对我国医患关系紧张成因的思考

在当前社会发展的大环境中，医患关系已经危机凸显，医患矛盾频发，这不仅使患者及家属感到不满，也对医院正常秩序和医生职业环境造成了不良影响，更是阻碍医学发展、人民健康水平提高的社会问题。目前的医患关系危机政府、媒体、医生、法律、患者、教育者等多方面都有不可推卸的责任。本文对医患关系的现状、影响因素和改善对策等进行论述总结，呼吁全社会共同努力构建信任、公平、和谐的医患关系。     

移动医疗服务中医患互动对患者感知价值的影响——以知识共享为中介变量

 移动通信和物联网等技术的迅速发展和深入应用，促使移动医疗成为公立医院医疗服务创新的重要技术手段。在三甲医院大力推广移动医疗的背景下，如何确保系统的有效使用、提高患者就诊的感知价值进而实现以患者为中心的服务创新成为行业和学界专家共同关注的问题。        从患者的层面分析移动医疗中医患互动对患者感知价值的影响。①从价值共创理论视角探讨移动医疗中医患之间的知识共享为医疗服务带来的价值创新，比较移动医疗与传统医疗服务中医患互动的变化；②提出医患互动对患者感知价值的积极影响以及知识共享在两者之间的中介作用的研究模型；③通过结构方程模型方法进行实证分析。研究人员在三甲医院的内科、外科和儿科挑选使用移动医疗技术的患者进行访谈，收集线上和线下不同科室420份患者的有效数据，运用Spss和Amos验证患者感知价值的结构维度以及知识共享的中介作用。        研究结果表明，医患互动对患者感知价值有积极作用，知识共享在医患互动与患者感知价值之间起中介作用，并将模型解释度提高到0.683。传统医疗注重医生与患者的临床知识转移，移动医疗不仅实现了临床知识的充分转移，还实现了患者知识的采集，形成了医生知识和患者知识的聚集效应，以及所有知识在网络中的共享机制，这些知识的共享为患者就医带来效率价值、功能价值、情感价值和社会价值。        研究结果进一步丰富了移动医疗中患者感知价值形成机制的范式研究，以及医患互动和医患知识共享行为等领域的研究，为医院如何设计移动医疗应用、满足患者就医需求提供理论指导依据。     

双因素理论与领导者培育下属追随力之策

正双因素理论也称为"保健-激励理论",它是美国心理学家弗雷德里克·赫兹伯格在20世纪50年代提出来的。该理论重点研究组织中个人与工作的关系问题。赫兹伯格在匹兹堡地区的11个工商机构中,向近2000名白领进行调查,结果发现,引起人们不满意的因素往往是一些工作的外在因素,引起人们满意的因素往往是工作本身。由此,赫兹伯格提出了双因素理论,认为影响人们行为的因素主要有两类:一是保健因素,就是那些与人们的不满     

在线医疗健康服务医患信任影响因素实证研究

 在线医疗健康服务作为线下医疗健康服务的补充对缓解医疗资源相对不足等问题有着重要的意义，而信任作为人际关系的基石对在线的医患关系有深刻影响，因此有必要研究在线医疗健康服务中的医患信任问题。        有诸多因素影响医患信任，医患信任的提升对患者的行为意向也有积极影响。以在线医患信任为核心，重点从患者角度研究在线医疗健康网站中医患信任的影响因素，分析个人、网站、医院和医生4个方面的影响。同时，感知风险和感知收益从宏观上也会影响在线患者信任和患者行为意向，也将其纳入分析。基于此，以信任模型的概念框架以及感知风险和感知收益等理论为基础构建模型，提出9个假设。以有在线医疗健康网站中服务经验的用户为研究对象，使用问卷调查的方法进行调研，获得271份有效样本，利用结构方程模型的实证方法对研究假设进行检验。        研究结果表明，除个人信任倾向外，医患信任影响因素中的网站、医院和医生的可信度均对在线患者信任有显著影响，其中网站因素的影响程度最高，在线患者信任也显著影响患者行为意向。感知收益和感知风险对在线患者信任也有显著影响，但对患者行为意向的影响不显著。        将医患信任的研究从线下延伸至线上，探讨在线患者信任的影响因素。研究结果为研究在线医疗健康服务中的患者信任提供理论依据，同时为在线医疗健康服务的发展提供参考策略。     

