studiedmeizhai

DevelopmentofanevaluationindexsystemforthehumanisticqualitiesofmedicalpractitionersinChina.
XiaoweiWu1*,ChangkunLuo2,JianjunHuang3,DixiongXu3,JidongHuang3,LinMei1,JiancaiZhai1,JunguoChen3,YunguiWang2*1OfficeofEducationalAdministration,ThirdMilitaryMedicalUniversity,Chongqing,PRChina2ThirdMilitaryMedicalUniversity,Chongqing,PRChina3DepartmentofTraining,ThirdMilitaryMedicalUniversity,Chongqing,PRChinaAbstractBackground:AcomprehensiveevaluationmodelfortheassessmentofthehumanisticqualitiesofmedicalpractitionersisnotcurrentlyavailableinMainlandChina;thus,weaimedtoconstructoneusingtheAnalyticHierarchyProcess(AHP)method.
Methods:Wedeterminedtheweightof37indicatorsofthehumanisticevaluationsystem.
Results:Wefoundthattheconsistencyratioindexprovidedbyeachexpertupongradingwaslessthan0.
1.
Amongalltheindicatorsintheschemelayer,"reverenceforlife"hadthehighestweight(0.
066),whereas"bioethics"and"abilitytoexpressempathy"were0.
053and0.
047,respectively.
TheresultsoftheAHPmodelwerebetterthantheresultsofthemeanmethodmodel.
Conclusion:ThemodelofevaluationthatwasestablishedbasedonAHPisanobjectiveandeffectivesystemandalsorepresentsasuitableguidefortheselectionandevaluationofpersonnel.
Keywords:Analytichierarchyprocess,Medicalpractitioners,Medicalhumanisticqualities,Evaluationindexsystem.
AcceptedonFebruary24,2017IntroductionMedicalhumanisticqualitiesarecharacteristicallybasedoncommonhumanqualitiesexpressedinthemedicalfield.
Thesequalitiesareanessentialrequirementformedicalprofessionalsandarecriticaltothemedicalfield.
Itiswellacceptedthat,foramedicalpractitioner,medicalhumanisticqualitiesareasequallyimportantasmedicalskills.
Withtherapiddevelopmentofnewandimprovedmedicaltechnologies,dramaticchangeshaveoccurredindoctor-patientrelationshipssincethe1960sand1970s[1].
Inrecentyears,increasinglyfrequentincidentsofdoctor-patientconflictsanddisturbancesindicatethatthebasicdoctor-patientrelationshipisbecomingtense,atleastinMainlandChina.
In2006,theChineseMedicalDoctorAssociationconductedaquestionnaire-basedsurveyin350hospitalsinChina.
Thedatarevealedthattheoccurrenceofmedicaldisturbancesincreasedfrom89.
58%in2004to97.
92%in2006.
Duringthisperiod,thenumberofmedicalprofessionalsinjuredincreasedfrom203timesperyearto332timesperyear,withadirecteconomiclossthatincreasedfromRMB9.
87milliontoRMB14.
48million(RightsProtectionCommitteeofChineseMedicalDoctorAssociation,2007)[2].
Thissurveyalsorevealedthatmanypatientsdonottrusthospitalsanddoctors,whichresultsinlowerpatientsatisfaction.
Therefore,theimportanceofmedicalhumanisticqualitiesinclinicalpracticehaswidelybeenacknowledgedbythesociety.
IntheUnitedStates,thehumanisticqualitiesofclinicalphysicianshavetraditionallybeenevaluatedfromapatient'sperspectiveduringroutineclinicalencounters.
Inthisway,theobjectiveistoassesstheeffectsofaclinician'semotionalcontentandcommunicationskillsontreatmentoutcomesratherthantoevaluatethecliniciancomprehensively.
Forexample,Carolassessedtheeffectsofdoctor-patientcommunicationduringclinicalencountersontheprogressionofdiseasebycorrelatingthephysician-patientinteractionwithbloodpressurecontrol.
Theresultssuggestedthateffectivecommunicationandanemotionalconnectionpositivelyaffectedtreatmentoutcomes[3].
Timothyevaluatedbothclinicalphysicians'abilitytocommunicatewithpatientsandtheirhumanisticqualitieswiththeassistanceofthreetrainedobservers,eachofwhomrated20videotapedclinicalencounters[4].
Theevaluationmethodologyemployedinthisstudyalsoreliedontheparadigmofpersonalizationandintuitivedirection.
Inanevenworsesituation,theevaluationofhumanisticqualitiesofphysiciansinMainlandChinahasnotbeenadequatelystudied.
