Gilson Lucy, Palmer Natasha, Schneider Helen
Centre for Health Policy, University of Witwatersrand, PO Box 1038, Johannesburg 2000, South Africa.
Soc Sci Med. 2005 Oct;61(7):1418-29. doi: 10.1016/j.socscimed.2004.11.062. Epub 2005 Jan 22.
Two relationships of particular importance to health care provision are those between patient and provider, and health worker and employer. This paper presents an analytical framework that establishes the key dimensions of trust within these relationships, and suggests how they may combine in influencing health system responsiveness. The paper then explores the relevance of the framework by using it to analyse case studies of primary care providers in South Africa. The analysis suggests that respectful treatment is the central demand of primary care service users, in terms of positive attitudes/behaviours, thoroughness, and technical competence, as well as institutions that support fair treatment. It is argued that such treatment is necessary for, and integral to, patient-provider trust. The findings also suggest that the notion of workplace trust (combining trust in colleagues, supervisor and employing organisation) has relevance to provider experiences of their workplaces, and so can provide important insights for strengthening management. Nonetheless, given the limitations of this preliminary analysis, further research is needed to develop the notion of workplace trust and to test what role it has, along with that of provider-community relations, in influencing health worker performance.
对医疗保健服务提供特别重要的两种关系是患者与提供者之间的关系以及卫生工作者与雇主之间的关系。本文提出了一个分析框架，该框架确立了这些关系中信任的关键维度，并指出它们如何结合起来影响卫生系统的响应能力。然后，本文通过运用该框架分析南非初级保健提供者的案例研究来探讨其相关性。分析表明，就积极态度/行为、彻底性、技术能力以及支持公平待遇的机构而言，受到尊重的对待是初级保健服务使用者的核心需求。有人认为，这种对待对于患者与提供者之间的信任而言是必要的且不可或缺。研究结果还表明，工作场所信任的概念（结合对同事、主管和雇佣组织的信任）与提供者对其工作场所的体验相关，因此可为加强管理提供重要见解。尽管如此，鉴于这一初步分析存在局限性，需要进一步开展研究以完善工作场所信任的概念，并检验它与提供者 - 社区关系在影响卫生工作者绩效方面所起的作用。
