Factors Influencing Healthcare Performance of the Elderly in Tai'an City Hospital,  The People's Republic of China

Qi Ma; Lavan  Tonesakulrungruang; Siriporn  Sajjanand; Supattra  Chantanasiri

doi:10.60027/iarj.2026.e294054

Authors

Qi Ma Bangkokthonburi University, Thailand https://orcid.org/0009-0003-6887-5188
Lavan Tonesakulrungruang Bangkokthonburi University, Thailand https://orcid.org/0009-0003-0741-2112
Siriporn Sajjanand Bangkokthonburi University, Thailand https://orcid.org/0009-0003-4500-7345
Supattra Chantanasiri Bangkokthonburi University, Thailand https://orcid.org/0009-0008-6587-8662

DOI:

https://doi.org/10.60027/iarj.2026.e294054

Keywords:

Healthcare Performance, Healthcare Management, Service Quality Improvement, Employee Empowerment, Innovation

Abstract

Background and Aims: China's rapidly aging population presents significant challenges for healthcare systems, particularly in prefecture-level cities like Tai'an, where elderly patients (aged 60 and above) represent 22.1% of the population and are projected to exceed 24% by 2025. This study aimed to investigate the factors influencing the healthcare performance of the elderly in hospitals in Tai'an City, examine the relationships between healthcare management, employee empowerment, innovation, service quality improvement, and healthcare performance, and propose policy recommendations for enhancing healthcare service performance and competitiveness under conditions of population aging.

Methodology: A mixed-methods approach was employed, combining quantitative and qualitative research. The quantitative component utilized structural equation modeling (SEM) to analyze data from 400 valid questionnaires collected from hospital officers across 112 hospitals in Tai'an City using stratified random sampling. The qualitative component involved in-depth interviews with 10 key informants, including hospital administrators, health commission officials, doctors, and nurses with over 10 years of experience. The conceptual framework examined three independent variables (healthcare management, employee empowerment, innovation), one mediating variable (service quality improvement), and one dependent variable (healthcare performance).

Results: All ten research hypotheses were supported. Healthcare management (β=0.522, p<0.001), employee empowerment (β=0.367, p<0.001), and innovation (β=0.261, p<0.001) significantly positively influenced service quality improvement. Service quality improvement significantly positively influenced healthcare performance (β=0.613, p<0.001). Direct positive effects were also found from healthcare management (β=0.140, p<0.01), employee empowerment (β=0.060, p<0.01), and innovation (β=0.224, p<0.001) on healthcare performance. Significant indirect effects were confirmed through service quality improvement, with healthcare management (0.320), employee empowerment (0.225), and innovation (0.160) all positively influencing healthcare performance via the mediating role of service quality improvement.

Conclusion: The study demonstrates that healthcare management, employee empowerment, and innovation are critical factors influencing healthcare performance for elderly patients, with service quality improvement serving as a crucial mediating mechanism. The findings provide evidence-based guidance for hospital administrators and policymakers to develop comprehensive strategies addressing population aging challenges. Key recommendations include strengthening medical-nursing integrated elderly care institutions, enhancing employee professional development and job satisfaction, promoting smart healthcare platform innovations, and implementing patient-centered service quality improvement initiatives.

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