基于公平理论探讨服务补救质量影响的实证研究——来自中国电信服务行业的证据

企业与客户交易时并不会一帆风顺,当客户面对交易过程中出现的故障时,不同服务补救措施会如何对客户感知、满意度和信任度产生影响?本文区别于以往实验或准实验法为主的定性或定量研究,引入组织行为学的公平理论,采取真实客户服务数据,基于不同客户类型深入探讨服务补救质量对客户满意、客户信任和客户忠诚的影响.实证研究发现,服务补救质量对感知价值、满意和信任均会产生正向作用;大客户对服务补救过程中的"互动公平"最为重视,公众客户更为强调"结果公平"的影响.这就告诉服务型企业应如何采取补救措施,大客户看重过程,一般客户更看重结果.本文从理论和实践两方面为服务补救领域的研究提供了有力证据.     

优化门诊就诊流程和提升服务质量途径

随着人们生活水平的日益提高,人们对健康保健的需求也不断上升,其希望获得高水准医疗服务的意识也在不断加强。门诊作为医院面向社会的第一窗口,门诊工作不仅可以直接反映全院的医疗质量,同时又能体现医务人员职业道德和行业风气。门诊服务坚持"以人为本"、"以患者为中心",持续改进就诊流程、不断提升服务质量,能明显的减少医患纠纷,提高患者满意度,提升医院的社会形象。     

浅论加强医护关系是维系医院运作的命脉

医护关系是医生和护士这两种不同职业的人们在医疗过程中的相互关系。本文通过对医护关系的协调运作展开研究，借以增进医护关系，发挥团队作用，促进医患关系和谐，提高患者满意度，减少医疗差错事故的发生。     

从患者与员工满意度的相关性看医院可持续发展

随着医改的不断深入,对医院产生极大的冲击,由医疗质量引发的医患矛盾不断增加,医疗纠纷也越来越多。夺丈通过对患者满意度和员工满意度的研究以及员工满意度与顾客满意度的相关性分析,提出了医院中员工满意度与患者满意度两者通过服务质量这一中间因素呈现正相关性,即只有提高医院员工满意度,才能提升其服务质量,才能使得患者满意度得到提高。只有患者和员工都满意,才有助于医院的可持续发展,提升医院的服务质量、提升医院在行业的地位。     

基于顾客满意度的品牌忠诚模型实证研究

本文在研究分析国内外最新关于商业银行顾客满意度和品牌忠诚等相关理论文献的基础上，通过对上海市主要商业银行个金客户的满意度调研，运用因子分析、多个独立样本的非参数检验以及回归分析等多种统计技术。得出了对商业银行个金客户顾客满意具有显著影响的因素．在此基础上进一步分析顾客满意与品牌忠诚的定量关系，建立了基于顾客满意的品牌忠诚模型。最后为商业银行提出了相关策略和建议，旨在为其制定高质量的服务品牌策略提供依据。     

浅谈如何构建和谐的疾患关系

自20世纪90年代以来,医患关系呈日趋紧张之势,医疗纠纷数目不断攀升。影响医患关系的因素很多,构建和谐的医惠关系是一个系统工程,是？滓随着社会发展、法律完善、制度健全、医务人员素质提高、患者认知度不断提升等多方面共同促进的,每个社会成员都有责任。对医疗机构来说,构建和谐的医患关系关键要从自身做起,从查找服务环境、服务理念、服务态度、服务效果等方面的不足做起,一切从患者利益出发,积极转变服务模式,提高服务质量,把病人的满意作为医院的追求。     

Improving medical decision-making with a management science game theory approach to liver transplantation

Even though nowadays medicine is necessarily linked with technology, it is still a service involving human interaction, which frequently requires the help of management science tools. Indeed, a medical consultation can be an extremely complex example of human interaction. Management science, operations research and in particular game theory may play a key role in helping to improve the results of medical decision-making processes. Game theory is widely used in a large variety of decision-making studies, but there is little application to health care issues, namely the doctor-patient relationship. This paper uses game theory to model the liver transplantation consultation for patients suffering from Alcoholic Liver Disease. This disease is very delicate, and patients at its end-stages require special dedication where management science tools are of utmost importance. They may try to deceive doctors, which may lead to bad outcomes. The Nash equilibrium behaviors by doctor and patient are obtained. Results show some health policy and managerial implications on the decision-makers’ parameters and on the order of play so as to achieve, for instance, higher rates of patient’s cooperation.     

