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【摘要】背景對基層衛生人員的(de)(de)(de)(de)(de)激(ji)(ji)勵(li)關(guan)乎新醫改“強(qiang)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)”和(he)(he)(he)分(fen)(fen)(fen)(fen)(fen)級診(zhen)療目標的(de)(de)(de)(de)(de)實(shi)(shi)現，研(yan)(yan)(yan)究(jiu)者大都(dou)關(guan)注外(wai)(wai)部(bu)(bu)激(ji)(ji)勵(li)措施及其(qi)對(dui)(dui)(dui)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果的(de)(de)(de)(de)(de)影響，忽(hu)視了工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)本(ben)身所具備的(de)(de)(de)(de)(de)內在(zai)激(ji)(ji)勵(li)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)用(yong)(yong)(yong)。目的(de)(de)(de)(de)(de)以工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)模型為(wei)(wei)研(yan)(yan)(yan)究(jiu)框架，分(fen)(fen)(fen)(fen)(fen)析當前基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)現狀，探究(jiu)其(qi)對(dui)(dui)(dui)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果的(de)(de)(de)(de)(de)內在(zai)激(ji)(ji)勵(li)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)用(yong)(yong)(yong)，并比(bi)較工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)五(wu)(wu)維(wei)(wei)度(du)與(yu)(yu)(yu)收入(ru)等(deng)外(wai)(wai)部(bu)(bu)激(ji)(ji)勵(li)因(yin)素(su)對(dui)(dui)(dui)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果的(de)(de)(de)(de)(de)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)用(yong)(yong)(yong)大小，為(wei)(wei)提高基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)的(de)(de)(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)動(dong)機(ji)(ji)(ji)與(yu)(yu)(yu)績(ji)(ji)效(xiao)(xiao)提出政策(ce)(ce)建議。方(fang)法采(cai)(cai)用(yong)(yong)(yong)多階段抽(chou)樣(yang)(yang)法，以山東省(sheng)三市(shi)18家社區衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)服務中(zhong)心和(he)(he)(he)20家鄉鎮衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)院為(wei)(wei)樣(yang)(yang)本(ben)來源(yuan)地，2021年2—6月選(xuan)取各樣(yang)(yang)本(ben)來源(yuan)地調查(cha)當日在(zai)崗的(de)(de)(de)(de)(de)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)為(wei)(wei)研(yan)(yan)(yan)究(jiu)對(dui)(dui)(dui)象，采(cai)(cai)用(yong)(yong)(yong)自(zi)(zi)設問卷對(dui)(dui)(dui)其(qi)進(jin)行調查(cha)。采(cai)(cai)用(yong)(yong)(yong)方(fang)便抽(chou)樣(yang)(yang)法，從完(wan)成調查(cha)者中(zhong)抽(chou)取167例(li)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)為(wei)(wei)訪(fang)談對(dui)(dui)(dui)象，對(dui)(dui)(dui)其(qi)進(jin)行半結(jie)(jie)構化(hua)訪(fang)談，了解(jie)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)對(dui)(dui)(dui)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)的(de)(de)(de)(de)(de)認知情況。采(cai)(cai)用(yong)(yong)(yong)Pearson相關(guan)分(fen)(fen)(fen)(fen)(fen)析工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)五(wu)(wu)維(wei)(wei)度(du)及外(wai)(wai)部(bu)(bu)激(ji)(ji)勵(li)因(yin)素(su)與(yu)(yu)(yu)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)自(zi)(zi)主動(dong)機(ji)(ji)(ji)、工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)績(ji)(ji)效(xiao)(xiao)、職業(ye)倦怠、離職意愿(yuan)之間的(de)(de)(de)(de)(de)相關(guan)性(xing)(xing)(xing)，采(cai)(cai)用(yong)(yong)(yong)多元分(fen)(fen)(fen)(fen)(fen)層(ceng)(ceng)(ceng)(ceng)線(xian)性(xing)(xing)(xing)回(hui)(hui)歸(gui)分(fen)(fen)(fen)(fen)(fen)析工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)五(wu)(wu)維(wei)(wei)度(du)及外(wai)(wai)部(bu)(bu)激(ji)(ji)勵(li)因(yin)素(su)對(dui)(dui)(dui)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果的(de)(de)(de)(de)(de)影響及其(qi)程(cheng)度(du)。采(cai)(cai)用(yong)(yong)(yong)主題框架法對(dui)(dui)(dui)訪(fang)談資(zi)料進(jin)行分(fen)(fen)(fen)(fen)(fen)析。結(jie)(jie)果共回(hui)(hui)收有效(xiao)(xiao)問卷870份。工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)五(wu)(wu)維(wei)(wei)度(du)中(zhong)，基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)在(zai)技能(neng)(neng)多樣(yang)(yang)性(xing)(xing)(xing)維(wei)(wei)度(du)上的(de)(de)(de)(de)(de)平(ping)(ping)均(jun)(jun)得分(fen)(fen)(fen)(fen)(fen)最高，為(wei)(wei)（4.09±0.71）分(fen)(fen)(fen)(fen)(fen)；在(zai)任(ren)務完(wan)整(zheng)性(xing)(xing)(xing)維(wei)(wei)度(du)上的(de)(de)(de)(de)(de)平(ping)(ping)均(jun)(jun)得分(fen)(fen)(fen)(fen)(fen)最低，為(wei)(wei)（3.18±1.04）分(fen)(fen)(fen)(fen)(fen)；在(zai)任(ren)務重要(yao)性(xing)(xing)(xing)、工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)反饋性(xing)(xing)(xing)、工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)自(zi)(zi)主性(xing)(xing)(xing)3個(ge)維(wei)(wei)度(du)上的(de)(de)(de)(de)(de)平(ping)(ping)均(jun)(jun)得分(fen)(fen)(fen)(fen)(fen)分(fen)(fen)(fen)(fen)(fen)別(bie)為(wei)(wei)（3.91±0.76）、（3.46±0.83）、（3.43±0.79）分(fen)(fen)(fen)(fen)(fen)。Pearson相關(guan)分(fen)(fen)(fen)(fen)(fen)析結(jie)(jie)果顯示，基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)自(zi)(zi)主動(dong)機(ji)(ji)(ji)、工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)績(ji)(ji)效(xiao)(xiao)與(yu)(yu)(yu)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)各維(wei)(wei)度(du)呈正(zheng)相關(guan)（P<0.05），職業(ye)倦怠和(he)(he)(he)離職意愿(yuan)與(yu)(yu)(yu)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)各維(wei)(wei)度(du)呈負相關(guan)（P<0.05）。多元分(fen)(fen)(fen)(fen)(fen)層(ceng)(ceng)(ceng)(ceng)線(xian)性(xing)(xing)(xing)回(hui)(hui)歸(gui)結(jie)(jie)果表明，工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)五(wu)(wu)維(wei)(wei)度(du)對(dui)(dui)(dui)自(zi)(zi)主動(dong)機(ji)(ji)(ji)、工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)績(ji)(ji)效(xiao)(xiao)、職業(ye)倦怠、離職意愿(yuan)等(deng)4個(ge)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果變(bian)(bian)量(liang)(liang)的(de)(de)(de)(de)(de)貢(gong)獻率（R2）分(fen)(fen)(fen)(fen)(fen)別(bie)為(wei)(wei)18.8%、11.3%、16.5%和(he)(he)(he)21.9%，其(qi)對(dui)(dui)(dui)4個(ge)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果變(bian)(bian)量(liang)(liang)的(de)(de)(de)(de)(de)解(jie)釋(shi)力強(qiang)于(yu)收入(ru)等(deng)5項(xiang)外(wai)(wai)部(bu)(bu)激(ji)(ji)勵(li)因(yin)素(su)〔5項(xiang)外(wai)(wai)部(bu)(bu)激(ji)(ji)勵(li)因(yin)素(su)對(dui)(dui)(dui)4個(ge)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果變(bian)(bian)量(liang)(liang)的(de)(de)(de)(de)(de)貢(gong)獻率（R2）分(fen)(fen)(fen)(fen)(fen)別(bie)為(wei)(wei)1.7%、3.4%、5.8%和(he)(he)(he)11.8%〕。通(tong)過(guo)訪(fang)談發現，基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)在(zai)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)的(de)(de)(de)(de)(de)5個(ge)維(wei)(wei)度(du)上存(cun)在(zai)任(ren)務碎片化(hua)、自(zi)(zi)主性(xing)(xing)(xing)受限、反饋機(ji)(ji)(ji)制(zhi)不足等(deng)問題。結(jie)(jie)論對(dui)(dui)(dui)于(yu)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)而言，工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)的(de)(de)(de)(de)(de)內在(zai)激(ji)(ji)勵(li)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)用(yong)(yong)(yong)對(dui)(dui)(dui)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果的(de)(de)(de)(de)(de)解(jie)釋(shi)力強(qiang)于(yu)外(wai)(wai)部(bu)(bu)激(ji)(ji)勵(li)因(yin)素(su)的(de)(de)(de)(de)(de)外(wai)(wai)在(zai)激(ji)(ji)勵(li)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)用(yong)(yong)(yong)，但基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)的(de)(de)(de)(de)(de)現實(shi)(shi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)與(yu)(yu)(yu)理論上的(de)(de)(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)特(te)(te)(te)(te)(te)征(zheng)(zheng)之間存(cun)在(zai)差距(ju)。應重視工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)本(ben)身的(de)(de)(de)(de)(de)內在(zai)激(ji)(ji)勵(li)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)用(yong)(yong)(yong)，通(tong)過(guo)增加(jia)培訓機(ji)(ji)(ji)會和(he)(he)(he)提高培訓質量(liang)(liang)、為(wei)(wei)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)減(jian)(jian)負賦能(neng)(neng)、加(jia)大資(zi)源(yuan)投入(ru)和(he)(he)(he)減(jian)(jian)少政策(ce)(ce)束縛、完(wan)善績(ji)(ji)效(xiao)(xiao)管理制(zhi)度(du)等(deng)重塑基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)對(dui)(dui)(dui)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)的(de)(de)(de)(de)(de)認知，從而提升基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)(yuan)(yuan)(yuan)(yuan)的(de)(de)(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)動(dong)機(ji)(ji)(ji)與(yu)(yu)(yu)績(ji)(ji)效(xiao)(xiao)。

【關鍵(jian)詞】工(gong)作(zuo)(zuo)特(te)征模型；基層(ceng)衛生人員；內在(zai)激勵；工(gong)作(zuo)(zuo)結果；工(gong)作(zuo)(zuo)設計；工(gong)作(zuo)(zuo)表現

