【作者】 谌永毅；

【导师】 刘家望； 肖水源；

【作者基本信息】 中南大学 ， 公共管理， 2013， 博士

【摘要】 研究背景：2011年卫生部优质护理服务示范工程活动中提出：利用2年左右的时间,通过开展以患者满意、社会满意、政府满意为目标的“示范工程”活动；2011年卫生部在《2011年公立医院改革试点工作安排》中明确提出：“开展医疗安全质量控制评价工作,推进医院管理评价评审工作,提高群众满意度”的要求,要求卫生行业形象持续提升是“三好一满意”活动的主题和主要目标,让广大人民群众和患者在就医过程中,社会对医疗卫生行业的服务满意度有了较大幅度提高。近年来,大部分医院在医疗服务过程中,非常注重患者在就医过程中对医疗行业的感受和意见,住院患者护理服务满意度开始作为住院患者护理服务质量考评的准则和标志。目前,国内关于患者护理服务满意度模型的研究基础还十分薄弱,可以借鉴的、比较成熟的研究成果相当有限。另外,国内关于住院患者护理服务满意度的研究,主要侧重于以满意度为导向用层次分析法、模糊综合评价法来构建评价指标体系,进而构建评价模型,关于患者服务满意度模型的研究往往直接借鉴比较成熟的顾客满意度模型,从顾客满意度的角度来构建模型,忽略了医院管理和企业管理的差别。鉴于以上实践背景和理论缺陷,开展本研究。研究目的：医院患者满意与否不仅决定了医院存在的价值,同时也是决定医院核心竞争力的关键因素。本课题拟通过问卷调查和理论研究与实证分析相结合,考虑医院护理服务的特点,利用结构方程建立肿瘤住院患者护理满意度理论模型。其次,通过满意度模型对湖南省肿瘤医院护理服务进行现状调查,深入了解患者对护理服务的期望,分析医院护理服务存在的主要问题,找出影响住院患者满意度影响的主要因素,对比分析医院护理服务是否满足患者对服务质量的期望,在此基础上针对性制定改进措施,提出改善服务质量,提高顾客满意的策略建议。研究方法本文采用的研究方法如下：(1)文献分析法本文在研究的过程中,通过文献查阅,了解本课题及相关课题的研究现状,获取最新的研究资历,通过这些文献资料的阅读理清了在患者满意度、患者满意度模型、护理满意度等方面已经取得的理论成功,进而确定本文的理论框架。(2)问卷调查法以护理服务满意度的测评指标体系为基础,设计调查问卷,以湖南省肿瘤医院住院患者为调查对象,主要采用问卷调查的方式作为发送与回收的渠道,调查主要患者对肿瘤医院护理服务的期望、感知质量、满意度情况等。(3)理论研究与实证研究相结合的方法对于满意度模型的构建方面,主要采用的是理论研究的方法,通过理论研究得出护理服务满意度的定义、肿瘤住院患者护理服务满意模型的理论基础、根据理论基础及我国的国情来设定潜变量和观察变量、根据理论研究来假设潜变量之间的关系,从而构建满意度模型。对于满意度模型的验证、评价、修正主要采用的是实证研究发,对住院患者护理服务满意度进行调研,对调研的数据进行统计和分析。(4)统计分析法本文主要采用结构方程的方法来构建肿瘤住院患者护理服务满意度模型,并用SPSS对调研的数据进行统计和分析,再用LISREL8.7软件来对构建的模型进行验证、评价和修正。对湖南省肿瘤医院护理服务满意度现状调查采用卡方检验和t检验。研究结果与结论此项研究为肿瘤住院患者满意度测评提供一个客观有效的方法,为患者提供高质量的护理服务与加强护理管理方面将有较大意义,主要的结果与结论有：1、建立了一个符合肿瘤医院专科特色的肿瘤住院患者护理服务满意度模型。本研究用结构方程的方法构建出一个适合肿瘤医院专科特色的住院患者服务满意度模型,经过验证后的肿瘤住院患者满意度指数模型拟合较好。感知质量对满意度有较显著的影响,患者预期和感知质量,感知质量对顾客满意起着决定性的作用。疾病压力影响住院患者满意度和对医院的忠诚度。问卷调查的28个问卷条目Cronbach系数为0.879,问卷各个指标间的一致性很高,7个潜变量的信度在0.716-0.879之间,均在0.7以上,说明调查的信度都在可接受的范围内。问卷设置的测量指标很好的诠释了潜变量,具有较高的效度。2、本研究模型可以作为住院患者护理满意度测评指标,提高了护理服务质量。通过肿瘤住院患者满意度模型对湖南省肿瘤医院护理满意度现状进行测评,护理管理部门可以更清楚患者对护理服务的期望程度、对护理服务质量的满意程度以及对医院管理部门的抱怨和对医院的忠诚程度,护理管理部门在了解患者对服务过程中质量和技术的需求时,能针对问题,制定改进措施,从而提高了服务质量和患者对护理服务的满意度。3、湖南省肿瘤医院护理服务满意度较高通过对湖南省肿瘤医院护理服务的满意度现状调查,湖南省肿瘤医院护理服务整体满意度水平较高,其中服务技术、护士态度与医疗服务的整体满意度评价关系最密切更多还原

