Organization is the basic unit that provides services to the society. The foundation of any organization is that it has specific social functions. The organizational mission is the specific position, professional role, obligation and role of the organization as a subsystem in the large social system. The mission of the hospital is to provide safe, effective, convenient and cheap medical and health services for the people. The mission of the university is to cultivate talents, create knowledge and serve the society. The mission of scientific research institutions is scientific research, technology development and application promotion. The most basic social organizational mission of the University Affiliated Hospital is medical service, but it also plays multiple roles in medical education and medical research. The three organizational missions are under the jurisdiction of the administrative departments of health, education and science and technology. For a long time, the administrative departments are limited by the scope of their responsibilities, which makes the three organizational functions of medical teaching and research in university affiliated hospitals unable to be fully integrated and unified from the macro management level; In recent years, under the background of the reform of "separation of management and management" of public hospitals, there has been a phenomenon that the hospital renovation system under the jurisdiction of local governments has been transferred to the management of medical colleges, or the new university affiliated hospitals have been built in the mode of "Government University cooperation". How these hospitals become university affiliated hospitals in the real sense is worth pondering. Based on this, this paper combs the relevant policies and regulations formulated by Chinese governments at all levels in recent years, compares and analyzes university affiliated hospitals with general local large hospitals, research institutions and college organizations, and discusses the connotation and characteristics of the organizational mission of university affiliated hospitals.
1. Relevant policy background and connotation concepts of the formation of organizational mission of University Affiliated Hospitals
The Ministry of education and the former Ministry of Health issued the "undergraduate medical education standard - Clinical Medicine Specialty (Trial)" in 2008, which stipulates that universities are institutions implementing higher education, University affiliated hospitals refer to hospitals attached to medical colleges and universities that undertake clinical teaching and scientific research tasks, and medical colleges refer to independent medical colleges and medical schools in comprehensive universities. From the perspective of organizational social function, the primary social function of university affiliated hospitals is the provider of medical services and health products. The attribute of organizational social function is medical institutions, specifically defined as hospitals, which is a part of the national public hospital system; As a subsidiary of medical colleges, it is also the key subject of medical innovation and medical talent training. Its organizational social function attribute is clinical education institution and medical science and technology innovation institution, which are specifically defined as clinical medical college and Translational Medical College (Center). The Interim Provisions on the management of clinical teaching bases of general higher medical education issued by the Ministry of education clearly stipulates that the affiliated hospitals of medical colleges and universities are an integral part of the University. According to the national hospital classification standard, the affiliated hospitals of undergraduate colleges and universities should reach the level of class III class a, and the affiliated hospitals of junior colleges should reach the level of class II class A or above. Considering the differences in the level of comprehensive strength, the former is the main research object of this paper. Class III class a hospital is the hospital with the highest standard in China's Hospital hierarchical management system. The functional positioning of university affiliated hospitals should take the class III class a hospital standard as the baseline.
1.1 sorting out relevant policies in China in recent 30 years
This paper collects and sorts out the relevant policies and regulations formulated in China in recent 30 years, classifies and combs the functional positioning contents of hospitals, clinical education institutions and medical science and technology innovation institutions, and tries to find out the organizational mission elements of university affiliated hospitals.
1.1.1 health field
According to the provisions of the measures for hierarchical management of hospitals issued by the former Ministry of health in 1989, China's hospitals implement a hierarchical management system. According to the comprehensive level of hospital function, task, facility conditions, technical construction, medical service quality and scientific management, hospitals are divided into 3 levels and 10 levels. The functional tasks of tertiary hospitals are: to provide high-level professional medical services to regions with multiple regions (with a population of more than one million) and carry out prevention, health care and rehabilitation services. Tertiary hospitals are the highest level medical institutions in the province or the country. Traditional Chinese medicine hospitals, specialized hospitals and other hospitals also have corresponding level positioning. According to the basic standards for medical institutions (for Trial Implementation) issued by the former Ministry of health in 1994, the state has formulated basic standards for hospitals at all levels from seven aspects: bed size, department setting, staffing, area of each bed, medical equipment, rules and regulations and funds. According to the evaluation standard for grade III General Hospitals issued by the former Ministry of health in 2011, on the basis of hierarchical management, grade III hospitals are rated as grade A and grade B according to the evaluation results.
