中国全科医生培养发展报告(2018)

  目的  了解中国东中西部地区全科医生的离职意愿现状及其影响因素,为稳定全科医生队伍、提升全科医生职业吸引力以及提高基层医疗卫生服务质量提供理论依据和政策建议。  方法  于2017年10月 — 2018年2月采用多阶段分层随机抽样方法在中国东中西部地区12个省/市/自治区360个社区卫生服务机构抽取3244名全科医生进行微信问卷调查。  结果  中国东中西部地区全科医生离职意愿总分为（15.07 ± 4.33）分,其中东部地区（15.11 ± 4.10）分,中部地区（15.26 ± 4.52）分,西部地区（14.83 ± 4.40）分。中国东中西部地区调查的3236名全科医生中,离职意愿很高者667人（20.61 %）,较高者1633人（50.46 %）,较低者728人（22.50 %）,很低者208人（6.43 %）。多元线性逐步回归分析结果显示,本科及以上文化程度、任职方式为合同制、工作压力较高、情绪耗竭得分较高、去人格化得分较高和个人成就感得分较高的中国东中西部地区全科医生离职意愿较高,女性、年龄较大、无行政职务、物质满意度得分较高和成长满意度得分较高的中国东中西部地区全科医生离职意愿较低;情绪耗竭得分较高的中国东部地区全科医生离职意愿较高,年龄较大、无行政职务、个人年均收入 ≥ 5万元、物质满意度得分较高和成长满意度得分较高的中国东部地区全科医生离职意愿较低;本科文化程度、任职方式为合同制、情绪耗竭得分较高、去人格化得分较高和个人成就感得分较高的中国中部地区全科医生离职意愿较高,物质满意度得分较高和成长满意度得分较高的中国中部地区全科医生离职意愿较低;本科及以上文化程度、任职方式为合同制、工作压力较高和情绪耗竭得分较高的中国西部地区全科医生离职意愿较高,女性、年龄较大、物质满意度得分较高和成长满意度得分较高的中国西部地区全科医生离职意愿较低。  结论  中国东中西部地区全科医生的离职意愿较高,性别、年龄、文化程度、任职方式、行政职务、工作压力以及物质满意度、成长满意度、情绪耗竭、去人格化和个人成就感得分是中国东中西部地区全科医生离职意愿的主要影响因素,不同地区的影响因素不同。     

The effect of head nurse behaviors on nurse job satisfaction and performance

Many nursing executives ponder the repeated problems at the unit level and occasionally surmise that effective supervision at that level holds the key to quality patient care. These pragmatic concerns, while commonplace, have yet to be explored empirically. The relationship of head nurse direction and support on subordinate job satisfaction and performance is not clearly understood. This study examines these relationships in the context of three moderating factors--role clarity, job anxiety, and unit size. Additionally, head nurse support is examined as a moderator of relationships between head nurse direction and subordinate satisfaction and job performance. Using a sample of 103 registered nurses in a medium-capacity metropolitan general hospital, the results show some significant correlations between head nurse behavior and job satisfaction and performance, and in moderating the effects of job anxiety, unit size, and support. The study highlights the need for replication in other settings. Additionally, other variables relevant to job satisfaction and performance such as life stressors (death or illness in the family) require investigation. The findings of this study reveal implications for management at the unit level and the importance of understanding subordinate behaviors in the context of head nurse support and direction.     

Publication output of National Health Service Bariatric centres in England

Obesity has been identified as an independent risk factor for a wide range of health conditions. Therefore, there is a clear need for high quality Bariatric research in order to improve patient selection, outcomes and safety for patients with obesity. We sought to identify and compare the quantitative and qualitative publication output from Bariatric centres in England. We identified 42 National Health Service (NHS) Trusts and 162 surgeons providing Bariatric services in England. A median of 4 (range 1–7) Bariatric surgeons were identified per centre. Eight NHS Trusts (19%) and 75 surgeons (46.3%) had no Bariatric publications during the study period, while 87 surgeons published a total of 432 Bariatric papers. Only 15 surgeons (9%) had ≥10 publications within the study period. However, these surgeons produced >50% of all Bariatric publications. Departments with more than 4 surgeons produced a significantly higher number of Bariatric publications (median 8.5 vs 2, p = 0.01). There is significant variation in research contribution amongst Bariatric centres in England. Academia should be encouraged and promoted across all bariatric services in order to broaden our understanding on Bariatric outcomes by expanding the service and proportional increase in funding. Given that a number of health conditions can afflict individuals living with obesity, bariatric surgery research becomes all the more important.     

Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health

Health care organizations may incur high costs due to a stressed, dissatisfied physician workforce. This study proposes and tests a model relating job stress to four intentions to withdraw from practice mediated by job satisfaction and perceptions of physical and mental health.     

英国卡梅伦政府医疗服务体系改革评述

英国首相卡梅伦联合政府对英格兰的国民医疗服务体系进行改革的核心目标在于改善公平和提高效率,将病人和临床专业人员置于决策和基金使用的核心位置,但受限于各方面的压力,不得不在最终立法阶段进行了大幅度的修改.理清卡梅伦政府的医改设想、修订内容和最终的立法框架问题,尤其是当前我国正在借鉴的内容,对我国完善医疗保险和卫生服务体系,具有一定的借鉴和警示作用.     

