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Research on the Evaluation System of Discipline Competitiveness in County-level Public Hospitals Based on Resource-Based Theory

This study constructs and validates a scientifically sound evaluation index system for discipline competitiveness in county-level public hospitals based on Resource-Based Theory, utilizing the Delphi method to establish a framework of 2 first-level, 6 second-level, and 36 third-level indicators that can effectively guide clinical discipline construction.

Original authors: Ping Wu, Tingting Li, Huihui Zuo

Published 2026-07-06

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CC BY 4.0

Original authors: Ping Wu, Tingting Li, Huihui Zuo

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a county-level public hospital not as a building, but as a garden filled with different types of plants (the medical disciplines, like Cardiology or Orthopedics). For this garden to thrive and produce the best fruit, each plant needs to be strong, healthy, and competitive.

This research paper is essentially a guidebook for gardeners (hospital managers) on how to measure which plants are doing well and which ones need more help. Here is the story of how they built that guidebook, explained simply:

1. The Big Idea: The "Secret Sauce" Theory

The researchers used a famous business idea called Resource-Based Theory. Think of this like a cooking competition.

Old Way: You might just judge a chef by how many dishes they cooked or how much money they spent on ingredients.
The New Way (This Paper): This theory asks, "What is the chef's secret sauce?" It looks at the unique ingredients they have, how rare those ingredients are, and how well the chef can mix them together to make something no one else can copy.

The researchers applied this to hospitals. They wanted to know: What "ingredients" (resources) does a hospital department have, and how well do they use them to become the best in the region?

2. The Mission: Building a Scorecard

The goal was to create a Scorecard (an evaluation index system) specifically for county-level hospitals. These are the hospitals that act as the bridge between big city specialists and local village clinics. The researchers wanted a tool that could tell a hospital exactly where its strengths and weaknesses lie.

3. How They Built the Scorecard: The "Expert Panel"

You can't just guess what makes a good hospital department. So, the researchers gathered a panel of 25 experts.

Who were they? Think of them as a mix of master gardeners (hospital presidents), botanists (university professors), and park rangers (health officials).
The Process (The Delphi Method): They didn't just have one meeting. They played a game of "refinement" over three rounds.
- Round 1: They threw out a huge list of possible things to measure.
- Round 2 & 3: They voted, discussed, and narrowed it down. If an expert said, "This metric is too hard to measure," it got cut. If they said, "This is crucial," it stayed.
- The Result: They ended up with a perfect, streamlined list: 2 main categories, broken down into 6 sub-categories, and finally 36 specific checkpoints.

4. What's on the Scorecard?

The final scorecard is like a report card with two main subjects:

Resource Input: This is like checking the garden's soil and water supply. Do they have enough doctors? Enough equipment? Enough funding?
Service Capability: This is like checking the actual fruit produced. How many patients did they treat? How well did they do?

Inside these two subjects, there are 36 specific questions (indicators) to answer, ensuring the evaluation is fair and covers everything from "Do they have the right tools?" to "Can they handle complex cases?"

5. Did It Work? (The Reliability Check)

Before publishing, the researchers tested their scorecard to make sure it wasn't just a random guess.

The "Yes" Factor: Every single expert said "yes" to participating and returned their forms.
The "Expert" Factor: The experts were highly qualified (most had advanced degrees and 20+ years of experience), so their opinions carried a lot of weight.
The "Agreement" Factor: At first, the experts didn't fully agree on the list. But after talking it through in the second and third rounds, they all started nodding in agreement. The scorecard became consistent and reliable.

6. Why Does This Matter?

The researchers argue that this scorecard is a management tool, not just a report.

It stops the "Blame Game": Instead of managers just pointing fingers, the hospital departments themselves get to look at the scorecard, assess their own "garden," and figure out how to grow better.
It finds the "Secret Sauce": It helps hospitals realize that having the most expensive equipment isn't enough; they need to know how to use their unique resources to stay competitive.

The Bottom Line

This paper didn't invent a new medicine or cure a disease. Instead, it built a compass. It gives county hospitals a scientifically tested, expert-approved way to look in the mirror, see where they stand, and figure out exactly what they need to do to become stronger and more competitive in their community.

Note: The paper focuses strictly on building this measurement tool. It does not claim to have used the tool to fix specific diseases or change patient outcomes yet; it simply provides the ruler with which to measure the progress.

