Integrated Synergistic Governance (ISG) for healthcare service improvement: a longitudinal study in a Chinese public hospital

Abstract Background Public hospitals are core pillars of global public health systems, yet fragmented internal governance tools and limited organizational learning persistently undermine healthcare service quality, safety, and operational efficacy. Existing research has predominantly examined individual governance tools in isolation, with limited empirical evidence on how multiple regulatory tools can be strategically combined to generate synergistic effects in healthcare settings. This study aims to develop and empirically describe the Integrated Synergistic Governance (ISG) framework, examining how four regulatory tools can be strategically coupled to enhance hospital governance. Methods This 7-year longitudinal revelatory case study (2019–2026) examined an integrated internal governance system in a Chinese tertiary public hospital with approximately 600 beds, over 1,000 staff, and an annual outpatient volume exceeding 540,000 visits, coupling four regulatory tools: a grid-based monitoring network, micro-power risk inventory, clean-department evaluation scheme, and data-driven integrity analytics. A sequential explanatory mixed-methods design was used, triangulating policy documents, 16 quarterly integrity reports, departmental panel data, and process-tracing of four decision cycles. Results The four-dimensional ISG framework was developed and empirically described. Quantitative analysis showed associations consistent with sustained improvements: outpatient satisfaction remained high throughout the study period; the declared value of refused gifts showed a declining trend; medical consumable expenditure stabilized after 2024. Process-tracing revealed that 82.6% of evaluation standard revisions (19/23, 2023–2026) were traceable to prior analytics recommendations, suggesting a functional organizational learning loop. Conclusions The ISG framework provides a preliminary model whose design principles may inform adaptive internal control systems in public hospitals. By demonstrating how four discrete regulatory tools can be strategically coupled in a specific institutional context, this study advances healthcare service governance research and offers actionable principles for health policymakers and hospital administrators to consider when strengthening health system resilience and service quality in comparable settings. Further multi-site comparative research is needed to assess generalizability.