医联体背景下基层医疗卫生机构发展需求模型构建

目的：构建基层医疗卫生机构发展需求模型。方法：对医疗机构工作人员、医联体负责人及卫健局相关负责人进行半结构化访谈，使用内容分析法，借鉴Leavitt组织变革理论构建基层医疗卫生机构发展需求模型，凝练出各类范畴，并进行频次统计。结果：组织结构发展、任务发展、技术发展和人员发展需求频次占比分别为57.2%、18.0%、12.7%和12.1%。组织结构发展需求包括人事政策、医保政策、基本公卫政策、首诊转诊机制、政府管理优化和医联体内管理优化；任务发展需求包括机构发展规划、辖区管理优化、业务整合、工作内容优化及机构内绩效管理；技术发展需求包括硬件设施建设、信息化建设、横纵向带动措施及专项服务能力提升；人员发展需求包括人员能力与职业精神提升。结论：基层医疗卫生机构存在组织结构、任务、技术和人员方面的多方位发展需求，相关政策和管理方式需定向完善以满足不同层次单位的需求。

Construction of development demand model of primary medical and health care institutions under the background of medical alliance

Objective: To construct the development demand model of primary medical and health care institutions. Methods: Semi-structured interviews are conducted with staff of the institutions, responsible persons of the medical alliance, and officials of the health bureau. Content analysis method is used to construct a development demand model of primary health care institutions based on the Leavitt organizational change theory, to extract categories, and to make frequency statistics. Results: The frequencies of organizational structure development demand, task development demand, technological development demand and personnel development demand account for 57.2%, 18.0%, 12.7%, and 12.1% respectively. Organizational structure development demand includes personnel policy construction, medical insurance policy construction, basic public health policy construction, first-diagnosis referral mechanism construction, government management optimization, and optimization of internal management of medical alliances. Task development demand includes institution development planning, jurisdictional management optimization, business integration, work content optimization, and performance management within the organization. Technological development demand includes hardware infrastructure construction, informationization construction, horizontal and vertical driving measures, and special service capacity enhancement. Personnel development demand includes personnel ability and professional spirit enhancement. Conclusion: Primary health care institutions have multi-dimensional development demand in terms of organizational structure, tasks, technology, and personnel. Relevant policies and management approaches need to be improved to meet the demand of different levels of units.