【Abstract】 Background:In2011Ministry of Health quality care demonstration project activities proposed that during two years, through regarding conducting patient satisfaction, social satisfaction, government satisfaction as the goal of the "demonstration project" activities. During the2011Public Hospitals reform in2011, the Ministry of Health clearly stated that carrying out medical safety and quality by controlling evaluation work, and promoting the hospital management evaluation assessment, improving public satisfaction, which demands to continue to improve the image of the health sector. Promoting the satisfaction and the maintain the theme, so that the masses and the patients in the course of medical treatment, social services for the healthcare department have a more substantial increasingly satisfaction. Recently, many hospitals in the medical service processing, plays role great importance to the medical treatment for patients in the medical workers feeling and opinion. Regarding Satisfaction with inpatient care as service quality evaluatial criteria and flags. Presently, the domestic service satisfaction regarding patient care model of foundation is still very weak, and other mature research results is quite limited. In addition, Research of the domestic inpatient satisfaction, mainly focused on the satisfaction oriented with analytic hierarchy process, fuzzy comprehensive evaluation method to construct evaluation index system, and then construct the evaluation model, those studies are often directly refers more mature customer satisfaction model. From the perspective of customer satisfaction to build the model, ignoring the hospital management and corporateing the governance differences. Given the above reasons and theoretical flaws practice, We are going to carry out this study.Research purposesPatients satisfaction in hospital will not only determine the existence value of the hospital, but also determine the core competitiveness of the hospital a key factor. The proposed project through questionnaires and theoretical research and empirical analysis of the combination, considering the characteristics of hospital care, the use of structural equation established tumors inpatient nursing satisfaction model. Secondly, through the satisfaction model Hunan Provincial Tumor Hospital Care Survey conducted in-depth understanding of the expectations of the patient care, hospital care analysis of the main problems, identify the impact of hospitalized patients of the main factors affecting satisfaction, comparative analysis of hospital care meets the patient’s expectations of service quality, on this basis to develop targeted improvement measures put forward to improve service quality, improve customer satisfaction policy recommendations.Research MethodsResearch methods are used in this paper in the following:(1) Literature analysisBased on the research processing, through literature review, the status of understanding of the issues and topics related research, obtaining the latest research qualifications, through these sort of literature in patient satisfaction, the model of patient satisfaction, the theory of nursing satisfaction’s success has been achieved, and reform the theoretical framework.(2) QuestionnaireSatisfaction with nursing care evaluation index system was designed which based on the survey questionnaire to Hunan Provincial Tumor Hospital patients. Questionnaires was sent and recycled which including cancer patients expectations of hospital care, perceived quality, satisfaction and so on.(3)Combining the theoretical research and empirical research methodThe main uses of theoretical research methods for the Satisfaction Model Construction, through theoretical studying nursing service satisfaction derived definition of inpatient care satisfaction of the tumor model theory. According to China’s national, conditions setor latent variables and observed variables. Based on theoretical studies, It assumed that the relationship between latent variables to build satisfaction model. For satisfaction model validation, evaluation, correction is mainly used in empirical studies to make the research and analysis.on inpatient care satisfaction research, statistical data.(4)Statistical analysisIn this paper, Structural equation approach was used to building the model of tumor inpatient satisfaction with nursing care, by using SPSS statistical data for research and analysis, LISREL8.7software to build the model validation, evaluation and correction. chi-square test was used in the Hunan Province Tumor Hospital Nursing Service Satisfaction Survey.Results and conclusionsTo provide an objective and effective way for the survey of hospitalized cancer patients satisfaction. Then promoting the high level of quality care services and enhanced the management of nursing care. It will have a greater significance in this study, the main results and conclusions as following.1.To establish the compliance specialist features of the tumor cancer hospital inpatient care satisfaction model. In this study, structural equation method to build the model of the suitable specialist cancer hospital inpatient services featured satisfaction, proving the tumor inpatient satisfaction index model fits better. Perceiving quality on satisfaction have a more significant impact on patient expectations and perceived quality, perceived quality on customer satisfaction plays a decisive role. Disease pressures affects hospitalized patient satisfaction and loyalty to the hospital. Questionnaire survey including28entries and the Cronbach coefficient was0.879. The questionnaire is high consistency among the various indicators,7latent variables in reliability between0.716-0.879, others were all above0.7, indicating that investigations are at an acceptable reliability range. with high validity, a good interpretation of latent variables should set the questionnaire measure.2.This study can serve as a model for inpatient care satisfaction survey indicators, to improve the quality of care in hospitals. To status the nursing satisfaction through the model of the Hunan Provincial Tumor Hospital. Medical departmentis managenent can clearly note the patient desire of nursing care,the degree of satisfaction with quality, the hospital administration, the hospital complaining of loyalty, the management’s understanding of patients during the process of service quality and technical requirements. By improving service quality and patient satisfaction with highly service.Which can solve the problem, develop improvement measures.3.Hunan Provincial Tumor Hospital care higher satisfaction.Through the survey of the Hunan Provincial Tumor Hospital nursing service satisfaction, Hunan Provincial Tumor Hospital care was higher than oters in the level of overall satisfaction. We must closely evaluated the service technicians, nurse’s attitude and overall satisfaction with health care services.更多还原