摘    要

目的 调查杭州市三级医院医护人员对医院高绩效工作系统（HPWS）的感知情况及其工作幸福感水平，分析医护人员感知的HPWS对其工作幸福感的影响，为改善医护人员工作幸福感，提升其工作积极性提供参考。方法 采用对希腊学者Mihail等编制的医疗环境下HPWS与工作幸福感量表进行修订后的问卷，对杭州市4家三级医院657名医护人员进行调查，采用t检验或单因素方差分析比较不同性别、学历、岗位、职称、工作年限等的医护人员工作幸福感评分，采用多重线性回归法分析人口学因素及HPWS各维度对医护人员幸福感的影响程度，利用结构方程模型分析感知的HPWS对工作幸福感各维度的作用，检验HPWS与工作幸福感间的因果关系。结果 本次调查共发放问卷720份，回收有效问卷657份，有效回收率为91。3%。医护人员工作幸福感从高到低排列依次为：工作投入（3。55±0。69）、工作满意度（3。18±0。63）、职业倦怠（3。15±0。87）；参与决策（标准系数=0。301，P<0。001）、工作安全（标准系数=0。102，P=0。021）和绩效管理（标准系数=0。169，P=0。001）对总体工作幸福感影响显著；参与决策（标准系数=-0。166，P<0。001）对职业倦怠影响显著；培训与发展（标准系数=-0。119，P=0。007）、参与决策（标准系数=0。288，P<0。001）、工作安全（标准系数=0。133，P=0。005）、绩效管理（标准系数=0。171，P=0。001）和职责说明（标准系数=0。088，P=0。033）对工作投入影响显著；招聘与录用（标准系数=0。103，P=0。012）、参与决策（标准系数=0。327，P<0。001）、职业保障（标准系数=0。071，P=0。044）和绩效管理（标准系数=0。222，P<0。001）对工作满意度影响显著。以因子分析和理论设计为基础，构建结构方程模型，经修正后的模型拟合度较好（2 /df=2。770，GFI=0。848，RMSEA=0。052），模型显示HPWS对职业倦怠的直接效应为0。198，并通过工作投入和工作满意度对其产生了间接效应（-0。355），总效应为-0。157；HPWS对工作投入产生的直接效应为0。557，未产生间接效应；HPWS对工作满意度的直接效应为0。507，并通过工作投入对其产生了间接效应(0。223)，总效应为0。730。在工作幸福感内部各维度中，工作投入对工作满意度的直接效应为0。401，并通过它对职业倦怠产生间接效应(-0。171)，而工作满意度对职业倦怠的直接效应为-0。427。结论：当前医护人员工作投入及工作满意度水平不高，且存在一定程度的职业倦怠。HPWS对工作幸福感产生了直接和间接影响，表现为积极的促进作用。由此对提升医护人员工作幸福感提出以下建议：推行服务型管理，拓宽医护人员参与管理的渠道；建立科学的绩效考核体系，调动低收入者积极性；构建团队认可的人才招聘机制，配备充足的人力；完善医护人员的培训与培养，建立合理的提拔任用标准。85277

毕业论文关键词：医护人员； 高绩效工作系统； 工作幸福感；结构方程模型

Abstract

Objective: To investigate the perceived high-performance work system(HPWS) and work-related well-being of medical staff from tertiary hospitals in Hangzhou City, and analyze the effects of perceived HPWS on work-related well-being, as to improve work-related well-being and work enthusiasm of medical staff。 Method: 657 medical staff  from 4 tertiary hospitals were surveyed by questionnaires of HPWS and work-related well-being designed by Mihail。 T test and one-way analysis of variance were used to compare the difference of scores of work-related well-being between medical workers of difference gender, educational background, position, title, and working years。 Multiple linear regression was used to identify the effects of demographic factors and dimensions of HPWS on work-related well-being。 Utilizing structural equation model to analyze the effects of perceived HPWS on work-related well-being and verify the causal relationship between them。 Results: The survey gave out about 720 questionnaires, and collected 657 effective questionnaires, the valid collecting rate was 91。3%。 Work-related well-being of medical staff ranked from high to low: work engagement（3。55±0。69）、job satisfaction(3。18±0。63)、emotional exhaustion（3。15±0。87)。 The participation in decision making (standard coefficient =0。301, P<0。001), the job security (standard coefficient =0。102, P=0。021) and performance management (standard coefficient =0。169, P=0。001) have significant effects on the total work-related well-being; The participation in decision making (standard coefficient =-0。166, P<0。001) has significant effects on the emotional exhaustion; The training & development (standard coefficient =-0。119, P=0。007), the participation in decision making (standard coefficient =0。288, P<0。001), the job security (standard coefficient =0。133, P=0。005), the performance management (standard coefficient =0。171, P=0。044) and job clarity (standard coefficient =0。088, P=0。033) have significant effects on the work engagement; The recruitment & selection (standard coefficient =0。103, P=0。012), the participation in decision making (standard coefficient =0。327, P<0。001), the employment security (standard coefficient =0。071, P=0。044)and performance management (standard coefficient =0。222, P<0。001) have significant effects on the job satisfaction。 Based on the factor analysis and theoretical design, the structural equation model was set up。 The results of the CFA indicated that the model fitting was good(2 /df=2。770，GFI=0。848，RMSEA=0。052)。 The model showed that HPWS produced the direct effect on emotional exhaustion was 0。198, and produced the indirect effect by work engagement and job satisfaction was -0。355, so the total effect was -0。157; the direct effect of HPWS on work engagement was 0。557 and no indirect effect; the direct effect of HPWS on job satisfaction was 0。507 and the indirect effect by work engagement was 0。223, added up to the total effect was 0。730。 Among the dimensions of work-related well-being, the job involvement made the direct effect on job satisfaction, was 0。401, and through it produced indirect effect equaling -0。171 on emotional exhaustion, and the direct effect of job satisfaction on emotional exhaustion was -0。427。 Conclusion: The work engagement and job satisfaction of medical staff was not satisfactory enough and there is a certain degree of emotional exhaustion。 HPWS made positive effects directly or indirectly on the work-related well-being。 Thus to put forward the following suggestions to enhance the work-related well-being: implement service-oriented management and broaden the channels for medical staff to participate in management; establish a scientific performance appraisal system to mobilize the enthusiasm of low-income people; build a team approved recruitment mechanism and equip sufficient human resources; improve the training of medical staff and establish a reasonable standard for promotion and appointment。