Introduction: A Quiet Revolution
In 2025, the National Health Commission clearly proposed the “implementation of an embedded supervision model” in the “Special Rectification Action Plan for the Medical Field,” marking a transition in medical anti-corruption from “storm-style rectification” to a new phase of “normal prevention and control.” The case of Ruijin Hospital in Shanghai achieving a 42% reduction in prescription violations through “integrity inspections” provides a breakthrough model for public hospital supervision reform. This article will deeply analyze how to localize this experience to help hospital discipline inspection commissions build a new ecological supervision system that prevents problems before they occur.
1. Current Pain Points: Three Major Dilemmas of Traditional Supervision
1. Limitations of Movement-style Anti-corruption
• Case: The corruption case at Gaozhou Hospital in Guangdong (involving 300 million) exposed the ineffectiveness of “one-off” inspections.
• Data: A surprise inspection at a tertiary hospital found that 30% of the records for consumables entering and leaving the warehouse did not match the actual items.
2. Supervision Blind Spots of Information Silos
• The SPD management system for drugs and the discipline inspection data platform are not interconnected, creating a “digital black box.”
• Case: A certain hospital’s equipment department used “shadow accounts” to siphon funds, going undetected for three years.
3. Covert Upgrades of Power Rent-seeking
• Under the DRG payment reform, new forms of corruption such as CMI value manipulation and case quality control have emerged.
• Data: In 2024, 35% of medical anti-corruption cases involved “false diagnosis and treatment” and “coding arbitrage.”
2. Decoding Shanghai’s Experience: Four Core Mechanisms of Integrity Inspections
1. Process Re-engineering: Embedding Supervision Throughout the Business Chain
• Reconstruction of inspection scenarios: The discipline inspection commission collaborates with medical, financial, and information departments to randomly select key departments weekly.
• Data penetration technology: Real-time capture of top 10 drug usage and high-value consumable usage frequency through the HIS system.
• Case: A certain tertiary hospital in Shanghai discovered a 300% surge in the usage of a specific surgical stapler in one department through inspections, leading to clues of commercial bribery.
2. Power Checks and Balances: Establishing a “Three-Dimensional” Prevention and Control System
• Self-assessment: Design of the “Integrity Risk Prevention and Control Checklist” (including 42 indicators across 6 categories).
• Cross-checking: Establishing a rotation mechanism where the pharmacy department checks the equipment department and the finance department checks the procurement department.
• Intelligent traceability: Key decisions must be recorded through the OA system’s “three major and one large” module.
3. Technological Empowerment: Building a New Infrastructure for “Digital Discipline Inspection”
• AI early warning model: Setting 10 major early warning indicators such as sudden changes in drug usage (threshold >150%) and abnormal inventory turnover of consumables.
• Blockchain evidence storage: Real-time on-chain recording of every entry and exit data in the consumable SPD management system to prevent tampering.
• Case: Zhejiang University Affiliated Hospital recovered 8.7 million yuan in illegal consumable costs within three months using blockchain technology.
4. Cultural Reshaping: Building an Ecosystem Where Corruption Cannot Occur
• Transparency: Establishing an “Integrity Inspection Column” in the OA system to publicly disclose problem rectification ledgers in real-time.
• Points assessment: Linking integrity performance directly to title promotion and performance bonuses (accounting for no less than 30%).
• Case: After implementing the “Integrity Passport” system, a certain hospital in Shanghai saw a 210% increase in the number of people voluntarily returning red envelopes.
3. Localization Path: Five-Step Replication Method
STEP 1: Draw the “Power Operation Map”
• Identify high-risk positions: Equipment department (consumables), pharmacy department (drugs), information department (data).
• Draw a power flow chart: Marking 12 key nodes such as drug selection and bidding procurement.
STEP 2: Develop the “Intelligent Inspection System”
• Functional modules:
• Data capture: Automatically connect to HIS, HRP, and SPD systems.
• Risk scanning: Setting algorithm models for high DRG coding and consumables used beyond indications.
• Early warning push: Real-time SMS alerts for abnormal data to discipline inspection committee members.
STEP 3: Establish a “Three-Dimensional Inspection” Mechanism
• Time dimension:
• Routine inspections (once a week): Regular checks on key departments.
• Special inspections (once a month): Focusing on hot topics such as DRG payments and equipment bidding.
• Surprise inspections (irregular): Spot checks on high-risk positions.
• Spatial dimension:
• Physical inspections: On-site checks of drug and consumable inventories.
• Digital inspections: Retrieving electronic medical records and billing lists.
• Cloud inspections: Analyzing anomalies in internet medical treatment data.
• Subject dimension:
• Discipline inspection commission-led: Organizing joint inspections across multiple departments.
• Department mutual checks: Establishing “woodpecker” supervision groups.
• Patient participation: Setting up a “scan to evaluate” integrity feedback channel.
STEP 4: Design the “Inspection Toolbox”
• Standardized checklist:
• “Eight Inspections and Eight Observations for Integrity Inspections” (check system execution, check process vulnerabilities, etc.).
• “Power Operation Process for High-Risk Positions” (including 23 marked risk points).
• Data templates:
• “Drug Usage Fluctuation Analysis Table” (automatically calculates year-on-year/month-on-month growth rates).
• “Consumable Procurement Price Comparison Matrix” (integrating market average price database).
STEP 5: Build a “Rectification Tracking System”
• Establish a “Three-Color Early Warning” mechanism:
• Yellow warning: Department self-inspection and rectification (feedback within 3 days).
• Orange warning: Discipline inspection commission interviews responsible persons (closure within 7 days).
• Red warning: Hand over to the discipline inspection and supervision office (initiate accountability procedures).
• Case: A certain hospital resolved 17 historical issues within six months through this system.
4. Support System: Three Major Supporting Mechanisms
1. Institutional Guarantee
• Issuing the “Implementation Rules for Embedded Supervision,” clarifying the boundaries of rights and responsibilities between the discipline inspection commission and business departments.
• Establishing a “Supervision Exemption” system: Proactively reporting issues can reduce penalties.
2. Technical Guarantee
• Developing the “Integrity Inspection APP,” integrating data query, early warning push, and rectification tracking functions.
• Deploying RPA robots to automatically capture abnormal bidding data.
3. Cultural Guarantee
• Launching “Integrity Micro-Classrooms”: Using VR technology to recreate typical cases of medical corruption.
• Implementing “Integrity Performance Points”: Directly linked to job promotions and awards.
5. Future Outlook: From “Inspections” to “Preventive Treatment”
1. Predictive Supervision: Using machine learning to predict high-corruption scenarios (e.g., early warning before a surge in high-value consumable usage).
2. Ecological Governance: Building a three-party integrity co-construction platform among hospitals, suppliers, and patients.
3. Value-based Medical Transformation: Deeply integrating integrity inspections with DRG/DIP payment reforms to achieve “quality improvement and efficiency enhancement.”
Conclusion
The successful practice of Shanghai’s “Integrity Inspections” proves that medical anti-corruption is not a “cat-and-mouse game,” but rather a transformation of supervisory power into developmental momentum through institutional reconstruction and technological empowerment. When embedded supervision becomes the “immune system” of hospital management, we will not only welcome a clean and upright industry ecology but also a new era of value-based medical care characterized by patient trust and physician peace of mind.
