新公共管理视角的医生参与管理:动因、影响因素与绩效

The engagement of doctors in management from the perspective of new public management: Motivation, influencing factors and performance

20世纪80年代以来,受全球新公共管理改革的影响,西方国家公立医院系统中出现临床专业人员积极参与管理工作的趋势。外部政策和内部组织变革的压力促使医生采取兼职、全职管理或领导等不同方式参与医院管理。由于制度、组织和个人三个层次不同因素的相互作用,不同国家具体的医生参与医疗管理模式与参与路径各有差异。医生参与管理在一定程度上有利于成本控制、有效监管与服务质量改进。本研究在相关文献研究的基础上,系统梳理和分析了一些国家医生参与管理的动因、影响因素与绩效,并构建了医生参与管理的过程模型,进而探究我国医生参与管理的现实与改革状况。

Since the 1980s, due to the global new public management reforms, there has been an international trend for clinical professionals to engage in management work in Western public hospital systems. Due to pressures from both external policies and internal organisational changes, clinical professionals tend were prompted to participate in hospital management of services in different ways, taking on full time or part time (hybrid) management or leadership roles. To understand factors affecting doctors involvement, due to the interaction of different factors in the system, it is necessary to invoke three different levels of analysis, namely, contextual, organizational and individual levels for the participation of specific doctors in hospital management modes and participation path. A growing body of evidence support that Doctors involvement in management is beneficial to cost control, effective supervision and service quality improvement to a certain extent. On the basis of literature research, this study systematically reviews the motivation, influencing factors and performance of doctors involvement in hospital management in Western countries, and constructs an explanatory model that offers a brief recap of the transformation process and highlighting the need to extend research in this area under China context. Therefore, this study explores the reality and reform of doctors participation in hospital management and draws the Western Countries experience to be applied in China.