China’s economic growth over the past two decades has increased the expectations of its citizens towards the services offered by different public institutions. However, the public sector has been characterized by numerous challenges in terms of quality of services they deliver. In this study, the researcher focused on the application of the new public administration to the public sector. It was also necessary to understand what causes poor performance, inefficiency and lack of enthusiasm in the public health sector and the impact of the recent reforms on the overall quality of services offered at these institutions.
The study used data from both primary and secondary sources. It was evident that issues such as culture, the education system and limited funding are some of the issues that have plagued public healthcare system in China. The recent reforms have made healthcare services more accessible, affordable and of better quality.
Introduction and Topic of the Research
The new public management currently witnessed in China is a deliberate effort to reform the public sector to improve its performance. According to Grinspun and Bajnok (2018), citizens of the country pay taxes regularly to fund the public sector to ensure that services they get from government institutions are within their expectations. Some of the crucial public services include education, law enforcement, healthcare, infrastructure and emergency services. Austin, Bentkover and Chait (2016) explain that law enforcement agencies should be quick to respond to the needs of the citizens, always ensuring that they are protected from critical activities.
The education system should meet the right standards so that upon completing their academic journey, graduates are equipped with the relevant skills needed in the job market. The government should also spend enough resources on the country’s infrastructure. The healthcare sector is another area that should not be ignored. The majority of the Chinese cannot afford the cost of some of the top private clinics operating locally and abroad. They have to rely on the services offered in public hospitals.
The quality of services offered in these institutions directly affects lives of people in the country. According to Pongsak (2018), the government should not compromise on the quality of these public sector services. When the quality of education is poor, individuals that will be graduating from local institutions of higher learning will be incompetent. They will lack the basic skills needed to achieve specific goals in the workplace environment.
Many industries will be paralysed in the process and some foreign corporations may be forced to hire parent country nationals (PCN) or third-country nationals (TCN) to undertake responsibilities that could have been done by the locals (Mohanty 2018). In the law enforcement sector, a compromised security system may have a significant impact on the ability of the officers to maintain law and order. Similarly, poor public medical services may have devastating consequences on the general population.
The study is an exploration of the applicability of new public administration in the public sectors in China with a special focus on the public health sector. As Mohanty (2018) observes, China has the largest population in the world. Although the country has witnessed massive economic progress over the years, the majority of Chinese make less than $ 400 per month (Pongsak 2018). This modest income is barely enough to meet all their basic needs. They cannot afford to visit expensive private hospitals in major cities around the country. As such, they heavily rely on services offered by the government because they are subsidised.
For a long time, members of the public have complained about the quality of services at these institutions. According to Mohanty (2018), it was common for a patient to visit a healthcare facility only to be informed that they had to purchase their medicine from private pharmacies. Some medical facilities have a limited number of the medical staff, so they have to spend several hours waiting to be attended to by the few physicians.
O’Loughlin and O’Loughlin (2016) note that another common problem in Chinese public hospitals was lack of proper diagnostic equipment. Sometimes patients would be informed to visit private facilities for specific tests before bringing back the laboratory reports. In some cases, a patient may be misdiagnosed (Veal 2018). These issues eroded the trust that members of the public have towards these public healthcare institutions.
In October 2009, Mohanty (2018) observes that Chen Zhu, who was the head of the Ministry of Health, introduced a new policy, Healthy China 2020, which was meant to introduce major reforms in the country’s healthcare sector. One of the main policies introduced was universal healthcare for all the Chinese. The government was keen on embracing international best practices as globalisation continued to affect various sectors of the economy. The government realised that there was a need to increase access to medical services, especially in major urban centres where the population was increasing rapidly.
In 2016, President Xi Jinping introduced the Healthy China 2030 Planning Outline when unveiling the China National Health and Family Planning Commission (Pongsak 2018). It was an indication that the regime was committed to new public management. In this paper, the researcher seeks to explore the applicability of new public administration in the public sectors in China.
The Chinese public healthcare sector has been under immense focus over the past decades as the country continues to experience massive economic growth. According to Veal (2018), China is currently considered the second-largest economy after the United States. If the current growth is sustained, China will soon become the world’s leading economy. It is unfortunate that with such significant economic growth, the healthcare sector is still below the expectations of many of the locals. Mohanty (2018) observes that the quality of services offered in private hospitals is significantly better than those in public healthcare facilities are.
The problem is that despite the massive growth of the country’s economy, the majority of Chinese earn a modest income of less than $ 400 every month. It means that they cannot afford to pay for healthcare services in expensive private hospitals. The insurance cover that most of those in formal employment have cannot be used in these expensive clinics because of their limited coverage. As such, the vast majority of people are forced to rely on government hospitals even if the quality is below the expected standards.
The quality of services offered in health sector has a direct impact on the socioeconomic forces in the country. The economy of China can only grow if it has a healthy population that can engage in different sectors. With the increasing prevalence of diseases such as cancer, coronary complications and mental health problems, it has become necessary to have effective medical systems in the country (Mohanty 2018).
The local Chinese society needs to be assured that they will get the right diagnosis and proper treatment within a reasonable period whenever they visit public hospitals. The current reforms introduced by the current government are seen as a deliberate effort to make these healthcare services universally acceptable to all the citizens of this country. However, Pongsak (2018) notes that sometimes the political leaders make public promises during the electioneering period to gain political seats.
Once they are elected, they forget about their promise and maintain the status quo. It is important to determine if genuine changes have been introduced in the country’s healthcare sector, especially the introduction of new public management. The reforms are expected to lower the waiting time for patients who visit public hospitals, equip all healthcare facilities in the country and ensure that adequate skilled staff is hired in these facilities. The study will assess if these issues have been addressed under the new public administration system.
Aims of the Research
When planning to conduct research, Mohanty (2018) argues that one of the factors that should be defined in clear terms is the aim of the study. Defining the aim of research gives it a focus. It makes it possible to understand what needs to be achieved by the end of the study. It makes it possible to set specific objectives that can be realised through the analysis of data from various sources. Pongsak (2018) argues that by defining the focus of the study, it eliminates cases where a researcher wastes time on issues, which are irrelevant to the study. The study aims to explore the application of the new public administration to China’s public sector, to investigate causes of poor performance in these institutions, and to determine the impact of recent reforms introduced by the government.
Once the aim of the study has been defined, the next step is to set research questions that would help in the data collection process. The following questions will be answered using data from both primary and secondary sources.
- What are the causes of poor performance, inefficiency and lack of enthusiasm in Chinese public sectors services?
- Can new public administration improve public sectors services in China?
The emerging technologies and the changing socio-economic and political systems have had a massive impact on the manner in which public services are offered. The need for transparency and openness in the public sector has become a major concern for members of the public. According to Lapsley and Knutsson (2017), people want to know why their government is making specific decisions and the impact of such decisions on the economy and their lives. Babar (2015) attributes such changes to increasing levels of literacy. As more people are academically empowered, they develop interest in government functions and the manner in which their resources are spent. They feel that they have a role to play in ensuring that the public sector performs as per their expectations. The wave of changes has forced the government to redefine its operations.
Flexibility, efficiency and the need to face social reality are issues that can no longer be ignored. Public servants must understand the needs of the people and find ways of meeting them to ensure that they remain relevant. In the past, the government would easily monopolise information because of communication systems and structures that made it difficult to share knowledge. However, the digital era has revolutionised the way people communicate. It is easy for people to share information on a large scale within a short time. These issues are directly affecting the public service sector. According to Lardy (2019), the Arab Spring was a clear indication that the global community is currently keen on getting the best services from their government.
In countries such as Egypt, Libya and Tunisia, citizens organised themselves, with the help of the social media platforms and forced their political leaders out of office (Ozgen 2019). In Yemen and Syria, the revolution displaced hundreds of thousands and thousands lost their lives.
