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在中西方学者的文献中,关于制度变迁与医疗服务组织间关系的研究一般基于“制度结构”与“制度过程”的二元划分。前者聚焦于制度的规制性要素,重视制度设计和结构对组织的外部影响,更强调结果评估和工具性考量,这种研究取向广泛地体现于早期和主流的文献中;后者将视野转向规范性和文化认知性的制度要素,不只是将制度当成外生变量,也将其视作一种内生性过程,对组织的行动、组织间的互动和相依关系、行动者对制度的影响等实施了更多的观照,这类研究虽在中国学者的文献中并不多见,但20世纪后期以来已经成为一种趋势。总的来说,两类研究的转变既与学者们不同的学科背景和研究旨趣有关,也与各国医疗服务组织所处的社会环境的变迁深刻相连,并顺应了组织理论研究从理性系统范式迈向自然系统、开放系统范式的趋势。对于中国的研究者而言,需甄别西方式的分析工具,从本土的经验出发,深入考察医疗服务组织的实践,进而寻求一种适当的解释逻辑。
In the literatures of Chinese and Western scholars, the research on the relationship between institutional change and medical service organizations is generally based on the dual division of “system structure” and “system process”. The former focuses on the regulatory elements of the system, emphasizing the external influence of institutional design and structure on the organization, and more on the result evaluation and instrumental considerations. This research orientation is widely reflected in the early and mainstream literature; the latter turns the field of vision to the norm The institutional elements of sexuality and cultural awareness are not just the system as an exogenous variable, but also as an endogenous process, the action of the organization, the interaction and interdependence among the organizations, the influence of the actors on the system, etc. Although more researches were done in Chinese scholars’ literature, it has become a trend since the late 20th century. In general, the change of the two types of researches is not only related to the different disciplinary backgrounds and research interests of scholars, but also deeply connected with the changes of the social environment in which medical service organizations of various countries are located, and complies with the organizational theory research from the paradigm of rational systems To the natural system, open system paradigm trend. For Chinese researchers, Western analytical tools need to be screened. Based on local experience, the practice of medical service organizations should be investigated in depth so as to seek an appropriate explanation logic.