摘要目的 探索上海市长宁区社区卫生服务机构组织与管理框架建设,发现问题并提出改进设想方案.方法 2015年10月12-30日,向上海市长宁区30名社区卫生管理者发放调查问卷,问卷内容包括社区卫生服务机构基本情况、当前组织与管理框架的运作情况、对组织与管理框架调整的意向.结果 长宁区社区卫生服务机构当前的组织与管理架构以五大系统(管理系统、全科团队系统、病房系统、支持系统、医技系统)为主.有效回答问卷的29名管理者中,27名(93.10％)管理者认为当前的组织体系存在问题.其中,22名管理者认为当前组织与管理体系职责有交叉,职责分界不清晰;22名管理者认为系统间协作性不强,配合度不高;10名管理者认为组织体系的理解和行动一致性较差;2名管理者认为存在其他问题.25名(86.21％)管理者认为管理模式运作存在问题,其中,18名管理者认为当前管理模式对改革或新工作的推进比较吃力;14名管理者认为管理层级比较多,管理效率不高;13名管理者认为缺乏有效的管理手段;4名管理者认为存在其他问题.29名管理者对社区卫生服务机构应具备的服务功能、管理功能、服务组织形式及新的组织与管理框架提出了建议;并具体提出以家庭医生工作室为核心的两大平台的组织与管理框架方案设想.结论 长宁区社区卫生服务机构的组织与管理框架在进一步改革发展中存在问题与瓶颈,本研究根据管理者建议提出新的框架设想.

abstractsObjective To explore the framework of organization and management of community health service institution in Changning district.Methods A questionnaire survey was conducted among 30 managers of 10 community health service centers in Changning district at October 2015.The questionnaire included the basic situation of the community health service institution,the operation of the current organization and management framework,and the intention of further adjustment.Results There were 5 systems (administration system,family doctor team system,inpatient system,support system and medical technical system) in current organization and management structure.Twenty seven responders (93.1％) thought that the bottlenecks and problems existed in the current organization structure (22 thought that the responsibilities of the organization and management system were unclear and overlapped;22 thought that the cooperation and coordination between systems were less strong;10 thought that organization systems had poor mutual understanding and consistency of action,2 mentioned other problems).Twenty five responders (86.2％) thought that the bottlenecks and problems existed in the current management structure (18 thought that the current management model was difficult to promote reform or new work;14 thought that there were more layers of management and less managerial efficiency;13 thought that there was lack of effective management measures;4 mentioned other problems).Twenty nine responders proposed suggestions dealing with the service function,management function,service organization form and new organization and management framework of community health service institutions.The family doctor studio as the core of service platform and management platform was recommended.Conclusions There are problems and bottlenecks in the current organization and management framework of community health service institutions in Changning district,and a new framework has been proposed according to the management recommendations.