公立医院医生工作满意度现状评价及策略研究
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摘要
目的医生作为医院最主要的人力资源,其工作满意度水平不仅关系到医生自身健康,而且直接影响到其所提供医疗服务的质量、工作效率及医生队伍的稳定性,乃至影响卫生事业发展。因此,开展医生工作满意度调查具有十分重要的现实意义。本研究旨在了解公立医院医生工作满意度现状,识别影响医生工作满意度的关键因素,分析医生工作满意度领域应优先解决的问题,据此提出提高公立医院医生工作满意度的对策与建议,为卫生管理部门进行相关决策提供依据,以期达到提高医生工作满意度,维护医生队伍稳定性,保证医疗服务质量,促进卫生事业可持续发展的目的。
方法研究以课题组编制的公立医院医生工作满意度量表作为测量工具,对我国4省12市5677名医生进行调查。采用项目分析法评价量表各条目的区分度,采用Cronbach'sα系数检验量表信度,采用因子分析法检验量表的结构效度;用均数、标准差、构成比等指标描述公立医院医生工作满意度现状,采用Spearman相关分析探讨各具体条目与医生工作满意度的相关关系;采用方差分析、t检验对不同人口学特征的医生工作满意度差异进行比较;运用模糊综合评判法、结构方程模型、OLS逐步回归、非条件Logistic回归等方法,对公立医院医生工作满意度进行评价,并识别其决定因素;运用因素重要性推导模型和情景分析法对公立医院医生工作满意度进行策略研究,发现需优先解决的问题并进行了简单情景构建。
结果医生工作满意度总量表及各分量表均具有较好的信度和结构效度;量表所涉及的工作满意度5个维度中,工作本身、内部环境、组织管理维度得分较高,而工作回报、执业环境维度得分偏低;不同地区、性别、年龄、婚姻状况、学历及职称等特征的医生工作满意度水平差异有统计学意义;所调查医生工作满意度水平不高,尚有较大提升空间;将对量表进行探索性因子分析所得的12个公因子作为医生工作满意度内部因素,通过结构方程模型发现,11项因素对医生工作满意度起作用,其中,以组织管理作用最大,其余作用较大的前几项依次为物质回报、工作条件、工作关系、工作适合、工作自主权;工作满意度5个维度中,专业兴趣和性格适合对工作本身满意度起主要作用,工作回报满意度中以收入水平和能力发挥作用最明显,医院内部环境中工作环境、办公空间等属于需要优先解决的问题,医生执业环境满意度主要受宏观制度环境的影响,所调查医生组织管理满意度水平不高,尤以制度建设水平较低;在医生工作满意度12项内部因素中,组织管理、宏观制度环境、物质回报、精神回报、工作条件属于需优先解决的问题,构建的三种情景中以无突变情景发生的可能最大。
结论课题组编制的公立医院医生工作满意度量表被证实具有较好的信度和结构效度;公立医院医生工作满意度总体水平尚有较大提升空间,医生对工作感到较为不满的项目多集中在工作回报和执业环境两方面;在医生工作满意度内部因素中,组织管理对医生工作满意度所起作用最大,同时,医生工作满意度受多项人口学变量的影响;在无突变情况发生的情景下,组织管理、宏观制度环境、物质回报等属于需优先解决的问题。本研究样本量较大、覆盖范围广,且综合运用多种统计方法对所得数据进行全面分析,因此,结果代表性较强,能真实地反映我国公立医院医生工作满意度现状。在此研究结果基础上,本研究根据系统论原理从政府、医院、社会及医生四方提出对策与建议,为卫生管理部门采取相应措施提供决策依据。
Objective As the most important human resources in hospital, physicians job satisfaction is related to not only the health status of themselves but also the quality of health services, efficiency and the stability of the contingent of physicians, and even influences the development of health service. So, developing the investigation of physician job satisfaction is very significant. The study aimed at knowing about the status of the physician job satisfaction in governmental hospital, distinguishing the key factors which affect physician job satisfaction, and proposing suggestion to improve the physician job satisfaction, so as to help health management department take corresponding measures, to maintenance the stability of the physicians, to enhance the health service quality and promote the sustainable development of public health service.
