Research On Human Resource Sharing Mechanism Of Vertical Closely Medical Consortium

[Purpose] This research is based on systematically reviewing the development process and research trend of medical consortium,and summarizing the theory and mechanism of human resource sharing research both at home and abroad.The framework of analysis method and mechanism is introduced into the field of human resource sharing in the longitudinal compact Medical Association.Combined with qualitative analysis,quantitative analysis,theoretical research and empirical research,case analysis and comparative study,the human resource sharing of vertical closely medical consortium(v CMC)is analyzed in detail.The practice and experiences of human resource allocation and sharing in the excellent samples of v CMC are summarize.Aiming at exploring the law of human resources sharing,summarizing the key problems and key isssues,the mechanism and the path of human resource sharing of the v CMC are constructed.It can provide references for China to improve and develop medical consortium,build hierarchical diagnosis and treatment system,and integrate medical and health resources.[Methods]1.Literature review.The Chinese database CNKI,Chongqing VIP and Wanfang database and Google academic,Web of knowledge,Pubmed and other English databases are selected to collect the literature of medical consortium and human resources sharing at home and abroad.Through literature analysis,the basic theories and basic methods of research in this field are summarized,and the factors and indexes affecting the effect of human resource sharing are summarized,and the preliminary framework of human resource sharing mechanism of v CMC is constructed to provide reference for follow-up research.2.Secondhand data collection.This study was based on Professor Tao Hongbing’s National Natural Science Foundation Project "performance evaluation of compact medical union based on structural equation model and Influencing Factors Research(batch number: 71473099)"(2015.1-2018.12).We selected 3 different provinces(Shandong,Tianjin,Hubei)which are in different economic development levels,and 12 typical v CMC were selected as the research object,involving 10 core hospitals and 22 grassroots health institutions.Data collection tools were designed and discussed after group discussion,and the results were perfected based on the preliminary survey conducted in the fifth hospital of Wuhan,Hubei.Finally,we collect data from three aspects:(1)structured questionnaires,collecting the needs,sharing attitude and sharing mechanism of the medical staff of the core hospital and the grass-roots organizations,and the existing problems and suggestions.Human resources sharing status,key problems and key links and sharing effects and influencing factors of type medical consortium;(2)related materials such as medical association and its human resources construction background,policy documents,sharing measures records,and so on are collected.According to the results of the present research part,typical case analysis was carried out.(3)the semi-structured interview was used to select 114 people,which were designed in advance and made a thorough interview with the interview outline.The views and feelings of human resource sharing,such as the objective,current situation evaluation,mechanism construction,problems and suggestions,have been interviewed and recorded for more than 30 minutes per person.It is used to establish the sharing mechanism and put forward the corresponding countermeasures and suggestions.3.Method of data analysis.(1)Data sorting methods: Word and Excel are used to sorting verbatim transcriptional interview recordings and other summary documents and forms;Epi Data3.0 was applied for data entry and export of the questionnaire,and we used SPSS11.0 for data cleaning and analysis,and Nvivo11 to conduct interview records for coding and analysis.(2)Descriptive statistical analysis of the questionnaire data: descriptive statistics analysis of the status quo and key issues of the human resource allocation and sharing of the sample v CMC.(3)Ordered multiple categorization dependent Logistic regression analysis: using ordinal multi-class Logistic regression to explore the influencing factors of sharing status.(4)Content analysis method: it is mainly used to analyze the interview data of pre-investigation,integrate the opinions of all parties to modify the data collection tools and research theoretical framework;(5)typical case analysis: the typical case analysis of two major kinds of v CMC is carried out,and the construction experience and the existing problems are summarized and compared.(6)grounded theory analysis: according to a certain standard,complete interview records 47 copies,22 papers are select to carry on the grounded theory analysis to construct the human resource sharing mechanism of v CMC,and put forward the pertinent policy suggestions.[Results]1.The Cronbach alpha coefficients of the questionnaires for medical staffs in the core hospital and the basic level institutions were 0.81 and 0.87 respectively,and the reliability was good,and the results were reliable.525 out of 550 former and 311 out of 330 latter compete questionnaires are recycled.2.On the analysis of the data,it is found that there are great demand for sharing,the reason is to improve the salary and the career development,and the grass-roots organizations should pay more attention to the improvement of their ability and medical treatment.Their training of the personnel are the most demanding measures;the most needed forms are the case analysis and the on-site observation,Few rely on knowledge sharing between network and information platform.The main reasons for not participating in the sharing are too much work load,imperfect incentive mechanism and no idle time;the overall self-evaluation of the effect of sharing is good(more than 40%),but there are still many practical problems to be solved.After the sequential multi classification Logistic regression analysis of effect factors,it was found that self feeling of sharing was effected by education(P<0.1),monthly average income(P<0.1),demand of sharing(P<0.1)and hindrance of sharing(P<0.05),and the modeling of core hospital was slightly different from the basic model.It indicates that trust,communication and incentive in the sharing of human resources have an impact on the sharing effect.3.Analysis of typical cases.In the practice of Medical consortium,there are many differences.Two