Workforce consequences of implementing DRG-based payment reform in China: an explanatory sequential mixed-methods study of hospital consumables managers

Diagnosis-related group (DRG)-based prospective payments are being implemented in China as a value-oriented provider-payment reform intended to promote cost-conscious, standardized care. This study examined how DRG implementation reshaped hospital consumables managers’ roles, perceived risks, organizational adaptation, and job satisfaction, and identified workforce, technological, and organizational factors relevant to implementation. We conducted an explanatory sequential mixed-methods study in three tertiary university-affiliated hospitals in China. A census survey of consumables managers ( n = 140) assessed five domains: changes in job responsibilities, adaptation to organizational change, professional competence and training needs, information systems, and job satisfaction. Measurement properties, correlations, and ordinary least squares regression were examined. Survey findings informed semistructured interviews with 14 purposively sampled managers. Qualitative data were analyzed using Colaizzi’s method and integrated with quantitative findings through joint displays guided by the job demands–resources model. Measurement testing favored the five-domain model, although discriminant validity was only partially supported. After adjustment for the other included domains, adaptation to organizational change (β = 0.386; p < 0.001), professional competence and training needs (β = 0.198; p = 0.017), and information systems (β = 0.412; p < 0.001) were positively associated with job satisfaction, whereas changes in job responsibilities were not significantly associated with job satisfaction (β=−0.076; p = 0.089). Sensitivity analyses indicated substantial shared explanatory variance between adaptation and professional competence and training needs, while the association between information systems and job satisfaction remained relatively stable. Qualitative findings described a shift from supply assurance to cost management, workflow–documentation misalignment, perceived personal accountability for billing and compliance-related problems, and informal workarounds. Participants emphasized interoperable information systems, practice-oriented training, standardized workflows, clearer responsibility boundaries, and cross-departmental coordination. Workforce consequences are an important component of DRG implementation. When technological and organizational support is insufficient, frontline staff may experience greater personal accountability pressure and reliance on individual coping strategies. Aligning payment reform with interoperable systems, practice-oriented training, clear responsibilities, and coordinated organizational support may facilitate more sustainable implementation.