【作者】 武爱文；

【导师】 郭国庆；

【作者基本信息】 中国人民大学 ， 市场营销管理， 2008， 博士

【摘要】 2006年到2008年,“看病贵、看病难”一再成为关系国计民生的重要话题,中国医疗体制改革也因此承载着前所未有的期望和压力。从一纸报告引发的有关“中国医改到底成功与否”的全国大讨论,到政府十一个部委集中各路精英和力量制定医改大计,每一步都牵着医疗行业的走向,关系着人民群众的健康,也决定着和谐社会的建设成败与否。从宏观角度看,医疗改革要达到各种利益相关者包括群众满意、政府满意、医务人员满意、公众满意才是比较理想的,在医疗改革过程中牺牲任何一方的利益都会导致总体效果的失衡和最终失败。从微观角度看,医院的绩效不但包括财务绩效和市场绩效,还包括社会绩效。要获取良好的财务/市场绩效和社会绩效,就必须要妥善处理政府、市场、患者、员工等的关系,这些都是能够影响医院目标实现,或者能够被医院实现目标的过程影响的任何个人和群体,再采取相应的战略和策略,这就是所谓的利益相关者导向。在历史和现实背景下,运用利益相关者导向理论来提高医院绩效包括财务/市场绩效和社会绩效,既符合社会和政府的利益,又迎合医院发展的必然规律,也满足医疗改革和建设和谐社会的大势。但在如何实施利益相关者导向方面需要理论和实践的探索。因此,本文拟在总结和吸收前人研究成果的基础上,运用实证研究的方法对非营利性医院利益相关者导向营销与绩效的关系展开分析和探讨。在研究方法上,本研究的思路是从社会现实出发,提出问题。而后,从我国目前医疗卫生服务提供的现状和问题出发,结合利益相关者理论,逐次分析各个利益相关者的实践现状和研究必要性。继而从理论层面,从利益相关者导向理论的发展和演进出发,通过归纳演绎,分析、构建利益相关者导向与绩效的理论框架,提出研究假设。其次,从实证研究角度,采用和借鉴文献报告中的利益相关者导向和绩效量表,对国内非营利性医院进行问卷调查。量表初稿经过小样本校验后扩大调查范围,调查结果通过统计软件工具SPSS进行信度和效度评价,而后探讨利益相关者导向与医院绩效(包括社会绩效、市场/财务绩效)的相互关系以及调控因素。最后,通过理论推演和实证验证,提出非营利性医院利益相关者导向管理策略,并构建利益相关者导向的持续营销模型。本文的研究内容主要分为三个部分、七个章节。第一部分为第1、2、3章,即导论、文献综述和研究的现实背景。这一部分是全文研究的概述、理论基础和现实背景;第二部分为第4、5、6章,即医院利益相关者导向模型构建、实证研究以及持续营销模型的构建和培育。这一部分是全文的主体,是本文研究及创新的核心所在。第三部分是第7章,即研究结论及展望。各章主要内容如下:第一章:导论。首先从本研究的现实背景入手,引出研究问题,并结合该研究领域的理论现状,阐释本研究的理论意义和实践意义;进而对本研究涉及的利益相关者导向(包括顾客导向和竞争者导向、员工导向、政府导向)以及绩效的概念进行界定,便于对后来研究内容的理解和把握;然后从总体上简要介绍研究的范围、对象、方法以及技术路线,并对本研究的预期创新点、研究难点以及解决方案进行提炼、说明;最后在概要介绍研究论文结构之后,进行本章小结。第二章:文献综述。本章在对利益相关者理论的产生、发展、界定、分类、理论基础以及测量系统综述的基础上,对利益相关者导向与绩效关系、利益相关者导向绩效评价以及利益相关者导向实施过程的矛盾冲突等问题进行文献梳理。最后,落足于中国公立非营利性医院,结合医疗市场分析、医疗服务特点以及非营利性组织发展等相关研究现状,对利益相关者导向各个维度(包括客户导向、竞争者导向、员工导向和政府导向)及其与医院绩效的关系作一综述,为本研究奠定理论基础。第三章:中国公立非营利性医院利益相关者研究的现实背景。本章着眼于中国公立非营利性医院利益相关者导向的现实背景,包括中国医疗卫生服务的发展历程、中国医疗体制改革的矛盾及困境,从利益相关者导向的几个维度管理(患者导向管理、竞争者导向管理、员工导向管理和政府的导向管理)现状分别进行阐述,提示本研究重要的现实意义,也为实证研究结果的讨论和分析奠定基础。第四章:利益相关者导向与医院绩效模型建立和实证研究设计。本章在前人和前期理论研究的基础上,本章试图构建利益相关者导向与医院绩效关系的理论模型。包括中国公立非营利性医院背景下的核心利益相关者界定、利益相关者导向与医院社会绩效、财务绩效的关系、控制因素(医院规模、等级和发展阶段)的作用以及不同利益相关者导向维度之间的相互影响。在此理论模型的基础上,对实证研究的设计、实施方案进行说明,主要涵盖研究对象、研究范围、研究假设提出、调查方案、调查问卷初稿的信度检验等,为进一步的实证研究构建理论框架,完善实证研究方案。第五章:问卷调查结果统计分析和讨论。本章首先对所调查的对象进行描述性分析,对样本数据的可靠性作进一步验证。而后通过相关分析和因子分析等统计方法对研究假设进行验证。第六章:医院利益相关者管理和持续营销模型构建。本章从我国处于特殊的历史阶段即加速转型期的现实出发,针对实证研究中发现的我国公立非营利性医院利益相关者管理的特点,包括政府导向占据重要地位、市场导向意识薄弱、员工导向程度不足等现象提出利益相关者管理及其转换机制。在此基础上,提出公立医院持续营销(sustainable market-ing)的概念和理论框架,并提出实施要点。第七章:研究结论、局限性和展望。概要总结本研究的结论、局限性,并对未来研究和实践提出展望。本研究主要结论如下:1.在公立性非营利性医院背景下,利益相关者导向与绩效(包括财务绩效和社会绩效)均有相关性。政府导向对医院绩效有正向效应。就是良好的政府导向可促进医院的财务绩效水平,提高医院的社会绩效。员工导向水平与医院绩效无论是财务绩效还是社会绩效都有直接的正面影响。员工导向水平高,则医院绩效水平将提高。竞争者导向无助于医院财务绩效的提高,而对社会绩效的提高有不利影响。患者导向同样对医院财务绩效无显著贡献,而在一定程度上会对医院社会绩效带来负面影响。2.患者导向与竞争者导向、政府导向和员工导向呈现负相关趋势,就是讲,患者导向可能会导致其他导向维度水平的下降。政府导向与竞争者导向、员工导向存在正相关,也就是讲政府导线水平提高,竞争者导向、员工导向水平也会提高;竞争者导向水平提高,员工导向水平也会提高。3.医院规模对利益相关者导向与绩效的关系有关,也就是不同医院规模,采用利益相关者导向可能会产生不同水平的绩效。而医院等级和发展阶段效应没有超过医院规模。本文的主要创新点主要体现在如下四个方面:紧扣医疗改革脉搏,瞄准学科研究前沿,促进两者有机结合。我国的医疗改革关系着的社会稳定和和谐,2007年医疗改革基本方向的确定为各级医院指明方向的同时也带来了困惑。本研究的结果将对不同类型的医院的战略决策提供科学依据,宏观上有助于医院公共卫生职能的实现和社会和谐发展,微观层面上可促进医院资源的合理配置和绩效的持续提高。同时,利益相关者导向是近年来社会责任日益受到关注情况下的管理学热点之一,在转型期中国医疗卫生行业的应用丰富了战略管理和营销管理的学科内容,具有较大的理论和实践意义。国内外从理论研究到实证验证系统探讨利益相关者导向和医院绩效关系的研究甚少,国内相关研究更为匮乏。本研究首先通过文献复习、问卷调查的方法界定医院利益相关者的范围以及核心利益相关者,构建医院利益相关者模型和利益相关者导向测评体系,并通过实证研究确定了公立非营利性医院核心利益相关者,首次通过实证研究验证了利益相关者导向与医院绩效之间的关系,为进一步研究打下基础。本研究在中国经济转型期的背景之下,在医疗卫生领域将社会绩效和财务绩效分别评价,探讨利益相关者导向对医院绩效(包括社会绩效和财务绩效)的影响以及医院规模、等级和发展阶段对上述关系的调节作用,为医院个体化利益相关者导向战略和持续营销策略实施提供理论和实践证据。创造性提出利益相关者导向管理和持续营销模型,将利益相关者导向理论和持续营销理论有机的结合,丰富了营销学的理论体系;构建利益相关者导向的持续营销模型,为医院的营销策略制定提供个体化的指导作用。总之,利益相关者导向是近年来社会责任日益受到关注的管理学热点之一,在转型期中国医疗卫生行业的应用丰富了战略管理和营销管理的学科领域,具有较大的理论和实践意义。从理论研究到实证验证系统探讨利益相关者导向和医院绩效关系的研究甚少,国内相关研究更为匮乏,本研究将在医疗卫生行业内通过实证研究对上述关系进行验证,所构建的医院利益相关者模型和利益相关者导向测评体系以及医院利益相关者分类方法将为进一步研究打下基础。此外,本文创造性提出利益相关者导向的医院持续营销策略,将利益相关者导向理论和持续营销理论有机的结合,丰富了营销学的理论体系;构建利益相关者导向的持续营销模型,希望能为医院的营销策略制定提供个体化的指导作用。当然,由于所从事的研究在理论研究领域尚属首次,可资借鉴的研究成果并不多,因此本研究中也还存在着一些不足和缺憾。另外,本研究也拓宽了目前理论界关于非营利医院市场营销的研究视野和研究方法。本文的研究才只是个开始,许多新问题还有待进一步的深入研究。更多还原

