Application of Healthcare Matrix to Hospital Accreditation in Taiwan: A Clinical Management Perspective

因應台灣新制醫院評鑑之全人照護互動架構：一個臨床管理上的應用

陳綾穗(Ling-Sui Chen) ； 賴春生(Chung-Sheng Lai) ； 郭彥宏(Yen-Hung Kuo) ； 陳建立(Chien-Li Chen) ； 李書欣(Su-Shin Lee)

《醫務管理期刊》 13卷4期 (2012/12) Pp. 295-311

摘要

目的：醫院評鑑制度是台灣政府改善醫療品質重要的衛生政策之一。近幾次的醫院評鑑改革著重於將健康照護品質、醫療倫理、病人安全、個案研究、與醫學教育等多面向融入臨床執業中，顯見目前醫療照護服務迫切需要一個兼具醫學專業、照護資源管理與病患需求的全人照護思維及服務模式。本研究依據健康照護矩陣建構一兼併多目標的整合性互動架構，提供在台灣新制醫院評鑑制度下的一個評估全人照護品質與臨床執業成效之機制。方法：本研究採用行動研究法結合PDCA循環改善機制，實際應用於一家南台灣醫學中心的兩個臨床科部。結果：我們結合醫學、護理、管理與醫學教育等各領域的專家，依據健康照護矩陣將新制醫院評鑑內容共同修改，並提出應用健康照護矩陣，作為一個整合性的全人照護互動架構。醫院評鑑條文可以被重新放置在一個包含二十個構面的應用健康照護矩陣中。這二十個構面包含醫療照護品質、醫學倫理、病人安全和個案討論等。這個應用健康照護矩陣經過實際採用後發現可以改善六大面向的全人照護成效。結論：本研究提出一個結合新制醫院評鑑內容與醫學教育原則的全人照護互動架構，可作為後續實務驗證之用。

關鍵字

健康照護矩陣 ； 行動研究 ； 全人照護 ； 醫院評鑑

並列摘要

Objectives: Hospital accreditation is a major healthcare policy issue to improve the healthcare quality in Taiwan. In the reformed hospital accreditation, emphasis is placed on healthcare quality, ethics, patient safety, case study, and education when taking into account engagement in clinical execution. It requires a holistic approach that addresses the concerns of medical professionals, health resource managers and patients. In this study, we developed a multi-purpose discussion model based on the Healthcare Matrix, allowing us to assess the effectiveness of the holistic healthcare care approach under the reformed hospital accreditation system in daily clinical practice.Method: The plan-do-check-action circulatory mechanism was adapted in our research activity. The Healthcare Matrix was revised and practiced in two departments of a 1712-bed medical center in Taiwan.Result: In the combined meetings with professionals in medicine, nursing, management and medical education fields, the reformed hospital accreditation system was reviewed extensively. The rules of accreditation were reviewed to check the correlations with the 20 dimensions of the Taiwan edition Healthcare Matrix. The twenty dimensions of the matrix framework include issues of healthcare quality and ethics, patient safety and case study findings. The model was proven to enhance the improvements of holistic care under six perspectives.Conclusion: This study provides a framework to incorporate the hospital accreditation and medical education into holistic care, but it needs further adaptation and evaluation.

並列關鍵字

healthcare matrix ； action research ； holistic care ； hospital accreditation

參考文獻

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Chung, Y. Y.、Hsu, Y. H.、Hsueh, Y. S.(2006)。Qualitative analysis of the implementation of the new hospital accreditation system。The Taiwan J Health Sci。8(4)，287-297。