【正文】 組織支持感對公立醫(yī)院醫(yī)務人員職業(yè)認同度的影響及對策研究 　　組織支持感對公立醫(yī)院醫(yī)務人員職業(yè)認同度的影響及對策研究STUDY ON INFLUENCE OF PERCEIVED ORGANIZATION SUPPORT ON PROFESSIONAL RECOGNITION OF MEDICAL STAFF IN PUBLIC HOSPITAL AND ITS COUNTERMEASURES 學　　校：　學　　號：　班　　級：　答辯日期： 2013年12月22日 組織支持感對公立醫(yī)院醫(yī)務人員職業(yè)認同度的影響及對策研究摘要醫(yī)生是個特殊的職業(yè)，具有高強度的工作壓力和難以預測的醫(yī)療風險，隨著不斷出現(xiàn)的傷害醫(yī)務人員的事件及醫(yī)患糾紛，醫(yī)生群體的職業(yè)認同度進一步降低，出現(xiàn)不同程度的職業(yè)抗拒和抑郁悲觀等心理疾病。當前的醫(yī)改工作以解決看病難看病貴問題為出發(fā)點，注重強調(diào)醫(yī)療服務體系的社會公益性，對如何大力維護患者利益以及著力推進公立醫(yī)院改革的思考較多，但對于醫(yī)生尤其是公立醫(yī)院的臨床一線醫(yī)生的利益維護方面考慮不夠，對醫(yī)務人員的人文關(guān)懷不足，影響了醫(yī)務群體的執(zhí)業(yè)穩(wěn)定性。本文從研究上海市公立醫(yī)院醫(yī)務人員職業(yè)認同現(xiàn)狀入手，通過文獻檢索，闡述了職業(yè)認同與組織支持等有關(guān)的一些理論知識。在研究方法上，對上海市衛(wèi)生局管轄的二級和三級公立醫(yī)院的員工采取問卷抽樣調(diào)查的方法，對上海市公立醫(yī)院職業(yè)認同度和組織支持感知現(xiàn)狀進行實證分析，揭示了當前上海市公立醫(yī)院醫(yī)務人員職業(yè)認同情況及其帶來的一系列問題，并提出相應對策與建議。研究顯示，上海市公立醫(yī)院醫(yī)務人員的職業(yè)認同主要來自于自我、環(huán)境和社會認同三個方面，其中環(huán)境認同權(quán)重最大，不同基本信息醫(yī)務人員的職業(yè)認同情況存在顯著差異。在酬薪、發(fā)展前途、社會地位、工作環(huán)境、工作壓力、醫(yī)患關(guān)系六個因素方面，其中社會地位與醫(yī)患關(guān)系占比最大。經(jīng)過調(diào)查研究得出的結(jié)論是，這些醫(yī)院的員工的組織支持主要分成價值認同、工作配合以及福利保障三部分。由于背景和社會經(jīng)歷的不一樣，每個醫(yī)生對組織支持的感知有著巨大差異。整體來看，他們總的職業(yè)認同度一般，對組織支持感知不高。在回歸分析中，發(fā)現(xiàn)組織支持對不同醫(yī)院級別的醫(yī)務人員的職業(yè)認同度產(chǎn)生一定影響。研究表明組織支持在社會認同與自我認同兩者間可以產(chǎn)生顯著的緩沖功能，增強了在進行職業(yè)認同管理工作時組織支持的作用。在對于研究結(jié)果的討論的時候，分別從組織應對與個體應對兩部分來給出一些有重要意義的建議與觀點，旨在找出增強上海市公立醫(yī)院醫(yī)務人員職業(yè)穩(wěn)定性和認同感的辦法，為管理衛(wèi)生工作的行政部門具體貫徹實施醫(yī)療衛(wèi)生改革工作提供參考。關(guān)鍵詞：組織支持，職業(yè)認同，醫(yī)務人員，公立醫(yī)院 STUDY ON INFLUENCE OF PERCEIVED ORGANIZATION SUPPORT ON PROFESSIONAL RECOGNITION OF MEDICAL STAFF IN PUBLIC HOSPITAL AND ITS COUNTERMEASURESABSTRACTDoctor is a special profession, with highstrength work pressure and medical risks which are difficult to be forecasted. With the continuous occurring of doctor murder events, the professional recognition of doctor group has been further reduced and doctors have suffered from psychological diseases of different degrees. The current medical reform, from the starting point of solving the problem of high cost and difficulty of getting medical treatment, emphasizes the public welfare of medical service system with more thinking on how to greatly maintain the patients’ interest and strive to promote the reform of public hospital, but insufficient consideration to the interest maintenance of doctors, especially the front clinical doctors of public hospitals, the insufficient humanistic solicitude to medical staff has influenced the practicing stability of medical group.Starting from the status of medical staff of public hospitals in Shanghai, through literature retrieval, this paper explains some theoretical knowledge on professional recognition and organization support. In the research method, questionnaire investigation is adopted to all staffs of the second and thirdlevel hospitals under the jurisdiction of Shanghai Municipal Bureau of Health, empirical analysis is conducted to the status of professional recognition and perceived organization support of public hospitals in Shanghai, the professional recognition condition of medical staff in public hospital of Shanghai and a series of problems it brings are revealed and corresponding countermeasures and