【Abstract】 That it is expensive and difficult to see a doctor has been one of the hot topics concerning the national economy and the peoples’livehood again and again during the period of 2006 and 2008, which makes the expectation and pressure unprecedented sofar bear by the Chinese medical system reform. Every step from the debates about whether the Chinese medical reform a success or not nationwide triggered by the surpring report issued by the Scioeconomic Research Center of State Department to the healthcare reform plan that will be publicized early this year pooling efforts and intelligence of eleven ministries and commissions, is concerned about the future of the Chinese healthcare system, the health of the mass, and also the success of the construction of harmonious society or not.Macrospectively speaking, the ideal plan of healthcare reform should reach the satisfaction of relevant stakeholders, such as the mass, the government, the medical professionals, and the public. Sacrificing either of the interests during the course of reform will lead to unbalance of the overall effect and ultimate failure. Meanwhile, performance of the hospital, in a miacrospective view, should be consisted of not only the financial performance and the market performance, but also the social performance. Appropriate managing the relationship among the government, market, patients, and medical professionals, is necessary to obtain favorable financial, market and social performance. Those individuals and colonies who can influence the goal realization, or who can be affected by the course to realize proposed goal, as referred before, are the stakeholders of the hospitals. So-called stakeholder orientation refers to adopting strategies and tactics to deal with the stakeholders’interest. Under current historical and realistic background, to improve the performances of the hospitals including financial, market and social performance with the guide of stakeholder theory, accords with the interests of the society and the government, cater for the rules of hospital development, and satisfies the trend of healthcare system reform and harmonious society construction. But, investigation theoretically and empirically is pressingly needed as to how to actualize the stakeholder orientation. Therefore, this study tries to analyze and investigate the relationship between stakeholder orientation and hospital performance with empical study, based on previous studie.The pathway of the present study is to develop from the realistic background and to issue questions. Then we analyzed the current status of either of the stakeholders and necessity of research from the status and problems of healthcare supply system with the aid of stakeholder theory. Theoretically, we began from the development and evolution, construted the theoretical framework of relationship between stakeholder orientation and performance through reduction and deduction, and put forward the study hypothesis. Secondly, a questionnaire investigation was carried out via an empically method, on the public non-profit hospitals in China with the scale mearsurement on stakeholder orientation and performance. The reliability and validity of the scale were tested with a sample of 30 hospitals, and then extended to the more samples. Statistical analysis was carried out with SPSS software, including reliability and validity analysis, the relationship between stakeholder orientation and performance, and the correlation and control variables analysis. Finally, based on the previous results, stakeholder orientation management and sustainable marketing model were advanced for discussion.This thesis contains three parts, seven chapters. The first part, is the scheme, theoretical, and the realistic basis, including introduction, review, and the realistic background of the study. The second part is the main body of the thesis and also the core of creation, including model construction, empirical study, and construction of sustainable marketing model as well. The third part is the conclusion, limitations, and perspectives of the study. The main content is as the following:Chapter 1 is the introduction. This