Governments in other parts of the world cannot ignore such events. It was a clear demonstration that people are currently very sensitive about activities of their government and they are willing to do anything within their powers to ensure that they get services they need. In this chapter, the researcher will focus on reviewing the literature on the public sector services in China and the transformation that has been witnessed over the years.
Public Sector Services in China and the Traditional Management Approach
In the last two decades, China has emerged as one of the dominant economies in the world primarily because of its large population, increasing cases of foreign direct investment and government policies. According to Amelung et al. (2017), China is currently the second-largest economy after the United States and some economists believe it has the potential to become the largest global economy in a few years to come.
These economic changes have had a major impact on the country’s socio-economic and political system. Chinese expect a lot from their government. Issues such as socio-economic inequalities, social injustices and favouritism in the country are expected to be eliminated as the country transitions into a developed economy (Liu, Vortherms & Hong 2017). Cases where people die of malnutrition or the inability to afford medical care is also expected to be fought in China. However, some of these concerns have not been addressed despite the flourishing economy of the country. The public sector has been riddled with so many issues that many have lost their trust in it.
The Chinese police, Chinese public housing sector and Chinese public health sector are some of the main public sector institutions expected to deliver excellent services because of the financial capacity of the government. However, Prescott (2016) explains that before the recent reforms, these public institutions have demonstrated a high level of inefficiency and poor performance because of various reasons.
The police would take time when responding to emergencies, especially in the rural setting, which makes it difficult to combat crime. Some of these officers would rarely follow up a case unless they are handling issues affecting the rich and the powerful in the country (Qian 2017). The housing sector in the country had also been performing poorly in the country. In most of the major cities in China, many people cannot afford to stay in decent houses.
The limited government houses can hardly accommodate all public servants in the country (Barber et al. 2014). There have been complaints that there is always favouritism when issuing these houses to public servants. Public servants who lack necessary links with top officials in the relevant ministries rarely succeed in getting such houses. The government has allowed the private sector to invest in real estate as a way of addressing the housing gaps.
However, the lack of public participation when developing these housing units has resulted in a situation where the majority of the city dwellers cannot afford to stay in such a private house. It is a demonstration of a failure of the government. According to Ward (2017), it is common to find cases where in one part of the city, different apartments are unoccupied because of their rental price. On the other part of the city, one would find a crowded population, with many families sharing homes as a way of sharing costs (Information Resources Management Association 2017).
The healthcare sector is another area that is rocked with numerous challenges. Berman and Prasojo (2018) argue that most of the Chinese hospitals rarely pay attention to the improvement of efficiency and effectiveness. Performance management is still a rare concept in these institutions as they struggle with the huge population of patients. In most of these healthcare institutions, their focus is on handling as many patients as possible without paying attention to the quality of services delivered. In such an environment, it is common to find cases of misdiagnosis. Such a patient would be put on a wrong medication, which may only worsen their condition.
Milcent (2018) argues that many patients have lost their lives because the medical staff failed to conduct correct diagnosis. It is unfortunate when people lose their lives to treatable and manageable conditions because of the inefficacy of the people they trust with their health.
The poor performance in the public sector services in China has resulted in a situation where people no longer trust public institutions. According to Ward (2017), many financially empowered families no longer rely on the police to investigate issues affecting them. They prefer to hire private detectives who will give full attention to their case and focus on finding the desired solution. The country has also witnessed an influx of private hospitals because of the rich no longer trust public hospitals. In a report by Beijing Jishuitan Hospital (2019), many international hospitals have collaborated with local investors to put up various healthcare institutions in different parts of the city. In major cities such as Beijing and Shanghai, the number of large private hospitals has been on the rise over the recent past (Bach & Bordogna 2016).
The fact that members of the public prefer to use these private healthcare facilities to those offered by the government is an indication of the weaknesses of the country’s public service sector. It is worrying that even the top government officials do not trust these public institutions. They rarely use public hospitals when they are sick. They prefer visiting some of the top private institutions in the country. Others even consider flying out of the country to receive these services in Europe or North America (Jing & Osborne 2016). It indicates that they believe the country cannot offer them the quality of services they believe they deserve. The problem is that the majority poor who cannot afford a ticket plane to North America or the medical cost in these foreign countries are forced to accept their fate and get the substandard services.
Why the Poor Performance in the Traditional Management Approach
The poor performance of the Chinese public sector service is widely documented in different publications. It was important to determine why this sector still performs so poorly at a time when the economy of the country seems to be performing well. According to Prescott (2016), one of the leading reasons why this sector registers a substandard performance is because of the low educational level of the majority of the employees.
A significant population of these government workers only has basic education that makes them barely qualified to work in such offices. Once the government hires them, there is no motivation for them to pursue further education as a way of honing their skills (Jing & Osborne 2016). Their limited income is barely enough to meet their basic needs. As such, they cannot afford to set aside some amount that they can use to fund their advanced education (Johnson, Stoskopf & Shi 2018).
Once they start their families, focus on education shifts from parents to their children. It means that these workers would remain with their basic education for the rest of their service. Such individuals are often less innovative in their workplace. They believe in following specific instructions and manuals when rendering their services. In fact Müller (2017) argues that employees with minimal education fear change and would try to fight it when they have the opportunity to do so.
They have the fear that their limited intellectual capacity may render their services within the firm unnecessary. Whenever a change is introduced, it takes longer to equip such employees with relevant skills that would improve their performance. The high cost of such training and the time that would be needed often make the government to avoid such endeavours. These employees are left to do what they can, which in most of the cases is below the expectations of members of the public.
Lack of enthusiasm is another issue that has been identified as a major concern when it comes to defining the quality of services offered in the public sector within the country. According to Prescott (2016), the morale of employees is not just defined by the amount of salary they get regularly. Other non-monetary factors such as the condition of working and the relationship between the manager and the employees also define the level of motivation of workers. Ward (2017) explains that for a long time, many public sector institutions embraced totalitarian rule to govern employees. Many of them were expected to follow strict instructions without deviations.
In such an environment, an employee is not allowed to be creative. Trying to be innovative would mean an individual would deviate from standard procedures and try something new (Garnaut, Song & Cai 2018). It is common to make mistakes in such cases. However, strict policies do not allow them to make such mistakes. To avoid punishment, they would be forced to stick to standard procedures even if they are mediocre.
The relationship between managers and junior officers has also been an issue that is affecting the performance of public sector institutions in the country. The rigid leadership structure that requires employees to report to their immediate supervisors limits creativity in these institutions. When an employee has a brilliant idea that may transform the operations of the firm, they have to share it with their immediate supervisor (Jing & Osborne 2016).
The supervisor will be expected to evaluate the idea and determine its relevance before communicating the same to their superiors. In most of the cases, the idea would be dismissed by the supervisors or junior managers for various reasons. The few that reaches the top managers would be so distorted that they may not make sense to the top management because of going through different individuals (Prescott 2016). Most of these employees would give up trying new ideas because of such frustrations.
The salary scale is another major issue that is directly affecting the performance of public sector institutions. According to Qian (2017), China has been attracting numerous investors from the West because of the huge population, the growing economy and cheap labour. When these multinationals set their branches in the country, they end up offering more attractive remunerations than what the government gives its workers (Sirakaya-Turk et al. 2017).
Some of these employees in the private sector are given a higher house, travel and hardship allowances than their colleagues working in the public sector. The disparity causes dissatisfaction among employees working for the government. They feel that their services are not appreciated as well as those who are in the private sector. Such a team of employees rarely give their best in their places of work (Zhang et al. 2016). They are not motivated to improve the quality of services they offer.