Method The study takes physician job satisfaction of governmental hospital scale as measurement tool, 5677 physicians of 12 cities in four provinces of our country were investigated. Using item analysis to discriminate the area indexing of the items in scale, using Cronbach's Alpha coefficient to examinate the scale of the reliability of the scale and useing the factor analysis to examine structure validity of the scale; Using mean and standard deviation to descriptive the status of the physician job satisfaction in governmental hospital, and using spearman correlation analysis to discuss the correlational between each item and the physician job satisfaction; Using variance analysis and t test to compare the physician job satisfaction of different demographic variables; Using fuzzy comprehensive evaluation, structural equation model, OLS stepwise regression, non-condition Logistic regression and so on, to evaluate the physician job satisfaction, and identify the key factors; Using important quadrant model to find out the problems need to be solved preferentially and using scenario analysis carrying on the simple scene construction to physician job satisfaction of governmental hospitals.
Results The scale is reliable and valid; Job itself, internal environment, organizational management had get higher scores, job-return, working environment had get lower scores; The satisfaction of different demographic variables are different; the level of the physician job satisfaction in governmental hospital is low; 11 factors decide the physician job satisfaction, of which organizational management has the greatest impact, among the others, job fitness, working condition, guard tendency, spiritual return, material return are in the first five. Satisfaction of job itself is mainly affected by internal factors; Income and ability displaying play an important role in the job return; Among the factors of internal environment, working environment, work space, technical equipment and so on, should be solved first; The level of physician organizational management satisfaction is low, especially the system construction; Among the internal factors organizational management, macroscopic system environment, material return, spiritual return, working condition need to be solved preferentially.
Conclusion The scale is reliable and valid; The physician job satisfaction needs improving, the problems that physicians feel not satisfied most are job return and professional environment; Among internal factors organizational management play the most important role, some demographic variables have effects on physician job satisfaction; Among the internal factors organizational management, macroscopic system environment and so on, need solving preferentially; The study has a large sample, and many kinds of statistical methods have been applied to analyze the data, so, the results can reflect the status of physician job satisfaction of governmental hospital literally. Based on the study results we propose suggestion to help healthe management department take propotional measures.
方法研究以课题组编制的公立医院医生工作满意度量表作为测量工具,对我国4省12市5677名医生进行调查。采用项目分析法评价量表各条目的区分度,采用Cronbach'sα系数检验量表信度,采用因子分析法检验量表的结构效度;用均数、标准差、构成比等指标描述公立医院医生工作满意度现状,采用Spearman相关分析探讨各具体条目与医生工作满意度的相关关系;采用方差分析、t检验对不同人口学特征的医生工作满意度差异进行比较;运用模糊综合评判法、结构方程模型、OLS逐步回归、非条件Logistic回归等方法,对公立医院医生工作满意度进行评价,并识别其决定因素;运用因素重要性推导模型和情景分析法对公立医院医生工作满意度进行策略研究,发现需优先解决的问题并进行了简单情景构建。
结果医生工作满意度总量表及各分量表均具有较好的信度和结构效度;量表所涉及的工作满意度5个维度中,工作本身、内部环境、组织管理维度得分较高,而工作回报、执业环境维度得分偏低;不同地区、性别、年龄、婚姻状况、学历及职称等特征的医生工作满意度水平差异有统计学意义;所调查医生工作满意度水平不高,尚有较大提升空间;将对量表进行探索性因子分析所得的12个公因子作为医生工作满意度内部因素,通过结构方程模型发现,11项因素对医生工作满意度起作用,其中,以组织管理作用最大,其余作用较大的前几项依次为物质回报、工作条件、工作关系、工作适合、工作自主权;工作满意度5个维度中,专业兴趣和性格适合对工作本身满意度起主要作用,工作回报满意度中以收入水平和能力发挥作用最明显,医院内部环境中工作环境、办公空间等属于需要优先解决的问题,医生执业环境满意度主要受宏观制度环境的影响,所调查医生组织管理满意度水平不高,尤以制度建设水平较低;在医生工作满意度12项内部因素中,组织管理、宏观制度环境、物质回报、精神回报、工作条件属于需优先解决的问题,构建的三种情景中以无突变情景发生的可能最大。
结论课题组编制的公立医院医生工作满意度量表被证实具有较好的信度和结构效度;公立医院医生工作满意度总体水平尚有较大提升空间,医生对工作感到较为不满的项目多集中在工作回报和执业环境两方面;在医生工作满意度内部因素中,组织管理对医生工作满意度所起作用最大,同时,医生工作满意度受多项人口学变量的影响;在无突变情况发生的情景下,组织管理、宏观制度环境、物质回报等属于需优先解决的问题。本研究样本量较大、覆盖范围广,且综合运用多种统计方法对所得数据进行全面分析,因此,结果代表性较强,能真实地反映我国公立医院医生工作满意度现状。在此研究结果基础上,本研究根据系统论原理从政府、医院、社会及医生四方提出对策与建议,为卫生管理部门采取相应措施提供决策依据。
