團隊表現與團隊領導風格及病人安全文化營造之關聯性-以擬真情境競賽為例

The relationships among leadership style, patient safety culture and team performance: the Joint Commission of Taiwan simulation campaign as an example

林明靜(Ming-Ching Lin)

指導教授 ： 朱宗信

共同指導教授 ： 楊志偉(Chih-Wei Yang)

國立臺灣大學/醫學院/醫學教育暨生醫倫理研究所/碩士(2021年)

https://doi.org/10.6342/NTU202104258

摘要

背景：近年來醫學教育在世界各地都發生許多重大變化，改變的其中一個原因是病人安全的議題越來越受到重視，在臺灣自2003年衛生福利部與財團法人醫院評鑑暨醫療品質策進會（以下簡稱醫策會）成立了病人安全委員會，是政府與醫界對於病人安全相關議題重視的開端，隨後醫策會亦開始推動各種品質改善活動及醫品相關教育訓練，並於2013年開始辦理擬真情境競賽，鼓勵醫療機構運用擬真訓練，加強醫療團隊合作與溝通技巧。本研究以醫策會擬真情境競賽為出發點，藉由分析團隊領導風格及病人安全文化風氣調查結果，作為未來臨床教師及機構管理者，在跨領域團隊及領導力等醫學教育與培訓之方向參考，主要研究目的為：（1）探討參與擬真情境類競賽活動之團隊領導風格對團隊表現的影響。（2）探討參與擬真情境類競賽的醫療機構病人安全文化風氣情形，分析病人安全文化風氣與參賽意願之間的關係。
方法：（1）第一部分的研究為觀察型研究，回溯觀察2019年至2020年參與醫策會擬真情境類競賽之127個團隊競賽影片，進行領導風格分類的編碼，並分析團隊領導風格與團隊表現（得分）之相關性。（2）第二部分的研究係引用醫策會病人安全文化風氣調查之次級資料庫，從2014年至2020年參與病人安全文化風氣調查之醫療機構中，篩選出參與擬真情境競賽及未曾參與擬真情境競賽之機構，分析其病人安全文化風氣調查之正向回答分數成長幅度，並推論參賽意願與病人安全文化風氣之間的關係。
結果：（1-1）2019年至2020年參賽團隊之領導風格分布，61.4%的團隊整體領導風格屬於直接型及交易型；38.6%的團隊整體領導風格屬於賦權型及動態型。（1-2）隨著競賽組別的不同，會有不同的團隊領導風格（交易型或是動態型）產生，統計上達到顯著差異，在急重症照護組及產兒組的團隊領導風格以交易型為主，分別佔59.4%及78.1%，新人組的團隊領導風格則以動態型（51.6%）居多。（1-3）賦權型領導在擬真情境競賽之「競賽總分」及「臨床技能面向得分」這兩部分的分數高於直接型領導，且達到顯著差異。（2-1）分析2014年至2020年間曾參與擬真情境競賽，且每年皆進行病人安全文化風氣調查的24家醫療機構，其病人安全文化調查之各構面正向回答分數，以團隊合作構面之正向回答分數最高，復原力構面之正向回答分數最低，其中在團隊合作、安全風氣、管理感受、工作狀況及復原力五個構面達到顯著差異。（2-2）以病人安全文化調查之各構面正向回答分數推論醫療機構的參賽意願，經二元羅吉斯迴歸結果發現參與競賽的意願與安全風氣、壓力認知及工作狀況三個構面呈現正相關，表示在這三個構面正向回答分數越高的醫療機構，其參與競賽的意願就越高。
結論：（1）有關參與擬真情境競賽的團隊表現，本研究結果顯示無論何種領導風格，領導行為的有效展現是增進團隊合作及臨床處理的關鍵，且每一位成員皆有領導團隊的責任，在賦權型領導為主的團隊，能更有效的面對緊急且複雜的臨床情境，並提升團隊表現。（2）擬真情境競賽可以作為促成醫療機構營造病人安全文化的一種催化劑，使醫療人員對於病人安全文化調查各構面的正向回答分數呈現正成長，另一方面來說，是醫療機構所營造的病人安全及正向文化氛圍，讓團隊願意持續投入擬真情境競賽。

