“Being an ophthalmologist is a golden occupation. Next in line is a career in surgery.  It is acceptable to be a gynecologist or an obstetrician. However, do not become a pediatrician.” This is a popular mocking saying in the medical field. It also expresses the hardship and difficulty of pediatricians. Pediatrics is seen as a "dumb" profession.  It is not easy to be a pediatrician, and it is even harder to be the president of a Children’s Hospital.

Over thirty years ago, Huang Guoying chose pediatrics as his lifelong career and later became the president of the Children’s Hospital of Fudan University (hereinafter referred to as Fudan Pediatrics). He attained many significant achievements in the field of his focus, pediatric congenital heart disease, the most challenging specialty.  Among them, he invented the simple screening method for congenital heart disease, which was widely recognized both at home and abroad and provided timely treatment for thousands of children with congenital heart disease in their early lives. The related research was published in The Lancet, a precedent for the Chinese pediatrics community.

By virtue of his scientific research achievements and management ability, Huang Guoying has won six ministerial and provincial-level awards, including the second prize for “Technology Progress Award of the Ministry of Education”, the first prize for “Shanghai Medical Science and Technology Award", the first prize for “Shanghai Teaching Achievement Award," and many others. He was selected as the Shanghai Shuguang Scholar, Outstanding Discipline Leader, and Talented Leader. He was also recognized as an exceptional individual in implementing the Eleventh Five-Year Plan for Women and Children in Shanghai, a special expert of the State Council, a young and middle-aged expert with outstanding contribution from the Ministry of Health, a model individual of the National Health System, and an excellent president of Chinese hospitals. He also received the Chinese Pediatrician Award and Fudan University’s Fuxing Hospital Management Award.

From a Straight-A Student to a Doctor, a "Pediatric Uphill Battle"

In 2007, Huang Guoying became the president of Fudan Pediatrics. Ten years later, Fudan Pediatrics has made strides to become the National Children's Medical Center.  

Under the leadership of Huang Guoying, it has made outstanding contributions to medical advancement and development. In retrospect, numerous pioneers have worked very hard in the establishment and advancement of Fudan Pediatrics to safeguard the health of children. Huang is one of those key leaders.

Huang Guoying was an outstanding student in high school and was particularly interested in mathematics, physics, and chemistry. In 1979, he took the college entrance examination. Under the advice of his mother and teachers, he gave up the opportunity to attend Nanchang Military Academy and chose the medical school at Fujian Medical University instead. In the 1980s, Huang Guoying made pediatrics his career after graduation because he felt that "pediatrics is a very challenging specialty."

In 1986, he was accepted into Shanghai Medical University, majoring in clinical pediatric cardiology, and studied under Professor Ning Shoubao, a renowned pediatric cardiologist in China. He completed his master’s and doctoral degrees in five years.  After graduation, he worked in Pediatrics at Fudan University. He also went to the Prince of Wales Hospital in Hong Kong, the Children’s Hospital of Philadelphia and  the Biological Science at University of Pennsylvania for further study and postdoctoral work.

Huang Guoying mentioned during the interview that the prerequisite for being a qualified cardiologist is to be an excellent pediatrician. In fact, there is an untold story behind his belief.

While studying under Professor Ning Shoubao, "I was quite interested in cardiology and was well-versed in the subject,” Huang stated. “I read many books in that field but was not interested in other disciplines." Professor Ning Shoubao soon discovered Huang’s learning problem and pointed out in a timely and serious manner, “Pediatrics actually includes multiple disciplines concerning the entire body. Cardiology can be a research direction. However, as a clinician, it is not good enough to treat patients with heart problems only.”

The diligent and studious Huang Guoying took Ning’s advice to heart. Afterwards, he consciously took turns to study earnestly in different departments. He not only strives to build solid professional foundations with a rigorous learning attitude himself but also tries to pass on this professionalism in his work and teaching.

It is more difficult to treat children than adults since children usually communicate through crying to express their emotions. Huang Guoying used the word “overwhelmed” to describe his early career as a pediatrician. It was very challenging, being a new graduate in his early 20’s, to treat newborns since he did not even know how to cradle a baby. However, born with the will to challenge himself, he started his battle to conquer. He learned from experienced nurses to cradle and feed babies and change diapers.