Therefore,acomprehensiveevaluationsystembasedonscientificmethodsisneededtobedevelopedfortheChinesecontext.
ISSN0970-938Xwww.
biomedres.
info4432BiomedicalResearch2017;28(10):4432-4438BiomedRes-India2017Volume28Issue10ExploringtheconstructionoftheHumanisticQualityEvaluationSystem(HQES)formedicalpractitionersandidentifyingitsbasicelementsareparticularlyimportantforthedevelopmentandevaluationofthehumanisticqualitiesamongmedicalpractitioners.
TheHQESisamultilevelandcomplexdatasystemthatcomprisesnumerousfactorsthataremutuallyassociatedandcontrolled.
TheHQESnotonlyrequiresanin-depthanalysisofthehierarchyevaluationofeachexpertbutalsocombinestheadviceofeveryexperttomakeafinaldecision.
Therefore,theAnalyticHierarchyProcess(AHP),whichisusedinthisstudy,isaneffectivemethodtomeettheserequirements[5,6].
MaterialsandMethodsWeusedtheAHPmethodthatwasslightlymodifiedbasedonthepreviousstudies[7,8].
Thedatainthisstudywerecollectedfrom31provincesovertheentireMainlandChina,includingBeijing,Tianjin,Hebei,Henan,Shan'xi,Shandong,Liaoning,HeLongjiang,NeiMenggu,Shanghai,Zhejiang,Jiangsu,Anhui,Guangxi,Fujian,Jiangxi,Hubei,Hunan,Guangdong,Hainan,Chongqing,Sichuan,Guizhou,Yunnan,Tibet,Shan'xi,Gansu,XinjiangandQinghai.
ThedatacollectionperiodwasfromJanuaryof2014toDecemberof2015.
Wedeclarenoconflictofinterestsinthisstudy.
EstablishmentoftheevaluationindexsystemAfour-layerHQES(Figure1)wasestablishedbyadoptingmultipleresearchmethods,e.
g.
,literaturestudies,ahistoricalreview,expertinterviews,andsurveyquestionnaires(Table1).
LayeroneistheTargetLayer(O).
Thislayerconsistsofquantitativerankingsoftheevaluationindexesofthehumanisticqualitiesofmedicalpractitioners.
LayertwoisCriterionLayerI(A).
ThislayeristheprimaryevaluationindexfactorsoftheHQES,whichincludesmedicalhumanisticknowledge,medicalhumanisticabilityandmedicalhumanisticspirit-markedasA1,A2andA3,respectively,insequence.
LayerthreeisCriterionLayerII(B).
Thislayerconsistsof11evaluationindexfactorsincludedinthethreeprimaryevaluationindexfactorsandaremarkedasBi(i=1,2,.
.
,11)insequence.
LayerfouristheProjectLayer(C).
Thislayerconsistsof37evaluationindexfactorsderivedfromCriterionLayerII(B)andmarkedasCj(j=1,2,.
.
,37)insequence.
Figure1.
Summarygraphforthefour-layerhumanisticqualityevaluationsystem.
Thissystemincludestargetlayer(O),criterionlayerI(A1,A2,A3),criterionlayerII(B1toB11)andprojectlayer(C1toC37).
Table1.
Projectlayerweightandcomprehensiveweightofeachexpert.
ExpertIExpertIIExpertIIIExpertIVExpertVExpertVIExpertVIIExpertVIIIExpertIXExpertXComprehensiveweightWeightorderC10.
0210.
050.
0730.
090.
0140.
0440.
0390.
0370.
0430.
0530.
0444C20.
0140.
0130.
0730.
0450.
0420.
0220.
0390.
030.
0080.
0420.
02715C30.
0340.
1530.
1460.
0450.
0420.
0220.
0390.
0240.
0230.
0330.
0532C40.
0240.
0350.
0360.
0450.
0490.
0530.
0070.
0050.
0140.
0090.
01826C50.
010.
0040.
0360.
0220.
0250.
0180.
0140.
0080.
0760.
0160.
02520C60.
0150.
0350.
0730.
0220.
0250.
0180.
0140.
0150.
0720.
030.
03411C70.
0110.
0230.
0870.
0270.
010.
0320.
0170.
0130.
0160.
0480.
02519C80.
0170.
0040.
0290.
0140.
0170.
0080.
0170.
0130.
0160.
0480.
01825C90.
0070.
0020.
0290.
0140.
0040.
0080.
0170.
0130.
0160.
0480.
01628C100.
0250.
0040.
0070.
0150.
0190.
0050.
0050.