It is not difficult to see that the functional positioning elements of the national health field for the tertiary hospitals include: bed size, clinical subject setting, staffing, hardware facilities, service geographical area, service population size, service content, positioning in the national medical service system, etc. With the development and progress of society, the overall service capacity of public hospitals has been improved. The service content of the state for tertiary hospitals is covered from the whole process of the initial medical services of "disease diagnosis and treatment, prevention, health care and rehabilitation services", emphasizing "basic standards", It gradually evolved into the guidance on the pilot reform of public hospitals jointly issued by the former Ministry of health and other five ministries and commissions in 2010 and the "mainly providing diagnosis and treatment services for acute, critical and difficult and complex diseases" proposed in the "13th five year plan for deepening the reform of the medical and health system" issued by the former national health and Family Planning Commission in 2017. Especially in recent years, with the continuous expansion of the scale of large hospitals and the imbalance in the distribution of regional medical resources, the requirements for the bed size of tertiary hospitals have also changed: the basic standard for medical institutions (Trial) issued in 1994 stipulates that tertiary general hospitals must have more than 500 beds, In 2010, the guiding opinions on the pilot reform of public hospitals was adjusted to "strictly control the bed size of public hospitals, and take comprehensive measures to gradually reduce the beds of public hospitals that exceed the scale standard", and strengthen "medical quality safety and operation efficiency" on the basis of "appropriate bed size". In 2014, the Ministry of science and technology, the former national health and Family Planning Commission and the Ministry of health of the General Logistics Department jointly issued the management measures of the National Clinical Medicine Research Center (for Trial Implementation). In 2018, the National Health Commission issued the opinions on promoting the high-quality development of medical services centered on people's health. In 2021, the State Council issued the opinions on promoting the high-quality development of public hospitals The National Health Commission issued the national clinical specialty capacity-building plan for the 14th five year plan. These policy documents put forward higher requirements: build a number of national medical centers with domestic and global influence, focus on tackling key problems in the diagnosis and treatment of difficult and critical diseases, carry out innovative research and achievement transformation of cutting-edge medical science and technology, implement high-level medical talent training, and master a number of international leading technologies, Promote relevant specialties to enter the forefront of the world, drive the national medical level to a new level, establish a medical quality management and control system in line with international standards and reflecting Chinese characteristics, and promote the main medical service quality indicators of medical institutions in China to reach or approach the world advanced level.
Organization is the basic unit that provides services to the society. The foundation of any organization is that it has specific social functions. The organizational mission is the specific position, professional role, obligation and role of the organization as a subsystem in the large social system. The mission of the hospital is to provide safe, effective, convenient and cheap medical and health services for the people. The mission of the university is to cultivate talents, create knowledge and serve the society. The mission of scientific research institutions is scientific research, technology development and application promotion. The most basic social organizational mission of the University Affiliated Hospital is medical service, but it also plays multiple roles in medical education and medical research. The three organizational missions are under the jurisdiction of the administrative departments of health, education and science and technology. For a long time, the administrative departments are limited by the scope of their responsibilities, which makes the three organizational functions of medical teaching and research in university affiliated hospitals unable to be fully integrated and unified from the macro management level; In recent years, under the background of the reform of "separation of management and management" of public hospitals, there has been a phenomenon that the hospital renovation system under the jurisdiction of local governments has been transferred to the management of medical colleges, or the new university affiliated hospitals have been built in the mode of "Government University cooperation". How these hospitals become university affiliated hospitals in the real sense is worth pondering. Based on this, this paper combs the relevant policies and regulations formulated by Chinese governments at all levels in recent years, compares and analyzes university affiliated hospitals with general local large hospitals, research institutions and college organizations, and discusses the connotation and characteristics of the organizational mission of university affiliated hospitals.
