Chen Xiaoming of The First Affiliated Hospital of Wenzhou Medical University Reveals the Secret Behind 4 Million Annual Outpatient Visits with Zero Queues

Hello everyone, I am Chen Xiaoming, President of the First Affiliated Hospital of Wenzhou Medical University. I sincerely thank VCBeat for providing this platform to facilitate our exchange. Today, I will share some case studies on how our hospital has leveraged the internet and information technology to implement process reengineering.

(The First Affiliated Hospital of Wenzhou Medical University)

Last year, our hospital was awarded the Gold Award in the “Customer Service” category of the Asian Hospital Management Awards, becoming the second hospital in mainland China to receive this honor after West China Hospital. The award was primarily granted because we leveraged the internet to optimize our service processes. Last year, our hospital handled 3.72 million outpatient visits while achieving zero wait times. Below, we will outline how our hospital accomplished this.

The Internet Era Has Arrived: Hospitals Must Embrace It

The Internet is a mode of human interaction. As social beings, all our activities are essentially information-based—from oral and written communication to the advent of the telegraph and telephone, and now the Internet, which has made communication increasingly effortless. The Internet has turned the world into a global village, transforming every industry, including medicine, where information continues to drive medical advancement.

The industrial era was defined by the economics of scarcity, manifested in hospitals as a shortage of medical resources. In contrast, the internet era is characterized by the economics of abundance, where material goods are plentiful and individuals can quickly find what they seek online. Thus, the internet makes information access more direct, widespread, human-centric, and reflective of human value.

Therefore, the Internet enables the general public to easily access medical information as well as details about physicians and hospitals, thereby expanding our choices. For physicians, the Internet facilitates lean operational models, enhances disciplinary branding, and drives technological advancement.

Currently, the rollout of various healthcare reform policies, such as tiered diagnosis and treatment, prompts us to consider what form of tiered diagnosis and treatment should be established in the information age. Additionally, the rise of private healthcare provision is also impacting the medical market.

If hospitals fail to improve their services, they risk significant patient attrition. Therefore, hospitals must prioritize the following: First, always place patients first by meeting their needs and creating value for them. Second, cultivate a sense of competition, crisis awareness, and adaptability, adjusting strategies in response to environmental changes.

“I greatly appreciate the saying, ‘In an era of drastic change like today, the success model of yesterday becomes the cause of failure tomorrow.’ Therefore, we must never rest on our past successes, as everything is changing in the internet age.”

The Core of Hospital Reform Is a Shift in Mindset

In reality, within our hospital’s operations, many individuals’ mindsets remain influenced by agrarian-era culture, as well as industrial-era culture—particularly the legacy of the planned-economy era. Therefore, during the process of hospital process reengineering, I have come to deeply realize that process reengineering under informatization conditions should not merely involve digitizing legacy processes.

What is meant by the informatization of legacy processes? It simply involves migrating your work to computers without altering your original operational model. While this improves efficiency, it does not fundamentally transform the status quo; it is merely replacing an abacus with a computer. This is what is referred to as the informatization of legacy processes.

Within hospitals, many processes and signage are clear to staff but incomprehensible to patients. This approach fails to align with customer needs, indicating significant room for improvement. I interpret this as the digitalization of legacy workflows.

Take the issue of queuing, for example. It is actually quite simple: if you have more machines, won’t the queues be shorter? At our hospital, we have 290 machines, so patients do not need to wait in line.

Therefore, I believe this is not a technological revolution, nor a revolution in software and speed; it is a revolution in mindset. If mindsets and thinking do not change, then the Internet and similar technologies will be of no use.

I heard Margaret Thatcher say this in the movie:Watch your thoughts, for they become your words; watch your words, for they become your actions; watch your actions, for they become your habits; watch your habits, for they become your character; watch your character, for it determines your destiny.Thought determines destiny; if your mindset remains unchanged, how can your fate possibly change? How can outdated models and old ways of thinking adapt to the modern era? We are living in an information age, and we must adopt behaviors appropriate to this digital era.

President Xi Jinping once stated at a diplomatic conference that we should not be bound by conventions or constrained by outdated rules. In the process of advancing information technology infrastructure in hospitals, I have gained a profound appreciation for the wisdom of this statement.

