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内在动机:它如何在改变临床医生行为方面发挥关键作用?

Intrinsic motivation: how can it play a pivotal role in changing clinician behaviour?

机构信息

Primary Healthcare Outpatient Department, Seremban Primary Care Health Clinic, Seremban, Malaysia.

出版信息

J Health Organ Manag. 2013;27(2):266-72. doi: 10.1108/14777261311321815.

Abstract

PURPOSE

In the light of an increasing healthcare burden, this paper seeks to offer insight about how intrinsic motivation could play a pivotal role in improving the pre-existing healthcare service delivery systems by altering clinician behaviour. The paper argues the case for four salient dimensions worth exploring through the lens of intrinsic motivation--non-financial incentives, positive affective states, organizational culture and prescribing quality.

DESIGN/METHODOLOGY/APPROACH: This article reviews literature from both social sciences and health management practices to provide rationale on how intrinsic motivational approaches could optimize healthcare service delivery systems.

FINDINGS

The scrutiny of the body of evidence leads to the assertion that there is neglect in the initiatives to reinforce intrinsic motivation as a method to address the ailing morale of doctors. This seems to have exacerbated negative outcomes that include job dissatisfaction, compromise in the quality of care and poor patient-doctor relationships. Diminution in positive affective states amongst doctors, largely controlled by intrinsic motivation, led to strained doctor-patient communication and poor quality of care. Barriers in a healthcare organizational culture that restricts autonomy and empowerment seem to directly undermine job satisfaction.

ORIGINALITY/VALUE: The article argues that it is crucial to shift away from the conventional tendencies promoting tangible rewards. A more holistic approach should be adopted by conducting formal research into intrinsic motivation and how it could aid the formulation of policies tailored to meet the current demands of the healthcare system.

摘要

目的

鉴于医疗保健负担不断增加,本文旨在探讨内在动机如何通过改变临床医生的行为在改善现有医疗服务提供系统方面发挥关键作用。本文认为,值得通过内在动机的视角探索四个突出的维度——非财务激励、积极的情感状态、组织文化和处方质量。

设计/方法/途径:本文回顾了社会科学和健康管理实践中的文献,为内在激励方法如何优化医疗服务提供系统提供了依据。

发现

对证据的审查得出的结论是,人们忽视了加强内在动机作为解决医生士气低落问题的一种方法的举措。这似乎加剧了包括工作不满、护理质量下降和医患关系恶化等负面后果。医生积极情感状态的减少,在很大程度上受到内在动机的控制,导致医患沟通紧张和护理质量下降。限制自主性和赋权的医疗保健组织文化中的障碍似乎直接破坏了工作满意度。

原创性/价值:本文认为,必须摆脱传统的、提倡有形奖励的倾向。应该通过对内在动机以及它如何帮助制定针对医疗系统当前需求的政策进行正式研究,采取更全面的方法。

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