基本药物制度背景下基于扎根理论的乡村医生离职倾向形成机制研究

Formation Mechanism of the Turnover Intention of Rural Doctors Under Essentail Medicine System Based on Grounded Theory

目的探讨基本药物制度背景下基于扎根理论的乡村医生离职倾向形成机制。方法于2012年7月采用目的性抽样和滚雪球抽样方法,选取济南、济宁、日照地区基本药物制度实施时间较长、对基本药物制度及其影响理解较深的乡村医生及乡镇卫生院、卫生局管理人员共22人,运用课题组研制的访谈提纲对其进行访谈,内容主要包括基本药物制度在当地的实施情况、相关配套政策的落实情况、基本药物制度实施后乡村医生的工作与生活情况、基本药物制度对乡村医生产生的影响以及乡村医生对基本药物制度及其配套政策的态度等。对收集到的访谈资料由两名研究人员按照扎根理论的研究方法,遵循开放编码、主轴编码和选择编码的步骤,进行阅读、转录、编码、属性归类、进行解释等工作。结果开放编码形成22个一级范畴,主轴编码形成了7个二级范畴,选择编码最终形成了乡村医生离职倾向产生路径:随着基本药物制度的实施,乡村医生队伍出现工作满意度下降以及情感耗竭等现象,由于当前情况下乡村医生工作的投入产出比太低,因此乡村医生队伍的工作积极性开始逐渐降低,职业认可度下降,由此导致其工作稳定性下降,离职倾向不断增强。结论基本药物制度实施后,乡村医生离职倾向的增强是多种因素共同作用的结果,最终将增加农村公共卫生服务体系以及三级医疗卫生服务网的脆弱性,相关部门应尽快采取针对性措施提高乡村医生稳定性。

Objective To explore the formation mechanism of the turnover intention of rural doctors under essential medicine system based on grounded theory. Methods Using purposive sampling method and snowball sampling method,we enrolled 22 rural doctors and managers of rural health centers and health offices who were influenced by essential medicine system for longer time and who had deeper understanding of the influence of the system in Ji＇nan,Jining and Rizhao. We used the self -designed interview outline to conduct interviews about the local implementation status of essential medicine system, the implementation of relevant policies,the working and living condition of rural doctors after the implementation of essential medicine system,the influence of essential medicine system on rural doctors and the attitude of rural doctors toward essential medicine system and relevant policies. Based on grounded theory and in a sequence of open coding,axial coding and selective coding,two researchers conducted reading,transcription,coding,natural classification and explanation of the data from the＆amp;nbsp;interviews. Results We worked out 22 first - grade categories in open coding and 7 second - grade categories in axial coding. And we found the formation path of the turnover intention of rural doctors by selective coding：with the implementation of essential medicine system,the rural doctors＇ satisfaction degree with work decreased,and their passion for work became exhausted;because of the low input - output ratio of the work of rural doctors at present,the working enthusiasm of rural doctors began to dampen,and the recognition degree of the occupation dropped;as a result,working stability began to decrease,and the turnover intention constantly increased. Conclusion After the implementation of essential medicine system,the decline of rural doctor＇s turnover intention is a result of a variety of reasons. It will exacerbate the vulnerability of rural public health service system and three - level service network. Measures should be taken to improve the stability of the group of rural doctors.