Model Innovation: Patient-Centered

We are often constrained by past conventions, outdated regulations, and obsolete mindsets, with insufficient comprehensive reforms, which hinders our progress in advancement and process reengineering. Therefore, regarding hospital informatization and process reengineering, my insight is that model innovation is more critical than functional improvement. This aligns with my earlier point that informatization requires process reengineering: the priority should be model innovation, rather than merely enhancing the efficiency of specific tasks through incremental improvements; instead, it calls for holistic innovation of the entire operational model.

Peter Drucker said, “The competition between current enterprises is not about products and services, but about business models.”This is correct.

What is our business model in hospitals? It is patient-centered. In the commercial context, it means maximizing customer value. Patients are the customers of hospitals, and their value must be reflected.

What do patients receive at a hospital? They receive not only medical expertise but also the value of service, the value provided by staff, and the value associated with the institution’s image.

Just as the value conveyed by treating someone to a fish varies depending on the location, inviting you to dine at a five-star hotel today certainly signifies great respect, or perhaps a favor is being sought, thereby highlighting your worth and status. In contrast, having a meal together at a regular restaurant may simply reflect a gathering of old friends, while sharing the same dish at home indicates a close and intimate relationship. Thus, the same fish carries different connotations of value depending on where it is consumed.

Historically, we have focused primarily on price and fees. While the amount a patient pays is certainly part of their cost, what about the time, physical effort, and mental energy they expend? Are these not also costs? From today’s perspective, I would argue that all of these constitute costs. The value a patient receives from hospital services minus the total costs they incur—including physical effort, mental energy, and money—determines their satisfaction. If the perceived value exceeds the costs, the patient feels they have gained more, reflecting true value and leading to higher satisfaction. Conversely, if the perceived value is less than the costs incurred, no value is demonstrated, resulting in significant dissatisfaction with the medical visit.

Therefore, hospitals must prioritize patient value., we must consider our service model. Although we are not engaged in business or commercial activities, our service model needs to evolve. Just as the rise and fall of an enterprise is determined by three factors—employer value proposition, business model, and technological innovation—the same applies to hospitals.

Therefore, from a business perspective, maximizing customer value requires integrating internal and external factors to create a complete, efficient, and uniquely competitive operational system. This is the essence of the internet model: leveraging optimal pathways and maximum speed to meet customer demands, thereby delivering customer value while ensuring profitability and sustainability.

What Are the Key Elements to Prioritize in Patient-Centered Care?

"Patient-centered care is easier said than done. Below, we will outline the key initiatives our hospital has implemented."

In hospitals, we require doctors and nurses to transform existing workflows and models to build brands and innovate care models, with the core principle being people-centeredness.

In the past, we believed that being people-oriented meant showing care, kindness, and understanding toward individuals. We recognize that human beings have many inherent flaws and shortcomings; the key to change lies in how we overcome these weaknesses.

Therefore, the people-oriented approach I refer to, in the context of hospitals, entails delivering comprehensive services, primarily reflected in three aspects:

First, to facilitate patients' access to medical care.

Second, to facilitate the work of medical personnel and create a favorable working environment for them.

Third, to facilitate management decision-making, we will leverage the internet and information technology to streamline administrative processes, thereby ensuring better service delivery and higher quality of medical care.

Next, we will discuss the three core principles our hospital adheres to in delivering patient-centered care.

Achieving a Zero-Wait Medical Experience

"Take a look at this photo. It shows the actual situation in our hospital back in 2009. With 2,000 outpatient visits and over 10,000 patients daily, not counting accompanying individuals, the number actually exceeds ten thousand. You can imagine how crowded our outpatient department was."

When I first arrived at this hospital in 2010, the scene was exactly the same. Imagine how a hospital director would feel upon witnessing such conditions. On one occasion, at a healthcare management forum in Shanghai, a university president displayed this image and remarked, “Is this how patients in China seek medical care? Do they still have any dignity?”

At first glance, this photo is clearly from my hospital. Do patients still have any dignity?Patients arrive at the hospital as early as 2:00 or 3:00 a.m. for medical consultations, with some even bringing straw mats to sleep in the hospital just to secure registration appointments. As depicted in the photo, it becomes nearly impossible for those on upper floors to come down for payment, and equally difficult for those needing to go upstairs to access care. Therefore, addressing this issue requires optimizing the management of patient care processes.