Emotional labour and emotional exhaustion: Interpersonal and intrapersonal mechanisms

Abstract

In some occupations, particularly in the service sector, dealing with patients or clients may require an employee to pretend to have emotions that they do not really have, or to actually experience required emotions. The regulation of emotion can be either automatic or controlled. This study extends research on the consequences and processes of emotional labour in two ways. First, it examines how the use of different emotion regulation strategies with patients relates to doctors’ emotional exhaustion. Second, it tests two mechanisms that may explain those relationships. A survey of 345 general practitioners (GPs) working in a large urban community in Spain was conducted for the study. Based on Côté's (2005) social interaction model, GP satisfaction with the responses of their patients was tested as a potential interpersonal mediator between their use of automatic, surface, and deep emotion regulation strategies and their emotional exhaustion. Psychological effort was tested as a potential intrapersonal mediator in the same pathway. Regression analysis indicated that emotion regulation was associated with GP emotional exhaustion when it was performed automatically, but that it had a positive and a neutral association when it was performed using surface and deep acting respectively. The mediating role of interpersonal and intrapersonal factors helped explain the differential associations between the GPs’ emotion regulation strategies and their emotional exhaustion.     

Social model of emotional labour and client satisfaction: exploring inter- and intrapersonal characteristics of the client−provider encounter

As part of healthcare organisations’ efforts to improve client satisfaction, special attention is directed to care providers’ expression of authenticity through genuine emotional displays in care encounters. The study’s aim was to test a mediating–moderating model for predicting clients’ satisfaction. The model combined intrapersonal forces (the healthcare provider’s level of caring and emotional load) and interpersonal forces (meeting the client in a team of professionals or alone, and client?provider similarity), as predictors of emotional labour strategies, and subsequent client satisfaction. Clients’ evaluation of whether or not the emotional displays were authentic was intended to moderate the link between emotional labour and client satisfaction. The sample consisted of 103 healthcare providers’ encounters with clients’ family members, randomly selected from five nursing homes. Data were collected by validated questionnaires at three time points. Mixed linear model analyses generally supported the proposed model. Meeting a client’s family in teams, ethnic similarity, and providers’ caring and emotional load stimulated higher levels of deep acting. Meeting clients alone and less emotional load involved more surface acting. These findings offer empirical support for the social interaction explanation of emotional labour, pointing to the importance of social characteristics of the service encounter in shaping emotional labour strategies and maintaining client satisfaction.     

Integrating Models and Data to Estimate the Structural Reliability of Utility Poles During Hurricanes

Utility systems such as power and communication systems regularly experience significant damage and loss of service during hurricanes. A primary damage mode for these systems is failure of wooden utility poles that support conductors and communication lines. In this article, we present an approach for combining structural reliability models for utility poles with observed data on pole performance during past hurricanes. This approach, based on Bayesian updating, starts from an imperfect but informative prior and updates this prior with observed performance data. We consider flexural and foundation failure mechanisms in the prior, acknowledging that these are an incomplete, but still informative, subset of the possible failure mechanisms for utility poles during hurricanes. We show how a model‐based prior can be updated with observed failure data, using pole failure data from Hurricane Katrina as a case study. The results of this integration of model‐based estimates and observed performance data then offer a more informative starting point for power system performance estimation for hurricane conditions.     

Service Personnel,Technology, and Their Interaction in Influencing Customer Satisfaction*

Managing both the technologies and the personnel needed for providing high‐quality, multichannel customer support creates a complex and persistent operational challenge. Adding to this difficulty, it is still unclear how service personnel and these new communication technologies interact to influence the customer's perceptions of the service being provided. Motivated by both practical importance and inconsistent findings in the academic literature, this exploratory research examines the interaction of media richness, represented by three different technology contexts (telephone, e‐mail, and online chat), with six customer service representative (CSR) characteristics and their influences on customer satisfaction. Using a large‐sample customer survey data set, the article develops a multigroup structural equation model to analyze these interactions. Results suggest that CSR characteristics influence customer service satisfaction similarly across all three technology‐mediated contexts. Of the characteristics studied, service representatives contribute to customer satisfaction more when they exhibit the characteristics of thoroughness, knowledgeableness, and preparedness, regardless of the richness of the medium used. Surprisingly, while three other CSR characteristics studied (courtesy, professionalism, and attentiveness) are traditionally believed to be important in face‐to‐face encounters, they had no significant impact on customer satisfaction in the technology‐mediated contexts studied. Implications for both practitioners and researchers are drawn from the results and future research opportunities are discussed.     