我國自2015年起大力推進分級診療制度建設，通過推進醫聯體建設和家庭醫生簽約服務高質量發展等措施，旨在實現“強基層”的醫改目標。作為基層衛生服務的提供主體和醫改政策的干預對象，基層衛生人員有著舉足輕重的地位，其工作績效很大程度上決定了基層衛生事業的發展水平［1］。近些年，國家通過實施績效工資制度、醫保支付方式改革、職稱晉升標準改革等激勵措施，旨在提高基層衛生人員的工作動機，進而促進其工作績效的提升。但諸多研究、證據表明，基層衛生人員普遍存在工作動機水平較低、工作滿意度低、離職意愿強、職業倦怠程度嚴重等問題［2-3］。根據動機理論，工作動機可分為外在動機和內在動機，二者均能影響工作結果，內在動機與外在動機相比對工作結果的影響更強且更持久［4］。當前，基層醫療衛生機構采取的各項激勵措施大都屬于外部激勵措施，旨在激發基層衛生人員的外在動機，其效果取決于各種外部獎勵對基層衛生人員的吸引力水平和激勵措施在實踐中的落實程度，具有較強的異質性和不確定性。而無論是現存激勵政策還是相關研究，都相對忽視了通過工作設計與工作重塑，賦予工作本身以激勵作用，促進人職匹配，提高基層衛生人員的內在動機水平。因此，本研究以工作特征模型作為理論框架，通過對山東省基層衛生人員進行問卷調查和訪談，描述基層衛生人員工作特征的現狀，驗證工作特征對其工作結果的內在激勵作用，并比較工作特征與外部激勵因素對工作結果的解釋力，從而提出助力完善基層衛生工作設計與激勵機制的政策建(jian)議，最終通過充分發揮工(gong)作本身的內在激(ji)勵作用，提(ti)高基(ji)層(ceng)衛生人員(yuan)的工(gong)作動機與績效水平(ping)。

1對象與方法

1.1理論模型工作特征模型由理查德·哈克曼和格雷格·奧爾德漢姆兩位學者在20世紀80年代提出，是在對推崇亞當·斯密的社會分工理論和泰勒的科學管理理論導致的工作專業化所造成的工作內容單調重復進行反思的基礎上逐步形成和發展的。工作特征模型強調內在工作動機的重要性［5］，認為工作本身對員工具有內在激勵作用，只要通過合理的工作設計，讓員工在工作中產生積極的心理狀態，就能達成符合組織期望的工作結果［6］。該模型將工作特征分為技能多樣性、任務完整性、任務重要性、工作自主性和工作反饋性5個維度：技能多樣性指工作內容需要員工應用多種技能和能力的程度；任務完整性指工作任務為員工提供的全面完成任務的程度；任務重要性指工作結果對他人的工作與生活影響的程度；工作自主性指工作方式允許員工自由獨立地安排工作進度和具體實施方式的程度；工作反饋性指員工能從工作本身得到工作效果信息反饋的程度［7］。這5個維度能影響員工的3種心理狀態，分別為對工作意義的感知、對工作責任的感知和對工作結果的了解，3種心理狀態同時作用會產生良好的個人和工作結果，包括獲得內在動機、對工作感到滿意、高質量完成工作、缺勤率和流動率低等［8］。由于人的心理是難以被精確測量的“黑箱”，因此本研究僅(jin)關(guan)注基(ji)(ji)層(ceng)(ceng)衛(wei)生人員(yuan)工(gong)(gong)(gong)作(zuo)(zuo)(zuo)特(te)征各(ge)維度的(de)(de)(de)現狀及其(qi)與基(ji)(ji)層(ceng)(ceng)衛(wei)生人員(yuan)工(gong)(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果間(jian)的(de)(de)(de)關(guan)系，即探(tan)究(jiu)基(ji)(ji)層(ceng)(ceng)衛(wei)生人員(yuan)工(gong)(gong)(gong)作(zuo)(zuo)(zuo)特(te)征對(dui)其(qi)工(gong)(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果的(de)(de)(de)內在(zai)(zai)激(ji)(ji)(ji)勵(li)(li)作(zuo)(zuo)(zuo)用。此外(wai)，本(ben)研(yan)究(jiu)在(zai)(zai)參考既(ji)往文獻的(de)(de)(de)基(ji)(ji)礎上［9-10］，引入收入、工(gong)(gong)(gong)作(zuo)(zuo)(zuo)量(liang)、工(gong)(gong)(gong)作(zuo)(zuo)(zuo)環境、職業(ye)發展和(he)管理制度5項外(wai)部(bu)激(ji)(ji)(ji)勵(li)(li)因素，檢驗其(qi)對(dui)基(ji)(ji)層(ceng)(ceng)衛(wei)生人員(yuan)工(gong)(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果的(de)(de)(de)外(wai)在(zai)(zai)激(ji)(ji)(ji)勵(li)(li)作(zuo)(zuo)(zuo)用，并將(jiang)外(wai)部(bu)激(ji)(ji)(ji)勵(li)(li)因素的(de)(de)(de)外(wai)在(zai)(zai)激(ji)(ji)(ji)勵(li)(li)作(zuo)(zuo)(zuo)用與工(gong)(gong)(gong)作(zuo)(zuo)(zuo)特(te)征的(de)(de)(de)內在(zai)(zai)激(ji)(ji)(ji)勵(li)(li)作(zuo)(zuo)(zuo)用進行比較，從而回答(da)“內在(zai)(zai)激(ji)(ji)(ji)勵(li)(li)和(he)外(wai)在(zai)(zai)激(ji)(ji)(ji)勵(li)(li)何者(zhe)對(dui)工(gong)(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果的(de)(de)(de)解釋力更(geng)強”這一研(yan)究(jiu)問題（圖1）。

1.2定量研究

1.2.1調查(cha)對象(xiang)采用多階(jie)段抽樣法。首(shou)先根(gen)據地理(li)位(wei)置和(he)經(jing)濟發展水平(ping)，結合考慮是否為醫改試(shi)點城市，選(xuan)擇(ze)(ze)山東(dong)省青島(dao)市、東(dong)營(ying)和(he)棗莊三(san)市；然后，在(zai)每個(ge)城市隨機(ji)選(xuan)擇(ze)(ze)4個(ge)區(qu)（縣）；接著(zhu)，在(zai)每個(ge)區(qu)（縣）隨機(ji)選(xuan)擇(ze)(ze)3~4家(jia)社區(qu)衛生(sheng)(sheng)服務中心和(he)鄉(xiang)鎮(zhen)衛生(sheng)(sheng)院，總計選(xuan)擇(ze)(ze)18家(jia)社區(qu)衛生(sheng)(sheng)服務中心和(he)20家(jia)鄉(xiang)鎮(zhen)衛生(sheng)(sheng)院作為樣本(ben)(ben)來源地。于2021年2—6月展開(kai)現場調研，選(xuan)取各樣本(ben)(ben)來源地調查(cha)當(dang)日在(zai)崗的所有基層衛生(sheng)(sheng)人(ren)員(yuan)為調查(cha)對象(xiang)。本(ben)(ben)研究(jiu)通過了(le)山東(dong)師范大學倫理(li)委員(yuan)會審查(cha)（審批(pi)號：［2022］IRB0528-1），所有調查(cha)對象(xiang)均(jun)在(zai)知情前提下(xia)自愿參與(yu)本(ben)(ben)研究(jiu)。

1.2.2調查工具

1.2.2.1自設問卷調(diao)(diao)(diao)查(cha)(cha)內容包括：（1）調(diao)(diao)(diao)查(cha)(cha)對(dui)象(xiang)(xiang)基本(ben)情況，即性別、年齡、工(gong)(gong)(gong)作(zuo)(zuo)崗(gang)位、學歷、職稱。（2）調(diao)(diao)(diao)查(cha)(cha)對(dui)象(xiang)(xiang)工(gong)(gong)(gong)作(zuo)(zuo)特征現(xian)(xian)狀。從(cong)工(gong)(gong)(gong)作(zuo)(zuo)特征5個維度（技能多(duo)(duo)樣(yang)(yang)性、任務完整性、任務重要性、自主性、反(fan)饋(kui)(kui)性）出發(fa)設置5道題(ti)(ti)(ti)，分別為“工(gong)(gong)(gong)作(zuo)(zuo)中是(shi)否需要掌握全面(mian)的(de)知識和(he)(he)多(duo)(duo)樣(yang)(yang)的(de)技能”“所從(cong)事的(de)工(gong)(gong)(gong)作(zuo)(zuo)完整性如(ru)(ru)何”“工(gong)(gong)(gong)作(zuo)(zuo)是(shi)否有意義(yi)”“工(gong)(gong)(gong)作(zuo)(zuo)中的(de)自主權(quan)如(ru)(ru)何”和(he)(he)“單位能否對(dui)工(gong)(gong)(gong)作(zuo)(zuo)表現(xian)(xian)進行(xing)及時反(fan)饋(kui)(kui)”，各題(ti)(ti)(ti)采用Likert5點計(ji)分法，非(fei)常差(cha)、比(bi)較(jiao)差(cha)、一般、比(bi)較(jiao)好、非(fei)常好分別賦(fu)(fu)1~5分。（3）外部(bu)激勵因(yin)素現(xian)(xian)狀。從(cong)收入、工(gong)(gong)(gong)作(zuo)(zuo)量(liang)(liang)、工(gong)(gong)(gong)作(zuo)(zuo)環(huan)境、職業發(fa)展(zhan)(zhan)和(he)(he)管(guan)理(li)制度5個方(fang)面(mian)出發(fa)設置5道題(ti)(ti)(ti)，分別為“您(nin)(nin)現(xian)(xian)在(zai)年收入是(shi)多(duo)(duo)少萬元”“您(nin)(nin)認為目前自己在(zai)本(ben)單位的(de)工(gong)(gong)(gong)作(zuo)(zuo)量(liang)(liang)如(ru)(ru)何”“您(nin)(nin)認為現(xian)(xian)在(zai)的(de)工(gong)(gong)(gong)作(zuo)(zuo)環(huan)境如(ru)(ru)何”“您(nin)(nin)認為在(zai)本(ben)單位的(de)職業發(fa)展(zhan)(zhan)前景如(ru)(ru)何”和(he)(he)“您(nin)(nin)認為單位的(de)管(guan)理(li)總體(ti)來說如(ru)(ru)何”，除第1題(ti)(ti)(ti)（邀請調(diao)(diao)(diao)查(cha)(cha)對(dui)象(xiang)(xiang)填(tian)寫實際值）外，其余各題(ti)(ti)(ti)采用Likert5點計(ji)分法，“非(fei)常差(cha)”~“非(fei)常好”分別賦(fu)(fu)值1~5分。（3）離(li)職意愿。采用單題(ti)(ti)(ti)項(xiang)(xiang)進行(xing)測量(liang)(liang)。通過直接詢問調(diao)(diao)(diao)查(cha)(cha)對(dui)象(xiang)(xiang)“您(nin)(nin)是(shi)否想要從(cong)現(xian)(xian)在(zai)的(de)單位離(li)職？”得(de)到(dao)答案，該題(ti)(ti)(ti)項(xiang)(xiang)采用Likert5點計(ji)分法，“非(fei)常不想”~“非(fei)常想”分別賦(fu)(fu)1~5分。

