我国136家三级公立医院医生视角下的执业环境变化

Changes in the practice environment from the perspective of doctors in 136 tertiary public hospitals in China

目的了解我国136家三级公立医院医生视角下的执业环境变化,为制定改善医生执业环境的策略和措施提供依据。方法本研究资料来自2015年12月至2021年3月进行的5次"全国改善医疗服务第三方评估"的医护人员调查,每次调查的样本量分别为17945、19774、20786、23289和22836份,总计104630份。采用编制的调查表从医患关系、工作负荷、行政后勤支持、职业认同4个维度测量医生对执业环境的体验。结果第1次到第5次调查,"本院行政后勤部门办事效率高"的认同比例呈"U型"分布,"赞同或鼓励子女继续从事医务工作"的认同比例从13.38%增长到23.91%;第2次到第5次调查,医生经历过医患纠纷的比例由28.96%降至23.20%,医生认同本院医患关系正在好转的比例从33.20%持续上升至60.45%;第3次到第5次调查,医生经历医闹的比例由15.10%降至14.19%,"本院食堂为医护人员提供了营养可口的餐食"的认同比例从36.25%增长到47.52%,"我目前的工作负荷较重"的认同比例从61.55%降至45.24%。第5次调查结果显示,不同性别、职称和医院类型医生的各维度认同比例差异有统计学意义(P<0.001)。结论综合来看,医生执业环境的改善仍不充分。医院管理者应持续着力于医患关系的改善,并采取必要措施减轻医生工作负荷,提高医生职业认同感。

Objective To understand the changes in the practice environment from the perspective of doctors in 136 tertiary public hospitals,and to provide evidence for formulating strategies and measures to improve the practice environment of doctors.Methods The data was collected from five rounds of China Healthcare Improvement Evaluation Survey from December 2015 to March 2021.The sample size was 17945,19774,20786,23289,and 22836,with a total of 104630.The self-designed questionnaire on four dimensions of doctor-patient relationship,workload,administrative logistics support and professional identity was performed.Results From the 1st to the 5th survey,the approval ratio of"the administrative and logistics department of this hospital is highly efficient"showed the characteristics of"U-shaped distribution",and the approval ratio of"approve or encourage children to continue to engage in medical work"increased from 13.38%to 23.91%.From the 2nd to the 5th survey,the percentage of doctors who experienced doctor-patient disputes dropped from 28.96%to 23.20%,and the percentage of doctors agreeing that the relationship between doctors and patients in this hospital was improving continued to increase from 33.20%to 60.45%.From the 3rd to the 5th survey,the proportion of doctors experiencing medical troubles dropped from 15.10%to 14.19%,and the recognition rate of"the cafeteria of this hospital provided medical staff with nutritious and delicious meals"increased from 36.25%to 47.52%,and the approval proportion of"my current work load is heavy"dropped from 61.55%to 45.24%.The results of the 5th survey showed that there were significant differences in the approval ratios of each dimension in different genders,job titles and hospital types(P<0.001).Conclusions From the perspective of doctor-patient relationship,workload,administrative logistics support,and professional identity,the improvement of doctors′practice environment is still insufficient.Hospital administrators should continue to focus on the improvement of the doctor-patient relationship,and take necessary measures to reduce doctors′workload and improve doctors′professional identity.