0040.
0290.
0070.
01335C110.
0100.
0120.
0150.
0060.
0040.
0070.
0040.
0080.
0070.
00737Wu/Luo/Huang/Xu/Huang/Mei/Zhai/Chen/Wang4433BiomedRes-India2017Volume28Issue10C120.
0250.
0010.
0180.
0150.
0240.
0060.
0120.
0050.
0240.
0110.
01434C130.
0130.
0030.
0180.
0150.
0240.
0070.
0150.
0120.
0260.
0240.
01630C140.
0250.
0050.
0180.
0150.
0320.
0050.
0090.
0120.
0180.
0240.
01629C150.
0270.
0740.
0110.
0320.
0250.
0390.
0050.
0240.
0050.
0280.
02518C160.
0190.
0140.
0060.
0160.
0250.
0210.
0120.
0120.
0030.
0140.
01236C170.
0380.
0150.
0110.
0160.
0250.
0150.
020.
0170.
0060.
020.
01827C180.
0130.
0040.
0110.
0160.
0250.
0160.
0340.
0170.
0070.
020.
01433C190.
0280.
0180.
0480.
0270.
0140.
0230.
0390.
0610.
020.
0360.
0369C200.
0180.
0710.
0480.
0270.
0430.
0110.
0970.
0380.
020.
0230.
0386C210.
0230.
0140.
0480.
0270.
0430.
0110.
0610.
0960.
020.
0570.
0473C220.
0610.
0150.
0220.
040.
0330.
0610.
0570.
0380.
0280.
0450.
0387C230.
0380.
0030.
0140.
020.
0330.
0610.
0230.
0380.
0140.
0450.
02716C240.
0960.
0010.
0090.
020.
0330.
0610.
0360.
0380.
0140.
0450.
0368C250.
0190.
040.
0040.
040.
0070.
0360.
0160.
0550.
0130.
0330.
02914C260.
0330.
010.
0020.
040.
0120.
0310.
0450.
0330.
0060.
020.
02223C270.
0390.
0490.
0050.
040.
0040.
0430.
0320.
0190.
0090.
0110.
02422C280.
0470.
0040.
010.
040.
010.
0720.
0230.
0070.
0050.
0040.
01532C290.
0240.
1170.
0230.
0220.
0490.
0630.
0710.
0160.
1890.
010.
0661C300.
0120.
0130.
0030.
0220.
0490.
0310.
0180.
020.
0630.
0130.
02421C310.
0120.
0130.
0030.
0220.
0490.
0310.
0110.
0260.
0630.
0170.
02517C320.
0380.
1010.
0110.
0270.
0890.
0180.
020.
0310.
0250.
020.
03610C330.
0240.
0090.
0170.
0270.
030.
0360.
0310.
0310.
0560.
020.
0313C340.
0610.
0330.
0270.
0130.
030.
0090.
0490.
0620.
0220.
040.
0435C350.
0310.
0040.
0060.
0220.
0040.
020.
010.
0240.
0040.
0160.
01631C360.
0160.
0060.
0020.
0220.
0160.
0160.
0160.
0390.
0080.
0250.
01924C370.
0310.
0380.
0030.
0220.
0160.
0260.
0250.
0610.
0150.
0390.
03412ConstructionofthejudgmentmatrixThejudgmentmatrixwasconstructedbycomparingtheinfluenceofallthefactorsonthesamelayerwiththecorrespondingfactorsoftheupperlayer.
Thismeansthateachfactoratthesamelayerwasrespectivelycomparedwiththecorrespondingfactors(attheupperlayer)inpairsaccordingtotheevaluationindexesoftheHQES.
Tocomparetheinfluenceofthenfactors(Y1,Y2,…,Yn)onX(attheupperlayer),theproportionofthenfactorsinXwasdetermined.
dijwasusedtodescribetheinfluenceratioofanytwofactors(forexample,YiandYj)toX,andtheproportionscaleofdij(I,j=1,2,…,n)wasmarkedfrom1-9.
Afterthisprocedure,thejudgmentmatrixD=(dij)n*nwasobtainedforpaircomparisons.
Forthisexample,theformulawouldobviouslybeDij>0,dji=i/dij,dii=1(I,j=1,2,.
.
,n)→(1)ConfirmationandconsistencycheckofweightTheformulaforthegeneraljudgmentmatrixDwasDW=λmaxWinwhichλmaxwasthemaximumcharacteristicrootofD,andWwasthecorrespondingeigenvectorofλmax.
WcanbeapproximatelytakenasaweightvectorofDafternormalization.
