Study On The Relationship Between The Trust Degree Of Primary Medical Staff To Patients And The Quality Of Health Service

Medical Staff to Patients and the Quality of Health ServiceDoctor patient trust is a special interpersonal trust relationship formed by both doctors and patients in medical activities.It directly affects the provision and utilization of health services,the improvement of health service quality and health outcomes,and the overall satisfaction and sense of gain of the public to the national health policy and health service system.Primary health service institutions are the cornerstone of the national health service system.How to establish the mutual trust between residents and grass-roots medical personnel,improve the popularization and utilization rate of primary health services,guide residents to seek medical treatment reasonably,and give full play to the "gatekeeper" function of primary health service institutions are the important premise and premise of deepening the reform of medical service system and Constructing Hierarchical Diagnosis and treatment system Basics.Objective:This study selected the perspective of grass-roots medical staff,from the perspective of medical staff's trust in patients,to analyze the impact of medical staff's job satisfaction,work engagement,emotional labor,and the quality of primary health services.Structural equation model was used to analyze the relationship between trust degree and the quality of primary health service,as well as the indirect role of other related variables.The impact path model of primary medical staff trust patients and health service quality was constructed,which provided a theoretical basis for the managers of primary health service institutions to attach importance to trust construction and promote the improvement of primary health service quality.The research on patient trust provides more empirical research basis.Methods:This study adopts the method of combining quantitative and qualitative research.In the quantitative study,1160 medical staff(doctors,nurses,medical technicians,etc.)from 18 community health service centers and 18 township health centers in 9 cities and prefectures of Jilin Province were selected as the research objects.The contents of the questionnaire include: social demography,medical staff's trust in patients,job satisfaction,work engagement,emotional labor,quality of primary health service,etc.The questionnaire was collected by the questionnaire star platform.The single variance analysis and multiple linear regression were conducted by using IBM SPSS 24.0 software.The influencing factor model was constructed by AMOS 24.0 software.Objective sampling method was used in the qualitative study.54 primary medical staff were selected for in-depth interviews from November to December 2018 and August to September 2019 respectively.The interview data were transcribed into the word file word by word.Results:(1)The trust degree of the medical staff to the patients was moderate,and the total score was 3.79±0.60(scoring range was 1-5),the patient role dimension score was 3.84±0.59,and the respect for interpersonal relationship dimension score was 3.73±0.67.The age,establishment and type of institution of medical staff had a statistically significant effect on the total score of patients with trust(P < 0.05).(2)The total quality of primary health care was 3.82±0.52(scoring range was 1-5),and the patient-centered and family-centered score was the highest(3.96±0.58).The dimension score of the first diagnosis was the lowest,3.53±0.74 points.The remaining six dimensions were scored as continuity 3.67±0.58,coordination 3.87±0.57,comprehensiveness(accessibility)3.90±0.62,comprehensiveness(service delivery)3.82±0.60,and community orientation 3.88±0.61.The age,educational background and institution type of medical personnel had statistically significant effects on the evaluation of the quality of primary health care services(P < 0.05).(3)There was a significant correlation between the degree of trust of medical staff and the quality of primary health care services,and the correlation coefficient was 0.649.The results of multiple linear regression showed that the degree of trust of medical staff had a positive influence on the total score of primary health service quality and the scores of all dimensions.(4)The total work input of medical staff was 4.22±1.17(score range 0-6),with the highest concentration score of 4.30±1.20 and the lowest vitality score of 4.15±1.20.The multivariate linear regression results showed that the work engagement,of medical staff had a positive influence on the total score of primary health service quality.The results of the structural equation show that the work engagement,of medical staff plays a mediating role in the relationship between the degree of patient trust and primary health services,that is,the trust of medical staff to patients indirectly affects the quality of primary health services by affecting the work engagement.(5)The total job satisfaction is 3.72±0.69(scoring range is 1-5),the internal satisfaction dimension score is 3.76±0.68,and the external satisfaction score is 3.67±0.76.After controlling for age,educational background and institution type,multiple linear regression results showed that the job satisfaction of medical staff had a positive influence on the total average score of primary health service quality.The results of the structural equation show that the job satisfaction of medical staff plays a mediating role in the relationship between the degree of patient trust and primary health services,that is,the trust of medical staff to patients indirectly affects the quality of primary health services by affecting the degree of job satisfaction.(6)The emotional labor was divided into 3.28±0.63(scoring range was 1-5),the highest score was in the dimension of true expression(3.68±0.70),followed by the score of deep performance(3.42±0.70),and the lowest score was in the dimension of surface performance(3.04±0.76).After controlling for age,educational background and institution type,multiple linear regression results showed that the deep performance and true expression of emotion of medical staff had positive influence on the total average score of primary health service quality.The results of the structural equation show that the emotional labor of medical staff plays an intermediary role in the relationship between the degree of patient trust and primary health care services,that is,the trust of medical staff to patients indirectly affects the quality of primary health care services by affecting emotional labor.(7)Research on the comprehensive action model construction of all variables found that work engagement,job satisfaction and emotional labor play a partial mediating role between medical staff's trust in patients and the quality of primary health care services,with mediating effects accounting for 22.79%,13.86% and 18.41% of the total effects respectively.The trust of medical staff to patients directly affects the work engagement,can be indirectly affected by job satisfaction;It can also indirectly affect work engagement through emotional labor,which directly affects the quality of health services.By using the structural equation group comparison,it is found that age can cause model difference,but education background and institution type do not.(8)Based on the qualitative interview data analysis,five themes were extracted,which were "Trust between doctors and patients in primary health care and its influencing factors","Work engagement of primary medical staff","Job satisfaction of primary medical staff","Emotional labor of primary medical staff" and "Current situation,problems and countermeasures of primary health care service quality".The results were summarized as follows: primary medical staff feel the trust of patients,and the positive experience of trust encourages medical staff to have trust in patients,generating positive work enthusiasm,which is conducive to improving the quality of basic health services.In particular,after the implementation of the family doctor service system,mutual trust between doctors and patients has increased.In the face of patients' distrust and negative trust atmosphere,primary medical staff will provide services to patients with a positive attitude according to the requirements of medical service institutions or the constraints of professional ethics,thus generating emotional labor process.However,the low remuneration of medical staff in primary health care institutions makes it difficult to provide positive external support and encouragement to medical staff,which in the long run will affect job satisfaction and ultimately the quality of primary health care services.Conclusion:(1)The trust level of primary medical staff to patients will affect the quality of health services,suggesting that a good doctor-patient trust relationship is the cornerstone of the development of medical and health undertakings,managers of primary health service institutions should pay attention to and build a doctor-patient trust mechanism,which is conducive to improving and improving the quality of services.(2)The health administrators and policy makers should pay attention to primary medical staff,job satisfaction,work engagement,trust patients initiating factor of emotional labor,as well as its impact on the quality of health services and formulate corresponding measures to improve the medical staff of the patient's trust,job satisfaction,work engagement,positive emotional labor strategy,to improve and improve the quality of health services.(3)This paper uses structural equation model to verify the relationship between the trust degree of primary medical staff and the quality of primary health service,which provides an empirical basis for the research on doctor-patient trust.It is suggested that health policy managers and policy makers should pay attention to the construction of trust mechanism,which is conducive to the improvement of health service quality.(4)The trust of primary medical staff on patients can affect the quality of primary health service through job satisfaction,work engagement and emotional labor.It is suggested that hospital managers should pay attention to improving the job satisfaction,work engagement and positive emotional labor strategy training of medical staff,which is conducive to improving and improving the quality of health service.