中国公立医院内部管理水平的初步测量——基于《中国医院管理调查表-扩展版》(D-CHMS)现场访谈法

目的：分析《世界医院管理调查表扩展版（D-WMS-H）》在我国公立医院开展应用的适用性，初步测量医院内部管理水平。方法：翻译、修订D-WMS-H调查表形成《中国医院管理调查表-扩展版》（D-CHMS），通过现场访谈定量测量63家样本医院管理水平，检验D-CHMS信度和效度。结果：D-CHMS的Cronbach''s alpha系数为0.911，因子分析提取5个公因子，累积方差贡献率66.986%；样本医院管理水平均分为2.97分，三甲医院和二甲医院分别为3.09分和2.82分。结论：D-CHMS具有较好信度和效度，适用于测量中国医院内部管理水平；宜采取现场访谈方法开展医院管理水平调查，不推荐使用电话访谈等非现场方法；我国三甲医院总体上建立了正式的、良好的主动管理，但二甲医院总体上还存在非正式的被动式管理；我国公立医院整体管理水平与世界主要发达国家尚存在一定差距，具备较大提升空间。

A preliminary measure of management practice in Chinese public hospitals based on Development Chinese Hospital Management Survey (D-CHMS) by on-site interview

Objective:To verify the applicability of Development World Management Survey-Hospital Version (D-WMS-H) in public hospitals in China and conduct preliminary measurement of the managerial practices therein. Methods:The Development Chinese Hospital Management Survey (D-CHMS) was developed from D-WMS-H and was applied to measure the management level of 63 sample hospitals by on-site interviews. The reliability and validity of D-CHMS were also tested. Results:The Cronbach''s alpha coefficient of D-CHMS was 0.911 after the measurement. From the analysis of the survey results, 5 public factors were extracted and the cumulative variance contribution rate reached 66.986% in Factor Analysis. The average management score of Samples was 2.97, in which tertiary hospitals and secondary hospitals were 3.09 and 2.82, respectively. Conclusions:Firstly, D-CHMS is suitable for measuring the internal management level of public hospitals in China for its good reliability and validity. Secondly, it is recommended to conduct on-site interview for an accurate investigation of the hospitals'' management level rather than using off-site methods such as telephone or online interviews. Last but not least, China''s tertiary hospitals have established formal and good active management systems, which is different from secondary hospitals because the case there is informal and passive. There is still a gap of hospital management practice between China and the many developed countries around the globe, and this gap need to be bridged through improvements and reforms, especially in secondary hospitals in China.