1. Relevant policy background and connotation concepts of the formation of organizational mission of University Affiliated Hospitals
The Ministry of education and the former Ministry of Health issued the "undergraduate medical education standard - Clinical Medicine Specialty (Trial)" in 2008, which stipulates that universities are institutions implementing higher education, University affiliated hospitals refer to hospitals attached to medical colleges and universities that undertake clinical teaching and scientific research tasks, and medical colleges refer to independent medical colleges and medical schools in comprehensive universities. From the perspective of organizational social function, the primary social function of university affiliated hospitals is the provider of medical services and health products. The attribute of organizational social function is medical institutions, specifically defined as hospitals, which is a part of the national public hospital system; As a subsidiary of medical colleges, it is also the key subject of medical innovation and medical talent training. Its organizational social function attribute is clinical education institution and medical science and technology innovation institution, which are specifically defined as clinical medical college and Translational Medical College (Center). The Interim Provisions on the management of clinical teaching bases of general higher medical education issued by the Ministry of education clearly stipulates that the affiliated hospitals of medical colleges and universities are an integral part of the University. According to the national hospital classification standard, the affiliated hospitals of undergraduate colleges and universities should reach the level of class III class a, and the affiliated hospitals of junior colleges should reach the level of class II class A or above. Considering the differences in the level of comprehensive strength, the former is the main research object of this paper. Class III class a hospital is the hospital with the highest standard in China's Hospital hierarchical management system. The functional positioning of university affiliated hospitals should take the class III class a hospital standard as the baseline.
1.1 sorting out relevant policies in China in recent 30 years
This paper collects and sorts out the relevant policies and regulations formulated in China in recent 30 years, classifies and combs the functional positioning contents of hospitals, clinical education institutions and medical science and technology innovation institutions, and tries to find out the organizational mission elements of university affiliated hospitals.
1.1.1 health field
According to the provisions of the measures for hierarchical management of hospitals issued by the former Ministry of health in 1989, China's hospitals implement a hierarchical management system. According to the comprehensive level of hospital function, task, facility conditions, technical construction, medical service quality and scientific management, hospitals are divided into 3 levels and 10 levels. The functional tasks of tertiary hospitals are: to provide high-level professional medical services to regions with multiple regions (with a population of more than one million) and carry out prevention, health care and rehabilitation services. Tertiary hospitals are the highest level medical institutions in the province or the country. Traditional Chinese medicine hospitals, specialized hospitals and other hospitals also have corresponding level positioning. According to the basic standards for medical institutions (for Trial Implementation) issued by the former Ministry of health in 1994, the state has formulated basic standards for hospitals at all levels from seven aspects: bed size, department setting, staffing, area of each bed, medical equipment, rules and regulations and funds. According to the evaluation standard for grade III General Hospitals issued by the former Ministry of health in 2011, on the basis of hierarchical management, grade III hospitals are rated as grade A and grade B according to the evaluation results.
