title: Factors influencing the success of rural cataract surgery programs in China: the study of hospital administration and relative productivity (SHARP).
abstract: OBJECTIVE
  To explore factors potentially influencing the success or failure of rural Chinese hospitals in increasing cataract surgical output and quality.
  
  
  METHODS
  Focus groups (FGs, n = 10) were conducted with hospital administrators, doctors, and nurses at 28 county hospitals in Guangdong Province. Discussions explored respondents' views on increasing surgical volume and quality and improving patient satisfaction. Respondents numerically ranked possible strategies to increase surgical volume and quality and patient satisfaction. FG transcripts were independently coded by two reviewers utilizing the constant comparative method following the grounded theory approach, and numerical responses were scored and ranked.
  
  
  RESULTS
  Ten FGs and 77 ranking questionnaires were completed by 33 administrators, 23 doctors, and 21 nurses. Kappa values for the two coders were greater than 0.7 for all three groups. All groups identified a critical need for enhanced management training for hospital directors. Doctors and nurses suggested reducing surgical fees to enhance uptake, although administrators were resistant to this. Although doctors saw the need to improve equipment, administrators felt current material conditions were adequate. Respondents agreed that patient satisfaction was generally high, and did not view increasing patient satisfaction as a priority.
  
  
  CONCLUSIONS
  Our findings highlight agreements and disagreements among the three stakeholder groups about improving surgical output and quality, which can inform strategies to improve cataract programs in rural China. Respondents' beliefs about high patient satisfaction are not in accord with other studies in the area, highlighting a potential area for intervention.
authors.affiliation: Department of Preventive Ophthalmology and State Key Laboratory, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Tianyu
authors.initials: T
authors.lastname: Liu
authors.forename: Ee Lin
authors.initials: EL
authors.lastname: Ong
authors.forename: Xixi
authors.initials: X
authors.lastname: Yan
authors.forename: Xinxing
authors.initials: X
authors.lastname: Guo
authors.forename: Mingguang
authors.initials: M
authors.lastname: He
authors.forename: David
authors.initials: D
authors.lastname: Friedman
authors.forename: Nathan
authors.initials: N
authors.lastname: Congdon
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002387:Cataract Extraction; D002681:China; D017598:Efficiency, Organizational; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006740:Hospital Administrators; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D017060:Patient Satisfaction; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires