china the new normal case study

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China: The New "New Normal"

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Richard H.K. Vietor

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China: The New Normal

China: The New Normal By: Richard H.K. Vietor
China: The New "New Normal" By: Richard H.K. Vietor and Haviland Sheldahl-Thomason

The “new normal” in US-China relations: Hardening competition and deep interdependence

Subscribe to the china bulletin, ryan hass ryan hass senior fellow - foreign policy , center for asia policy studies , john l. thornton china center , chen-fu and cecilia yen koo chair in taiwan studies, the michael h. armacost chair @ryanl_hass.

August 12, 2021

The intensification of U.S.-China competition has captured significant attention in recent years. American attitudes toward China have become more negative during this period, as anger has built over disruptions resulting from the COVID-19 pandemic, Beijing’s trampling of Hong Kong’s autonomy, human rights violations in Xinjiang, and job losses to China.

Amidst this focus on great power competition, two broader trends in the U.S.-China relationship have commanded relatively less attention. The first has been the widening gap in America’s and China’s overall national power relative to every other country in the world. The second has been the continuing thick interdependence between the United States and China, even amidst their growing rivalry. Even on economic issues, where rhetoric and actions around decoupling command the most attention, trade and investment data continue to point stubbornly in the direction of deep interdependence. These trends will impact how competition is conducted between the U.S. and China in the coming years.

Separating from the pack

As America’s unipolarity in the international system has waned, there has been renewed focus on the role of major powers in the international system, including the European Union, Russia, India, and Japan. Each of these powers has a major population and substantial economic weight or military heft, but as my Brookings colleague Bruce Jones has observed , none have all. Only the United States and China possess all these attributes.

The U.S. and China are likely to continue amassing disproportionate weight in the international system going forward. Their growing role in the global economy is fueled largely by both countries’ technology sectors . These two countries have unique traits. These include world-class research expertise, deep capital pools, data abundance, and highly competitive innovation ecosystems. Both are benefitting disproportionately from a clustering effect around technology hubs. For example, of the roughly 4,500 artificial intelligence-involved companies in the world, about half operate in the U.S. and one-third operate in China. According to a widely cited study by PricewaterhouseCoopers, the U.S. and China are set to capture 70% of the $15.7 trillion windfall that AI is expected to add to the global economy by 2030.

The United States and China have been reinvesting their economic gains to varying degrees into research and development for new and emerging technologies that will continue to propel them forward. While it is not foregone that the U.S. and China will remain at the frontier of innovation indefinitely, it also is not clear which other countries might displace them or on what timeline. Overall, China’s economy likely will cool in the coming years relative to its blistering pace of growth in recent decades, but it is not likely to collapse.

Deep interdependence

At the same time, bilateral competition between the United States and China also is intensifying. Even so, rising bilateral friction has not – at least not yet – undone the deep interdependencies that have built up between the two powers over decades.

In the economic realm, trade and investment ties remain significant, even as both countries continue to take steps to limit vulnerabilities from the other. For example, Chinese regulators have been asserting greater control over when and where Chinese companies raise capital; Beijing’s recent probe of ride-hailing app Didi Chuxing provides but the latest example. China’s top leaders have been emphasizing the need for greater technology “self-sufficiency” and have been pouring billions of dollars of state capital into this drive. Meanwhile, U.S. officials have been seeking to limit American investments from going to Chinese companies linked to the military or surveillance sectors. The Security and Exchange Commission’s scrutiny of initial public offerings for Chinese companies and its focus on ensuring Chinese companies meet American accounting standards could result in some currently listed Chinese companies being removed from U.S. exchanges. Both countries have sought to disentangle supply chains around sensitive technologies with national security, and in the American case, human rights dimensions. U.S. officials have sought to raise awareness of the risks for American firms of doing business in Hong Kong and Xinjiang .

Even so, U.S.-China trade and investment ties remain robust. In 2020, China was America’s largest goods trading partner, third largest export market, and largest source of imports. Exports to China supported an estimated 1.2 million jobs in the United States in 2019. Most U.S. companies operating in China report being committed to the China market for the long term.

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U.S. investment firms have been increasing their positions in China, following a global trend . BlackRock , J.P. Morgan Chase, Goldman Sachs, and Morgan Stanley have all increased their exposure in China, matching similar efforts by UBS , Nomura Holdings , Credit Suisse , and AXA . The Rhodium Group estimates that U.S. investors held $1.1 trillion in equities issued by Chinese companies, and that there was as much as $3.3 trillion in U.S.-China two-way equity and bond holdings at the end of 2020.

One leg of the U.S.-China economic relationship that has atrophied in recent years has been China’s flow of investment into the United States. This has largely been a product of tightened capital controls in China, growing Chinese government scrutiny of its companies’ offshore investments, and enhanced U.S. screening of Chinese investments for national security concerns.

Another area of U.S.-China interdependence has been knowledge production. As U.S.-China technology expert Matt Sheehan has observed , “With the rise of Chinese talent and capital, the exchange of technological know-how between the United States and China now takes place among private businesses and between individuals.” Leading technology companies in both countries have been building research centers in the other. Alibaba , Baidu , and Tencent have all opened research centers in the United States, just as Apple , Microsoft , Tesla , and other major American technology companies rely upon engineering talent in China.

In science collaboration, The Nature Index ranks the joint research between the two countries as the world’s most academically fertile. U.S.-China scientific collaboration grew by more than 10% each year on average between 2015 and 2019. Even following the global spread of COVID-19, American and Chinese experts collaborated more during the past year than over the previous five years combined . This has led to over 100 co-authored articles in leading scientific journals and frequent joint appearances in science-focused workshops and webinars.

China also is the largest source of international students in the United States. In the 2019-20 year, there were over 370,000 Chinese students in the U.S., representing 34% of international students in colleges and universities. Up until now, many of the top Chinese students have stayed in the United States following graduation and contributed to America’s scientific, technological, and economic development. It remains to be seen whether this trend will continue.

Competitive interdependence

The scale of American and Chinese interests implicated will likely induce sobriety over time in Washington and Beijing as to how the relationship is managed. The U.S. policy focus for the foreseeable future is not likely to be seeking to “defeat” China or compel the collapse of the Chinese Communist Party. Rather, the focus will be on taking steps at home and with partners abroad to strengthen America’s long-term competitiveness vis-à-vis China. At the same time, American leaders will continue to push their Chinese counterparts to improve the treatment of their citizens. Such efforts are definitional to America’s self-identity as a champion of values.

The dense webs formed by trade, financial, scientific, and academic links between the United States and China will make it difficult for one side to inflict harm on the other without hurting itself in the process. As Joe Nye has written , “America can decouple security risks like Huawei from its 5G telecommunications network, but trying to curtail all trade with China would be too costly. And even if breaking apart economic interdependence were possible, we cannot decouple the ecological interdependence that obeys the laws of biology and physics, not politics.”

President Joe Biden likely will use the challenges posed by China as a spur for his domestic resilience agenda. He is not an ideologue, though, and is unlikely to limit his own flexibility by painting the world with permanent black and white dividing lines. The Biden team knows it will be harder to realize progress on serious global challenges like climate change, pandemics, and inclusive global economic recovery without pragmatic dealings with non-democratic states.

Major near-term improvements to the U.S.-China relationship are unlikely, barring an unexpected moderation in Beijing’s behavior. At the same time, the relationship is also unlikely to tip into outright hostility, barring an unforeseen dramatic event, such as a Chinese act of aggression against an American security partner.

U.S.-China relations are going to be hard-nosed and tense. Neither side is likely to offer concessions in service of smoother relations. At the same time, the balance of interests on both sides likely will control hostile impulses, placing the relationship in a state of hardening competition that coexists alongside a mutual awareness that both sides will be impacted — for good or ill — by their capacity to address common challenges.

China: the New "New Normal"

By: Richard H.K. Vietor, Haviland Sheldahl-Thomason

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Publication Date: Jun 23, 2016
Discipline: Business & Government Relations
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Home > Books > Proceedings of the 2nd Czech-China Scientific Conference 2016

China’s “New Normal” and Its Quality of Development

Reviewed: 09 November 2016 Published: 01 February 2017

DOI: 10.5772/66791

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Proceedings of the 2nd Czech-China Scientific Conference 2016

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China’s new normal means a new higher stage of development, when an alternative is to improve the quality of economic development instead of accelerating growth rate by expansion policies. And the quality of development is the quality of living of most people. This study is to examine the current situations of China’s quality of development by comparing China’s human development index, inequality indices (Gini, quintile, and Palma), and development potential (human capital index) with the developed countries in Europe, North America, and Oceania, as well as countries with typical traits, such as the Latin American countries, Japan, and Czech Republic; further to put forward China’s policy focuses in the new normal stage according to the concluded research results.

China’s new normal
human development index (HDI)
human capital index (HCI)
quality of life

Author Information

Faculty of Economics, Hebei GEO University, Shijiazhuang, Hebei, China

Haochen Guo

Mengnan zhang.

*Address all correspondence to: [email protected]

1. China’s new normal–a new higher stage

China’s new normal is original from the slowdown of the GDP growth rate in recent years. Graph 1 shows three obvious slowdowns since 1979. The three slowdowns are all accompanying with economic upheavals and big inflations, only the last and current one induces a new concept, “New Normal.”

Graph 1.

Per capita GDP growth China 1979–2014 (1978 constant). Data source: Chinese statistics yearbook 2015: 3–1, 3–5.

In May 2014, President Xi Jinping put forward the “new normal of China’s economy,” and described a series of new performances of China’s economy. On December 5, 2014, the Politburo meeting of the Communist Party of China formally advocated to “take the initiative to adapt to the economic development of the new normal.” Since then, the Chinese economy has entered a “new normal” stage.

Generally, the “new normal” has two characteristics: the first is about the slowdown from high-speed growth to high-middle-speed growth; the second is about the transformation of growth pattern from scale extensive growth to quality and intensive growth [ 1 ]. For the future strategy of Chinese government, there seem also two main streams: one is focusing on the growth speed, while thinking the transformation of growth pattern is given, for they think China need to sustain a growth speed to cross the middle-income trap that is the first priority of China [ 2 – 5 ]; another is to focus on the transformation of growth pattern and growth quality, while keeping the high-middle-speed growth even middle-speed growth [ 1 , 6 , 7 ]. We stand for the second view.

The speed slowdown of China’s economic growth is not a bad thing. First, the growth rate from the high-speed down to high-middle-speed is suitable for China. China’s GDP growth rate of 6.9% and per capita GDP growth rate of 6.3% in 2015, are still high enough in the context of the world (the world average of GDP growth rate is 2.5%, 2015). Second, the slowdown is beneficial from the consideration of the limit of natural resources and serious environmental problems of China, as the environment could no longer sustain the long lasting high-speed growth, even if it is further lower; after all, the ecological environment is the precondition of a country’s sustainable development. Third, as a common sense, high-speed growth is apt to bring economic upheaval, and destroy the stability of development. Hence, in long run, keeping a high-middle-speed is better than high-speed for the sake of stable sustainable development.

Moreover, the speed slowdown is a good signal that indicates China has been entering a new stage of development, when an alternative is to improve the quality of economic development instead of accelerating growth rate by expansion policies. And the quality of development is the quality of living of most people; i.e., we can pay more attentions to most people’s quality of life, as like a developed country’s performances.

In brief, China’s new normal means a new higher stage of development with the pursuit of a developed country. This study is to examine the current situations of China’s quality of development by comparing China’s human development index, inequality indices (Gini, quintile, and Palma), and development potential (human capital index) with the developed countries in Europe, North America, and Oceania, as well as countries with typical traits, such as the Latin American countries, Japan and Czech Republic; further to put forward China’s policy focuses in the new normal stage, so to catch up with the developed countries in quality of development.

2. Material and methods

For comparing the quality of development, we arrange here with representative countries, comparable indicators and methodologies.

2.1. Countries considered

China is a large developing country with the largest population and large land mass in the world, and with socialist nature as its Constitution expressed. The countries as comparing counterparts, we choose mainly concerning: (1) well developed (at least its HDI higher than China’s); (2) relative competent size of territory and population; and (3) representative in different regions and social models. By data testing, 14 countries have been selected as reference countries as follows.

The four countries, Norway, Denmark, Sweden, and Finland, are all Nordic countries, well developed with long-term stable sustainable qualified development, as generally accepted model of ideal society on the globe currently, the “Nordic model,” which have more socialist component, such as generous social welfare and equal opportunity for public services to each family and individual all over the country.

These two countries, Germany and Switzerland, are high developed market economies with more socialist-natures in the “Rhine model,” as major roles in mainland Europe with long-term stable qualified development and good performance in equality aspect.

The two countries, USA and UK, are well-developed market economies, natured as typical capitalist market in the “Anglo-Saxon model,” and once the super powers in different ages.

The country of Australia is on the Oceania, tightly related with China in commercial intercourse; well-developed capitalist economy with sound social welfare as well.

The country of Japan is the next neighbor of China, the first and most developed economy in Asia, and has good performance generally but in depression for a long time in recent years.

The country of Czech Republic is a former socialist country located in central-eastern Europe, with the history of a member of former Soviet Union alliance, and keeps the most equal society record; not well developed but with very high value of human development index (Rank 28 in 2014 in nearly 200 countries).

The three countries, Argentina, Mexico, and Brazil, are also developing countries but capitalist natured in Latin America, ranking forefront of the world in inequality.

2.2. Indicators and methods

The chapter is to examine China’s “new normal” state by comparing related indicators with 14 other countries typically scattered in the world (except Africa). Considering the paper’s international angle, we make comparability and internationalism as the prime principles when selecting indicators utilized. Therefore, all indicators and data as follows are from UNDP, (http://hdr.undp.org) [ 8 ], the exception sources will be marked in addition at the right point.

2.2.1. Human development index (HDI)

The HDI represents a broader definition of well-being and provides a composite measure of three basic dimensions of human development: health (a long and healthy life), education (knowledge), and income (a decent standard of living) [ 9 ]. HDI is the most comparable and available indicator for measuring quality of life among countries.

2.2.2. Inequality indices (Gini, quintile, and Palma)

The World bank emphasizes, “To begin to understand what life is like in a country–to know, for example, how many of its inhabitants are poor–it is not enough to know that country’s per capita income. The number of poor people in a country and the average quality of life also depend on how equally–or unequally–income is distributed” [ 10 ]. The Gini Coefficient is the most frequently used inequality index as “the mean difference from all observed quantities” [ 11 ]. However, the Gini does not capture where in the distribution the inequality occurs. For this reason, other two indicators, quintile ratio, and Palma ratio, are also chosen in the paper, which are more clearly reflect the high income and low income gap, successfully excluding the influence of middle income people.

The quintile ratio (20:20 or 20/20 ratio) compares how much richer the top 20% of populations are to the bottom 20% of a given population, which is actually a part of the Gini Coefficient that prevents the middle 60% statistically obscuring inequality, meanwhile highlighting the difference between two poles.

The Palma Ratio, meaning the ratio of the top 10% of population’s share of gross national income (GNI), divided by the poorest 40% of the population’s share of GNI–could provide a more policy-relevant indicator of the extent of inequality in each country, and may be particularly relevant to poverty reduction policy. It is based on the work of Chilean economist Jose Gabriel Palma who found that the “middle classes” tend to capture around 50% of national income, while the other half is split between the richest 10% and poorest 40% [ 12 ].

2.2.3. Human capital index (HCI)

“A nation’s human capital endowment–the skills and capacities that reside in people and that are put to productive use–can be a more important determinant of its long-term economic success than virtually any other resource. This resource must be invested in and leveraged efficiently in order for it to generate returns–for the individuals involved as well as an economy as a whole” [ 13 ].

Graph 2 is drawn to show the relations among human development index and its three components, human, capital, and equality. Here, we emphasize that the HDI includes HCI, which account for two-thirds of HDI, even though education and health are not the whole HCI, but at least the major aspects; education and health are both capabilities residing in people, which is directly related to a person’s income and in social level to both quantity and quality of economic development; Equalization and justice are important complement of HDI, which also have promoting effects on people’s education and health by its benefiting mostly to the general public. That is, HDI, HCI, and equality are interrelated and tend to promote along the arrow directions, which constitute and cooperate the quality of development/quality of life.

Graph 2.

The promoting relations of equality, human capital, and human development.

All data used are registered in official sources. The international data for comparing among countries are from international organizations, UNDP. The method used in the chapter is mostly comparative analysis approaches with statistical graphs and tables.

3. Experimental

Here, we examine for comparing China’s quality of development with the representative countries by using the three serials indicators; and conduct comprehensive comparative analysis and evaluation.

3.1. Human development and living quality

3.1.1. hdi overall status.

Graph 3 shows the level of human development index of the 15 countries selected with various colors, which implies the overall quality of development and quality of life of different country groups. China is at the bottom of the row, ranked 90th in the world, and approximately accounts for 77% of the highest valued country, Norway; 79% of the United States, the typical capitalist country; and 82% of Japan, Asia’s most developed country. That means we have a long distance to go in quality of life.

Graph 3.

HDI in world context 2014.

Table 1 shows the overall level of HDI of four level groups, and the world and the developing countries. China, the second biggest economy in the world, is nearly 20% less than the level of the first 50 countries, and just at the average level of the world in quality of life.

Table 1.

Overall level of human development in different groups 2014.

3.1.2. HDI components

In Annex Table 1 , we make HDI and its component indicators in order respectively and make a sum rank in order to see the influence of each component. From Annex Table 1 and Graph 4 , we notice first that the general pattern does not change: (1) the upper ranked 8 countries are still upper but with changed ranks; (2) the lower seven countries are lower by the same rank with HDI order; (3) China retains at its bottom position by reordering, including total rank and almost all component cases (life expectancy of China is the only factor that does not row at the extreme bottom, which might somehow show off the medical condition or Chinese traditional medicine).

Graph 4.

Components of HDI by GNI order 2014.

Moreover, we find some prominent features in Annex Table 1 and Graph 4 : (1) Both Germany and UK’s re-ranks are upper by the same factor, “mean years of schooling” showing social sustainability, which imply the labor force and the civilized residents endowed by education; UK in Anglo-Saxon model with capitalist nature, has the similar pattern (8:1:8) with Germany (6:1:6) in “Rhine model,” but far from the pattern of USA (10:4:3); Czech Republic (with similar pattern 11:8:11) rows upper also by its “mean years of schooling,” which means education gains much attention in Czech as well. (2) Australia (3:3:7) has almost the opposite pattern with USA, but with better momentum of development in practical economy than USA. (3) The life expectancy order of Japan is at the first, which might reflect Japanese life style is very healthy.

3.2. Inequality

Equalization and justice are important complement of HDI, so we here analyze income inequality standing for measuring social equality and justice, although which is far from comprehensive but essential and quantitative. According to the data of the National Bureau of Statistics, China’s Gini coefficient has ever peaked to 49.1 in 2008, began to decline since 2010, to 46.9 in 2014, along with policy’s functioning.

Graph 5 shows that, in the Gini coefficient case, China (2014) performs better than the three Latin countries and the two typical capitalist countries, USA and UK. However, the quintile ratio that shows the polarization in income distribution by the top 20% to the bottom 20%, has different performance: China’ s value of quintile ratio is only better than that of the three Latin countries but worse than USA and UK, and far worse than other countries included; The Palma ratio, the richest 10% of population’s share of gross national income divided by the poorest 40%’s share, provides support to the quintile’s case.

From the computing results in Table 2 , we can see more clearly that China’s polarization in income distribution, i.e., the highest income group to the lowest, excluding the influence of middle income people is conspicuous worse than the Gini performance with the influence of middle income populations included, by observing the deviations from the average of the 15 countries considered.

Graph 5.

Income inequalities by Gini order 2014.

Table 2.

Fifteen countries’ comparison of income inequality by Gini Order 2014.

Of course, the income inequality in three Latin countries show much worse cases than in China; and their polarization is even much worse than their Gini case as well. That is probably the reason why the Latin countries could not performance better with so much endowment of natural resources. Therefore, equality and social justice in China as institutional environment given by the government should improve continuously for the sake of promoting the living quality of the people.

In addition, China is a socialist country as its Constitution expressed, and in case any adverse effect happens, it is very necessary for China to have higher pursuit in equality and social justice, e.g., reach to 35/7/1.5 (Gini/quintile/Palma), equivalently the average level of listed 15 countries, close to the level of UK (38/7.6/1.7) or Australia (34/5.9/1.3), as the minimum pursuits in 5–10 year, from 37/10/2, the currently level of China by the inequality index.

3.3. Human capital

Generally observing the history and experiences of all developed countries, it is common nature that every country pays enough attention to two factors: labor force and ecological environment, which are two bases of a human society. We here focus on labor force only for which is the most active factor for social economic development, though ecological environment is a big problem in China.

A group of American economists, such as Gary S. Becker, T. W. Schultz, George J. Stigler, Milton Friedman, etc., advocate the concept “human capital” to describe the quality of labor force [ 14 ]. Now, that the concept of human capital has been widely spread and accepted, and for the sake of comparing the quality of labor force internationally, we take the advantage of data availability to use it, even though we are a bit shy to treat labors as capital.

3.3.1. Human capital index and its aging structure

From Graph 6 , we can see that China’s human capital level rows at the lowest position in the other 14 countries, and upper than Brazil. In aging structure, it seems a common problem currently for all other 14 countries but China. In fact, the aging issue in China is becoming a problem because of China’s one-child policy which lasted 35 years. So, it becomes urgent to promote the quality of labors, if given the labor force participation and employment rate.

Graph 6.

Human capital index and its structure by overall order 2015.

3.3.2. Labor force participation and employment

China has no doubt the best performance both in labor force participation and employment ( Graph 7 ). Then, we see the quality of labor, for “education and training are the most important investments in human capital” [ 14 ].

Graph 7.

Employment and labour force paticipationparticipation by unemployment order

3.3.3. Education efficiency

From 15-year-old students’ performance in 2012, we find that the quality of labor force in China is worth optimistic for the future. But on second thought, Chinese is so diligent and smart that China should have the highest quality of development, but China’s HDI is at the 90th position, just at the middle level of the world. Why? There might be many reasons involved, may we have another paper to discuss the issue for the limit of article length.

4. Results and conclusions

From what has been discussed above, we conclude the following results:

Equalization and justice are important complement of HDI; The HDI includes HCI; The two major parts of HCI, education and health, are both capabilities residing in people, which directly related to a person’s income and in social level to both quantity and quality of economic development, and directly benefited from equalization and justice; Hence, HDI, HCI, and equality are inter relatedly constitute and cooperate the quality of development/quality of life. ( Graph 2 ) The economy (income) is the business of market, while the education and health of labors and the income distribution should be supervised and guaranteed by the government; that is to say that the quality of life should be achieved by the combination of government and market.

The overall level of HDI in China is nearly 20% less than the level of the first 50 countries, and just at the average level of the world in quality of life. Among the selected 15 countries, China is at bottom of the row, ranked 90th in the world, and approximately accounts for 77% of the highest valued country, Norway; 79% of the United States, the typical capitalist country; and 82% of Japan, the Asian most developed country. That means we have a long way to go in quality of life ( Table 1 , Graph 3 ).

Both Germany and UK have best performance in “Mean years of schooling,” which implying the labor force and the civilized residents endowed by education; UK in Anglo-Saxon model with capitalist nature, has the similar pattern (8:1:8, means rank of health/education/economy) with Germany (6:1:6) in “Rhine model,” but far from the pattern of USA (10:4:3); Czech Republic (with similar pattern 11:8:11) rows upper also by its “Mean years of schooling,” which means education gains much attention in Czech as well. Australia (3:3:7) has almost the opposite pattern with USA, but with better momentum of development in practical economy than USA. China should not take the model of USA, but learn more from Germany, UK and Australia, and Czech, that is, pay more attention to education for a civilized society in the future (Annex Table 1 ).

In the Gini coefficient case, China (2014) performs better than the three Latin countries and the two typical capitalist countries, USA and UK; China’ s quintile ratio is only better than that of the three Latin countries but worse than USA and UK; The Palma ratio provides support to the quintile’s case. That is, China’s polarization in income distribution is conspicuous worse than the Gini performance with the influence of middle income populations included. Hence, we should concern more of the low income groups ( Graph 5 , Table 1 ).

The income inequality of three Latin countries shows much worse cases than in China, and their polarization is even much worse than their Gini case as well. Serious inequality cannot bring a developed economy from the lesson of Latin countries. Therefore, equality and social justice in China as institutional environment given by the government should improve continuously for the sake of promoting the living quality of the people ( Table 1 ).

China is a socialist country as its constitution expressed, and in case any adverse effect happens, it is very necessary for China to have higher pursuit in equality and social justice, e.g., reach to 35/7/1.5 (Gini/quintile/Palma), equivalently the average level of listed 15 countries, close to the level of UK (38/7.6/1.7) or Australia (34/5.9/1.3), as the minimum pursuits in 5–10 years, from 37/10/2, the currently level of China by the inequality index ( Table 1 ).

China’s human capital Index row at the lowest position among the countries, only better than Brazil’s ( Graph 6 ). But as the positive factor of HCI, China has the best performance in all 15 countries both in labor force participation and employment ( Graph 7 ). From 15-year-old students’ performance in education efficiency in 2012, the quality of labor force in China is worth optimistic for the future ( Graph 8 ). Therefore, China has its advantages in human capital, and furtherly in the potential of development.

It is possible to achieve better growth speed while we are focusing on the quality of development.

Graph 8.

Education quality by order of science 2012 (Pperformance of 15-year-old student).

Acknowledgments

The authors would like to thank Dr. Tomáš Wroblowský, VSB, Czech Republic, for his feedback and suggestions regarding data and the quantitative methodologies used in the chapter.

We would also like to thank anonymous referees for their valuable comments and corrections to our English writing.

We would like to express our gratitude to both Social Science Foundation (Serial No: HB15LJ002), funded by Hebei Programming Office for Philosophy and Social Science, China, and Soft Science Foundation (Serial No: 16457699D), funded by Hebei Bureau of Science and Technology, China, for providing us with research funds.

The research is supported by the SGS project of VŠB-TU Ostrava Czech Republic under No. SP2016/11.

JEL classification: E6, F5, F6, O15, O5

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© 2017 The Author(s). Licensee IntechOpen. This conference paper is distributed under the terms of the Creative Commons Attribution 3.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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New normal and new economy: a new growth engine for China

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Population and Economic Development in East Asia 2
Published: 31 March 2020
Volume 14 , pages 301–312, ( 2020 )

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Yusaku Nishimura 1

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As the economy stepped into the “new normal,” the Chinese government has implemented various policies to transform its economic development model to pursue an innovation-driven growth. Against this background, the most innovating field is the Internet-based “new economy.” A major feature of the Chinese new economy is that it is based on a new payment system. Various new businesses have been developed owing to third-party payment platforms (particularly Alibaba's Alipay and Tencent's WeChat Pay) and a vast ecosystem has been created around them. Moreover, the development of the Chinese new economy is helping to expand consumer spending and is becoming a new economic growth engine.

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The Post-WTO Era: NGEs’ New Development and the Sustained Rapid Growth of China’s Economy

Introduction

China’s transfer payment mechanism: A case study

The keynote speech was titled “Seek Sustained Development and Fulfill the Asia-Pacific Dream.” Full text is available at the official website of the Ministry of Foreign Affairs of the People's Republic of China ( https://www.fmprc.gov.cn/mfa_eng/topics_665678/ytjhzzdrsrcldrfzshyjxghd/t1210456.shtml ).

China implemented the two-child policy in 2016, however, potential impacts of this policy on labor supply was limited. Zhang [ 9 ] estimates the working-age population scale and forecasts the trend of scale and structure of labor supply in China between 2018 and 2050. Four scenarios were estimated: the total fertility rate could not change (1.5), experience a low growth (between 1.6 and 1.7), a mid-sized growth (between 1.8 and 1.9) or a high growth (between 1.9 and 2.0). The results show that the future labor supply in China decreased under all four total fertility rate scenarios.

The negative impact on economic growth generated by the working-age population decline is a global phenomenon. Manyika et al. [ 4 ] points out that the declining working-age population share implies a 19 % decrease in per capita income growth over the next 50 years.

Although China’s corporate debt-to-GDP ratio has fallen since 2016 (peaking at 142 % of GDP), it remains one of the highest in the world (see [ 1 ] for details).

Through a simulation analysis, [ 3 ] found that both improvement in TFP and in labor force participation can increase the potential GDP growth rate of China. However, the policies for increase in labor force participation have only short-term effects. By contrast, policies aimed to improve TFP can enhance the potential GDP growth rate over a long period.

In a report on the work of the government, Chinese Premier Li Keqiang mentioned “We should strive to achieve major breakthroughs in basic research, applied research, and research in strategic and frontier fields by 2020. China's investment in research and development is expected to reach 2.5% of GDP, and the contribution of scientific and technological advances toward economic growth should come to reach 60%.” Full text is available at the official website of the National People's Congress of the People's Republic of China ( https://www.npc.gov.cn/englishnpc/c2866/201603/8432092de21b4ea3a019d443a1fce93d.shtml ).

In an executive meeting held in March 2015 to discuss the implementation of new guidelines, Chinese Premier Li Keqiang stated: “We will implement the Made in China 2025 strategy to seek innovation-driven development, apply smart technologies, strengthen foundations, pursue green development, and redouble our efforts to upgrade China from a manufacturer of quantity to one of quality” ([ 2 ], p.54). For a comparative study of Made in China 2025 and Germany's Industry 4.0, see also [ 7 ].

A document regarding the implementation of the “Internet Plus” strategy was approved on June 24, 2015. The government pledged to encourage national innovation platforms to open up to enterprises, especially small and medium-sized ones (For more details, see the official website of the State Council the People’s Republic of China, https://english.www.gov.cn/2016special/internetplus/ ).

See [ 8 ] for details.

This paper used the exchange rate of 6.8841 RMB per US dollar (31 July 2019). The exchange rate data were obtained from the People’s Bank of China.

“Overseas talents help China shift growth pattern” by China Daily (April 12, 2012). For more detailed information about the “Thousand Talents Plan , ” see the official website of the Recruitment Program of Global Experts ( https://www.1000plan.org.cn/en/ ).

A third-party payment platform is an independent agency with the necessary strength and reputation to protect the transaction payment. When performing a transaction, the user buys a commodity and pays the purchase through a third-party payment platform which should inform the seller that the goods were shipped immediately after the receipt of payment (see also [ 10 ]).

Tencent’s third-party payment system is called “Tenpay . ” Therefore, strictly speaking, WeChat Pay is part of Tenpay. For convenience, this paper would refer to “WeChat Pay” as the Tencent’s third-party payment system.

China’s per capita credit card numbers are still relatively low. In fact, there are 711 million cards in China, which means an average of 0.51 cards per person in the second quarter of 2019. (Data source: People’s Bank of China).

For a more detailed explanation about Chinese new economy, see [ 5 ].

In 2009, the total retail sales of consumer goods were 1.33 trillion CNY (193 million USD).

At the end of 2018, the personal consumption expenditures’ share of GDP reached 68.0 % in the U.S. (Data source: U.S. Bureau of Economic Analysis).

In 2018, the proportion of the national online retail sales including both goods and services reached 23.6%.

International Monetary Fund (2019), People's Republic of China, IMF Country Report, No. 19/274.

Liu, S. X. (2016). Innovation design: made in China 2025. Design Management Review, 27 (1), 52–58.

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Nishimura, Y. (2019). The cashless nation: the light and shadow of the Chinese new economy . Tokyo: Bunshun Shinsho. ( in Japanese ).

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Acknowledgements

The author wishes to thank Yoji Taniguchi, Hiroshige Tanaka and seminar participants at the 18th International Conference of the Japan Economic Policy Association for helpful comments.

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Nishimura, Y. New normal and new economy: a new growth engine for China. IJEPS 14 , 301–312 (2020). https://doi.org/10.1007/s42495-020-00037-y

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Home > The Governance of China > The Governance of China II > The New Normal of Economic Development

The New Normal: How to Respond and Adapt

Xi Jinping: The Governance of China II Updated: 2021-12-24

The New Normal: How to Respond and Adapt*

December 18, 2015

How should we respond to the new normal? China's economic development is now in the new normal. This conclusion is drawn from analyzing the world economic cycle, China's development stage, and the interaction between the two. This conclusion has been widely recognized by the rest of the world. According to the IMF, China's economic development is in the new normal, so is global economic development. We must act as the conditions permit. As the Chinese economy is in a stage of shifting the growth rate, restructuring the economy, and addressing the impact of previous incentive policies, we should see the new normal from the following perspective.

First, we must have a correct and full understanding of China's economic development. An ancient scholar said, "Everything exists for a reason." 1 The growth pattern in our country is evolving from an extensive economy to an intensive economy; the division of labor is changing from simple to complex. This is an objective law, and we cannot go against it no matter what we think. The extensive economy once played a great role in accelerating China's economic growth. But now neither the domestic nor international environment allows China to maintain this mode of unsustainable economic development. If we do not change it, we will hit the buffers. We must be fully aware of this point.

To release the great potential and strengths of the Chinese economy, we must move faster in changing the growth model, restructuring the economy, and fostering new growth drivers. By changing the economic growth pattern, we can realize sustained and higher-level development. This is essential if a middle-income country is to skip the middle-income trap. I have emphasized repeatedly that we must escape the Thucydides Trap and the middle-income trap. The former is related to the political sphere – we should carefully tackle the relationships with other major countries such as the United States. The latter is about the economy – we must improve the quality and effectiveness of economic growth. The latter was emphasized at the Fifth Plenary Session of the 18th CPC Central Committee in 2015, and we were required to change the economic growth model and restructure the economy more quickly.

We should have a deeper understanding of this complicated stage of economic development and the new normal, abandon the old ways of thinking and approaches that were pursued to realize rapid growth, and align our thoughts and actions with the decisions, policies, and plans made by the Central Committee.

Second, we must overcome difficulties and pass through this critical stage of economic development. We should see the Chinese economy dialectically. On the one hand, it is basically positive, having great potential, being tenacious and adaptive, with strong new growth drivers and new forms of businesses emerging; many industries in numerous regions are witnessing gratifying changes and have a promising future. On the other hand, it is also facing difficulties and challenges, especially structural overcapacity.

After the founding of the PRC in 1949, the CPC promoted industrialization. In spite of all its difficulties, China laid the early foundations for industrialization. Since reform and opening up began in 1978, China's capacity has boomed in all industries. Much of this capacity was achieved during the golden era of global economic growth to meet international demand, and in a period of rapid domestic growth. To respond to the shock of the global financial crisis in 2008, capacity in some industries was inflated. Now, as technological change accelerates and the consumption model updates, while international market growth is slowing, much of China's industrial capacity has peaked. Some capacity cannot find markets, while production costs are rising, resulting in the decline of the marginal profit ratio and the average profit ratio in the real economy. China is not the only case in the world. It is for this reason that a large amount of finance is flowing to the virtual economy. This causes expanding asset bubbles, emerging financial risks, and poor overall circulation of production, products, distribution, and consumption.

This is an inevitable historical stage. As long as we accelerate reform and innovation, we will pass through it successfully. If we fail to make strategic adjustments at this critical moment, fail to get rid of the old and build the new, we will not cross this hurdle, and the accumulated problems will hinder the realization of the overall objective.

Third, we must be bold in promoting reform and innovation. The difficulties and problems we are facing were indeed partially caused by the global financial crisis, but there are root causes that play a decisive role. These are the supply-side, structural, and institutional conflicts. We should free our minds, be realistic, and keep pace with the times. Upholding the philosophy of innovative, coordinated, green, open, and inclusive development, we should create new theories on innovation, devise far-sighted policies, strengthen structural reform, reallocate misplaced factors of production, increase effective supply, make the supply structure more adaptive and flexible, and improve total factor productivity.

Our current problems are not periodic and we cannot trigger a V-shaped rebound through short-term stimulus. The phase of L-shaped growth for China might be long. We must be ready for a time-consuming process, be ready for hardships and setbacks, be reasonable in our expectations while the growth rate shifts, and wait for the growth rebound. We should confront difficulties, stay on the right course, remain confident, and work together to foster greater institutional impetus and vitality, thereby releasing our great potential for economic growth and bringing the economy to a higher level of development.

How should we adapt to the new normal? Specifically, we should shift the focus of our work in the following respects.

First, we should promote economic development by improving quality and effectiveness. The measurements for this are returns on investment, markets for products, profits for enterprises, income for employees, tax revenues for government, and an improved environment. This is the development we are expecting. We need a reasonable growth rate. In addition, the measurement of economic achievement should be changed from high growth rate to high development quality and effectiveness.

Second, we should ensure steady growth by promoting supplyside structural reform. During this stage of shifting the growth rate, restructuring the economy, and addressing the impact of previous incentive policies, the problems hindering growth are not only about economic aggregate but also structural conflicts. Since effective supply cannot adapt to the changes of aggregate demand and structure, to maintain steady growth, we must expand aggregate demand and adjust the demand structure to a proper extent, and at the same time, promote supply-side structural reform, so as to achieve highlevel balance between supply and demand.

Third, we should implement macroeconomic control by imposing positive influence on market. When carrying out macroeconomic control, we should pay close attention to and guide market anticipation and realize counter-cyclical goals. We should study the market anticipation and social mentality hidden in consumption and investment behavior, reflect on the features of market behavior of major actors, increase policy transparency and predictability, communicate and reach consensus with major actors of market behavior, strengthen international exchanges on these policies, and make macroeconomic control more reasonable and adaptive.

Fourth, we should employ multiple means to restructure industries. As capacity in many industries has reached its peak, if we do not reduce it and allow prices to fall steadily, competitive enterprises might collapse. We should encourage economic increment and foster new growth impetus; we should take the initiative to reduce over-capacity and weed out inferior capacity so as to realize the principle of the survival of the fittest; we should promote innovation as the primary driving force for development, implement important technology projects, make breakthroughs in key technologies, boost high-tech economic development, and increase productivity and the returns on investment. We should strengthen vocational training to improve the quality and structure of human resources.

Fifth, we should advance urbanization by putting people first. The essence of urbanization is to bring more people to settle in urban areas. We should encourage those rural households which are capable of maintaining a stable job and life in urban areas to relocate there. In this way, we can achieve a steady increase in the labor supply, reduce the pressure of the rising labor cost, and expand consumption in real estate and other fields. This is also the fundamental solution to narrow the urban-rural gap, promote urban and rural integration and agricultural modernization.

Sixth, we should promote regional development with a spatial balance between population, the economy, resources, and the environment. We should balance the economy and population between regions, and narrow the regional gap of per capita GDP; we should also ensure that the capacity of resources and environment is able to support regional economies and populations, and narrow the gap between the two. According to the regional zoning plan, we should coordinate development between geographical areas by ensuring that factors of production move freely and in a well-ordered way, principal zoning is effectively implemented, basic public services are equally available, and neither environmental nor resource carrying capacity is exceeded.

Seventh, we should protect the environment and form green production models and consumption patterns. To preserve our green mountains and clear waters, we should tackle ecological problems at source and foster endogenous impetus. We should proceed on the path of green, circular, and low-carbon development, build a green industrial system and spatial pattern, encourage green ways of production and life, and promote harmonious coexistence between man and nature.

Eighth, we should improve the people's wellbeing, taking targeted measures to help specific groups with special difficulties. On the basis of economic development, we should increase the quantity and quality of basic public services such as education and healthcare, and promote equal access to education. To take targeted measures to help specific groups, we should spend funds in addressing their particular problems, providing them with a sense of gain, and ensuring that their capability to develop will improve and be passed on to future generations.

Ninth, we should enable the market to play a decisive role in resource allocation. We should value and release the vigor of micro units. The government should intensify its efforts to do things that cannot be done by the market, and fulfill its responsibilities on macroeconomic control, market supervision, public services, social management, and environmental protection.

Tenth, we should open wider to the outside world, in particular by promoting high-level mutual opening. We should remain committed to the mutually beneficial strategy of opening up, coordinate domestic and external demand, balance imports and exports, give equal importance to bringing in and going global, attract investment, technology, and outstanding professionals, take an active part in global economic governance and the supply of public goods, and have more say in the formulation of global rules.

To sum up, it is essential that we adapt to the new normal. Supply-side structural reform is an ideal innovative means of doing this. It is also the choice we have made to adapt ourselves to the new demands of international competition in the aftermath of the global financial crisis. Let us work together to achieve this goal.

* Excerpts from the speech at the Central Conference on Economic Work.

Notes

1 Ye Shi: Comments on the Pre-Qin Classics (Xi Xue Ji Yan Xu Mu) . Ye Shi (1150-1223) was a thinker and writer of the Southern Song Dynasty.

(Not to be republished for any commercial or other purposes.)

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The New Normal: How to Respond and Adapt

The New Normal: How to Respond and Adapt*

December 18, 2015

First, we must have a correct and full understanding of China's economic development. An ancient scholar said, "Everything exists for a reason." The growth pattern in our country is evolving from an extensive economy to an intensive economy; the division of labor is changing from simple to complex. This is an objective law, and we cannot go against it no matter what we think. The extensive economy once played a great role in accelerating China's economic growth. But now neither the domestic nor international environment allows China to maintain this mode of unsustainable economic development. If we do not change it, we will hit the buffers. We must be fully aware of this point.

How should we adapt to the new normal? Specifically, we should shift the focus of our work in the following respects.

* Excerpts from the speech at the Central Conference on Economic Work.

(Not to be republished for any commercial or other purposes.)

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Research on Cross-Industry Digital Transformation Under the New Normal: A Case Study of China

With the rapid development of cloud computing, big data, artificial intelligence, 5G and other digital technology, the digital wave characterized by digital networking, information and intelligence has swept the world (Cloud Computing and big data Research Institute of China Academy of Information and Communications, 2021). In addition, the COVID-19 epidemic has also accelerated the process of digital transformation. Opinion papers (Fletcher & Griffiths, 2020), reports of advisory and opinion-makers (UN opinion Governors 2020 McKinsey Digital, 2020), and statements of respected personalities from the worlds of science and business (Martin-Barbero, 2020) have confirmed that the COVID-19 pandemic has undoubtedly led to organizational change, forced a redefinition of business strategy, and acted as a catalyst for digital transformation in many areas of the economy, health care, and education (Renata, 2020). By 2020, the global digital economy has accounted for more than 40% of GDP (Figure 1). The digital economy has become an important power source of world economic growth and the trend of digitization has been irresistible.

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China: the new normal change management analysis & solution, hbr change management solutions, leadership & managing people case study | richard h.k. vietor, haviland sheldahl-thomason, case study description.

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What is Change Management Definition & Process? Why transformation efforts fail? What are the Change Management Issues in China: The New Normal case study?

According to John P. Kotter – Change Management efforts are the major initiatives an organization undertakes to either boost productivity, increase product quality, improve the organizational culture, or reverse the present downward spiral that the company is going through. Sooner or later every organization requires change management efforts because without reinventing itself organization tends to lose out in the competitive market environment. The competitors catch up with it in products and service delivery, disruptors take away the lucrative and niche market positioning, or management ends up sitting on its own laurels thus missing out on the new trends, opportunities and developments in the industry.

What are the John P. Kotter - 8 Steps of Change Management?

Eight Steps of Kotter's Change Management Execution are -

1. Establish a Sense of Urgency
2. Form a Powerful Guiding Coalition
3. Create a Vision
4. Communicate the Vision
5. Empower Others to Act on the Vision
6. Plan for and Create Short Term Wins
7. Consolidate Improvements and Produce More Change
8. Institutionalize New Approaches

Are Change Management efforts easy to implement? What are the challenges in implementing change management processes?

According to authorlist Change management efforts are absolutely essential for the surviving and thriving of the organization but they are also extremely difficult to implement. Some of the biggest obstacles in implementing change efforts are –

Change efforts are often targeted at making fundamental aspects in the business – operations and culture. Change management disrupts are status quo thus face opposition from both within and outside the organization.
Change management is often a lengthy, time consuming, and resource consuming process. Managements try to avoid them because they reflect negatively on the short term financial balance sheet of the organization.
Change efforts create an environment of uncertainty in the organization that impacts not only the productivity in the organization but also the level of trust in the organization.
Change efforts are often made by new leaders because they are chosen by board to do so. These leaders often have less trust among the workforce compare to the people with whom they were already working with over the years.
Change management efforts are made when the organization is in dire need and have fewer resources. This creates silos protection mentality within the organization.

China: The New Normal SWOT Analysis, SWOT Matrix, Weighted SWOT Case Study Solution & Analysis

How you can apply Change Management Principles to China: The New Normal case study?

Leaders can implement Change Management efforts in the organization by following the “Eight Steps Method of Change Management” by John P. Kotter.

Step 1 - Establish a sense of urgency

What are areas that require urgent change management efforts in the “ China: The New Normal “ case study. Some of the areas that require urgent changes are – organizing sales force to meet competitive realities, building new organizational structure to enter new markets or explore new opportunities. The leader needs to convince the managers that the status quo is far more dangerous than the change efforts.

Step 2 - Form a powerful guiding coalition

As mentioned earlier in the paper, most change efforts are undertaken by new management which has far less trust in the bank compare to the people with whom the organization staff has worked for long period of time. New leaders need to tap in the talent of the existing managers and integrate them in the change management efforts . This will for a powerful guiding coalition that not only understands the urgency of the situation but also has the trust of the employees in the organization. If the team able to explain at the grass roots level what went wrong, why organization need change, and what will be the outcomes of the change efforts then there will be a far more positive sentiment about change efforts among the rank and file.

Step 3 - Create a vision

The most critical role of the leader who is leading the change efforts is – creating and communicating a vision that can have a broader buy-in among employees throughout the organization. The vision should not only talk about broader objectives but also about how every little change can add up to the improvement in the overall organization.

Step 4 - Communicating the vision

Leaders need to use every vehicle to communicate the desired outcomes of the change efforts and how each employee impacted by it can contribute to achieve the desired change. Secondly the communication efforts need to answer a simple question for employees – “What it is in for the them”. If the vision doesn’t provide answer to this question then the change efforts are bound to fail because it won’t have buy-in from the required stakeholders of the organization.

Step 5 -Empower other to act on the vision

Once the vision is set and communicated, change management leadership should empower people at every level to take decisions regarding the change efforts. The empowerment should follow two key principles – it shouldn’t be too structured that it takes away improvisation capabilities of the managers who are working on the fronts. Secondly it shouldn’t be too loosely defined that people at the execution level can take it away from the desired vision and objectives.

China: The New Normal PESTEL / PEST / STEP & Porter Five Forces Analysis

Step 6 - Plan for and create short term wins

Initially the change efforts will bring more disruption then positive change because it is transforming the status quo. For example new training to increase productivity initially will lead to decrease in level of current productivity because workers are learning new skills and way of doing things. It can demotivate the employees regarding change efforts. To overcome such scenarios the change management leadership should focus on short term wins within the long term transformation. They should carefully craft short term goals, reward employees for achieving short term wins, and provide a comprehensive understanding of how these short term wins fit into the overall vision and objectives of the change management efforts.

Step 7 - Consolidate improvements and produce more change

Short term wins lead to renewed enthusiasm among the employees to implement change efforts. Management should go ahead to put a framework where the improvements made so far are consolidated and more change efforts can be built on the top of the present change efforts.

Step 8 - Institutionalize new approaches

Once the improvements are consolidated, leadership needs to take steps to institutionalize the processes and changes that are made. It needs to stress how the change efforts have delivered success in the desired manner. It should highlight the connection between corporate success and new behaviour. Finally organization management needs to create organizational structure, leadership, and performance plans consistent with the new approach.

Is change management a process or event?

What many leaders and managers at the Normal Casename fails to recognize is that – Change Management is a deliberate and detail oriented process rather than an event where the management declares that the changes it needs to make in the organization to thrive. Change management not only impact the operational processes of the organization but also the cultural and integral values of the organization.

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China â€“ The New Normal Case Solution & Answer

Home » Case Study Analysis Solutions » China â€“ The New Normal

Question: How has China performed since its accession to the World Trade Organization?

China, under the leadership of the Moo Zedong, faced many complications domestically, and its ideology was based on Marxism-Leninism alongside Chinese revolution.On the other hand, the approach of Mao structured the country into a government controlled production and prices. However, Maoâ€™s leadership faced many negative campaigns which led to the Great Leap Forward and resulted in millions of deaths in the country. Hence, Mao backed from his responsibilities and handed over to the senior leader, Deng Xiaoping.

Similarly, following the death of Mao, Deng became thenewleader of the Peopleâ€™s Republic of China, and he immediately took the export-led strategy to grow in the market. On the other hand, Deng the initiated the agriculture support program to feed its growing population on priority basis through the household responsibility system. In this system, thegovernment leased the land to the farmers and asked them to sell products in the market. It brought many incentives and doubled the agriculture output in the country, and through this way, China becameself-sufficient to feed its population.

Furthermore, the government performed well to adhere to its export-led country, and it further directed the Township and village enterprises (TVEâ€™s) to produce simple products for the exports.Due to these reasons, TVEâ€™s grew annually by 9% between 1978 and 1996, and it employed 135 million people.Apart from that, after 15 years of negotiations with the WTO authorities, China entered WTO, but at some agreed reforms in the country to facilitate foreign enterprise, free trade, and increased transparency of the Chinese law.

Similarly, Chinaincreased its sales of goods and products in the market to facilitate the foreign companies, and it also provided national treatments to the foreign banks, as well as it increased the transparency in laws and regulations. However, these restrictions did not prevent China from becoming the worldâ€™s largest exporting country in 2009. Similarly, China went on to follow as imposed by WTO, as well as it focused on the theft of intellectual property. Additionally,a study identified that China is the largest producer of replicated products, and that it copies foreign patents. Moreover, China was athird largest country in the world for aninternational patent filer in 2014.

China has the unconventional approach towards export growth rather than free trade, openness to trade, and planned economy.Nonetheless,its exports were three times larger than per-capita income, which included electronic items and auto parts. Moreover, since 2001 to 2014, the exports of Chinaincreased by 15%, which made Chinathe worldâ€™s largest trade surplus of $595 billion in 2015, however that surplus was not because of export, but it was also due to the decrease in the imports.Aside from the growth of the country, China controls all the capital account transactions including the capital market securities, commercial and financial credits, real estate transactions, and direct investment as well. This resulted in capital inflow in the country, however there was aninsignificant capital outflow. Consequently, Chinaâ€™s foreign exchange reserves increasedsignificantly due to which, China is one of the largest US Treasury bill holders.Apart from that, after its entry into the world trade organization, it performed well in the trade and FDI in the country…………….

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Fordham University China the New Normal Case Study

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Assigned HBS case reading: China: the new normal

Based on Exhibit 1 which provides 1997-2019 data identify the changes during this period for the following variables:

1. Real per capita GDP change

2. Change in the composition of GDP, that is, Consumption, Investment, Government spending, Exports-Imports

3. Change in the structure of the economy, that is, Agriculture, Industry and Services

4. Foreign reserves

5. Real exchange rage

Based on these statistics, discuss briefly the key changes in China’s economy during the 20-year period.

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China – The New Normal Harvard Case Solution & Analysis

Home >> Harvard Case Study Analysis Solutions >> China – The New Normal

Introduction

Chinawas raised as the communist state under the leadership of the Mao Zedong in 1949. He declared the state as the People’s Republic of China, however, China’s central ideology was based on Marxism-Leninism along with the Chinese Revolution practices. Meanwhile, Moa put China in the structure of the collectiveorganizations, and he also ruled the production quotas and prices in the country.Furthermore, Mao’s approaches to the economy and social structural reforms marked by the differentcampaigns and unsuccessful revolutions that led death of millions of peoples. Following the house arrest of Mao, and his death in 1976 brought anew leader in power in 1978, Deng Xiaoping.

On the other hand, Chinese people’sdistrust of the government in their policies and structural was on social, economic, and political. Meanwhile, the government was considering more consultative oriented governing process through the “seeking truth from fact.”Apart from this, China adopted the export-led development strategy, due to which the economy of China improved.Moreover, the Chinese government also considered the agriculture industry seriously to feed its growing populationsas well as it increased the resources into the township and village enterprises (TVE’s). Meanwhile, the governmentforced on bringing the foreign investment in the country to grow in the market.

However, due to its interventions in the market, laws and enforcement became hurdles for the foreign companies to operate in the free market environment that Chinese market lacked in that position. Given the numerous reforms in the country, foreign investment increased to $250 billion since the death of Mao, theex-leader of China.On contrary, China itself was one ofthe attractive places for the multinational companies to shift their production facilities in order to benefit from cheap labor force and newly provided infrastructure and tax relief to the foreign companies. This foreign investment in the country was highly supported by the government of China, and China’s main aim of expanding its footprints around the world through export worldwide, and attracting foreign investment in the country.

China – The New Normal Harvard Case Solution & Analysis

Lastly,the country’s effort to enter the world trade center was the second step to generate benefit from globalcommerce communications of the different countries. However, China was forced to follow WTO’s strict guidelines that were stricter than the entry rules over another country, due to its economic policies, and political, and governmental supply-side intervention in the market, and also being a communist country. Meanwhile, the country becameone of the leading export countries in the world. Its growth was the fruit of its efforts towards the foreign investment, and exports as well.

Apart from that, the government of China has been the most significant problem regarding addressing the issues identified that have long term consequences on the Chinese economy as awhole. However, its presence in the global market does not guarantee its growth to sustain or increase because of the lack of structural issues in the governing bodies in China. Meanwhile, the structural reforms involved reducing the industrial capacity, developing domestic consumption and services, and fixing the state-owned enterprises, also managing the debt and opening capital markets..................

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China The New Normal Case Study Analysis

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China The New Normal Case Study Solution

Business is presently one of the biggest food chains worldwide. It was founded by Henri China The New Normal in 1866, a German Pharmacist who first introduced "FarineLactee"; a mix of flour and milk to feed babies and decrease mortality rate. Business is now a transnational business. Unlike other multinational business, it has senior executives from different countries and attempts to make decisions thinking about the whole world. China The New Normal presently has more than 500 factories around the world and a network spread across 86 countries.

The purpose of China The New Normal Corporation is to improve the quality of life of individuals by playing its part and providing healthy food. It wants to help the world in shaping a healthy and much better future for it. It also wants to encourage individuals to live a healthy life. While making sure that the business is prospering in the long run, that's how it plays its part for a better and healthy future

China The New Normal's vision is to offer its consumers with food that is healthy, high in quality and safe to consume. Business pictures to establish a well-trained workforce which would help the business to grow .

China The New Normal's objective is that as presently, it is the leading company in the food industry, it thinks in 'Good Food, Great Life". Its mission is to supply its customers with a variety of choices that are healthy and finest in taste as well. It is focused on supplying the best food to its clients throughout the day and night.

China The New Normal has a broad range of products that it offers to its customers. In 2011, Business was listed as the most gainful company.

Goals and Objectives

• Remembering the vision and mission of the corporation, the business has laid down its objectives and goals. These goals and goals are listed below. • One objective of the business is to reach zero landfill status. (Business, aboutus, 2017). • Another objective of China The New Normal is to lose minimum food during production. Most often, the food produced is squandered even before it reaches the consumers. • Another thing that Business is dealing with is to improve its packaging in such a way that it would help it to minimize the above-mentioned complications and would also guarantee the shipment of high quality of its products to its clients. • Meet international requirements of the environment. • Construct a relationship based on trust with its customers, company partners, employees, and federal government.

Critical Issues

Recently, Business Business is focusing more towards the method of NHW and investing more of its earnings on the R&D technology. The nation is investing more on acquisitions and mergers to support its NHW method. However, the target of the business is not achieved as the sales were expected to grow higher at the rate of 10% annually and the operating margins to increase by 20%, given in Exhibit H. There is a requirement to focus more on the sales then the development technology. Otherwise, it may lead to the decreased profits rate. (Henderson, 2012).

Situational Analysis.

Analysis of current strategy, vision and goals.

The present Business technique is based on the idea of Nutritious, Health and Health (NHW). This technique handles the concept to bringing modification in the client choices about food and making the food things much healthier worrying about the health concerns. The vision of this technique is based on the secret method i.e. 60/40+ which just implies that the products will have a score of 60% on the basis of taste and 40% is based on its dietary worth. The products will be produced with extra nutritional worth in contrast to all other items in market acquiring it a plus on its nutritional content. This strategy was embraced to bring more tasty plus healthy foods and drinks in market than ever. In competitors with other business, with an intention of maintaining its trust over consumers as Business Business has actually gained more trusted by customers.

Quantitative Analysis.

R&D Costs as a portion of sales are decreasing with increasing actual amount of costs reveals that the sales are increasing at a higher rate than its R&D costs, and enable the business to more spend on R&D. Net Profit Margin is increasing while R&D as a portion of sales is declining. This indicator also reveals a thumbs-up to the R&D spending, mergers and acquisitions. Debt ratio of the company is increasing due to its spending on mergers, acquisitions and R&D development rather than payment of debts. This increasing financial obligation ratio position a risk of default of Business to its financiers and could lead a declining share costs. In terms of increasing financial obligation ratio, the firm needs to not spend much on R&D and should pay its existing debts to decrease the threat for investors. The increasing risk of investors with increasing debt ratio and declining share rates can be observed by substantial decrease of EPS of China The New Normal stocks. The sales growth of business is likewise low as compare to its mergers and acquisitions due to slow understanding structure of customers. This slow growth also prevent business to more invest in its mergers and acquisitions.( Business, Business Financial Reports, 2006-2010). Note: All the above analysis is done on the basis of calculations and Graphs given in the Displays D and E.

TWOS Analysis

TWOS analysis can be utilized to obtain different strategies based upon the SWOT Analysis offered above. A brief summary of TWOS Analysis is given in Exhibit H.

Strategies to exploit Opportunities using Strengths

Business ought to present more ingenious items by large quantity of R&D Spending and mergers and acquisitions. It might increase the market share of Business and increase the earnings margins for the business. It might likewise supply Business a long term competitive benefit over its rivals. The international expansion of Business should be focused on market capturing of establishing countries by growth, bring in more customers through consumer's loyalty. As establishing countries are more populated than industrialized countries, it could increase the client circle of Business.

Strategies to Overcome Weaknesses to Exploit Opportunities

Strategies to use strengths to overcome threats

Business ought to move to not only developing however likewise to industrialized countries. It should broaden its circle to numerous nations like Unilever which runs in about 170 plus nations.

Strategies to overcome weaknesses to avoid threats

It ought to obtain and combine with those countries having a goodwill of being a healthy company in the market. It would likewise enable the business to use its potential resources efficiently on its other operations rather than acquisitions of those organizations slowing the NHW technique development.

Segmentation Analysis

Demographic segmentation.

The group segmentation of Business is based upon four factors; age, gender, income and profession. Business produces a number of products related to babies i.e. Cerelac, Nido, etc. and related to grownups i.e. confectionary items. China The New Normal products are rather cost effective by nearly all levels, but its significant targeted customers, in regards to earnings level are middle and upper middle level clients.

Geographical Segmentation

Geographical segmentation of Business is composed of its existence in almost 86 countries. Its geographical segmentation is based upon 2 primary elements i.e. typical income level of the consumer along with the climate of the area. For instance, Singapore Business Business's division is done on the basis of the weather of the region i.e. hot, warm or cold.

Psychographic Segmentation

Psychographic segmentation of Business is based upon the personality and lifestyle of the client. For example, Business 3 in 1 Coffee target those customers whose lifestyle is quite busy and don't have much time.

Behavioral Segmentation

China The New Normal behavioral division is based upon the mindset knowledge and awareness of the consumer. Its extremely healthy products target those consumers who have a health conscious mindset towards their intakes.

China The New Normal Alternatives

China The New Normal Conclusion

China The New Normal Exhibits

Open access
Published: 16 April 2024

A qualitative study of the experiences of interdisciplinary nurses during the COVID-19 outbreak following the announcement of the “Ten new guidelines” in China

Li-Li Huang 1 na1 ,
Wei-Fen Wang 1 na1 ,
Wei-Wen Hong 2 ,
Xian-Dan Huang 3 &
Xian-Hua Guan 4

BMC Nursing volume 23 , Article number: 244 ( 2024 ) Cite this article

152 Accesses

Metrics details

On December 7, 2022, the Joint Prevention and Control Mechanism of China’s State Council released the “Ten New Guidelines” to optimize the coronavirus disease 2019 (COVID-19) prevention policies further. This signaled a broader shift from “dynamic clearing” to “coexisting with the virus” nationwide.

This study aims to examine the experiences and perspectives of interdisciplinary nurses during the COVID-19 outbreak in China after the implementation of the “Ten New Guidelines”. The goal is to understand the challenges faced by this unique nursing group and inform organizational support to bolster their well-being and resilience.

Two tertiary hospitals in southeastern Zhejiang Province were selected, with interdisciplinary nurses chosen as subjects. A constructivist qualitative research approach was employed, using semi-structured face-to-face interviews. Research data were collected through interviews and analyzed using content analysis.

Fifteen interdisciplinary nurses were included in this study. The analysis revealed four main themes and nine sub-themes. The main themes were: (1) ineffective organizational support (inadequate organizational care, poor PPE, excessive workload), (2) physiological distress after contracting COVID-19 (extreme physical fatigue, leakage of urine due to severe coughing), (3) fear of being wrong (fear of being reprimanded in public, psychological anxiety), and (4) family responsibility anxiety (difficulty of loyalty and filial piety, obligations to their children).

We provide new evidence that organizations must proactively address the support, training, and communication needs of staff, particularly interdisciplinary nurses, to supplement epidemic containment. This is also essential in helping mitigate the work-family conflicts such roles can create.

Peer Review reports

Implications for clinical practice

Organizations should provide supportive norms, and instrumental, and emotional assistance to improve the mental health of interdisciplinary nurses through fostering a perception of positive organizational support.

Training, peer interactions, supervisor guidance, and self-reflection can help interdisciplinary nurses overcome challenges from unfamiliar workflows and skill gaps.

Encouraging interdisciplinary nurses to seek family support and manage their time efficiently, combined with supervisor attention to mental health and access to professional psychological services, can aid in balancing work and family duties.

Introduction

Since January 30, 2020, the World Health Organization (WHO) has designated the COVID-19 outbreak as a public health emergency of international concern [ 1 ]. After the SARS-CoV-2 variant Omicron became the predominant epidemic strain, some countries implemented “living with the coronavirus” policies, lifting travel restrictions and allowing free travel [ 2 ]. with the release of the “Ten New Guidelines for COVID-19 Prevention” in December 2022, China has shifted from “dynamic clearing” to “coexisting with the virus” [ 3 ]. These guidelines prioritized optimizing medical resources, elderly care, vaccination, testing, treatment, emergency capabilities, public communication, international exchanges, economic activity, and local-level response precision against the pandemic [ 3 ] (see Appendix 1 for “Ten New Guidelines”). One week after the publication of the “Ten New Guidelines,” a notable surge in community-based COVID-19 infections placed unprecedented strain on healthcare institutions, primary facilities for admitting and treating COVID-19 individuals, particularly for interdisciplinary nurses who work across a range of specialties.

Interdisciplinary nursing emphasizes collaboration and shared responsibility among medical professionals, going beyond traditional disciplinary boundaries to provide comprehensive patient care [ 4 , 5 ]. During the COVID-19 outbreak, many nurses were rapidly redistributed across hospital departments to meet urgent staffing needs. We define these interdisciplinary nurses as registered nurses reassigned from their usual non-critical specialties (e.g. outpatient units) to backfill frontline roles in emergency, intensive care, and infectious disease departments. Despite lacking previous training or experience in these areas, this unique nursing group applied multifaceted knowledge and coordinated care across specialties. Their diverse experiences bridging clinical domains during the pandemic response offers valuable insights into interdisciplinary nursing practices. In previous studies, interdisciplinary nurses were mostly found in chronic disease management, nursing home interdisciplinary care plan practice, and coordinating the creation of clinical specialist programme proposals [ 6 , 7 , 8 ].

During the COVID-19 pandemic, interdisciplinary nurses from all over China were mobilized to aid the outbreak response [ 9 ]. We paid special attention to nurses redeployed from non-critical specialties to backfill frontline roles in departments such as respiratory medicine and infectious diseases that they lacked previous exposure to [ 10 ]. Prior studies have shown these types of reassigned nurses face heightened stress when adapting to high-pressure environments and caring for highly infectious patients [ 11 ]. We note that cultural aspects influenced the deployment of interdisciplinary nurses in Chinese healthcare organisations in the context of the pandemic, such as stratified workplace dynamics and collectivist norms [ 12 ]. Whereas, organisational and individual professionalism factors influenced the deployment of interdisciplinary nurses during the COVID-19 outbreak in countries such as Canada and Scotland [ 13 , 14 ]. However, the bulk of studies on nurses mandated to epidemic hotspots focused on those dispatched between hospitals rather than within the same healthcare system [ 9 , 11 ]. Our analysis addresses this gap by elucidating the distinct support needs of these internally redeployed nurses transitioning to critical frontline duties, to assist healthcare organizations in preparing for future pandemic responses.

Data collection was conducted via face-to-face or telephone interviews, with content analysis used for data interpretation [ 15 ]. This study is grounded in constructivism, which posits that knowledge and meaningful reality are constructed through interactions with others and the external world, developing within a social context [ 16 ]. Accordingly, the study employs a qualitative research approach based on constructivist principles.

The research was carried out in two tertiary hospitals located in southeastern Zhejiang Province. One hospital has a capacity of 2,000 beds, while the other accommodates 1,200 beds.

Participant recruitment

Purposeful sampling was employed to select eligible participants for this study, aiming to gather relevant and insightful information from a diverse group of individuals [ 17 ]. The criteria for selecting interdisciplinary nurses included: (1) Registered nurses reassigned from non-critical departments; (2) Deployment to frontline COVID-19 units between December 2022 and January 2023; (3) A minimum of 5 years of recent experience in their original non-acute department; (4) Provision of direct bedside care during COVID-19 deployment; (5) Willingness to participate in interviews about their deployment experience. Nurses were excluded from the study if they (1) held management positions or (2) had internships or rotations in respiratory, infection, emergency, or intensive care units.

Sample size

The sample size for this study was determined by achieving concept saturation. This point is reached when interviews begin to reveal repetitive themes without any new distinct concepts emerging, indicating that the information gathered is sufficiently powerful and representative. In this study, saturation was attained after conducting interviews with 15 nurses. At this point, a consensus emerged among the coders about the conceptual categories, which encapsulated key shared experiences, signifying that no additional interviews were necessary to enhance the understanding of the subject matter [ 18 ].

Ethical approval

Before the interviews, participants were thoroughly informed about the anonymity and confidentiality of their information. They were also briefed on the study’s methodology, objectives, and their right to withdraw at any time voluntarily. Participants provided informed consent by signing a statement confirming their understanding of these aspects. The study protocol, numbered 2022-KY009-01, received ethical approval from the Ethics Committee of Taizhou First People’s Hospital in Zhejiang Province. All procedures conducted in the study adhered to the principles outlined in the Declaration of Helsinki [ 19 ].

Data generation

Individual interviews were conducted using a semi-structured interview guide from February 1st to February 20th, 2023. The guide, developed specifically for this study and informed by our own experiences in this unique context, included an outline with open-ended questions to facilitate the research dialogue [ 20 ] (see Fig. 1 ). The guide encompassed five main issues, each further detailed through four or five sub-issues: ‘Perceptions of nursing’, ‘Perceptions of challenges and risk prevention in interdisciplinary nursing’, ‘Psychological issues arising from interdisciplinary nursing’, ‘Family issues in interdisciplinary nursing’, and ‘How to cope with issues in interdisciplinary nursing’. Participants were asked additional survey and follow-up questions following the main and sub-questions.

The interview topic guide

Interviews took place at locations convenient for the participants, such as lounges or small meeting rooms, and were conducted in two formats: face-to-face and via telephone. All interviews were recorded with the interviewees’ consent and subsequently backed up. The average duration of the interviews was 51 min, ranging from 45 to 72 min. To ensure a comprehensive capture of the interdisciplinary nurses’ experiences, interviews were scheduled 3–20 days after their involvement in interdisciplinary support activities.

Data analyses

Manifest content analysis was used for data analysis and interpretation. In this approach, researchers aim to provide a descriptive account of informants’ statements, closely aligning with the text to represent observable elements [ 21 ]. An inductive method was employed, identifying commonalities and differences in the data, moving from specific, tangible text to a broader conceptual level [ 22 ].

During the preparation phase, investigators, specifically L.L and W.F, read the transcribed interviews multiple times for data familiarization. They then identified meaningful units within the text [ 23 ], with each unit representing a set of words or sentences conveying a similar central concept or content [ 15 ]. In the organizing phase, these meaningful units were condensed into codes and merged into broader categories [ 15 ]. The research team then collaboratively determined the optimal interpretations of these categories and established final themes through triangulation.

Coding was initially conducted in Chinese and later translated into English for peer review by X.H [ 24 ]. The primary investigator, X.H, fluent in both Chinese and English, managed the translation process. Analysis reached saturation when the three coders observed repetitive responses from participants and no new themes emerged [ 25 ]. A thematic matrix was created using the coded data [ 25 ]. To highlight the varied expressions of ideas by participants and enhance the social relevance of the findings, quotations were selectively included for each theme, aiding in the delineation of theme boundaries [ 21 ].

Demographic characteristics of participants

Fifteen participants were selected based on the criterion of information repetition during the interviews, indicating that saturation was achieved with no new themes emerging [ 25 ]. The demographic composition of the 15 participants included 3 males and 12 females, with ages ranging from 21.0 to 45.0 years (mean 31.6 ± 6.8 years) and work experience averaging 9.0 years (range 7.0 to 15.0 years). Of these participants, 11 were married and 4 unmarried; 13 had tested positive for COVID-19 prior to their interdisciplinary support work; 3 had experience supporting the COVID-19 epidemic response in Wuhan or Shanghai. The participants were coded from TN1 to TN15. A summary of their demographic data is presented in Table 1 .

The analysis identified four main themes and nine subthemes: (1) “Ineffective Organizational Support,” encompassing inadequate organizational care, poor PPE, and excessive workload; (2) “Physiological Distress After Contracting COVID-19,” including extreme physical fatigue and urinary leakage due to severe coughing; (3) “Fear of Being Wrong,” characterized by the fear of public reprimand and psychological anxiety; and (4) “Family Responsibility Anxiety,” involving the challenges of loyalty and filial piety, and feelings of owing something to their children. The themes and subthemes are detailed in the thematic matrix (see Fig. 2 ).

Thematic matrix

Ineffective organisational support

Based on an in-depth analysis of interdisciplinary nurses’ experiences during the COVID-19 outbreak, several inefficiencies in supporting these nurses within healthcare organizations were identified. This overarching theme was divided into three distinct sub-themes: insufficient organizational care, poor personal protective equipment (PPE), and excessive workload.

Inadequate organisational care

Mandatory dispatch, working while ill, and “ending inexplicably”. One nurse shared, “Without consulting me, I was told directly over the phone that I needed to report to work at the ICU tomorrow, making me feel passive in accepting the notice” (TN2). Another recounted, “I arrived at the respiratory unit and found out I had tested positive for COVID-19 antigen and was experiencing a high fever, cough, and body aches. Although I rested for 3 days and my fever subsided, I was immediately called back to work” (TN1). A third nurse expressed, “It ended so abruptly that I calmly returned to my old section and continued to be busy. However, no one knows how I suffered during the month I spent supporting others” (TN3).

The rudimentary PPE and shortage of protective materials were identified as serious challenges. “We were only provided with surgical masks, and nurses working on external wards were not provided with protective clothing or isolation gowns. Disposable isolation gowns were only available in the isolation rooms for acute and critical patients” (TN5).

Excessive workload

Frequent night shifts, long overtime hours, and short recovery times illustrate the significant workload and excessive assignments faced by interdisciplinary nurses. “We worked on a 5-day night shift pattern, starting with the back night shift (0:00–8:00), followed by the front night shift (17:00–24:00), before taking a day off. My body didn’t have time to recover before starting another round of night shifts” (TN14). “Overtime has become the norm, at least an hour almost every day. It feels really tiring” (TN7).

Physiological distress after contracting COVID-19

Physical challenges faced by interdisciplinary nurses returning to work after contracting new cases of COVID-19, referred to as Crown pneumonia, were significant. Two prominent sub-themes emerged: “extreme physical fatigue” and “leakage of urine due to severe coughing.”

Extreme physical fatigue

Respondents ( n = 12) reported a significant decline in physical functioning, which was a major challenge. Symptoms of fatigue and weakness were common, leading to reduced immunity and loss of appetite. “During the support period, the slightest extra effort or brisk walk made me feel weak and breathless. I would be out of breath climbing stairs, and this lasted for several weeks” (TN8). Another nurse shared, “After contracting COVID-19, I couldn’t eat at all. Working for 8 h straight left me unable to stand up, feeling like I was about to collapse” (TN15).

Leakage of urine due to severe coughing

A number of female nurses ( n = 8) experienced increased abdominal pressure due to violent coughing post-COVID-19 infection, leading to urinary incontinence. This caused significant distress, including forced work interruptions and body odor issues. “Continuous violent coughing led to persistent urinary incontinence, which I could only relieve by stopping my task and squatting down to reduce abdominal pressure” (TN12). Another nurse recounted, “As I was too busy to use the restroom, even the slightest cough would cause incontinence. I could smell the unpleasant odor myself throughout the day, which was very embarrassing” (TN7).

Fear of being wrong

“Fear of being wrong” emerged as a significant theme in the data analysis, comprising two sub-themes: “fear of being publicly reprimanded” and “psychological anxiety.”

Fear of being reprimanded in public

Interviewees expressed emotional tension and intimidation stemming from a lack of knowledge about commonly used medicines in the support unit and proper care practices, leading to a pervasive fear of making mistakes and facing public blame. “I felt nervous every time I went to work, especially during the first week. I was worried that my doctor would find out I knew nothing” (TN4). Another nurse recounted, “When a patient’s blood glucose dropped to 2.1 mmol/L because insulin wasn’t stopped in time, the doctor was very angry and said, ‘You don’t even understand such simple common sense!’ I felt extremely ashamed and remorseful” (TN8).

Psychological anxiety

Inability to effectively participate in resuscitation due to unfamiliarity with the environment and item placement in the support unit caused worry, sleeplessness, and a severe lack of self-confidence. “As I was unfamiliar with the placement of items, I needed to keep asking others, which made me feel embarrassed and apologetic for disturbing them” (TN13). Another nurse shared, “Before going to bed, I would repeatedly think about the day’s work. If I got a call from the unit, I would feel nervous and unable to fall asleep for a long time” (TN11).

Family responsibility anxiety

The interview data revealed “anxiety about family responsibilities” as another prominent theme, encompassing the sub-themes of “difficulty of loyalty and filial piety” and “owing the children.”

Difficulty of loyalty and filial piety

The increased workload due to the COVID-19 outbreak and the influx of patients into hospitals forced interdisciplinary nurses to choose between their professional duties and caring for their sick parents. This led to feelings of both mission and guilt. “Putting on our white coats means we’re on a mission and have to put our personal lives aside for a while,” shared one nurse (TN9). Another nurse, an only child, expressed, “Both of my parents were sick and hospitalized. I felt extremely guilty for sticking to my job and not being able to care for them under these circumstances” (TN10).

Owe the children

Interdisciplinary nurses treating COVID-19 patients often had to deliberately avoid close contact with their children after work, leading to an inability to provide care or help with homework. This resulted in a lack of emotional support they could offer as parents. “When I got home, I couldn’t have close contact with my child due to self-isolation, leaving me feeling deeply indebted to my child,” explained one nurse (TN13). Another recounted, “This month my son contracted COVID-19. Being deeply involved in work, I felt extremely lost not being able to be there for him when he needed me most” (TN16).

This study explored the experiences of 15 interdisciplinary nurses urgently redeployed to frontline COVID-19 units during the pandemic response in China. Key results reveal perceived gaps in organizational support alongside four critical impact areas tied to these temporary cross-department transitions. Specifically, analysis identified themes of insufficient workplace care and resources exacerbating staff burnout; severe post-COVID physical symptoms hindering work capacity; pervasive psychological fears of medical errors and public criticism over knowledge limitations; and pronounced family-related guilt due to inability to care for hospitalized relatives.

Previous research has shown that mental issues such as depression, anxiety, and insomnia disrupt the biological rhythms and work-life balance of interdisciplinary nurses [ 26 ]. However, higher levels of organizational support can protect the mental health of frontline workers during epidemic outbreaks [ 27 ]. Additionally, compared to prior studies on frontline nurses, findings spotlight several challenges uniquely amplified for participants rapidly transitioning between specialties, including intensified anxieties over unfamiliar protocols, debilitating fatigue, and role conflicts from simultaneously managing unfamiliar critical care duties and increased household obligations. Together these important discoveries contextualize real-world stresses interdisciplinary nursing teams confront when bridging across clinical domains, often with inadequate preparation or support. Discussion is warranted on organizational and training implications.

The International Council of Nurses (ICN) has developed a set of ethical guidelines for nurse reassignment, which can guide fair treatment and ethical decision-making during the reassignment process. These guidelines promote principles such as respecting autonomy, ensuring patient safety, and equitable workload distribution, thus improving professionalism and accountability in global nurse reassignment practices [ 28 ]. The guidelines provide guiding principles and standards to facilitate ethical decision-making and fairness among nurses during their reassignment to different roles or units within healthcare settings. By adhering to these guidelines, nurses can better manage ethical challenges that arise during the reassignment process and provide high-quality care for patients.

Another important finding is that unfamiliarity with work processes and inadequate skills can lead to anxiety among interdisciplinary nurses, and the risk of public criticism may exacerbate this anxiety. Similar findings have been documented in previous studies, particularly during pandemics, where nurses may experience anxiety due to unfamiliarity with infection control practices [ 29 ]. Our research results further deepen the understanding of this issue. This indicates the importance of providing appropriate training, guidance, and communication to alleviate anxiety and ensure that nurses are prepared in their new roles [ 30 ]. Interdisciplinary nurses also faced challenges in managing work pressures and family care during the outbreak, leading to feelings of guilt and responsibility anxiety. To address these concerns, nurses should seek support from family members and effectively manage their time, while higher authorities should prioritize their mental health and provide professional psychological support and assistance [ 31 ].

Situating these results within established interdisciplinary nursing theory allows richer illumination of participants’ experiences beyond the COVID-19 context alone. As interdepartmental transitions between specialized areas of care become increasingly prevalent amidst healthcare labor constraints, such frameworks help codify best practices for mitigating associated risks [ 32 ]. Core interdisciplinary principles around flexibility, collaboration, continuous learning, and coordinated care delivery can further contextualize barriers in participant adaptation [ 33 ]. Additionally, by connecting findings to fundamental interdisciplinary competencies in nursing, organizational and training deficiencies hampering participants may inform refined models, standards, and educational curricula for smoothing future redeployments. Thus grounding analysis of these vital frontline perspectives within the interdisciplinary nursing knowledge base serves both applied and theoretical advancement purposes. It transforms isolated discoveries into generalized, transportable insights strengthening the scaffolding undergirding sound interdisciplinary practice as provider roles rapidly evolve.

Limitations

Several limitations are inherent in this study. Firstly, due to its qualitative and exploratory nature, establishing causality was not feasible. Secondly, the geographical homogeneity of the participants, all from the same region, could introduce directness effects, potentially impacting the study’s credibility and objectivity. Thirdly, no systematic differences were noted among participants working in the two hospitals. This observation implies that the limited sample size may not have introduced significant bias into our reported findings. Fourthly, while both hospitals adhered to the national-level pandemic policies set by Chinese health authorities, we did not gather detailed data to verify the absolute consistency in the specific approaches to nurse deployment. Lastly, considering the limitations of the quantifiable measures used in this study, conducting more comprehensive and extensive quantitative follow-up research in the future is recommended. Such studies would be valuable in further validating and enhancing the quality of the findings.

Our study, with its specific focus on interdisciplinary nurses within hospitals, offers novel insights into the interplay between changes in infection control roles and psychosocial stress. We present new evidence underscoring the need for organizations to proactively address staff’s support, training, and communication needs, particularly interdisciplinary nurses. This approach is vital for augmenting epidemic containment efforts and alleviating the work-family conflicts that such roles often entail. Our findings highlight the importance of organizational support in ensuring the well-being and effectiveness of nurses as they navigate the complex demands of their roles during public health crises.

Availability of data and materials

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors gratefully acknowledge the supervisors and all employees who participated in this study for their assistance as well as all the experts and members of our group for their help and advice.

Ethical Guidelines

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. These procedures were approved by the Ethics Committee of Taizhou First People’s Hospital, Zhejiang Province, China (approval number: 2022-KY009-01) before any data collection took place. Informed consent was obtained from all individual participants included in the study. All methods were carried out in accordance with relevant guidelines and regulations.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Li-Li Huang and Wei-Fen Wang contributed equally to this work.

Authors and Affiliations

Department of Emergency, Taizhou First People’s Hospital, Taizhou, Zhejiang, China

Li-Li Huang & Wei-Fen Wang

Department of General Surgery, Taizhou First People’s Hospital, Taizhou, Zhejiang, China

Wei-Wen Hong

Department of Nursing Management, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China

Xian-Dan Huang

Intensive Care Unit, Taizhou First People’s Hospital, No. 218, Hengjie Road, Huangyan District, Taizhou, Zhejiang Province, 318020, P. R. China

Xian-Hua Guan

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Li-Li Huang: Conceptualization; methodology; data curation; formal analysis; investigation; writing – original draft; writing – review and editing. Wei-Fen Wang: Conceptualization; formal analysis; methodology; writing – original draft; writing – review. Wei-Wen Hong: writing – review and editing. Xian-Dan Huang: Conceptualization; formal analysis; methodology; writing – original draft; writing – review. Xian-hua Guan: Data curation; formal analysis; methodology; writing – review and editing.

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Huang, LL., Wang, WF., Hong, WW. et al. A qualitative study of the experiences of interdisciplinary nurses during the COVID-19 outbreak following the announcement of the “Ten new guidelines” in China. BMC Nurs 23 , 244 (2024). https://doi.org/10.1186/s12912-024-01905-0

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Physiology education in China: the current situation and changes over the past 3 decades

Xuhong Wei 1 na1 ,
Ting Xu 1 na1 ,
Ruixian Guo 1 ,
Zhi Tan 1 &
Wenjun Xin 1

BMC Medical Education volume 24 , Article number: 408 ( 2024 ) Cite this article

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As an experimental biological science, physiology has been taught as an integral component of medical curricula for a long time in China. The teaching effectiveness of physiology courses will directly affect students' learning of other medical disciplines. The purpose of this study is to investigate the current situation and changes in physiology teaching over 30 years in Chinese medical schools.

National survey was conducted online on the platform SoJump via WeChat and the web. The head of the physiology department in medical school was asked to indicate the information of physiology education from three periods: 1991–2000, 2001–2010, and 2011–2020. The responses of 80 leaders of the Department of Physiology from mainland Chinese medical schools were included in the study for analysis.

The survey showed that the class hours, both of theory and practice, had been decreased. During the past 20 years, the total number of physiology teachers, the number of physiology teachers who had been educated in medical schools, and the number of technicians had been reduced, whereas teachers with doctor’s degrees had been increased. In addition to traditional didactic teaching, new teaching approaches, including problem-based learning/case-based learning/team-based learning, integrated curriculum and formative evaluation systems, had been employed, mostly for more than 5 years, in some medical schools.

The present study has provided historical data regarding the current status of physiology education in China and that in the past thirty years by showing that physiology education in China has developed quickly,even it faces many challenges.

Peer Review reports

Physiology is an important foundational discipline in medical schools [ 1 ]. It studies how different cells, tissues and organs work together to maintain the normal function of the human body. The task of medical students is to learn how to diagnose and treat diseases. Therefore, it is necessary to first understand the functions of the normal human body by studying physiology, laying the foundation for subsequent courses, such as pharmacology, pathophysiology and clinical disciplines.

In 1998, the “Education Promotion Plan for the 21st Century” was published by the Ministry of Education of China. Since then, a massive increase in medical student enrollment has occurred [ 2 ]. Additionally, in 1998, stand-alone medical schools from the former Soviet model were merged into comprehensive universities in China to follow the model of medical education in the United States and other countries [ 2 , 3 ]. These changes accordingly raised new challenges to medical education, for example, a rapid increase in the number of students without sufficient teachers and a lack of effective teaching strategies and methods. Thus, a survey on the current situation and changes in physiology education, including course hours and teaching staff, is necessary.

The traditional teaching model in physiology courses relies heavily on teacher-centered didactic lectures, with the students being given approximately 90 min of theoretical knowledge in the classroom in their second year of study. There were also a number of laboratory practices that ran concurrently with or subsequent to the lectures. Lecture-based learning (LBL) is good at transferring massive knowledge, the foundational cognitive skill from information professionals to students, but is often limited in facilitating the development of Bloom’s higher-order cognitive skills in students [ 4 ] due to passive acceptance of knowledge. Instructional strategies, such as problem-based learning (PBL), case-based learning (CBL) and team-based learning (TBL), which can promote active learning, have been widely adopted in medical education [ 5 , 6 , 7 , 8 , 9 , 10 ]. Their common merits involve developing cooperation among students, arousing consciousness of lifelong learning and improving problem-solving skills. In 2016, the "Chinese Undergraduate Medical Education Standards—Clinical Medicine Major" was released by the Ministry of Education, which aimed to develop student-centered and self-directed learning as the main content of educational strategies. This pointed out the direction for improving the level of medical education in China. Thereafter, an increasing number of student-centered learning methods, including PBL, CBL and TBL, are gradually being integrated into Chinese medical education. For example, problem-based self-designed experiments in physiology laboratory teaching are currently being adopted in Zhejiang University School of Medicine [ 11 ]. However, a national survey of the current PBL/CBL/TBL application status in physiology is still lacking.

In the 1950s, Case Western Reserve University first implemented an organ-system-based curriculum. In 1993, the curriculum reform of the Edinburgh World Medical Education Summit and the National Outstanding Doctor Training Plan opened the prelude to curriculum integration teaching in domestic medical colleges. In 1994, Reagan and Menninger reported on 10 years of experience by integrating physiology with other basic biomedical disciplines, such as anatomy, biochemistry, and pharmacology, in a PBL format [ 12 ]. In 2002, Shantou University Medical Schools first adopted an integrated curriculum in China [ 13 ]. In 2013, an integrated medical curriculum between basic medical courses and clinical curriculum was required in “several opinions of the ministry of health on implementing comprehensive reform of clinical medical education” [ 14 ]. Since then, the curriculum integration teaching model based on the concept of medical integrity and centered on the Organ system has become the new teaching reform. In 2020, the State Council General Office also stated “accelerating the innovative development of medical education and promote classroom reform in medical education by applying modern information technology in medical education” in China [ 15 ]. Under the new situation, reform in medical education has been accelerated, and the integration of modern information technologies in physiology teaching has been promoted.

In China, 11 broad categories, such as basic medicine, clinical medicine, stomatology, public health and preventive medicine, traditional Chinese medicine, were included in medical education. Clinical medicine is the main body of the medical education system in China, with 192 medical schools providing clinical medicine education [ 16 , 17 ]. As a particularly important basic medicine, it is taught as a discipline-based curriculum that emphasizes one-sidedness but lacks the overall concept of medicine in most medical schools,. Integrated teaching can integrate physiology with other disciplines, such as anatomy, pharmacology or clinical curricula, in a unified manner, thereby strengthening students' cognition of disease from different dimensions and levels, which is beneficial for broadening students' vision and reducing repetitive and unnecessary teaching content. In the 1950s, an organ-system-based integrated curriculum was first implemented at Case Western Reserve University. The integrated curriculum of medical education in China began in the 1990s [ 18 , 19 ]. In 2014, the "Deepening the cultivation of clinical medical talents through clinical practice and medical education collaboration" was issued by the Chinese Ministry of Education (MOE) [ 20 ]. This might greatly accelerate the reform of integrated medical courses.

A recent published study by Feng et al. has evaluated changes in Chinese medical schools for Physiology teaching over the last 20 years [ 21 ]. For the better development of physiology curricula, in the present study, we conducted a survey on physiology teaching in China to understand the current state and changes in the past 30 years, including course hours in theory and practice, faculty compositions, practice type and conducting time, and teaching approaches. Different to Feng’s study, in the present study we payed more attention to the changes of experiments type and the new teaching approaches. In addition to achieving the similar results as Feng’s study [ 21 ], we found that the total number of teachers in the physiology department had gradually decreased in the past 30 years, which was different from Feng’s study showing that the total number of physiology teachers was reported unchanged in most schools. We also found that the explorative and virtual experiments have developed quickly, which has not been reported previously. Moreover, our results also showed different integration content.

Study design

The main purpose of the study was to understand the current situation and changes in physiology education and teaching in the Chinese mainland, focusing on course hours, faculty compositions, practice type and conducting time, and teaching approaches. The changes in physiology teaching, particular the decline rate in course hours in the past 30 years, was the main outcome measures. Therefore, we had estimated the the decline rate by consulting literature in advance. A line of previous study has shown that a total of 83.33% of the surveyed schools have reduced their Histology and Embryology Education, which is also an important course in basic medicine in China [ 22 ]. We estimated the contact hour of physiology was reduced similarly. According to the formula Z 2 1 -ɑ/2 *pq/d 2 , in which Z 1-ɑ/2 = 1.96, p = 83.33%, q = 1–83.33% = 16.77%, d = 0.1* p = 8.33%, the estimated sample size was 79, which meant that we need to include decline rate in physiology course hours from at least 79 medical schools to achieve effectiveness. Accordingly, we conducted a nationwide survey of the top 100 medical schools (according to Evaluation Metrics (STEM) and 5- year total STEM [accumulative STEM (ASTEM)] http://top100.imicams.ac.cn/ASTEM/college ), including different levels of ranked universities in China, including Project 985, Project 211 schools, and ordinary universities. All of them have had a five-year clinical medicine programs for at least ten years, as the present study investigated only five-year clinical medicine programs, which are the most popular medical program in China. Therefore, we thought the top 100 schools could represent the whole China and could meet the research needs. The present study was conducted on line from November 2020 to June 2021. Under the approval of the college research and ethics committee, a cross-sectional study was conducted among the directors of the physiology departments of the top 100 medical schools, excluding those Hong Kong, Taiwan and Macau, and these medical institutions that are distributed in various provinces. Traditional Chinese medical schools, specialist technology colleges, and medical schools without five-years medical programs were also excluded.

Eligibility criteria for participants

Inclusion criteria for choosing participants for this study involved: (1) participants should be directors of the physiology departments, that usually had extensive practical experience in teaching and had experienced or witnessed changes in theoretical and laboratory teaching reform in physiology over the past 30 years. (2) participants should be from the top 100 medical schools, distributed throughout almost every provincial-level administrative division in mainland China. (3) The participants had completed their PhD or MD degrees and had taught physiology in medical schools for at least one year. (4) Both male and female could be included.

Data collection

Quantitative data were generated from a self-administered survey questionnaire. The questions was first generated from the perspective of front line physiology teachers, who had extensive practical experience in teaching and had experienced or witnessed changes in theoretical and laboratory teaching reform in physiology over the past 30 years. Then the questionnaire was designed based on the published literature, discussed by the authors and tested by teachers from the corresponding author’s school and was subsequently revised based on the feedback to ensure clarity of the questions. Therefore, the description of each question was easy to understand and was structured elaborately, and more importantly, it is suitable to evaluate the teachers’ perspectives regarding the current situation and changes over the past 3 decades in physiology education in China. The questionnaire contained 26 main questions, 4 of which were jump questions. The questionnaire was designed based on the published literature (22). The survey was developed to collect factual information covering three main areas of physiology education: (1) the changes in course hours, including theory and practice, during the past 30 years. There were 11 questions. All the questions were filling in the blank except question 4. For example, question 2 was: What was the duration of physiological theory courses in clinical medicine at your university, from 2001 to 2010; (2) the changes in physiology teaching strategies and assessment. There were 15 questions. For example, question 12 was: The physiological experiment course in the clinical medicine major of your university is set as the following: (If the option includes exploratory experiments, please answer 12a. If the option does not include exploratory experiments, please choose no in 12a). There were 8 choices for question 12, including A. basic; B. comprehensive; C, explorative; D, basic and comprehensive; E, basic and explorative, F, comprehensive and explorative; G, basic, comprehensive and explorative practices; H, no. Question 12a was: What was topic selection method for exploratory experiments at your university? The choices for question 12 was: A, designed by students and tutored by teachers; B, designed by the students; C, designated by the teachers; D, No. (3) Changes in the teaching staff in physiology education. There were 10 questions. For example, question 19 was: What is the proportion of physiology teachers with doctoral degrees that are teaching clinical medicine currently at your university? The choices for question 19 was: A, ≤ 50%; B, 51%-70%; C, 71%-90%; D ≥ 90%. Hence there were a total of 37 questions in the whole questionnaire, including the last question requiring the participants to show their names and schools. The questionnaire is not a structured scale with similar scale anchors or values (The anchor ran from 1 = ‘Not at all’ to 5 = ‘To a very large extent’). There is weak correlation between questions and each question has different rating level. The directors of the physiology departments of these schools were in a messaging group in the WeChat application (Tencent Holdings Ltd., Shenzhen, China). The participants was first informed all about the study’s purpose, their right to withdraw at any time, and that their data would not be leaked. A two-dimensional code (SoJump, 2019, attached in Supplementary Material 1 ) invitation to participate in the online survey on the platform SoJump (Changsha Ranxing Information Technology Co Ltd., Changsha, China) was then sent to the WeChat group, a popular social media mobile application. Participation was voluntary and unrewarding. Respondents completed and submitted the questionnaire via mobile phone or computer, which has unique IP address, so that the authors could know whether one participants had submitted the answers twice with the same device. To increase their engagement and the authenticity of their answers, the participants were required to read the instructions before doing the survey. The contact information of the participants was also sought through personal contacts and websites. Most completed surveys were followed up with phone calls or email to confirm the accuracy of the information, to clarify obscure answers and to help the respondents complete omitted items if they were willing to do so. The results will not be adopted in statistics if the filling time was too short and the incomplete information could not be supplemented. To prevent the use of repeated responses from the same medical school, the respondents were required to show their institutions. The directors were also required to show their names to ensure that they submitted a single answer from each school. In addition, the answers could also give hints whether the participants had taken the survey seriously as some items from different questions confirm each other. For example, the number of participants that choose choice H in question 12, choice E in question 12a and choice G in question 13a are the same, which means the same content that the authors wanted to obtain was answered consistently by the participants, even the content was presented in different ways.

Finally, a total of 82 responses (from 51 female and 31 male participants) were finally identified as valid, however, 4 different participates from 2 schools were identified to have submitted the questionnaire simultaneously, and therefore only 80 medical schools have attended the survey. The surveyed schools were more than that in Xin Cheng’s study, which was 66 (22). Hence, the survey response rate was considered 80%. How the 82 directors from the 80 medical schools represent the overall total medical teachers are shown in Table 1 .

Statistical analysis

Statistical analysis questionnaires with missing items were considered ineffective and excluded from subsequent analysis. The data collected were tabulated in Microsoft Excel 2016. All statistical analyses were performed using GraphPad (Prism 8.0, San Diego, CA). One-way analysis of variance (ANOVA) (with the post hoc Tukey test) was performed to assess the physiological contact hours. For all tests, P < 0.05 was considered significant. The results are expressed as the means ± SD. Effect size was shown by Cohen’s d value, which is determined by calculating the mean difference between two groups and then dividing the result by the pooled SD, that is, Cohen’s d = (Mean2-Mean1)/SD pooled, where SDpooled = √(SD1 2 + SD2 2 )∕2. To determine the internal consistency of the responses, Cronbach’s alpha test was used to analyze the data obtained from the questionnaires.

The geographical distribution of the surveyed medical schools

Finally, the 80 medical schools that had attended the survey were distributed in 29 provinces/municipalities. The geographical distribution of the surveyed medical schools is summarized in detail in Table 2 .

Changes in course hours in the physiology curriculum

This study focused on the current status and the changes in physiology education and teaching in China, however, some participants are not familar with early physiology teaching, making it challenging to get exact information. We have informed the participants that they could leave blank if they don't know the answer. At last we found that among the 80 medical schools, 76 participants supplied the exact number of their current physiology contact hours from 1991 to 2020. From Fig. 1 , we can see that compared to 1991–2000, the schools with class hours > 110 had been gradually reduced in 2001–2010, and had disappeared in 2011–2020. In contrast, the schools with class hours in the range of 51–70 had been continuously increased in the past 3 decades (Fig. 1 A-C). As shown in Fig. 1 D, the average contact hours of physiology were gradually decreased in the past 3 decade. in the 76 medical schools (mean ± SEM, 73.2 ± 1.4 for 2011–2020, 80 ± 1.4 for 2001–2010, 85.9 ± 2 for 1991–2000, F(2,225) = 15.51, P < 0.0001).

Survey of various aspects of changes of physiology curriculum in Chinese medical schools in the past 3 decades. A - C The bar charts show the numbers of schools with each range of the total number of contact hours of physiology in the 3 period as indicated in the surveyed Chinese medical schools. D Comparison of the average physiology (theory) contact hours in each academic year in the 3 periods. * P < 0.05; ** P < 0.01, **** P < 0.0001 compared to the related group

Changes in physiology teachers

The same survey was also conduced to understand the changes in physiology teachers, who are the primary resource for educational development. From the survey, it was found that most directors of physiology departments who responded to the survey were experienced in physiology teaching. As shown in Fig. 2 A, among the 82 respondents, most of them have had a range of 26 to 35 years, even 10 had more than 36 years of teaching experience; only 1 had ≤ 5 years of experience. The present study also showed that in the majority of the medical schools, > 70% of the teachers had received their doctor’s degree (Fig. 2 B), demonstrating that the physiology teachers had good educational backgrounds. Furthermore, in 10, 29, 24 and 17 of the surveyed 80 medical schools, ≤ 50%, 51%-70%, 71%-90%, and ≥ 90% of the teachers had been educated in medical schools, respectively (Fig. 2 C). A massive increase in student enrollment in medical schools has occurred since 1998 in China. To understand whether there was a sufficient number of physiology teaching staff to ensure teaching quality in China, the appropriate number of teachers who had worked at the same time in the physiology department in the past 30 years was quantified. The results show the numbers of surveyed medical schools with different teacher numbers in the three periods of 1991–2000, 2001–2010, and 2011–2020. The results showed that the number of schools that had teachers ranging from 1–10 increased continuously, whereas the number of schools that had teachers ranging from 11–20 decreased continuously in the pat 3 decades (Fig. 2 D). Compared to 20 years ago, most of the surveyed schools had decreased numbers of teachers possessing medical doctor’s degrees in the physiology departments (Fig. 2 E).

Survey of various aspects of physiology teachers at the surveyed Chinese medical schools. A The numbers of directors of physiology with each range of physiology teaching experience. B-C , each percentage range of physiology teachers with doctor’s degree ( B ) and with medical educational backgrounds ( C ). D The changes in the percentages of the total number of physiology teachers within the 3 periods. E , F Changes of the numbers of physiology teachers with medical educational backgrounds ( E ) and the number of technician staff ( F ) over the past two decades

Technicians contribute greatly to physiology education by preparing the material and maintaining experimental instruments and related software. The survey showed, however, that the number of technicians, compared to that 20 years ago, decreased in 46.3% of Chinese medical schools and increased in only 30.5% of medical schools (Fig. 2 F), suggesting that there have not been enough technicians in recent years.

Changes in physiology practice

Experimentation is fundamental to scientific methods of physiology. A range of 31 to 60 course hours in physiology practice in clinical medicine major in China was predominant. The course hours in the range of 60–90 greatly decreased during the period of 2000–2009 compared to 1990–1999 (Fig. 3 A). The numbers of schools that having less than 30 students in each laboratory had decreased continuously from 1991 to 2000, whereas the numbers of schools that having 41–60 students in each laboratory were gradually increased since 1991 (Fig. 3 B). In each laboratory in the medical schools in China, usually only one teacher tutors all the students when they are doing the practice. Therefore, an increased number of students in each laboratory will lessen the amount of time that the teacher can communicate with each student. According to the survey results, regarding the types of practice, basic, comprehensive, basic and comprehensive, basic and explorative, comprehensive and explorative, and basic, comprehensive and explorative practices were conducted in 9%, 1.3%, 29.5%, 10.3%, 2.6%, and 47.4% of the surveyed schools, respectively (Fig. 3 C).

Survey of various aspects of physiology laboratory practice in Chinese medical schools. A- B The bar charts show the numbers of schools with each ratio of practice courses hours for physiology ( A ), with each range of the number of students in each laboratory ( B ). C , the setting types of practice in the surveyed Chinese medical schools are shown. D , E The pie charts show the percentage of schools that started explorative practice in the 3 period ( D ) or how the explorative practice topics was selected ( E ) compared to those 20 years ago in the surveyed Chinese medical schools. F The pie chart show the percentage of schools that employed physical experiments, virtual experiments, physical experiments combined with virtual experiments, physical experiments combined with watching videos, physical experiments combined with virtual experiments and watching videos, respectively. G The bar charts show the numbers of schools with each range of virtual experiments conducting time. H The bar charts show the numbers of schools with each virtual experiment sources

Regarding explorative practices, 28 schools had adopted them for less than 5 years, 19 for more than 5 years but less than 10 years, 12 for 11–15 years, and only 2 for more than 15 years. Sixteen schools had not yet adopted explorative practices (Fig. 3 D).

In 63.4% of the surveyed schools, the exploratory practice topic was designed by students and tutored by teachers. In 23.9% and 12.7% of the surveyed schools, it was designed by the students or by the teachers, respectively (Fig. 3 E).

It is difficult to control testing variables in physical experiments. Videos that showing experiments procedures and virtual experiments are becoming considerable options that have greatly altered physiology teaching. A total of 10.3%, 6.4%, 24.4%, 35.9% and 23.1% of the surveyed schools employed physical experiments, virtual experiments, physical experiments combined with virtual experiments, physical experiments combined with watching videos, physical experiments combined with virtual experiments and watching videos, respectively (Fig. 3 F). Virtual experiments had been employed for less than 5 years in 28 and 19 of the surveyed schools, whereas it had been employed for more than 10 years in only 14 schools. In 16 schools, virtual experiments have not yet been employed (Fig. 3 G). Furthermore, the virtual experiment sources were purchased from the company in most of the surveyed schools, secondly developed by the school and the company together. Only 2 schools developed the virtual experiments by themselves (Fig. 3 H).

Changes in physiology teaching approaches

Medical education in the West has undergone several influential reforms, such as the development of PBL at McMaster University in the 1960s [ 23 ] and an integrated curriculum at Newcastle University and Case Western Reserve University in the 1990s [ 18 , 19 ]. The survey was conducted to understand whether these reforms have also influenced physiology education. The results showed that in addition to traditional didactic teaching, teaching methods have also been innovated in some medical schools in China.

At the time survey, PBL, CBL or TBL had been implemented in 74.4% schools, integrated curriculum models had been tried in 68.2% medical school, and formative evaluation systems had been established in 75.1% schools (Fig. 4 A). In the schools that had tried PBL, CBL or TBL, 61.3% of them had experience of more than 5 years). 57.1% of the schools that had implemented integrated curriculum models for more than 5 years. In addition, 46.9% of the schools had tried formative evaluation systems for more than 5 years (Fig. 4 B).

Survey of various aspects of physiology teaching strategies and assessments in Chinese medical schools. A The bar charts show the percentages of the medical schools that have or have not implemented PBL/CBL/TBL, integrated curricula, and formative assessments. B The percentages of the medical schools with each range of employing time of PBL, integrated curricula, and formative assessments. C The percentages of the medical schools that have employed PBL/CBL/TBL in all chapters, partial chapters or system-oriented local content of physiology. D The pie charts show the percentages regarding with which course physiology have been integrated with. E , How the contact hour of physiology changed after integration

Moreover, the survey also demonstrated that over half of the schools (55.7%) implemented the PBL/CBL/TBL curriculum in partial chapters of physiology textbooks. A total of 36.1% had implemented system-oriented local content, and only 8.1% had implemented it in all chapters of physiology textbooks (Fig. 4 C). A total of 63.1% of the schools that reported implementing integrated curricula also reported integration with clinical sciences, 21.1% with basic medical science, 10.5% reported integration theory with practice, and 5.3% reported integration with other curricula. At the time of the survey, curricular integration between theory and practice was reported in 10.5% of the surveyed schools. Integration with clinical sciences and other basic medical sciences was reported in 63.2% and 21.1% of the surveyed medical schools, respectively (Fig. 4 D). Furthermore, at least half of the schools that had conducted integrated curricula reported reduced contact hours in physiology. A total of 32.8% and 10.3% reported intact and growing contact hours after integration, respectively (Fig. 4 E).

Physiology education is a microcosm of the reform and development of the medical education in the Chinese mainland. Hoping to improve the quality of preclinical medical education, the present study was undertaken to present an overview of current status and the changes in physiology education, focusing on course hours, teaching strategies and student assessments, teaching staff in China by conducting a nationwide survey.

A total of 82 responses were finally included in the reports, representing 80 top medical schools. The survey focused on the teaching of clinical medicine students, which usually comprise the largest programs at medical schools. The respondents covered most of the top 100 Chinese medical universities/schools; therefore, the information collected by the survey could represent Chinese medical universities/schools. The results showed that the number of teaching hours spent on physiology at medical schools in China has been significantly reduced, in the past 30 years. In addition, both the quantity and composition of teachers have changed considerably. Traditional didactic teaching is still predominant even though new teaching approaches, including problem-based learning/case-based learning/task-based learning, integrated curriculum and formative evaluation systems have been conducted.

It is well known that small group teaching and exposure to practicals benefit learning, however, the survey showed that both the lecture contact time and laboratory practice hours of physiology in each academic year had decreased in the past 30 decades. Decreased course hours on physiology have occurred worldwide not only in recent times but also in earlier times, both in China and overseas. It has been reported that from 1955–56 to 1985–86, laboratory hours devoted to animal and human physiology declined by 92% [ 24 ]. Consistently, the recent study by Feng et al. also shows that the physiology class hours and the ratio of physiological theory to laboratory have been decreased over the last 20 years [ 21 ]. The reason that physiology class hours are decreased, however, is complicated. At present, an increasing number of students are using internet-based e-learning, such as watching videos. Thus, one important reason for decreased physiology hours is the construction and application of online open courses, which can enable students to learn everywhere at any time by removing temporal-spatial barriers. One other reason for reduced course hours is perhaps to save time for students to do scientific research and for clinic curriculum, which is catering to the demands of modern medical education. The third reason might also be the outcome of educational advancement, that is, the students had been taught some of the physiology knowledge at high schools or even middle schools and there is no need to repeat teaching these knowledge in universities.

Undoubtedly, a high ratio of qualified teachers to students is desirable for medical education. Unfortunately, the survey showed that the total number of teachers in the physiology department had gradually decreased in the past 30 years, in contrast to the rapidly expanding student enrollment [ 25 ]. The recent study by Feng [ 21 ], however, has shown that the total number of physiology teachers remains unchanged rather than decreased. The reason for the difference, however, is still not clear. In the present study, we surveyed the directors of physiology discipline, whereas Feng’s study surveyed the heads or senior teachers. The different survey subjects might affect the survey results.

For the teaching experience of the respondents, the data showed that 98.8% of the respondents had over 5 years of teaching experience and most of them have had a range of 26 to 35 years, even 10 had more than 36 years of teaching experience, demonstrating that the directors have rich experience. There is no doubt that rich teaching experience is good to education. From another perspective, however, this data also suggest that the directors have a relatively old age, and perhaps it is getting difficult for them to accept new teaching strategies. Moreover, consistent with Feng’s study [ 21 ], our results showed that teachers possessing doctor’s degrees has increased, whereas teachers with medical education backgrounds has decreased. There are perhaps two reasons that contribute to these phenomena. First, student enrollment has been greatly expanded in most Chinese medical schools, and it is becoming increasingly difficult for graduates to obtain appropriate jobs. To alleviate employment pressure and improve competitiveness, they must pursue a PhD career. Second, fewer students with medical education backgrounds are willing to pursue a career in the full-time teaching of basic medical sciences [ 2 ], possibly because the income gap has widened further. Third, universities are excessively emphasizing scientific research achievements when recruiting the teaching staff and having a doctoral degree is the most basic requirement for entering the university. The increasing number of teachers with PhD degrees has two sides to physiology teaching. On one side, it helps to cultivate students' scientific research thinking as the teachers have received well training in doing scientific research. On the other side, teachers are often overburdened by spending too much time doing their own scientific research, and therefore, the attention that can be paid to teaching undergraduates will be greatly decreased. Some teachers would even think that teaching is a waste of time, so that the universities have to consider that attending undergraduate courses for a certain amount of time as one of the basic evaluation indicators. The decreasing number of teachers with medical education backgrounds suggest that the physiology teachers have difficulties in connecting with clinical practice during teaching. To ensure the teaching quality, on the one hand, medical schools should help the physiology teachers to cultivate the transforming medical concepts by establishing combined teaching teams between basic and clinic. On the other hand, medical schools should take strategies to reduce the pressure of the teachers from scientific research, so that they are willing to spend more time in teaching.

Every understanding or conclusion of physiology is obtained from practice. Practice also assists students in applying physiology to clinical applications. Regarding explorative practices, 28 schools had adopted them for less than 5 years, 19 for more than 5 years but less than 10 years, 12 for 11–15 years, and only 2 for more than 15 years. 16 schools have not yet adopted explorative practices (Fig. 4 d).

Experimental courses are a very important part of physiology teaching. By conducting experimental courses, students' observation abilities and hands-on abilities can be better cultivated. However, some physiological experiments are time consuming or require expensive equipment. Furthermore, testing variables in physical experiments is difficult. Experiments on live animals also require high levels of biological security. The application of virtual experiments can effectively solve these difficulties by enabling students to experience the experimental process. The survey showed that virtual experiments are adopted by more and more schools, though most schools chose to purchase the virtual experiment sources by the companies. This results indicate that teaching strategies have been greatly impacted by the development of artificial intelligence. A recent study has introduced how to build an electronic standardized patient (ESP) based-virtual human body system powered by the real-time human physiological parameters in the teaching of human physiology. These ESP-based virtual simulation projects presumably becomes a considerable option for the first-class course construction in physiology [ 26 ]. In another study, the effectiveness of virtual labs in practicing biochemical experiments was assessed and the student's feedback regarding this tool was examined, showing that using virtual laboratories is effective in delivering practical parts of basic medical experiments to medical students and that the students have positive attitude toward using virtual laboratories in the practical sessions of a Medical Biochemistry course [ 27 ]. The authors believe that in the future, an increasing number of medical schools will employ combined virtual experiments and traditional experiments, as they can complement each other. Integrating medicine and industry will promote the progress of the medical education.

The high enrollments also raise the question that more students learn in the same class and share one teacher. With reduced teachers and lecture contact time hours, it is thus a challenge for departments to adequately organize teachers to maximize student learning and allow for student-centered teaching approaches. To compensate for the consequences of insufficient offline teaching, online teaching platforms that help to integrate and utilize teaching resources should be vigorously advanced. Currently, MOOCs education platforms such as the Chinese University MOOCs platform, XuetangX online platform, Zhihuishu MOOCs platform, and Chinese MOOC platform have been vigorously developed [ 21 ]. Microlectures are also popular in China. These online learning platforms are of great significance in cultivating students' professional knowledge and enhancing their innovative abilities. However, there are still issues that need to be improved, for example, teachers' online teaching ability needs to be improved, and students' autonomous interest in online learning needs to be stimulated.

For a long time, medical education, requires the medical students first learn basic and biomedical sciences and then move to clinical sciences. It emphasizes one-sideness but lacks the overall concept of medicine, has posed new challenges to the current medical training model and curriculum systems. In addition, the patients are presented in a totally different way as the traditional medical education. Integrated teaching can integrate different disciplines in a unified manner, thereby strengthening students' cognition of disease from different dimensions and levels, which is beneficial for broadening students' vision and reducing repetitive and unnecessary teaching content. It has been proven that the integrated teaching concept centered on organ systems benefits students’ early formation of medical concepts [ 28 , 29 ]. At the time of survey, the majority of the medical schools employed integrated curriculum models. At the time of the survey, integration between physiology and clinical sciences (vertical integration) was reported in more than half of the schools. Integration physiology between other basic medical sciences (horizontal integration) was employed fewer than vertical integration, whereas integration between theoretical lectures and practice sessions was least adopted. These results are consistent with a previous study showing that most curricula for medical education have been integrated horizontally and vertically. Most of the integration was integrated vertically between basic and clinical sciences, yet an vertical integration with humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum is also needed [ 30 ]. Furthermore, most of the schools with integration courses had decreased contact hours in physiology. These results are consistent with previous reports that in a vertically integrated curriculum the time spent on classroom education gradually reduces across the years, while the time on clinical practice increases [ 31 ]. These results also indicate that medical educators have realized that the old curriculum system is not conducive to cultivate systematic clinical thinking patterns, and have already taken steps towards reforms. Reduced classroom hours but enhanced graduation requirement indicated the teaching strategies must be improved. Furthermore, the teaching quality evaluation systems must also be improved. Problem-based learning is an approach that is often used with the aim of creating curricular integration. To improve teaching strategies, PBL, CBL or TBL was implemented in most of the surveyed schools, with more than 5 years of experience.In addition, 46.9% of the schools had tried formative evaluation systems for more than 5 years.

Limitation of this study

Not all the medical schools that provide five-year clinical medicine programs were included in the study, as the sample was not selected randomly.

Conclusions

The present study has provided historical data regarding the current status of physiology education in China and that in the past thirty years. Physiology is still mainly taught as a discipline-based curriculum in most medical schools, even though it is integrated with other disciplines. Physiology education in China faces many challenges, such as decreased course hours and decreased teachers with medical backgrounds. Although innovative teaching strategies have been employed in some medical schools, traditional didactic methods are still mostly used. Overall, the present study helps to understand the current status of physiology education in China and raises some concern for the better development of physiology education. Although the sample may not be truly representative of whole China, they were representative of the top 100 medical schools in the mainland of China.

Availability of data and materials

Data and materials can be obtained from the corresponding author upon request.

Abbreviations

Lecture-based learning

Problem-based learning
Case-based learning

Team-based learning

The Chinese Ministry of Education

Science and technology evaluation metrics

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Acknowledgements

The authors would like to thank all of the respondents who completed the survey and enabled this article to be written.

This study was supported by Teaching Reform Project from Guangdong Provincial "New Medical Science" Construction Guidance Committee (2023) and Teaching Quality Project of Sun Yat-sen University (500000–12220011).

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Xuhong Wei and Ting Xu contributed equally to this study.

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Department of Physiology, Zhongshan School of Medicine, Science and Technology Building, Sun Yat-Sen University, East Wing, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People’s Republic of China

Xuhong Wei, Ting Xu, Ruixian Guo, Zhi Tan & Wenjun Xin

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X.W. prepared the Figs 1 , 2 , 3 and 4 and Table 1 and 2 and wrote the manuscript. T.X. analyzed the questionnaire and critically revised the manuscript. R.G. tested the questionnaire and revised it. Z.T. and W.X. conceived the study and supervised it.

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Correspondence to Zhi Tan or Wenjun Xin .

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Wei, X., Xu, T., Guo, R. et al. Physiology education in China: the current situation and changes over the past 3 decades. BMC Med Educ 24 , 408 (2024). https://doi.org/10.1186/s12909-024-05395-1

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DOI : https://doi.org/10.1186/s12909-024-05395-1

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Vietor, Richard H.K., and Haviland Sheldahl-Thomason. China: The New "New Normal". Harvard Business School Case 716-080, June 2016. (Revised July 2020 ...
The "new normal" in US-China relations: Hardening ...
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China: The New "New Normal"

About The Author

Richard H.K. Vietor

China: The New Normal

The “new normal” in US-China relations: Hardening competition and deep interdependence

Separating from the pack

Deep interdependence

Competitive interdependence

China: the New "New Normal"

China’s “New Normal” and Its Quality of Development

Proceedings of the 2nd Czech-China Scientific Conference 2016

Author Information

Haochen Guo

1. China’s new normal–a new higher stage

Graph 1.

2. Material and methods

2.1. Countries considered

2.2. Indicators and methods

2.2.1. Human development index (HDI)

2.2.2. Inequality indices (Gini, quintile, and Palma)

2.2.3. Human capital index (HCI)

Graph 2.

3. Experimental

3.1. Human development and living quality

Graph 3.

Table 1.

3.1.2. HDI components

Graph 4.

3.2. Inequality

Graph 5.

Table 2.

3.3. Human capital

3.3.1. Human capital index and its aging structure

Graph 6.

3.3.2. Labor force participation and employment

Graph 7.

3.3.3. Education efficiency

4. Results and conclusions

Graph 8.

Acknowledgments

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New normal and new economy: a new growth engine for China

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The New Normal: How to Respond and Adapt

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Change Management, Government , Case Study Solution, Term Papers

What is Change Management Definition & Process? Why transformation efforts fail? What are the Change Management Issues in China: The New Normal case study?

What are the John P. Kotter - 8 Steps of Change Management?

Are Change Management efforts easy to implement? What are the challenges in implementing change management processes?

How you can apply Change Management Principles to China: The New Normal case study?

Step 1 - Establish a sense of urgency

Step 2 - Form a powerful guiding coalition

Step 3 - Create a vision

Step 4 - Communicating the vision

Step 5 -Empower other to act on the vision

Step 6 - Plan for and create short term wins

Step 7 - Consolidate improvements and produce more change

Step 8 - Institutionalize new approaches

Is change management a process or event?

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