The Study Of Medical Disputes Formation Mechanism And Governance Strategy Based On Service Lapse Of Public Hospital

China has made rapid economic development,but also faced various contradictions of the high incidence,especially in the most prominent doctor-patient conflicts.Public hospital is an important part of medical and health service in China.Recently,the incidence of medical disputes had risen sharply,and the conflicts between doctors and patients continued to upgrade.The violence had occurred a lot in hospitals,.which takes not only a serious impact on social stability,but also not conducive to the realization of the Chinese dream.The causes of medical disputes in public hospitals are complex,not only related to medicine,economics and management,but also to sociology,psychology and ethics.Research at home and abroad on prevention and treatment measureof medical disputes focused on hospital,patients and society from a macroscopic perspective,which are short of systematic and comprehensive analysis.As aresult,only to understand on the mechanism and process of medical disputes happended can take the governance strategies in order to prevent and reduce the occurrence of medical disputes,so as to promote the healthy development of China’s medical and health undertakings.Therefore,it is great theoretical and practical significance to study on the mechanism of medical disputes in public hospitals.In this paper,the author build the theoretical basis with the theory of grounded,cognitive behavior,patient satisfaction,patient role transform,role conflict and medical model.Comprehensive utilized the combination of theoretical research and empirical research,the method combining Western theory with Chinese contextualization.Then analyzed the formation mechanism of medical disputes in public hospitals from three perspectives: medical field(medical service misconduct),patients(patients with role reversal),and governance(medical dispute prevention and treatment measures),and put forward the governance strategy of medical disputes in public hospitals.Firstly,the author defines the concepts of public hospitals,public hospitals misconduct,medical disputes,patients’ cognitive biases,medical behavior deviation and low service satisfaction,and clarifies the related research fields.Then,the theories are used in this research,of which are social role theory,cognitive behavior theory,patient satisfaction and modern medical model,to provide theoretical support for further research.The relationships between medical service misconduct and medical disputes,patient deviation and medical dispute,patient deviation and patient role transfer in public hospital was analyzed,which reveals the nature of the formation of medical disputes in public hospitals,and puts forward the research framework of this paper.Secondly,from the perspective of medical service misconduct,the author used the rooted theory as research methods,to analysis on the content and causes of medical service misconduct,and discussed 4 main driving factors of medical service misconduct,such as the imbalance in resources allocation,the core competence homogenization,fuzzy classification of medical products and non-standard medical service.Taking the S hospital as the sample,the author determined the core category of research in order to further enrich and develop the core category select P,H and Z hospital for theoretical samples.The four drivers subcategories of medica service misconduct are as fellow: resource misallocation including specialized division of labor,investment orientation relationship,key business selection;Homogeneous core competence including equipment purchase convergence,object of service convergence,introducing talents convergence;Product classification fuzzy including state-private,slow,easy or not;non-standard of medical services including despise diagnosis and treatment process,disregard for specification,ignore the key nodes.Thirdly,from the perspective of patients,the author used quantitative and qualitative combination as analytical methods,analyzed the connotation of patients role transformation,the internal and external driving factors,the relationship between patients role transformation and medical dispute.Cleared and definited the influence factors of patients perceptual dimensions(resource misallocation 、homogeneous core competence、medical products fuzzy classified and medical service non-standardization)and patients deviation dimensions(patients cognitive bias、medical treatment behavior deviation、low service satisfaction)were the inner drivers of patients role transfermation.Establishing the conception model of public hospital medical disputes which based on patients role transfermation,using statistical software SPSS22.0 and AMOS17.0,by analyzing the data of questionnaire and testing the model,analyzed the influence factors of public hospital disputes and acting path deeply.This paper makes an empirical study on the influencing factors of public hospital medical dispute from the perceived dimensions of patients’ improper service in public hospitals(resource allocation imbalance,core competence homogeneity,fuzzy classification of medical products and non-standard medical services),constructs the conceptual model,and puts forward the hypotheses,carries on the questionnaire survey and recovers and carries on the data analysis.By using structural equation modeling method,the role size and the mode of action of the influencing factors proposed in the hypothesis are demonstrated in details.the model and hypotheses were tested,and the effect mechanism and the practical effect of the factors were revealed.Then,the author analyzes the mechanism of the medical dispute from the governance perspective,taking X Hospital(the Fourth Affiliated Hospital of Harbin Medical University)as the main case study object.According to the characteristics of the patient role transfer,the analyzition is focused on the physical level,social psychological level and administrative legal level of patients.From the positive and negative compare perspectives of single and multiple cases of patients’ cognitive biases,medical behavior deviation and low service satisfaction,it reveals that the public hospital medical dispute prevention and the influence of management measures for medical dispute.Finally,according to the perspectives of hospital service misconduct,the patient’s role conversion and governance,main impact factors and generation mechanism of medical disputes in public hospital are analized in this paper,and the autor combined with medical dispute prevention and management practice,proposed the targeted prevention management strategies of doctors,patiens and the social three levels,which are based on modern medical model.