chapter introduces the research topics from the realistic phenomena, illustrates the theoretical and practical significance after reviewing current status of relavant theories. After defining the conceptions of stakeholder orientation including customer orientation, competitor orientation, employee orientatation and government orientation, and performance for the convenience of understanding and grasping, it briefly describes the objects, methods, and technical route of this study. Expectant creation, difficulties encountered and proposed solutions are distilled and described. Finally, summary of the chapter is carried out following schetcking the structure of the thesis.Chapter 2 is the review. This chapter reviews the relationship between stakeholder orientation and performance, its evaluation, and conflicts in the application of stakeholder theory, based on the retrospective study on the production, evolution, definition, classification, theoretical basis, and its measurement. This chapter ends up in the public non-profit hospital, reviewing the relationship between hospital performance and customer orientation, competitor orientation, employee orientatation or government orientation, respectively. Theories on analysis on the medical market, characteristics of medical service, and development of non-profit organization are involved in the study.Chapter 3 is the realistic background. The purpose of this chapter is to reveal the realistic significance and to lay a foundation for further discussion and analysis. The course of medical survice in China, the dilemmas and difficulties in the reform of medical service system and current status in the stakeholder management in separate aspects are reviewed.Chapter 4 is model contruction of stakeholder orientation and hospital performance and design of the empirical study. A theoretical model of stakeholder orientation and hospital performance is attempted based on the previous theoretical study and literature review, which is consisted of defining of core stakeholder in public non-profit hospital of China, relationship between stakeholder orientation and social, market, financial performance, the role of control variables, and interactive effect among different stakeholders. Detailed information on design, protocol, objectives, hypothesis, and reliability analysis of the preliminary draft of the questionnaires are reported for further construction of the framework.Chapter 5 is the statistical analysis and discussion of the empirical study. The first step is confirmation of reliability of the second round sample data after descriptive analysis. The second step with correlation and regression analysis validates the hypothesis proposed.Chapter 6 is construction of model of stakeholder orientation management and sutainable marketing. From the point of rapid transition period, the author suggests the importance and potential transition mechanism of stakeholder orientation management, especially in the special historical period with the characteristics of government orientation dominance, weak market orientation consciousness, and insufficient employee orientation. Then a sustainable marketing model, including the conception or theoretical framework, and the points of application are addressed.Chapter 7 is the conclusion, limitation, and perpectives of the study.The main results of the study are as follows:Stakeholder orientation is related to the hospital performance for the study object of public non-profit hospitals. Government orientation has a positive correlation to hospital performance. High level of government orientation will lead to improved financial performance and social performance. Employee orientation is also correlated to financial performance and social performance. Competitor orientation has no effect on the hospital performance, while the patients’orientation is negatively related to the performance.A negative correlationship trend is found among patient orientation, competitor