医患信任脆弱性:理论框架与反脆弱发展体系  

Vulnerability of Trust between Doctors and Patients: Theoretical Framework and Antifragile Development System

作　　者：王振辉 王永杰 胡培[1] 赵成 Wang Zhenhui;Wang Yongjie;Hu Pei;Zhao Cheng(School of Economics and Management,Southwest Jiaotong University,Chengdu 610031;School of Public Affairs&Law,Southwest Jiaotong University,Chengdu 610031)

机构地区：[1]西南交通大学经济管理学院,成都610031 [2]西南交通大学公共管理与政法学院,成都610031

出　　处：《甘肃行政学院学报》2019年第6期105-113,127,128,共11页Journal of Gansu Administration Institute

基　　金：四川省哲学社会科学重点研究基地项目“基于患者感知风险视角医患信任洞察:医患冲突解决有效途径研究”(SR16A07);四川省哲学社会科学重点研究基地项目“邻避风险的可接受性与解决措施研究——基于邻避设施的类型”(SR16A08);四川省哲学社会科学“十二五”规划项目“公共工程项目社会稳定风险评价研究”(SC11B050)

摘　　要：近二十年,医疗纠纷事件频发,恶性伤医事件也屡见报端,直指医患信任系统的脆弱程度。已有医患关系研究与管理制度面临两大挑战:一是管理实践上重视自上而下的医疗服务质控体系及规制建设,忽略自下而上的患者赋能干预及制度设计;二是医患关系管理研究侧重于系统外部因素,未能将医方与患方作为共同体纳入医患关系治理的框架。本文以“风险-脆弱性分析框架”为基础,以医患信任为研究为切口,分析医患信任脆弱性发生的系统内部扰动因素,提出“医疗服务感知-医患信任脆弱性分析框架”,以反脆弱性核心思想为依据,反思制度设计,而非关注医疗纠纷事件本身,提出自下而上的医患信任反脆弱发展框架体系,旨在为医患关系管理的制度设计提供框架与思路,为医患关系研究提出新范式。期望以患者为中心的医疗服务升级与以人民为中心的治国理念相呼应。In the past two decades,medical disputes and malignant injuries have been reported frequently,which directly refers to the vulnerability of the doctor-patient trust system.The existing research and system of management are faced with two challenges:first,in management practice,the top-down medical service quality control system and regulatory construction are emphasized,while the bottom-up patient empowerment intervention and system design are ignored;second,the research of doctor-patient relationship management focuses on the external factors of the doctor-patient system,and fails to integrate the doctor-patient relationship management as a community into the framework of doctor-patient relationship management.Based on the framework of risk-vulnerability analysis,this paper analyzes the internal disturbance factors of the system,and puts forward the framework of medical service perception-vulnerability analysis.Based on the core idea of antifragile,this paper rethinks the system design,rather than focusing on the medical disputes,and puts forward the framework of antifragile development from bottom to top system,which is coupled with the top-down regulation,aims to provide a framework and ideas for the system design of doctor-patient relationship management and a new paradigm for the research of doctor-patient trust.So that the upgrading of patient-centered medical services corresponds to the concept of people-centered governance.

关 键 词：医患信任脆弱性 患者感知风险 医疗服务无形性 反脆弱发展 

分 类 号：F063.1[经济管理—政治经济学]