制度创业视角下地方紧密型县域医共体创新的生成逻辑与实现路径  

The generation logic and realization path of local merged county medical community innovation from the perspective of institutional entrepreneurship

作　　者：崔兆涵 田笑予 王虎峰[2] CUI Zhao-han;TIAN Xiao-yu;WANG Hu-feng(School of Health Policy and Management,Nanjing Medical University,Nanjing Jiangsu 211166,China;Health Reform and Developement Center of Renmin University,Beijing 100872,China)

机构地区：[1]南京医科大学医政学院,江苏南京211166 [2]中国人民大学医改研究中心,北京100872

出　　处：《中国卫生政策研究》2024年第5期1-8,共8页Chinese Journal of Health Policy

基　　金：教育部人文社会科学研究青年基金项目(23YJCZH030);国家自然科学基金面上项目(71874086、72174093);江苏省高校哲学社会科学研究一般项目(2023SJYB0291)。

摘　　要：本文基于制度创业理论构建分析框架,通过对T县医院集团创新案例的分析,呈现紧密型医共体创新的生成逻辑与实现过程:场域中制度矛盾与创新空间的形成是开启创新的前置条件,会引导潜在制度创业者注意力聚焦并进行机会判断,若能够达成共识即可实现对创业集体的激活。在创新实施过程中,制度创业者通过回应性创新、延伸性创新、开拓性创新等策略突出改革的特殊性,并综合使用愿景阐释、权威运用、利益联结、社会网络等执行策略加以推进,同时在制度框架与创新策略的互动中实现制度合法性的获取,并进一步实现创新的制度化与扩散。基于上述分析,可以得出以下结论:地方紧密型县域医共体创新的形成具有制度性成因与互动性触发条件;创新具体过程由制度与行动者共同塑造;互补嵌合的执行策略是制度创新实现的重要支撑。This paper constructs an analysis framework based on the theory of institutional entrepreneurship.Through the in-depth description of the innovation case of T County Hospital Group,the specific process of the occurrence and realization of merged county medical community innovation is shown:the institutional contradictions in the field and the formation of the innovation space are the preconditions for the trigger of innovation,which will guide the potential institutional entrepreneurs to focus their attention and make opportunity judgment.If a consensus can be reached,the activation of the entrepreneurial collective can be realized.In the implementation of innovation,institutional entrepreneurs highlight the particularity of reform through strategies such as responsive innovation,extended innovation and pioneering innovation,and comprehensively use executive strategies such as vision interpretation,authority application,interest connection and social network to promote it,and realize the acquisition of institutional legitimacy through the interaction between institutional framework and innovation strategy,and further realize the institutionalization and diffusion of innovation.It can be concluded that the generation of local merged county medical community innovation has institutional causes and interactive triggering conditions;the process of innovation is shaped by the system and the actors;the implementation strategy of complementary chimera is an important support for the implementation of institutional innovation.

关 键 词：紧密型县域医共体 制度创业 地方创新 生成逻辑 

分 类 号：R197[医药卫生—卫生事业管理]