Xu Xiao Ping, Ke Dong Ge, Deng Dong Ning, Houser Shannon H, Li Xiao Ning, Wang Qing, Shan Ng Chui
Department of Medical Service, Shenzhen Hospital, The University of Hong Kong , Shenzhen, China.
ISCTE-Instituto Universitario de Lisboa , Lisbon, Portugal.
Int J Health Care Qual Assur. 2019 Aug 12;32(7):1055-1071. doi: 10.1108/IJHCQA-02-2017-0033.
The purposes of this paper are two-fold: first, to introduce a new concept of primary care consultation system at a mainland Chinese hospital in response to healthcare reform; and second, to explore the factors associated with change resistance and acceptance from both patients' and medical staff's perspectives.
DESIGN/METHODOLOGY/APPROACH: A survey design study, with two questionnaires developed and distributed to patients and medical staff. Convenience and stratified random sampling methods were applied to patient and medical staff samples.
A 5-dimension, 21-item patient questionnaire and a 4-dimension, 16-item staff questionnaire were identified and confirmed, with 1020 patients (91.07 percent) and 202 staff (90.18 percent) as effective survey participants. The results revealed that patient resistance mainly stems from a lack of personal experiences with visiting general practice (GP) and being educated or having lived overseas; while staff resistance came from occupation, education, GP training certificate, and knowledge and experience with specialists. Living in overseas and knowledge of GP concepts, gender and education are associated with resistance of accepting the new practice model for both patients and staff.
ORIGINALITY/VALUE: There are few Chinese studies on process reengineering in the medical sector; this is the first study to adopt this medical consultation model and change in patients' consultation culture in Mainland China. Applying organizational change and process reengineering theories to medical and healthcare services not only extends and expands hospital management theory but also allows investigation of modern hospital management practice. The experience from this study can serve as a reference to promote this new consultation model in Chinese healthcare reform.
本文有两个目的:第一,介绍中国大陆一家医院为响应医疗改革而提出的基层医疗咨询系统的新概念;第二,从患者和医务人员的角度探讨与变革阻力和接受度相关的因素。
设计/方法/途径:一项调查设计研究,编制了两份问卷并分发给患者和医务人员。对患者和医务人员样本采用了便利抽样和分层随机抽样方法。
确定并确认了一份包含5个维度、21个条目的患者问卷和一份包含4个维度、16个条目的员工问卷,有效调查参与者分别为1020名患者(91.07%)和202名员工(90.18%)。结果显示,患者的阻力主要源于缺乏看全科医生的个人经历以及在海外接受教育或生活过;而员工的阻力来自职业、教育程度、全科医生培训证书以及与专科医生相关的知识和经验。在海外生活以及对全科医生概念的了解、性别和教育程度与患者和员工接受新实践模式的阻力相关。
原创性/价值:中国关于医疗领域流程再造的研究较少;这是中国大陆第一项采用这种医疗咨询模式并改变患者咨询文化的研究。将组织变革和流程再造理论应用于医疗保健服务,不仅扩展了医院管理理论,还能对现代医院管理实践进行研究。本研究的经验可为中国医疗改革中推广这种新的咨询模式提供参考。