The significant growth in the human resource as well as in the number of CND involved in the QM system in Jiangsu provided a promising development of professionals within the nutrition area. After the illustration of staff shortage in 2018, the QMCNJ has focused on its improvement together with all quality control system departments. This progress certified that the importance of CNM in healthcare services had been concentrated by health institutions, department managers, and other national organizations such as JPHC8. The ratio criteria between CND professionals to hospital beds issued by JPHC for hospital accreditation is 1:200 (0.50 × 10-2). Compared with the mean value from this research (0.36 × 10-2), the CND is still in need of implementation for human resource and should make more effort or resource management.
The increasing number of departments that participated in QMSNJ brought their staff into the QM system of CN, which led to an increased total amount of human resources. However, most of this growth was resulted from the hired clinicians and nurses instead of dietitians. The dietitians in Jiangsu decreased from 113 to 104, while the clinicians increased by 13 and nurses increased by 29. This led to a shrink of the professionals who were graduated from nutrition majors and desired to provide nutrition-related medical services. Based on the human resource profile from surveyed hospitals and the documentation in JPCNMP, most of the clinicians employed in CND were educated as physicians, such as gastroenterologists or endocrinologists. As a result, though the hospital, the human resource department, and the CND director realized the importance of CNM and desired to improve its staff resource, the CND was still in lack of certified dietitians. This vagueness may be induced by the late development of CN in China. The certification of RD/RDNs was officially organized by the CNS in the past five years. Compared to the lack of RD/RDNs throughout the province two years before, there were 92 now accounted for 26.98% in total, while 38.04% are from nutrition majors. Though it is still less ideal than the proportion of RD/RDN in the US CNM (98.6%)9, it had achieved breakthroughs within this time period.
The advancement of CND`s staff resource might be mainly related to the expansion of QMSNJ, which has proved the QMCNJ has achieved initial results in the QM of human resource engaged in CN in Jiangsu in recent years. However, judging from the comparison of the personnel situation of the 48 original CNDs, which had been involved in the 2018 QMSNJ and participated in the last construction survey7, the number of their dietitians has increased significantly (p = 0.02, t=-0.42). Simultaneously, the number of clinicians in relevant departments is the same, and the number of nurses has shown a decreasing trend without statistical significance. From the perspective of balancing the CN resources and health service requirements, which could be illustrated by the professional ratio in CND to hospital beds, the dissertation was only observed in nurse number (p = 0.05, t = 0.19). At the same time, no obvious change has been found in the clinician, nor the dietitian. These results confirmed that the medical institution and the department`s director had realized the importance of a solid foundation of professional staff to improve the quality of specialist work and ensure patient safety. These 48 CND have continuously increased their emphasis on CNM, while QMCNJ has indicated in promoting the RD/RDN resource within clinical trial by improving CND professionalism. Within the “Education in QM” part of this questionnaire, 327 out of 330 employees took part in the QM training held through the online platform JPCNMP by QMCNJ in 2020. In the exam after the course, the passing rate of trainees was 99.20%.
The expansion of the organization of QMCNJ has been proved through this research and the rising focus on CNM and human resource management by medical institutions and health commission. All of these signs of progresses are inseparable from the introduction of AI instruments. With the implementation of the specialized online platform JPCNMP after 2019, a real-time quality assessment of CND`s daily work could be observed both by themselves and by QMCNJ. The platform functions involve quality assessment, information communication, personnel education, and training, etc. Through the login interface of the CND, the department director and the secretary can browse its historical QM data, grasp the current status and trends of its medical service quality, as well as the department management quality. Relevant problems will be exposed, and adjustments can be implemented in time. Through the login interface of QMCNJ, the center specialists can browse each department’s data within QMSNJ. JPCNMP system has installed automatic warnings for departments and quality control centers of abnormal information, such as inconsistencies, missing values, outliers, and similarities. It provides a great advantage for QMCNJ to adjust its QM methods based on the current status of CND and quality assessment throughout Jiangsu and to apply for management policies to the JPHC.
Apart from data collection and quality assessment, JPCNMP is convenient for QMCNJ to publish the latest QM guidelines, the QM progress of CNDs in Jiangsu, and the frontier QM research trends, etc. It is effectively saving the resource consumption caused by traditional forms such as paper information filling and on-site supervision with the application of this AI technology. Consistent with the trend of the information technology revolution of our era, AI provides an automated method and various rules that are able to deal with the quality assessment of big data for healthcare4. Its advantages have been reported in multidiscipline, such as geothermal systems9, medical centers4, clinical laboratories10, as well as medical QM11. The JPCNMP provides a freely available, open-source tool in data collection for CND of QMSNJ, which achieves the goal of intelligent management. The part of artificial is still in need of QMCNJ to achieve data curation and evaluation. As a result, QMCNJ highlights the importance of the QM data quality assessment by developing and continuously revising the index evaluation standards since its foundation in 2010. Similar to any data analysis service, the most crucial process of JPCNMP is the data quality assessment, which is related to the evaluation of data metrics, the organizational structure of the data, and the overall information management4, 12. Rather than the initial QM system requires artificial analysis of quality control data, it will be more accurate and reliable if an automated framework to effectively manages the quality of JPCNMP`s data in the future.