基于扎根理论的公立医院医生离职意愿形成驱动机制研究

Study on the driving mechanism of the formation of doctors′turnover intention in public hospitals based on the grounded theory

目的基于扎根理论探讨公立医院医生离职意愿形成的驱动机制。方法以"公立医院医生离职意愿或离职倾向"为主题词,在中国知网检索2017年1月1日至2022年1月1日发表的相关文献。基于扎根理论,利用NVivo 11.0软件对文献进行质性分析,采用开放式编码、轴心式编码和选择式编码的三级编码方法,得到影响公立医院医生离职意愿的主类属并在此基础上整合驱动机制模型。通过对医院管理人员的深度访谈进行理论饱和度检验。结果对获取的31篇文献进行编码,将公立医院医生离职意愿形成的影响因素归纳为择业偏差、执业现实、感知体验和外部机会4个一级节点。其中,择业偏差是离职意愿形成的初始驱动因素,执业现实是关键驱动因素,二者共同作用于感知体验这个直接驱动因素,而外部机会则是可能驱动因素。结论为避免医生产生离职意愿,医院管理者应完善招聘评价指标,强调招聘有效性;注重医生心理资本管理,培养正向感知;推进绩效薪酬改革,强调公平与价值;重视员工关系管理,建设支持性医院文化。

Objective To explore the driving mechanism contributing to doctors′turnover intention in public hospitals based on the grounded theory.Methods"Willingness or intention for doctors to quit public hospitals"was used as the theme word,and the literature was retrieved from CNKI published from January 1,2017 to January 1,2022.Based on the grounded theory,NVivo 11.0 software was used for a qualitative analysis of the literature.The three-level coding method of open coding,axial coding and selective coding was used to identify the main categories affecting the willingness of doctors to quit public hospitals.On this basis,the driving mechanism model was integrated.In-depth interviews with hospital managers were used to test the theoretical saturation.Results When 31 papers were coded,four level-1 influencing factors of the formation of doctors′turnover intention in public hospitals were summarized:career selection deviation,practice reality,perceived experience and external opportunity.Among them,perceived experience was the direct driving factor;career selection deviation was the initial driving factor,and the practice reality was the key driving factor,both of them affected the perceived experience;external opportunity was the possible driving factor.Conclusions In order to prevent doctors from willing to leave,the following measures are expected:the hospital management should improve both its recruitment evaluation indexes and recruitment effectiveness;pay attention to doctors′psychological capital management and cultivate positive perception;promote the reform of performance pay,emphasize fairness and value;pay attention to employee relationship management and build a supportive hospital culture.