Objective  To explore main obstacles to the construction of harmonious doctor-patient (DP) relationship and to provide evidences for developing strategies on the improvement of doctor-patient relationship in China.

  Methods  We conducted a on-site survey among 1 127 medical staff, administrative personnel, experts, and citizens selected with stratified cluster sampling in Beijing, Shanghai, and Harbin city between 2014 and 2015. A self-designed questionnaire was used to collect information on demographics, cognition on DP relationship, impact factors of DP relationship, social influence and outcome of poor DP relationship, and consideration on the improvement of the relationship. Descriptive statistics and factor analysis were adopted in data analyses.

  Results  The participants scaled higher scores for maintaining public-welfare nature of medical institutions (8.28), improving financial security level of medical insurance system (8.19), reforming hospital performance management system (7.92), and controlling unreasonable scale enlargement of hospitals (7.91) among the 13 items for strategies or measures on improving DP relationship; then three common factors were extracted from the 13 items using factor analysis and the cumulative variance contribution of the three common factors was 60.282%. The three common factor were namely institutional culture (composed of maintaining public-welfare nature of medical institutions and improving financial security level of medical insurance system), organizational administration (consisting of controlling unreasonable scale enlargement of hospitals and reforming hospital performance management system), and quality of medical personnel (involving the enhancement of communication skill, technical expertise and professional ethics in medical workers), with the variance contribution rates of 47.614%, 7.892%, and 4.839%, respectively.

  Conclusion  The efforts for improving doctor-patient relationship should be made on three aspects of health system, hospital, and medical personnel and special concerns should be paid to maintaining non-profit nature of public medical institutions and medical insurance system construction, internal management of medical institutions and training of medical staff in the establishment of harmonious doctor-patient relationship in China.