A pediatrician is someone who not only comforts children but also acts as a detective who infers from limited clues. "Pediatrics is a ‘dumb’ profession. Treating a child requires observation. Sometimes, I can find many problems by personally examining and interacting with children.”

“Sick children cannot communicate through words but only cry. At most, they can only point to where it hurts using their hands.” Therefore, Huang Guoying believes that pediatricians must possess strong observation skills, combined with the input from parents, to make reasonable diagnosis and treatment.

Another challenge stems from the dynamic process of children's continuous growth and development. Unlike adults, children's illnesses display different symptoms at different ages. The symptoms of a one-year-old patient are different from that of a ten-year-old one, regardless of clinical manifestation, treatment, or observation. “I am delighted to see listless and sick children recovering greatly after being treated with injections and medications.” Comparing with overcoming challenges, Huang Guoying is more satisfied with the accomplishment of curing children.

Choose what you like and love what you have chosen. Huang Guoying, who has been a pediatrician for more than 30 years, finds great happiness in helping others with his expertise. He has increasingly played a leading role in the field of children’s health.    Many provincial and ministerial awards and honor certificates of technology and teaching achievements have left strong marks on his “Book of Merit”.

"Fudan Pediatrics Program" Becomes the "Chinese Standard"

Being an expert in pediatric cardiovascular diseases, Huang Guoying has made outstanding contributions in the field with respect to diagnoses and treatments. One of his greatest contributions is converting clinical diagnosis and treatment research results into national public health policies and standards to benefit sick children.  

Congenital heart disease roughly accounts for a quarter of congenital deformities. It seriously endangers the health of infants and young children. It may cause death if not detected early. To better detect newborns with congenital heart disease, Professor Huang Guoying led his research team and invented a simple and easy test called "Cardiac Auscultation and Transcutaneous Blood Oxygen Saturation” after three years of hard work. It can screen, within 2 to 3 minutes, newborns with congenital heart disease within the first 24 to 72 hours after birth. The sensitivity of the test for severe congenital heart disease is above 92%.

This dual-criteria screening test is not only accurate but also easy to operate. “Both physicians and nurses can administer the test after training. It only takes about 3 to 4 minutes to perform the test.” High compliance, non-invasive, and low cost are some of the advantages of the test. More importantly, it has a high detection rate for severe and critical cases.

This forward-looking research has been recognized by international peers. The results have been published in the top international academic journal, "The Lancet." This is the first time that the journal has published research articles from the Chinese pediatrics community since its inception in 1823. This large-sample research also provides important evidence for other countries to form similar policies.

His team has also established a complete collaboration network and computer-based

congenital heart disease registration system. This ensures that, once flagged by the screening test, children with congenital heart disease can receive definite diagnosis in the shortest possible time in addition to timely and effective treatment.

"From June 1, 2016 to the end of 2019, there were more than 500 cases of very serious congenital heart disease in Shanghai, which were discovered through using the dual-criteria screening test. Patients received timely and effective diagnosis and treatment through the “Green Channel.” Many young lives have been saved.  According to Huang Guoying, Shanghai has integrated newborn congenital heart disease screening into its routine newborn screening program since 2016. It has also established a world leading newborn congenital heart disease screening, diagnosis, and evaluation system. The current screening rate has reached 99.27%. This effort has been awarded the first prize for the Shanghai Women and Children Development Research Achievement’s "Policy Recommendation Achievement Award."

Shanghai’s success attracted national attention. In 2018, the National Health Commission published the "Working Plan for Newborn Congenital Heart Disease Screening Project." It included congenital heart disease screening as a part of newborn screening in China. It has been implemented in 28 provinces across the country as a routine screening item. Thousands of children with congenital heart disease have received timely treatment early in their lives.

As the guardian of children's health, Huang Guoying has never stopped his research in pediatrics. He has worked relentlessly and attained significant achievements in the study related to the diagnosis and treatment of coronary artery lesions of the Kawasaki disease and the pathogenesis of the congenital heart disease.

Kawasaki disease, also known as Mucocutaneous Lymph Node Syndrome, mainly occurs in children under the age of five. It damages coronary arteries and can lead to life-threatening symptoms, such as occlusion of cardiac coronary arteries, myocardial infarction, and myocardial ischemia. Huang Guoying said, "Currently in Shanghai, about one out of 1,000 children under the age of five suffers from the Kawasaki disease every year."