Technical Summary: Evaluation System of Discipline Competitiveness in County-level Public Hospitals Based on Resource-Based Theory

Problem Statement
Discipline construction is identified as the core driver for the high-quality development of public hospitals in China. While the level of discipline construction in county-level public hospitals directly impacts regional healthcare accessibility and equity, specialized research focusing on this specific administrative level remains scarce. Existing evaluation frameworks often rely on singular quantitative metrics (e.g., publication counts, funding scale) rather than comprehensive dimensions. There is a critical need for a scientifically grounded evaluation tool that helps county-level hospitals identify key resources, form long-term competitive advantages, and guide effective management measures for discipline improvement.

Methodology
The study employed a mixed-method approach grounded in Resource-Based Theory (RBT) to construct and validate an evaluation index system:

Theoretical Framework: The study utilized RBT, which posits that competitive advantage stems from heterogeneous resources that are valuable, rare, inimitable, and supported by organizational capabilities. This framework guided the shift from traditional metrics to a multidimensional assessment of resource value and integration capacity.
Study Subjects: Three Grade A Class II county-level public general hospitals in a central Chinese province were selected as the research subjects. These hospitals were comparable in scale (approx. 500 beds) and volume. The study focused on 15 clinical disciplines across these institutions, including Cardiology, Respiratory Medicine, Neurology, Orthopedics, and General Surgery.
Indicator Construction: A preliminary pool of indicators was generated through a literature review using keywords such as "clinical discipline" and "discipline competitiveness." This was refined through an initial expert consultation questionnaire.
Delphi Method: A three-round Delphi consultation was conducted with a panel of 25 experts (60% from hospitals, 10% from health administrative departments, and 30% from medical universities). The panel included hospital management specialists, health officials, hospital presidents, and clinical department chairs.
Selection Principles: Indicators were screened based on principles of suitability for dynamic evaluation, clarity, measurability, comparability, and the ability to be routinely extracted from hospital information systems.
Weighting and Validation: The Analytic Hierarchy Process (AHP) was used in the third round to assign weights to the second and third-level indicators. Reliability was assessed using Cronbach's alpha, while expert consensus was measured using Kendall's coefficient of concordance. Statistical analysis was performed using SPSS (v22.0) and MATLAB (R2010b).

Key Contributions and Results
The study successfully constructed a comprehensive evaluation index system for discipline competitiveness in county-level public hospitals.

System Structure: The final system comprises:
- 2 First-level indicators: Resource Input and Service Capability.
- 6 Second-level indicators.
- 36 Third-level indicators.
Reliability and Validity:
- Internal Consistency: The overall Cronbach's α for the system was 0.904 ( $P < 0.001$ ). The 'Resource Input' indicator had a $\alpha$ of 0.901, and 'Service Capability' had a $\alpha$ of 0.811.
- Expert Authority: The experts demonstrated a high degree of authority, with judgment basis and familiarity coefficients exceeding 0.8 for all indicator levels.
- Expert Consensus: The Kendall's coordination coefficient improved significantly across rounds. It rose from 0.557 (2nd-level) and 0.467 (3rd-level) in the first round to above 0.600 for all levels by the second round, indicating a progressive enhancement in consensus.
- Response Rate: The positive coefficient (response rate) was 100% across all three consultation rounds.

Significance and Claims
The authors assert that the constructed evaluation index system is scientifically sound and offers a practical management tool for county-level hospitals.

Strategic Alignment: By applying RBT, the system assists disciplines in identifying the specific resources that determine competitiveness and provides effective levers for improvement. It aligns the practical objectives of discipline construction with the theoretical goal of forming sustained competitive advantages.
Management Utility: The system is designed not merely for assessment but as a management tool to streamline complexity and help disciplines continuously enhance their core competitiveness.
Participatory Approach: The study claims to mitigate the "managerialist tendency" of traditional evaluations by involving all stakeholders (evaluators and the evaluated) in a consultative process. This approach fosters co-construction, reduces discrepancies, and returns the evaluation function to its essential role of promoting development through diagnosis, orientation, and motivation.
Methodological Rigor: The combination of key informant interviews, expert panel discussions, and the Delphi method is presented as a robust approach to screening indicators, with post-screening reliability tests ensuring the system's scientific soundness.

Limitations
The authors modestly acknowledge limitations, noting that the applicability of the index system may be constrained and that the fairness of using a single set of criteria for disciplines at different developmental tiers requires further optimization in future research.