# Exploring the effectiveness of proactive service models in preventing medical disputes and petitions: a pilot investigation using a before-and-after design at a single center in Hangzhou, China

## TL;DR

A pilot study at a hospital in Hangzhou, China, found that a proactive service model improved communication and reduced medical petitions.

## Contribution

This study introduces and evaluates a proactive service model to address medical disputes in a Chinese hospital setting.

## Key findings

- The proactive service model significantly increased communication resolution rates at both hospital campuses.
- Petition incidence rates decreased notably after implementing the proactive service model.
- Effect sizes were substantial, with statistically significant improvements observed in communication outcomes.

## Abstract

Healthcare conflicts are a global public health priority, and medical petitions are a primary resolution pathway in China. Zhejiang Provincial Hospital of Chinese Medicine (ZPHCM) found that a reactive administrative approach failed to curb clinical disagreements and petition frequency, requiring optimized management strategies.

A single-institution before-and-after observational pilot study (no concurrent control) was conducted across ZPHCM’s Qiantang and Hubin campuses. The Proactive Service Model (PSM) was initiated in January 2025; outcome metrics were compared between an 8-month pre-intervention period and a 9-month post-intervention period. Analyses were performed using IBM SPSS Statistics 27.0 and R v.4.4.3 (descriptive statistics, Cohen’s d, Mann–Whitney U tests).

Post-PSM deployment, both campuses showed significant improvements: Qiantang Campus had communication resolution rate (CRR) increased from 35.95% ± 13.02 to 52.97% ± 8.22 (+17.02 percentage points) and petition incidence rate (IP) decreased from 34.88% ± 6.89 to 27.67% ± 5.47 (−7.20 points); Hubin Campus had CRR raised from 46.02% ± 8.55 to 57.87% ± 5.75 (+11.85 points) and IP reduced from 33.48% ± 7.73 to 25.85% ± 5.29 (−7.63 points). Effect sizes were substantial (CRR: Qiantang d = 1.59, Hubin d = 1.65; IP: both d = −1.17) with 95% CIs excluding zero, and CRR changes were statistically significant (U = 9, p = 0.011).

As a pilot study, this work lacks definitive causal evidence, but it demonstrates a meaningful association between PSM implementation and improved communicative dispute resolution alongside reduced petition incidence at ZPHCM, supported by notable effect sizes.