In the past 20 years, Huang Guoying has diagnosed and treated the Kawasaki disease together with specialists from other disciplines in Shanghai, "reducing the fatality rate from 0.26% to zero in recent years." Exploring the pathogenesis of newborn congenital heart disease and preventing heart birth defects from the source is another one of Huang Guoying's research directions.

Creating Medical Coalitions to Build a Pediatric National Team

On August 17th of last year, the 2019 Value-Based Healthcare Summit was held in Shanghai. Huang Guoying delivered a keynote speech and shared the experience of the Fudan Pediatrics Coalition on value-oriented and multi-tiered diagnosis and treatment, where patients start off at their nearby hospitals and are only moved to top-tier hospitals if necessary.

At the summit, he presented a set of data based on the 2014 national pediatrician attrition rate survey. In 2015, the national rate was 12%, while Shanghai remained at 10%. The turnover rate is lower for hospitals specialized in pediatrics and was about 4%. “For Fudan Pediatrics, it was about 2%. We are very proud of that.”

The numbers attracted the attention of the audience. Not only that, Fudan Pediatrics has also established a Pediatrics Coalition, where doctors are provided with rotational assignment opportunities to work at affiliated hospitals within the coalition. The coalition was selected as one of Shanghai's top ten innovative measures for medical reforms. It also won the Science and Technology Innovation Award from the Chinese Hospital Management Association. It has become a service brand in Shanghai.

It has been widely recognized that there is a serious shortage of pediatric resources in China. The high attrition rate of pediatricians presents a big problem for society.  How does Fudan Pediatrics retain people and build a pediatric medical coalition?

To fulfill the increasing demand of health services for children and solve the problem of inadequacy and unreasonable allocation of pediatric resources, Huang Guoying has taken the lead to systematically explore pediatrics coalitions in China since 2014.   Fudan Pediatrics established a horizontal pediatrics coalition consisting of ten hospitals like Fudan Pediatrics in size and reputation. It also established a vertical coalition comprised of hospitals of different sizes and reputations including thirteen community medical service centers covering the Minhang District and three general hospitals.

After more than 4 years of effort, the multi-tiered diagnosis and treatment service system of the Pediatric Coalition has achieved initial success. The data provided by Huang Guoying indicates that the proportion of patients seeking treatment in the internal medicine department at Fudan Pediatrics decreased from 35% in 2014 to 25% in 2018. On the other hand, the proportion of patients with uncertain diagnosis and difficult cases has been increasing continuously. The clinical service structure gradually becomes more balanced and reasonable. As a National Children Medical Center, it has become increasingly clear that Fudan Pediatrics has become a place for treating patients with difficult and critical medical conditions.

After joining the Fudan Pediatric Coalition, all 13 community health service centers in Minhang District provided pediatric outpatient services. In 2018, the number of pediatric outpatient visits at community health service centers increased by 26% compared to 2014, while the number of pediatric outpatient visits at Fudan Pediatrics dropped by 22% and declined from 109,500 to 85,200.

The program, fully affirmed by the government and society, provided important experiences and references for the promotion of pediatrics coalitions in Shanghai. It won the third prize for the Chinese Hospital Association Hospital Science and Technology Award. It has also been recognized as a Shanghai Medical Service Brand.

The medical coalition adopted the “Three Transfers and Four Uniformities” method so patients can visit their nearby hospitals in an orderly manner. “Three Transfers” refers to management system, technology, and brand transfers. “Four Uniformities” makes references to unified medical safety and quality requirements, unified medical service models, unified discipline development planning, and unified information system platforms. These are the measures required for other hospitals to replicate the success and brand name of Fudan Pediatrics and improve their quality and reputation.  Today in Shanghai, Fudan Pediatric Coalition has expanded to 88 hospitals. This “Fudan Model” and “Shanghai Experience” have been promoted nationwide.  Through the medical coalition, children and parents have experienced the changes brought about by "quality medical care".

In addition to the vertical pediatrics coalition, Fudan Pediatrics also explored horizontal pediatrics coalitions, collaborating with 12 children's medical centers affiliated with first-class universities such as Peking University, Peking Union Medical College, and Zhejiang University. On January 31, 2015, Fudan Pediatrics formally established the National Pediatric Development Alliance, a platform used to influence other children’s hospitals and showcase high quality pediatrics in China.

