| As the renovation of medical mechanism deepened, collectivized management strategy has been employed in some areas in China. Concerning such a new subject in the medical field, vigorous discussion has been caused in academic circles. However, this research focus on how to increasing the efficiency and core competitiveness in the collectivized operation model and seldom involve in its effort to the construction of medical ethics and atmosphere.To discuss the effort of collectivized management to the construction of medical ethics and atmosphere to explore successful experiences, find the diversity and problem and propel the modernization of hospital, the author made a study of the concept evolvement construction, influencing factors, and new current situation of medical ethics and atmosphere and construction, operation and advantages of collectivized hospital management. Some disadvantages were found as followings: firstly, after employing the collectivized model, hospitals attach importance to profits and income, while ignore resolving the problems which the population focuses on, such as the medical expenditure increases too much faster, the medicine market is in a mess, large equipments are installed and used lavishly and medical ethics and atmosphere are bad. The inner driver and force are lacking. Secondly, the arrogant, self-worth thought and distant phenomena in core medical staff has been increasing and the excessive therapy phenomena can't be alleviated. Thirdly, the anaclisis of the staff in grass-roots unit has been increasing and defensive treatments increase. Finally, new dissatisfaction appears due to the diversity of service.On the basis of collecting the first-hand data as above, to explore successful experiences and influencing factors of the collectivized management in promoting the construction of medical ethics and atmosphere, the author took the hospital attached to the general hospital group in Taching oil field to perform research. The research was divided into three parts: retrospective analysis on the data of patients' satisfaction for hospitals attached to the general hospital group in the year of 2005 and 2006 was employed and in the meanwhile the stratified sampling method was involved in the first part. In the second part, patients in each hospital were sampled to be interview by questionnaires every three months. 200 Questionnaires in two third-class hospitals and 320 Questionnaires in eight second-class hospitals were taken back to find out the situation of patients' satisfaction for medical ethics and atmosphere. In the third part, medical staff such as doctors and nurses in each hospital are sampled to be interview by questionnaires every three months.80 Questionnaires in two third-class hospitals and 160 Questionnaires in eight second-class hospitals were taken back to find out the situation of the medical staff's satisfaction for medical ethics and atmosphere. All the data were input into database and SPSS 12.0 statistic software was employed to analyze the data.The results showed the degree of satisfaction in 2005 was 93.06 and in 2006 it is 95.63 and the degree increased by 2.57 between before and after the collectivized management. The diversity was statistically significant (P<0.05), which showed collectivized management propelled the improvement of medical ethics and atmosphere at some extents and increased the patients' overall satisfaction degree. During the same period, the diversity was large between in the third-class hospitals and in the second-class hospitals that were all more than 6 and was statistically significant (P<0.01). It can be regarded that the satisfaction degree in the third-class hospitals are more than that in the second-class hospitals. In the year of 2008, the satisfaction degree of comprehensive hospitals for medical ethics and atmosphere was 94.39, which are far more than the result (70%) reported in some foreign papers. This result showed the collectivized management in the general hospital group promoted the construction of medical ethics and atmosphere at a large extent, make the relation between doctors and patients more harmonious and the satisfaction degree higher in the hospitals employing the collectivized system. Three in the 12 assessing indexes belonged to the indexes of economy. In these three indexes, the satisfaction degree for the index of there are no phenomena of claiming and receiving bribery money' was 97.51, which was more than the overall satisfaction degree of the group. While, the other two indexes of there are no phenomena of excessive medicine and examinations' and ' there are no phenomena of excessive fee and charge' were 94.11 and 93.95 respectively, which was less than the overall satisfaction degree of the group. These results showed after the employment of collectivized management the behavior of receiving and claiming bribery money in the medical staff had been decreased by reinforcing education, system restriction and supervision. However, the excessive treatments still existed influenced by economy factors. The results showed the staff's reorganization of importance of their jobs was high and they took care of the developments of the hospitals, which showed they had sense of success and belonging, approved the development of the hospitals and the harmonious relation of the staff. The first three dissatisfaction factors were the bad reward allocation system, narrow development space and bad welfare. This result showed the chief reason for the dissatisfaction of the staff was income problem. The improvement in this hand might help promoting the satisfaction degree of the staff, improving the level of medical ethics and atmosphere to provide further optimum and humanized service for the patients, which might reach the aim of increasing the patients' satisfaction and enlarging the developing space for the hospital.According to the results in the questionnaires, the author proposed the collectivized management had the promoting efforts to the construction of medical ethics and atmosphere. There was diversity between hospitals in different class and it was better in the third-class hospital than in the second-class hospital. On the foundation of approving, patients raised new and higher demands. The staff with different educational history, professional title and job had different satisfaction degree for their own jobs. On the base of the above problem concluded in the theoretical and practical research, several propositional countermeasures for construction of medical ethics and atmosphere were raised in this paper as followings:1, it is proposed to optimize the operation system of collectivized management. The medical resources should be allocated rationally by help of the advantages of large scales and areas in local place, by using methods of medical administration to avoid prodigality of resources and aggravation of competitions and realize development side by side.2, it is proposed to improve the inner humanism quality of the medical staff, make the thinking of 'respecting and caring patients' run through the medical activities, take 'kindhearted medical technique' as basic principle of medicine. The phenomena of failing to listen to and talk with the patients, which reflects the thinking of paying attention to technique while scorning humanism, should be changed.3, it is proposed to reinforce the thinking of medical ethics, establish fair mechanism, provide the chance of cultivation and advancing, give the staff more right and freedom, increasing the salary and welfare of the mid-class staff to improve the satisfaction degree qualitatively to raise the level of medical ethics and atmosphere.4, it is proposed to enlarge the service to fit the change of market, erect the optimum concept of professional ethics by reinforcing education, establish optimum standard of professional ethics by system restriction and improve the system of professional ethics by reinforcing supervision.5, it is proposed to advocate reasonable treatment by education, analyze the focus problem of medical ethics and atmosphere in the view of the whole society and take these problems as ones of the social problem. |
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