患者视角下多重制度逻辑对医患关系的作用路径研究

Study on the action path of multiple institutional logic on the doctor-patient relationship from the patient′s perspective

目的探究患者视角下多重制度逻辑对医患关系的作用路径, 为推动我国公立医院深化医改及完善现代医院管理制度提供依据。方法基于多重制度逻辑理论, 提出多重制度逻辑对医患关系作用路径的研究假设;通过随机抽样, 于2022年3—6月对江苏省2家三级公立医院的住院患者进行问卷调查, 问卷包括由政府逻辑、社会逻辑、市场逻辑和专业逻辑4个维度组成的多重制度逻辑量表, 以及由满意、承诺和信任3个维度构成的医患关系量表两部分。基于问卷调查结果, 运用结构方程模型分析患者视角下多重制度逻辑及其交互对医患关系的作用路径。结果共有效调查住院患者308人。结构方程模型分析结果显示, 多重制度逻辑对医患关系有直接影响, 路径系数为0.331(P<0.05);市场逻辑、社会逻辑以及专业逻辑分别对医患关系有直接影响, 路径系数为0.139、0.289和0.236(P<0.05);市场逻辑与社会逻辑的交互在一定程度上直接影响医患关系, 路径系数为0.257(P<0.05)。结论患者视角下多重制度逻辑及其交互作用会影响医患关系的发展, 政府及公立医院可聚焦市场逻辑、社会逻辑及专业逻辑采取相应措施, 同时关注制度逻辑交互, 加强多主体协同治理, 提升患者就医体验, 推动公立医院高质量发展及医患关系健康发展。

Objective To explore the action path of multiple institutional logics on the doctor-patient relationship from the perspective of patients,providing a basis for promoting the success of medical reform in public hospitals in China and improving the modern hospital management system.Methods Based on the theory of multiple institutional logic,propose a research hypothesis on the impact path of multiple institutional logic on doctor-patient relationships.Through random sampling,a questionnaire survey was conducted on inpatients from two tertiary public hospitals in Jiangsu Province from March to June 2022.The questionnaire consisted of a multiple institutional logic scale consisting of four dimensions:government logic,social logic,market logic,and professional logic,as well as a doctor-patient relationship scale consisting of three dimensions:satisfaction,commitment,and trust.Based on the survey results,structural equation modeling was used to analyze the impact of multiple institutional logics and their interactions on doctor-patient relationships from the patient′s perspective.Results A total of 308 inpatient were effectively surveyed.The multiple institutional logic had a direct impact on the doctor-patient relationship,with a path coefficient of 0.331(P<0.05).Market logic,social logic,and professional logic had direct effects on the doctor-patient relationship,with path coefficients of 0.139,0.289,and 0.236(P<0.05),respectively.The interaction between market logic and social logic directly affected the doctor-patient relationship to a certain extent,with a path coefficient of 0.257(P<0.05).Conclusions From the perspective of patients,multiple institutional logics and their interactions could affect the development of doctor-patient relationships.Governments and public hospitals can focus on market logic,social logic,and professional logic to take corresponding measures,while paying attention to the interaction of institutional logic,strengthening multi-party collaborative governance,improving patient experience,promoting high-quality development of public hospitals,and healthy development of doctor-patient relationships.