【作者】 郝敏；

【导师】 乐虹； 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2006， 硕士

【摘要】 随着人们法制观念和维权意识的增强,人们对医疗这个特殊服务行业的要求也不断提高。中华医学会某调查结果:医疗非技术质量问题引发的纠纷占74.4%,显示了人们对医疗质量范围认识的扩展。在医疗质量中,除了众所周知的诊疗技术因素外,非技术因素也开始扮演着越来越重要的角色,但相关系统研究却很少。本文通过调查影响医疗质量的非技术因素,探讨主要干预点及可行措施,为防范医患纠纷、改善医患关系、提高医疗质量提供新思路。研究方法与资料来源:本研究主要采用文献研究和现场调查相结合的方式,运用文献分析、专家咨询等定性研究方法,结合现场调查等定量研究方法,运用统计分析方法对指标分析比较并分析相关因素。资料主要来源于国内外有关医患关系与医疗质量的理论书籍及文献;卫生管理专家对医疗质量中非技术因素的认同及其重要性判断的调查资料、湖北省相关人群(医务人员、患者、居民)对影响医疗质量的非技术因素意向的调查资料等。结论:1.医疗质量与医患关系相互作用、相互影响随着社会医学和医患关系模式的改变,医疗行为已成为一个既含有不同层次的专业内容,又涉及医患之间全方位交往的服务性行为。而对医疗质量的认识也从“符合技术规范”转变为“满足病人需要”。从这个角度出发,和谐的医患关系是评价医疗质量的重要内容,而良好的医疗质量则是改善医患关系的基础。从理论研究、法律分析、到相关人员的意向调查结果都显示:医疗质量不仅包括技术质量,还包括非技术质量。而患者由于对医疗专业知识的缺乏使其难以正确评价医疗技术质量,故对医疗质量的感受常受到非技术因素的影响。2.调查显示,非技术因素已日益受到人们的关注和重视,提出可通过干预非技术因素来改善医患关系的新策略就医选择调查结果显示:人们在选择医院时不仅重视技术水平(24.03%),对非技术因素也愈加重视,特别是良好的服务(20.07%)和合理的价格(19.43%)。其次,人们对受到尊重、医院环境等情况亦有所关注。医患都认为有以下影响医疗质量的非技术因素:服务价格、医院环境、职业道德与服务态度、服务设施、服务行为、尊重保密和保健知识宣教等方面。患方总体认同率(97.6-99.7%)明显高于医方(89.7-91.0%),都有极显著性差异。比较双方意向的重要性分值,医方分值普遍较低,特别是在医院环境、病房服务设施、尊重保密及保健知识宣教四个方面,患方评分明显高于医方,具有显著性差异。提示医疗机构应提高对这些因素的认识,积极开展干预活动。3.调查显示患方更重视以下具体方面,应成为干预重点在很多细化指标上患方分值显著高于医方,重点比较有差异性四个指标的具体内容。患方结果显示:①医院环境:最看重清洁卫生、温度适宜,对文化氛围要求最低;②病房服务设施:最看重监控呼叫完善,对电梯服务快捷要求最低;③尊重保密:最看重人格尊重和隐私保密,对选择治疗方案要求最低;④保健宣教:最看重多举措宣教,对保健预防知识讲解要求最低等。这些都提示医院应重点关注。4.医疗机构应加强医患沟通,防范非技术因素引发的医患纠纷,提高医疗质量本研究认为通过控制以下因素有助于提高非技术医疗质量,防范非技术因素引发的医患纠纷,构建和谐的医患关系。建立服务行为的及时反馈体系,为群众提供高效的医疗服务建立合理的收费项目及标准,规范医疗价格加强医务人员的医德医风和职业道德建设,纠正行业不正之风建立完善的病房监控呼叫系统,营造人性化的病房服务设施医疗机构应树立尊重患者人格和保护患者隐私的理念更多还原

