【摘要】：目的:了解新醫(yī)改以來江蘇省醫(yī)患媒三方對(duì)于醫(yī)患關(guān)系的理解和主觀評(píng)價(jià);為公立醫(yī)院改革和建立現(xiàn)代醫(yī)院管理制度提供可行的建議;分析醫(yī)患關(guān)系的影響因素和不和諧的根源所在,探究醫(yī)患媒三方認(rèn)知差異的原因,從管理學(xué)角度對(duì)醫(yī)患媒三方評(píng)價(jià)的差異性做出系統(tǒng)分析并給出政府監(jiān)管和醫(yī)院內(nèi)部管理的途徑和側(cè)重點(diǎn),為和諧醫(yī)患關(guān)系的構(gòu)建提供借鑒。方法:本研究基于文獻(xiàn)研究、問卷調(diào)查和訪談,運(yùn)用主體框架分析法和相關(guān)統(tǒng)計(jì)學(xué)方法輔助分析研究?jī)?nèi)容。對(duì)新醫(yī)改以來的專業(yè)期刊、政府醫(yī)療衛(wèi)生相關(guān)文件及相關(guān)網(wǎng)絡(luò)信息,查詢研究?jī)?nèi)容,在數(shù)據(jù)庫(kù)中查閱國(guó)內(nèi)外相關(guān)文獻(xiàn);問卷調(diào)查在南京、無錫、南通、淮安四所城市中,選取四家綜合性醫(yī)院開展;針對(duì)醫(yī)患媒三方認(rèn)知下醫(yī)患關(guān)系現(xiàn)狀及其影響因素,采取個(gè)別訪談和專家訪談相結(jié)合的形式,集多方意見,探討和諧醫(yī)患關(guān)系構(gòu)建方案;通過主體框架分析法對(duì)原始資料構(gòu)建分析框架,將訪談資料和文獻(xiàn)資料比較分析后進(jìn)行整合處理,最終得到基于醫(yī)院管理的改善醫(yī)患關(guān)系的主體框架,并根據(jù)所得的框架設(shè)計(jì)問卷;運(yùn)用Epidata3.0對(duì)數(shù)據(jù)進(jìn)行雙錄入,利用office軟件進(jìn)行數(shù)據(jù)的初步整理后轉(zhuǎn)入SPSS20進(jìn)行描述性及推斷性統(tǒng)計(jì)分析:對(duì)于率的比較采用卡方檢驗(yàn),對(duì)于醫(yī)患關(guān)系影響因素及個(gè)研究者的政策建議采用Logistic回歸方法。結(jié)果:40.6%的患方和41.7的媒體人員對(duì)醫(yī)患關(guān)系的評(píng)價(jià)在80分以上,比例遠(yuǎn)高于醫(yī)務(wù)人員(9.2%);認(rèn)為醫(yī)患關(guān)系非常差的前三位科室是內(nèi)科31.1%,中醫(yī)25.0%,外科23.9%,調(diào)查對(duì)象對(duì)醫(yī)患關(guān)系的評(píng)價(jià)受個(gè)體差異、執(zhí)業(yè)環(huán)境、社會(huì)大環(huán)境影響;醫(yī)療費(fèi)用高是醫(yī)患媒三方認(rèn)知下阻礙和諧醫(yī)患關(guān)系前五位影響因素的唯一一個(gè)共同因素,其中醫(yī)方認(rèn)為排在前三位的是媒體宣傳不當(dāng)(82.8%),政府醫(yī)改缺陷(60.3%)、社會(huì)風(fēng)氣差(58.5%),患方認(rèn)為是醫(yī)療費(fèi)用高(56.7%)、市場(chǎng)經(jīng)濟(jì)影響(49.6%)、醫(yī)務(wù)人員態(tài)度差(28.1%),媒體人員覺得依次為醫(yī)療費(fèi)用高(60.7%)、市場(chǎng)經(jīng)濟(jì)影響(57.7%)、醫(yī)務(wù)人員服務(wù)態(tài)度差(53.4%);約七成以上醫(yī)患認(rèn)為醫(yī)院的內(nèi)部設(shè)施和環(huán)境有所改善,服務(wù)態(tài)度有所提升,服務(wù)流程有所優(yōu)化;醫(yī)患媒三方認(rèn)為改善醫(yī)患關(guān)系對(duì)個(gè)人來說非常重要的均超過五成,其中醫(yī)方比例最高(76.8%),患方其次(59.8%),媒體為55.2%;93.2%的醫(yī)務(wù)人員、80.1%的患方和73.6%媒體表示愿意盡自己的努力改善醫(yī)患關(guān)系;認(rèn)為暴力傷醫(yī)需要依法嚴(yán)懲的醫(yī)方、患方和媒體分別占各自群體的94.7%、73.3%和81.6%;醫(yī)患媒三方對(duì)新醫(yī)改政策知曉度偏低,非常了解及比較了解的分別占48.2%、21.1%和11%;醫(yī)患溝通對(duì)和諧醫(yī)患關(guān)系構(gòu)建的重要性得到85.30%的媒體人員、91.00%的患方和91.50%的醫(yī)方肯定;醫(yī)生工作繁忙和醫(yī)患間的利益矛盾是醫(yī)患媒三方認(rèn)為造成醫(yī)患溝通不暢的主要因素。結(jié)論:醫(yī)患關(guān)系并沒有社會(huì)上感知緊張,醫(yī)患關(guān)系發(fā)展態(tài)勢(shì)趨于樂觀。醫(yī)患認(rèn)知的影響因素有個(gè)體差異、媒體輿論和宏觀社會(huì)環(huán)境;經(jīng)濟(jì)因素和醫(yī)院管理是構(gòu)建和諧醫(yī)患關(guān)系的重難點(diǎn)。政府應(yīng)綜合一線反饋意見,不斷增強(qiáng)分級(jí)診療和多點(diǎn)執(zhí)業(yè)的可操作性,加大醫(yī)改政策宣傳力度,加大基層醫(yī)療機(jī)構(gòu)建設(shè)與監(jiān)管力度,嚴(yán)格控制醫(yī)院擴(kuò)建預(yù)算同時(shí)下放醫(yī)院人事權(quán),推動(dòng)藥品統(tǒng)一招標(biāo)與醫(yī)院自主招標(biāo)兩線并存;構(gòu)建新媒體官方溝通平臺(tái);引導(dǎo)患者認(rèn)知。醫(yī)院應(yīng)不斷加強(qiáng)內(nèi)部精細(xì)化管理,運(yùn)用品管圈、按照J(rèn)CI評(píng)審標(biāo)準(zhǔn)對(duì)醫(yī)院進(jìn)行管理,利用醫(yī)療事件報(bào)道強(qiáng)化風(fēng)險(xiǎn)管理和危機(jī)管理,有針對(duì)性地推進(jìn)人力資源管理、人文醫(yī)院和學(xué)習(xí)型醫(yī)院的建設(shè),發(fā)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.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.3

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