Excessive centralisation of authority has been another major concern that affects service delivery in China’s public sector. Fang (2018) explains that decision-making in the country has been left in the hands of a few top officials. In most of the large hospitals in the country, doctors, nurses, clinical officers and other medical staff cannot make important decisions without consulting the top management unit (Quan-Haase & Sloan 2017).
It means that when such a manager is away from the institution for official or personal reasons, some operations may slowly stop if they cannot be reached to give their approval. Heads of departments find it almost impossible to develop effective plans of running their departments without the approval of the top manager. In the past, centralisation of power in such public institutions was viewed as a sign of discipline and commitment to the country’s leadership (Ward 2017). However, it is currently becoming a hindrance to creativity and innovativeness in these institutions.
Some studies suggest that there is a mismatch of socio-economic development in theory and practice within the country (Zhang et al. 2015). The political system of China feels that the country’s economic growth puts it at per with some of the advanced economies in Europe and North America. As such, it is common to find cases where models of public service used in the United Kingdom or Sweden is borrowed in its entirety, hoping that it would work in China (Rubin & Babbie 2017).
The problem that emerges in such situations is that local government employees lack the skills needed to implement such models. The mismatch of the theory and practice worsens the public sector service delivery instead of improving it. As explained in the section above, a significant number of people working in China’s public sector lack advanced academic qualification. As such, they would require models that match their intellectual capacity instead of those borrowed from economically and socially advanced nations in other parts of the world.
Globalisation has been both a blessing and a curse to China’s public sector service delivery. On the one end, this change has opened up the community to international best practices (Xiaodong 2017). As foreign companies come to the country, they introduce new practices, which help to transform the manner in which services are rendered. On the other hand, some members of society still hold dear various Chinese cultural practices.
It is difficult to merge some of these practices with the traditional culture and practices (Ward 2017). Awakening of civil rights has also been attributed to globalisation. Workers are joining unions to enable them to champion for their rights. Such industrial actions often have a devastating impact on service delivery within the public sector. Other issues such as pressure of domestic economic development and the changing international politics also have a direct impact on public health service delivery. These changes may have positive long-term benefits (Zhang & Chang 2016). However, within the short-term they are disadvantageous because of issues such as go-slows as employees demand change.
The Public Sector Services Reforms: Moving Towards the New Public Management
China has focused on making major reforms in its public sector service delivery, especially in the medical sector. One of the areas where the administration has focused on in its medical sector reforms is the cultural policy. According to Christensen and Lægreid (2017), the ability of the country to reform its public sector has often been affected by some of the traditional cultures and beliefs.
As such, the government has initiated programs and policies meant to reform the culture itself. For a long time the country had maintained its traditional culture against the prevailing western culture. However, as the wave of globalisation, capitalism and technology continue to sweep the region, it has become unavoidable for the country to redefine its culture. The country is embracing a liberal policy of governance where employees are allowed to work under some form of freedom (Halperin & Heath 2017). It is becoming easier for junior employees to consult the top managers and bureaucratic systems become less popular in various institutions in the country.
Reforms in the education sector have also been considered an important way of redefining the country’s public healthcare system. According to Yu and Guo (2019), the country’s educational system was viewed as being out of touch with reality. It focused more on white-collar jobs but ignored the informal sector and the emerging industrial sector in the country. As such, the government introduced consistent reforms in the education sector to introduce practical skills that graduates can use when they get into the job market (Xu et al. 2019).
Currently, these academic institutions are focusing on competency-based education as a way of ensuring that learners’ skills are aligned with the expectations in the job market (Yang 2017). These initiatives are expected to introduce a new class of workers who are creative, innovative, techno-savvy and keen on delivering the best quality services to members of the public.
Technical ability reform is another area that the government is making a significant investment into (Britnell 2015). Technology is redefining the manner in which services are delivered in public hospitals. Medical conditions such as cancer, diabetes and various heart conditions currently require state-of-the-art technology to ensure that they are managed effectively. The problem is that some hospitals have these facilities but lack technocrats who can implement them effectively. The problem is more common in rural parts of China (Walle & Groeneveld 2016). The lack of experts who can run these machines means that even if the government installs them, they may not be of service to the public. The initiative to improve the technical ability of the employees seeks to address these weaknesses.
The new public administration in China has been brought up by the deliberate attempt and the desire to reform the sector to improve performance and the quality of service delivery. Society has come to appreciate the significance of improving the country’s public health sector (Huang & Dai 2019). Reforms are mainly introduced in the educational system to ensure that public health officers are equipped with skills that can enable them to deliver the best service to people. Technology has also become a major factor that is propelling these reforms (Sirakaya-Turk et al. 2017). The government is spending a significant amount of money to equip local healthcare institutions.
Challenges in the Public Service Reforms
The desire by the government and all the relevant stakeholders in the public health sector and other public sector service providers to introduce reforms has been affected by various challenges. According to Brødsgaard (2014), one of the major challenges that are still a major issue is the problem of the traditional managerial system that limits creativity and innovativeness. The government has committed to reforming the culture as a way of promoting various reforms.
However, it may take a while for the culture to change. Some of those in leadership still feel that they need to centralise power as the only way of remaining in control (Xu & Mills 2019). Such practices make it difficult to achieve specific goals. The increasingly diversified managerial needs in the public sector cannot be achieved through the traditional and unitary methods of leadership.
The perception of a section of the society may be viewed as another major hindrance to the reforms that the government intends to introduce (Tu 2019). The formal education sector in China was once viewed as a failure because a significant number of graduates in the country could not find jobs commensurate to their qualifications (Wang, Loban & Dionne 2019). As such, this sector gained fame as fee collection systems instead of institutions of learning.
Changing that perception has been difficult even after a raft of reforms were introduced (Sirakaya-Turk et al. 2017). On the one hand, the government is using learning institutions to introduce major reforms in the public health sector to meet international standards. On the other hand, many people had lost trust in the country’s education system. Introducing these reforms through schools and colleges becomes challenging when members of the public do not trust such institutions. Discrimination has also been identified as a major issue in the country’s education system.
When introducing the reforms in China’s public service sector, it would be important to take into consideration various theoretical concepts that would help make the implementation simple. One of these theories is Kurt Lewin’s model of change shown in figure 1 below. Lewin holds that many people fear change and they may try to resist it for various reasons (Ward 2017). Some stakeholders may resist change because of unfounded fear, making it impossible for an organisation to achieve specific goals. As such, it is important to find a way of introducing it as smoothly as possible. He suggested three stages of introducing change within an organisation, which may be relevant to Chinese public sector reforms.
When using this model of change management, the first stage is to unfreeze. The management is expected to explain to the employees’ reasons why the current system is inadequate and steps that the management is taking to address the inadequacies. Unfreezing primarily involves preparing all the parties involved for change. They need to understand the benefits of the new system and the manner in which it would make their work easier than it is currently (Information Resources Management Association 2018).
The goal is to increase the acceptance rate of the new system among employees and dispel any fears and misconceptions that employees may have. In China’s public sector, various reforms have been introduced as discussed above. The government officials should explain to employees the relevance of each reform and the new roles they are expected to play.
Involving employees at this early stage of policy implementation often increases chances that all stakeholders would support it. Weishaar, Philipsen and Xu (2017) believe that the only way of introducing new reforms successfully is to start by preparing the employees and making them ready to work under the new system. The unfreezing stage may also require some form of training to equip the healthcare workers with skills needed under the new system.
On-job training is one of the most preferable forms of equipping employees with new skills because of its practical nature (Tulchinsky & Varavikova 2014). In some cases, a firm may collaborate with local institutions of higher learning to expand the intellectual capacity of the employees.
