【摘要】 目的：探讨DIP运行中，影响三级公立医院医疗服务能力变化的多重并发因果路径。方法：基于动态能力理论，运用纳入时间维度的模糊集定性比较分析，对黑龙江省8所三级公立医院的问卷与运行数据进行组态分析。结果：DIP学习能力是医疗服务能力提升的必要条件(一致性=0.957)。识别出两类能力提升路径构型为“政策-学习-行为驱动型”和“协商-经济双导向型”。能力下降的核心条件组合为政策缺位、低DIP学习能力与病案书写行为不规范。结论：医疗服务能力变化是多因素交互的“组态效应”。医院应着力培育DIP学习能力，依据自身条件在政策内化、行为规范、外部协商与经济激励间寻求动态平衡，实施差异化系统性策略。更多还原

【Abstract】 Objective:To explore the multiple conjunctural causal pathways influencing changes in healthcare service capacity of Grade Ⅲ public hospitals under DIP operation.Methods:Based on dynamic capability theory,fuzzy-set qualitative comparative analysis (fsQCA) incorporating a temporal dimension was applied to analyze questionnaire and operational data from eight Grade Ⅲ public hospitals in Heilongjiang Province.Results:DIP learning capability was identified as a necessary condition for the improvement of healthcare service capacity (consistency=0.957).Two configurations for capacity improvement were identified:the “policy–learning–behavior driven” type and the “negotiation–economic dual-oriented” type.The core conditions leading to capacity decline included absence of policy support,low DIP learning capability,and non-standard medical record documentation behaviors.Conclusion:Changes in healthcare service capacity are the result of multi-factor interactive “configuration effects.” Hospitals should focus on cultivating DIP learning capability and,based on their own conditions,seek a dynamic balance among policy internalization,behavioral standardization,external negotiation,and economic incentives,thereby implementing differentiated and systematic strategies.更多还原