| 引用本文：张萍, 叶贝珠, 王玙璠, 孙奕, 梁渊.公立医院医生正向执业环境现状与分析[J].中国卫生政策研究,2017,10(6):38-42 |
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| 公立医院医生正向执业环境现状与分析 |
| 投稿时间：2016-11-10 修订日期：2017-04-28 PDF全文浏览 HTML全文浏览 |
| 张萍, 叶贝珠, 王玙璠, 孙奕, 梁渊 |
| 华中科技大学同济医学院公共卫生学院 湖北武汉 430030 |
| 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（P<0.001）；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。 |
| 关键词:正向执业环境 组织管理 医患关系 |
| 基金项目:国家自然科学基金项目（71273098） |
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| Investigation of present situation and analysis of positive practice environments of doctors in public hospital in China |
| ZHANG Ping, YE Bei-zhu, WANG Yu-fan, SUN Yi, LIANG Yuan |
| School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430030, China |
| Abstract:Objective:This study aims to investigate the positive practice environments evaluation of doctors in public hospital and provide suggestions for Chinese health care reform from the perspective of health service providers.Methods:Using self-designed questionnaire,a national cross-sectional survey was performed in 77 public hospitals across seven provinces/metropolis,involving a total of 3564 doctors.Positive practice environment includes organizational management and doctor-patient two-dimension relationships.Results:The doctor's mean score of positive practice environment evaluation was 18.02±4.86(out of 40).Doctors had a higher evaluation (score) of organizational management than doctor-patient relationship.In the organizational management dimension,the personal advice got the lowest scores (2.24±1.04);and in doctor-patient relations,evasion of medical risk got the lowest scores (1.59±0.81).There was a difference in the positive practice scores of physicians in different regions,and the scores of doctors from the western China were the lowest (P<0.001.Doctors from western medicine hospitals had lower evaluation of positive practice environments than ones from Chinese Traditional Medicine hospitals (P=0.002.Conclusion:As per the analysis conducted in this investigation,the current medical practice environment of doctors in China is not a promising one.Doctor-patient relationship is worse than organizational management.Hospitals should adopt a participatory decision-making model in management and establish a broadband performance based compensation to motivate junior doctors.Besides,government should establish reasonable compensation incentive mechanism,with the aim of promoting doctor-patient trust. |
| Key words:Positive practice environments Organizational management Doctor-patient relations |
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