医患关系认知现状与和谐医患关系构建研究
发布时间：2018-08-14 15:32
【摘要】：目的:了解新医改以来江苏省医患媒三方对于医患关系的理解和主观评价;为公立医院改革和建立现代医院管理制度提供可行的建议;分析医患关系的影响因素和不和谐的根源所在,探究医患媒三方认知差异的原因,从管理学角度对医患媒三方评价的差异性做出系统分析并给出政府监管和医院内部管理的途径和侧重点,为和谐医患关系的构建提供借鉴。方法:本研究基于文献研究、问卷调查和访谈,运用主体框架分析法和相关统计学方法辅助分析研究内容。对新医改以来的专业期刊、政府医疗卫生相关文件及相关网络信息,查询研究内容,在数据库中查阅国内外相关文献;问卷调查在南京、无锡、南通、淮安四所城市中,选取四家综合性医院开展;针对医患媒三方认知下医患关系现状及其影响因素,采取个别访谈和专家访谈相结合的形式,集多方意见,探讨和谐医患关系构建方案;通过主体框架分析法对原始资料构建分析框架,将访谈资料和文献资料比较分析后进行整合处理,最终得到基于医院管理的改善医患关系的主体框架,并根据所得的框架设计问卷;运用Epidata3.0对数据进行双录入,利用office软件进行数据的初步整理后转入SPSS20进行描述性及推断性统计分析:对于率的比较采用卡方检验,对于医患关系影响因素及个研究者的政策建议采用Logistic回归方法。结果:40.6%的患方和41.7的媒体人员对医患关系的评价在80分以上,比例远高于医务人员(9.2%);认为医患关系非常差的前三位科室是内科31.1%,中医25.0%,外科23.9%,调查对象对医患关系的评价受个体差异、执业环境、社会大环境影响;医疗费用高是医患媒三方认知下阻碍和谐医患关系前五位影响因素的唯一一个共同因素,其中医方认为排在前三位的是媒体宣传不当(82.8%),政府医改缺陷(60.3%)、社会风气差(58.5%),患方认为是医疗费用高(56.7%)、市场经济影响(49.6%)、医务人员态度差(28.1%),媒体人员觉得依次为医疗费用高(60.7%)、市场经济影响(57.7%)、医务人员服务态度差(53.4%);约七成以上医患认为医院的内部设施和环境有所改善,服务态度有所提升,服务流程有所优化;医患媒三方认为改善医患关系对个人来说非常重要的均超过五成,其中医方比例最高(76.8%),患方其次(59.8%),媒体为55.2%;93.2%的医务人员、80.1%的患方和73.6%媒体表示愿意尽自己的努力改善医患关系;认为暴力伤医需要依法严惩的医方、患方和媒体分别占各自群体的94.7%、73.3%和81.6%;医患媒三方对新医改政策知晓度偏低,非常了解及比较了解的分别占48.2%、21.1%和11%;医患沟通对和谐医患关系构建的重要性得到85.30%的媒体人员、91.00%的患方和91.50%的医方肯定;医生工作繁忙和医患间的利益矛盾是医患媒三方认为造成医患沟通不畅的主要因素。结论:医患关系并没有社会上感知紧张,医患关系发展态势趋于乐观。医患认知的影响因素有个体差异、媒体舆论和宏观社会环境;经济因素和医院管理是构建和谐医患关系的重难点。政府应综合一线反馈意见,不断增强分级诊疗和多点执业的可操作性,加大医改政策宣传力度,加大基层医疗机构建设与监管力度,严格控制医院扩建预算同时下放医院人事权,推动药品统一招标与医院自主招标两线并存;构建新媒体官方沟通平台;引导患者认知。医院应不断加强内部精细化管理,运用品管圈、按照JCI评审标准对医院进行管理,利用医疗事件报道强化风险管理和危机管理,有针对性地推进人力资源管理、人文医院和学习型医院的建设,发展信息化。
[Abstract]:Objective: To understand the understanding and subjective evaluation of doctor-patient relationship among the three parties of doctor-patient vectors in Jiangsu Province since the new medical reform; to provide feasible suggestions for the reform of public hospitals and the establishment of modern hospital management system; to analyze the influential factors and the root causes of disharmony between doctors and patients; to explore the reasons for the differences of cognition among the three parties of doctor-patient vectors; and to discuss the doctor-patient relationship from the perspective of management Methods: Based on literature review, questionnaire survey and interviews, this study used the main frame analysis method and related statistical methods to assist the analysis of content. Since the reform, professional journals, government medical and health related documents and related network information, inquiry research content, in the database access to relevant literature at home and abroad; questionnaire survey in Nanjing, Wuxi, Nantong, Huai'an four cities, selected four comprehensive hospitals to carry out; in view of the doctor-patient relationship status and its influencing factors under the tripartite cognition of the doctor-patient vector, Taking the form of individual interviews and expert interviews, gathering opinions from various parties, discussing the construction scheme of harmonious doctor-patient relationship; constructing the analysis framework of the original data through the main frame analysis method, integrating the interview data and literature data after comparative analysis, and finally getting the main frame of improving doctor-patient relationship based on hospital management. The questionnaires were designed according to the obtained framework; the data were double-entered with Epidata 3.0, and the data were preliminarily sorted out with office software, then transferred to SPSS20 for descriptive and inferential statistical analysis: Chi-square test was used for comparison of rates, Logistic regression was used for influencing factors of doctor-patient relationship and policy recommendations of the researchers. Results: 40.6% of the patients and 41.7% of the media staff rated the doctor-patient relationship above 80 points, which was much higher than that of the medical staff (9.2%). High cost is the only common factor that hinders harmonious doctor-patient relationship under the tripartite cognition of doctor-patient vectors. The top three factors