社会协同治理视域下公立医院医患满意度测评及提升机制研究

Since the new medical reform, despite government attempted to continually regulate public hospitals by strengthening internal management and the external supervision of public hospitals, the expected social effect was not received. The status that conflict between medical staff and patient superimposes medical reform dissatisfaction of all sectors of society has been a public problem that focuses on the success of public hospital reform and has a significant social impact. This project intends to use advanced theories such as social governance, cooperative governance and limited rationality and qualitative and quantitative methods to clarify the concept and connotation of job satisfaction of medical staff and patient satisfaction in the context of social pluralism and governance in China, to dig into the multiple stakeholders behind medical staff and patient and the network of social governance structure, to analysis mechanism how the medical system and mechanism, social policy, organization management, public and social participation, public opinion and individual psychological characteristics, and other factors effect job satisfaction of medical staff, patient satisfaction and public hospital governance, to explore to establish job satisfaction of medical staff and patient satisfaction evaluation and relationship model, to reveal the formation and interaction of the job satisfaction of medical staff and patient satisfaction system in China, to quantitatively test the correlation, cause effect and synergy between job satisfaction of medical staff and patient satisfaction, and to finally construct the promotion mechanism of the social multiple combination, organic interaction and collaborative governance of job satisfaction of medical staff and patient satisfaction. The projector aims to provide theoretical and empirical basis for improving the current doctor-patient conflicts, promoting the harmonious relationship between doctors and patients, and promoting the modernization of public hospital governance system and governance capacity.

新医改以来,尽管政府试图不断规制公立医院加强内部管理并强化外部行政监管,并未获得预期的社会效应,且医患冲突叠加社会各方对医改均不满意的现状,已成为聚焦公立医院改革成败且具有重大社会影响的公共问题。本项目拟运用社会治理、协同治理及有限理性等前沿理论,定性、定量和质性研究相结合方法,厘清我国社会多元治理背景下医患满意度概念及内涵,挖掘医患双方背后的多元利益主体及网络化社会治理结构,剖析社会医疗体制机制、医疗政策、医疗舆情、组织管理、公民与公众参与和个体心理特征等要素对医患满意度及公立医院治理效果的作用机理;探索建立医患满意度测评及其关系模型,揭示我国医患满意度体系形成及互动的协同治理逻辑;定量检验医患满意系统间的相关、因果及协同关系;构建医患满意度社会多元联合、有机互动、协同治理的提升机制,为改善当前医患突出矛盾、促进和谐医患社会关系,推进公立医院治理体系和治理能力现代化提供理论与实证依据。

本项目聚焦近年来社会医患关系矛盾突出的问题，运用社会治理、协同治理及有限理性等国际前沿理论，结合深入挖掘、丰富和拓展我国传统文化精髓的“和谐”思想及“和谐管理”理论，以医患满意度测评为切入点，以构建医患共赢和谐关系的提升机制与制度路径为目标，科学界定了医务人员工作满意度、患者满意度和医患和谐满意度概念以及解析相关内涵和处延；站在和谐治理视域下自行设计研制了医务人员工作满意度和患者满意度测评量表；深入不同经济发展区域的6市县共19家公立医院约1900名医务人员和2020名患者开展满意度与治理因素相关调查与实证分析。研究发现，本项目自行研制医务人员工作满意度量表和患者满意度量表均具有较好的信效度，可用于对医患满意度的科学测评以及结果的解释，按照以调查科室为单位将医务人员与患者进行匹配组合的设计确保了医患和谐满意度测评的有效科学性；医务人员工作满意度及满意率总体均处于“及格”线的偏低水平，患者满意度及满意率总体均处于良好水平，医患和谐满意度处于“基本和谐”的关系状态；医患满意度均受到医院管理水平、政府治理职责履行、社会医疗环境、医患关系、社会舆论氛围等要素的共同影响与制约，其中医院管理水平对医患共赢满意关系具有直接正向影响的关键作用；政府治理职责履行对医患协同共赢满意关系虽没有直接的影响，但通过医院管理水平这一中介变量对医患共赢满意关系发挥着间接的重要正向影响作用；当前患者满意度是医患满意和谐演化机制的序参量，尚在医患和谐满意关系演化过程中起着主导与支配作用。项目从理论到实证研究最终构建的和谐医患共赢满意关系及中国特色“和谐治理”机制与路径策略，不仅具有重要的学术探讨和应用价值，也为公共服务领域相关命题深入挖掘、丰富、提升构建具有中国特色话语体系的“和谐治理”理论、概念及操作化，提供逻辑框架及方法学借鉴，对增强和彰显中国特色理论、制度以及文化自信有积极且重要意义。