Inside China’s World-Class Hospitals: What Makes Them So Advanced?

China has undergone a remarkable transformation in its healthcare sector over the past decade, with its leading hospitals increasingly being recognized for their advanced capabilities and commitment to quality. This ascent is attributed to a combination of strategic policy decisions, substantial technological investments, a unique management philosophy, and a burgeoning research and innovation ecosystem.

Inside China’s World-Class Hospitals: What Makes Them So Advanced?

Driving Digitalization with Electronic Health Records (EHRs) A primary indicator of China's medical digitalization is the widespread adoption of Electronic Health Records (EHRs) in its hospitals. From 2007 to 2018, the average EHR adoption rate in sampled Chinese hospitals surged from 18.6% to 85.3%. The total number of hospitals adopting EHRs in China reached over 16,000 by 2018, significantly exceeding the 4,814 nonfederal U.S. hospitals that adopted EHRs between 2008 and 2017. This rapid adoption has been fueled by top-level design and government-led policies, which included EHR adoption as a crucial indicator for performance evaluation and public hospital appointments. Since 2015, the Chinese central government has invested over US $3.5 billion in health information technology (HIT) and EHRs, alongside issuing 31 national policies and 134 technical standards to guide medical care digitalization. The National Health Commission's definition of EHRs and the implementation of a tiered evaluation system (Levels 0-8) have also played a significant role in promoting high-quality adoption. For instance, by the end of 2020, all Level III and Level II hospitals were mandated to use at least Level IV and Level III EHRs, respectively, with approximately 87% of tertiary hospitals reaching Level III or above by July 2020, closely aligning with predictions.

Innovations in High-End Medical Equipment and Digital Services China's drive for healthcare advancement extends to its high-end medical equipment industry. Once largely dependent on foreign imports, China is now making significant strides towards autonomous and controllable development of high-end medical equipment, especially after weaknesses were exposed during the COVID-19 epidemic. The country's national system provides a significant advantage for developing key technologies, as seen in the rapid breakthrough of extracorporeal membrane oxygenation (ECMO) equipment during the pandemic. Influential domestic industry giants like Mindray and Yuwell have increased their market shares, with Mindray's respirators surpassing imported brands in China in the first half of 2020. The Chinese government actively promotes the integration of medicine with engineering, building public service platforms and encouraging the industrialization of high-end medical equipment and the application of big data service platforms. Diversified investment, including from large private enterprises and internet companies like Alibaba, Tencent, and Baidu, further supports innovation in this sector. Furthermore, the application of AI, 5G, and other new technologies is a priority for the future development of the medical device industry.

Beyond equipment, China has significantly enhanced digitalized services within hospitals. Reforms over the past decade have led to over 5,500 comprehensive hospitals providing "one-stop" services, allowing 77.7% of hospitalized patients to settle bills on discharge day. Mutual recognition of medical examination results in most public hospitals has reduced repetitive tests. Empowered by the internet, over 3,000 medical institutions offer online medical and nursing services, crucial for those unable to visit in person. The mandatory and ubiquitous AI-based "health code system," implemented during the COVID-19 pandemic, stands out as a revolutionary service system leveraging AI and big data for real-time tracking of whereabouts, contact information, and physiological data to manage public health. This system was rapidly introduced by leading Chinese corporations like Alibaba and Tencent.

Excellence in Hospital Management: The SCOPE Model Chinese public hospitals demonstrate impressive management capabilities, with their overall management practice being comparable to the best-performing countries like the U.S. and UK, and even surpassing some high-income countries like Canada and France in certain areas. A qualitative study identifies four core attributes contributing to this excellence, summarized in the System–Culture–Operation–Performance–Employee (SCOPE) model:

• Organizational System: Chinese hospitals operate under a collective decision-making leadership system, typically involving the Party Committee (Secretary) and the President (Director). This ensures scientific, democratic, and normative decision-making, effectively avoiding unscientific choices by centralizing power in an individual. The cooperation and communication between the party secretary and the president foster an efficient and harmonious leadership.

• Organizational Culture: Hospitals are deeply influenced by traditional Chinese culture, emphasizing "benevolence" and "love," leading staff to adhere to "patient-centered care and service". The core value is patient-centeredness, with a vision to build "world-class hospitals with Chinese characteristics". This culture aims to create an environment that instills a sense of value, responsibility, and mission among staff.

• Operations and Performance Management: Leading hospitals have dedicated operations management departments responsible for analyzing overall hospital operations, optimizing resource allocation, and continuously innovating performance appraisal systems to achieve hospital goals and improve service capacity. This focus on full-process, refined, and informed management has significantly improved efficiency.

• Employee Management: There's a strong emphasis on attracting and retaining high-quality healthcare professionals and providing continuous learning and training opportunities. Practices include cultivating a sense of professional reverence, establishing reasonable compensation systems, and offering opportunities for innovation, further training, and expert cooperation. This approach ensures a hierarchical echelon and quality of hospital talent.

The impact of better management practices is evident in superior hospital performance, including significantly lower mortality rates for acute myocardial infarction (AMI), shorter average lengths of stay (LoS) for pneumonia in children (PC), and lower complication rates for coronary artery bypass grafting (CABG). These well-managed hospitals also report higher inpatient satisfaction ratings.

Leading Global Research and Policy Implementation China's commitment to scientific advancement is increasingly global. In the last decade, China has displaced the U.S. as a global leader in research, with nine of the world’s top 10 research institutions now Chinese. Chinese institutions like the University of Science and Technology of China (USTC), Zhejiang University, Peking University, and Tsinghua University are producing groundbreaking research in fields from quantum computing to renewable energy. China's dominance is particularly notable in chemistry, physical sciences, and earth and environmental sciences. While the U.S. maintains a lead in biomedical and translational research, China is rapidly closing this gap, with institutions like Shanghai Jiao Tong University and the Chinese Academy of Sciences making significant inroads into biotechnology, genetics, and pharmaceutical sciences. This rise is a result of deliberate policy decisions, substantial financial investment (reaching approximately $500 billion in R&D expenditure in 2024), and systemic reforms that prioritize impactful and innovative research over sheer publication volume.

Furthermore, China is actively internationalizing its hospital accreditation system. The Shenzhen Hospital Accreditation Research Center (SHARC) has developed International Hospital Quality Accreditation Standards (CIHA 2021 Edition) that fully conform to international requirements as evaluated by the International Society for Quality in Health Care External Evaluation Association (ISQua-EEA). This marks a significant milestone in ensuring that Chinese hospitals meet global benchmarks for quality and safety, with the first three hospitals successfully accredited in June 2024. Shenzhen serves as a pilot demonstration zone for reforms in cross-border medical services and international hospital accreditation. This effort is supported at national, provincial, and municipal levels, including the Hong Kong SAR government, which plans to restart its hospital accreditation program and support SHARC's internationalization efforts.

In conclusion, China's "world-class" hospitals are a product of comprehensive reforms encompassing advanced digitalization, robust technological innovation in medical equipment, sophisticated management practices as embodied by the SCOPE model, strong government policy and financial support, and a rapidly expanding global leadership in scientific research. These multifaceted efforts are continuously improving healthcare quality, efficiency, and patient satisfaction across the nation.