Reflection on Global Public Health Ethics from the Perspective of Community / 中国医学伦理学

The global spread of COVID -19 indicates that cultivating public health awareness and constructing the concept of human health community has become an urgent need and a long-term plan in the current social situation. In the post-epidemic period, only by adhering to the concept of human health community, strengthening the cooperation among individuals, families, communities, institutions, urban and rural areas, countries and so on, weaving closely and consolidating the "net bottom" of grass-roots prevention and control from point to area, and establishing the mechanism of group prevention, group control and joint prevention and control, can we thoroughly curb the spread of the epidemic in the world. Under the development concept and value orientation of human health community, the individual is not only a booster of public health, but also a component of public health, and also a beneficiary of public health. The realization of public health is inseparable from the practice of each individual. Under the guidance of the concept of human health community and the awareness of individual health first responsibility, all citizens need to shape health promotion behaviors that fit the individual’s own situation, promote the health maintenance atmosphere consciously followed by the whole society, create a healthy ecological environment accessible to everyone, and let all citizens share the good results of public health management, so as to achieve the good vision of human health community.

Exploration and Analysis of Volunteers’ Participation in Hospice Care Service Mode from the Perspective of Multiple Mutual Aid / 中国医学伦理学

In an aging society, the coexistence of multiple diseases among the elderly is prominent, and the prevalence of malignant tumors continues to rise.It has positive practical significance that improving the quality of life of dying patients and developing hospice care. Based on welfare multivariate theory, volunteers joining the hospice care team is conducive to the diversified development of the hospice care. By carrying out voluntary services and giving dignity to the dying, the quality of death can be improved and social support can be reflected. Based on the theory of mutual aid, volunteer participation in hospice care services is conducive to promoting the improvement of social spiritual civilization and achieving a virtuous cycle of intergenerational mutual aid. The mode of volunteer participation in hospice care service is still being gradually explored. This paper aimed to propose that the government introduces relevant voluntary service policies to build a good social atmosphere; based on the knowledge, belief and practice model, carry out education and training for volunteers and promote the overall coordinated development of the service team; put forward suggestions on improving the volunteer service mechanism by reaching confidentiality agreements, and improving the willingness of the dying and their families to accept volunteer services, so as to provide reference for the sustainable development of hospice care.

Exploration on Cognitive Differences and Improvement Approaches of "Internet+" Doctor-patient Relationship from the Dual Perspective of Doctors and Patients / 中国医学伦理学

The multi-dimensional embedding of "Internet+" has led to new evolutions in the operating environment, service methods, interpersonal relationships. in the medical field, and promoted the transformation of the traditional face-to-face consultation and the physician-dominated interaction model. Based on the dual perspective of doctors and patients, taking the demands of stakeholders under "Internet+Medical" as entry point, this paper analyzed the dual impact of "Internet+" on the doctor-patient relationship and explored the reconstruction countermeasures of doctor-patient relationship under "Internet+". This paper found that the doctors’ cognition of "Internet+Medical" was not high, leading to the limited scope of service supply, patients had a low awareness of "Internet+Medical", resulting in a narrow range of service audiences, "Internet+Medical" helped to improve the accessibility of resources and had the possibility of increasing risks for both doctors and patients. In response, some countermeasures were proposed, including strengthening the government’s supervision and management to promote the online safe interaction and orderly communication between doctors and patients, strictly investigating the qualifications of doctors and information management on internet platforms to protect the legitimate rights and interests of both doctors and patients, cultivating doctors’ medical humanistic literacy to improve the non-technical communication relationship between doctors and patients, enhancing patients’ personal health literacy and maintaining appropriate expectations of doctors and services, adhering to the appropriate expectations of doctors and services, and urging the media to promote and report objectively and impartially to create a good atmosphere of mutual trust between doctors and patients.

