医疗卫生服务体系整合型改革对医务人员工作动机及行为影响的系统综述

目的:探究医疗卫生服务体系整合型改革中医务人员工作动机和行为的改变。方法:采用系统综述法检索筛选文献,主题综合法提取文献信息,基于ERG理论分析工作动机影响机制。结果:纳入的19篇研究发现整合型改革有利于满足医务人员不同需求层次,提高了工作满意度或降低职业倦怠和工作压力。但是各类整合改革都存在薪酬体制改革滞后,难以弥补工作量和工作压力增多的不足。结论:整合型改革会改变激励因素,建议注重各类政策的协调,改变传统收入结构,优化运行环境和资源获取渠道,打造横纵贯通的职业发展路径,发挥基层医疗机构的作用,延伸家庭医生团队内涵。

A systematic review of the impact of integrated health care system on the motivation and behavior of medical workers

Objective: To explore the changes of work motivation and behavior of health service providers during the construction and implementation of integrated medical and health service system. Methods: Systematic review method was used to retrieve and screen the literatures, thematic synthesis method was adopted to extract the literatures'' information, and then we analyzed the influence mechanism of work motivation based on ERG theory. Results: The 19 included studies found integrated reform had met different levels of the medical workers, influencing job satisfaction, job burnout and job stress positively. But every integrated pattern had relative lag compensation system, that was income cannot compensate for the negative effects of increased workload and work pressure. Conclusions: In the process of integrated reform, attention should be paid to the influence of the incentive factors. It is recommended to focus on the coordination of policy within and between integration, change the traditional income structure, optimize the operating environment and resource acquisition, create a career path in both horizontally and vertically, specially pay attention on the role of primary health care institutions and their medical personnel, and extend the connotation of family doctor team.