1.2.2.2改(gai)編版(ban)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)動(dong)(dong)機(ji)(ji)(ji)(ji)量(liang)表由研究者對TREMBLAY等［4］研制的(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)動(dong)(dong)機(ji)(ji)(ji)(ji)量(liang)表進行(xing)改(gai)編，形成(cheng)改(gai)編版(ban)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)動(dong)(dong)機(ji)(ji)(ji)(ji)量(liang)表。采用改(gai)編版(ban)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)動(dong)(dong)機(ji)(ji)(ji)(ji)量(liang)表評價調(diao)查對象(xiang)的(de)(de)自(zi)主(zhu)(zhu)動(dong)(dong)機(ji)(ji)(ji)(ji)水平(ping)，其包(bao)括6個條(tiao)目(mu)，分(fen)(fen)(fen)(fen)別為(wei)(wei)“因(yin)為(wei)(wei)我熱(re)愛這份工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)”“因(yin)為(wei)(wei)我覺得(de)(de)(de)現在的(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)很有趣”“因(yin)為(wei)(wei)我喜歡工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)的(de)(de)內容”“因(yin)為(wei)(wei)投身(shen)醫療(liao)衛生事業(ye)是我的(de)(de)人生目(mu)標”“因(yin)為(wei)(wei)我的(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)對患者非(fei)(fei)常重要(yao)”“因(yin)為(wei)(wei)我想為(wei)(wei)他人和社會做出貢獻”。各條(tiao)目(mu)采用Likert7點計分(fen)(fen)(fen)(fen)法，“非(fei)(fei)常不(bu)同(tong)意”~“非(fei)(fei)常同(tong)意”分(fen)(fen)(fen)(fen)別賦1~7分(fen)(fen)(fen)(fen)，各條(tiao)目(mu)得(de)(de)(de)分(fen)(fen)(fen)(fen)相加(jia)即得(de)(de)(de)總分(fen)(fen)(fen)(fen)，得(de)(de)(de)分(fen)(fen)(fen)(fen)范圍為(wei)(wei)6~42分(fen)(fen)(fen)(fen)，得(de)(de)(de)分(fen)(fen)(fen)(fen)越(yue)高表明自(zi)主(zhu)(zhu)動(dong)(dong)機(ji)(ji)(ji)(ji)水平(ping)越(yue)高。本研究中(zhong)，改(gai)編版(ban)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)動(dong)(dong)機(ji)(ji)(ji)(ji)量(liang)表的(de)(de)Cronbach'sα系數(shu)為(wei)(wei)0.862。

1.2.2.3改(gai)(gai)編(bian)(bian)版(ban)(ban)工(gong)(gong)(gong)(gong)(gong)作(zuo)績(ji)效量表由研究者對趙世超［3］編(bian)(bian)制的(de)工(gong)(gong)(gong)(gong)(gong)作(zuo)績(ji)效量表進行改(gai)(gai)編(bian)(bian)，形成改(gai)(gai)編(bian)(bian)版(ban)(ban)工(gong)(gong)(gong)(gong)(gong)作(zuo)績(ji)效量表。采用(yong)改(gai)(gai)編(bian)(bian)版(ban)(ban)工(gong)(gong)(gong)(gong)(gong)作(zuo)績(ji)效量表測(ce)量調查對象的(de)工(gong)(gong)(gong)(gong)(gong)作(zuo)績(ji)效水(shui)平(ping)(ping)(ping)，其(qi)包括10個條目(mu)，分別(bie)(bie)為“我(wo)(wo)(wo)的(de)工(gong)(gong)(gong)(gong)(gong)作(zuo)數量高(gao)于(yu)(yu)組(zu)(zu)織(zhi)的(de)平(ping)(ping)(ping)均(jun)水(shui)平(ping)(ping)(ping)”“我(wo)(wo)(wo)的(de)工(gong)(gong)(gong)(gong)(gong)作(zuo)質量高(gao)于(yu)(yu)組(zu)(zu)織(zhi)的(de)平(ping)(ping)(ping)均(jun)水(shui)平(ping)(ping)(ping)”“我(wo)(wo)(wo)的(de)工(gong)(gong)(gong)(gong)(gong)作(zuo)效率高(gao)于(yu)(yu)組(zu)(zu)織(zhi)的(de)平(ping)(ping)(ping)均(jun)水(shui)平(ping)(ping)(ping)”“我(wo)(wo)(wo)經(jing)常(chang)主(zhu)(zhu)動(dong)加班”“我(wo)(wo)(wo)經(jing)常(chang)主(zhu)(zhu)動(dong)幫(bang)助同(tong)事解(jie)決其(qi)工(gong)(gong)(gong)(gong)(gong)作(zuo)中的(de)問題”“我(wo)(wo)(wo)經(jing)常(chang)主(zhu)(zhu)動(dong)為組(zu)(zu)織(zhi)提出合理的(de)意見和(he)建議”“我(wo)(wo)(wo)經(jing)常(chang)主(zhu)(zhu)動(dong)給身邊的(de)人宣傳和(he)推(tui)薦(jian)我(wo)(wo)(wo)的(de)單(dan)位”“我(wo)(wo)(wo)重視學(xue)(xue)(xue)習，有非(fei)(fei)常(chang)強(qiang)烈的(de)學(xue)(xue)(xue)習意愿”“我(wo)(wo)(wo)利用(yong)各種渠(qu)道學(xue)(xue)(xue)習了(le)很(hen)多職業(ye)知識和(he)技能”“我(wo)(wo)(wo)通過學(xue)(xue)(xue)習提高(gao)了(le)自身能力并學(xue)(xue)(xue)以致(zhi)用(yong)”。各條目(mu)采用(yong)Likert7點計分法，“非(fei)(fei)常(chang)不同(tong)意”~“非(fei)(fei)常(chang)同(tong)意”分別(bie)(bie)賦(fu)1~7分，各條目(mu)得(de)(de)分相加即得(de)(de)總分，得(de)(de)分范圍為7~70分，得(de)(de)分越(yue)高(gao)表明工(gong)(gong)(gong)(gong)(gong)作(zuo)績(ji)效水(shui)平(ping)(ping)(ping)越(yue)高(gao)。本研究中，改(gai)(gai)編(bian)(bian)版(ban)(ban)工(gong)(gong)(gong)(gong)(gong)作(zuo)績(ji)效量表的(de)Cronbach'sα系(xi)數為0.909。

1.2.2.4中(zhong)(zhong)(zhong)(zhong)文(wen)(wen)版(ban)Maslach工作倦怠(dai)(dai)量表(biao)（MBI）MBI由(you)MASLACH等［11］編(bian)制(zhi)。采用中(zhong)(zhong)(zhong)(zhong)文(wen)(wen)版(ban)MBI中(zhong)(zhong)(zhong)(zhong)的(de)情感耗(hao)竭維度測量調(diao)(diao)(diao)查(cha)對(dui)(dui)象(xiang)的(de)職業倦怠(dai)(dai)水平。中(zhong)(zhong)(zhong)(zhong)文(wen)(wen)版(ban)MBI情感耗(hao)竭維度包(bao)括9個條(tiao)(tiao)目(mu)，各條(tiao)(tiao)目(mu)采用Likert7點計分法，“從來沒有”~“每天都有”分別賦0~6分，各條(tiao)(tiao)目(mu)得(de)(de)分相加即得(de)(de)總分，得(de)(de)分范圍為(wei)0~54分，得(de)(de)分越高(gao)表(biao)明(ming)職業倦怠(dai)(dai)水平越高(gao)。本研究(jiu)中(zhong)(zhong)(zhong)(zhong)，中(zhong)(zhong)(zhong)(zhong)文(wen)(wen)版(ban)MBI中(zhong)(zhong)(zhong)(zhong)的(de)情感耗(hao)竭維度的(de)Cronbach'sα系數為(wei)0.880。1.2.3調(diao)(diao)(diao)查(cha)過(guo)程(cheng)與質量控(kong)制(zhi)調(diao)(diao)(diao)查(cha)開始前，對(dui)(dui)調(diao)(diao)(diao)查(cha)員(yuan)進(jin)行(xing)統一培訓，使其熟悉調(diao)(diao)(diao)查(cha)目(mu)的(de)、內容和質量控(kong)制(zhi)措施。調(diao)(diao)(diao)查(cha)當(dang)天，調(diao)(diao)(diao)查(cha)員(yuan)將(jiang)問(wen)(wen)(wen)卷(juan)發放給調(diao)(diao)(diao)查(cha)對(dui)(dui)象(xiang)后，對(dui)(dui)調(diao)(diao)(diao)查(cha)目(mu)的(de)和填(tian)寫(xie)(xie)注意事項作出(chu)說明(ming)，調(diao)(diao)(diao)查(cha)對(dui)(dui)象(xiang)自行(xing)填(tian)寫(xie)(xie)問(wen)(wen)(wen)卷(juan)，填(tian)寫(xie)(xie)問(wen)(wen)(wen)卷(juan)期(qi)間由(you)調(diao)(diao)(diao)查(cha)員(yuan)進(jin)行(xing)指導與監督。問(wen)(wen)(wen)卷(juan)填(tian)寫(xie)(xie)完成后，調(diao)(diao)(diao)查(cha)員(yuan)現場檢(jian)查(cha)所(suo)填(tian)內容有無(wu)邏(luo)輯錯(cuo)誤，如有邏(luo)輯錯(cuo)誤則(ze)讓(rang)調(diao)(diao)(diao)查(cha)對(dui)(dui)象(xiang)進(jin)行(xing)修改，經檢(jian)查(cha)確認無(wu)誤后回收問(wen)(wen)(wen)卷(juan)。

