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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (3): 529-536. doi: 10.19723/j.issn.1671-167X.2025.03.017

• 论著 • 上一篇    下一篇

传染病应急响应阶段医疗机构韧性及其影响因素

付亚群1,2, 张佳伟1, 韩冰3, 王权1, 朱正1, 聂智杰1, 谭一阳1, 刘青4, 李晓光5, 郭静1, 蒋荣猛3, 杨莉1,2,*()   

  1. 1. 北京大学公共卫生学院卫生政策与管理学系, 北京 100191
    2. 北京大学首都卫生与健康发展研究院, 北京 100191
    3. 首都医科大学附属北京地坛医院传染病临床研究中心, 北京 100015
    4. 北京大学第三医院第二门诊部, 北京 100096
    5. 北京大学第三医院感染疾病科, 北京 100191
  • 收稿日期:2025-02-08 出版日期:2025-06-18 发布日期:2025-06-13
  • 通讯作者: 杨莉
  • 基金资助:
    国家自然科学基金(72174010); 北京市自然科学基金(M22033); 首都卫生研究与发展专项(2021-1G-4091)

Healthcare institution resilience and the influencing factors during infectious disease outbreaks

Yaqun FU1,2, Jiawei ZHANG1, Bing HAN3, Quan WANG1, Zheng ZHU1, Zhijie NIE1, Yiyang TAN1, Qing LIU4, Xiaoguang LI5, Jing GUO1, Rongmeng JIANG3, Li YANG1,2,*()   

  1. 1. Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
    2. Beijing Institute for Health Development, Peking University, Beijing 100191, China
    3. Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
    4. Second Outpatient Section, Peking University Third Hospital, Beijing 100096, China
    5. Department of Infectious Diseases, Peking University Third Hospital, Beijing 100191, China
  • Received:2025-02-08 Online:2025-06-18 Published:2025-06-13
  • Contact: Li YANG
  • Supported by:
    the National Natural Science Foundation of China(72174010); Beijing Municipal Natural Science Foundation(M22033); the Capital Health Research and Development of Special Fund(2021-1G-4091)

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摘要：

目的: 分析传染病暴发应急响应阶段医疗机构医务人员心理健康状况、机构物资和设施、组织间协作情况与医疗机构韧性指标的关联。方法: 2023年1月13日至2月9日对北京市146所医疗机构的医务人员进行线上问卷调查, 共收集到1 434份有效问卷, 其中三级、二级和基层医院分别为408、117和909份。医疗机构韧性指标为医疗服务满足患者需求程度, 其影响因素包括物理因素(如物资短缺和空间改扩建等)、组织因素(如信息共享和转诊等)和心理因素[如工作满意度(外在满意度、内在满意度)、职业倦怠(情感耗竭、去人性化、个人成就感降低)、抑郁状况等]。运用有序多分类Logistic回归模型分析各因素对医疗服务满足患者需求程度的影响, 同时控制可能影响机构韧性的人口学因素。结果: 应急响应阶段93%的受访医院可以满足患者需求, 受访三级医院无法满足患者需求的比例较高(21.05%); 全部受访机构均出现了物资短缺, 其中三级医院出现多种物资短缺的比例更高; 机构间合作方面, 分别有87.50%的基层医院、42.86%的二级医院和31.58%的三级医院可以实现患者转诊; 各类医务人员表现为轻度抑郁, 以及中度至重度的职业倦怠。回归分析显示人员满意度高(总体满意度β=0.04, 外在满意度β=0.06, 内在满意度β=0.08)、职业倦怠程度低(情感耗竭越严重β=-0.04, 去人性化程度越高β=-0.07, 个人成就感越高β=0.01)、抑郁程度低(β=-0.06)均与较高的医疗机构韧性显著相关。此外, 物资短缺与较低的医疗机构韧性显著相关, 对诊疗空间进行改扩建、信息共享均与较高的机构韧性相关。而人口学因素(年龄、性别、婚姻状况、学历等)对医疗机构韧性的影响不显著。结论: 医务人员心理健康状况显著影响医疗机构的韧性, 人力资源是医疗机构的核心资源, 在应急响应中可以通过优化人力资源的有序调配和改善心理状况提高医疗机构韧性; 有序和及时的物资补给和调配、对诊疗空间进行改扩建可以提高医疗机构韧性; 促进信息共享也可以提高医疗机构韧性。

关键词: 医疗机构韧性, 心理因素, 组织因素, 物理因素, 有序多分类Logistic回归

Abstract:

