Patient-Oriented Public Hospital Culture And Its Influence On Physician's Medical Professionalism

[Objective] The study investigated the situation of culture,physicians' occupation attitude and behavior of 6 public hospitals in three provinces in China.The purpose is to understand the physicians' cognition and evaluation,analyze the difference and influence factors of physicians' evaluation of hospital culture,then explore the influence path of hospital culture on the professional attitudes and behaviors.On basis of the data,the study provided a theoretical basis for cultivating the hospital culture which is conducive to improve physicians' occupation spirit.Besides,suggestions are put forward on the construction of hospital culture to create a healthy medical service environment and train qualified health personals.[Methods] 316 physicians were chosen from six public hospitals in Beijing,Hubei and Jiangxi Provinces.All of them were from the main clinical departments,including internal medicine,surgery,gynecology,pediatrics.The contents of investigation were including personal state of physicians,22 items on hospital culture,20 items on attitude and 10 items on behavior.[Results] 1 The current situation of hospital culture and its influencing factors The survey results showed that the average score of hospital culture evaluation of physicians is 3.15,the spirit and system culture,material culture,behavior and organizational culture negative evaluation of 3 average scores were 3.41,2.96 and 2.84 respectively.Among them,the influence factors of the hospital culture were including the level and area of the hospital,the position,length of service,annual salary,and weekly working hours.The influencing factors of spiritual/ institutional culture were including physicians' annual salary and working hours of week.The influencing factors of behavior /material culture were including the level and area of hospitals,physicians' position and age,age of working in the hospital,employment form and annual salary.The factors that influenced the negative evaluation on hospital culture were including hospitals' area,physicians' age and education background and position,annual salary and working hours per week.2 The current situation of professional attitude and behaviorThe survey results showed that the recognition of the 18 items was higher than 80% while 14 items was more than 90%.The proportion of agreement was more than 80%.As for professional behavior,the incidence rate of all positive behaviors was higher than 85%.3 The situation and influencing factors of professional attitude and behaviors The results of hierarchical regression analysis on professional attitude showed that 19% of the variance had been explained by predictor variables,The culture of spiritual/institutional had a significant impact on the professional attitude of physicians,the interpretation rate was 15.1%.The physicians' professional attitude of public hospitals in Beijing and Yingtan was higher,which explained 1.2% and 1.4% of variation ratio respectively.The demographic variables had no significant effect on physicians' professional attitude.The results of hierarchical regression analysis on professional behaviors showed that the predictor variables accounted for 17.4% of the variance.There was a variable has significant influence on the behaviors of the occupation among four levels.The explanatory rates of professional attitude and organizational culture negative evaluation were 6.0% and 5.7% respectively,and they had a positive impact on professional behaviors.Comparing with the influence of professional attitude,the scores of professional behaviors in Yingtan were lower than those in Wuhan.The influence of physician age also had some explanatory power.[Conclusions] Discussion The culture evaluation scale of public hospitals had a good reliability(2)The overall score of public hospitals culture was at a high level,but the negative evaluation on hospital culture need to be improved(3)The spiritual/ institutional culture is related to the annual salary and the working hours of the doctors(4)The spiritual/ institutional culture is an important influencing factor of professional attitude(5)The influence of behaviors/material culture on professional behavior is very limited(6)The main influencing factors professional behaviors were including negative evaluation on hospital culture,geography and age.Suggestions(1)Strengthen top-level design of the culture and implement the specific construction of spiritual/ institutional culture(2)Improve the hospital management system and the enthusiasm of physicians in the construction of hospital culture.(3)Carry out the guiding ideology of "people-oriented" spirit.(4)Enrich the incentive mechanism and improve physicians' treatment reasonable,(5)Create a harmonious and safe working atmosphere of physicians.(6)Strengthen the exchanges and learning of culture between different hospitals and areas.(7)Insist on “patient-oriented” and promote the transformation of good occupation attitude to the good behaviors.