顾客满意度不确定性对服务质量评价的影响

在以顾客为中心的时代,企业服务质量的评价直接依赖于顾客满意度的高低,而顾客满意度的评价结果往往是基于某种评价等级的一个分布.论文研究顾客满意度评价的不确定性对服务质量总体评价的影响,结果表明在服务质量的评价中存在着一种“反射现象”,即当服务质量总体水平处于满意的状态下,管理者追求的是保持和稳定,展现出对不确定性的厌恶;而当服务质量总体水平处于不满意的状态时,管理者力图改变和进步,展现出对不确定性的偏爱,而且,顾客满意度评价的负面结果要比同等程度的正面结果对服务质量总体评价的影响要大.这些现象在两项实证研究中获得了中高层管理人员的确认.作者进一步建立了一个在顾客满意度有不确定性情况下服务质量评价的模型.     

Emotional labour,collectivism and strain: a comparison of Turkish and U.S. service employees

ABSTRACT

Global growth in service employment highlights the need to understand how cross-cultural differences impact emotional labour processes for service employees. The current study investigates these differences by examining the impact of national and individual level collectivistic values on emotional labour strategies and employee strain (emotional strain, turnover intentions, job satisfaction, and organisational commitment). Cross-sectional data was collected from U.S. (n?=?191) and Turkish (n?=?249) customer service employees. Results indicate that collectivism impacts the process model of emotional labour via direct and interaction effects. Collectivism was associated with higher emotional labour engagement and lower employee strains. Surface acting was uncorrelated with Turkish employees’ strain, though moderated regression analyses revealed interaction effects associated with national and individual level collectivism. These results suggest that collectivistic values may serve as a buffer against harmful effects associated with surface acting. This study is the first to directly compare emotional labour processes in U.S. and Turkish service employees and expand the process model of emotional labour to include collectivism. The theoretical implications of this expanded model are discussed, along with future research directions and practical applications of these findings.     

Role of negative emotion in communication about CO2 risks.

This article describes how the effectiveness of risk communication is determined by the interaction between emotional and informative elements. An experiment is described that examined the role of negative emotion in communication about CO2 risks. This experiment was based on the elaboration likelihood model and the related heuristic systematic model of attitude formation. The results indicated that inducing fear of CO2 risks leads to systematic processing of information about energy conservation as a risk-reducing strategy. In turn, this results in more favorable attitudes toward energy conservation if strong arguments are provided. Individual differences in concern seem to have similar effects.     

Role of Negative Emotion in Communication about CO2 Risks

This article describes how the effectiveness of risk communication is determined by the interaction between emotional and informative elements. An experiment is described that examined the role of negative emotion in communication about CO₂ risks. This experiment was based on the elaboration likelihood model and the related heuristic systematic model of attitude formation. The results indicated that inducing fear of CO₂ risks leads to systematic processing of information about energy conservation as a risk-reducing strategy. In turn, this results in more favorable attitudes toward energy conservation if strong arguments are provided. Individual differences in concern seem to have similar effects.     

Sources of stress in the national health services: A comparison of seven occupational groups

This paper reports a comparative study of sources of occupational stress affecting the seven major occupational groups within the National Health Service. The groups are compared on seven dependent variables. These are the six sub-categories of stressors identified by Cooper and Marshall (1978) and measured by the Occupational Stress Indicator (OSI) (Cooper et al. 1988), and a total stress score that is derived by summing scores for each of the six sub-categories. Occupational groups differed significantly (p.05) in only two of the six sub-categories. In these cases occupational groups not normally associated with front-line care reported higher levels of stress than either doctors or nurses. The results show that high levels of occupational stress are experienced by all occupational groups within the NHS and the subsequent discussion argues for a more progressive research policy that gives adequate attention to 'lower status' groups, such as ancillary, works and maintenance, and administrative and clerical.