It is not difficult to see that the functional positioning elements of the national health field for the tertiary hospitals include: bed size, clinical subject setting, staffing, hardware facilities, service geographical area, service population size, service content, positioning in the national medical service system, etc. With the development and progress of society, the overall service capacity of public hospitals has been improved. The service content of the state for tertiary hospitals is covered from the whole process of the initial medical services of "disease diagnosis and treatment, prevention, health care and rehabilitation services", emphasizing "basic standards", It gradually evolved into the guidance on the pilot reform of public hospitals jointly issued by the former Ministry of health and other five ministries and commissions in 2010 and the "mainly providing diagnosis and treatment services for acute, critical and difficult and complex diseases" proposed in the "13th five year plan for deepening the reform of the medical and health system" issued by the former national health and Family Planning Commission in 2017. Especially in recent years, with the continuous expansion of the scale of large hospitals and the imbalance in the distribution of regional medical resources, the requirements for the bed size of tertiary hospitals have also changed: the basic standard for medical institutions (Trial) issued in 1994 stipulates that tertiary general hospitals must have more than 500 beds, In 2010, the guiding opinions on the pilot reform of public hospitals was adjusted to "strictly control the bed size of public hospitals, and take comprehensive measures to gradually reduce the beds of public hospitals that exceed the scale standard", and strengthen "medical quality safety and operation efficiency" on the basis of "appropriate bed size". In 2014, the Ministry of science and technology, the former national health and Family Planning Commission and the Ministry of health of the General Logistics Department jointly issued the management measures of the National Clinical Medicine Research Center (for Trial Implementation). In 2018, the National Health Commission issued the opinions on promoting the high-quality development of medical services centered on people's health. In 2021, the State Council issued the opinions on promoting the high-quality development of public hospitals The National Health Commission issued the national clinical specialty capacity-building plan for the 14th five year plan. These policy documents put forward higher requirements: build a number of national medical centers with domestic and global influence, focus on tackling key problems in the diagnosis and treatment of difficult and critical diseases, carry out innovative research and achievement transformation of cutting-edge medical science and technology, implement high-level medical talent training, and master a number of international leading technologies, Promote relevant specialties to enter the forefront of the world, drive the national medical level to a new level, establish a medical quality management and control system in line with international standards and reflecting Chinese characteristics, and promote the main medical service quality indicators of medical institutions in China to reach or approach the world advanced level.
The comprehensive strength of medical teaching and research is the core competitiveness of a hospital. University affiliated hospitals should be at the top of a region in the diagnosis and treatment of difficult and critical diseases, medical talent training, clinical research, disease prevention and control, hospital management, etc. one or several aspects of medical teaching, research and prevention should represent the highest level in a region, and finally achieve all-round growth through their own continuous development, It can represent the top level in the country. Specifically, in terms of medical treatment, it has the leading medical technology level in the region, outstanding diagnosis and treatment ability of difficult and critical diseases, can provide technical support and guidance for other medical institutions in the region, continuously improve the overall medical level in the region, can undertake the medical and health emergency rescue task of public emergencies, and has a certain number of national and provincial key clinical specialties. In terms of medical education, it has strong clinical education ability and senior clinical medical talent training ability, and has become a national standardized physician training base or a standardized specialist training base. In terms of scientific research, it has certain clinical research and transformation capabilities, and has national or provincial and municipal research platforms to promote academic exchanges and cooperation in the region. In terms of disease prevention, be able to formulate guidelines for major disease prevention and control in the region and undertake guidance and training on disease prevention and control. In terms of management, establish a modern hospital management system, continuously improve medical quality and safety, and actively participate in the comprehensive reform of public hospitals.
2 Comparison of organizational mission connotation between university affiliated hospitals and local large hospitals, universities, colleges and research institutions
University affiliated hospitals and local large hospitals, university colleges and research institutions have both similarities and different characteristics in the connotation of organizational mission. The following attempts to compare them from the dimensions of organizational mission subject, medical service, medical education and medical scientific research, so as to explore the connotation characteristics of organizational mission of University Affiliated Hospitals. From the perspective of organizational mission, University affiliated hospitals need to undertake the three organizational missions of medicine, education and research at the same time; Large local hospitals take the medical mission as the main body; The University College takes the mission of medical education as the main body and also has the mission of medical research; Research institutions take the mission of medical research as the main body and have the mission of medical education. From the perspective of social medical services: the University Affiliated Hospital mainly undertakes the diagnosis and treatment of difficult, critical and severe diseases, represents the highest medical level of the region and even the country, and aims to reach the world leading level; Large local hospitals focus on the diagnosis and treatment of critical and severe diseases, and the diagnosis and treatment level of some diseases is leading; Universities, colleges and research institutions do not have a medical service mission. From the perspective of medical education: The Affiliated Hospital of the university should undertake the education of clinical medicine and related fields at all levels and majors; Large local hospitals focus on undergraduate clinical medical education, as well as graduate education and standardized training; University colleges focus on basic medical education; Research institutions are mainly medical postgraduate education. From the perspective of medical scientific research: the affiliated hospitals of the university mainly focus on clinical research and translational medicine research; Research on regional application of large hospitals; Universities and colleges focus on basic research and original innovation research; Research institutions focus on problem-oriented, regional or industrial major problem research.