Analysis on the content and mode of family doctor contract service in the mountain area of northern Beijing / 中华医院管理杂志

Objective:To understand the development of family doctor contract service and the actual demand of local residents for contract service, so as to provide the basis for the establishment of family doctor contract service mode suitable for mountainous residents.Methods:Based on the relevant policy requirements of family doctor contract service, a questionnaire and an interview outline were developed. A questionnaire survey was conducted among 583 residents of each township health center in all eight townships in the mountainous area north of Huairou District, and 16 residents were interviewed in depth in September 2019. The count data were analyzed by composition ratio, frequency description and ranking. The content analysis of qualitative interview data was carried out by topic frame method.Results:133 residents(22.8%) were unaware of the family doctor contract system at all, and 164(28.1%) knew a little about it. Residents′ lack of awareness tend to affect their medical seeking behavior. 361 residents(61.9%) knew that they had signed agreements with family doctors. Residents were not active enough to sign contracts, and their demand for family doctor signing service was mainly for various kinds of door-to-door services, and the demand for online service was low.Conclusions:The contract service relationship between residents and family doctors in mountainous areas is not working as desired. We should actively explore the contract service mode and performance evaluation mode suitable for the characteristics of mountain areas, so as to promote the healthy development of family doctor contract service.

Discussion on the doctor-patient relationship under the "Internet+" scenario based on the concept of value co-production / 中华医院管理杂志

Thanks to the advent of " Internet + medical care" , the conventional doctor-patient relationship is facing changes, mostly the rise of patients′say in healthcare services.This paper is based on a research hypothesis of the community of interests and value community in the healthcare system as well as a theory of value co-production. On such basis, the author explored how to understand the interests of the medical, patient, and network groups, analyzed the interest linkage mechanism affecting the relationship between doctors and patients, and established the design process of creating doctor-patient value and the cooperation mechanism between doctors and patients. Upon a reasonable realization of the interests of all parties, the effective establishment of an interactive relationship between doctors and patients and the mutual benefit of the interests of all parties should be effectively promoted.

Analysis of the doctor-patient trust strategies in family physicians contracted service from residents′perspectives / 中华医院管理杂志

Objective To learn the current doctor-patient trust in contracted service of family physicians in suburban Beijing, and analyze its influencing factors from residents′ perspectives to propose countermeasures. Methods A total of 197 contracted residents were sampled from 12 community health service centers in 4 out of 10 suburb districts of Beijing, for a questionnaire survey using stratified random sampling method. Items of the questionnaire cover residents′knowledge of the family physicians′ contracted service, their trust of family physicians′ competence, and their trust level of the ethics and the influencing factors. Measurement data were calculated form the mean value, while the count data were subject to proportion analysis, frequency description and rank ordering. Results 175(88.8% )and 156(79.2% )of the contracted residents trust the ethics and competence of their family physicians. Whether the ethics trust exists between doctors and patients was decided by if residents′respect, care, and interests considerations taken into account by the physicians; the factors influencing the competence trust of the residents were the age, education of the residents, and whether the physicians display respect, care. Conclusions Upgrading the medical competence and ethical conduct is conducive to the establishment of doctor-patient trust. In the establishment of the family physicians contracted service, it is necessary to improve acceptance of the contracted residents. At the same time, medical ethics issues such as respect for care, privacy protection, and maximum interests of the residents in the process of medical treatment deserve further attention.

Qualitative study on the impacts of policy exterior environment on rural doctors'ranks in Beijing / 中华医院管理杂志

Objective To study the impact of policy external environmental changes on rural doctors'ranks,and to find out the adaptability between the two.Methods The purposeful sampling method was used to study 84 people of district H in Beijing by means of both field observation and individual in -depth interviews from July to August in 2016.The data acquired was analyzed by qualitative method, and interview results were categorized and analyzed by citing typical expressions of the respondents.In October 2016,rural doctors from 260 village clinics in 14 townships in district H were subject to a basic information survey,by means of general description.Results The changes of village governance model, strength of personal relationship made in adaptation between health policy and policy environment,retained the practice of senior village doctors.These people,though low in competence,were advantageous as being locals(237 of them being in the same village)and for their familiarity with health conditions, namely family disease history and diet habits,of local villagers.At the same time,health policies were not adaptive to the policy environment,as village committees tend to ignore management of doctors.12 of the 21 village leaders were not involved in the management.Conclusions Development of rural doctors ranks is highly challenging as making policies friendly to external policy environment, and the constraints of such environment on health policies deserves more attention.

