县域医疗共同体背景下县级公立医院动态能力发展与思考  

Developments and Thoughts on the Dynamic Capability of County-level Public Hospitals Under the Impacts of County-level Medical Community

作　　者：李昕昀 李文敏[2] 闵锐 LI Xinyun(School of Medicine and Health Management,Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei,430030,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]湖北大学政法与公共管理学院,湖北武汉430062 [3]华中科技大学同济医学院公共卫生学院,湖北武汉430030

出　　处：《医学与社会》2022年第3期85-90,113,共7页Medicine and Society

基　　金：教育部人文社会科学研究规划基金项目,编号为19YJA630041;美国中华医学基金会CMB项目,编号为15-223。

摘　　要：目的:探讨县级公立医院在县域医疗共同体建设中如何培育竞争优势,为提升医院动态能力提供依据。方法:采用半结构式访谈及问卷调查,在我国东部地区(山东省)、中部地区(湖北省)、西部地区(重庆市)选择共26所不同类型县域医疗共同体县级公立医院进行现场实证调研,了解医院在医共体组建前后4年的动态能力情况,包括创新力、吸引力和整合力三个维度。结果:在创新力维度,县级公立医院在医共体组建后第2年的床位规模(P<0.05)、人力资源数量(P<0.05)与固定资产值(P<0.05)相比于组建前都有所提升。医院服务数量虽逐年增加,但医疗服务效率提升不明显(P_(平均住院日)=0.82,P_(床位使用率)=0.09)。在吸收力维度,某些典型医院将远程医疗注入到医共体建设中,形成竞争优势。在整合力维度,县级医院资源整合利用效率不断增长,但仍存在不同程度的资源浪费和产出不足现象。结论:我国县级公立医院的动态能力在医共体组建后都取得了一定的发展,但仍存在部分问题,建议从配套措施建设、专科建设培育核心竞争力以及人才队伍建设三方面进行完善,切实提高医院医疗服务能力及水平。Objective:To investigate how county-level public hospitals can cultivate competitive advantages in the construction of county-level medical community,so as to provide evidence for improving the dynamic capability of hospitals.Methods:Semi-structured interviews and questionnaires were applied to 26 county-level public hospitals with different types of county medical community in eastern China(Shandong),central China(Hubei)and western China(Chongqing).Dynamic capability of the hospital in the four years before and after the establishment of the medical community was investigated and understood,including the three dimensions of innovation,attractiveness and integration.Results:For innovation capability,the number of beds(P<0.05),the abundance of human resources(P<0.05)and the value of fixed assets(P<0.05)of county-level public hospitals remarkably improved in the second year after the establishment of the medical community.Although the number of hospital services increased year by year,the efficiency of medical services not improved significantly(P average hospital stay=0.82,P bed occupancy rate=0.09).For absorptive capability,some typical hospitals adopted telemedicine in construction of medical community,gaining the competitive advantage.For integration capability,the efficiency for resources integration and utilization of county-level hospitals had been increasing.However,the waste of resources and insufficient output still existed to varying degrees.Conclusion:The dynamic capability of county-level public hospitals in China has achieved certain development after the establishment of medical community.However,there were still some problems.It was recommended to improve the hospital medical service capability and level through the construction of supporting measures,the construction of specialties to cultivate core competitiveness,and the construction of talent team.

关 键 词：县级公立医院 县域医疗共同体 动态能力 竞争优势 

分 类 号：R197.3[医药卫生—卫生事业管理]