1.2.4統計學(xue)方(fang)法使(shi)用DataEasy軟(ruan)件雙錄入數據，并對(dui)(dui)(dui)錄入數據進(jin)行一致性(xing)檢驗(yan)。借(jie)助SPSS21.0軟(ruan)件對(dui)(dui)(dui)數據進(jin)行統計分(fen)析。正態分(fen)布的(de)計量(liang)資料(liao)以(yi)（x-±s）表示；計數資料(liao)以(yi)相(xiang)對(dui)(dui)(dui)數表示。采用Pearson相(xiang)關分(fen)析工(gong)作特(te)(te)征(zheng)各(ge)維度(du)及各(ge)項(xiang)外部激(ji)勵因素與基(ji)層衛生人員自(zi)主動(dong)機、工(gong)作績效、職業倦(juan)怠(dai)、離職意(yi)愿之間的(de)相(xiang)關性(xing)，采用多元分(fen)層線性(xing)回歸分(fen)析工(gong)作特(te)(te)征(zheng)五維度(du)及外部激(ji)勵因素對(dui)(dui)(dui)工(gong)作結果的(de)影(ying)響及其(qi)程度(du)。以(yi)P<0.05為(wei)差(cha)異有統計學(xue)意(yi)義。

1.3定性研究

1.3.1訪談對(dui)象采用方便抽樣(yang)法(fa)，根據(ju)基層醫療衛(wei)生機構的(de)人員規模，從每家機構中(zhong)選取(qu)4~5例完成調查的(de)基層衛(wei)生人員者作為訪談對(dui)象。訪談對(dui)象均對(dui)本研(yan)究(jiu)知情，并自愿參與(yu)本研(yan)究(jiu)。

1.3.2研究(jiu)方法

1.3.2.1訪(fang)(fang)(fang)談(tan)數(shu)據(ju)收集(ji)首先，在(zai)文獻研究的(de)(de)(de)基礎上(shang)初步制定(ding)訪(fang)(fang)(fang)談(tan)提(ti)(ti)綱，經課題(ti)組成(cheng)員討論與(yu)修改后敲定(ding)最終(zhong)的(de)(de)(de)訪(fang)(fang)(fang)談(tan)提(ti)(ti)綱，內(nei)容(rong)(rong)包(bao)括“您如何評價(jia)現在(zai)的(de)(de)(de)這份(fen)工作(zuo)(zuo)（如是(shi)(shi)否(fou)有(you)意(yi)(yi)(yi)義、是(shi)(shi)否(fou)有(you)成(cheng)就感、是(shi)(shi)否(fou)自(zi)主(zhu)）？”“對(dui)(dui)(dui)工作(zuo)(zuo)本(ben)身(shen)（工作(zuo)(zuo)內(nei)容(rong)(rong)和(he)性(xing)質）的(de)(de)(de)哪些因素感到(dao)滿(man)意(yi)(yi)(yi)或不滿(man)意(yi)(yi)(yi)？”“有(you)沒有(you)一些特(te)別(bie)能(neng)提(ti)(ti)高你(ni)工作(zuo)(zuo)積極性(xing)的(de)(de)(de)事(shi)情，以(yi)及特(te)別(bie)打擊你(ni)工作(zuo)(zuo)積極性(xing)的(de)(de)(de)事(shi)情？”。由經過培訓的(de)(de)(de)訪(fang)(fang)(fang)談(tan)員在(zai)機(ji)構對(dui)(dui)(dui)訪(fang)(fang)(fang)談(tan)對(dui)(dui)(dui)象進行(xing)“一對(dui)(dui)(dui)一、面對(dui)(dui)(dui)面的(de)(de)(de)半(ban)結(jie)構化訪(fang)(fang)(fang)談(tan)，詢問(wen)基層衛生人員對(dui)(dui)(dui)工作(zuo)(zuo)的(de)(de)(de)感受與(yu)評價(jia)。在(zai)訪(fang)(fang)(fang)談(tan)對(dui)(dui)(dui)象知情，且獲取(qu)其同意(yi)(yi)(yi)的(de)(de)(de)情況(kuang)下，訪(fang)(fang)(fang)談(tan)過程(cheng)(cheng)全(quan)(quan)程(cheng)(cheng)錄音(yin)，對(dui)(dui)(dui)訪(fang)(fang)(fang)談(tan)進行(xing)全(quan)(quan)程(cheng)(cheng)錄音(yin)。每次訪(fang)(fang)(fang)談(tan)的(de)(de)(de)時間為20~30min。

1.3.2.2資料整理與分析于訪(fang)談結(jie)束(shu)15d內，將錄音逐字轉錄為(wei)文本，資料的(de)整理與分析同(tong)步進(jin)(jin)(jin)(jin)行(xing)。采用主題框(kuang)架法對資料進(jin)(jin)(jin)(jin)行(xing)分析。首先把工作(zuo)(zuo)特(te)征模型(xing)的(de)5個維(wei)度作(zuo)(zuo)為(wei)5個編(bian)碼名(ming)，然后(hou)(hou)借助MAXQDA軟(ruan)件(jian)對訪(fang)談內容(rong)進(jin)(jin)(jin)(jin)行(xing)編(bian)碼，將可體現某(mou)一維(wei)度工作(zuo)(zuo)特(te)征的(de)訪(fang)談內容(rong)歸類到相應的(de)編(bian)碼名(ming)下，最后(hou)(hou)對每個編(bian)碼名(ming)下的(de)訪(fang)談內容(rong)進(jin)(jin)(jin)(jin)行(xing)匯總分析，提煉研(yan)究結(jie)論。

2結果

2.1定量研究結果

2.1.1基(ji)層衛生人員(yuan)一(yi)般(ban)資料共(gong)回收有效(xiao)問卷870份。基(ji)層衛生人員(yuan)中，22.5%（194/862）為(wei)(wei)(wei)男性(xing)，77.5%（668/862）為(wei)(wei)(wei)女性(xing)；21.6%（186/860）年齡為(wei)(wei)(wei)30歲(sui)以(yi)下(xia)，32.3%（278/860）年齡為(wei)(wei)(wei)30~39歲(sui)，37.3%（321/860）年齡為(wei)(wei)(wei)40~49歲(sui)，8.8%（75/860）年齡為(wei)(wei)(wei)50歲(sui)以(yi)上；工作崗位方面，39.4%（337/856）為(wei)(wei)(wei)醫生，29.8%（255/856）為(wei)(wei)(wei)護士，8.5%在(zai)（73/856）為(wei)(wei)(wei)公共(gong)衛生人員(yuan)，16.0%（137/856）為(wei)(wei)(wei)醫技(ji)人員(yuan)，6.3%（54/856）為(wei)(wei)(wei)行政后勤人員(yuan)；學(xue)(xue)(xue)歷(li)方面，8.1%（70/863）學(xue)(xue)(xue)歷(li)為(wei)(wei)(wei)高(gao)中/中專及以(yi)下(xia)，32.8%（283/863）學(xue)(xue)(xue)歷(li)為(wei)(wei)(wei)大專，59.1%（510/863）學(xue)(xue)(xue)歷(li)為(wei)(wei)(wei)本(ben)科(ke)及以(yi)上；職稱(cheng)(cheng)方面，20.3%（173/851）無職稱(cheng)(cheng)，37.4%（318/851）職稱(cheng)(cheng)為(wei)(wei)(wei)初級，36.1%（307/851）職稱(cheng)(cheng)為(wei)(wei)(wei)中級，6.2%（53/851）職稱(cheng)(cheng)為(wei)(wei)(wei)高(gao)級。

2.1.2基層(ceng)衛生人(ren)員工作特征現狀基層(ceng)衛生人(ren)員在技能多樣性(xing)維(wei)度(du)上(shang)的(de)(de)平均得(de)(de)分(fen)最高，為(wei)（4.09±0.71）分(fen)，自(zi)評結(jie)果為(wei)“比較好”和(he)“非(fei)常好”者占(zhan)比達84.1%（728/866）；在任務(wu)完整性(xing)維(wei)度(du)上(shang)的(de)(de)平均得(de)(de)分(fen)最低，為(wei)（3.18±1.04）分(fen)，自(zi)評結(jie)果為(wei)“非(fei)常差”和(he)“比較差”者占(zhan)比達到28.5%（247/867）；在其(qi)他(ta)任務(wu)重要性(xing)、工作反饋性(xing)、工作自(zi)主性(xing)3個維(wei)度(du)上(shang)的(de)(de)平均得(de)(de)分(fen)分(fen)別為(wei)（3.91±0.76）、（3.46±0.83）、（3.43±0.79）分(fen)（表1）。

2.1.3基層(ceng)衛(wei)生(sheng)人(ren)員外部激勵現狀基層(ceng)衛(wei)生(sheng)人(ren)員平均年收入為(wei)（5.77±2.79）萬元，對(dui)工作量(liang)、工作環境(jing)、職業發展、管理制度評分(fen)的均值順(shun)次(ci)為(wei)（3.58±0.64）、（3.52±0.71）、（3.35±0.77）、（3.68±0.82）分(fen)。

2.1.4基層衛生人員改編(bian)版工作外在(zai)(zai)動(dong)(dong)機(ji)和(he)內在(zai)(zai)動(dong)(dong)機(ji)量(liang)表(biao)(biao)、改編(bian)版工作績效量(liang)表(biao)(biao)、中文(wen)版MBI情(qing)感耗竭維度(du)、離職意愿(yuan)得分基層衛生人員改編(bian)版工作外在(zai)(zai)動(dong)(dong)機(ji)和(he)內在(zai)(zai)動(dong)(dong)機(ji)量(liang)表(biao)(biao)、改編(bian)版工作績效量(liang)表(biao)(biao)、中文(wen)版MBI情(qing)感耗竭維度(du)、離職意愿(yuan)平均(jun)得分順次為（31.43±7.44）、（50.17±10.22）、（17.31±11.51）、（2.35±0.98）分。

2.1.5基(ji)層衛生人員工(gong)(gong)(gong)作(zuo)特(te)征(zheng)(zheng)與其工(gong)(gong)(gong)作(zuo)結果間的相(xiang)關(guan)(guan)性(xing)分析(xi)基(ji)層衛生人員工(gong)(gong)(gong)作(zuo)特(te)征(zheng)(zheng)各維度(du)(du)與其各工(gong)(gong)(gong)作(zuo)結果間具(ju)有(you)相(xiang)關(guan)(guan)性(xing)（P<0.05），其中自主動(dong)機、工(gong)(gong)(gong)作(zuo)績效與工(gong)(gong)(gong)作(zuo)特(te)征(zheng)(zheng)五(wu)維度(du)(du)呈正(zheng)相(xiang)關(guan)(guan)，職(zhi)業倦(juan)怠和離職(zhi)意愿與工(gong)(gong)(gong)作(zuo)特(te)征(zheng)(zheng)五(wu)維度(du)(du)呈負相(xiang)關(guan)(guan)（表2）。