A survey on service status of rural doctors in Beijing suburb / 中华全科医师杂志

Objective To survey the service status of rural doctors in Beijing suburb.Methods Twenty one village officials,21 rural doctors and 42 local residents from 21 villages in Beijing Huairou district were selected with purposive sampling method as the objects of this qualitative study.The service status of rural doctors was assessed from four aspects:basic public health service,basic medical service,management ability,responsibility and communication ability.Results All the 21 village clinics provided basic public health services,including hypertension management (100.0％),diabetes management (100.0％);11 clinics (52.4％) also provided vaccination services.Eighteen village doctors (85.7％) assisted township health center to provide signing health service,but were lack of knowledge about the types of service the general practitioners (GPs) should provide.The well performed basic medical services among 21 village clinics included diagnosis and differential diagnosis of common diseases in 19 (90.5％) clinics,home visits in 18 (85.7％) and physical examinations in 15 (71.4％),but the service like trauma management,changing dressing,subcutaneous injection,intravenous infusion were performed less well.The top three most satisfied aspects in the medical service were the service attitude (4.14 points),the quality of service (3.98 points) and service time (3.66 points),and the bottom three were equipment facilities,the types and varieties of drug,and the environment of clinics.In aspect of emergency service,7 village doctors (33.3％) would choose self-referral by patients without preliminary on-site emergency treatment,5 (23.8％) would give on-site emergency treatment before self-referral by patients.In aspect of training needs,18 (42.9％) local residents and 9 (42.9％) village officials considered that it was not necessary to provide training for village doctor because of relatively older age.In aspect of patient's satisfaction,21 village doctors (100.0％),21 village officials (100.0％) and 34 villagers (81.0％) considered that the village doctor had a high professional sense of responsibility and medical ethics,and their doctor-patient communication skills were strong.Conclusion The survey reveals the current service status of village doctors in Beijing suburb,and it is necessary to take comprehensive measures to upgrade the competence of village doctors and to improve the quality of service in village clinics.

Correlation Study on Rural Doctors' Service Ability and Interest Demand:Taking M District in Beijing as a Case / 中国医学伦理学

Objective:To investigate the correlation of rural doctors' service ability and interest demands,and analyze the countermeasures for improving the service capacity of rural doctors from the perspective of the personal interest demands of rural doctors. Methods:Through the combination of qualitative and quantitative research meth-ods,we described the current situation and correlation of rural doctors'service ability and interest demands. Result:The interest demands of rural doctors mainly included raising the level of old - age insurance,increasing economic subsidies,clarifying the position of rural doctors,increasing the training opportunities and solving practice risk. These five demands had different level effect on the service ability of rural doctors. Conclusion:It should compre-hensively promote the progress of rural integration,improve the rural doctor's economic subsidies and pension secu-rity level and integrate rural doctor into medical and health system;establish a rural doctor' risk sharing mechanism to solve the practice risk of rural doctors;optimize the training mechanism for rural doctors to improve the technical level of rural doctors.

"Ethical Study on the Influence of ""Sense of Identity"" on Village Health Human Resource Distribution——Based on Field Research in H County of Beijing" / 中国医学伦理学

Rational distribution of health human resources that can keep,use and manage is the key process to strengthen the rural three-level health service network,and to be sure,the sense of identity plays a pivotal role in it.This study,with qualitative research of sociology and research in historic culture,analyzed the influence of the status quo of social,cultural and historical background on rural doctors as health human resource.Through the field observation and individual in-depth interview,it explored the current condition of relationship mode and interaction way behind village life,analyzed the influences of them upon health human resource,and put forward some suggestions to adapt rural culture environment,following the view of existence determines consciousness of historical materialism.