different v CMC in urban and rural areas are selected to make detailed analysis,and compare sharing measures and their effects.The contents of the case study are that Medical consortiums should develop according to local conditions and avoiding compitition.The sharing of human resource takes the supporting measures.The leading party decides the Medical consortium’s trend,and should pay more attention to the sharing demand of the grass-roots level.Lack of effective incentive mechanism may affect the sustainability of the resource sharing measures,and the informatization construction can improve the efficiency and effect of human resource sharing.4.Grounded theory analysis is used to construct theory,extract key problems,and put forward countermeasures and suggestions.From 114 interviews,a total of 47 complete records and 22 closely related papers were selected,of which 80% were selected as theoretical sampling,and the remaining 20% were used as theoretical saturation test,and 324 of the open nodes were obtained.On the basis of comparison and synthesis,there are 7 main spindle codes on a comparative and comprehensive basis.After comparison,focusing noding,writing memo and other steps,the mechanism is finally constructed.After coding and selective coding,the theory of this study is developed and theoretical saturation test is carried out.The result satisfies the requirement of theoretical saturation test,that is,there is no new concept classes for the continuous coding of 20% uncoded materials,and the extraction information is saturated.The mechanism of human resource sharing and its key problems and countermeasures are gradually formed.[Conclusions]1.The mechanism of human resource sharing in v CMC.Based on grounded theory,this study constructs a human resource sharing mechanism and its realization path.The sharing mechanism is divided into two parts: dynamic and static,namely,the dynamic mechanism of three parts: sharing trust,communication and motivation,and the static mechanism containing shared platform.The latter part is the structural basis of the implementation of dynamic mechanism,usually the system structure formed by long-term operation experience and practice,while the former plays a role on the basis of static mechanism,it is a processing and dynamic.The basic function of sharing mechanism is to establish,maintain,protect the implementation of sharing and promote the realization of shared goals.2.The current situation and key issues of human resource sharing in the v CMC.The problems of human resource sharing are divided into two parts.On the one hand,it is the problem of sharing itself,including the poor participation,no actual effects,the low self-evaluation of the implementation,and the obstacles that stopped sharing from fully functioning.The main reasons for the lack of participation are the overburden of work,the lack of spare time and the unperfectness of incentive measures.On the other hand,the sharing mechanism still needs to be improved,including the non-standard sharing platform,the lack of trust between the trust base and the sharing of the strategic target and culture,the mismatch between the incentive mechanism and the sharing measures,the difficulties in implementing the incentive measures and the imperfect performance appraisal system.Sharing communication path and communication timeliness is not complete.3.Countermeasures and suggestions.We should pay attention to the sharing management and optimize the sharing platform: through the guidance of management services,improve the understanding of the sharing of human resources by various stakeholders,build a shared cultural atmosphere and incentive system,and clarify the function orientation,the medical consortium management framework and the path of unified integration of resources.To break the conflict of interests and enhance mutual trust and interaction: through the goal of Unified Medical Consortium development,the establishment of institutional objectives for cooperative development,the rationalizing of inter agency interests,division of labor and cooperation to reduce competition and conflict,and gradually unify the core interests,communicate fully in the process of interaction,avoid mechanism and develop omni-directional trust.Broaden communication dimensions and levels to solve practical problems: under the support of good sharing atmosphere,fully advocating communication behavior and improving communication atmosphere,using a variety of formal and informal communication methods,gradually improving the communication platform,and maximizing the effectiveness of communication to solve practical problems.To improve the pertinence of incentive measures,establish dynamic adjustment system: integrate and allocate related incentive resources,establish targeted and multi-dimension sharing incentive measures,and monitor and dynamically adjust in the process of sharing,so as to stimulate the sharing power to the maximum extent.4.Research summary and ProspectThis study focuses on the mechanism of human resource sharing in v CMC.First,the research object is unique.It is different from other Medical consortium in the aspects of organizational structure,relationship degree,cooperation and distribution of interests.Secondly,it focuses on the analysis of the mechanism of human resources sharing and its key problems.This perspective is rare in the literature and fills the lack of related research.In methodology,this study comprehensively uses qualitative and quantitative analysis methods to explore the theoretical mechanism,path and current situation,existing problems and Countermeasures of human resource sharing in v CMC,and the research system is well-designed and complete.This study uses grounded theory to analyze the construction mechanism and existing problems.The research design is relatively standardized,and the quality control is fully considered,and the result is ideal.In this study,the results and conclusions of closely medical consortiums related research in this study can not only provide reference for the construction of v CMC,but also provide reference for the construction and development of other type(non closely)medical consortium to a large extent.Therefore,the results and conclusions of this study are widely used.Future research can be carried out in a more detailed and systematic analysis of the sub-mechanisms of the human resource sharing mechanism,the sharing measures and forms,and the sharing effect(efficiency and efficiency)evaluation.