Research On The Evaluation And Multi-subject Collaborative Governance Mechanism Of Doctor-patient Harmony Satisfaction

Objective: Comprehensive using frontier theories such as harmonious management,collaborative governance and stakeholds,scientifically defining the concepts and connotations of doctor-patient harmony satisfaction,in-depth analyzing the influence of the government,public hospital,social pluralistic subjects on the doctorpatient satisfaction,constructed a harmonious mechanism model of doctor-patient satisfaction that meets the overall interest of the whole system.On the basis of self-designed questionnaires and field investigation,through qualitative and quantitative methods to verify the theoretical model.Based on empirical analysis results,constructed multi-subject vollaborative governance mechanism of doctor-patient harmony satisfaction,to provide a theoretical reference for improving doctor-patient satisfaction as well as promoting doctor-patient harmony.Methods:(1)Literature research.Made a literature review on doctor-patient satisfaction,doctor-patient harmonious relationship and related theories,which laid the foundation for the research on the evaluation and multi-subject collaborative governance mechanism of doctor-patient harmony satisfaction.(2)Focus group discussion.After many focus group discussions,eventually determined the key indicators of doctor-patient harmony satisfaction evaluation,and designed medical staff job satisfaction and patient satisfaction questionnaires.(3)Questionnaire survey.Using quota sampling method to investigate 1900 medical staff and 1500 inpatients from city and county public hospitals in different economic development zones of Zhengjiang Province,1855 medical staff and 1382 inpatients valid samples were recovered,matched doctors and patients at a ratio of 1:2,finally,391 medical staff and782 patients were obtained.(4)Mathematical Statistics.Using Cronbach's ?coefficient and exploratory factor analysis to test the reliability and validity of the scale;Using mean,standard deviation,composition ratio and satisfaction weighting method to statistics and describe doctor-patient satisfaction and satisfaction rate;Using t test,variance analysis and multiple linear regression to analyze the influencing factors of dortor-patient satisfaction.Using multi-index comprehensiveevaluation method to calculate doctor-patient harmony satisfaction;Using structural equation model,haken model and coupled coordination model to verify the theoretical model of doctor-patient satisfaction harmonious mechanism.Results:(1)The Cronbach's alpha coefficient of the medical staff's job satisfaction scale was 0.929,the Cronbach's alpha coefficients of the five dimensions are greater than 0.7,the cumulative variance contribution rate was 71.61%;The Cronbach's alpha coefficient of the patient satisfaction scale was 0.952,the Cronbach's alpha coefficients of the five dimensions are greater than 0.8,the cumulative variance contribution rate was 76.23%.(2)The overall satisfaction score of medical staff was 70.9,medical staff were most dissatisfied with workload and salary;The overall satisfaction score of patient was 85.6,patients were most dissatisfied with service charge;the doctor-patient harmony satisfaction score was0.75.(3)The differences in job satisfaction score of medical staff of different genders,working times,professional titles,and hospital types were statistically significant(P<0.05);The differences in satisfaction score of patients of different medical insurance and hospital types were statistically significant(P<0.05).(4)Among the factors of hospital management,medical disputes solution,process design,medical service price and other information disclosure in hospitals had a greater impact on medical staff's job satisfaction,medical ethics construction,information disclosure in hospitals had a greater impact on patient satisfaction(P<0.05);Among the factors of government governance,the government's effect on maintening public hospitals' public welfare and medical services price making had a greater impact on medical staff's job satisfaction,the government's effect on maintening public hospitals' public welfare and medical health personnel training had a greater impact on patient satisfaction(P<0.05);Among the factors of the social medical environment,the impartiality of social professional organizations to the identification of medical accidents,implementation of the duties of the public media "social supervision of the medical industry" had a greater impact on medical staff's job satisfaction,public media "social supervision of the medical industry" duties implementation,the public'initiative to reflect the opinions and demands of doctors and patients had a greaterimpact on patient satisfaction(P<0.05);Between the factors of doctor-patient relationship,patients respect and trust doctors had a greater impact on medical staff's job satisfaction,doctors communicate patiently with patients had a greater impact on patient satisfaction(P<0.05);Among the factors of public opinion atmosphere,the impact on medical staff's job satisfaction from big to small were overall evaluation of doctor groups by surrounding persons,overall evaluation of public hospitals by surrounding persons,overall evaluation of doctor groups by network media and overall evaluation of public hospitals by network media,the impact on patient satisfaction from big to small were overall evaluation of public hospitals by network media,overall evaluation of public hospitals by surrounding persons,overall evaluation of doctor groups by network media and overall evaluation of doctor groups by surrounding persons(P<0.05).(5)Structural equation model analysis showed,hospital management had a direct positive impact on the doctor-patient collaborative satisfaction,government governance had no direct impact on the doctor-patient collaborative satisfaction,but it had a indirect positive impact on the doctor-patient collaborative satisfaction through hospital management;Results from haken model analysis showed that,the systematic order parameter was patient satisfaction rather than medical staff job satisfaction;Coupled coordination model analysis showed that,the coupling coordination degree between medical staff's job satisfaction and patient satisfaction was 0.872,the coupling coordination degree of doctor-patient satisfaction governance subjects and elements was 0.853.Conclusion:(1)The self-developed scales of medical staff's job satisfaction and patient satisfaction had favorable reliability and validity,and could be used to accurate measurement and reflect medical staff's job satisfaction and patient satisfaction.(2)Doctors and patients were in a satisfactory state of basic harmony,but compared with patient satisfaction,medical staff's job satisfaction and satisfaction rate are lower,need to increase the maintenance and protection of the rights and interests of medical staff.(3)Medical staff's job satisfaction and patient satisfaction were affect and restricted by hospital management,government governance,the social medical environment,doctor-patient relationship and the atmosphere of public opinion,amongthem,hospital management was the key factor.(4)There was a certain degree of disconnection between doctor-patient satisfaction and social multi-subjects,which prompted to further mobilize social forces to participate in the governance of doctorpatient satisfaction and expand the channels of participation.(5)There was a good coordination and interaction between medical staff's job satisfaction and patient satisfaction and the subjects and elements of doctor-patient satisfaction governance.(6)It is proposed to establish a multi-subject cooperative governance mechanism of doctor-patient harmonious satisfaction including "guarantee,incentive,communication,participation in decision-making,social supervision and integration",put forward countermeasures and suggestions from three levels of "harmonic principle","harmony principle" and "coupling".The government implemented the leadership,security,supervision and management responsibilities of the medical industry,and improved the information disclosure system;Public hospitals improved internal management level and strengthened the construction of medical ethics and style;Public media standardized the guidance of public opinion;Social forces assumed social responsibility,medical staff and patients built a community of destiny;Finally,constructed a multi-subject cooperative governance pattern of government leadership,hospital responsibility and social participation in doctor-patient harmonious satisfaction.