计划行为理论视角下公立医院外科医护人员执行RBRVS绩效分配制度的行为影响因素研究——以重庆医科大学附属儿童医院为例

Study on the Influencing Factors of Implementing The RBRVS Performance Allocation System of Surgical Staff in Public Hospitalsfrom the Perspective of Planned Behavior Theory

目的:探讨在实施RBRVS绩效分配制度过程中影响外科医护人员执行该制度的主要因素,为进一步提高公立医院外科医护人员对RBRVS绩效分配制度的适用性和实用性提出建议。方法:引入计划行为理论,建立公立医院外科医护人员执行RBRVS绩效分配制度的结构方程模型,从行为态度、主观规范、知觉行为控制三方面来分析影响外科医护人员执行RBRVS绩效分配制度行为的影响因素。结果:外科医护人员执行RBRVS绩效分配制度的行为态度、主观规范、知觉行为控制对行为意向的标准化回归系数分别为0.305,0.350,0.341,P<0.01,说明该三项对行为意向产生了较为显著的正向关系,其中主观规范对行为意向的正向关系最为显著;知觉行为控制和行为意向对行为的标准化回归系数为0.307和0.362,P<0.01,说明该两项对行为产生显著正向影响。结论:为了更好地执行RBRVS绩效分配制度,外科医护人员应该以积极的态度接受该制度,加强对该制度的学习和掌握,提升医疗水平。医院及科室应当营造支持该制度的氛围,制定执行情况的奖惩措施,同时强化培训,进一步获得外科医护人员理解和支持。

Objective To explore the main factors affecting the implementation of the RBRVS performance allocation system of surgical staff,and put forward suggestions for further improving the applicability and practicability of the RBRVS performance allo-cation system to surgical staff in public hospitals.Methods The theory of planned behavior was introduced to establish a structural equation model of the implementation of the RBRVS performance allocation system of surgical staff in public hospitals,and the fac-tors affecting the implementation of the RBRVS performance allocation system were analyzed from three aspects of behavioral atti-tude,subjective norm and perceptual behavior control.Results The standardized regression coefficient of behavior attitude,sub-jective norm and perceived behavior control on behavior intention was 0.305,0.350,0.341,respectively,which showed that these three items had a significantly positive relationship to the behavioral intention,and the subjective norm had the most signifi-cantly positive relationship to the behavioral intention.The standardized regression coefficient of perceived behavioral control and behavioral intention on behavior was 0.307 and 0.362,respectively,indicating that these two items had significantly positive effects on behaviors.Conclusion In order to better implement the RBRVS performance allocation system,surgical staff should ac-cept the system with a positive attitude,strengthen the learning and mastery of the system,and improve the medical services.Hos-pitals and departments should create an environment to support the system,formulate incentives and punishments for implementa-tion,and strengthen training to further gain the understanding and support of surgical staff.