are improper media publicity (82.8%), deficiency of government health care reform (60.3%), bad social atmosphere (58.5%), high medical cost (56.7%), market economy (49.6%) and medical staff. About 70% of the doctors and patients believed that the internal facilities and environment of the hospital had been improved, the service attitude had been improved, and the service process had been optimized. More than 50% said it was very important, with the highest proportion of doctors (76.8%), the second highest proportion of patients (59.8%) and the media (55.2%), 93.2% of medical staff, 80.1% of patients and 73.6% of the media expressing their willingness to do their utmost to improve the doctor-patient relationship, and 94.7%, 73.3% and 8% of the doctors and media believing that violent injuries require severe punishment according to law accounted for 94.7%, 73.3% and 8% of their respective groups, respectively. 1.6%; the awareness of the three parties to the new health care reform policy was low, 48.2%, 21.1% and 11% were very familiar with and compared with each other; the importance of doctor-patient communication to the construction of harmonious doctor-patient relationship was confirmed by 85.30% of media personnel, 91.00% of patients and 91.50% of doctors; the contradiction between doctors'busy work and interests between doctors and patients was considered by the three parties. Conclusion: Doctor-patient relationship is not socially perceived tension, and the development trend of doctor-patient relationship tends to be optimistic. The influencing factors of doctor-patient cognition are individual differences, media public opinion and macro-social environment; economic factors and hospital management are the key and difficult points in building a harmonious doctor-patient relationship. Opinions should be made to enhance the maneuverability of graded diagnosis and treatment and multi-point practice, to intensify the publicity of medical reform policies, to intensify the construction and supervision of primary medical institutions, to strictly control the budget for hospital expansion and to decentralize hospital personnel power, to promote the coexistence of unified drug bidding and hospital independent bidding, to construct an official communication platform for new media, and to guide patients. Hospitals should constantly strengthen the internal fine management, apply quality control circle, manage hospitals according to JCI evaluation standards, strengthen risk management and crisis management by reporting medical incidents, propel the construction of human resources management, humanistic hospitals and learning hospitals, and develop information technology.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3
本文编号：2183316
[Abstract]:Objective: To understand the understanding and subjective evaluation of doctor-patient relationship among the three parties of doctor-patient vectors in Jiangsu Province since the new medical reform; to provide feasible suggestions for the reform of public hospitals and the establishment of modern hospital management system; to analyze the influential factors and the root causes of disharmony between doctors and patients; to explore the reasons for the differences of cognition among the three parties of doctor-patient vectors; and to discuss the doctor-patient relationship from the perspective of management Methods: Based on literature review, questionnaire survey and interviews, this study used the main frame analysis method and related statistical methods to assist the analysis of content. Since the reform, professional journals, government medical and health related documents and related network information, inquiry research content, in the database access to relevant literature at home and abroad; questionnaire survey in Nanjing, Wuxi, Nantong, Huai'an four cities, selected four comprehensive hospitals to carry out; in view of the doctor-patient relationship status and its influencing factors under the tripartite cognition of the doctor-patient vector, Taking