2.1.6外(wai)部(bu)激勵因(yin)素與基(ji)(ji)(ji)層衛(wei)生人員(yuan)(yuan)工(gong)作(zuo)結果(guo)間的(de)相(xiang)(xiang)關(guan)性分析收入、工(gong)作(zuo)量、職(zhi)業(ye)發展、管理制度與基(ji)(ji)(ji)層衛(wei)生人員(yuan)(yuan)各工(gong)作(zuo)結果(guo)間具有(you)相(xiang)(xiang)關(guan)性（P<0.05），工(gong)作(zuo)環境與基(ji)(ji)(ji)層衛(wei)生人員(yuan)(yuan)自主(zhu)動機、職(zhi)業(ye)倦怠、離職(zhi)意愿間具有(you)相(xiang)(xiang)關(guan)性（P<0.05，表3）。

2.1.7工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)特征(zheng)(zheng)五維(wei)度及(ji)外(wai)部(bu)激(ji)(ji)(ji)勵(li)因(yin)素(su)對(dui)(dui)(dui)(dui)基(ji)層(ceng)衛(wei)生人員工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果的(de)影(ying)響(xiang)及(ji)其程度的(de)多(duo)(duo)元(yuan)分(fen)(fen)(fen)層(ceng)線(xian)性(xing)(xing)(xing)(xing)回歸(gui)分(fen)(fen)(fen)析(xi)分(fen)(fen)(fen)別(bie)(bie)以(yi)(yi)基(ji)層(ceng)衛(wei)生人員改(gai)(gai)編版(ban)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)動(dong)(dong)機量(liang)(liang)(liang)表自(zi)主(zhu)動(dong)(dong)機維(wei)度得分(fen)(fen)(fen)、改(gai)(gai)編版(ban)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)績(ji)效(xiao)量(liang)(liang)(liang)表得分(fen)(fen)(fen)、中文版(ban)MBI情(qing)感(gan)耗竭維(wei)度得分(fen)(fen)(fen)、離職意愿(yuan)得分(fen)(fen)(fen)為(wei)因(yin)變(bian)(bian)量(liang)(liang)(liang)（賦值(zhi)(zhi)：原值(zhi)(zhi)進入），針對(dui)(dui)(dui)(dui)每個(ge)(ge)(ge)(ge)因(yin)變(bian)(bian)量(liang)(liang)(liang)，均(jun)采用(yong)多(duo)(duo)元(yuan)分(fen)(fen)(fen)層(ceng)線(xian)性(xing)(xing)(xing)(xing)回歸(gui)法(fa)建立3個(ge)(ge)(ge)(ge)模(mo)型。第1步，以(yi)(yi)性(xing)(xing)(xing)(xing)別(bie)(bie)、年(nian)齡、工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)崗位、學歷和(he)(he)職稱(cheng)5個(ge)(ge)(ge)(ge)人口學變(bian)(bian)量(liang)(liang)(liang)作(zuo)(zuo)(zuo)(zuo)為(wei)自(zi)變(bian)(bian)量(liang)(liang)(liang)，建立模(mo)型1。第2步，以(yi)(yi)性(xing)(xing)(xing)(xing)別(bie)(bie)、年(nian)齡、工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)崗位、學歷和(he)(he)職稱(cheng)5個(ge)(ge)(ge)(ge)變(bian)(bian)量(liang)(liang)(liang)作(zuo)(zuo)(zuo)(zuo)為(wei)控制(zhi)變(bian)(bian)量(liang)(liang)(liang)，以(yi)(yi)調查對(dui)(dui)(dui)(dui)象在(zai)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)特征(zheng)(zheng)5個(ge)(ge)(ge)(ge)維(wei)度上(shang)的(de)得分(fen)(fen)(fen)作(zuo)(zuo)(zuo)(zuo)為(wei)自(zi)變(bian)(bian)量(liang)(liang)(liang)（賦值(zhi)(zhi)：原值(zhi)(zhi)進入），建立模(mo)型2；第3步，在(zai)模(mo)型2的(de)基(ji)礎上(shang)，將收入，以(yi)(yi)及(ji)對(dui)(dui)(dui)(dui)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)量(liang)(liang)(liang)、工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)環境、職業發展和(he)(he)管理制(zhi)度的(de)評分(fen)(fen)(fen)亦作(zuo)(zuo)(zuo)(zuo)為(wei)自(zi)變(bian)(bian)量(liang)(liang)(liang)（賦值(zhi)(zhi)：原值(zhi)(zhi)進入）納入分(fen)(fen)(fen)析(xi)，建立模(mo)型3。模(mo)型3結(jie)(jie)果顯(xian)示(shi)(shi)：（1）人口學變(bian)(bian)量(liang)(liang)(liang)對(dui)(dui)(dui)(dui)4個(ge)(ge)(ge)(ge)因(yin)變(bian)(bian)量(liang)(liang)(liang)的(de)影(ying)響(xiang)均(jun)較小(xiao)，其對(dui)(dui)(dui)(dui)自(zi)主(zhu)動(dong)(dong)機、工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)績(ji)效(xiao)、職業倦(juan)(juan)(juan)怠和(he)(he)離職意愿(yuan)的(de)貢(gong)獻率（R2）分(fen)(fen)(fen)別(bie)(bie)為(wei)5.9%、7.5%、3.0%和(he)(he)8.5%；（2）工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)特征(zheng)(zheng)5個(ge)(ge)(ge)(ge)維(wei)度對(dui)(dui)(dui)(dui)自(zi)主(zhu)動(dong)(dong)機、工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)績(ji)效(xiao)、職業倦(juan)(juan)(juan)怠、離職意愿(yuan)4個(ge)(ge)(ge)(ge)因(yin)變(bian)(bian)量(liang)(liang)(liang)的(de)貢(gong)獻率（R2）分(fen)(fen)(fen)別(bie)(bie)為(wei)18.8%、11.3%、16.5%和(he)(he)21.9%，而(er)外(wai)部(bu)激(ji)(ji)(ji)勵(li)5個(ge)(ge)(ge)(ge)因(yin)素(su)對(dui)(dui)(dui)(dui)4個(ge)(ge)(ge)(ge)因(yin)變(bian)(bian)量(liang)(liang)(liang)的(de)貢(gong)獻率（R2）分(fen)(fen)(fen)別(bie)(bie)為(wei)1.7%、3.4%、5.8%和(he)(he)11.8%，提示(shi)(shi)對(dui)(dui)(dui)(dui)于(yu)同一工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)結(jie)(jie)果而(er)言，工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)特征(zheng)(zheng)5維(wei)度所(suo)產生的(de)內在(zai)激(ji)(ji)(ji)勵(li)作(zuo)(zuo)(zuo)(zuo)用(yong)大于(yu)5個(ge)(ge)(ge)(ge)外(wai)在(zai)激(ji)(ji)(ji)勵(li)因(yin)素(su)所(suo)產生外(wai)在(zai)激(ji)(ji)(ji)勵(li)作(zuo)(zuo)(zuo)(zuo)用(yong)；（3）技(ji)能多(duo)(duo)樣性(xing)(xing)(xing)(xing)、任(ren)(ren)務(wu)完(wan)整性(xing)(xing)(xing)(xing)和(he)(he)任(ren)(ren)務(wu)重(zhong)(zhong)要性(xing)(xing)(xing)(xing)對(dui)(dui)(dui)(dui)自(zi)主(zhu)動(dong)(dong)機有(you)(you)正(zheng)向(xiang)影(ying)響(xiang)，技(ji)能多(duo)(duo)樣性(xing)(xing)(xing)(xing)和(he)(he)任(ren)(ren)務(wu)重(zhong)(zhong)要性(xing)(xing)(xing)(xing)對(dui)(dui)(dui)(dui)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)績(ji)效(xiao)有(you)(you)正(zheng)向(xiang)影(ying)響(xiang)，任(ren)(ren)務(wu)完(wan)整性(xing)(xing)(xing)(xing)、任(ren)(ren)務(wu)重(zhong)(zhong)要性(xing)(xing)(xing)(xing)和(he)(he)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)自(zi)主(zhu)性(xing)(xing)(xing)(xing)對(dui)(dui)(dui)(dui)職業倦(juan)(juan)(juan)怠有(you)(you)負向(xiang)影(ying)響(xiang)，任(ren)(ren)務(wu)重(zhong)(zhong)要性(xing)(xing)(xing)(xing)和(he)(he)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)自(zi)主(zhu)性(xing)(xing)(xing)(xing)對(dui)(dui)(dui)(dui)離職意愿(yuan)有(you)(you)負向(xiang)影(ying)響(xiang)（P<0.05）；（4）任(ren)(ren)務(wu)重(zhong)(zhong)要性(xing)(xing)(xing)(xing)是對(dui)(dui)(dui)(dui)4個(ge)(ge)(ge)(ge)因(yin)變(bian)(bian)量(liang)(liang)(liang)均(jun)有(you)(you)影(ying)響(xiang)的(de)工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)特征(zheng)(zheng)維(wei)度，工(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)量(liang)(liang)(liang)是對(dui)(dui)(dui)(dui)4個(ge)(ge)(ge)(ge)因(yin)變(bian)(bian)量(liang)(liang)(liang)均(jun)有(you)(you)影(ying)響(xiang)的(de)外(wai)部(bu)激(ji)(ji)(ji)勵(li)因(yin)素(su)（表4）。

2.2定性(xing)研究結(jie)果

2.2.1訪談(tan)對象一般資料共對167例(li)基(ji)層衛生(sheng)人員(yuan)(yuan)進行訪談(tan)，其中醫生(sheng)53例(li)（31.7%），護士36例(li)（21.6%），公共衛生(sheng)人員(yuan)(yuan)41例(li)（24.5%），醫技人員(yuan)(yuan)37例(li)（22.2%）。

2.2.2訪談結(jie)果(guo)訪談結(jie)果(guo)顯示，不(bu)同人員對基層(ceng)衛生(sheng)工(gong)(gong)作的評價(jia)差異較大，但(dan)在(zai)某些問題上達成一些共(gong)識，如不(bu)少人員認(ren)為自(zi)身工(gong)(gong)作技能(neng)需進一步提高，并(bing)指出工(gong)(gong)作中存在(zai)工(gong)(gong)作任(ren)務完(wan)整性不(bu)足(zu)、工(gong)(gong)作內(nei)容繁多瑣碎、工(gong)(gong)作自(zi)主(zhu)性受一定限制、反饋(kui)機制不(bu)足(zu)等問題（表5）。