2.1 comparison between university affiliated hospitals and local large hospitals
The medical service mission of university affiliated hospitals is mainly the diagnosis and treatment of difficult acute and critical diseases, especially the comprehensive diagnosis and treatment of some rare difficult and severe diseases. The professional level of these hospitals generally represents the highest medical level of the whole region. Large local hospitals are mainly responsible for the diagnosis and treatment of clinical acute and critical diseases. For rare and very serious patients and some rare and difficult diseases, they will be transferred to higher-level hospitals for diagnosis and treatment; Large provincial local hospitals with larger scale and stronger strength also have strong comprehensive diagnosis and treatment capacity for some difficult and severe diseases, representing the highest medical level in the city or province. University affiliated hospitals need to undertake all-round and professional medical education at all academic levels, so as to cultivate high-level medical talents in various subdivisions. Large local hospitals mainly undertake clinical medical education at the undergraduate level, while some hospitals with strong strength in secondary disciplines of clinical medicine also undertake postgraduate education. These hospitals are lower than the affiliated hospitals of the University in the academic level and professional coverage of medical education. University affiliated hospitals undertake high-level and large-scale clinical scientific research and translational medicine tasks with high-intensity investment. Their scientific research platform, scientific research projects and output have obvious advantages over local large hospitals. According to the actual medical needs, large local hospitals undertake small-scale clinical applied research with small investment in a specific scope, and participate in large-scale clinical research as a sub center to contribute clinical research cases. There are also some large provincial hospitals with strong research strength and undertake a certain number of high-level clinical research projects. University affiliated hospitals and local hospitals; Third, promote the homogenization of regional medical quality management through the information platform, and finally realize the all-round, accurate and real-time management of medical quality in the whole industry; Fourth, strengthen the intelligent fee control management under different medical insurance payment modes, such as payment by disease, payment by head, payment by disease diagnosis related groups, payment by service performance and so on; Fifth, explore the joint procurement mode of drugs and consumables, implement the basic medical and health system, and effectively control the unreasonable growth of medical expenses.
3.2 promote the application of health care big data
The era of big data will have a profound impact on medical education, clinical research and clinical decision-making models. University affiliated hospitals are not only the collection of medical teaching and research resources, but also the collection of medical big data. In the new era, they shoulder the new mission of promoting the application of health big data. The main tasks are as follows: first, open up the data channel between the hospital's internal management information system and clinical information system, integrate and analyze clinical, operation and quality evaluation data, and promote the improvement of hospital operation management and medical quality; Second, use the resources of medical teaching and research platform to establish a large clinical medicine database and regional clinical medicine data demonstration center to improve the transformation and application efficiency of medical scientific research; Third, eliminate data barriers, establish a cross sectoral and cross sectoral health care data integration and sharing mechanism, and strengthen the application and decision-making assistance of health care big data in clinical and scientific research, public health, education and training and other fields.