Objective: To analyze the association between healthcare workers mental health, institutional supplies and facilities, inter-organizational coordination during infectious disease outbreaks, and the healthcare institution resilience. Methods: An online questionnaire survey was conducted among the healthcare workforce from 146 institutions in Beijing from January 13, 2023 to February 9, 2023, and a total of 1 434 eligible respondents were included. The sample comprised 408 responses from tertiary hospitals, 117 from secondary hospitals, and 909 from primary care institutions. The resilience indicator for healthcare institutions was defined as the degree to which medical services met patient demands, with influencing factors including physical factors, such as material shortages and facility space adaptation or expansion, organizational factors such as information sharing and patient referral, and psychological factors were evaluated using job satisfaction (extrinsic satisfaction, intrinsic satisfaction), burnout (emotional exhaustion, depersonalization, reduced personal accomplishment), and depression status. Ordered multiclassification Logistic regression was used to examine the impact of various factors on the degree to which healthcare services met patient needs; additionally, demographic factors that might influence institutional resilience were controlled. Results: During the emergency response phase, 93% of hospitals maintained the capacity to meet patient needs, though tertiary hospitals demonstrated significantly higher rates of service inadequacy (21.05%). Material shortages were reported across all institutions, with tertiary hospitals experiencing more frequent multi-item shortages. Inter-institutional collaboration patterns revealed substantial variation: 87.50% of primary care facilities, 42.86% of secondary hospitals, and 31.58% of tertiary hospitals. Healthcare workers across all levels reported mild depressive symptoms and moderate-to-severe burnout levels. Regression analysis showed high satisfaction (overall satisfaction β=0.04, extrinsic satisfaction β=0.06, and intrinsic satisfaction β=0.08), low degree of job burnout (emotional exhaustion β=-0.04, depersonalization β=-0.07 and reduced personal accomplishment β=0.01), low degree of depression (β=-0.06) were significantly associated with higher healthcare institution resilience. In addition, material shortages were significantly associated with lower resilience, and renovation and expansion of treatment spaces, and information sharing, were all associated with higher resilience. Demographic factors (age, gender, marital status, educational background, etc.) had no significant impact on resilience. Conclusion: Mental health status significantly influences healthcare institution resilience. As human resources constitute the core asset of healthcare institutions, strategic optimization of workforce allocation and psychological support interventions can effectively strengthen resilience. Moreover, healthcare institution resilience is positively impacted by orderly material supply chains, timely resource distribution, and adaptive reconfiguration of clinical spaces. Finally, facilitating information sharing also enhances institutional resilience.

Key words: Healthcare institution resilience, Psychological factors, Organizational factors, Physical factors, Ordered multiclassification Logistic regression

中图分类号: 

  • R197

表1

研究的变量定义及说明"

Variable type Variable name Code
Dependent variable
  Service level Whether service can meet patient’s needs Y
Independent variable
  Psychological resilience Job satisfaction (overall) X1
  Job satisfaction (extrinsic satisfaction)
  Job satisfaction (intrinsic satisfaction)
Burnout (emotional exhaustion)
Burnout (depersonalization)
Burnout (reduced personal accomplishment)
Depression
  Organizational resilience Convenient access to patient history X2
Patient referrals X3
  Physical resilience Shortages of drugs, equipment and protective materials X4
Space renovation and expansion X5
  Demographic characteristics and hospital level Gender X6
Age X7
Marital status X8
Job category X9
Highest education level X10
  Other Hospital level X11

表2

受访者基本信息"

Items Tertiary hospital (n=408) Secondary hospital (n=117) Primary hospital (n=909)
Age/years, ${\bar x}$±s 35.58±8.28 37.62±9.58 39.73±8.91
Gender, n(%)
  Male 65 (15.93) 32 (27.35) 285 (31.35)
  Female 343 (84.07) 85 (72.65) 624 (68.65)
Job category, n(%)
  Doctor 192 (47.06) 62 (52.99) 594 (65.35)
  Nurse 210 (51.47) 54 (46.15) 101 (11.11)
  Other 6 (1.47) 1 (0.85) 214 (23.54)
Highest education level, n(%)
  Junior college and below 73 (17.89) 31 (26.50) 184 (20.24)
  College degree 200 (49.02) 71 (60.68) 612 (67.33)
  Master’s degree and above 135 (33.09) 15 (12.82) 113 (12.43)
Marital status, n(%)
  Married 286 (70.10) 89 (76.07) 756 (83.17)
  Unmarried 114 (27.94) 25 (21.37) 117 (12.87)
  Other 8 (1.96) 3 (2.56) 36 (3.96)