關鍵字

擬真醫學教育 ； 擬真情境競賽 ； 領導風格 ； 團隊表現 ； 病人安全文化風氣

並列摘要

Background: In recent years, there have been many significant changes in medical education around the world. One of the reasons for this is the increasing attention given to the issue of patient safety. In 2003, the Ministry of Health and Welfare of Taiwan and the Joint Commission of Taiwan (JCT) established the Patient Safety Committee, which was the beginning of the emphasis on patient safety-related issues by the government and the medical profession. Since then, JCT has also started to promote various quality improvement activities and education training related to healthcare quality. In 2013, a simulation campaign was launched to encourage healthcare organizations to use realistic training to enhance healthcare teamwork and communication skills. This study uses the JCT’s simulation campaign as a starting point to analyze team leadership styles and the results of the Taiwan Patient Safety Culture Survey (TPSCs) as a reference for the future direction of medical education and training for clinical teachers and facility managers in the areas of cross-disciplinary teamwork and leadership. The main objectives of the study include: (1) to investigate the influence of team leadership style on team performance in the simulation campaign; and (2) to investigate the patient safety culture in healthcare institutions participating in the simulation campaign, and to analyze the relationship between patient safety culture and willingness to participate.
Methods: (1) The first part of the study was an observational study, which retrospectively observed the campaign videos of 127 teams participating in JCT's simulation campaign from 2019 to 2020, and coded the leadership style categories, then analyzed the correlation between team leadership style and team performance. (2) The second part of the study draws on the secondary database of JCT's Taiwan Patient Safety Culture Survey (TPSCs), which screens out healthcare organizations that participated in the Taiwan Patient Safety Culture Survey (TPSCs) from 2014 to 2020, and identifies those that participated in the simulation campaign and those that did not participate in the simulations. The survey was used to analyze the growth of positive response scores in the Taiwan Patient Safety Culture Survey (TPSCs) among healthcare organizations that participated in the simulation campaign and those that did not participate in the simulation campaign from 2014 to 2020, and to infer the relationship between the willingness to participate and the culture of patient safety.
Results: (1-1) Regarding the distribution of leadership styles of the participating teams from 2019 to 2020, 61.4% of the teams' overall leadership styles were in the categories of Directive Leadership and Transactional Leadership; 38.6% of the teams' overall leadership styles were in the categories of Empowering Leadership and Dynamic Leadership. (1-2) Statistically significant differences were found between the different team leadership styles (Transactional Leadership or Dynamic Leadership) according to the campaign group. In the Acute Care and Maternity groups, Transactional Leadership was the predominant team leadership style, accounting for 59.4% and 78.1% respectively. In the newcomer group, Dynamic Leadership (51.6%) was the predominant leadership style. (1-3) Empowering Leadership scored higher than Directive Leadership in both the "Total Campaign Score" and "Clinical Skills Oriented Score" sections of the simulation campaign, and achieved significant differences. (2-1) An analysis of the 24 medical institutions that participated in the simulation campaign and conducted the Taiwan Patient Safety Culture Survey (TPSCs) every year from 2014 to 2020 reveals that among the positive response scores of the patient safety culture survey, the positive response scores of the teamwork dimension were the highest and the positive response scores of the resilience dimension were the lowest. Significant differences were found in the five domains of teamwork, safety culture, management perception, work status and resilience. (2-2) When the positive response scores of the patient safety culture survey were used to infer the willingness of healthcare organizations to participate in the campaign, the Binary Logistic Regression results showed that the willingness to participate in the campaign was currently correlated with the three dimensions of safety culture, stress perception and working conditions, indicating that the higher the positive response scores in these three dimensions, the higher the willingness of healthcare organizations to participate in the campaign.
Conclusion: (1) Regarding the performance of teams participating in the simulation campaign, the results of this study showed that regardless of the leadership style, effective demonstration of leadership behavior is key to enhancing teamwork and clinical management, and that each member has the responsibility to lead the team. Teams led by Empowering Leadership are more effective in dealing with urgent and complex clinical situations, and improve team performance. (2) The simulation campaign serves as a catalyst for the creation of a patient safety culture in the healthcare organization, resulting in a positive growth in positive responses to the patient safety culture survey components by the medical staff. On the other hand, it is the patient safety and positive culture created by the organization that makes the team want to stay engaged in the simulation campaign.

並列關鍵字

Simulation-based medical education ； simulation campaign ； leadership style ； team performance ； patient safety culture

參考文獻

中文文獻

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