Discussion on the Improvement Measures of Ethical Relations and Moral Behaviors among Rural Medical Staff from the Perspective of Moral Contract / 中国医学伦理学

Based on the practical dilemma that the moral relation model of traditional acquaintance society has already declined incurrent social development,it is urgent tocarry out the field observation and comparative study of two-level moral field in rural areas and to discuss appropriate strategies to reconstruct new ethical relations and moral behaviors among rural medical staff from the perspective of moral contract.Based on this,both the village acquaintance society in rural and the non-acquaintance society in towns need to adapt to the change of contractual service models to some extent because of different presentation of multidimensional moral connotation.Under the guidance of moral contract theory and practical application,moral relations and moral behaviors should be reconstructed to promote the formation of advocating moral and goodness and doctor-patient trust.

Qualitative research of the team building of rural doctors in Beijing under different views / 中华医院管理杂志

Objective To learn from various view points the team building of rural doctors in Beijing.Methods 84 village officials,rural doctors and villagers were enrolled from three townships in district H of Beijing,for an interview to learn the makeup and selection approach of rural doctors,and their recommendations on team building of these doctors.Results 76.19% of the interviewees prefer their own villagers as candidates for their rural doctor.Top three factors for their retention were their medical competence,geo-relations,and service attitude;60.71% of the interviewees held that the village committee should be the decision maker for appointment of rural doctors; in terms of team building,senior doctors emphasize retirement conditions,while new ones prefer training opportunities.Conclusions The topmost criterion for rural doctor candidates should be their medical competence,instead of sacrificing this criterion for geo-relations.The village committee and the villagers' congress should play a greater role of supervision and management of the rural doctors.Targeted incentives are recommended for the rural doctors in view of their retention.

Preliminary Exploration on the Development of Family Doctor's Netting Service from the Perspective of Management Ethics / 中国医学伦理学

Based on management ethics,this paper explored the related ethical problems in the development of family doctor'netting services,and put forward the ethical principles that should be obeyed.In addition,this paper pointed out the corresponding countermeasures and suggestions from the perspective of management ethics.In view of nation,society,and individual,it analyzed the countermeasures in order to make this service develop more standardly and thus to better service for people's health and building a healthy medical environment for doctor-patient harmony,mutual trust and win-win situation.

Survey on the Village Clinics′Service Capacity in H District of Beijing- in View of Doctors / 中国医学伦理学

Objective:To understand the current service capacity of village clinics in H District of Beijing, to find out the existing problems and deficiencies, and to provide the basis for the development of village health poli-cy. Methods:The census method was used to investigate all the village clinics in H District of Beijing, and 260 rural doctors were investigated. Purposive sampling method was used to select 3 townships in H District of Beijing and 6 villages in each township as the research field. Observation and in-depth interviews were used in this study, and the sample size was 18 rural doctors. Results: At present, the village clinic in H district of Beijing has the problems of low quality of personnel, lack of business premises, inadequate infrastructure, and poor service capaci-ty. Conclusion:In order to improve the service capacity of village clinic in H District of Beijing City, it is sugges-ted to establish human resources management system, improve the overall quality of rural doctors, manage systemat-ically and improve the level of resource allocation in village clinics.

Exploration on the Construction Path of Medical Students′Humanistic Ability in the Perspective of Humanization / 中国医学伦理学

Medical students′ humanistic quality and ability are the key practice elements beyond professional skills. In the perspective of humanization, the cultivation of humanistic ability should guide medical students to es-tablish the human-centered service concept, and break through the narrow limitation of technological view with re-garding disease as the center, and. To integrate the humanism and medicine, the medical humane education should broaden the practical teaching channel and enrich the contents of teaching, based on clarifying the multi-demands.