The second stage, according to this model, is the actual introduction of change. Ward (2017) believes that it is the most challenging of the three stages of this model. The team is expected to execute the intended change based on the blueprint developed. Developing a blueprint is significantly different from its implementation. At this stage, unforeseen challenges may emerge, with devastating consequences (Xiaodong 2017). The management is expected to analyse these challenges and find an appropriate solution within the shortest period possible. During the implementation, the management is expected to determine the sustainability of the reform and if it has the expected impact.
The new public management theory can help in exploring the applicability of new public administration in the public sectors in China. According to Sirakaya-Turk et al. (2017), this model offers an approach of governing public sector organizations. Developed in the 1980s, this model focuses on running public agencies in a business-like manner to improve their efficiency (Britnell 2015). They give priority to superior customer service, reduction of cost of operation, and the use of technology when running these institutions. It introduced performance standards, output controls, decentralization, and competitiveness in the public sector.
The model has gained popularity beyond the United Kingdom and Australia where it started. When introducing reforms in its public sector, China can embrace this model to improve the outcome of its initiatives.
The previous chapter provided a detailed review of literature, explaining the reforms of public sector services in China. In this chapter, the focus is to explain the method that was used to collect data that informed the conclusion of the research. When conducting research, Patten and Newhart (2018) explain that it is important to have a plan on how data will be collected from various sources, analysed, interpreted and presented. A researcher can use primary data, secondary data or both, depending on various factors encountered during the data collection process. Irrespective of the sources of data that a researcher uses, it is crucial to have a clear method of how the information would be obtained and processed.
The methodology section helps a reader to ascertain the authenticity of a report by providing a detailed explanation of steps taken when compiling the report (Veal 2018; Brennen 2017). In this study, the researcher was interested in exploring the applicability of new public administration in Chinese public hospitals. The chapter will discuss the relevance of the qualitative research method that was used in the study, the application of secondary data in the analysis and the presentation of the finding in the study.
Qualitative Research Method
A researcher can opt to use qualitative, quantitative or mixed-method research when conducting the analysis. The choice of the method, as Ozgen (2019) observes, depends on the topic under investigation and the nature of the research question. The selected method should be capable of enabling a researcher to achieve research goals. In this exploratory study, the qualitative research method was considered the most appropriate approach to analysing data collected from various sources. According to Bertrand and Hughes (2017), a qualitative research method helps to explain why a phenomenon happened in a given manner.
It goes beyond statistics to create an understanding of the chain of events regarding the issue under investigation (Coolican 2014; Tan 2017). When using this method of analysing data, a researcher is expected to focus on specific events and explain why they took place, their implications and any other relevant issues in the study.
In this research, the goal was to explore the applicability of new public administration in China’s public sector, paying special attention to the country’s healthcare. The sector has undergone a massive transformation over the past decade. Conducting a quantitative study may help in explaining the magnitude of change and its impact. However, Card (2016) notes that statistics cannot explain the forces behind such changes and the nature of the effect of the change. As such, a quantitative research method, despite its desirability in explaining the magnitude of the impact, was considered inappropriate for the study.
Qualitative research made it possible to identify specific changes that have taken place in the country’s healthcare sector (Rubin & Babbie 2017; McNabb 2015). The researcher identified who benefited from such changes and steps that the government and other stakeholders need to take to sustain the positive change that has been realised.
Second Data Analysis of Hospital Service in China
The researcher found it necessary to use secondary data from hospitals to inform the study. According to Halperin and Heath (2017), the best way of addressing research gaps identified during the review of the literature is to collect primary data from respondents. Primary data collected from sampled respondents often helps to understand current issues relating to the topic under investigation. In this case, collecting primary data was a major challenge because of various constraints (Coolican 2014). As such, it was not considered a viable procedure of data collection based on the circumstances that the researcher encountered.
Using secondary data was considered as the most effective option of obtaining the information needed in the study. Secondary data was obtained from various sources. Company reports were considered appropriate sources of data that could help provide the needed information. According to Quan-Haase and Sloan (2017), a firm’s annual reports always explain steps that it is taking to transform its operations to improve efficiency in production and cut operations cost. Such reports often explain how the firm has implemented new reforms in different departments and the possible outcomes.
The researcher identified two public hospitals in Shanghai and Beijing to help understand the reforms that public healthcare institutions are taking place in the country’s public healthcare sector. Reports from these institutions were considered crucial because they have been identified as some of the most dynamic healthcare institutions in the country because of the reforms they have introduced. Further secondary data was obtained from journal articles and books recently published about reforms in China’s public sector.
This issue has attracted the attention of many scholars over the recent past. Studies about the motivation of these reforms and their impact on the public healthcare system in China have become common. Reviewing these documents was considered an effective way of understanding these changes. Reliable websites such as that of the ministry of health and individual hospitals websites also proved crucial in the study.
Data obtained from these sources was analysed qualitatively. The researcher identified factors that came out as the main triggers for change in China’s public health sector. According to Coe et al. (2017), when conducting qualitative research using secondary data, it is important to define the information that the researcher seeks to obtain. The desired information can then be presented in the form of themes or subtopics that address the main research question (Walliman 2016; Pruzan 2016). The researcher groups themes identified from the secondary data analysis into two groups. The first group identified the possible causes of the reforms and stakeholders involved.
It involved explaining the process of the reform. The second group of themes identified the impact of these reforms on the institutions and members of the public. It helped to explain the benefit of the changes introduced and how relevant authorities within the country’s public health sector can play different roles to ensure that the consistent positive progress witnessed over the past decades remain sustainable. The outcome of the analysis informed the conclusion made at the end of the study.
When conducting academic research, it is important to be ethical in every stage of the study. One of the main ethical requirements when conducting academic research is to protect the identity of the respondents (Sirakaya-Turk et al. 2017). However, that was not a concern in this study because the researcher did not have time to collect data from a sample of respondents. The researcher was keen to observe rules and regulations of the school regarding plagiarism and other academic malpractices (Prescott 2016). Information obtained from secondary sources was cited using the Harvard referencing style. All the sources used were then listed in the reference list of the paper.
This chapter has explained the method that the researcher used to obtain and analyse data from various sources. The information used in this study primarily came from published sources. Publications from the selected hospitals proved critical in understanding the reforms they have embraced over the years, reasons for such reforms and the impact they have had on efficiency and productivity of the institutions. Information from their websites also proved critical in providing knowledge about the reform of public sectors services in China. Secondary data was obtained from books, journal articles and reliable online sources.
These secondary data sources provided background information upon which this paper was developed. As explained in the chapter, a qualitative research method was considered most desirable for the investigation. This method goes beyond mathematical data to provide detailed information about the issue under investigation. It was appropriate in responding to the research question and meeting the primary goal of the study. The next chapter focuses on presenting findings made in the study during the investigation.
When data has been collected from various sources, as discussed in the section above, the next step is to conduct analysis. Tulchinsky and Varavikova (2014) explain that a researcher is expecting to analyse data in line with the research questions and objectives. The findings presented should answer the main research questions and sub-questions. It should also address the objectives of the study. In this chapter, the researcher will present findings made from the selected healthcare institutions in Beijing and Shanghai to understand the progress that they have made in their attempt to transform their operations. The information from the analysis of data from the two institutions will help in understanding the reforms that Chinese public sector service providers have made over the past decades.
Collecting Data from Some Hospitals
The public sector reforms in China have focused on improving efficiency, quality of service and cutting down the overall cost of operation. According to Information Resources Management Association (2018), one of the areas that have experienced massive changes is in the healthcare sector. With a population of about 1.39 billion people, China is the most populous country in the world (Bolchover, Lin & Lange 2016).
The government is under massive pressure to ensure that its citizens receive quality healthcare services in various provinces around the country. The government has been investing in the sector to improve the infrastructure and the personnel to ensure that there is the capacity to offer services that citizens need. Yu and Guo (2019) explain that the majority of Chinese use public hospitals because their services are subsidised. The researcher collected data from two of the leading healthcare facilities to understand how various reforms have been implemented to improve the quality of their service delivery.
