【作者】 桑秀丽；

【导师】 王华； 王天朝；

【作者基本信息】 昆明理工大学 ， 质量工程与管理， 2013， 博士

【摘要】 近年来,随着医患纠纷的频发,特别是医闹事件的屡屡发生,医患关系成为社会各界热议和研究的焦点。有关医患关系、医疗改革的议题也成为十八大代表们关注的热点。构建和谐医患关系已经成为实现中国梦的重要组成部分。目前有关和谐医患关系的研究还不够全面和完善,研究者多集中研究单一的患者或医护人员满意度的影响因素或满意度指数,医院管理人员在医患关系中的作用和影响鲜有研究：而系统的研究患者、医护人员、医院管理人员的影响因素及三方之间的作用机制的还未见报道,急需有新的研究来全面厘清三方主体满意度的影响因素及相互作用机制,并科学、定量的描述三方主体的满意度度指数及相互影响的程度,从而更有针对性的提出改良医患关系的对策和建议,构建和谐的医患关系。本文从“该如何测算医患关系和谐度指数”逆向思维,构建了“医患关系和谐度指数理论模型”,系统全面的研究并测算了患者、医护人员、医院管理人员满意度的影响因素及满意度指数等,主要完成了以下研究工作：(1)借鉴前辈对患者、医护人员满意度及其影响因素的研究,充分发挥质量功能展开技术中将“顾客需求”逐级展开为可观测具体指标的优势,优化问卷设计,系统的研究了患者、医护人员和医院管理人员三方满意度的影响因素,弥补医院管理人员满意度影响因素研究的缺失,丰富了医患关系研究的基础理论与内容；(2)将结构方程模型和“质量屋”的展开技术相结合引入到医患满意度测评研究中,得到了一种更直观、客观的“基于SEM的QFD满意度指数测评”的新方法。该方法可以让研究者清晰了解每个变量对满意度的影响程度,弥补了传统结构方程模型中只能得到最终结果而无法掌握过程变量对因变量的解释程度的不足；利用该方法科学的计算了医患关系三方主体的满意度指数；(3)在(1)(2)研究的基础上,通过一种潜变量构面的处理方法,创新的构建了医患关系和谐度的结构方程模型,并测算出了医患关系和谐度指数；利用数值模拟仿真再现并阐释了医患关系和谐度：(4)对照研究成果,完成了对我国医患现状的分析,并提出了提升医患关系和谐度的对策及建议。更多还原

【Abstract】 With the frequent occurrence of medical disturbance in recent years, especially medical violence events, doctor-patient relation becomes the focus of researches and the hot issue concerning the whole society. Proposals of doctor-patient relation and medical system reform have aroused deputies’attention at18th Party Congress. To construct a harmonious doctor-patient relation is a vital part of realizing the Chinese dream.Current studies of doctor-patient relation need improved. Researchers mainly focus on studying single factor affecting the satisfaction degree of patients or medical staff. Few studies involve the function and influence of hospital administrators within doctor-patient relation. Studies of three subjects, patients, medical staff and hospital administrators, and their working mechanism are unreported. A comprehensive study of these three subjects and their relations is required with scientific and quantitative description of satisfaction degree of three subjects, and suggestions and countermeasures are pointedly put forward to improve doctor-patient relation and construct a harmonious doctor-patient relation.By adopting a reverse thinking of "how to measure the harmonious degree of doctor-patient relation", this paper establishes a theoretical model of indicators for doctor-patient harmonious degree, and conducts a comprehensive study of factors of patients, medical staff and hospital administrators and satisfaction degree. Main achievements are as follows.First, by drawing upon the advantages of other scholars’work in this field, we give full play the Quality Function Deployment Method, which allows the customers’ needs to be predicted and assessed via indicators. The questionnaire design is optimized, which compensates the lack of studies on hospital administrators and factors of satisfaction degree, enriching the basic theories and contents of doctor-patient relation researches.Second, a new method combined Structural Equation Modeling (SEM) and Quality Function Deployment (QFD) in House of Quality is explored, which is more direct and more objective in assessing the satisfaction indicators. It enables researchers to have a clear grasp of each variable, which makes up the disadvantages of studies that can acquire the result only but no details in the process. This method is adopted to scientifically calculate the satisfaction indicators of three subjects in doctor-patient relation.Third, with the help of latent variable dimensions, this paper creatively constructs a structural equation model of satisfaction degree in doctor-patient relation and calculates the satisfaction indicators. Numerical simulation reproduces the harmonious degree of doctor-patient relation.Fourth, based on above achievements, current situation of China’s doctor-patient relation is analyzed and suggestions for improving the harmonious degree of doctor-patient relation are provided.更多还原