When Cao Hua first assumed oversight of the Fujian Provincial Maternity and Children’s Hospital in 2017, the hospital had approximately 1,300 staff members, only 10 of whom held PhD degrees. Needless to say, research productivity was stagnant as few clinicians saw research and publishing as part of their roles.
Fast forward to August 2023, the hospital staff strength had more than doubled, reaching nearly 3,000 members. More importantly, the hospital was infused with a palpable energy, animated by a renewed culture of research excellence that was scarcely evident before Cao’s arrival.
This case study is a well-documented example of cultural change in a public medical institution in China. It shows that research capacity is not only a function of funding or infrastructure, but also of norms, incentives, and leadership behaviour.
The Fujian hospital
The hospital was established in 1935 as Fuzhou Maternity Hospital. It adopted its current name in the 1990s and was accredited as a Tier-3 Class-A hospital in 1996, the highest level in China’s public healthcare system. Located in Fuzhou, it became Fujian province’s leading centre for maternal and child healthcare, with responsibilities for clinical care, teaching, research, and technical guidance.
By 2018, it operated more than 1,000 beds and served millions of women and children each year, even as its research capacity lagged behind leading hospitals in Beijing or Shanghai. Cao recalled his keynote speech at the 2018 Meeting of the Obstetrics and Gynaecology Branch of the Fujian Medical Association, where he stressed that scientific research — notably the pursuit of national research grants and publishing in top-tier journals and academic conferences — was critical to propel the hospital further.
Using gamification to encourage intellectual curiosity
Cao introduced structured, hospital-wide research competitions. The main component was the “Yi Yi” initiative, which used a gamified format to prompt questioning, literature reading, and peer comparison. The contest was structured according to three phases — weekly rounds, quarterly finals, and grand finals. There was a total of 44 rounds for the first year, and the top eight winners would be sent for overseas exchange and immersion in European hospitals.
The gamified format drew inspiration from a hit singing competition on Hunan Television, in which contestants performed before a panel of judges, and advanced with votes and revival rounds. ‘Yi Yi’, which means ‘One Doubt’ in Mandarin, takes its name from the prominent 16th century Confucian philosopher Wang Yangming, who was credited with the saying “He had one doubt, and the matter was resolved.”
Cao explained his rationale for using Yi Yi to prompt clinicians to question their work: “The pursuit of knowledge requires doubt, in other words, one needs to question. Reading without questioning makes it hard for one to improve, but the ability to ask probing questions can only be honed through a long period of reading and practice. For physicians, it is especially important to progress through questioning while reading large volumes of medical literature. The ‘Yi Yi’ competition is just the beginning.”
Creating a cultural shift to align research with clinical work
From 2021, the focus shifted from literature reviews to research proposals in the style of National Natural Science Foundation of China (NSFC) proposals. This pushed clinicians to design fundable projects and align with national research standards. Participation in research was also made part of core clinical work, not an add-on.
Furthermore, career and incentive systems were redesigned to reinforce this shift. Promotion to senior professional titles was tied to high-quality publications and active research output. Financial rewards were offered for successful national grants, while incentives for lower-level projects were removed. This sent a clear signal about what the institution valued and where clinicians should focus their efforts.
The hospital also strengthened its research infrastructure and talent pipeline. It expanded the number of master’s and doctoral supervisors and provided significant internal grants to top-performing research teams. These measures provided clinicians both the mentorship and resources needed to move from ideas to execution.
Finally, organisational routines were adjusted to sustain the new culture. Interdisciplinary research tracks encouraged collaboration across clinical and technical roles. Regular research briefings and seminars made research discussion part of everyday hospital life. Together, these structural changes embedded research into how the hospital worked, not just how it was measured.
In other words, instead of relying on top-down mandates, the hospital used peer competition, recognition, and career signals to reshape daily practice. By institutionalising interest in scientific research through gamified competition, peer recognition, and structural incentives (and disincentives), acting on a good research question is now celebrated. This cultural change was enduring, and across the country, the hospital started gaining recognition for its clinical publications.
Scaling the hospital’s success
By early 2023, the hospital had consistently ranked among the top 10 tertiary specialist maternity hospitals in the country, and been awarded many other accolades, such as being designated a provincial model hospital.
The cultural change had not been easy, but it was deeply rewarding. Cao’s efforts show the possibilities for growth by drawing on China’s intellectual heritage in a bureaucratic environment. As Cao reflected on the journey, he asked himself: “Could this model scale beyond one hospital? Or was it the product of a unique moment, a particular team, and his own leadership style?”
The case ‘Reviving Research Excellence: Cultural Turnaround at Fujian Provincial Maternity and Children’s Hospital’ is written by Associate Professor Daniel Zheng and Dr Wee-Kiat Lim at the Singapore Management University, and Professor Debiao Li at Fuzhou University. To read it in full, please visit the CCX website by clicking here.