跨層級醫院機構合作模式之初探：以品質績效量測指標系統與落實改善計畫為例

A Preliminary Study of Cross-level Hospital Institutional Cooperation Model： The Case of Hospitals in Pay for Performance Demonstration Program

林綉敏(Xiu-Min Lin)

指導教授 ： 鍾國彪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2020年)

https://doi.org/10.6342/NTU202001100

摘要

背景：醫策會於2012年開始實施「醫院品質績效量測指標系統與落實品質改善」論質計酬試辦計畫，而計畫中發展出以申請醫院輔導合作醫院的跨層級醫院合作模式，希望此互動模式能夠帶動醫院整體健康照護品質優質化。
目的：旨在了解申請醫院如何輔導合作醫院，探討跨層級醫院合作模式是否能帶動醫院整體健康照護品質優質化，並檢視合作模式對於醫院執行「醫院品質績效量測指標系統與落實品質改善」試辦計畫產生之實際影響，以及彙整出相關影響因素。
方法：本研究以個人深度訪談以及焦點團體訪談來蒐集資料，並以半結構式訪談大綱為指引，根據研究目的以及抽樣方法分為兩組受訪者： (1)參與醫品改善計畫同一個群組中的申請醫院和合作醫院 (2)參與醫品改善計畫非在同一個群組中的申請醫院和合作醫院，並利用滾雪球方式，分別邀請醫院之管理階層以及基層承辦人員進行個人深度訪談，直至資料飽和即停止邀請受訪者。使用NVivo12軟體整理與分析訪談資料，並彙整出跨層級醫院合作模式概念圖以及相關的影響因素，研究者亦根據訪談資料對各子因素作定義與說明，並引述受訪者訪談內容作為佐證。
結果： 本研究訪談19家醫院，包含8位管理階層、14位基層承辦人員，共計訪談人數為22人。本研究針對「跨層級醫院合作模式行為」、「動機因素」、「阻礙因素」和「情境因素」的核心概念進行分析，歸納出影響跨層級醫院合作模式的因素如下： (1)合作行為：包括「合作原因與管道」、「合作執行」以及「合作交流方式」；(2)動機因素：包括「內在動機」和「外在動機」；(3)阻礙因素：包括「內在阻礙」和「外部阻礙」；(4)情境因素：包括「領導」和「組織文化與制度」。而跨層級醫院合作模式對醫院的實質影響分為「正面影響」，包含對 「醫院層面」、「單位層面」、「個人層面」之影響，其中，醫院層面提及次數最多的為「提升醫院組織文化」因素；單位層面為「指標收集依循SOP」、「提升指標收集正確性與效率」因素；而個人層面則為「院內同仁對品質概念提升」因素。另外，「負面影響」，包含對「單位層面」、「個人層面」之影響，其中，單位層面提及次數最多的為「病人層級指標收集耗費人力」因素；個人層面則為「增加同仁工作量」。
結論：本研究所提出之跨層級醫院合作模式概念圖，與過去國、內外文獻相比有其異同之處，而本研究亦發現跨層級醫院合作模式確實能帶動醫院整體健康照護品質的優質化，並可以提供此經驗為未來醫策會或衛福部推行其他試辦計畫之實務架構參考，未來，此合作模式初探之概念圖亦可作為後續驗證或發展架構圖與問卷之基礎。

關鍵字

跨層級醫院合作 ； 醫院品質績效量測指標系統與落實品質改善計畫 ； 個人深度訪談 ； 焦點團體 ； 合作對醫院影響

並列摘要

Background： The Joint Commission of Taiwan began to implement the "Hospital Quality Performance Measurement Index System and Quality Improvement" pay for performance demonstration program in 2012. To improve healthcare quality of all hospital levels, it develops a cross-level hospital institution cooperation model in this demonstration program.
Purpose： The purpose of this study are: (1) to understand how do medical centers cooperate with regional and district hospitals and explore whether this cooperative model can improve the quality of healthcare；(2) to discuss how does the cross-level hospital cooperation model affect the hospitals participating in P4P demonstration program, and (3) to explore the influential factors and draw the concept map of the cross-level hospital institution cooperation model.
Method： Individual in-depth interview and focus group interview method was adopted for this study by using semi-structure interview guide. According to the research objectives, there are two kinds of interviewees: executives or staffs of (1) hospitals that are in the same group；(2) hospitals that are not in the same group, then stop recruiting interviewees until the data is saturated. The recording files were transcribed verbatim for analysis, and the data were analyzed by NVivo12 software. The content analysis and thematic analysis method were adopted for developing the cross-level hospital institution cooperation model.
Result： This study interviewed 19 hospitals, including 8 executives and 14 staffs, and a total of 22 interviewees in this study. The core concept and influential factors of each concept are listed as follows： (1) cooperative behavior, including "reasons and channels of cooperation", "cooperation execution" and "methods of cooperation"; (2) motivation factors, including "intrinsic" and "extrinsic" motivations; (3) obstacle factors, including "intrinsic" and "external" obstacles; (4) Situational factors, including "leadership" and "organizational culture and system". The impact of the cross-level hospital institution cooperation model is divided into two parts, one is "the positive impact", including the impact on the "hospital level", "unit level", and "individual level"；and the other is "the negative impact", including the impact on the "unit level" and "individual level."
Conclusion： The concept map of cross-level hospital institution cooperation model proposed by this research has similarities and differences with the past literatures, and the results of this study also find that this cooperation model can drive up overall quality of the healthcare. In the future, this preliminary concept map can also be used as a foundation for subsequent verification or development of the framework map and questionnaire in Taiwan.

並列關鍵字

Cross-level Hospital Institutional Cooperation ； P4P demonstration program ； individual in-depth interview ； focus group ； the influence of cooperation on hospitals

參考文獻

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