多重制度逻辑视角下紧密型县域医共体的治理机制与组织协同： 理论机理与实证检验

Objective To explore the mechanism by which governance mechanisms within the merged county medical community affect organizational collaboration. Method Based on institutional logic theory, this study analyzes the bureaucratic logic, market logic, and community logic within the merged county medical community, clarifies the administrative mechanisms, competitive mechanisms, relational mechanisms, and other governance mechanisms arising from different logics, and constructs a framework for the role of governance mechanisms in organizational collaborative behavior. Using 235 township health centers within the merged county medical communities across the country as a sample, the study employs path analysis to empirically test the mechanism framework for county-township collaboration and township-village collaboration models. Results In the county-township collaboration model, there are a total of 7 pathways. Administrative mechanism and competitive mechanism directly influence collaborative behavior, while organizational interests and need cognition play a partial mediating role; organizational cognition fully mediates between relational mechanism and collaborative behavior. In the town-village collaboration model, there are a total of 4 pathways. Administrative mechanism and competitive mechanism directly influence collaborative behavior, with organizational interest cognition partially mediating between competitive mechanism and collaborative behavior; organizational interest cognition fully mediates between relational mechanism and collaborative behavior. Conclusion Administrative mechanism serve as the foundation for organizational collaborative behavior; competitive mechanism have a significant negative impact on organizational collaborative behavior; relational mechanism are an important safeguard for organizational collaboration; enhancing organizational interests can directly enhance collaborative behavior.