医院院长文化价值观介导下的医院病人安全文化形成机制及实现路径研究

Hospital patient safety culture has become increasingly important for hospital to build patient security systems. Previous studies mainly focus on the concept, connotation and measurement of hospital patient safety culture. However, less research concentrate on the construction and the implementation mechanism of hospital patient safety culture . In addition, the corresponding study more concerned about the impact of personal and job characteristics of the medical staff on hospital patient safety culture , and ignore the influence of cultural values of the director of hospital and the internal and external environmental determinants of hospital on hospital patient safety culture..The director of hospital is the legal representative of hospital and policy-makers, practitioners and advocates of hospital’s regulation, rules, norms, and culture. Therefore, the cultural values of the director of hospital have an important influence on the formation and establish of hospital patient safety culture undoubtedly. This research is to identify the relationship between the cultural values of the director of hospital and hospital patient safety culture, to clarify the formation mechanism of hospital patient safety culture mediated in different cultural values of the directors of hospital, to explore multiple strategies and methods to improve hospital patient safety culture such as the driving and transformation conditions construction of the cultural values of the director of hospital, synergistic effects of inside and outside the hospital system, between hospital regulation and environment variables, the goals of patient safety and the guidance of staff culture values and the design of incentive measures about patient safety, and to discuss the feasible selection pathways of hospital patient safety culture construction and the specific intervention strategies, by starting from the study on the cultural values of the hospital director and the cognitive features and content of hospital patient safety culture, by the means of literature analysis, field investigation, in-depth interview and multilevel models and structure equation analysis, and so on. .This study will give some suggestion to develop hospital patient safety culture. It is useful for the directors of hospital to remodel their cultural values with the core importance of patient safety, to provide theoretical and empirical evidences for hospital administrators about the formation mechanism and implementation means to build hospital patient safety culture effectively .

病人安全文化对保障病人安全的重要性日益凸显。以往研究主要关注病人安全文化的概念、内涵及测量等方面，但对病人安全文化构建和实现机制研究较少；相应研究多关注医务人员的个人和职务特征，而忽视医院院长文化价值观对病人安全文化的影响。院长是医院法人代表和政策制定者，其管理理念和文化价值观对病人安全文化的形成和确立可能产生重要影响。本课题旨在通过文献分析、深入访谈、现场调查和结构方程模型等研究和分析方法，从院长文化价值观取向与病人安全文化认知特征和内涵入手，探讨院长文化价值观与病人安全文化的关联机制，探索通过院长文化价值观驱动与转化条件构建，医院内外制度、机制与环境协同，病人安全目标与价值观引导、以及激励机制设计等多重策略和手段来推动病人安全文化构建的可行途径及优先干预策略选择，为推动以病人安全为核心理念的医院文化价值观重塑，为医院管理者探讨更有效的病人安全文化形成机制和实现路径选择提供理论实证依据。

病人安全文化（简称PFC）对保障病人安全的重要性日益凸显。以往研究对PFC构建和实现机制研究较少，忽视医院院长文化价值观对PFC的影响。本项目系统地了解了国内外PFC研究现状、热点及前沿情况，探索了医院院长文化价值观的构成、内涵、及特征，研制出中文版的医院院长文化价值观评价量表，调查了广西少数民族地区医院医务人员PFC认知状况，探讨了影响PFC认知的因素，比较了不同级别医院医务人员PFC认知水平，分析了导致其产生差异性的影响因素，主要研究结果有：① 国内外PFC研究热点为护理人员安全行为及认知、病人安全文化测评量表的构建以及领导在干预中起到的指向性作用。国内PFC相关领域尚不完善，与发达国家相比有较大差距。② 桂林市医务人员对PFC认知总体积极反应率为58.8%；认知的优势区域为组织的学习与持续改进（78.53%），待改进区域为交接班与转科（46.93%）、人员配置（44.55%）、差错的非惩罚性反应（21.67%）；医务人员PFC的整体认知水平较低，相关的影响因素有：受教育程度、职称、对病人安全文化的熟悉程度、用工性质、直接接触病人情况等。③ 三级医院PFC认知水平最好，其次是二级医院，最后是社区卫生服务中心；医院因素对PFC的影响程度比医务人员个体因素大。④ 研制出的医院院长文化价值观量表，包含4个一级指标， 13个二级指标和39个三级指标。人文关怀、医学伦理、风险意识、患者安全等四个维度全面界定了医院院长文化价值观内涵。通过横断面调查显示该量表具有较好的内部一致性（总量表的Cronbach's α系数为0.969，其中4个一级指标的Cronbach's α系数均>0.8），较好的内容效度（专家评价），较好的结构效度（13个二级指标对总体方差的累计贡献率为88.219%）和较高的可接受度（问卷完成时间在5-10分钟之间）。⑤ 目前广西公立医院医务人员薪酬水平较低（不满意率为50.2%），且对福利方面关注不足。这些研究成果可以为推动以病人安全为核心的医院文化价值观重塑，为医院管理者探讨更有效的病人安全文化形成机制和实现路径选择提供循证决策依据。

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