| Objective: By analyzing the operation status and difficulties encountered by the medical community in Guangxi X City,this paper analyzes the interests of all relevant stakeholders in the operation practice of the medical community in Guangxi,finds out the reasons for conflicts between the subjects and the consequences of conflicts of interest,so as to seek construction measures to resolve conflicts,mutual benefit and common progress,and provide ideas and suggestions for the better operation and implementation of Guangxi Medical Community in the future.Methods: Firstly,through the literature analysis method,the search is carried out by keywords such as county medical community,medical community,and medical consortium to understand the current construction and basic situation of medical communities in various places and the problems and obstacles they face.Then,according to the actual local situation,the medical staff and managers in the lead hospital and member hospitals were investigated to design questionnaires and interview outlines,with different focuses and contents.Develop questionnaire interview content and carry out in-depth communication.The content of the interviews mainly involves the subjects’ cognition of the regional medical community,their interest demands,and the current difficulties and obstacles.The interview subjects included the medical staff and managers of the lead hospital,the medical staff and managers of member hospitals,the heads of the medical community,and patients.Finally,after collating the literature and summarizing the questions,combined with the interview content,the interest demands that the main stakeholders in the medical community may be concerned about are sorted out,so as to design a questionnaire for the interest appeal,and investigate the questionnaire distributed by multiple stakeholders in the medical community.Identify the interests of different stakeholders,so as to study the conflicts of interest between the various actors in the medical community,and then find out why conflicts arise and what impact they will have.Ultimately,it reduces the formation of conflicts,establishes a real community of interests,and provides suggestions for the sustainable development of the medical community.Results: A total of 427 people were surveyed.155 people in the lead hospital(91 medical and nursing,64 managers);131 in the member hospitals(101 medical and nursing,30 managers)and 141 patients.(1)In terms of understanding of the policy of the Medical Community,the degree of understanding varied among the stakeholders,with medical and nursing staff and patients of member hospitals still having a shallow understanding of the policy and needing further strengthening of publicity to raise awareness.(2)With regard to the progress of support,the medical and nursing staff of the lead hospital replied that the most frequent projects were "professional training seminars" and "business visits",while the greatest incentive for support was for "title promotion".The biggest motivation for support is for "title promotion".When the administrators of the lead hospitals answered whether they felt overburdened in the process of helping the grassroots,44(68.75%)of them said "yes";over 50% of them answered "yes" to the question of whether there was a lack of mentoring ability in the support provided by the medical and nursing staff."In terms of whether the government has not encouraged the lead hospital to take the initiative to help by setting up special funding to increase investment,over 40% said " yes " and over 50% of the staff said " no " that it had not.Nearly 60% of the medical and nursing staff at member hospitals had not been to a higher level hospital for training,and 40% of them chose to have been to a higher level for further training;in terms of whether the current arrangements for support activities at the higher level hospital were reasonable,nearly 40% of them thought " more reasonable " and about 37% thought " average "." The biggest problem with the current support is that the number of doctors and nurses in the hospital is only enough to maintain the operation of the hospital,so it is not possible to send people out for further training.(3)In terms of two-way referrals,only 16.48% of the medical and nursing staff in the lead hospital were "fully familiar" with the referral procedures,while those who were "basically familiar" and "relatively familiar" accounted for more than 50%.In terms of how well the two-way referral system is being implemented,76.32% of the medical and nursing staff said it was "very good" and "average";more than 70%of the medical and nursing staff said it was "necessary" to put in place a two-way referral system.The proportion of medical and nursing staff in member hospitals who chose "the number of downward referrals is average,low or very few" was as high as 90%,which shows that the problem of "difficult downward referrals" is still prominent.(4)In terms of medical insurance,the number of medical and nursing staff in member hospitals who chose to transfer to other hospitals was as high as 90%.(4)In terms of health care insurance,less than 20% of the administrative staff of the lead hospital thought that the impact on health care insurance payments and settlements after the construction of the community would be "very significant or significant",i.e.over 80%thought that the impact on health care insurance payments and settlements after the construction of the community would be minimal.The same was true for the administrative staff of member hospitals,with over 80% of them saying that the impact on hospital insurance payments and settlements would be minimal.(5)The perceptions of the four parties were also completely different in terms of the problems with the current construction.The top five selected by the medical and nursing staff of the lead hospital are: lack of talents and imperfect construction of talent team,accounting for 54.95%;lagging information technology construction,accounting for 49.45;unclear boundaries of authority,blurred division of labour and confused interpersonal relationships,accounting for 35.16%;unclear strategic positioning of the hospital lacking long-term goals,accounting for29.67%;discontinuous operation and management processes,not well articulated,accounting for of 29.67%.The top five selected by the lead hospital administrators: "unclear boundaries of authority,blurred division of labour and confusing interpersonal relationships"(50.00%);"unclear strategic positioning of the hospital and lack of long-term goals"(46.88%).The proportion of "lack of talents and imperfect construction of talent teams" was 37.50%;the proportion of "implementation of the system within the medical community is only superficial and formal" was35.94%;the proportion of "information technology construction is lagging behind The percentage of "information technology is lagging behind" was 31.25%.The top five choices made by the medical and nursing staff of member hospitals were: 49.50% chose "unclear boundaries of authority,blurred division of labour and confused interpersonal relationships";43.56% chose "lack of talents and imperfect construction of talent teams";43.56% chose The proportion of those who chose "unclear strategic positioning of the hospital and lack of long-term goals" was 43.56%;the proportion of those who chose "the implementation of the system within the medical community is only superficial and formal" was 39.60%;the proportion of those who chose"the operation The percentage of those who chose "the management process is not continuous and not well connected" was 32.67%.The top five choices made by the managers of member health centres were: 70.00%chose "information technology construction is lagging behind";53.33%chose "unclear boundaries of authority,blurred division of labour and confused interpersonal relationships";and 53.33% chose "lack of talents,talent team building".The proportion of those who chose "lack of talents and imperfect construction of talent team" was 43.33%;the proportion of those who chose "unclear strategic positioning of the hospital and lack of long-term goals" was 43.33%;the proportion of those who chose"implementation of the system within the medical community The proportion of those who chose "the implementation of the system within the medical community is only superficial and formal" and "the operation and management process is not continuous and not well connected" was40%.(6)Among the residents(patients),57(40.71%)chose county/district hospitals;42(30%)chose to go to township health centres;17(12.14%)chose to go to tertiary hospitals;and 18(12.86%)chose to go to village health clinics for first consultation.(7)In the interest claim survey,after a non-parametric rank sum test,it was determined that the ranking of the mean values of the interest claims of the three interest groups,namely the medical staff of the lead hospital,the medical staff of the member hospitals and the patients,was statistically significant,and it could be considered that there were differences in the expectations and importance attached to the different interest claims.Conclusions:(1)Between the lead hospital and the member hospitals,the lead hospital lacks the motivation to provide lasting financial and policy assistance,cannot undertake all tasks,and brings damage to its own interests.The transformation of the health center cannot be completed in the short term,and it will take longer for the health center to truly undertake the primary public health service and basic diagnosis and treatment services,and the two have not formed a deep interest cooperation.(2)Patients still have prejudice and distrust of the level of diagnosis and treatment of health centers,and the current medical service technology of primary health centers does not fully meet the needs of all residents.(3)The medical insurance department has not truly delegated power,and other administrative departments have not participated,and the horizontal synergy effect is poor.The impact of the above problems is that the continuity of the construction of the county medical community is poor,and a good pattern of medical treatment has not been formed in the region.Therefore,we propose countermeasures based on the interests and conflicts between each entity,from the patient,medical institution,and government level. |
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