探討遠距照護服務利害關係人的互動與衝突

Exploring the Interactions and Conflicts of Telecare Service Stakeholders

呂麗雯(Li-Wen Lu) ； 張碩芳(Shofang Chang) ； 戴珮珺(Pei-Jung Dai)

《醫療資訊雜誌》 27卷3期 (2018/09) Pp. 49-60+62

摘要

近年來由於科技產業技術不斷進步，醫療相關服務從傳統面對面模式，延伸為遠距離的虛擬方式。而台灣人口結構呈現高齡化趨勢漸趨嚴重，為解決老人長期照護及慢性病照護，醫療產業紛紛導入資訊與通訊技術，遠距照護服務的便利，成為世界各國未來健康照護服務產業上採用的方式。遠距照護服務需要許多相關領域的利害關係人的參與，然而，當前遠距照護服務的相關研究，鮮少以各個利害關係人之角度，架構出完整的服務模式。因此，本研究欲推行遠距照護服務，探討相關利害關係人在權力-利益矩陣中的定位，以及其互動、衝突與解決方式。本研究分兩階段進行。第一階段透過權力－利益矩陣，瞭解遠距照護服務利害關係人的定位及重要性，針對國內13家實施遠距照護服務之機構，包括北、中、南、東七家醫院、三家護理之家、兩家養護中心及一家長期照護中心的遠距照護服務和相關單位參與人員，發出問卷共73份、回收問卷共66份，有效回收率達90.4%。回收資料採用Excel散佈圖，繪製遠距照護服務之利害關係人在權力－利益矩陣中之群眾、隸屬關係、脈絡因素及關鍵參與者中的定位。第二階段以立意抽樣的方式針對遠距照護服務相關領域的主管共十位，藉以深度訪談方式以及語幹分析的方法，運用紮根理論進行資料分析，探討實施遠距照護服務之想法與建議。結果發現最關鍵參與者有醫師、政府相關單位、照護端、護理人員、個案、營運端、個案管理師、藥師及家屬，次關鍵參與者為醫療設備及器材業、系統管理 、資訊系統工程人員、其他醫療人員及照顧服務員。本研究建議，照護端、營運端與政府相關單位應加強推廣及宣導遠距照護服務，使民眾更能瞭解此服務模式；法規面上應採開放性的角度實施遠距照護服務，使服務的層面較廣闊；最後，對於遠距照護服務相關參與人員應給予適當的獎勵與補助，使其更有意願參與。本研究期望在有限資源下能對遠距照護服務利害關係人做最有效的管理，使得遠距照護服務發揮最大效益。

關鍵字

遠距照護服務 ； 利害關係人 ； 權力－利益矩陣 ； 深度訪談

並列摘要

Due to the continuous improvement of technology industry in recent years, medical care services have extended their pathways from face-to-face to virtual approaches. To cope with the serious issues of aging population in Taiwan, the development of telecare services, which imported information technology as the service platform, have become a new trend of health care industry. Telecare service requires the participation of many relevant stakeholders in the field. However, the current telecare services research rarely explores the viewpoints of the various stakeholders and construct an integrated model. Therefore, this study aims to introduce telecare services and explore the positioning of the stakeholders using power-interest grid as well as the interaction, and conflicts solutions among them. There are two phases in the study. In Phase one study, thirteen institutions, including seven hospitals from northern, middle, southern, and eastern areas in Taiwan, three nursing homes, and three long-term care institutions which have been implementing telecare services participated the study. A total of 73 questionnaires were mailed, and a total of 66 questionnaires returned, with the effective response rate of 90.4%. Scattering diagrams using EXCEL were employed to construct a power-interest grid of the stakeholders in telecare services. Phase two study used purposive sampling and conducted ten in-depth interviews with chief conductors of telecare divisions in various organizations. Grounded theory was used to analyze the qualitative data and explore the perceptions and suggestions of participants. The results showed that physicians, government agencies; the caregivers, nurses, caretakers, the operating units, case managers, pharmacists and family members are positioned as the primary key players. Medical devices and equipment industry, system management corporations, information systems engineering personnel, medical staff and care attendants are secondary key players. This study suggests that caregivers, the operating units and the government agencies should strengthen the promotion and advocacy of telecare services to enable people to better understanding of this mode of service. Deregulations are requisite for the market expansions. Lastly, more stakeholder participation in strategic planning should be encouraged upon appropriate incentives and subsidies. This study expects to manage telecare services stakeholders in a most efficient way in order to obtain their maximum benefits.

並列關鍵字

telecare services ； stakeholders ； power-interests grid ； in-depth interview