise of adding objective quantitative indicators is the national networking.

Nowadays, various types of hospital rankings have emerged. Some has made research funding and output as the important dimensions. Gao, once the head of the research department, is well aware of the mystery. He bluntly expressed that scientific research should uphold the result-orientation principle, while the amount of investment should not be dominated. 

“In many cases, today's investment in science and technology may be tomorrow's output, but beware that there are many phenomena in which research and development are not producing output,” Gao said.

Question 3: What happens to the latest list? What are the rules?

It is not hard to see from the analysis that the first tier in the leaderboard is relatively stable, the second tier slightly alternates, and the fluctuations after the 12th place are greater. This result stems from the hospital's clinical reputation which is relatively constant. The scientific research output is slightly different from each year. Moreover, the overall rankings of the leaderboard have been narrowing and have gradually stabilized. Gao believes this means that the evaluation system is highly feasible.

Another rule presented in the rankings is that teaching hospitals have a higher scientific research score while traditional nursing homes are more likely to win their clinical reputation.

Question 4: How do you think the rankings exacerbate the problem of patient access?

The China’s hospital rankings, which have been published for eight consecutive years, are asked the same question every year: will the rankings guide patients to the top hospitals?

Gao mentioned, orderly medical guide way is to set up the classification and treatment system, including the referral system, medical insurance payment and reimbursement ratio, but the patients have the right to know, when suffering from mysterious and serious illnesses, so that they can timely find the best solutions, without wasting time travelling in multiple agencies. “If the ‘hard to see a doctor’ is caused by the hospital rankings, then think about this. When there is no ranking list, is it hard for you to see a doctor?” asked Gao.

Question 5: What improvements will the rankings make in the future?

Different consideration dimensions and methods have different reference value of the hospital. For the hospital rankings, Gao has never abandoned the heart of the original share. He hopes that the leaderboard will continue to be dominated by academic reputation and clinical level in the future. 

On the basis of this, he will conduct research on various influential factors such as hospital scale, regions, risk and disease spectrum, and will work closely with the clinical priorities of the state and the Ministry of Health Specialist and other horizontal comparative analysis. At the same time, the expert library will also be expanded and updated in time, and the statistical processing methods will strive for continuous improvement.

Top hospitals: Who says I do not care?

After the ranking list was released, as usual there was a lot of controversy. No matter how rampant the controversy, China's hospital rankings have been going on for eight consecutive years and it is foreseeable that Gao will still lead the team to move the list forward in the future.

Facing the list, some of the deans have just laughed while some have continued to pay attention. Xiong lize, the President of Xijing Hospital of the Air Force Medical University, chose to read the list at the first time. Although the overall ranking has not changed much, in the specialist ranking, the ultrasound medicine of Xijing Hospital fell to the seventh place from the sixth place of last year. “We'll go back and show the list to the hospital staff again, and the reasons for the steady decline or regression should be found,” Xiong said. 

It is worth mentioning that at the conference, a hospital with only one specialist nomination, the dean also assigned a middle executive to attend the meeting. This participant traveled thousands of miles to the scene to clarify a problem: compared with last year, the hospital was more open and published more papers, but why was the junior college kicked out of the region’s top five?

Discipline construction is the top priority of hospital development, and it is the cornerstone of hospital brand, reputation and status. How to enhance the influence of key disciplines is a problem that hospital chiefs must think about, and the rankings exactly reflect the strength of a hospital's disciplines to a certain extent. 

For rankings, Peking University Third Hospital also attached great attention. Party Secretary Jin Changxiao told CN-Healthcare at the press conference that both orthopedics and clinical pharmacy are strong disciplines of the hospital. Although these two disciplines are at the top of the pyramid throughout the country, they have not dared to slacken their efforts. “Discipline development must forge ahead or it will be driven back, and less advance means retreat. The more advantageous the subject, the more need to focus on the international level, and work hard on the talent introduction and international communication.”

Jin is not worried about the academic gap with other hospitals. He believes that the reality of the gap between hospitals has long been formed, which is related to the history of the hospital, long-term practice, talent echelon structures. “The dramatic rise of the academic level cannot be accomplished overnight, and it is a positive solution to stabilize the current situation.” said Jin.