Xinhua General Hospital in Shanghai
The hospital was founded in 1958 as one of the major referral hospitals in Shanghai (Xiaodong 2017). At that time, the population of the municipality of Shanghai was increasing rapidly and it was necessary to enhance medical services in the region. Both the local and central governments invested massive resources into this facility to enhance its capacity to handle the increasing population. It soon became a teaching hospital when it became affiliated to Shanghai Jiao Tong University, School of Medicine (Xiaodong 2017). This move was an important milestone for the institution because it also meant that it became a research institution. It has since become one of the best paediatric institutions in the country and it hosts Shanghai Institute for Paediatric Research (Xiaodong 2017).
It is also reported that the hospital is one of the very few healthcare institutions capable of performing cardiac surgery and transposition of great vessels on new-borns (Christensen & Lægreid 2017). As shown on the website of the hospital, it is currently ranked Grade 3, Class A, which is the highest grade of hospital in China, because of its quality services. It has also been awarded the title of Civilised Unit of Shanghai for a record seven times because of its consistency in the delivery of quality services. Despite these achievements, the institutions have been under pressure to implement reforms put in place by the government to improve quality of services delivered and to cut the cost of service delivery in a way that would lower the prices that citizens have to pay when visiting the public hospital.
Data collected from the secondary sources show a commitment by the government to improve efficiency and lower cost at all major public hospitals by introducing a raft of new policies meant to redefine their mode of operation. The State Council released a new guideline for the hospitals, which focus on modern management of hospitals with clearly defined responsibilities, efficient operation, strong supervision and scientific governance (Xiaodong 2017).
Wang Hesheng, who is the director of the medical reform and working under the State Council, said, “They focus on public health at its core, keep public hospitals non-profit and create a modern hospital management system,” (Xiaodong 2017, para. 4). In his report, he noted that most of the public hospitals in China operated without clear guidelines on how to maximise on their resources, a fact that has led to cases where hospital beds are wasted. Tulchinsky and Varavikova (2014) note that the government has remained committed to making healthcare affordable to all the citizens irrespective of their socio-economic conditions.
Xiaodong (2017, para. 9) said, “All public hospitals in Chinese cities should carry out comprehensive reforms before the end of September and remove all the medicine mark-ups.” This directive was meant to lower the cost of operation and increase productivity. Xinhua General Hospital is one of the public healthcare institutions, which have embraced the reforms introduced by the government. Figure 2 below shows the model that the institution and many other public hospitals in the country such as Beijing Jishuitan Hospital, follows to improve efficiency.
This model was introduced to increase the affordability of medical services in the country. One of the major reforms that Xinhua General Hospital has embraced is the abolition of drug price mark-ups. The institution is expected to issue drugs to patients at the same price that it purchases them from suppliers. As a government-funded facility, it is not expected to focus on profits but the quality and affordability of its products.
Registration, diagnosis and treatment fees have also been abolished at the institution to lower the cost of service delivery. Some of these directives were meant to increase the use of outpatient services in grade C hospitals, which are lower-level healthcare facilities and discourage the same at grade A hospitals, which are major referral hospitals. The move helps in ensuring that complex cases are handled by referral grade A hospitals, which have advanced equipment and capabilities to handle such cases.
When the burden of care is lowered at these institutions of advanced care, they can focus on specialised cases, while the lower level hospitals offer care for less complicated medical problems. Most importantly, the reform introduced reimbursement program as shown in figure 1 above. Patients are often reimbursed part of the payments they make for the services as a way of making healthcare affordable to all citizens irrespective of one’s financial status.
In this reform program, the government was focused on having a carefully planned care for patients depending on their needs. Before its introduction, patients would visit grade A hospitals with minor complications that could be handled in lower-level hospitals. On the other hand, some patients in critical conditions would be forced to visit these low-level hospitals with complications that needed advanced medical care.
The outcome was a situation where patients with advanced condition losing their lives because the low-level hospitals cannot handle their needs. On the other, larger hospitals would be burdened by numerous minor medical needs, compromising their capacity to attend to serious cases of medical emergencies. Christensen and Lægreid (2017) note that the country lacked policies that define how to direct patients to specific healthcare institutions based on their conditions.
The reform introduced in 2017 was meant to ensure that patients would be taken to specific hospitals based on their medical needs. In this new arrangement, large referral hospitals such as Xinhua General Hospital would handle serious medical emergencies that require specialised medical attention. On the other hand, the lower-level hospitals would lower the burden of larger hospitals by handling minor medical needs. Directing patients to specific institutions based on the nature of their medical needs were considered the most effective way of lowering mortality rates and improving efficiency in the country’s medical sector.
Beijing Jishuitan Hospital
Beijing Jishuitan Hospital was established on January 28, 1956, in a former palace site (Beijing Jishuitan Hospital 2019). The hospital has gone through a massive transformation over the years as it seeks to meet the medical needs of the ever-increasing population in the city of Beijing. It has become a grade A level three hospital, which mainly focuses on burn and orthopaedics within the last decade (Barber et al. 2014).
According to a report released by the hospital through its website, the institution currently has 1500 beds, with more than 2900 employees working in different departments. Its specialisation on paediatric, bone tumour, spine surgery, adult joint and sports medicine has made it partner with numerous medical training institutions. Some of these training institutions include Beijing Orthopaedic Research Institute, Beijing Hand Surgery Institute, Beijing Burn Research Institute, Beijing Trauma and Burns Institute and Beijing Orthopaedic Research and Treatment Centre (Beijing Jishuitan Hospital 2019).
The hospital also hosts Computer Assisted Surgery Research and Application Centre and the National Computer Assisted Surgery Society (Beijing Jishuitan Hospital 2019). These initiatives have transformed Beijing Jishuitan Hospital into one of the most preferred institutions on emergencies related to fire accidents. In 2008, Prime Minister Wen Jiabao described the institution as the best hospital when it responded effectively to the earthquake by saving hundreds of lives (Müller 2017).
This institution has given a special focus on research and development as a way of improving its service delivery. In 2008, the institution partnered with the Edinburgh Royal College of Surgeons and the Hong Kong College of Osteopathic to have a joint certification for their medical training programs. It has since become one of the most active medical training institutions in Asia.
Beijing Jishuitan Hospital has initiated a raft of reforms to help it meet the emerging needs of patients in the city. One of the reforms introduced in this institution, according to information available at its website, included introducing new departments to meet new medical needs in the city. They include departments of general surgery, urinary surgery, internal medicine, cardiac surgery, gynaecology, obstetrics, paediatrics, ENT, orthopaedics, rehabilitation, endoscopy centre, infection disease and traditional Chinese Medicine (Beijing Jishuitan Hospital 2019).
The introduction of these departments has widened the scope of this hospital in terms of the number of medical complications it can handle. In 2013, the management of the hospital also upgraded various units such as the critical care unit (CCU), intensive care unit (ICU), electronic intensive care unit (EICU), respiratory intermediate care unit (RICU), blood bank, radiology, digital operating room and the laboratory (Beijing Jishuitan Hospital 2019). These changes have improved service delivery at this institution.
The hospital has become one of the most advanced cancer hospitals in the country. According to Milcent (2018), cancer is one of the leading causes of death in China and many other parts of the world. As such, the management of the hospital, with donations from the government, upgraded its Department of Radiology. It introduced advanced nuclear magnetic, angiography, CT and breast medicine. It introduced 16 operation rooms, out of which six have digital operating capabilities, which enables them to have real-time video interactions with other branches.