The snakes and ladders of National Health Service management in England

This article explores managerial careers in the National Health Service (NHS) through the lens of talent management, particularly focusing on how managers view barriers (snakes) and facilitators (ladders) to career progression. There is a significant literature on enablers and barriers to career progression, but much of this focuses on specific groups such as black and minority ethnic and female workers, and there is relatively little material on the general workforce of the NHS. The research design is a mixed method quantitative (questionnaire) and qualitative (interview and focus group) approach consisting of a quasi‐probability element that focuses on a maximum variety sample and a purposive element that seeks policy views at central and strategic health authority level, and examines talent management in high‐performing NHS organisations. Ladders are identified as follows: volunteering, secondment, networking, mentoring, academic qualifications, development, good role models/managers and appraisal/personal development plan. Snakes are identified as managing expectations; identity and cognitive diversity; location; sector; NHS toxic and favouritism culture; poor talent spotting; credentialism; exclusive approach to talent; and sustainability. It concludes that while previous conceptual and empirical work is fairly clear on any ladders, it is less clear on snakes. Copyright © 2013 John Wiley & Sons, Ltd.     

The role of job satisfaction, job dissatisfaction and demographic factors on physicians' intentions to switch work sector from public to private

This study is based on a unique data set for the years 1988-2003 and uses structural equation models to examine the impact of job satisfaction and job dissatisfaction on physicians' intention to switch from public- to private-sector work. In Finland, physicians who work primarily in a public-hospital or health-centre setting can also run a private practice. Therefore, we also analysed the impact of having a private practice on a physician's intention to change sector. We found that private practice had a positive, statistically significant effect on the intention to switch sector in 1998 and 2003. Results also suggest that job satisfaction decreases a physician's intention to switch sector, although for 1998 it had no effect. Surprisingly, job dissatisfaction significantly increased the physicians' intentions to leave the public sector only in the 1988 data.     

Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction

Emergency departments in most developed countries have been experiencing significant overcrowding under a regime of severe resource constraints. Physicians in emergency departments increasingly find themselves toiling in workplaces that are characterized by diminished availability of, limited access to, and decreased stability of critical resources. Severe resource constraints have the potential to greatly weaken the overall job satisfaction of emergency physicians. This article examines the impact of hospital resource constraints on the job satisfaction of a large sample of emergency physicians in Canada. After controlling for workflow and patient characteristics and for various institutional and physician characteristics, institutional resource constraints are found to be major contributors to emergency physician job dissatisfaction. Resource factors that have the greatest impact on job satisfaction include availability of emergency room physicians, access to hospital technology and emergency beds, and stability of financial (investment) resources.     

Assessing the context for partnerships between communities and the National Health Service in England

The debates surrounding public involvement in healthcare decision making have centred around how and in what capacity the public should be engaged. There is evidence that the public is reluctant to participate in setting priorities. More fundamentally, there is the question of whether the public sector can assess the capacity of communities to achieve a shared perspective on healthcare delivery. The notion of social capital addresses this question by examining the level of social cohesion and mutual trust within communities, thus providing an understanding on the one hand of the capacity of communities to develop a perspective on the 'common good' and on the other their willingness to connect with public sector organizations. It is important to gauge community capacity before developing strategies and methods for public involvement in healthcare decision making.     

Employer retention strategies and their effect on nurses' job satisfaction and intent to stay

Faced with a nursing shortage and anticipated increase in demand, home care agencies are implementing retention strategies with little knowledge of their effectiveness. The purpose of this study is to describe the strategies implemented and their effect on nurse job satisfaction and intention to leave. Data were collected from a random sample of 123 New England agencies during in-person interviews. Most agencies reported implementing multiple recruitment and retention strategies. Regression results suggest that the effects of employer retention strategy on nurses' intent to stay are the indirect result of its effects on job satisfaction. The only retention intervention that made a statistically significant difference in job satisfaction was shared governance, and no retention strategy directly affected nurses' intention to stay in their jobs.     

"The nurse satisfaction,service quality and nurse retention chain": implications for management of recruitment and retention

This paper presents the findings of a qualitative study, based on interviews with over 130 nurses and midwives in four London Trust hospitals on: the main factors influencing nurse satisfaction and retention; empirical support for the robustness of a conceptual framework or model "the nurse satisfaction, service quality and nurse retention chain"; and some managerial considerations for recruitment and retention. The three main factors influencing job satisfaction were patients, the inherent characteristics of nursing and the nursing team; the two main sources of job dissatisfaction were staff shortages and poor management and amongst nurse retention strategies improving working conditions was more important than increased pay. For recruitment, as well as retention, improving the image and reputation of nursing along with improvements in work-life balance were pre-requisites for meeting the challenging target of an additional 20,000 nurses on the wards by 2004.     

Implementing a national strategy for patient safety: lessons from the National Health Service in England

Improving patient safety has become a core issue for many modern healthcare systems. However, knowledge of the best ways for government initiated efforts to improve patient safety is still evolving, although there is considerable commonality in the challenges faced by countries. Actions to improve patient safety must operate at multiple levels of the healthcare system simultaneously. Using the example of the NHS in England, this article highlights the importance of a strategic analysis of the policy process and the prevailing policy context in the design of the national patient safety strategy. The paper identifies a range of policy "levers" (forces for change) that can be used to support the implementation of the national safety initiative and, in particular, discusses the strengths and limitations of the "business case" approach that has attracted recent interest. The paper offers insights into the implementation of national patient safety goals that should provide learning for other countries.