基于推拉理论的优质医生下沉基层行为的动力模型构建

Construction of a Dynamic Model for High-Quality Doctors Sinking to the Primary Hospitals Based on Push-Pull Theory

目的构建优质医生下沉基层的动力模型,分析优质医生下沉基层的影响因素,为相关部门制定促进优质医生下沉方案提供借鉴。方法基于推拉理论的推力、拉力、阻力三个因素设计由14个指标构成的问卷,调查广东省4所大型三甲医院优质医生,采取结构方程模型验证影响因素与医生下沉行为的关系。结果构建由推力、拉力、阻力三个因素,业务能力、配套措施、实践机会和晋升表彰四个维度组成的优质医生下沉基层行为动力模型。晋升表彰、实践机会对优质医生下沉行为有显著正向影响,配套措施和业务能力对优质医生下沉行为有显著负向影响。结论政府需强化法制保障、增加财政支持,公立医院应制定合理的绩效考评方案与晋升表彰机制,基层医院需加强自身软硬件能力建设,同时考虑为优质医生提供更多参与管理的机会。

Objective To construct a dynamic model of high-quality doctors sinking to primary hospitals,analyze its influencing factors,and provide references for making plans to promote it.Methods According to push-pull theory,the questionnaire was designed on the basis of push,pull and resistance factors,which was used to investigate the high-quality doctors from 4 large-scale tertiary hospitals in Guangdong Province.Structural equation model(SEM)was used to analyze and verify the relationship between doctors’sinking behavior and those influencing factors.Results A dynamic model to the behavior of high-quality doctors sinking to primary hospitals was constructed by three factors of push,pull and resistance factors,and four dimensions of professional capabilities,supporting measures,practical opportunities and promotion and commendation.The factors of promotion and commendation and practice opportunities had a significantly positive influence on the sinking behavior of high-quality doctors,while supporting measures and professional capabilities had significantly negative influence on it.Conclusion It is suggested for the government to strengthen legal guarantee and improve financial security,for public hospitals to formulate reasonable performance appraisal plan and promotion and commendation mechanism,and for the primary hospitals to strengthen their own software and hardware capabilities,and provide more opportunities for the high-quality doctors to participate in hospital management.