基于CWB模型的医务人员隐性缺勤形成机制与干预策略研究

Presenteeism, mainly influenced by health and job stress, is defined as the recessive reduced productivity at work due to health problems or other events that distract one from full productivity, the costs of which is much higher than medical costs and absenteeism. Since medical staffs are suffering from extremely high job stress, their health is often impaired and presenteeism increases among medical staffs. This weakens the quality of health care services that they supplied. Thus, the investigation of the mechanism and intervention strategies of presenteeism are extremely called. We aim to (1) develop the instrument of presenteeism, investigate the challenges/hindrance stress, health and presenteeism of medical staffs in different areas and different levels of hospitals, based on Stressor-Emotion Model of Counterproductive Work Behavior; (2) using the structural equation modelling, we aim to investigate the mechanism of presenteeism, taking health and job stress into account, and the significant factor impacting on presenteeism; (3) using Hierarchical Linear Models, we aim to investigate the appropriate zone of the challenges/hindrance stress of medical staffs, and develop the differentiated strategies to intervene the presenteeism among medical staffs, considering the differences of medical staffs in different parts of China.

作为隐蔽性较强的生产力损失，广义隐性缺勤是由于员工健康或生活中其他原因不能全身心的投入工作而造成的，其损失数额已远超医疗支出和旷工，主要受工作压力和健康等影响。我国三甲医院医务人员由于自身职业的特点，承受较大工作压力，从而导致其健康受损，隐性缺勤行为增加，最终降低了其所提供的医疗服务质量。故隐性缺勤的形成机制及其有效干预策略成为亟待解决的科学问题。本研究拟从以下三方面展开：（1）根据反生产力行为模型（Stressor-Emotion Model of Counterproductive Work Behavior），开发测量广义隐性缺勤量表，调研医务人员挑战性/阻碍性压力、健康、隐性缺勤现状；（2）运用结构模型方程等方法，研究隐性缺勤的形成机制，确定隐性缺勤的最显著影响因素；（3）确定挑战性/阻碍性压力合理区间，借助多层线性模型分析不同地区医务人员间的差异，制定差别化的隐性缺勤干预策略。

作为隐蔽性较强的生产力损失，广义隐性缺勤是由于员工健康或生活中其他原因不能全身心的投入工作而造成的，其损失数额已远超医疗支出和旷工。隐性缺勤的形成机制及其有效干预策略成为亟待解决的科学问题。主要研究内容与结果具体如下：（1）根据反生产力行为模型，开发测量广义隐性缺勤量表，发现我国中西地区医务人员阻碍性压力较高，东部地区医务人员挑战性压力较高；私立医院工作人员健康状况好于公立医院医务人员；公立医院隐性缺勤较高；（2）广义的工作压力是隐性缺勤显著的前因变量；（3）社会支持可以显著降低隐性缺勤行为；（4）组织承诺、薪酬公平感可有效的中介工作压力对隐性缺勤的正面作用；（5）压力对工作能力的显著负面影响在队列数据中检验成立；（6）工作压力对医疗服务质量有着显著的负面效应，医务人员的健康对于保证医院医疗服务质量有着十分显著的正面作用。上述成果可供我国行政、卫生、军队相关部门在制定如何有效激发员工绩效、显著降低隐性生产力损失、从根本上发挥员工能动性等政策时提供必要的实证支持。