專責主治醫師病房團隊互動模式之初探

目的：探討團隊成員對醫院整合醫學照護制度的態度、專責主治醫師病房團隊運作情形與團隊成員互動模式。方法：採用質性研究方法，以便利取樣方式選擇台北市一家醫學中心，進行專責主治醫師病房的參與觀察，同時邀請九位成員完成半結構式深度訪談，並運用模版式分析方式進行後續資料整理。結果：研究顯示：（1）團隊成員認知專責主治醫師病房的特殊目標、特性與特有問題與挑戰；（2）專責主治醫師病房團隊具階層運作特性，仰賴組內、組間與跨團隊合作，組織扁平化現象更有利於提升團隊運作效率；（3）團隊組成、團隊運作歷程、任務目標與組織脈絡為專責主治醫師病房團隊互動模式的基本架構；（4）團隊成員間出現特殊的互動現象，像是啟動抗爭或忽略的反制、仿效醫師護士遊戲(Stein,1967)、以及運用觀望的拖延策略；（5）對病患處置意見不同乃是團隊內主要的衝突來源，主治醫師較不易透過團隊合作排除與團隊成員間的溝通障礙。結論：團隊成員認同醫院整合醫學照護制度的重要性與成立專責主治醫師病房的必要性。在整體組織脈絡中，團隊成員透過運作歷程達成任務目標。最後，研究者依據研究發現提出建議。

關鍵字

醫院整合醫學照護制度；專責主治醫師病房；團隊合作；團隊互動模式

並列摘要

Purpose: The aim of this study was to explore the process of teamwork in Hospitalist-Based Ward, the model of team interactions and team members’ attitude toward the Hospital Medicine Care System. Methods: Qualitative research was employed in this study, including the methods of participant observation and interviews. Nine team members of Hospitalist-Based Ward were recruited by a convenience sampling from a medical center in Taipei. Semi-structured and in-depth interviews with participants were conducted for data collection and template analysis was utilized afterward. Results: Several findings in this study were as follows: (1) Team members realized specific objectives and character of the Hospitalist-Based Ward, including problems to solve. (2) Hospitalist-Based Ward relied on team members’ cooperation in groups under a hierarchical structure and collaboration with the transdisciplinary team. The team of Hospitalist-Based Ward operated efficiently by a flat organization structure. (3) There were four components in the Model of Team Interactions, including team members, the process of teamwork, team goals and the organizational context. (4) Unusual interactions could be found among team members of Hospitalist-Based Ward, such as using tactics of Fight or Ignore, mimicking the Doctor-nurse game (Stein, 1967), and adopting the strategy of Wait and See. (5) Having different opinions about making plans for patients was quite common to make a team conflict in the Hospitalist-Based Ward. Attending physicians had difficulties in overcoming barriers of communication by teamwork. Conclusion: Team members of the Hospitalist-Based Ward recognized the importance of Hospital Medicine Care System. Members achieved the team goals through the process of teamwork within the organizational context of Hospitalist-Based Ward. Finally, practical suggestions were proposed based on the findings of the study.