Aconsistencycheckwasanimportantapproachtoevaluatethereasonablenessofthejudgmentmatrix.
Theevaluationmethodwasasfollows:CR=CI/RI→(2)Inthisformula,CI=λmax-n/n-1,RIwasarandomconsistencyindex,andthematriceswithdifferentorderscorrespondedtodifferentvalues.
InthecaseofCR<0.
10,theconsistencyofthematrixwasacceptable.
DeterminationoftheweightvectorWAofCriterionLayerI(A)totheTargetLayer(O)DevelopmentofanevaluationindexsystemforthehumanisticqualitiesofmedicalpractitionersinChinaBiomedRes-India2017Volume28Issue104434JudgmentmatrixD0=(dij)3*3wasconstructedaccordingtotheprincipleofconstructingjudgmentmatrices,andD0wasthestraightreciprocalmatrixofOrder3.
Thevalueofλmaxanditscorrespondingeigenvectorweresolved,alongwithnormalizationforthiseigenvector.
Afterthisprocess,theweightWAofCriterionLayer(A)totheTargetLayer(O)wasobtained.
WA=(w1a,w2a,w3a)T→(3)AfterobtainingthevalueWAoftenexpertswithEquation3,theconsistencyratiowascalculatedwithEquation2.
Asaresult,theCRAofallexpertswaslessthan0.
1,whichsuggeststhatWAcanbeusedasaweightvectorbecausethisconstructedjudgmentmatrixsatisfiestheconsistencyrequirements.
DeterminationofthecombinationweightofcriterionlayerII(B)tothetargetlayer(O)JudgmentmatricesD1=(dij)4*4,D2=dij)4*4andD3=dij)3*3wereconstructedbyfollowingtheprincipleofconstructingjudgmentmatricesandbycorrespondingtothefactorindexesofcriterionlayerIA.
TheweightsP1B=(P11b,P12b,P13b,P14b)T,P2B=(P21b,P22b,P23b,P24b)TandP3B=(P31b,P32b,P33b,P34b)TofcriterionlayerIItocriterionlayerIwerethencalculated.
ThecombinationweightWBofcriterionlayerIItothetargetlayerIAwasWB=(w1aP1B,w2aP2B,w3aP3B)=(wb11,wb12,wb13,wb14,wb21,wb22,wb23,wb31,wb32,wb33)→(4)BecauseCI(B)=CI(B)WoandRI(B)=RI(B)Wocanbeobtainedfromtheaboveformula,theindexofthecombinedconsistencyratiowasCRB=CRA+CI(B)/RI(B)→(5)ThecalculatedCRBvaluesofallexpertswerelessthan0.
1,whichcomplieswiththeconsistencyrequirementinconstructingthejudgmentmatrix.
Therefore,WBcanbeappliedastheweightvectorofcriterionlayerII.
DeterminationofthecombinationweightWCoftheprojectlayertothetargetlayerJudgmentmatrixDci(i=1,2,.
.
,11)wasconstructedbasedontheprincipleofconstructingjudgmentmatrices.
EachjudgmentmatrixcorrespondstothefactorindexofcriterionlayerII.
ThecombinationweightvectorWCoftheprojectlayertothetargetlayerwasobtainedaftercalculatingthecombinationweightwiththejudgmentmatrixWC=(wk)37*1=(wbijSijk)37*1→(6)Inthisformula,SijkreferstotheweightofindexCkundertheindexweightwbijofcriterionlayerII.
Fromtheformula,CIC=CI(C)WBandRIC=RI(C)WBcanbeobtained.
CI(C)andRI(C)refertothecorrespondingconsistencyindexvectorandrandomconsistencyindexvector,respectively,ofthejudgmentmatrixinCriterionLayerII;thus,thecombinedconsistencyratioindexoftheProjectLayerwasCRC=CRB+CIC/RIC→(7)ThecalculatedCRBvaluesofallexpertswerelessthan0.
1,whichindicatesthatthejudgmentofeachexpertconcerningtheentireevaluationsystemcompliedwiththerequirementsofconsistency.
WeightvectorWCoftheProjectLayercanbeusedasthefinalweightofeachexpert.
TheresultsareshowninTable1.
CalculationofcomprehensiveweightBecausedifferentexpertsmayhavedifferentunderstandingsregardingaproblem,expertweightcanbeestablishedaccordingtotheirlevelsofunderstandingconcerningthisproblem.
WhenthedistancesbetweenthecombinedconsistenciesindexCRicofexpertiand0.
1arefartherapart,thereliabilityofthescoreandthereliabilityoftheweightarehigher.
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