To address this, our initial solution is to establish multi-channel appointment scheduling and multi-channel payment settlement, as well as to resolve the issue of patient identification.

1. Enable multi-channel appointment scheduling.We prioritize the 114 hotline, a decision made after gaining a thorough understanding of our patient demographics. Since 70% of our patients are not from urban areas and a significant proportion are elderly, accessibility is key. In 2010, online appointment booking was proposed as an effective solution; however, many of our rural patients lacked digital literacy, and smartphones were not yet as prevalent as they are today. Although some hospitals introduced online booking systems at that time, I believed such services had not yet gained sufficient traction. Therefore, we maintained telephone booking as our primary channel. Practice has proven this approach correct, as telephone bookings account for the highest volume in our hospital. Notably, these telephone bookings are essentially online reservations completed by customer service representatives on behalf of patients.

To facilitate the work of call center agents, we have implemented not only disease-specific, specialty-specific, and designated-doctor appointment booking, but also an assisted booking feature. What is assisted booking? We have developed a software system where agents simply input the patient’s symptoms, and the system automatically identifies the most appropriate medical specialty. This enables agents without medical training to make accurate selections. Furthermore, even if a patient is initially registered with the wrong department, our consultation mechanism allows the attending physician to refer the patient to the correct department as needed.

Appointment booking methods have become more diverse, including intranet booking, hospital internal network booking, and mobile phone booking. Later, WeChat and Alipay booking were added. Currently, QuYiWang (Fun Doctor Network) booking is also available, and we are receiving the highest volume of appointments through QuYiWang nationwide.

Patients receive SMS notifications at every stage of their hospital visit. Upon successful appointment booking via phone or online from home, patients receive an SMS reminder specifying the month, date, building number, and exact time to arrive at the hospital for waiting. Recognizing that some elderly patients may have difficulty using mobile phones, we have equipped each physician with a compact printer to provide printed slips as an alternative form of notification.

To date, we have sent over 20 million text messages without charging patients a single cent. All three major telecom operators have installed SMS gateways at our hospital. Furthermore, as part of our next phase of optimization, we are considering eliminating the need for patients to register or make on-site payments when seeking care at our hospital.

2. Register using your ID card.What are the benefits of registering with an ID card? First, doctors can view the patient’s photo during consultation. Furthermore, we have integrated citizen cards, medical insurance cards, and New Rural Cooperative Medical Scheme (NRCMS) cards into the hospital’s own card system; patients who do not possess these cards can also use the hospital-issued card. To facilitate billing and settlement, we link the ID cards of elderly patients and minors to those of their guardians—for instance, linking an elderly person’s ID to that of their children, or a child’s ID to that of their parents. By binding the IDs of elderly patients to those of their children, seniors need only focus on discharge and returning home. Settlement is handled through a pre-deposit model, allowing family members to settle the bill at their convenience.

Registration using a national ID card allows for the permanent retention of patient information. Even if the hospital card is lost, it can be easily replaced by presenting the national ID card. This measure also helps prevent ticket scalping. Some reporters have questioned our hospital, alleging that scalpers still operate here. However, after we explained the entire process to them, they understood that, in theory, scalping should be impossible because we require both medical insurance cards and national ID cards for registration. Another advantage of using the national ID card is that it enables us to retain all outpatient records, inpatient records, physical examination results, and other test results, effectively establishing a comprehensive health record. This is highly beneficial for subsequent case management. Furthermore, it significantly improves patient care; for instance, healthcare providers can access outpatient records when treating inpatients, and vice versa, as we integrate all patient data into a unified system.

3. Resolve multi-channel settlement issues.Everyone knows that hospitals have an inpatient billing department and an outpatient billing department. Can we merge these two? In fact, hospitals can achieve this by merging the outpatient billing department with the inpatient billing department, fully transplanting the inpatient billing model to the outpatient setting, thereby aligning the two. When a patient is hospitalized, they make an initial deposit at the hospital; if the balance becomes insufficient, they can top up as needed, with charges calculated based on daily treatment costs.