The first "Pediatric Collaborative Center of National Telemedicine and Internet Medical Center" was established in May 2018. The center covers 31 provinces, cities, and autonomous regions across the country with more than 4,500 branches. It makes quality medical resources accessible to remote areas by offering multidimensional services such as remote consultations, remote live surgery broadcasts, remote rounds, distance learning, and remote scientific research collaborations. This has advanced the effort to improve the overall health of children in China.

Fudan Pediatrics emphasizes discipline development and talent training. It also takes initiatives to assume social responsibility to extend quality medical resources of the “National Team” to more places. "Through the Pediatric Development Alliance and the Pediatric Coalition, we have established close relationships with more than 100 hospitals to make progress together to create win-win situations. Among them, we have the strongest relationship with Xiamen Children's Hospital."

In 2014, the city of Xiamen and Fudan University launched a city-school cooperation to establish the Children’s Hospital of Fudan University Xiamen Branch in Xiamen, also known as Xiamen Children's Hospital. Different from other hospitals, Xiamen Children's Hospital relies on the guidance of Fudan Pediatrics to bring it to the same level as Fudan Pediatrics through brand, management, and technology transfers.

"Xiamen Children's Hospital has progressed rapidly and has grown into a regional children’s medical center. It can now provide comprehensive and high-quality medical and health services for children in the region. It also serves as a replicable model for developing high-quality medical centers.” Huang Guoying proudly introduced the progress of Xiamen Children's Hospital since its inception.   

Building a World-Class Children’s Medical Center

Pediatrics sub-disciplines have increased gradually as the medical community gains deeper and better understanding of diseases. Children’s Hospitals face challenges to overcome technical obstacles in sub-disciplines and build reputations by offering more specialized treatment.

As the president of Fudan Pediatrics, Huang Guoying has a forward-looking and strategic vision when it comes to hospital management. He implemented the "ward and outpatient department integrated management" specialty development strategy, an operating model focusing on patients and rooted in discipline development.

Huang Guoying also built an innovative management group and a highly capable clinic team composed of junior and senior physicians to ensure orderly operations in the hospital. They focused on the needs of patients, clinical treatments, scientific research, as well as education and training.

Under this management framework, the hospital is required to perform many public welfare activities every year. For example, the hospital has currently created 30 funds to relieve more than 1,000 low-income families from financial difficulties and burdens every year. The hospital has also established specialty scholarships to recruit physicians specialized in pediatric cardiac surgery, internal medicine, anesthesiology, imaging and ultrasound, and nursing. It recruits about 30 people every year, setting a model for children’s hospitals across the country.

Furthermore, the hospital continues to expand its collaborations internationally.  Presently, it has formed extensive cooperation and exchange programs with 26 internationally renowned children's hospitals, including the Vancouver Children's Hospital in Canada and the Children's Hospital of Columbia University in the United States, positioning the development of the hospital at the international forefront.

Huang Guoying said, "The 14th Five-Year Development Plan is being formulated.  We have done a lot of research work and positioning analysis in the early stages. In conclusion, our vision and plan are to become a world-class children's medical center."

In the future, in the blueprint planned by Huang Guoying and his team, Fudan Pediatrics will implement the "medical prevention integration: medical treatment, teaching, scientific research, prevention, and management" five-in-one development strategy. This strategy focuses on the diagnosis and treatment of difficult and critical pediatric diseases, the development of top-notch pediatricians, and the transferring of pediatric clinical research into practice. Moreover, it will, under the guidance of the government, work with brother hospitals to implement major children’s disease registration as well as monitor and collect information on pandemics and public health.

Fudan Pediatrics, as the most comprehensive pediatrics hospital in China, has ranked first in the field of pediatrics in multiple domestic authoritative rankings for years. It has developed a comprehensive and balanced set of clinical disciplines. It also possesses several leading-edge technologies within its Center for Molecular Genetics, the Center for Precision Medicine, and the Center for Translational Medicine.  Further, with the support of a strong technical team from the Shanghai Primary Laboratory of Birth Defects, Fudan Pediatrics has accumulated rich experiences in the diagnosis and treatment of complex as well as rare and undiagnosed diseases. It has also cultivated a competent professional diagnosis and treatment team.

"If I could choose my next life, I would choose to be a pediatrician again," said Huang Guoying. Medical workers are heroes because they serve their countries and people with compassion. During his 30 years of medical practice, Huang Guoying, has always maintained a heart of innocence and quietly devoted himself to hospital development.