orientation, government and employee orientation, which means patient orientation, may lead to reduction of other orientations. A positive correlation is found between government orientation and competitor orientation, employee orientation, respectively. That is to say, higher level of government orientation will result in higher level of competitor orientation and employee orientation.Hospital size affects the relation between stakeholder orientation and performance. Same level of stakeholder orientation will produce different performances in hospitals with different size. But the effect of hospital grade and stage of development do not exceed that of the hospital size.This thesis contributes to medical service in public non-profit hospitals academically and practically in four points:The first one is the oranic combination of managerial science advances and medical reform. The success of medical reform is concerned with the stability and harmony of the society. The direction of medical reform enlightens the hospital management in the late 2007 and early 2008. It also brings confusion at the same time. The result of the study will provide scientific evidences for strategy decision making in hospitals of all kinds. It contributes to the fulfillment of public health function and development of harmonious society macroscopically, and propels the proper collocation of resources and sustainable improvement of hospital performance. Meanwhile, stakeholder orientation is one of hot spots in managerial science of recent years and its application in medical fields will certainly enrich the content of strategy management and marketing management and holds great theoretical and practical significance.Few studies have been found regarding the relationship between theoretical study and hospital performance, even fewer in Chinese literatures. This study, defines the stakeholders and the core stakeholders, constructs relevant model and evaluation questionnaires through literature review and empirical study. The correlation between stakeholder orientation and performance is firstly confirmed, which lays a good foundation for further research.The third innovation is separate evaluation of social and financial performance in the healthcare field in the investigation of effect of stakeholder orientation on hospital performance, and the modulation of hospital scale, grade, and stage of development. Thus it provides theoretical and practical evidences for individualized strategy and sustainable marketing for public non-profit hospitals.The fourth innovation is the construction of sustainable marketing model, which combines the stakeholder orientation and sustainable marketing theory organically and enriches the marketing theory greatly.In conclusion, stakeholder orientation is one of the hot spots among management science and social responsibility. It may and can have a great theoretical and practical sense, especially when used in the healthcare system management during the transition period, and also enriches the content of strategy and marketing management fields. Few studies have been carried out to investigate the relationship between stakeholder orientation and performance, even fewer in China. This study may lay a helpful foundation for further study with the stakeholder orientation model, and stakeholder evaluation system, after the verification of proposed hypothesis. Another, this study issue the stakeholder orientation management and sustainable marketing model with creativity, combine the stakeholder theory and sustainable marketing organically, enrich the theoretical system of marketing, and may guide the individualized marketing strategy with the model.This study is the first time in the theoretical field and has few references, leaving some limitations and shortcomings of the study behind. Though it enlarges the vision and the methods of current marketing in non-profit hospitals, this study is just a beginning and many issues is to be learned.更多还原