| Objective:Based on the framework proposed by WHO,study the level and distribution of responsiveness of Shandong provincial hospitals,to identify the problems in provincial hospitals.Policy suggestions on the improvement of responsiveness are to be put forward to provide evidences for policy-making.Methods:Both quantitative and qualitative methods were used in the survey,to study responsiveness of in-patients,dependents,nurses and doctors in Qilu Hospital of Shandong University,Qianfoshan Hospital and Shandong Provincial Hospital.1.Questionnaire survey was conducted to understand the level and distribution of responsiveness and identify the problems in Shandong provincial hospitals.2.Panel discussion and key informant discussion were hold to explore the problems in responsiveness of provincial hospital and the way to improve responsiveness.Results:1.It found out that the rating of level of responsiveness was better than average level of nationwide.Respects for patients and confidentiality performed better, autonomy and basic amenities like catering and convenient equipments need to be improved.2.The order of the eight aspects of responsiveness for in-patients were Confidentiality,Dignity,Prompt Attention,Social Support,Communication, Autonomy,Choice of Providers and Quality of Basic Amenities.The order for dependents were Dignity,Confidentiality,Prompt Attention, Autonomy,Communication,Social Support,Choice of Providers and Quality of Basic Amenities.The order for nurses were Confidentiality,Dignity,Autonomy,Prompt Attention, Choice of Providers,Communication,Social Support and Quality of Basic Amenities.And the order for doctors were Dignity,Confidentiality,Prompt Attention, Autonomy,Social Support,Choice of Providers,Communication and Quality of Basic Amenities.3.The order of the eight aspects'significance for in-patients were Dignity, Prompt Attention,Confidentiality,Communication,Autonomy,Quality of Basic Amenities,Social Support and Choice of Providers.The order for dependents were Prompt Attention,Dignity,Communication, Quality of Basic Amenities,Autonomy,Confidentiality,Social Support and Choice of Providers.The order for nurses were Dignity,Prompt Attention,Communication, Confidentiality,Autonomy,Quality of Basic Amenities,Social Support and Choice of Providers.And the order for doctors were Dignity,Prompt Attention,Communication, Autonomy,Confidentiality,Quality of Basic Amenities,Social Support and Choice of Providers.4.The influential factors of responsiveness in in-patients were that age effected Quality of Basic Amenities(F=2.78,P＜0.05),health status effected Prompt Attention(F=3.21,P＜0.05),inhabited area effected Social Support(F=3.15, P＜0.01),culture degree effected Communication(F=2.54,P＜0.05).The influential factors of responsiveness in dependents were that culture degree effected Dignity(F=5.59,P＜0.01) and Communication(F=4.44,P＜0.01).The influential factors of responsiveness in nurses were that marriage status(F =5.03,P＜0.01),length of clinical work(F=1.86,P＜0.01),salary(F= 3.19,P＜0.05),health status(F=3.09,P＜0.05) and the title of a technical post (F=3.14,P＜0.05) were potential factors effect Communication,health status (F=3.43,P＜0.01) and the title of a technical post(F=2.72,P＜0.05) effected Quality of Basic Amenities.The influential factors of responsiveness in doctors were that length of clinical work effected Dignity(F = 3.31,P＜0.05) and Quality of Basic Amenities(F = 4.13, P＜0.01),culture degree effected Prompt Attention(F= 5.17,P＜0.01)and Choice of Providers(F=4.30,P＜0.01),salary effected Dignity(F=2.55,P＜0.05), Autonomy(F=5.30,P＜0.01),Prompt Attention(F=4.25,P＜0.01)and Quality of Basic Amenities(F=4.32,P＜0.01),health status effected Quality of Basic Amenities(F=3.03,P＜0.05),the title of a technical post effected Dignity(F =4.10,P＜0.05),Autonomy(F=3.08,P＜0.05) and Quality of Basic Amenities (F=3.77,P＜0.05).5.The correlation analysis showed that age had significant positive relationship with Quality of Basic Amenities(r=0.85,P＜0.01),health status had significant positive relationship with Prompt Attention(r=0.41,P＜0.05),inhabited area had significant negative relationship with Social Support(r=-0.51,P＜0.05),culture degree had significant positive relationship with Communication(r=0.54,P＜0.05) in in-patients.Culture degree had significant positive relationship with Communication (r=0.43,P＜0.01) in dependents.Length of clinical work had significant positive relationship with Communication(r=0.13,P＜0.05),marriage status had significant positive relationship with Communication(r=0.12,P＜0.05),salary had significant positive relationship with Communication(r=0.18,P＜0.01),health status had significant positive relationship with Communication(r=0.12,P＜0.05),the title of a technical post had significant positive relationship with Communication(r=0.14,P＜0.05), health status had significant positive relationship with Quality of Basic Amenities(r=0.18,P＜0.01),the title of a technical post had significant positive relationship with Quality of Basic Amenities(r=0.15,P＜0.05) in nurses.Length of clinical work had significant positive relationship with Dignity(r=0.34,P＜0.01)and Quality of Basic Amenities(r=0.40,P＜0.01), culture degree had significant negative relationship with Prompt Attention(r=-0.26,P＜0.05)and Choice of Providers(r= - 0.23,P＜0.05),salary had significant positive relationship with Dignity(r=0.33,P＜0.01)and Quality of Basic Amenities(r=0.37,P＜0.01),the title of a technical post had significant positive relationship with Dignity(r=0.35,P＜0.01),Autonomy(r=0.32,P＜0.01) and Quality of Basic Amenities(r=0.36,P＜0.01) in doctors.6.Distribution of responsiveness was fairly,but more efforts should be done to improve the Provincial hospitals'response to vulnerable groups like the poor,rural population and illiterates.7.It was found out in the panel discussion that responsiveness of Provincial hospitals in Shandong was fairly good.But all the eight aspects should to be improved.Insufficient health reform,no service notion in some of health staff and lack of incentives for hospital were attributed to the problem.8.It was found out in key informant discussion that it exsited some problems in responsiveness of provincial hospitals to be resolved.Conclusions:1.The level of responsiveness of Provincial Hospital was good,but some aspects needed to be improved by correspond measures.2.In-patients,dependents,nurses and doctors had different opinions of responsiveness,include the marking order and significance order.3.Age had significant positive relationship with Quality of Basic Amenities, health status had significant positive relationship with Prompt Attention,inhabited area had significant negative relationship with Social Support,culture degree had significant positive relationship with Communication in in-patients.4.Culture degree had significant positive relationship with Communication in dependents.5.Length of clinical work,marriage status,salary,health status and the title of a technical post all had significant positive relationship with Communication,health status and title of a technical post both had significant positive relationship with Quality of Basic Amenities in nurses. 6.Length of clinical work had significant positive relationship with Dignity and Quality of Basic Amenities,culture degree had significant negative relationship with Prompt Attention and Choice of Providers,salary had significant positive relationship with Dignity and Quality of Basic Amenities,the title of a technical post had significant positive relationship with Dignity,Autonomy and Quality of Basic Amenities in doctors.7.Distribution of responsiveness was not fairly to some vulnerable groups.8.Key informant discussion found that clients and medical personnels both put forward proposals for the responsiveness. |
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