This initiative was meant to help doctors share knowledge when handling advanced medical conditions without having to move from one hospital to another. In 2015, the institution introduced its first intraoperative three-dimensional images and robot-assisted thoracolumbar spinal invasive surgery complex (Beijing Jishuitan Hospital 2019). In the same year, it introduced congenital deformity for cervical spine surgery to help address the increasing needs of patients who need such services (Johnson, Stoskopf & Shi 2018).
The institution also introduced a new leadership approach to help improve its service delivery. When Tian Wei took over as the president of Beijing Jishuitan Hospital in 2017, he introduced a new concept of management meant to improve the performance of the institution. Using the slogan ‘Enthusiasm, Expertise and Elaborateness’, the new manager creates a system where junior workers and specialists could work in an enabling environment (Beijing Jishuitan Hospital 2019).
He encouraged workers to enthusiastic in their work. They were informed that they were at liberty to discuss with the management any issue that may limit their capacity to achieve specific goals in the market. Expertise was another issue that the new leader emphasised on as a way of reforming operations of the institution. Workers were encouraged to focus on their area of specialisation instead of working in a broad field.
The new directive mainly affected nurses who previously would move from one department to another. The regulation required everyone to stick with a specific department and unit based on the area of expertise. It was meant to ensure that the medical staff would gain more experience in these fields hence they would have an increased capacity to achieve greater success. The new administration also emphasised the need for all stakeholders to be elaborate in their engagements (Johnson, Stoskopf & Shi 2018). Whenever an issue arose, relevant stakeholders needed to be elaborate when seeking solutions. It was equally important for the medical staff to be elaborate when handing over patients at the end of their shift. Such high levels of elaborateness were critical in eliminating mistakes and miscommunications within an organisation (Johnson, Stoskopf & Shi 2018).
Beijing Jishuitan Hospital introduced a digital data management platform in 2018 to enhance information at the institution (Beijing Jishuitan Hospital 2019). The hospital was using paper files to manage patients’ records. According to Milcent (2018), using paper files in a hospital setting poses numerous challenges. It takes a lot of time to record, process, store, retrieve and share patients’ record in this format. It requires large spaces to store patients’ paper records, which means that the institution had to hire more employees.
The new digital system eliminated these challenges. It was simple to manage records of the patients under the new platform. In the past, records of a patient had to be moved manually from one specialist to another, which was a cumbersome and time-consuming process. However, the new system made it possible for all the information to be made available at a central database. Each specialist would access them at any time when attending to the patient. They would be expected to add their findings to the file of the patient to make it easy for other staff members to understand the service they would need to offer to the patient. The digital system also played a crucial role in eliminating cases of lost or destroyed files. The institution has created back-up databases just in case of cyber-attack or damages that may affect the one that is in operation.
The information obtained from the institution shows that although the digital data management system has revolutionised how patients’ information is processed and shared, the current challenge that these institutions go through is cyber insecurity. The ability of hackers to gain unauthorised entry into the database and access confidential patients’ information is worrying to the stakeholders. Even in cases where the hospital has a backup system, such hacks may have devastating impact on the operations of these institutions, especially if the vicious attack involves erasing critical information or manipulating of data. It is necessary to find ways of dealing with this new threat.
Data Analysis and Discussion
The previous chapter has provided detailed information about reforms collected from two public hospitals in Shanghai and Beijing. The chapter has provided information about reforms that the institutions have made in light with the government directives and the effort individual institutions have made to improve the efficiency of their operations. In this chapter, the researcher will discuss findings made from the investigation.
The researcher will integrate information from the literature review and data from the specific institutions to understand the reform of the public service sector in China. The chapter starts by looking at factors that motivate the transformation in China’s public health sector. It then reviews benefits of the reforms and challenges that these institutions face when implementing the reforms. The chapter makes it possible to provide recommendations on how the government can achieve greater success in its reform agenda.
Factors Promoting Transformation in China’s Public Health Sector
It is evident that the public sector in China, especially the healthcare sector, has undergone a massive transformation over the past decades. Data management and the use of emerging technologies when offering medication to patients are some of the changes witnessed in this sector. As the population of the country continues to grow, there has been a need to improve the quality of service delivery in this sector. According to Yang (2017), the reform that has been witnessed in the Chinese healthcare sector has been motivated by two factors. The first one is the government initiative that focuses on improving the performance of all healthcare institutions in line with the changing demands.
As shown in the findings above, many public hospitals such as Xinhua General Hospital in Shanghai have introduced cost-cutting initiatives to enable them to comply with the government directive that require them to reimburse their patients a percentage of the medical fees that they pay. As the government introduces initiatives meant to make medical services affordable, hospitals are forced to introduce reforms that can help them lower their operational costs by using emerging technologies and lowering the number of their employees.
Lowering the medical fees does not mean that they are at liberty to compromise the quality of their products because these institutions are receiving increased government support. In fact, they have to find ways of improving the quality of their services to match standards offered by private medical institutions operating in the country. Government-initiated policies affect all public hospitals in different provinces and sometimes in the entire country because these institutions have to follow them (Zhang & Chang 2016).
However, at an institutional level, these hospitals have also created various initiatives such as digitizing data management system to improve the quality of their service delivery. It is important to discuss some of the factors that have motivated individual public healthcare institutions to improve the quality of the services that they offer. The following are some of the factors that have promoted reforms at various public hospitals in China.
Transparency, from an ethical perspective, refers to operation in an open manner (Prescott 2016). It is another issue that that has been fuelling the reforms in Chinese public health sector over the recent past. According to Liu, Vortherms and Hong (2017), many people in China have been complaining about the hidden high cost of healthcare services in the country. Some hospitals do not clearly define the cost of their services and as such, patients and their loved ones end up paying a significantly higher amount of money than they had expected.
Medical insurance providers have also complained that most of the local healthcare institutions are deliberately charging high amounts of money when attending to patients with medical cover. The outcome of such malpractices is that these institutions have increased premiums that their clients have to pay on a monthly or yearly basis to meet the high cost of medication. The outcome is that innocent people are forced to pay a lot of money to be covered by these local health insurance companies (Bach & Bordogna 2016).
The government has issued a raft of measures to enhance transparency and to eliminate unforeseen medical charges. Individual institutions have also taken initiatives to enhance transparency when handling their patients (Qian 2017). They have introduced new quality assurance policies that emphasise the need to explain to patients and their loved ones any critical issue relating to the medication, from the cost to any complication that may emerge during the medication process.
The outcome of such high levels of transparency is that patients can understand what to expect whenever they visit these institutions (Lam, Rodlauer & Schipke 2017). Operating in an opaque environment is an issue that is becoming less prevalent in most the Chinese hospitals. The need to be transparent has created the pressure for public sector hospitals to improve the quality of services they offer to their customers.
Leadership is another major issue that has motivated the reforms that have been witnessed in the public sector service in China. The information obtained from the two institutions shows that when an individual takes over the leadership of these public healthcare institutions from another, they introduce new reforms as a way of creating a legacy. At Beijing Jishuitan Hospital, Tian Wei introduced the open-door policy of leadership when he took over as the president of the institution. He realised that the existing system made it almost impossible for the junior employees to share with their seniors issues that affected their operations.
As such, it was impossible to have cases of employee-driven change. Senior managers would enact policies and expect their junior officers to follow them without question. Wei was concerned that in such a system, it was impossible to promote creativity and innovativeness at the institution (Weishaar, Philipsen & Xu 2017).
The new policy that he introduced made it easy for all stakeholders to share their views and opinions on how to improve performance and address issues that affected the firm. According to Zhang et al. (2015), change of leadership from one individual to another is currently viewed as a way of promoting change and innovativeness in public institutions. When a new person takes over the management of a given organisation, they would try to redefine various management policies to improve the overall performance.
