组织变革情境下医师主动参与主诊医师负责制的影响因素研究

A Study on the Influencing Factors of Physician’s Active Participation in Attending Responsibility System under the Context of Organizational Change

目的 探析个人、组织和领导的联动效应下医师主动参与主诊医师负责制的驱动路径,为医院实施主诊医师负责制提供参考。方法 随机抽取重庆市7所市级三甲医院的206名医师进行调研,采用模糊集定性比较分析法分析医师主动参与主诊医师负责制的医院变革氛围、领导类型和工作调节焦点的组态效应。结果 单个条件一致性均小于0.90,条件组态共产生5条驱动路径,3种变革模式,即“以促进焦点为导向的激进变革模式”“渐进变革情境下的领导驱动模式”“以防御焦点为导向的渐进变革模式”,总体覆盖度为0.77,总体一致性为0.91。结论 个人、组织与领导协同才可促使医师主动参与主诊医师负责制,其中领导发挥着更为重要的作用,建议管理者根据组织资源和自身条件禀赋,选择相匹配的驱动路径,并提出针对性措施。

Objective To explore the driving path of physician’s active participation in attending responsibility system under the interaction of individual, organization and leadership, and to provide reference for hospital managers to implement attending responsibility system.Methods A total of 206 physicians were randomly selected from 7 top-three hospitals in Chongqing, and fsQCA was used to analyze the combination of hospital reform atmosphere, leadership type and work regulatory focus.Results The individual condition consistency is less than 0.9,and the condition configuration produces 5 driving paths, 3 change models: "Radical Change with promotion focus", "Personal-leadership interaction",and "Gradual change with defense focus",the overall coverage was 0.77 and the overall consistency was 0.91.Conclusion Only when individuals, organizations and leaders cooperate can physicians take the initiative to participate in the attending responsibility system, in which leaders play a more important role.It is suggested that the managers should choose the matching driving path according to the organizational resources and their own condition endowments, and put forward the corresponding measures.