suggestions are proposed.According to the research, the professional recognition of medical staff of public hospitals in Shanghai is mainly from ego, environment and society, in which environmental recognition has the largest weight, and there exists a significant difference in the professional recognition of medical staff of different basic information. In the six factors, remuneration, development prospect, social status, work environment, work pressure and doctorpatient relation, social status and doctorpatient relation have the largest proportion. According to the investigation, it is concluded that the organization support of staffs in these hospitals is mainly divided into value recognition, work cooperation and welfare guarantee. Due to difference of background and social experience, there exists a wide difference in the perception of organization doctor for each doctor. Overall, they have an ordinary overall professional recognition and not high organization support. In the regression analysis, it is found that organization support has a certain influence on the professional recognition of medical staff of different levels of hospitals.The research shows that organization support has a significant buffering function between social recognition and selfrecognition, enhancing the role of organization support while managing professional recognition. During the discussion of research result, some significant suggestions and opinions are given from the aspects of organization response and individual response, aimed to find out the measures to enhance the professional stability and recognition of medical staff of public hospitals in Shanghai, so as to provide reference for the health management administrative department to specifically carry out and implement medical and health reform. KEY WORDS: organization support, professional recognition, medical staff, public hospitals 目錄摘要 IIABSTRACT IV第一章 緒論 1第一節(jié) 研究背景 1第二節(jié) 研究目的和意義 4一、研究的目的 4 二、研究的意義 4第二章 相關(guān)理論文獻述評 6第一節(jié) 組織支持理論研究述評 6一、組織支持理論的產(chǎn)生與內(nèi)涵 6 二、組織支持感的結(jié)構(gòu)及測量 8 三、組織支持理論研究現(xiàn)狀與主要進展 9第二節(jié) 職業(yè)認同理論的研究述評 11 一、職業(yè)認同的內(nèi)涵 11 二、職業(yè)認同的定義及理論模型 11第三節(jié) 組織支持與職業(yè)認同的相關(guān)性研究 14第四節(jié) 對現(xiàn)有研究的述評與小結(jié) 17第三章 研究方法與過程 19第一節(jié) 研究假設(shè) 19第二節(jié) 研究方法 20 一、組織支持感量表 20 二、職業(yè)認同度量表 20第三節(jié) 數(shù)據(jù)獲取 22 一、數(shù)據(jù)收集 22 二、樣本描述 23第四節(jié) 數(shù)據(jù)分析與現(xiàn)狀特點 27 一、職業(yè)認同量表的信度與效度分析 27 二、控制變量對各變量的影響結(jié)果 29 第四章 討論與結(jié)論 34第一節(jié) 公立醫(yī)院醫(yī)務人員組織支持感分析 34第二節(jié) 組織支持與職業(yè)認同的交互效應 39 一、組織支持與職業(yè)認同各維度的相關(guān)分析 39二、組織支持與職業(yè)認同各維度的回歸分析 39第三節(jié) 實證研究的結(jié)論 41第五章 對策與建議 42第一節(jié) 基于組織層面的建議 42一、完善酬薪分配制度，增強職業(yè)預期 42 二、組建專業(yè)隊伍，加強心理輔導 44 三、建立公正的評價體系，提升專業(yè)素養(yǎng) 46 四、營造文化環(huán)境，在新醫(yī)改中體現(xiàn)針對醫(yī)務群體的人文關(guān)懷 48第二節(jié) 基于醫(yī)務人員自身的建議 49一、深入了解自身的特質(zhì)與職業(yè)選擇 49二、夯實專業(yè)知識技能，增強執(zhí)業(yè)實力 51 參考文獻 53致謝 58攻讀學位期間發(fā)表的學術(shù)論文目錄 5942第一章 緒 論醫(yī)務工作者是醫(yī)療體制改革的重要執(zhí)行者和落實者，醫(yī)務人員的職業(yè)認同狀況是衛(wèi)生體制改革能否順利推進和成功完成的關(guān)鍵因素，因此以醫(yī)務人員為研究對象進行抽樣調(diào)研，能客觀了解當前衛(wèi)生體制改革階段的難點和著眼點，為我國新醫(yī)改方案的進一步完善與實施提供依據(jù)。第一節(jié) 研究背景隨著醫(yī)療體制改革的不斷深入和民營及個體醫(yī)療機構(gòu)的鼓勵入駐，中國的醫(yī)療行業(yè)正在悄悄發(fā)生著變革。公立醫(yī)院作為醫(yī)療體系中占有重大份額的成員，在面臨穩(wěn)定醫(yī)療隊伍