The strategy has worked in many public sector institutions in China. Zhang et al. (2016) note that the trend where various institutions are allowed to operate without excessive interference from government agents is also benefiting these institutions. Xu and Mills (2019) note that the ministry of health has allowed public healthcare facilities some level of autonomy to enable them align their operations with local needs and international best practices. The ministry is expected to come up with policies and regulations that guide the operations of hospitals in the country (Berman & Prasojo 2018).
The management of these institutions is expected to develop their policies, in line with government regulations, to define how they operate. As long as these institutions operate as per the guidelines set by the relevant ministry, chances are minimal that government agencies would interfere with their operations. The analysis of public service sector shows that the traditional bureaucratic public administration is significantly different from the new more liberal public administration system (Brødsgaard 2014).
In new public administration, individual institutions are given opportunity to make operational management decisions without being micromanaged by the ministry. Most of the managers of these institutions find themselves in situations where they have to guide these institutions towards success without major interference from top government officials. The trend is significantly different from what would happen in the past (Xu & Mills 2019). Traditionally, most of these institutions had to operate according to strict guidelines and constant supervision by top officials from the ministry of health.
Advantage of the Reforms and New Public Administration
It is important to appreciate the benefits of the reforms that have been realised through the new public administration initiatives. As shown in the information obtained from Xinhua General Hospital, one of the benefits of the reforms is a significant reduction in the cost of operations (Amelung et al. 2017). The raft of measures that this institution and many other public sector hospitals, has embraced, such as embracing the emerging technologies in data management and patients’ treatment, lowered the cost of delivering medical services to patients. The reduced cost of operation has benefited patients and their loved ones too because most of the public hospitals have lowered their cost of operation.
The trend has made it possible to have an affordable medical care system that benefits both the rich and the poor. The new system has also inculcated a culture of creativity and innovation at many institutions of public healthcare.
In the past, numerous policies forced employees to work under strict guidelines of their superiors (Garnaut, Song & Cai 2018). However, this is changing, especially among institutions that have embraced the open-door policy of management. Junior officers can easily visit their superiors and share their new idea on how a different task can be done effectively and within a short period. The innovative culture is critical in enhancing service delivery, especially in a field where cases such as cancer still require more research.
Creativity and innovativeness give hope that such complex diseases would become easily manageable (Babar 2015). It is important to note that the new public administration has made it possible for the local institutions to embrace international best practices. Most of these public hospitals in China even partner with some of the global healthcare research institutes to improve the quality of services they offer.
Globalisation refers to the process where cultures and economies are drawn together because of the increased interaction of people from all over the world (Walle & Groeneveld 2016). The interaction of people and culture has had a major impact on the healthcare sector. It is one of the leading motivators of change in most of the public hospitals in China. According to Britnell (2015), when people from different parts of the world continue to interact, new best practices keep emerging. Some of these Chinese institutions such as Beijing Jishuitan Hospital has partnered with different international healthcare hospitals, especially in Europe and North America such as Edinburgh Royal College of Surgeons, in their effort to enhance research and development (Beijing Jishuitan Hospital 2019).
Through such interactions, new practices emerge. The local players learn about trends and practices in Europe and other parts of the world. To improve their service delivery at a lower cost, these institutions get to emulate some of these international practices. Some of the medical staff at local Chinese hospitals were trained in foreign countries before coming back to work in local institutions. They come with new practices that when implemented, enhances the service delivery of the local hospitals. As Fang (2018) observes, the world has been transformed into a global village where others can easily embrace practices in one part of the world in other countries.
The cultural barrier that slowed the ability of people to embrace foreign practices is also disappearing. In China, English has become one of the most spoken foreign languages among the locals (Britnell 2015). The trend has eliminated the language barrier, which was another issue affecting the ability of the locals to embrace international practices. The findings demonstrate that as the local healthcare workers continue to interact with foreign experts, new reforms will continue to emerge (Lapsley & Knutsson 2017). Most of these reforms such as the reimbursement policy discussed above focus on lowering the cost of operation, making healthcare services affordable, improving efficiency and enhancing the quality of medical products that these institutions offer.
Technology is another major factor that has propelled most of the local public health institutions to embrace reforms. According to Xu et al. (2019), emerging technologies have transformed the way data is managed in various institutions. Data collected from Xinhua General Hospital in Shanghai and Beijing Jishuitan Hospital show that both institutions have transformed how they manage patients’ data. In the past, recording, processing and storing of patients information was done using paper files. However, that has changed as the two institutions embrace digital technology.
They have introduced digital data management systems that allow clerical officers to record patients’ details before sending them to relevant specialists, who will find the information in a central database. The trend has become common as a way of eliminating time wastage, minimising cases of lost or destroyed files and making it possible for different experts within the hospital to share patients’ information (Jing & Osborne 2016).
Technology has also transformed how patients receive their medical services. When managing complex medical problems such as cancer, cardiovascular diseases or brain problems, it is necessary to use state-of-the-art diagnostic tools and treatment equipment (Walle & Groeneveld 2016). The study has shown that individual institutions have taken the initiatives to install some of these new tools to help offer their clients the best care.
The government has been willing to fund such purchases in various stimulus plans (Wang, Loban & Dionne 2019). The presence of numerous private healthcare institutions in China means that public hospitals cannot afford to compromise on the quality of services they offer. They have to match the quality of services these private entities offer by installing some of the best tools needed to deliver the desired outcomes. Training of employees on how to use these tools is critical.
Drawbacks and Weakness of the Reforms in Traditional Public Administration
The traditional public administration had various weaknesses, most of which have been discussed in the sections above such as the inability to embrace change, bureaucracy, and limited creativity. However, it is important to outline specific drawbacks of the traditional approaches that have made it necessary to introduce the new reforms. One of the main issues that have been raised with the traditional public administration is the rigid management approach. According to Huang and Dai (2019), some of the government policies limited the capacity of individual institutions to introduce major changes to their operations without getting express permission from top government officials.
In most of the cases, any proposal that was considered pro-west would be rejected even if it had merits in an attempt to limit the influence of western countries on the country’s policies. For instance, according to National Centre for Complementary and Integrative Health (2019), many Chinese believed that Tai Chi is a better medication for stress than conventional therapies. The outcome of such policies was that most public sector institutions ignored international some best practices primarily because of the need to preserve traditional Chinese culture (Ward 2017). The traditional public administration was also rendered obsolete because of the emerging trends and culture in the country.
The authoritarian rule entrenched in the traditional public administration was becoming irrelevant, especially when dealing with the young and techno-savvy employees who wanted their private space to be respected by those in the management (Lardy 2019). It meant that the traditional approach of leadership had to be re-evaluated to ensure that managers could cope with the emerging trends. Technology also identified major drawbacks of the previous approach of managing public sector institutions (Tu 2019).
The introduction of the digital data platform meant that different officers in different departments could have access to information available in the central database as long as they have the justification and authorization to do so (Information Resources Management Association 2017). Traditional public administration policies would outline various steps that one would have to take before having access to such files. Such steps are unnecessary when operating on the new platform. Trust and a sense of responsibility are the main factors that define data sharing in the modern business environment. The new management model also emphasizes the need to have effective data protection systems.
Information from various sources showed that the introduction of the digital data management platform has issues that should not be ignored by the relevant stakeholders. One of the main issues identified is cyber insecurity. According to Yang (2017), one of the cardinal rules that guide doctor-patient relationship is privacy. Doctors are expected to ensure that information of their patients’ conditions is protected from third parties. It was easy for medical staff to ensure the safety of such files by lacking them in secure cabinets. However, in the digital data management system the security can easily be compromised even if one does not gain physical access to the database.