3討論

3.1完(wan)(wan)成工(gong)作需(xu)(xu)要基(ji)層衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)具備多(duo)(duo)樣(yang)的(de)技(ji)(ji)能(neng)(neng)(neng)，但(dan)培(pei)訓(xun)不(bu)足可能(neng)(neng)(neng)削弱工(gong)作特征技(ji)(ji)能(neng)(neng)(neng)多(duo)(duo)樣(yang)性(xing)維度(du)(du)(du)的(de)內在激(ji)(ji)(ji)勵(li)作用在工(gong)作特征5個維度(du)(du)(du)中，調查對象在技(ji)(ji)能(neng)(neng)(neng)多(duo)(duo)樣(yang)性(xing)維度(du)(du)(du)上的(de)平(ping)均(jun)得(de)分最高，自評結果為“比較好(hao)”和“非常(chang)好(hao)”者占(zhan)比超過(guo)80%，說明大多(duo)(duo)數基(ji)層衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)認為完(wan)(wan)成工(gong)作需(xu)(xu)要其(qi)掌握較多(duo)(duo)的(de)知識(shi)和技(ji)(ji)能(neng)(neng)(neng)。在全面(mian)推進分級診療制度(du)(du)(du)建設的(de)背景下，衛(wei)(wei)生(sheng)(sheng)(sheng)健康行政部門對基(ji)層衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)提出(chu)了更(geng)高要求，家(jia)庭醫生(sheng)(sheng)(sheng)簽約服務及“醫防融合”的(de)深入推進、新(xin)型冠(guan)狀病毒感染疫情常(chang)態化(hua)防控措(cuo)施的(de)貫(guan)徹落(luo)實等(deng)［12］，都需(xu)(xu)要基(ji)層衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)具有較高的(de)知識(shi)和技(ji)(ji)能(neng)(neng)(neng)水平(ping)。但(dan)在訪(fang)談中，一(yi)(yi)些基(ji)層衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)談到自身因(yin)能(neng)(neng)(neng)力(li)不(bu)足無法完(wan)(wan)全勝任這一(yi)(yi)角色(se)，而(er)接受培(pei)訓(xun)的(de)機會(hui)較少(shao)，以及培(pei)訓(xun)內容陳舊(jiu)、針(zhen)對性(xing)不(bu)強等(deng)因(yin)素會(hui)使其(qi)因(yin)無法完(wan)(wan)全勝任角色(se)而(er)產生(sheng)(sheng)(sheng)的(de)焦(jiao)慮情緒進一(yi)(yi)步加劇(ju)，這與其(qi)他研究的(de)結果相似［13-14］。外在資源的(de)不(bu)匹配可能(neng)(neng)(neng)會(hui)削弱工(gong)作技(ji)(ji)能(neng)(neng)(neng)多(duo)(duo)樣(yang)性(xing)的(de)激(ji)(ji)(ji)勵(li)作用［15］，甚至會(hui)增強勝任感缺乏的(de)去(qu)激(ji)(ji)(ji)勵(li)作用。

3.2基(ji)(ji)(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)工作(zuo)較為碎片化(hua)，基(ji)(ji)(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)服務(wu)(wu)(wu)連(lian)續性(xing)(xing)和(he)綜合(he)性(xing)(xing)特征(zheng)(zheng)尚未(wei)很好突顯在工作(zuo)特征(zheng)(zheng)5個維(wei)度中，調查對象在任務(wu)(wu)(wu)完(wan)整(zheng)(zheng)性(xing)(xing)維(wei)度上(shang)(shang)的(de)平均得分最低(di)，自評結果(guo)為“非常差”和(he)“比(bi)較差”者占比(bi)例(li)接近30%，證(zheng)明(ming)當前基(ji)(ji)(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)工作(zuo)較為碎片化(hua)。基(ji)(ji)(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)人員常需同(tong)時面對不同(tong)上(shang)(shang)級(ji)部(bu)(bu)門布置的(de)任務(wu)(wu)(wu)/同(tong)時接受不同(tong)上(shang)(shang)級(ji)部(bu)(bu)門的(de)考核，不少基(ji)(ji)(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)人員要同(tong)時基(ji)(ji)(ji)(ji)本提供醫(yi)療服務(wu)(wu)(wu)和(he)公(gong)共衛(wei)(wei)(wei)(wei)(wei)生(sheng)服務(wu)(wu)(wu)，在完(wan)成專業技(ji)術(shu)工作(zuo)之余還要處(chu)理“填表報數”等繁瑣的(de)行政事(shi)務(wu)(wu)(wu)［16］。基(ji)(ji)(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)服務(wu)(wu)(wu)本應是建立在醫(yi)患彼此熟悉基(ji)(ji)(ji)(ji)礎(chu)上(shang)(shang)的(de)連(lian)續性(xing)(xing)、綜合(he)性(xing)(xing)衛(wei)(wei)(wei)(wei)(wei)生(sheng)服務(wu)(wu)(wu)［17］，工作(zuo)完(wan)整(zheng)(zheng)性(xing)(xing)較差從側(ce)面反映出基(ji)(ji)(ji)(ji)層(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)人員“健康守門人”的(de)作(zuo)用可能尚未(wei)得到很好發揮。

3.3醫(yi)改政策目標(biao)突(tu)顯基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)健(jian)康工作(zuo)(zuo)的(de)(de)(de)重要(yao)(yao)性，但基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)及居民對基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)健(jian)康工作(zuo)(zuo)的(de)(de)(de)認同(tong)感有待增強調查對象在(zai)(zai)任務(wu)(wu)重要(yao)(yao)性維(wei)度(du)上的(de)(de)(de)平(ping)均得分同(tong)樣較高，接近75%的(de)(de)(de)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)在(zai)(zai)任務(wu)(wu)重要(yao)(yao)性維(wei)度(du)上的(de)(de)(de)自(zi)評結(jie)果為(wei)“比較高”和“非常高”，說明(ming)大部分基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)從(cong)內心認可基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)工作(zuo)(zuo)的(de)(de)(de)重要(yao)(yao)性，但仍有少(shao)部分基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)認為(wei)自(zi)身所(suo)從(cong)事的(de)(de)(de)工作(zuo)(zuo)缺乏意義。根據訪談結(jie)果，總結(jie)出兩個可能的(de)(de)(de)原(yuan)因(yin)：第(di)一，部分地方對基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)機(ji)構(gou)(gou)的(de)(de)(de)財政投入不足(zu)，人(ren)(ren)(ren)、財、物等資(zi)源有限的(de)(de)(de)情(qing)況下，外加業務(wu)(wu)范(fan)圍、服(fu)務(wu)(wu)價格、藥品和醫(yi)保(bao)基(ji)(ji)金使用(yong)等受到(dao)(dao)嚴格的(de)(de)(de)監(jian)管［18］，導致基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)醫(yi)療衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)機(ji)構(gou)(gou)醫(yi)療服(fu)務(wu)(wu)范(fan)圍逐漸(jian)萎(wei)縮甚(shen)至基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)醫(yi)療機(ji)構(gou)(gou)無(wu)法提供部分醫(yi)療服(fu)務(wu)(wu)。第(di)二(er)，公共衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)服(fu)務(wu)(wu)普遍難(nan)以(yi)得到(dao)(dao)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)和居民的(de)(de)(de)認同(tong)。這是因(yin)為(wei)公共衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)服(fu)務(wu)(wu)的(de)(de)(de)效(xiao)果在(zai)(zai)短期內難(nan)以(yi)被居民感知，而在(zai)(zai)考(kao)核壓力(li)下，基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)公共衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)服(fu)務(wu)(wu)工作(zuo)(zuo)中存(cun)在(zai)(zai)形式主(zhu)義和文牘主(zhu)義傾(qing)向［19］，導致基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)和居民對基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)工作(zuo)(zuo)的(de)(de)(de)認同(tong)感降低。

3.4基(ji)層衛(wei)生(sheng)(sheng)人(ren)員(yuan)的(de)(de)工作(zuo)(zuo)自(zi)主(zhu)性受(shou)資(zi)源和(he)(he)(he)政策(ce)(ce)限(xian)制，不(bu)利于其(qi)提升服務(wu)能(neng)力(li)和(he)(he)(he)基(ji)層醫(yi)(yi)(yi)療衛(wei)生(sheng)(sheng)機構吸引患(huan)者調查對象在(zai)工作(zuo)(zuo)自(zi)主(zhu)性維(wei)度上的(de)(de)平均得分(fen)處于中等偏上水平，但仍有(you)10%的(de)(de)基(ji)層衛(wei)生(sheng)(sheng)人(ren)員(yuan)在(zai)工作(zuo)(zuo)自(zi)主(zhu)性維(wei)度上的(de)(de)自(zi)評結果為(wei)“非常差(cha)”和(he)(he)(he)“比較(jiao)差(cha)”。其(qi)原因主(zhu)要包括兩方面：一是護(hu)士、公共(gong)衛(wei)生(sheng)(sheng)人(ren)員(yuan)的(de)(de)職業特點決(jue)定了其(qi)工作(zuo)(zuo)流程較(jiao)為(wei)標準化(hua)、操作(zuo)(zuo)規范內(nei)容較(jiao)為(wei)全面細致，其(qi)少有(you)自(zi)主(zhu)決(jue)策(ce)(ce)和(he)(he)(he)靈活處理工作(zuo)(zuo)任務(wu)的(de)(de)機會(hui)；另一方面，醫(yi)(yi)(yi)生(sheng)(sheng)和(he)(he)(he)醫(yi)(yi)(yi)技(ji)(ji)人(ren)員(yuan)因受(shou)到(dao)資(zi)源和(he)(he)(he)政策(ce)(ce)限(xian)制，自(zi)主(zhu)性受(shou)限(xian)。基(ji)層醫(yi)(yi)(yi)療衛(wei)生(sheng)(sheng)機構多存(cun)在(zai)藥物、設備不(bu)足的(de)(de)問題，且醫(yi)(yi)(yi)保(bao)部(bu)門出于控費的(de)(de)目的(de)(de)對基(ji)層醫(yi)(yi)(yi)療衛(wei)生(sheng)(sheng)機構醫(yi)(yi)(yi)療服務(wu)項(xiang)目的(de)(de)開展施(shi)加了一些政策(ce)(ce)性限(xian)制，醫(yi)(yi)(yi)生(sheng)(sheng)和(he)(he)(he)醫(yi)(yi)(yi)技(ji)(ji)人(ren)員(yuan)可(ke)能(neng)無(wu)法按照臨床判(pan)斷來(lai)提供部(bu)分(fen)衛(wei)生(sheng)(sheng)服務(wu)，從(cong)而產生(sheng)(sheng)了“巧婦難(nan)為(wei)無(wu)米之炊”的(de)(de)無(wu)力(li)感，其(qi)他研究者也在(zai)其(qi)研究中指出了類似問題［20］。

