公立医院医生正向执业环境现状与分析

发布时间：2018-12-25 13:52

【摘要】：目的:了解我国医生对正向执业环境的评价,从卫生服务供方角度提出对医改的建议。方法:采用自行设计的医务人员正向执业环境调查表,对全国7个省/直辖市的77家公立医院的3 564医生进行问卷调查。正向执业环境包括组织管理和医患关系两个维度。结果:医生的正向执业环境评分仅18.02±4.86分(满分40分),组织管理维度的评分高于医患关系;组织管理维度中,评分最低的是组织对个人建议的重视(2.24±1.04);医患关系维度中,评分最低的是规避医疗风险(1.59±0.81);不同地区医生的正向执业环境评分存在差异,西部地区医生的评分最低(P0.001);中医的正向执业环境评分高于西医(P=0.002)。结论:目前医生的执业环境不容乐观,医院外部紧张的医患关系比医院内部低效的组织管理更严重;促进正向执业环境,医院应采用参与式决策管理模式、建立向医院基层倾斜的宽带绩效薪酬制度;政府应以促进医患信任为基本价值取向,建立合理的医院补偿激励机制。
[Abstract]:Objective: to understand the evaluation of positive practice environment by doctors in China, and put forward some suggestions on medical reform from the point of view of health service provider. Methods: 3 564 doctors in 77 public hospitals in 7 provinces / municipalities were investigated with self-designed questionnaire. The positive practice environment includes two dimensions: organizational management and doctor-patient relationship. Results: the positive practicing environment score of doctors was only 18.02 卤4.86 (full score 40), and the score of organization management dimension was higher than that of doctor-patient relationship, and the lowest score of organization management dimension was that the organization attached importance to personal advice (2.24 卤1.04). In the dimension of doctor-patient relationship, the lowest score was to avoid medical risk (1.59 卤0.81), there were differences in positive practicing environment scores among doctors in different regions, and doctors in western regions had the lowest score (P0.001). The positive environmental score of TCM was higher than that of western medicine (P0. 002). Conclusion: at present, the doctor's practice environment is not optimistic, the external tense doctor-patient relationship is more serious than the inefficient organization and management inside the hospital. In order to promote the positive practice environment, the hospital should adopt the participatory decision-making management mode, establish the broadband performance pay system that tilts to the hospital grass-roots level, and the government should take the promotion of doctor-patient trust as the basic value orientation, establish the reasonable hospital compensation incentive mechanism.
【作者单位】：华中科技大学同济医学院公共卫生学院;
【基金】：国家自然科学基金项目(71273098)
【分类号】：R197.1

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