医学是有温度的。随着“生物-心理-社会”现代医学模式的出现，人们对健康的内涵产生了新的认识。“以患者为中心”的思想以及对医学人文关怀的日益关注，推动着医务社会工作进入人们的视野，带来改善医疗环境的新可能。

2017年12月，国家卫生计生委和国家中医药局联合发布《关于印发进一步改善医疗服务行动计划（2018-2020）的通知》（国卫医发〔2017〕73号），明确要求医疗机构开展医务社会工作。随后发布的《进一步改善医疗服务行动计划（2018-2020年）考核指标》（国卫办医函〔2018〕894号）将“医务社工制度”单独列为一级考核指标，纳入医疗机构考核标准。此举给我国医务社会工作发展带来了前所未有的政策支持，使医务社会工作成为医疗服务体系中不容忽视的部分。

本研究关注医疗机构对这一政策的执行情况，以医疗机构如何建立及发展本院医务社会工作以完成政策内容要求为研究问题，了解当前医疗机构医务社会工作开展情况，探究影响医疗机构政策执行行为的主要因素，为推进政策顺利执行提供建议。本研究采用质性研究方法，通过半结构式访谈对京津地区7家三级医院进行资料收集。研究首先从政策实际影响、具体入驻模式、部门设置情况、人员配置管理、工作开展情况、医务人员看法，共计六个方面对医疗机构具体政策执行情况展开阐述。随后，以生态系统理论与范·米特和范·霍恩政策执行系统模型为依托，笔者构建政策执行主体行为分析框架，对医疗机构政策执行行为展开分析，明确影响医疗机构政策执行行为的内外部因素。研究发现，政策属性、决策者、环境因素、目标群体，以及政策执行主体自身情况均影响了医疗机构的政策执行行为。

经研究可知，这一政策的出台确实在一定程度上推进了医务社会工作的发展，特别是让部分医疗机构有了“零”的突破。但是，由于政策本身模糊性较高，加上政府部门监管不利等因素的影响，医疗机构拥有了过大的自由裁量空间。在此基础上，医疗机构的政策执行行为明显受到来自内外部多方因素的影响，尤其是其自身内在因素的影响，出现政策执行偏差。因此，这一政策实际起到的效果有限。基于研究发现，本研究从影响政策执行主体行为的内外部因素出发，为推进政策有效执行提供对策建议，助力我国医务社会工作未来发展。

Medicine has its temperature. With the emergence of the bio-psycho-social medical model, people have a new understanding of the health. Patient-centered care and people's attention to medical humanities encourage more people to learn about medical social work, which brings new possibilities to improve the medical environment.

In December 2017, the National Health and Family Planning Commission China and the State Administration of Traditional Chinese Medicine formulated and released the China Healthcare Improvement Initiative (2018-2020), which required medical institutions to establish medical social work systems. Subsequently, the assessment index system of the China Healthcare Improvement Initiative (2018-2020) came up, stipulating that the medical social work system belongs to the first-level assessment index of medical services. This decision brings unprecedented policy support to the development of medical social work in China, which makes medical social work an essential part of the mission that cannot be ignored in medical institutions.

The study focuses on the implementation of this policy. By researching how medical institutions establish and develop medical social work systems to fulfill the policy requirements, the study aims to learn about the status of the development of medical social work in medical institutions and explore the main influence factors that affect the policy implementation actions of medical institutions, and then provide recommendations for advancing smooth policy implementation. The qualitative research method was adopted in the study—data collection from 7 tertiary hospitals in Beijing and Tianjin through semi-structured interviews. At first, the study elaborated on the policy implementation from six aspects, including the impact of the policy, the specific mode of entry, the setting of the department, staff allocation and management, work implementation, and perceptions of medical staff. Subsequently, based on ecological systems theory and the policy implementation process model (Van Meter and Van Horn), an analytical framework focused on policy implementers was constructed to clarify the internal and external factors that influence the policy implementation of medical institutions. The study found that policy attributes, policy makers, environmental conditions, target groups, and policy implementers all influenced the actions of medical institutions.

According to the research, the release of this policy promotes the development of medical social work to some extent. Especially for those medical institutions which did not employ medical social workers before the policy was established, this policy brought them a "zero" breakthrough. However, medical institutions have too much room for discretion because of the policy's high ambiguity and the influence of unfavorable government supervision. Based on that, internal and external factors greatly affected medical institutions' actions, especially internal factors, resulting in policy implementation deviation. Therefore, the practical effect of this policy is limited. According to the findings, the study provides countermeasures and suggestions for enhancing the effectiveness of policy implementation from both internal and external factors that influence the actions of policy implementers to contribute to the future development of medical social work in China.