基于科层制理论的公立医院医患信任质性研究

摘要

Objective To analyze the impacts of bureaucracy management at tertiary public hospitals in Beijing on exchange modes and trust between doctors and patients, using both the bureaucracy theory and trust theory. To study the role of such management as an organizational structure for hospital operation and service, in the transition of doctor-patient trust from traditional special trust to a universal trust based on bureaucracy structure and specialized job division. Methods The purpose sampling method was used to select 94 hospital administrators, medical staff, and patients from six tertiary hospitals for a field survey. Results Bureaucracy at public tertiary hospitals keeps improving, and its systematic and refined organizational structure is changing the exchanges between doctors and patients, earmarking universal trust of the fundamental type of doctor-patient trust, aided by special trust. Rules and regulations of bureaucracy normalize medical services, and specialization enables medical workers in their clinical work against difficult and severe diseases, winning both reputation and patient trust as well. However, the specialized, professional and dehumanized characteristic of bureaucracy tend to encourage doctors to attend to diseases than patients, and separate links in medical services to decrease doctor-patient trust in the meantime. Conclusions Bureaucracy is a necessary organizational form of urban public hospitals, but it should strengthen their humanity feature and improve their communication with patients with rules and regulations. At the same time, with the use of integrated medical mode in clinical practice, bureaucracy could be improved to benefit patients and enhance trust of patients.%目的 以科层制理论和信任理论为基础,分析北京三级甲等医院科层制管理对医患交往方式与医患信任的影响,研究科层制作为医院运转和服务的组织结构,对医患信任从传统的特殊信任向基于层级结构、专业分工等的普遍信任转变的作用.方法 采用目的性抽样方法,抽取6家三级甲等医院管理者、医务人员、患者共计94人进行实地研究.结果 三级甲等医院科层组织日趋完善,其系统、精细的组织建构改变着医患之间的交往方式,使医患信任以普遍信任为基本类型,辅之以特殊信任.科层制的规章制度使医疗服务规范化,专业化使医务人员更好地开展疑难重症的疾病诊治,在获得声誉的同时赢得了患者的信任.然而,科层制专业化分工、去人格化等特点使医务人员更加关注病症而非患者,同时分割了医疗服务环节,影响了医患信任.结论 科层制是城市公立医院的组织形式,在运行中应加强人文方面建设,制定制度规章改变医患间沟通方式等;同时,通过整合医学模式在临床中的运用与实践,不断完善医院科层管理,提升医患信任水平.