After transitioning inpatient services to the outpatient setting, the outpatient process follows a similar model: patients first make a prepayment. For instance, if your estimated expenses for the day are around RMB 500, you can deposit approximately that amount—avoiding excessive deposits. The hospital does not charge fees at the point of service; instead, costs are deducted directly after the physician’s consultation or upon completion of procedures in the respective departments. All charges are settled post-visit. If funds become insufficient during treatment and the patient is unable to top up immediately, we offer flexible timing for replenishing the account, allowing patients to do so at their convenience. Multiple recharge channels are available, including bank branches, mobile banking apps, Alipay, and WeChat Pay.

After the consultation, fees are deducted instantly through an automated computer system; the physician simply clicks “Confirm” to complete the charge. For inpatients, billing can be settled directly with the nurse during admission and discharge procedures. Currently, 74% of all admissions and discharges are processed at the nursing station.

Our hospital has 290 self-service kiosks, where all functions can be completed, such as all payment services, printing lab test reports, and printing outpatient medical records. These machines were designed and developed by our hospital. Our goal is to replace manual labor with these devices, meaning that once the machines are in place, human staff are no longer required.

Currently, a large volume of our patients complete the payment process via self-service kiosks, with transaction volumes three times those of manual service windows. In 2014, we introduced banking terminals that enabled banks to provide services, assisted by patient guides who help patients navigate the process. From another perspective, this approach achieved zero capital investment in equipment and negative labor input. What is meant by “negative labor input”? It refers to situations where external parties contribute labor without requiring payment from us, thereby leveraging social resources. Additionally, our kiosk-based patient guidance rate has reached 74%, meaning that 74% of patients at our hospital no longer use the traditional payment model.

"Let Information Run More, Let Patients Walk Less"

2. Real-time prescription error correction.In the past, if a physician prescribed the wrong medication, patients would be informed at the pharmacy window that there was an error in the prescription. They were typically instructed to return to the physician for correction. If a refund was required after the correction, it needed approval from the Finance Department. Once approved, the refund would be processed manually, after which the patient had to pay again and wait in line once more. Now, is it possible to avoid these multiple trips?

By leveraging digital systems, if a medication error occurs, pharmacy staff can directly annotate the reason and send it to the physician online. The physician can then make corrections electronically. Since such adjustments affect costs, and patients maintain prepaid accounts within the hospital system, the financial updates are calculated automatically, eliminating the need for patients to queue at the billing counter.

This ensures that patients are not penalized for physicians’ errors. It has long been a persistent concern that patients were previously forced to run around due to medical mistakes.

Out-of-Hospital Medical Care System

1. Achieve seamless collection of doctor-patient information.Patients returning for follow-up visits or being discharged can access the hospital’s website via Alipay or WeChat to input their symptoms, ensuring that physicians are informed at the time of consultation. This is particularly beneficial for elderly patients, as their children can record their parents’ symptoms on a mobile phone from home, making the information visible to doctors upon arrival at the hospital. Inpatients can enter their condition details on an iPad, which also alerts the medical team. Patients may document their medical history while en route to their appointment.

2. Strengthen communication among patients.We have also established patient support groups, bringing together individuals with the same condition to facilitate communication both between patients and physicians and among patients themselves. These groups serve as a channel for ongoing doctor-patient dialogue, fostering mutual trust. For instance, physicians send text message reminders to each patient, who are required to follow the instructions upon receipt. In cases where a physician is unexpectedly unavailable despite having scheduled appointments, we promptly notify patients online that the physician is absent and reschedule the appointment, thereby preventing patients from making unnecessary trips.

3. Mobile outpatient services make follow-up visits smoother.Our mobile outpatient service primarily targets existing patients and those requiring follow-up visits. Previously, patients had to visit physicians at least twice: the first visit for ordering diagnostic tests and the second for prescribing medication. However, could we streamline this process by allowing physicians to issue orders during an initial phone consultation? Given that physicians are already familiar with their patients’ conditions, patients do not call physicians directly; instead, they dial 12580, which then connects them to the physician. If the physician agrees to take the call, the patient is connected, and the patient’s medical records are pushed to the physician’s mobile device. This enables the physician to order necessary tests in advance. This approach is particularly beneficial when physicians are traveling, as it allows their patients to complete required examinations without delay.

