Impact of organizational and individual factors on patient-provider relationships: A national survey of doctors, nurses and patients in China

Objectives
To provide an empirical examination of patient–provider relationships (PPR) and its association with organizational and individual factors.
Methods
A national cross-sectional survey was conducted by stratified cluster sampling in 77 hospitals across seven provinces in China between July 2014 and April 2015, involving 3621 doctors, 5561 nurses, and 8022 patients with response rates of 62.93%, 61.16%, and 33.08%, respectively. Self-perceived PPR was the outcome variable. Organizational factors included hospital type (western medicine [WM] and traditional Chinese medicine [TCM] hospital); hospital level (tertiary and secondary hospital); area of specialization (internal medicine and surgery); ratio of doctors (nurses) to ward beds; doctors/nurses’ concerns about performance assessment; and patients’ perceptions of healthcare cost. Individual factors included consultation, listening to patients and socio-demographic factors.
Results
54.6% of doctors, 36.6% of nurses, and 10.2% of patients perceived PPR as poor. Organizational factors independently associated with providers’ perception of poor PPR included hospital type (WM vs TCM: OR = 1.25 [95% CI: 1.06–1.47]) and concerns about performance assessment (high vs low levels: OR = 1.40 [95% CI: 1.14–1.72]) for doctors, and concerns about performance assessment (average vs low levels: OR = 0.79 [95% CI: 0.67–0.93]) for nurses. Those associated with patients’ perception of poor PPR included hospital type (WM vs TCM: OR = 0.63 [95% CI: 0.53–0.74]) and hospital level (tertiary vs secondary: OR = 0.65 [95% CI: 0.51–0.82]). Doctors and nurses reporting listening to patients “frequently” had better perceptions of PPR (OR = 0.46 [95%CI: 0.38–0.56] and 0.49 [95% CI: 0.41–0.59] for doctors and nurses, respectively), as did their patients (OR = 0.24 [95% CI: 0.18–0.31] and 0.54 [95% CI: 0.35–0.84] for doctors and nurses, respectively).
Conclusions
Although our findings require validation in different organizational settings given the likely variability of these associations across systems, our results suggest that implementing moderate levels promoting the level of medical treatment, and broadening doctors/nurses training regarding listening to patients, may benefit to enhance PPR.

## 研究目标
对医患关系（patient–provider relationships, PPR）及其与组织、个体因素的关联开展实证检验。

## 研究方法
本研究于2014年7月至2015年4月间，采用分层整群抽样方法，在中国7个省份的77家医院开展全国性横断面调查，共纳入3621名医生、5561名护士及8022名患者，对应应答率分别为62.93%、61.16%与33.08%。本研究以自我感知的医患关系作为结局变量。组织因素涵盖：医院类型（西医（western medicine, WM）与中医（traditional Chinese medicine, TCM））、医院等级（三级医院与二级医院）、专科领域（内科与外科）、医生（护士）与病房床位配比、医护人员对绩效考核的关注度，以及患者对医疗费用的感知。个体因素则包含诊疗沟通、患者倾听行为及社会人口学特征。

## 研究结果
54.6%的医生、36.6%的护士及10.2%的患者认为自身所处的医患关系较差。与医护人员感知的较差医患关系独立相关的组织因素包括：对于医生而言，医院类型（西医相较中医：比值比（odds ratio, OR）=1.25，95%置信区间（confidence interval, CI）：1.06~1.47）与绩效考核关注度（高vs低水平：OR=1.40，95%CI：1.14~1.72）；对于护士而言，绩效考核关注度（中等vs低水平：OR=0.79，95%CI：0.67~0.93）。与患者感知的较差医患关系相关的组织因素包括医院类型（西医相较中医：OR=0.63，95%CI：0.53~0.74）与医院等级（三级相较二级：OR=0.65，95%CI：0.51~0.82）。频繁倾听患者的医生与护士对医患关系的感知更优（医生组OR=0.46，95%CI：0.38~0.56；护士组OR=0.49，95%CI：0.41~0.59），其对应的患者亦呈现更积极的医患关系感知（医生对应患者组OR=0.24，95%CI：0.18~0.31；护士对应患者组OR=0.54，95%CI：0.35~0.84）。

## 研究结论
尽管本研究结果需在不同医疗组织场景中加以验证——鉴于不同医疗体系下此类关联可能存在异质性——但研究结果显示，推行适度的医疗服务优化举措并拓宽医护人员的患者倾听技能培训，或有助于改善医患关系。