Objective As the most important human resources in hospital, physicians job satisfaction is related to not only the health status of themselves but also the quality of health services, efficiency and the stability of the contingent of physicians, and even influences the development of health service. So, developing the investigation of physician job satisfaction is very significant. The study aimed at knowing about the status of the physician job satisfaction in governmental hospital, distinguishing the key factors which affect physician job satisfaction, and proposing suggestion to improve the physician job satisfaction, so as to help health management department take corresponding measures, to maintenance the stability of the physicians, to enhance the health service quality and promote the sustainable development of public health service.
Method The study takes physician job satisfaction of governmental hospital scale as measurement tool, 5677 physicians of 12 cities in four provinces of our country were investigated. Using item analysis to discriminate the area indexing of the items in scale, using Cronbach's Alpha coefficient to examinate the scale of the reliability of the scale and useing the factor analysis to examine structure validity of the scale; Using mean and standard deviation to descriptive the status of the physician job satisfaction in governmental hospital, and using spearman correlation analysis to discuss the correlational between each item and the physician job satisfaction; Using variance analysis and t test to compare the physician job satisfaction of different demographic variables; Using fuzzy comprehensive evaluation, structural equation model, OLS stepwise regression, non-condition Logistic regression and so on, to evaluate the physician job satisfaction, and identify the key factors; Using important quadrant model to find out the problems need to be solved preferentially and using scenario analysis carrying on the simple scene construction to physician job satisfaction of governmental hospitals.
Results The scale is reliable and valid; Job itself, internal environment, organizational management had get higher scores, job-return, working environment had get lower scores; The satisfaction of different demographic variables are different; the level of the physician job satisfaction in governmental hospital is low; 11 factors decide the physician job satisfaction, of which organizational management has the greatest impact, among the others, job fitness, working condition, guard tendency, spiritual return, material return are in the first five. Satisfaction of job itself is mainly affected by internal factors; Income and ability displaying play an important role in the job return; Among the factors of internal environment, working environment, work space, technical equipment and so on, should be solved first; The level of physician organizational management satisfaction is low, especially the system construction; Among the internal factors organizational management, macroscopic system environment, material return, spiritual return, working condition need to be solved preferentially.
Conclusion The scale is reliable and valid; The physician job satisfaction needs improving, the problems that physicians feel not satisfied most are job return and professional environment; Among internal factors organizational management play the most important role, some demographic variables have effects on physician job satisfaction; Among the internal factors organizational management, macroscopic system environment and so on, need solving preferentially; The study has a large sample, and many kinds of statistical methods have been applied to analyze the data, so, the results can reflect the status of physician job satisfaction of governmental hospital literally. Based on the study results we propose suggestion to help healthe management department take propotional measures.
引文
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