双元制度逻辑视角下医养结合机构的医生身份认同研究——基于清晰集定性比较分析

Study on the Identity of Doctors in the Medical and Nursing Integration Institutions from the Perspective of Dual Institutional Logic——Qualitative Comparative Analysis based on Clear Set

目的:研究影响医养结合机构医生身份认同的制度逻辑,为提升医养结合机构医生的岗位吸引力、降低流失率提供启示。方法:基于制度逻辑理论,运用清晰集定性比较分析方法,分析影响医养结合机构医生身份认同的制度逻辑。结果:政府逻辑通过多重政策调控,影响医养结合机构医生身份认同;市场逻辑的影响路径有3条,是效率、利润、开拓市场、打造品牌四个因素的不同组合;政府逻辑与市场逻辑兼容作用的影响路径表现为“政策倾斜加强机构合法性实现经济效益”和“资源帮扶助力机构发展”的共同联动;政府逻辑与市场逻辑冲突作用的有效路径为“对政府购买项目过度依赖会弱化医养结合机构的市场竞争能力”。结论:制度逻辑的单一作用以及交互作用均会对医养结合机构医生的身份认同产生影响,对此应充分发挥政府的规划引领作用,合理运用市场功能,通过政府的资源助力机构发展,同时减少机构对政府购买服务的依赖性,从而提升医养结合机构医生的身份认同。

Objective To study the institutional logic that affects the identity of doctors in medical and nursing integration institutions,and to provide insights for improving the job attraction and reduce the turnover rate.Methods Based on the theory of institutional logic,the institutional logic affecting the identity of doctors in medical and nursing integration institutions was analyzed by using qualitative comparative analysis based on clear set.Results The government logic influenced the identity of doctors in medical and nursing integration institutions through multiple policy regulation.There were three influencing paths of market logic,which were different combinations of efficiency,profit,market development and brand building.The compatible effect of government logic and market logic was manifested as the joint linkage of"policy tilt to strengthen the legitimacy of the institutions to achieve economic benefits"and"resources assistance to help institutions development".The effective path of conflict between government logic and market logic was"excessive reliance on government purchase projects would weaken the market competitiveness of medical and nursing integration institutions".Conclusion The single and interactive effects of institutional logic will have an impact on the identity of doctors in medical and nursing integration institutions.In this regard,it is necessary to give full play to the planning and leading role of the government,rationally use the function of market mechanism,assist the development of the institutions through the government resources,and simultaneously reduce institutions dependence on government procurement of services,so as to enhance the identity of doctors in medical and nursing integration institutions.