Research On Evaluation Index System Of Humanistic Care In Public Hospitals In Anhui Province

Background: From August 19 th to 20 th,2016,the National Health and Wellness Conference was held in Beijing.It was the first time that such a high-level national health work conference was held in China in the past 20 years.This means that the party and government have begun to recognize the importance of "health" for development and reform,and we need to incorporate "health" into the overall framework of deepening reform with the same deployment,requirements,and assessment.As for the definition of "Health",the World Health Organization(WHO)made the following interpretation in 1990: "Health is no longer just that the body has no disease,but also includes physical,psychological and social integrity as well as moral and emotional health.".As one of the first batch of comprehensive medical reform pilot provinces in China,anhui province has been groping in the deep-water area of medical reform for many years,aiming to explore a medical reform road that conforms to the spirit of the central government,the objective law and the reality of anhui province."Anhui province in 2016 to deepen the comprehensive reform of the medical and health system pilot key tasks" will "vigorously improve medical services,build a harmonious doctor-patient relationship,improve the feeling of medical care,enhance the people's sense of access" as one of the deepening of the comprehensive reform of public hospitals.The key point of deepening the reform of public hospitals may not be the microscopic problems such as the disease itself.For the reform of public hospitals,it is necessary to construct a harmonious culture of doctor-patient relationship from a macroscopic perspective,and reach the consensus "destiny community" through a subtle "soft environment".The realization of the reform of public hospitals in the sense.The power to give full play to the hospital's humanistic care is dominant in it,making humanistic care an inevitable choice for the province's response to the new medical reform.Objective:To understand the current situation of humanistic care construction in public hospitals in China,to construct the theoretical framework for the evaluation of humanistic care in hospitals in line with the actual construction needs of anhui province,and to develop the evaluation index system of humanistic care in hospitals for the practical development needs of anhui province,so as to lay the theoretical foundation and practical needs for the realization of humanistic care in hospitals in China.Methods : Based on the grounded theory,this study determined the theoretical framework and index pool of humanistic care evaluation for public hospitals in anhui province through policy analysis,literature review,expert discussion,semi-structured interview and other methods;Through two rounds of Delphi expert consultation,the index pool was deleted and modified to determine the evaluation index system of humanistic care in public hospitals in anhui province.The index weight and combination weight of the index system are determined by the analytic hierarchy process.Through literature review,policy analysis and expert discussion to determine the connotation of the first and second level indicators and defining standards;In the empirical study of index fitting,statistical analysis is mainly used to sort out the data and further improve the evaluation index system.Results:(a)the theory framework of this study is based on qualitative research framework of glaser and strauss(grounded theory),combined with literature review and policy analysis effectively build the include environment and facilities,process optimization,medical services,communication and coordination,system guarantee,"five dimensions(indicators)theoretical framework under the framework of public hospital humanistic care in anhui province.(b)the index system of development: the study based on the principle of index system building,humanistic care in the hospital on the basis of literature review and policy fully interpreted,through expert discussion,brainstorming,semi-structured interview methods such as audition indexes,set up the initial evaluation index pool of hospital humanistic care,and then after 2 rounds of Delphi expert consultation method finally confirmed in the environment and facilities,process optimization,medical services,communication and coordination,system guarantee,"five dimensions(indicators)under the framework of 20 secondary index and 53 three-level index;Based on the analytic hierarchy process(ahp),the first-level index weights of the index tools were determined to be 0.206,0.195,0.195,0.198 and 0.206 respectively,and the connotation of each index and the specific three-level index observation points were determined.Delphi expert consultation as the main development method,the main results are as follows.(1)basic information of Delphi consulting experts: 21 representative and authoritative experts engaged in administrative management,business practice and academic research in hospitals with representatives in anhui province were selected.They come from the outpatient,medical,nursing and medical technology departments of the first affiliated hospital of anhui medical university,anhui provincial hospital,hefei first people's hospital,hefei second people's hospital,the first affiliated hospital of anhui university of traditional Chinese medicine,the first affiliated hospital of bengbu medical college and the first affiliated hospital of wannan medical college.Among them,13 were male,accounting for 61.9%,and 8 were female,accounting for 38.1%.There were 9 experts with more than 20 years of working experience,accounting for 42.86%.There were 9 persons with deputy senior titles or above,accounting for 42.86%.(2)experts' positivity,authority and coordination: First,in terms of enthusiasm,the enthusiasm of experts directly reflects the value of research.In the two rounds of expert consultation,we distributed questionnaires to 21 representative and authoritative experts selected by us.All the experts responded to our consultation and showed great attention to the research.The positive coefficients are all 100%,15 experts in the two rounds of expert consultations,accounting for 71.43%,indicating that the experts involved in the consultation are very concerned about the research of this topic.Second,the authoritative aspect,the authoritative coefficient of expert opinions explains the value and reliability of expert opinions.It is determined by two factors.One is the judgment basis(Ca)of the experts for the evaluation of hospital humanistic care,and the other is the expert.Familiarity with the hospital's human care(Cs).In general,the average coefficient of authority(Cr)of the first round of the study was 0.79,and the average of the authoritative coefficient of the second round was 0.78.For the authoritative coefficient Cr ? 0.70,we generally think that the research has a relatively reliable reliability.The authors of the two rounds of expert consultation three-level indicators are higher than 0.75,and the research results can be more reliable;Third,in terms of coordination,the coordination coefficient is generally used to indicate the degree of coordination of expert opinions.The level of coordination coefficient determines the reliability of the evaluation index system.When the degree of coordination tends to 0.5,it indicates that the opinions of experts are basically consistent.reliable.The results of the two rounds of expert consultation showed that the coordination coefficient of the importance and operability of the second round of consultants for the third-level indicators was 0.527 and 0.563,respectively,which was significantly higher than the0.149 and 0.147 in the first round.After two rounds of expert consultation,experts believe that the evaluation index system has become more and more perfect.At the same time,the P values of the two rounds of coordination coefficient test are less than0.05,indicating that the degree of coordination is better after two rounds of consultation with experts,and the credibility of the evaluation results is higher.(c)the index system of fitting empirical research: to further verify the practicality of the index system,we respectively from anhui province of anhui,anhui and northern anhui each choose a representative strong tertiary public hospital as fitting test and research base,by making a detailed fitting experimental study plan,training field test research personnel,with support from the provincial administrative department of health,in three hospitals to major medical personnel department,inpatient and outpatient patients has carried on the investigation and study.The fitting experiment shows that the index system has good scientific,feasible,operable and guiding functions,and the application of the index system can better measure the actual construction of humanistic care in public hospitals in anhui province.Conclusion: This study based on glaser and strauss qualitative research framework(grounded theory),combined with literature review,policy analysis,semi-structured interviews,Delphi method and analytic hierarchy process(ahp)to effectively build the include environment and facilities,process optimization,medical services,communication and coordination,system guarantee,"five dimensions(indicators)under the framework of 20 secondary index,53three-level index of evaluation index system of public hospitals in anhui province hospital humanistic care,each index weight was determined by the analytic hierarchy process(ahp)at the same time,provide the weight of the scientific and rational definition,endowed with the connotation and definition of standard secondary indicators.The field fitting experiment shows that the index system has good scientific,feasible,operable and guiding functions,and the application of the index system can better measure the construction of humanistic care in public hospitals.