使用理論觀點規劃照護改善：以醫院感染控制為例

Using Theoretical Perspectives for Planning the Improvement of Care: An Example of Infection Control in Hospital

汪秀玲(Hsiu-Ling Wang) ； 羅永欽(Joon-Khim Loh) ； 關皚麗(Aij-Lie Kwan) ； 洪純隆(Shen-Long Howng)

《醫務管理期刊》 12卷1期 (2011/03) Pp. 1-14

https://doi.org/10.6174/JHM2011.12(1).1

摘要

目的：回顧以理論為基礎的臨床實務文獻，考量專業人員、團隊、組織以及政經等多層次因素，提出可行的感染控制改善。方法：使用社會科學所公認且應用於健康照護十五種理論，分四層次說明執行改善的誘因和阻礙：專業人員層次納入認知理論、教育理論、動機理論；社會互動層次如溝通理論、社會學習、社會網絡、團隊效益、領導理論；組織層次納入創新組織理論、整合照護理論、複雜理論、組織學習／知識管理、組織文化理論；政經層次包括報償理論和契約理論。根據不同理論假說詮釋各種改善作法。結果：與專業人員相關理論，著重醫護人員作決策的方式，他們的知識技能、認知和自我效能；與社會互動相關理論探討行為改變的決定因子，如溝通說服模式、意見領袖的影響，以及團隊和領導力角色；組織系絡相關理論強調改變工作場合文化、定期聯繫分享經驗、技術創新和管理創新等產生更佳的感控流程；政經系絡理論著重保險系統與市場因素，主張以醫療支付制度獎勵加諸醫院感染防治之財務風險，健保局與醫院協商醫療品質目標。結論：規劃感控計畫應同時考量不同理論觀點，尚未有實證指出所有取向能貢獻於感控管理，不易對各理論的相對優勢做評論。然而，著重臨床領導人和模式化行為的社會學習理論，對洗手常規、職業感染防護似乎更適合。對於隔離防治、肺結核、腸道傳染等偵測處理，以創新擴散理論、整合照護、TQM以及報償理論，可能比較容易奏效。

關鍵字

理論 ； 多層次 ； 感染控制

並列摘要

Objectives: After reviewing the literature about theory-based clinical practice, we argue for a consideration of factors at multiple levels including professional, social interaction, organizational, and political- economic in order to recommend a variety of possible improvements to infection control in hospitals.Methods: We used fifteen theories recognized by the social sciences as applied to health care to understand the incentives and obstacles to improvement. We differentiated the theories into four levels: professional level (e.g. cognitive theory, educational theory, motivational theory); social interaction level (e.g. communication theory, social learning theory, social network theory, team effectiveness theory, leadership theory); organizational level (e.g. innovative organizations theory, integrated care theory, complexity theory, organizational learning /knowledge management, organizational culture); and political economic level (e.g. reimbursement theory, contracting theory).Results: Theories related to professionals in health care focus on the way that these people make decisions and their knowledge, skills, attitudes and motivation. Most of the theories related to social interaction discuss the influence of opinion leaders, the team, and the role of leadership. Theories related to organization see an opportunity for better care processes in terms of structural conditions and reforms, technical and managerial innovation, and change in the culture of the work setting. Political and economic theories encompass determinants of improvement related to insurance systems or markets factors.Conclusions: Several theoretical perspectives must be considered simultaneously in order to develop a good plan for infection control. Evidence shows that all approaches could contribute to improved infection control in general; however some theories seem to be more suitable in particular circumstances.

並列關鍵字

Theories ； Multilevel ； Infection Control

參考文獻

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