【Abstract】 With the enhancement of people’s concept of the rule of law and consciousness of safeguarding the rights, people’s requisition for medical treatment, this special service industries, is improving constantly. Some investigation of Chinese Medical Association shows: something wrong with non-technique causing the dispute accounts for 74.4 percent. This has already demonstrated people’s expansion to the cognition range of medical quality. In the service quality of medical organization, besides well-known diagnostic and technological factors, the non-technological factors begin to play a more and more important role too. The report on system research of the non-technological factors is seldom. This article researches the non-technical factors to affect medical service quality, to determine primary non-technical factors; to discuss mainly feasible intervention measure under the present stage as well as the existing condition. It provides the strategy and reference to prevent the dispute between doctors and patients, to improve the relationship between doctors and patients, to improve the medical service quality.Research approach and materials source:This research mainly adopts documents research and locale investigation. It uses qualitative research approach, such as document analysis, expert consultation, etc and quantitative research approach, such as locale investigation. It also uses statistical analysis methods to analyze and compare about the statistical indexes and the analysis of the relevant factors. The materials mainly stem from the domestic and overseas theory books and documents about the relationship between doctors and patients and medical quality; The survey materials stem from the cognition and important judgement of non-technical factors of health managerial experts. The survey materials stem from the cognition of non-technical factors of the relevant crowd in Hubei (medical stuff, patients, residents) etc.Conclusion:1. The medical quality and relationship between doctors and patients influence and affect each other.With the changes of social medical science and mode of relationship between doctors and patients, medical behavior has already become a professional content with different levels and the all-directional service behavior among the crowds. And the understanding of medical quality is changed since "according to the technical specification" into "meeting patient’s needs". From this angle, the harmonious relationship between doctors and patients is the important content of appraising medical quality, and good medical quality is the foundation of improving the relationship between doctors and patients.Theoretical research, law and relevant crowds’investigation results all show: The medical quality that the patient requires not only includes technological quality but also includes non-technological quality. It is hard for people to appraise medical technique quality correctly due to lacking of professional knowledge. Therefore, patient’s impression of medical quality is often influenced by non-technological factors.2. The investigation shows: people have already paid much attention to the non-technological factors. We can put forward the new tactics that improve the relationship between doctors and patients through controlling the non-technological factors.This investigation result about choosing hospitals proves: people not only pay attention to technological level(24.03 percent) but also pay more and more attention to the non-technological factors in medical quality, especially good service (20.07 percent) and rational price (19.43 percent). Secondly, people also pay close attention to these things, such as: respected, fine environment, etc.The non-technological factors which doctors and patients both sides admit has included service price, hospital environment, professional moral, service attitude, service facility, respect, privacy protection and healthy education etc. The cognitive investigation result of non-technological factors which influences medical quality shows: the patients’rate of identification (97.6- 99.7 percent) is obviously higher than that of the doctors (89.7- 91.0 percent) and they have significance differences.Comparing valued scores of both sides, generally the doctors’scores are usually low, especially in cognition of hospital environment, ward service facility, respect, privacy protection, and healthy education. The patients’scores are obviously higher than the doctors’and they have significance differences. It indicates that the doctors pay less attention to these four respects. Hospitals should improve the understanding of these factors and actively develop intervening activity.3. The investigation shows that doctors and patients’ cognition of some non- technological factors has greater differences and these factors should become intervening points.The patients’scores are obviously higher than the doctors’. Analyzing four notably different indexes: the patients pay much attention to Sanitation and cleanness (hospital environmental), perfect monitor and ringing system (ward service facility), many measures of propaganda and education (healthy education) and respect(respect and privacy protection). The relatively valued least is culture atmosphere in hospital environment, swift lift service facility in ward service facility, health care prevention knowledge in healthy education and choice doctors in respect and privacy protection. The hospitals should pay close attention to all these sides.4. The medical organization should strengthen communication with doctors and patients, to establish the service theory of "patients centered", to improve the non-technological service quality, to prevent the dispute caused by non-technological factors and structure harmonious relationship between doctors and patients. We get most important technology medical interventions. Medical organization can improve the non-technological service quality, prevent the dispute and structure the harmonious relationship between doctors and patients through these interventions.To establish prompt feedback systems of services behavior, and provide highly effective medical service for the people.To set up reasonable charging project and standard, and standardize medical price.To strengthen medical ethics and professional ethics construction of the medical personnel, and correct the malpractices in all trades and professions.To set up the perfect ward and controls the system of calling out, build patient-centered ward service facility.Medical organizations should establish the idea of respecting patient’s personality and protecting patient’s personal secrets.更多还原