3.3 promote the development of "Internet + medical health"
"Internet +" technology will create many new business forms, change the traditional service mode, and greatly improve the overall efficiency of the society. According to the national strategic demand for promoting the development of "Internet + medical health", University affiliated hospitals, relying on the foundation of physical medical institutions, must undertake the new mission of promoting the development of "Internet + medical health". The main tasks are as follows: first, actively build smart Internet hospitals and promote health care services for the convenience and benefit of the people. Second, establish an integrated platform for telemedicine diagnosis and treatment services, build a telemedicine application system, and promote the sinking of high-quality medical resources; Third, promote the application of health education and training.
3.4 develop convenient and efficient intelligent services
Artificial intelligence realizes scientific and technological innovation through multi domain technology integration, which has brought an unprecedented new wave of technological revolution to the whole society. According to the national strategy to promote the development of artificial intelligence, University affiliated hospitals should give full play to their advantages of big data in medical teaching and research, promote the cross integration of medical and artificial intelligence related disciplines, and promote the upgrading and development of medical services from digitization and networking to intelligence. The main tasks are as follows: first, develop human-computer collaborative clinical intelligent diagnosis technology to realize intelligent image and medical document recognition, intelligent pathological classification and intelligent multidisciplinary consultation; Second, research and develop artificial intelligence medical equipment such as man-machine cooperative surgical robot to realize man-machine Cooperative Intelligent treatment; Third, carry out large-scale genome recognition, proteomics, metabolomics and other diagnostic technology research based on artificial intelligence.
3.5 become the main force of national emergency rescue for public health emergencies
Public emergencies are sudden and have various causes. The harm often affects groups and often causes extensive social impact. On site treatment and disposal as soon as possible after the disaster is the main strategy to deal with public health events. In the prevention and control of SARS, novel coronavirus pneumonia and other infectious diseases, University affiliated hospitals have played a decisive role in the national emergency medical rescue system. The increasingly extensive and frequent global economic and population exchanges have brought unprecedented severe challenges to the prevention and control of infectious diseases. Under the new situation, University affiliated hospitals must strive to build and improve the normal response mechanism for public health emergencies, integrate the cooperation mechanism of resource information sharing, and establish a social mechanism for the popularization and promotion of prevention and control knowledge, so as to become the backbone of national emergency rescue for public health emergencies.
4 Summary
As the main force of national medical services, medical science and technology and medical education, University affiliated hospitals should build a Chinese model in all aspects of medical technology, clinical diagnosis and treatment standard formulation, hospital operation management, medical quality management, medical education model innovation and scientific and technological innovation system construction, especially when big data, Internet, artificial intelligence and other technologies leading the development of the future era enter a new stage, Take the initiative to respond, comprehensively strengthen the integration of new technologies, accelerate the in-depth application of new technologies, form unique advantages of development, and create a "China model" of health care, so as to provide strong support for the country to achieve a strong health power. In recent years, all parts of the country have actively explored the reform of "separation of management and management" of public hospitals, transferred the renovation system of some local hospitals to the management of medical colleges, or adopted the mode of "government university cooperation" to build new university affiliated hospitals, trying to improve the overall level of medical teaching and research through the adjustment of hospital affiliation and the innovation of management mechanism, and with the help of the advantages of professional resources of medical colleges. Among the transferred hospitals, there are some high-level large "top three" hospitals, and some transferred or newly-built hospitals are lack of overall strength. In 2020, the guiding opinions of the State Council on accelerating the innovative development of medical education put forward that "prevent the blind addition of affiliated hospitals and scientifically plan the number of affiliated hospitals". In the process of reform, how the subordinate relationship is transferred to medical colleges and universities and the Newly-built University Affiliated Hospital in the mode of "political university cooperation" can be built and developed into a real university affiliated hospital is placed in the University, transferred and newly-built hospitals Practical problems faced by educational and health administrative institutions. Only by starting with the organizational mission of the University Affiliated Hospital and further clarifying the construction objectives and standards of the University Affiliated Hospital, can we have a definite goal and truly realize the implementation of reform measures, which is also the direction that academics, hospital managers and policy makers need to work hard.