表3

受访医疗机构的基本情况"

Items Tertiary hospital(n=19) Secondary hospital(n=7) Primary hospital(n=120)
Level of service provision, n(%)
  Unable to meet patients’ needs 4(21.05) 0(0.00) 6(5.00)
  Basically meet patients’ needs 11(57.90) 6(85.71) 61(50.83)
  Fully meet patients’ needs 4(21.05) 1(14.29) 53(44.17)
Shortage situation, n(%)
  Only drugs 8(42.11) 7(63.64) 75(62.50)
  Only medical devices 2(10.52) - -
  Drugs, medical devices and medical protective supplies 9(47.37) 4(36.36) 45(37.50)
Setting of fever clinics, ±s
  Number of regular consulting rooms 3.37 ±1.07 3.00 ±1.29 -
  Number of consulting rooms during the peak of outbreak 3.54 ±1.61 3.57 ±2.07 -
Expansion and renovation of areas, n(%) - - 80(66.67)
Cross-institutional cooperation，n(%)
  Conduct referrals 6(31.58) 3(42.86) 105(87.50)
  Convenient access to patients’ previous medical records 12(63.16) 5(71.57) 103(85.83)

表4

研究量表的信度和效度评价"

Scale Cronbach α KMO
Minnesota job satisfaction scale (MSQ) 0.975 3 0.968 3
Job burnout scale (MBI-GS) 0.908 4 0.932 5
Patient health questionnaire-9 (PHQ-9) 0.945 1 0.927 6

表5

不同类别医务人员的满意度倦怠和抑郁情况"

Variables Doctors (n=848) Nurses (n=365) Other (n=221) P value
Job satisfaction, ${\bar x}$±s 75.95±13.72 76.64±15.25 76.43±14.87 0.723
  Extrinsic satisfaction 46.07±8.18 46.64±9.05 46.21±8.97 0.562
  Intrinsic satisfaction 29.88±5.75 29.99±6.45 30.22±6.11 0.754
Job burnout, ${\bar x}$±s
  Emotional exhaustion 24.01±12.89 22.57±13.83 21.93±15.05 0.059
  Depersonalization 6.93±6.37 7.60±7.07 7.15±7.54 0.284
  Reduced personal accomplishment 30.82±10.21 28.97±11.89 26.86±13.06 < 0.001
Depression, ${\bar x}$±s 7.70±5.82 8.01±6.12 7.32±6.06 0.390

表6

医疗服务满足患者需求情况的影响因素分析"

Items Model 1 β(95%CI) Model 2 β(95%CI) Model 3 β(95%CI) Model 4 β(95%CI) Model 5 β(95%CI) Model 6 β(95%CI) Model 7 β(95%CI)
Psychological factors - - - - - - -
Job satisfaction 0.04*** (0.03, 0.04) - - - - - -
  Extrinsic - 0.06*** (0.04, 0.08) - - - - -
  Intrinsic - - 0.08*** (0.06, 0.10) - - - -
Burnout
  Emotional exhaustion - - - -0.04*** (-0.05, -0.03) - - -
  Depersonalization - - - - -0.07*** (-0.08, -0.05) - -
  Reduced personal accomplishment - - - - - 0.01** (0.00, 0.02) -
Depression - - - - - - -0.06*** (-0.09, -0.04)
Organizational factors
  Convenient access to patient history 0.22 (-0.05, 0.50) 0.22 (-0.05, 0.50) 0.23 (-0.05, 0.50) 0.27* (-0, 0.55) 0.28** (0.00, 0.56) 0.30** (0.02, 0.57) 0.28** (0.01, 0.55)
  Patient referrals 0.17 (-0.10, 0.43) 0.17 (-0.09, 0.44) 0.17 (-0.10, 0.43) 0.2 (-0.06, 0.47) 0.2 (-0.06, 0.47) 0.24* (-0.02, 0.50) 0.25* (-0.01, 0.51)
Physical factors
  Shortages of drugs, equipment and protective materials -0.25** (-0.49, -0.00) -0.26** (-0.51, -0.02) -0.23* (-0.48, 0.01) -0.2 (-0.45, 0.05) -0.24* (-0.49, 0.00) -0.27** (-0.51, -0.03) -0.22* (-0.46, 0.03)
  Space renovation and expansion 0.1 (-0.21, 0.41) 0.11 (-0.20, 0.42) 0.11 (-0.20, 0.42) 0.31** (0.00, 0.62) 0.25 (-0.06, 0.56) 0.23 (-0.08, 0.54) 0.22 (-0.09, 0.53)
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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
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