Abstract
ObjectivesTo provide an empirical examination of patient–provider relationships (PPR) and its association with organizational and individual factors.MethodsA national cross-sectional survey was conducted by stratified cluster sampling in 77 hospitals across seven provinces in China between July 2014 and April 2015, involving 3621 doctors, 5561 nurses, and 8022 patients with response rates of 62.93%, 61.16%, and 33.08%, respectively. Self-perceived PPR was the outcome variable. Organizational factors included hospital type (western medicine [WM] and traditional Chinese medicine [TCM] hospital); hospital level (tertiary and secondary hospital); area of specialization (internal medicine and surgery); ratio of doctors (nurses) to ward beds; doctors/nurses’ concerns about performance assessment; and patients’ perceptions of healthcare cost. Individual factors included consultation, listening to patients and socio-demographic factors.Results54.6% of doctors, 36.6% of nurses, and 10.2% of patients perceived PPR as poor. Organizational factors independently associated with providers’ perception of poor PPR included hospital type (WM vs TCM: OR = 1.25 [95% CI: 1.06–1.47]) and concerns about performance assessment (high vs low levels: OR = 1.40 [95% CI: 1.14–1.72]) for doctors, and concerns about performance assessment (average vs low levels: OR = 0.79 [95% CI: 0.67–0.93]) for nurses. Those associated with patients’ perception of poor PPR included hospital type (WM vs TCM: OR = 0.63 [95% CI: 0.53–0.74]) and hospital level (tertiary vs secondary: OR = 0.65 [95% CI: 0.51–0.82]). Doctors and nurses reporting listening to patients “frequently” had better perceptions of PPR (OR = 0.46 [95%CI: 0.38–0.56] and 0.49 [95% CI: 0.41–0.59] for doctors and nurses, respectively), as did their patients (OR = 0.24 [95% CI: 0.18–0.31] and 0.54 [95% CI: 0.35–0.84] for doctors and nurses, respectively).ConclusionsAlthough our findings require validation in different organizational settings given the likely variability of these associations across systems, our results suggest that implementing moderate levels promoting the level of medical treatment, and broadening doctors/nurses training regarding listening to patients, may benefit to enhance PPR.
Highlights
Over the past few decades, progress in medical science and technology has made treatments more effective
Organizational factors independently associated with providers’ perception of poor patient–provider relationships (PPR) included hospital type (WM vs Traditional Chinese Medicine (TCM): odds ratios (ORs) = 1.25 [95% CI: 1.06–1.47]) and concerns about performance assessment for doctors, and concerns about performance assessment for nurses
Patient-provider relationships in China type (WM vs TCM: OR = 0.63 [95% CI: 0.53–0.74]) and hospital level
Summary
Over the past few decades, progress in medical science and technology has made treatments more effective. In China, the deteriorated PPR has caused a large number of medical disputes between patients and healthcare providers, primarily doctors and nurses, with some extreme cases involving violence towards providers [6]. According to a recent survey of the Chinese Hospital Association, the average number of incidents of violence against providers in public hospitals increased from 20.6 cases/hospital in 2008 to 27.3 cases/hospitals in 2012 [7]. According to China’s National Health and Family Planning Commission, there were about 70,000 medical disputes in 2013, and about 80% of violence against providers took place in tertiary general (public) hospitals [8]. The deteriorated PPR negatively affects patient care and threatens the safety of healthcare staff
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