Correspondence

Shortage of paediatricians in China

China has the largest number of individuals with congenital heart disease (CHD) in the world and a heavy burden of CHD. Therefore, understanding current CHD treatment outcomes and patterns in China will contribute to global progress in CHD treatment and be a valuable experience. Generally, CHD treatment in China has satisfactory outcomes owing to the joint efforts by all relevant stakeholders across the country. However, efforts are needed to overcome the remaining challenges: management of mitral valve disease and paediatric end-stage heart failure needs to be improved; cohesive paediatric cardiology teams should be established and collaboration between hospitals enhanced; CHD-related medical resources need to be more accessible and equitable; and nationwide CHD databases should be enhanced. In the second paper of this Series, we aim to systematically summarise the current CHD treatment outcomes in China, discuss potential solutions, and provide future perspectives.

Pediatric nurses are at high risk for burnout, resulting in unsatisfactory care quality. Although job resources like social support can prevent the development of burnout under work stress, the mediating role of personal resources like occupational commitment is not well studied. This study was to examine the mediating role of occupational commitment in the relationship between work stress and burnout, and test if the effect of work stress on occupational commitment varies at different levels of social support among pediatric nurses.

A cross-sectional survey was conducted to collect data of pediatric nurses from 6 hospitals in Chengdu, China. Multiple linear regressions and bias-corrected bootstrap confidence intervals were used to test the proposed model.

In this sample of 488 pediatric nurses, work stress was significantly associated with emotional exhaustion (β = 0.278, p < 0.001), depersonalization (β = 0.112, p < 0.001), and personal accomplishment (β = −0.047, p < 0.05). Occupational commitment partly mediated the links of work stress and emotional exhaustion (β = 0.056, 95%CI: 0.034–0.082), and depersonalization (β = 0.026, 95%CI: 0.014–0.041), and fully mediated the relationship between work stress and personal accomplishment (β = −0.059, 95%CI: −0.080 ∼ −0.039). Social support significantly moderated the relationship between work stress and occupational commitment (β = 0.007, p < 0.01).

Among pediatric nurses, work stress has an indirect influence on burnout through occupational commitment, and such an effect is weakened when social support is high.

Nurse managers could consider developing interventions by promoting both occupational commitment and social support to prevent burnout of employees.

Physician rescheduling for a short term is common and critical when the guideline schedule for a long-term horizon needs adjustments. However, this topic is less studied in the literature. In this study, we develop a physician rescheduling model (PRM) with capacity allocation for outpatients. As in practice, the stochastic demand is assumed to be nonstationary and driven by auxiliary features. The capacity shortage risk is measured by the certainty equivalent that has shortage probability and expected shortage guarantees. To mitigate the capacity shortage risk, the Minimized Risk Tolerance Level (MRTL) decision criterion against the demand uncertainty is adopted for risk-averse hospital managers. Based on that, a bi-objective formulation that jointly considers PRM and MRTL is proposed to balance the operational costs and capacity shortage risk. We establish the tractability by an exact iterative algorithm that exploits the integer property of capacity and show that it finds all Pareto solutions. The case studies based on the real-life data of mental disorders demonstrate that our PRM performs well in handling the tradeoff between the capacity shortage risk and rescheduling costs.

Hospital violence has become a worldwide issue that disturbs health care systems. China is in a particular dilemma between meeting the healthcare demand of 1.39 billion residents and ensuring the safety of 12.3 million health professionals. Drawing on data from an administrative survey, we presented the types and distribution of disruptive behaviors, as well as the summary statistics of 225 medical disputes that took place from 2012 to 2013 in Z city. Logit and OLS regression analyses show that disruptive behaviors, characterized by the number of protest participants and the length of protest, can significantly predict whether the claimant receives compensation and the amount of compensation. All else equal, a one-person increase in the number of participants is associated with 3.94% higher odds of getting compensated, whereas a one-day increase in the length of protest is associated with a 1.03% increase in the odds of receiving compensation. Further analyses show that the link between disruptive behaviors and compensation outcomes is due to the involvement of the state, which tends to press hospitals to pay when substantial violence is present. Chinese government's overwhelming emphasis on social stability gives protestors leverage against hospitals, which can be summarized as “the squeaky wheel gets the grease.” Ironically, the sensitivity of Chinese government towards social stability becomes a weakness of its own. Government's active intervention to reach a peace-oriented goal will incentivize patients to resort to violence in pursuit of compensation. This study has implications for understanding the Chinese government's logic of addressing social problems that range from hospital violence, labor disputes, land disputes to demolition compensation and civil petitions.