Objectives: “Karoshi” (death due to overwork) of doctors occurred frequently and attracted increasing attention in recent years in China. This study aimed to determine the prevalence of work-related accumulated fatigue of doctors and its associated factors in tertiary hospitals of China. Methods: A cross-sectional questionnaire survey was conducted on 1729 full-time doctors employed by 24 tertiary hospitals across eastern developed, central developing, and western underdeveloped regions of China. Accumulated fatigue was categorized into four levels using the “Self-diagnosis Checklist for Assessment of Workers’ Accumulated Fatigue” rated on a scale matrix considering both overwork and fatigue symptoms. Ordinal logistic regression analyses were performed to identify factors associated with work-related accumulated fatigue. Results: About 78.8% of respondents reported a “high level” of work-related accumulated fatigue, including 42.0% at a “very high” level. Male doctors and those aged between 30 and 45 years and who had a professional title were found to have higher levels of accumulative fatigue than others. Low salary and poor working conditions (in the western region) were also significantly associated with high levels of work-related accumulated fatigue (p < 0.05). Conclusion: High levels of work-related accumulated fatigue are prevalent in doctors working in tertiary hospitals in China. Male doctors establishing their early- and mid-careers are the high-risk group. Poor working conditions are associated with work-related accumulated fatigue.

In recent years, the government has paid more attention to the development of community health service (CHS) in urban areas in China. Therefore, determining if it plays important roles and establishing methods to evaluate the effects of CHS are critical emphases in research. This study measured the effects of CHS through the choices of patients and their evaluation of CHS, and aimed to contribute to the development of primary health services. Face-to-face interviews were performed using the questionnaire with a random sample of 865 patients in CHS institutions from five provinces in China. Pearson's Chi square tests and binary logistic regression were used to analyze influencing factors that are associated with the patients' choices and evaluations. A total of 62.2 % of the patients would choose CHS for their first treatment. Patient choice was mainly affected by the following: (1) social demographic factors of the patients, namely, age, educational level, medical insurance, and survey areas; (2) evaluation of CHS by the patients: convenience, reasonable charges, and attitude of the doctors. In addition, the patients showed more satisfaction with convenience, waiting time, and communication with doctors, and less satisfaction with the medical charges, drug costs, and medical equipment of CHS. Through the results, we suggest that the government should provide more regard to the convenience, reasonable charges, and the attitude of the doctors as important factors to attract the patients to CHS. The government should also exert efforts to reduce the medical charges (especially the drug costs) for CHS.

BackgroundAfter the implementation of new healthcare reform, Chinese government paid increasing attention to developing community health service (CHS). The current focus is mainly on cultivating community general practitioners but paying less attention to the working status and occupational demands of in-service CHS workers. Work passion is playing an important role for medical workers. With work passion, CHS workers’ team will become more stable and more effective, ensuring the sustainable development of CHS system. At present, the work passion of CHS workers is relatively low. Studying on influencing factors of work passion of CHS workers, promoting their work passion, and making them keep enthusiasm for work are significant.MethodsA total of 100 CHS organizations were sampled randomly in 10 cities from 5 Chinese provinces for this study. A total of 3450 CHS workers from these CHS institutions took part in the surveys. Questionnaires were used to collect data, including socio-demographic information, work passion and opinion on influencing causes, and work-related satisfaction. Pearson chi-square statistical method was used to identify the factors related to CHS workers’ work passion. Binary logistic regression was performed to determine the significant factors that influence CHS workers’ work passion.ResultsA total of 38.77% of those who accomplished the questionnaire expressed that they didn’t have passion for current work. The related factors that influence CHS workers’ work passion are (1) socio-demographic factors such as age, and years of employment, and (2) other work-related factors such as learning and training opportunities, compensation packages, work stress, and personal development opportunities. CHS workers were most dissatisfied with the balance between remuneration and workload, job promotion opportunities.ConclusionsBased on the results, the government should concern for CHS workers’ working status and work-related demands, pay more attention and meet their demands for reasonable compensation packages and self-development, balance the income and workload, provide more learning and training opportunities and personal development opportunities for CHS workers, in order to promote CHS workers’ work satisfaction, improve their work passion and enthusiasm.

ObjectivesPatient experience is being widely considered in the evaluation of healthcare service quality, which is a key target for public hospitals under China’s New Healthcare Reform. This study aimed to illustrate patients’ experiences in county-level public hospitals, and identify aspects that need to be improved.Setting and participantsBetween 2016 and 2018, a cross-sectional study with 500 outpatients and 800 inpatients was conducted in 10 county-level public hospitals from Shandong Province, Hubei Province and Chongqing Municipality.MethodA three-part questionnaire was used to evaluate patients’ experiences during their visits to hospitals. It comprised a questionnaire for basic information, the Picker Patient Experience (PPE-15) Questionnaire and the overall evaluation (a 3-point Likert scale to express patients’ satisfaction and patient loyalty). Patients’ experiences were classified according to six dimensions (information transmission and patient education, respect for patient preference, emotional support, physical comfort, involvement of family or friends and continuity of medical service). Both univariate and multivariate analyses were performed to evaluate patient experience.ResultsA total of 1241 valid questionnaires were analysed. The mean PPE-15 score was 41.33 (range, 23–56). The better the patient experience and satisfaction, the higher the patient loyalty (p<0.001). Except for hospital disparities, patients’ age and occupation status had a significant impact on patient experience (p<0.05). Of the six dimensions, the physical comfort score was the highest, while the respect for patient preference score was the lowest. Additionally, a strong correlation was found between the respect for patient preference dimension and patients’ overall satisfaction with their treatment experience.ConclusionsHospital managers and staff members should pay close attention to the preferences of patients and their families to improve patient experience.