4. Desktop Cloud Facilitates Referrals Between Tertiary and Primary Hospitals.We have adopted desktop cloud technology. With this technology, doctors are no longer confined to the physical hospital premises; they can schedule appointments, provide consultations, and prescribe medications for their patients from any location with internet access. For instance, if a surgeon needs to perform an operation and is contacted by a former patient, they can complete certain diagnostic and treatment procedures remotely from home. Additionally, desktop cloud technology facilitates communication between physicians at different hierarchical levels and enables training for doctors at hospitals under our management. After passing assessments, some of these doctors become qualified to issue inpatient admission orders directly for our hospital. This allows patients requiring transfer to our facility to be admitted directly to the ward, bypassing intermediate administrative steps, as patient data can be transmitted electronically to nursing staff via the network.

5. Pre-admission system to reduce patients' medical expenses.We have also implemented a pre-admission system. Since medical insurance reimbursement is only available for inpatient services, some patients previously had to wait for hospital admission just to undergo necessary examinations. In coordination with the medical insurance authorities, we launched this initiative in 2011, allowing patients to complete outpatient examinations prior to formal admission, with the associated outpatient costs transferred and reimbursed under their inpatient coverage. This is what we refer to as “pre-admission.” By 2014, the number of pre-admission cases had exceeded 10,000.

6. Strengthen the hospital's software and hardware infrastructure to improve patient satisfaction.As we perform over 200 surgeries per day, a large number of family members gather at the entrance to the operating rooms each day, causing congestion. To address this issue, we have designated a room opposite the operating rooms specifically for patients’ families to wait. In addition, we have installed a television screen in the corridor of each ward to display surgical status updates for patients in that ward. To protect patient privacy, we omit patients’ names and use their bed numbers to inform family members of the current status of the patient’s procedure.

In addition, we have established an infusion pharmacy adjacent to the infusion room, allowing patients requiring intravenous therapy to collect their medications directly from this pharmacy. The IV fluids are transported via conveyor belts to a sterile preparation area. After compounding, they are conveyed to the outpatient infusion center. Patients are managed using barcodes, which not only standardizes the infusion process but also enhances convenience for patients.

In addition, all hospital beds in our facility are designed for immediate mobility. Patients can be transported directly on their beds to diagnostic tests or surgical procedures, offering significant convenience.

7. Improve patients' basic living conditions, including clothing, food, housing, and transportation, to enhance satisfaction.To improve service attitudes, we have nurses identify and document points of conflict with patients. For instance, analysis of these records revealed that conflicts are more likely to occur when patients are newly admitted or experiencing anxiety during injections. In response, we provide nurses with specific communication scripts for such scenarios. This training has significantly enhanced patient satisfaction.

In terms of daily living amenities, in addition to providing round-the-clock access to boiling water for patients, we also permit them to dine at the staff cafeteria. As our hospital is located in a suburban area with limited nearby commercial facilities, dining at the hospital cafeteria offers greater convenience. Patients can pay for their meals by swiping their medical visit cards, using the pre-deposited funds available in their accounts.

Our hospital is extensive, covering an area of 350,000 square meters. Initially, patients struggled to navigate the facilities, so we recruited university students as volunteers to assist them. Subsequently, residents of Wenzhou learned of this initiative and participated enthusiastically, which was highly appreciated by the patients. In recognition of these efforts, the Wenzhou Municipal Committee of the Communist Youth League designated our hospital as the first “Wenzhou Volunteer Service Base.”

Additionally, we have considered patient transportation. Shuttle buses operate between the old and new hospital campuses every 15 minutes, providing great convenience for patients. Some have asked how the two campuses are managed. Furthermore, there is parking available outside the hospital, and we also allow patients to drive their vehicles onto the premises directly to the outpatient department for easier access.

Many hospitals have unclear positioning for their websites. Is the hospital website intended for patients or for the hospital itself? Many hospitals cannot answer this question. We have also noticed this issue. The image above shows the hospital’s old website; note how small and inconspicuous the appointment booking feature is. Below is our new website, which highlights the issues that concern patients most. What I wish to convey is that hospital websites are designed for patients, reflecting a shift in our philosophy.