摘要
目的:应用扎根理论方法,研究医共体背景下基层卫生人力资源建设问题并探讨解决方案,为进一步强化基层人力资源部署提供理论依据及思路。方法:采用典型抽样方法,按经济发展水平和医疗改革效果选取浙江省D县、安徽省F县和贵州省Y县,于2019年8月—10月对县卫健部门、县级医保局、县级医院、乡镇卫生院的管理人员、临床医生和乡村医生进行半结构式访谈,经开放式编码、主轴编码、选择性编码对医共体背景下基层卫生人力资源问题的成因、影响、现存对策及效果进行提取、归纳与分析。结果:经过三级编码,获得104个概念,15个范畴、4个主范畴,最终形成一条故事线——当前基层卫生人力资源不足问题严峻,主要受到个人激励与保障欠缺、医院力量薄弱、医共体推进乏力、财政投入不足等影响,目前的策略并不足以有效缓解这一困境。结论:基层医务人员工作内容繁杂、工作负荷重,人力资源不足问题带来恶性循环,外部帮助无法从根本予以解决,终需从基层自身出发,加大人才培养和激励力度,改善当前环境是首要之策,“开源节流”是过渡策略,综合施策才是根本出路。
Objective To explore the problems of primary health human resources construction and its countermeasures in the context of regional medical alliance,and provide theoretical basis and ideas for further strengthening it.Methods Using a typical sampling method,D County in Zhejiang Province,F County in Anhui Province and Y County in Guizhou Province were selected according to the level of economic development and effect of medical reform.Semi-structured interviews were conducted in managers,clinicians and village doctors of relevant units from August to October 2019.Through open coding,main axis coding and selective coding,the causes,impacts,existing countermeasures and effects of the primary health human resources problems under the background of medical community were extracted,summarized and analyzed.Results 104 concepts,15 categories and 4 main categories were obtained,and finally the severe problems were concluded as insufficient primary health human resources,which was mainly influenced by the lack of personal incentives and guarantees,weak hospitals,weak promotion from the regional medical alliance,and insufficient financial investment.And the current strategies were not sufficient to effectively alleviate this dilemma.Conclusion The work content of the primary medical staffs is complicated,with heavy workload.The issue of insufficient health human resources brings a vicious circle,which can not be fundamentally solved by external help.It is necessary to intensify the talent cultivation and stimulation,improve the environment,increase income and reduce expenditure,and implement comprehensive countermeasures.
作者
陈楚颖
魏来
周丽
程银霞
蒲海峰
刘岚
余昌胤
Chen Chuying(School of Management,Zunyi Medical University,Zunyi,P.R.China)
出处
《中国卫生事业管理》
北大核心
2022年第3期180-184,共5页
Chinese Health Service Management
基金
国家社会科学基金项目“健全上下联动、衔接互补的医疗服务体系”(17BGL188)
贵州省大地论文专项经费资助(CJ-2019-15)。
关键词
医共体
扎根理论
质性研究
人力资源
基层
medical alliance
Grounded theory
qualitative research
human resources
grassroots