Comparison of Doctor-patient Trust Mechanism between Doctors in Urban and Rural Areas from the Perspective of Rural Residents---Based on the Field Research in H County of Beijing / 中国医学伦理学

Objective:To compare the similarities and differences of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents by the empirical study .Methods:Based on the field research and secondary in -depth interviews to the related personnel in H County of Beijing .Re-sults:There had obvious difference of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents .Trust building mechanism between village doctors were mainly the trust of the similar social background , between the doctors in township health centers and city hospital were the trust based on reputation , institution-based trust , and relationship-based trust .Conclusion:The difference of re-gional and cultural between urban and rural areas ,the nature of medical institutions the relationship with doctors , reputation of medical institution and medical and health care system in urban and rural areas ,maybe the reasons that The difference of doctor -patient trust building mechanism between doctors in urban and rural areas .

Present Situation and Influencing Factor of the Doctor-patient Trust in Rural Area from the Villager′s Perspective / 中国医学伦理学

Objective:To analyze the status of doctor -patient trust and its influencing factors based on the per-spective of the villagers .Methods:Using purposive sampling method , the selection of the H area as the research site in Beijing , for in the 14 township 80 administrative villages of trust information in the form of questionnaire sur-vey .Results:The 350 villagers were surveyed 301 villagers of village clinics held a positive attitude to the doctor -patient relationship , accounted for 86 .00%;There are 44 villagers of village clinics the middle ground the doctor-patient relationship , accounted for 12 .57%;Only five of the villagers of village clinics have held a denial atti-tude to the doctor-patient relationship , accounts for 3.43%of the proportion of the total .Based on blood kinship relationship between the villagers of village clinics and rural doctors more trust , but the technical level and service ability are the main factors affecting doctor -patient trust .Conclusion:Rural doctors and villagers in the same vil-lage , has a common living environment , interpersonal relationship , morality , interpersonal trust between each other is higher .In clinical activities , formed by the interpersonal relationship with the clinical common existing doctor -patient trust , is essentially interpersonal trust mask a lack of technology .Transformation in the society , how to im-prove the service ability of the village clinic , realize the village clinic real doctor -patient trust is the important connotation of health reform .

On the incentives mechanism of performance appraisal for posts in community health service centers / 中华医院管理杂志

An analysis of the existing incentives mechanism of performance appraisal for community health service centers, and insight into the challenges for linking the post performance appraisal in community health service centers with incentive measures. It is pointed out the administrators should take a variety of measures including material incentive, target incentive, knowledge incentive, and emotional incentive among others. In addition, such measures should be used sophistically, flexibly and reasonably, while timing of incentives should meet the human resource needs of the institution, notably a combination of positive incentive with negative ones,, mostly the former incentive.

Service provision by township hospitals in Beijing / 中华医院管理杂志

Objective To probe into the current services and outcomes of township hospitals following their transformation, and their future positioning of functionality. Methods Pinpointing townships A, B and C as samples from a district in Beijing, in which field surveys were made in the township hospitals to learn their services, service provision methods and outcomes. Results Among the current services provided by these three hospitals, those of public health and primary healthcare nature in hospital A account for 50% each; those in hospital B account for 70% and 30% respectively; those in hospital C account for 60% and 40% respectively. Recommendable services provided in these hospitals include universal coverage of medical files, management of infectious diseases, public health emergency management, and immunization. Conclusion Township hospitals as the center of the 3-tier rural health service network, deserve a repositioning of their functionality to fit the health needs of residents at large.

Proposal for a job-analysis based performance appraisal for posts in community healthcare organizations / 中华医院管理杂志

A brief description of performance appraisal as used in the healthcare sector, and an analysis of problems existing in performance appraisal for posts in community heahhcare organizations in the country. The paper proposes a job-analysis based performance appraisal for such posts, featuring the appraisal model of "performance + skills + attitude+ work intensity". On the basis of work analysis, a job description should be worked out for such healthcare workers as doctors, nurses and prevention workers in community healthcare organizations, aided by a targeted job-based performance appraisal system. These efforts can effectively enhance the job performance in such organizations, catering to the healthcare needs of community residents.