通讯作者: 于海宁, yuhaining@sdfmu.edu.cn

DOI：10.12201/bmr.202306.00016

A study on the formation mechanism of job burnout among primary health workers from a multidimensional perspective: based on grounded theory

• 摘要：目的：探究我国基层卫生人员职业倦怠的多维成因和形成机制,为改善基层卫生人员工作态度提供政策依据。方法：采用多阶段抽样和目的抽样,于2021年2-7月期间,对东营市、青岛市以及枣庄市的38家基层卫生机构的167名基层卫生人员进行半结构式访谈,其中包括53名医生、36名护士、41名公卫人员和37名医技人员。采用Strauss程序化扎根理论的编码思路,并运用MAXQDA2020定性分析软件对访谈资料进行分析。结果：共提炼得到39个概念和19个范畴,将职业倦怠的形成机制归纳为宏观行政主导治理模式的弊端、中观基层卫生机构机制失准、微观基层卫生人员工作压力超载3个维度,构建出基层卫生人员职业倦怠形成机制模型。结论：基层卫生人员职业倦怠的形成受宏观、中观、微观三个维度的共同影响。其中,宏观层面的体制弊端是产生职业倦怠的根源,微观层面的工作压力过载是导致职业倦怠的直接原因,中观组织机制失准既起到加剧压力转化为职业倦怠的负向调节作用,也在宏观体制层面与微观个体层面之间起“压力传导”的中介作用。应创新基层卫生机构管理体制,在强化三医协同治理的同时提高基层自主权,逐步缓解基层卫生人员的职业倦怠状况。

  关键词： 基层卫生人员; 职业倦怠; 形成机制; 多维视角; 扎根理论

   

  Abstract: Objective: To investigate the multidimensional causes and formation mechanism of job burnout among primary health workers in China and provide a policy basis for further improving their work attitude. Methods: Semi-structured interviews were conducted from February to July 2021, with a multi-stage purposive sampling of 167 primary health workers, including 53 doctors, 36 nurses, 41 public health workers, and 37 medical technicians from 38 primary health institutions in Dongying, Qingdao, and Zaozhuang. The interview data were analyzed using the coding method of Strauss procedural grounded theory and using MAXQDA 2020 qualitative analysis software. Results: 39 concepts and 19 categories related to the formation mechanism of job burnout among primary health workers were extracted, which were then categorized into three dimensions: macro-level institutional weaknesses stemming from administrative governance models, meso-level mechanical malfunctions in the system of primary health institutions, and micro-level overload of work pressure experienced by primary health workers. From these dimensions, a model was constructed to illustrate the mechanism behind the development of job burnout among primary health workers. Conclusion: The formation of job burnout among primary health workers is influenced by factors at multiple levels. Specifically, the macro-level institutional weaknesses were identified as the root cause of job burnout, while the micro-level overload of work pressure was found to be the direct cause. The meso-level organizational mechanisms not only exacerbate the negative impact of overload on the development of job burnout, but also serve as a mediator of the pressure transmission between the macro-institutional level and the micro-individual level. Therefore, the management system of primary health institutions should innovate to enhance the autonomy of primary institutions while strengthening the collaborative governance of medical care, pharmaceutical, and medical insurance, gradually alleviating the job burnout experienced by primary health workers.

  Key words: primary health workers; job burnout; formation mechanism; multidimensional perspective; grounded theory

  提交时间：2023-06-28

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• 序号	提交日期	编号	操作
  1	2023-04-04	bmr.202306.00016V1	下载

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