3.5基(ji)(ji)層(ceng)(ceng)(ceng)醫(yi)療(liao)衛生(sheng)機構(gou)內部(bu)的(de)(de)(de)工(gong)作反(fan)饋(kui)機制(zhi)簡單(dan)(dan)，外(wai)部(bu)反(fan)饋(kui)總體(ti)良好，但(dan)來自個別(bie)患(huan)者的(de)(de)(de)負反(fan)饋(kui)易引發(fa)“井繩(sheng)效(xiao)(xiao)應(ying)”調(diao)查對象在任(ren)務反(fan)饋(kui)性維度(du)上的(de)(de)(de)平(ping)均得分(fen)亦處于中等偏(pian)(pian)上水(shui)平(ping)，超(chao)過10%的(de)(de)(de)基(ji)(ji)層(ceng)(ceng)(ceng)衛生(sheng)人員在任(ren)務反(fan)饋(kui)性維度(du)上的(de)(de)(de)自評結果(guo)為“非常(chang)差”和“比(bi)較差”。訪(fang)談中，不少基(ji)(ji)層(ceng)(ceng)(ceng)衛生(sheng)人員表示單(dan)(dan)位(wei)的(de)(de)(de)績(ji)(ji)效(xiao)(xiao)考(kao)核(he)制(zhi)度(du)流于形式，少對其(qi)工(gong)作結果(guo)進行及(ji)時(shi)反(fan)饋(kui)。當(dang)前(qian)，基(ji)(ji)層(ceng)(ceng)(ceng)衛生(sheng)機構(gou)在對員工(gong)的(de)(de)(de)績(ji)(ji)效(xiao)(xiao)進行考(kao)核(he)時(shi)仍多沿用(yong)相對簡單(dan)(dan)粗放(fang)的(de)(de)(de)評價方法，主(zhu)要從(cong)“德能(neng)勤績(ji)(ji)廉(lian)”五方面進行評價，且績(ji)(ji)效(xiao)(xiao)考(kao)核(he)結果(guo)與(yu)收入(ru)分(fen)配情況之間(jian)的(de)(de)(de)關(guan)聯性不強，“多勞多得、優(you)績(ji)(ji)優(you)酬”的(de)(de)(de)原(yuan)則(ze)未得到充分(fen)體(ti)現［1］。此外(wai)，居民是重要的(de)(de)(de)外(wai)部(bu)反(fan)饋(kui)主(zhu)體(ti)，盡管當(dang)前(qian)基(ji)(ji)層(ceng)(ceng)(ceng)醫(yi)療(liao)環境(jing)已得到明顯改善，但(dan)個別(bie)患(huan)者的(de)(de)(de)不良就醫(yi)體(ti)驗/行為、主(zhu)觀(guan)偏(pian)(pian)見會增加醫(yi)患(huan)矛盾與(yu)糾紛的(de)(de)(de)發(fa)生(sheng)風險，而醫(yi)患(huan)沖突(tu)一旦出現就會給基(ji)(ji)層(ceng)(ceng)(ceng)衛生(sheng)人員帶(dai)來巨(ju)大的(de)(de)(de)心理壓(ya)力，加劇其(qi)職業倦怠感，還可(ke)能(neng)使其(qi)因“井繩(sheng)效(xiao)(xiao)應(ying)”產生(sheng)防御(yu)性醫(yi)療(liao)行為［21］，最終導致醫(yi)患(huan)之間(jian)的(de)(de)(de)信任(ren)度(du)下(xia)降。

3.6工(gong)(gong)作(zuo)特(te)征(zheng)(zheng)五維度(du)對(dui)(dui)基層衛(wei)生(sheng)(sheng)人(ren)員工(gong)(gong)作(zuo)結果(guo)(guo)(guo)(guo)有(you)(you)積極影(ying)響(xiang)(xiang)，且(qie)其(qi)產生(sheng)(sheng)的(de)(de)(de)(de)內(nei)在(zai)激勵(li)(li)(li)作(zuo)用(yong)(yong)強(qiang)于(yu)外部激勵(li)(li)(li)因(yin)素(su)(su)產生(sheng)(sheng)的(de)(de)(de)(de)外在(zai)激勵(li)(li)(li)作(zuo)用(yong)(yong)多(duo)元線(xian)性(xing)回歸(gui)(gui)結果(guo)(guo)(guo)(guo)表(biao)明，工(gong)(gong)作(zuo)特(te)征(zheng)(zheng)的(de)(de)(de)(de)多(duo)個維度(du)對(dui)(dui)基層衛(wei)生(sheng)(sheng)人(ren)員工(gong)(gong)作(zuo)結果(guo)(guo)(guo)(guo)有(you)(you)影(ying)響(xiang)(xiang)，且(qie)作(zuo)用(yong)(yong)方向大都(dou)(dou)符(fu)合預期。具體(ti)而(er)言(yan)，有(you)(you)如下主要發現：（1）既往研究大都(dou)(dou)強(qiang)調收入、職(zhi)業發展、工(gong)(gong)作(zuo)環(huan)境等(deng)外部激勵(li)(li)(li)因(yin)素(su)(su)對(dui)(dui)工(gong)(gong)作(zuo)動(dong)機和(he)績效(xiao)(xiao)的(de)(de)(de)(de)影(ying)響(xiang)(xiang)［9-10］，但本研究回歸(gui)(gui)分析結果(guo)(guo)(guo)(guo)顯(xian)示，工(gong)(gong)作(zuo)特(te)征(zheng)(zheng)的(de)(de)(de)(de)內(nei)在(zai)激勵(li)(li)(li)作(zuo)用(yong)(yong)對(dui)(dui)工(gong)(gong)作(zuo)結果(guo)(guo)(guo)(guo)的(de)(de)(de)(de)解釋力(li)(li)(li)強(qiang)于(yu)外部激勵(li)(li)(li)因(yin)素(su)(su)的(de)(de)(de)(de)外在(zai)激勵(li)(li)(li)作(zuo)用(yong)(yong)。可用(yong)(yong)雙因(yin)素(su)(su)理(li)論來解釋這(zhe)一(yi)(yi)現象(xiang)：外在(zai)激勵(li)(li)(li)因(yin)素(su)(su)是(shi)(shi)消(xiao)除不滿(man)意(yi)的(de)(de)(de)(de)“保健(jian)因(yin)素(su)(su)”，而(er)內(nei)在(zai)激勵(li)(li)(li)因(yin)素(su)(su)才是(shi)(shi)真能(neng)(neng)促進(jin)(jin)工(gong)(gong)作(zuo)積極性(xing)提高的(de)(de)(de)(de)“激勵(li)(li)(li)因(yin)素(su)(su)”［22］。（2）在(zai)工(gong)(gong)作(zuo)特(te)征(zheng)(zheng)的(de)(de)(de)(de)5個維度(du)中，任務(wu)(wu)重要性(xing)維度(du)對(dui)(dui)各(ge)工(gong)(gong)作(zuo)結果(guo)(guo)(guo)(guo)的(de)(de)(de)(de)作(zuo)用(yong)(yong)最強(qiang)（|b|最大）。根據馬斯洛(luo)需求層次理(li)論，任務(wu)(wu)重要性(xing)較(jiao)高有(you)(you)助于(yu)滿(man)足基層衛(wei)生(sheng)(sheng)人(ren)員“尊重和(he)認可”這(zhe)一(yi)(yi)高層次心理(li)需求，從而(er)能(neng)(neng)促進(jin)(jin)其(qi)工(gong)(gong)作(zuo)表(biao)現的(de)(de)(de)(de)改善［23］。（3）工(gong)(gong)作(zuo)特(te)征(zheng)(zheng)對(dui)(dui)離職(zhi)意(yi)愿(yuan)的(de)(de)(de)(de)解釋力(li)(li)(li)最強(qiang)，對(dui)(dui)工(gong)(gong)作(zuo)績效(xiao)(xiao)的(de)(de)(de)(de)解釋力(li)(li)(li)相(xiang)對(dui)(dui)較(jiao)弱(ruo)。工(gong)(gong)作(zuo)特(te)征(zheng)(zheng)首(shou)先(xian)作(zuo)用(yong)(yong)于(yu)人(ren)的(de)(de)(de)(de)心理(li)［6］，導致其(qi)對(dui)(dui)與心理(li)有(you)(you)關的(de)(de)(de)(de)工(gong)(gong)作(zuo)結果(guo)(guo)(guo)(guo)（如離職(zhi)意(yi)愿(yuan)）會(hui)產生(sheng)(sheng)較(jiao)大影(ying)響(xiang)(xiang)。而(er)根據FRANCO等(deng)［24］的(de)(de)(de)(de)研究結果(guo)(guo)(guo)(guo)，衛(wei)生(sheng)(sheng)人(ren)員的(de)(de)(de)(de)工(gong)(gong)作(zuo)績效(xiao)(xiao)受到能(neng)(neng)力(li)(li)(li)、動(dong)機、資源、衛(wei)生(sheng)(sheng)系統和(he)社會(hui)環(huan)境等(deng)多(duo)層面、多(duo)因(yin)素(su)(su)影(ying)響(xiang)(xiang)，因(yin)此工(gong)(gong)作(zuo)特(te)征(zheng)(zheng)對(dui)(dui)其(qi)作(zuo)用(yong)(yong)相(xiang)對(dui)(dui)有(you)(you)限。