Britnell (2015) notes that once an unauthorised individual gains access to the database, it may not be easy to predict what they can do. Some may only be interested in accessing information about specific patients for various reasons. Others may have sinister motives such as the desire to manipulate the data. Manipulating patients’ data may have a significant impact on the condition of the patient, especially if it results in administering the wrong medication. As such, the reforms introduced by the government should also focus on how to deal with this threat. The security of digital databases should be guaranteed to ensure critical information is protected.
The current reforms are having a positive impact on the quality of services offered in public hospitals. However, it is necessary to put more effort into public-private partnerships (Yang 2017). Xinhua General Hospital in Shanghai has been partnering with some foreign private clinics to help advance research and development in various fields. Such initiatives should be encouraged in different public hospitals across the country. They help in introducing new concepts and practices in these institutions. According to Britnell (2015), implementing international best practices in the field of healthcare may be a challenging process. However, when these institutions collaborate with foreign hospitals that have already embraced the practices, it would be easy to implement these new policies.
Public participation should be encouraged when introducing reforms in the public health sector. According to Johnson, Stoskopf and Shi (2018), the ability to transform the country’s healthcare sector depends on the effectiveness of the system to change the current perception of the community towards western medicine. Yang (2017) notes that for a long time many Chinese, especially those living in rural settings, trusted traditional Chinese medicine over western medicine.
It was common to find cases where patients would visit traditional medicine men instead of going to the hospital. Lack of trust of modern medicine can have a major impact on the ability to have a positive transformation in this sector. Changing the perception of people starts by encouraging public participation in this sector. Britnell (2015) argues that the government should involve the locals when introducing new policies in this sector meant to improve service delivery. Doctors, nurses, clinical officers and the entire medical staff should also be allowed to participate in such policy development because they are required to be responsible for the implementation process.
The public sector in China has a major role to play as the country continues to experience economic prosperity. The paper focused on exploring the applicability of new public administration in the public sectors in the country. The investigation revealed that the quality of services offered in the education, law enforcement, infrastructure and healthcare sectors all have a major impact on the lives of citizens in the country.
In this study, the researcher was specifically interested in the quality of healthcare service offered in public institutions. The review of literature had revealed that public healthcare system in China has been below the expectation of citizens of the country. It was necessary to understand primary reasons why these services were below the expectations. It was also necessary to determine if the reforms that were recently introduced by the government to improve service delivery in this sector have had the desired impact.
It was evident that the traditional approach of public administration had various challenges. The study has identified various issues that directly affect the quality of the public healthcare services in China. Funding has been identified as one of the major issues that affect the quality of services offered by public hospitals. As shown in the analysis of both primary and secondary data, the subsidy that these institutions receive from the government is barely enough to meet the needs of these institutions.
They are also expected to avoid charging high prices for the services that they offer to patients. The financial constraints that the institution has forced them to compromise on the quality of their services (Tait et al. 2015). The problem explains why it is common to find some of these public hospitals lacking some critical machines needed to manage complex medical conditions such as cancer. Others cannot stock expensive medicine and often advise their patients to purchase them at private pharmacies.
The unattractive salary was noted as another problem that affects the quality of services in public hospitals. Some of the top private clinics in major urban centres in China pay their medical staff attractive salaries. The study shows that the difference in the salary paid to doctors in private hospitals and those in public healthcare institutions is a major concern. Top doctors with unique skills and experience are poached from public hospitals to private clinics because of the pay gas. As such, the trend has led to mistrust of public hospitals. There is always the fear that some of those attending to patients in these institutions are trainees who lack the relevant skills to offer the needed help.
The level of poverty in rural parts of China is another major concern. According to the study, the majority of well-educated young Chinese are moving from rural to urban centres. Some of those in rural settings live in deplorable conditions. The problem has been compounded by government neglect. Although major cities such as Beijing and Shanghai have some of the best infrastructures in the world, most of the rural parts of China do not receive the same attention from the government. Public hospitals in these places lack some of the best-trained doctors (Meramour & Ensworth 2018). The ratio of doctors to patients in these areas is lower than the national average, which means that the medical staff here are often overwhelmed. The trend has become common because of the assumption that these patients can always travel to urban centres to get the medication that they need.
Discrimination was identified as a major issue that directly affects the quality of the healthcare system in China. The social class system, although not currently practiced in its traditional form, is still common in the country. When China embraced capitalism as the most viable economic system, the gap between the rich and the poor started to widen. A small fraction of the super-rich individuals started to emerge while the masses became more impoverished. The system discriminates against the poor and makes it impossible for them to achieve economic success. The financially empowered can afford to take their children to the best school, give their families premium medical services and have access to the finest services in the country (Löfgren & Williams 2013). On the other hand, the poor have to attend public schools and hospitals where quality is rarely given priority. Such discriminative systems make it difficult to achieve the desired level of success.
The study has confirmed the application of the new public administration to the public sector in China. The benefits of new public management have proven that the country’s public sector can be reformed when there is good will from the leadership of the country. The impact of the major reforms in the healthcare sector started in 2009 when the government introduced Healthy China 2020 has confirmed the applicability of new public administration in the public sectors in the country. In 2016, President Xi Jinping introduced the Healthy China 2030 Planning Outline as a sign of the commitment of the government to transform the health sector.
These reforms have had major impacts on the services delivered in public hospitals in the country. The introduction of universal healthcare system meant that all Chinese would have access to medical services irrespective of their financial position. One such initiative was the reimbursement program. Under this policy, patients were to be reimbursed part of the money they spend getting medical services in public hospitals. The study shows that the initiative had a major impact on many families that previously could not afford to pay for their medication. The Ministry of Health introduced other new measures, which were meant to lower the cost of services offered in the public sector. Many public hospitals such as Xinhua General Hospital in Shanghai had to redefine their operations to meet the set government regulations.
Technology formed part of the major reforms that the government introduced. The study shows that many public hospitals have embraced emerging technologies to improve their service delivery. One such area is the data management system. In the past, these institutions would use paper files to record, share and store patients’ data. The traditional system was time-consuming and prone to failure. Cases where files would be lost or destroyed were common, especially among patients who had to revisit these facilities regularly because of their chronic conditions. It also took a long time to transfer files from one department or from one physician to another.
These challenges were eliminated with the introduction of a digital platform. Patients’ data is currently managed in the digital platform, which is less time-consuming and more efficient. These hospitals have also installed some of the latest diagnostic and treatment machines that can enable them to manage some of the serious medical conditions such as cancer and heart problems.
The study shows that the changing cultural practices and beliefs, which are part of the new public management strategies, have also had an impact on the quality of services offered in the public hospitals. The study shows that a significant number of people have come to realise that Chinese traditional medicine is no longer effective in managing some of the medical conditions. The government partly ignored the public healthcare sector, especially in the rural sector, because the majority of the locals trusted traditional medicine (Veal 2018). However, the culture is changing and the majority is embracing the western medication. Hospitals are becoming relevant to people in both urban and rural settings. The increased attention given to this sector has forced the government to increase its budgetary allocation to ensure that the increasing needs can be met.
The Chinese public sector, especially in the field of healthcare, plays a critical role in the overall growth of the country’s economy and socio-political system. However, studies have revealed that the quality of services offered in public hospitals is below the expectations of members of the public. The study has confirmed the application of the new public administration to the public sector. The reforms that the government has introduced are meant to address the weaknesses identified with the current system. The following recommendations may help to improve the quality of services offered in these public institutions:
- The government of China needs to increase its funding on public health sector. The study revealed that some of these institutions were underperforming because they are underfunded.
- The government should support the change of culture to ensure that people can trust western medicine. Public awareness campaigns can help members of the public to understand that traditional Chinese medicine may not be effective in managing some conditions.
- Redefining the education system is another issue that all stakeholders in the public sector should consider. The curriculum should equip learners with practical skills needed in their respective places of work.
- Improving the pay of workers in the public sector and creating an enabling environment for them can improve their enthusiasm and performance at work.
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