the form of individual interviews and expert interviews, gathering opinions from various parties, discussing the construction scheme of harmonious doctor-patient relationship; constructing the analysis framework of the original data through the main frame analysis method, integrating the interview data and literature data after comparative analysis, and finally getting the main frame of improving doctor-patient relationship based on hospital management. The questionnaires were designed according to the obtained framework; the data were double-entered with Epidata 3.0, and the data were preliminarily sorted out with office software, then transferred to SPSS20 for descriptive and inferential statistical analysis: Chi-square test was used for comparison of rates, Logistic regression was used for influencing factors of doctor-patient relationship and policy recommendations of the researchers. Results: 40.6% of the patients and 41.7% of the media staff rated the doctor-patient relationship above 80 points, which was much higher than that of the medical staff (9.2%). High cost is the only common factor that hinders harmonious doctor-patient relationship under the tripartite cognition of doctor-patient vectors. The top three factors are improper media publicity (82.8%), deficiency of government health care reform (60.3%), bad social atmosphere (58.5%), high medical cost (56.7%), market economy (49.6%) and medical staff. About 70% of the doctors and patients believed that the internal facilities and environment of the hospital had been improved, the service attitude had been improved, and the service process had been optimized. More than 50% said it was very important, with the highest proportion of doctors (76.8%), the second highest proportion of patients (59.8%) and the media (55.2%), 93.2% of medical staff, 80.1% of patients and 73.6% of the media expressing their willingness to do their utmost to improve the doctor-patient relationship, and 94.7%, 73.3% and 8% of the doctors and media believing that violent injuries require severe punishment according to law accounted for 94.7%, 73.3% and 8% of their respective groups, respectively. 1.6%; the awareness of the three parties to the new health care reform policy was low, 48.2%, 21.1% and 11% were very familiar with and compared with each other; the importance of doctor-patient communication to the construction of harmonious doctor-patient relationship was confirmed by 85.30% of media personnel, 91.00% of patients and 91.50% of doctors; the contradiction between doctors'busy work and interests between doctors and patients was considered by the three parties. Conclusion: Doctor-patient relationship is not socially perceived tension, and the development trend of doctor-patient relationship tends to be optimistic. The influencing factors of doctor-patient cognition are individual differences, media public opinion and macro-social environment; economic factors and hospital management are the key and difficult points in building a harmonious doctor-patient relationship. Opinions should be made to enhance the maneuverability of graded diagnosis and treatment and multi-point practice, to intensify the publicity of medical reform policies, to intensify the construction and supervision of primary medical institutions, to strictly control the budget for hospital expansion and to decentralize hospital personnel power, to promote the coexistence of unified drug bidding and hospital independent bidding, to construct an official communication platform for new media, and to guide patients. Hospitals should constantly strengthen the internal fine management, apply quality control circle, manage hospitals according to JCI evaluation standards, strengthen risk management and crisis management by reporting medical incidents, propel the construction of human resources management, humanistic hospitals and learning hospitals, and develop information technology.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3
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