3.7完(wan)善基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)工(gong)(gong)作(zuo)(zuo)(zuo)設(she)計與激勵機(ji)(ji)制的(de)政(zheng)策(ce)建議根據工(gong)(gong)作(zuo)(zuo)(zuo)特征模型，可(ke)(ke)通(tong)過工(gong)(gong)作(zuo)(zuo)(zuo)再設(she)計對(dui)工(gong)(gong)作(zuo)(zuo)(zuo)內容(rong)與流程進行(xing)(xing)優化(hua)(hua)(hua)，或通(tong)過完(wan)善管理(li)制度重塑員(yuan)(yuan)工(gong)(gong)對(dui)工(gong)(gong)作(zuo)(zuo)(zuo)的(de)認知(zhi)，從(cong)而發(fa)揮工(gong)(gong)作(zuo)(zuo)(zuo)本身的(de)激勵作(zuo)(zuo)(zuo)用。結合本研究結果(guo)，提(ti)出(chu)(chu)如下(xia)政(zheng)策(ce)建議：第(di)一，提(ti)高(gao)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)培訓(xun)的(de)數量(liang)和質量(liang)，以滿(man)足其(qi)對(dui)自(zi)身具(ju)備多樣化(hua)(hua)(hua)技能(neng)(neng)的(de)需求，尤其(qi)應(ying)增強(qiang)培訓(xun)的(de)針對(dui)性(xing)(xing)和內容(rong)的(de)時效(xiao)性(xing)(xing)，使基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)在接受培訓(xun)后能(neng)(neng)夠做(zuo)到學有(you)所用、知(zhi)行(xing)(xing)合一。第(di)二，為基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)“減(jian)負賦能(neng)(neng)”，讓基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)“化(hua)(hua)(hua)零(ling)為整(zheng)”，提(ti)高(gao)其(qi)工(gong)(gong)作(zuo)(zuo)(zuo)完(wan)整(zheng)性(xing)(xing)。可(ke)(ke)考(kao)慮增加專職行(xing)(xing)政(zheng)人(ren)(ren)(ren)員(yuan)(yuan)數量(liang)，并通(tong)過制度優化(hua)(hua)(hua)提(ti)升管理(li)效(xiao)能(neng)(neng)，將(jiang)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)從(cong)“文山會海”、填表報數等瑣(suo)碎(sui)的(de)事(shi)務性(xing)(xing)工(gong)(gong)作(zuo)(zuo)(zuo)中解放出(chu)(chu)來(lai)，使其(qi)專注于衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)技術工(gong)(gong)作(zuo)(zuo)(zuo)本身。第(di)三，加大基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)醫療(liao)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)資源投入，減(jian)少(shao)有(you)損基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)醫療(liao)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)機(ji)(ji)構(gou)運行(xing)(xing)活力的(de)政(zheng)策(ce)限(xian)制。保障藥品、設(she)備、信息等必要衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)資源的(de)供(gong)給，對(dui)現(xian)行(xing)(xing)醫療(liao)和醫保政(zheng)策(ce)中可(ke)(ke)能(neng)(neng)限(xian)制基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)事(shi)業發(fa)展的(de)“過度管制”條例進行(xing)(xing)調(diao)整(zheng)和完(wan)善，如適當擴大基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)醫療(liao)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)機(ji)(ji)構(gou)醫療(liao)服(fu)務和藥品配(pei)備使用范圍，給予(yu)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)醫療(liao)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)機(ji)(ji)構(gou)用人(ren)(ren)(ren)和分配(pei)自(zi)主權。第(di)四，完(wan)善績效(xiao)管理(li)制度，提(ti)高(gao)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)的(de)人(ren)(ren)(ren)文素養(yang)和心(xin)理(li)韌性(xing)(xing)，促(cu)成(cheng)(cheng)正(zheng)(zheng)向反饋循環的(de)建立。應(ying)發(fa)揮獎勵性(xing)(xing)績效(xiao)工(gong)(gong)資“獎勤罰懶(lan)”的(de)作(zuo)(zuo)(zuo)用，適當拉開收(shou)入差距，促(cu)進組(zu)織內良性(xing)(xing)競爭氛(fen)圍的(de)形成(cheng)(cheng)。第(di)五，應(ying)通(tong)過提(ti)高(gao)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)的(de)溝通(tong)能(neng)(neng)力和人(ren)(ren)(ren)文素養(yang)來(lai)增強(qiang)患者對(dui)基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)的(de)“情(qing)(qing)感信任”，并引導(dao)媒體正(zheng)(zheng)面宣傳基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)醫療(liao)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)機(ji)(ji)構(gou)的(de)社會價值，同(tong)時關注基(ji)(ji)層(ceng)(ceng)(ceng)(ceng)(ceng)(ceng)衛(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)人(ren)(ren)(ren)員(yuan)(yuan)的(de)心(xin)理(li)健康和情(qing)(qing)感需求。

3.8本(ben)研(yan)究(jiu)(jiu)的(de)(de)(de)(de)(de)局限性首先，本(ben)研(yan)究(jiu)(jiu)是(shi)橫(heng)斷面研(yan)究(jiu)(jiu)，只能(neng)得出(chu)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)/外(wai)部激(ji)勵因素與(yu)(yu)(yu)工(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果(guo)(guo)之(zhi)間的(de)(de)(de)(de)(de)相關關系而(er)(er)非因果(guo)(guo)關系，未(wei)來需采(cai)用(yong)縱向研(yan)究(jiu)(jiu)設(she)計驗證(zheng)(zheng)變量(liang)(liang)(liang)間的(de)(de)(de)(de)(de)因果(guo)(guo)關系；其(qi)次，研(yan)究(jiu)(jiu)者(zhe)(zhe)采(cai)用(yong)單題(ti)項(xiang)測量(liang)(liang)(liang)基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)在(zai)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)各(ge)維度上的(de)(de)(de)(de)(de)水平，可(ke)能(neng)對(dui)(dui)(dui)測量(liang)(liang)(liang)的(de)(de)(de)(de)(de)效(xiao)度有一定影(ying)響，未(wei)來可(ke)在(zai)對(dui)(dui)(dui)工(gong)(gong)作(zuo)(zuo)(zuo)診(zhen)斷調查表（JobDiagnosticSurvey，JDS）進行漢化的(de)(de)(de)(de)(de)基(ji)礎上，使用(yong)其(qi)作(zuo)(zuo)(zuo)為(wei)測量(liang)(liang)(liang)工(gong)(gong)具，進一步驗證(zheng)(zheng)本(ben)研(yan)究(jiu)(jiu)的(de)(de)(de)(de)(de)結(jie)論；最后，本(ben)研(yan)究(jiu)(jiu)并未(wei)就(jiu)不(bu)同崗位(wei)基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)的(de)(de)(de)(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)及(ji)其(qi)對(dui)(dui)(dui)工(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果(guo)(guo)的(de)(de)(de)(de)(de)影(ying)響而(er)(er)展開有針對(dui)(dui)(dui)性的(de)(de)(de)(de)(de)討論，實際(ji)上不(bu)同崗位(wei)的(de)(de)(de)(de)(de)基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)的(de)(de)(de)(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)可(ke)能(neng)存在(zai)較大差異，未(wei)來可(ke)對(dui)(dui)(dui)不(bu)同崗位(wei)基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)的(de)(de)(de)(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)及(ji)其(qi)對(dui)(dui)(dui)工(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果(guo)(guo)的(de)(de)(de)(de)(de)影(ying)響進行比較研(yan)究(jiu)(jiu)。當(dang)前基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)現(xian)實的(de)(de)(de)(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)與(yu)(yu)(yu)理(li)論上的(de)(de)(de)(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)存在(zai)差距，其(qi)對(dui)(dui)(dui)任(ren)務完(wan)(wan)整(zheng)性的(de)(de)(de)(de)(de)評價相對(dui)(dui)(dui)較低。訪談結(jie)果(guo)(guo)體(ti)現(xian)出(chu)基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)工(gong)(gong)作(zuo)(zuo)(zuo)在(zai)工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)五(wu)維度上存在(zai)培訓數(shu)(shu)量(liang)(liang)(liang)不(bu)足與(yu)(yu)(yu)質(zhi)(zhi)量(liang)(liang)(liang)不(bu)高、工(gong)(gong)作(zuo)(zuo)(zuo)內容碎片(pian)化、醫療(liao)服(fu)務能(neng)力(li)下(xia)降(jiang)而(er)(er)公共(gong)衛(wei)(wei)生(sheng)(sheng)(sheng)服(fu)務流(liu)于(yu)形式、工(gong)(gong)作(zuo)(zuo)(zuo)自主性受資(zi)源和(he)(he)政(zheng)策(ce)限制(zhi)、內部反饋機(ji)制(zhi)效(xiao)果(guo)(guo)較差等(deng)問題(ti)。鑒于(yu)本(ben)研(yan)究(jiu)(jiu)證(zheng)(zheng)明了對(dui)(dui)(dui)于(yu)主要(yao)工(gong)(gong)作(zuo)(zuo)(zuo)結(jie)果(guo)(guo)，工(gong)(gong)作(zuo)(zuo)(zuo)特(te)征(zheng)(zheng)的(de)(de)(de)(de)(de)內在(zai)激(ji)勵作(zuo)(zuo)(zuo)用(yong)強于(yu)收入等(deng)外(wai)部激(ji)勵因素的(de)(de)(de)(de)(de)作(zuo)(zuo)(zuo)用(yong)，因此政(zheng)策(ce)制(zhi)定者(zhe)(zhe)和(he)(he)基(ji)層(ceng)醫療(liao)衛(wei)(wei)生(sheng)(sheng)(sheng)機(ji)構管理(li)者(zhe)(zhe)應(ying)通過增(zeng)加培訓機(ji)會和(he)(he)提高培訓質(zhi)(zhi)量(liang)(liang)(liang)、為(wei)基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)“減負賦能(neng)”、加大資(zi)源投入和(he)(he)減少政(zheng)策(ce)束縛、完(wan)(wan)善績(ji)(ji)效(xiao)管理(li)制(zhi)度等(deng)舉措重(zhong)塑基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)對(dui)(dui)(dui)工(gong)(gong)作(zuo)(zuo)(zuo)的(de)(de)(de)(de)(de)認知，從而(er)(er)提升(sheng)基(ji)層(ceng)衛(wei)(wei)生(sheng)(sheng)(sheng)人(ren)員(yuan)(yuan)的(de)(de)(de)(de)(de)工(gong)(gong)作(zuo)(zuo)(zuo)動機(ji)與(yu)(yu)(yu)績(ji)(ji)效(xiao)水平，降(jiang)低其(qi)職業倦(juan)怠感和(he)(he)離職意愿度。作(zuo)(zuo)(zuo)者(zhe)(zhe)貢(gong)獻：趙(zhao)世超、王(wang)穎負責(ze)文章(zhang)的(de)(de)(de)(de)(de)構思與(yu)(yu)(yu)設(she)計、結(jie)果(guo)(guo)的(de)(de)(de)(de)(de)分析與(yu)(yu)(yu)解(jie)釋、論文的(de)(de)(de)(de)(de)修訂(ding)；平靜負責(ze)資(zi)料整(zheng)理(li)和(he)(he)撰寫論文；朱虹、紀婉婷、王(wang)雨燕負責(ze)數(shu)(shu)據分析、質(zhi)(zhi)量(liang)(liang)(liang)控制(zhi)和(he)(he)審校。本(ben)文無利益沖突。

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作者:趙世超(chao) 平靜(jing) 朱虹 紀婉(wan)婷 王雨(yu)燕 王穎