I 摘要 随着医疗服务业的不断发展和人们物质生活水平的提高，人们对健康的需求 也越发强烈，对医疗服务行业的要求也越来越高。为了适应当前人们对健康的需求， 我国的医疗体制也在不断的进行改革，但医疗资源依旧是属于稀缺的资源，人们看 病难，看病贵，对疗效不满意等问题仍然存在，这导致近年来医患关系也越发的紧 张。一方面，医方认为自己的付出没有得到患者的认可，患者没有完全遵循医方的 治疗方案，另一个方面，患方认为医方的专业技术和态度等没达到自己的预期，这 使得医方和患方对心理契约结构的认知出现差异。 本文从心理契约理论入手，采用实证分析的方法对医患心理契约结构进行分 析，对医患心理契约结构中的医方责任对患者信任有什么影响展开研究。研究以四 川成都地区的公立医院的医务工作者以及患者为对象，通过文献分析法确定调查 问卷，进行问卷调查，对收集到的 370 份有效问卷进行数据分析，并得出相应的结 论。 本研究将医患心理契约分为医方责任和患方责任，通过探索性因子分析得到 医方责任包括两个因子，根据因子的特征将两个因子分别命名为交易责任和发展 关系责任；患方责任包括两个因子，根据特征命名为尊重责任和服从责任，患者信 任也包括两个因子，并分别命名为技术信任和关系信任。对数据进行检验，结果表 明数据具有良好的信度效度。 通过差异性分析表明，医患双方在心理契约结构的认知上存在差异的，医方和 患方在交易责任、发展关系责任、服从责任、尊重责任的认知上均存在显著性差异； 医方在医方责任的交易责任、发展关系责任的敏感度要高于患方，患方在患方责任 的服从责任和尊重责任上的感知均高于医方。通过回归分析表明，医方责任的交易 责任对患者技术信任存在显著正向影响，交易责任和发展关系责任对患者的关系 信任有显著正向影响。 在实证研究基础上，本文提出了相关对策建议，希望为构建和谐健康的医患关 系，创造良好的医疗环境做出贡献，对新医疗体制改革提出参考，以创造更大的社 会价值。 关键词：医患，心理契约，心理契约结构，患者信任ABSTRACT II ABSTRACT With the continuous development of the medical service industry and the improvement of people's material living standards, people's health needs are becoming more and more intense, and the requirements for the medical service industry are getting higher and higher. In order to adapt to the current people's health needs, China's medical system is also undergoing continuous reforms, but medical resources are still scarce resources. People are difficult to get medical service, expensive to get medical service, and dissatisfied with the efficacy. The doctor-patient relationship is also becoming more and more tense in this year. On the one hand, the doctors think that their efforts are not recognized by the patients, and the patients do not fully follow the treatment plan of the doctors. On the other hand, the patients think that the professional skills and attitudes of the doctors do not meet their expectations, which leads to the differences in the cognition of the psychological contract structure between the doctors and the patients. This paper starts with the theory of Psychological Contract, analyzes the Psychological Contract structure of doctors and patients by means of empirical analysis, and studies the influence of medical responsibility on the trust of patients in the Psychological Contract structure of doctors and patients. The research aimed to identify medical questionnaires and patients in public hospitals in Chengdu, Sichuan, through questionnaireanalysis,conductquestionnairesurveys,and analyzethecollected370valid questionnaires, and draw corresponding conclusions. In this study, the Psychological Contract of doctors and patients is divided into doctor’s responsibility and patient’s responsibility. The doctor's responsibility is divided into two factors through exploratory factor analysis. According to the characteristics of the factor, the two factors are named as Transaction Responsibility and Development Relationship Responsibility. Patient’s responsibility includes two factors, named Respect Responsibility and Obedience Responsibility. Patient’s trust also includes two factors, namedTechnicalTrust and RelationshipTrust.The data is tested and the results show that the data has good reliability and validity. The difference analysis shows that there are differences in the cognition of the structure of psychological contract betweendoctors and patients, and there aresignificant differences in the perception of transaction responsibility, relationship responsibility,ABSTRACT III obedience responsibility and respect responsibility between doctors and patients. The sensitivity of the transaction responsibility and relationship responsibility of the medical party is higher than that of the patient, and the patient's perception of the obedience responsibility and respect responsibility of the patient is higher than that of the doctor. The regression analysis shows that the transaction responsibility of medical party has a significant positive impact on patients' technical trust, and the transaction responsibility and relationship responsibility have a significant positive impact on patients' relationship trust. On the basis of empirical research, this paper puts forward relevant countermeasures and suggestions, and hopes to contribute to building a harmonious and healthy doctor- patient relationship and create a good medical environment, and to provide reference for the reform of the new medical system to create greater social value. Keywords: Doctor-patient, Psychological Contract, Psychological Contract Structure, Patient trust目 录 IV 目 录 第一章 绪论.................................................................................................................... 1 1.1 研究背景与问题................................................................................................ 1 1.1.1 研究背景................................................................................................ 1 1.1.2 研究问题................................................................................................ 2 1.2 研究意义............................................................................................................ 3 1.2.1 理论意义................................................................................................ 3 1.2.2 现实意义................................................................................................ 3 1.3 研究思路及方法................................................................................................ 4 1.3.1 研究思路................................................................................................ 4 1.3.2 研究方法................................................................................................ 4 1.4 本章小结............................................................................................................ 6 第二章 文献综述............................................................................................................ 7 2.1 心理契约的研究综述........................................................................................ 7 2.1.1 心理契约的概念.................................................................................... 7 2.1.2 心理契约的维度与测量........................................................................ 8 2.1.3 医患心理契约的研究现状...................................................................11 2.1.4 心理契约在医疗服务业的研究.......................................................... 15 2.1.5 心理契约的研究述评.......................................................................... 15 2.2 信任的文献综述.............................................................................................. 16 2.2.1 信任的概念.......................................................................................... 16 2.2.2 患者信任的维度与测量...................................................................... 17 2.2.3 信任的研究现状.................................................................................. 18 2.2.4 患者信任的研究述评.......................................................................... 22 第三章 理论模型与研究设计........................................................................