醫療機構促進病人安全文化之管理模式—以中部某區域醫院為例

The Management Model of Medical Institutions to Promote Patients Safety Culture in a Taichung Regional Hospital

藍豔柔(YAN JOU LAN)

指導教授 ： 蔡雅芳

中山醫學大學/健康管理學院/國際健康產業經營管理碩士在職專班/碩士(2020年)

https://doi.org/10.6834/csmu202000054

摘要

本研究以台灣中部某區域醫院為研究對象，採用質性訪談的方式，訪談的時間自2020年4月28日至5月11日止。個案醫院選取10位管理年資在3年以上之管理者進行深入訪談，研究目的在於了解其在組織內促進病人安全文化之管理模式。
研究結果可得知，醫院在推動病人安全文化的管理模式涵蓋如下幾個構面與作為:1.執行與管控方面:組織的管控設計需要將效率作為重要的關鍵，結合醫院流程優化整合出來的架構方案才能有助於提高管理效率，減少管理上的負擔。2.稽核與審查方面:常態性的稽核與審查能夠有效促進病人安全文化，其中又以外部稽核的方式對於問題改善最具效果，稽核的方式也容易形成一種單位間的默契，讓病人安全文化成為組織共通的語言。3.教育訓練方面:教育訓練的形式需要再創新、再翻轉，才能夠真正符合臨床單位的需要，競賽類的活動及工作坊形式的教育訓練方式更能產生學習效益。4.獎勵與懲罰措施方面:概念上都反對懲罰，但發生醫療上的錯誤時，也必須收集和分析醫療不良事件發生的原因，以發展符合病人安全照護的最佳模式。5.政策執行方面:政策的推動過程需要讓員工能充分了解其重要性，重要的是與自己切身的關係，唯有跟員工自己的權益產生連結，政策推動與執行才能見到成效。6.組織與權責劃分:專責單位在處理全院的異常事件時，應到現場了解事件發生的人、事、時、地、物，避免流於書面審核的形式，另外，最高領導人對於病人安全文化的宣誓及態度十分重要。7.資源投入方面:資源的投入需要有計畫性，計畫性的資源分配，可以預防資源過度集中於某個單位或是某個醫療項目。

關鍵字

病人安全 ； 病人安全文化 ； 異常事件

並列摘要

In this study, the research project took a regional hospital in Taichung, Taiwan as the research object, and the qualitative interview was applied. The interview period started from April 28 to May 11, 2020. Ten managers with over three years of managing experience were selected in The Case Hospital to conduct in-depth interviews. The purpose of the study is to understand its management model that promotes the organization's patient safety culture.

The research results show that the hospital's management model to promote patient safety culture covers the following aspects and actions: 1. Implementation and control aspects: Organizational control design requires efficiency as an essential key, and the optimization and integration of hospital process architecture schemes can help improve management efficiency and reduce management burden. 2. Evaluation and review: Normal audit and review can effectively promote patient safety culture. Among them, the external evaluation method is the most effective problem improvement approach. Also, this evaluation method is an accessible way to form a tacit understanding between divisions so that the patient safety culture becomes a common language of the whole organization. 3. Education and training: The method of education and training needs to be more innovative and then reversed to meet the needs of clinical units truly. Competitive activities and workshop educating and training methods can create learning benefits. 4. Rewards and punishment: Conceptually opposed to punishment, when medical errors occur, we must collect and analyze the causes of adverse medical events to develop the best model for patient safety care. 5.Policy Implementation: The policy promotion process needs a period of adaptation in the beginning so that employees can fully understand their importance. The substantial thing is that they have a personal relationship with themselves. By connecting with employees' rights and interests, there will be positive results in the promotion and implementation policy. 6. the organization and the division of powers and responsibilities: When dealing with the abnormal events of the hospital, specialized units should visit the scene to understand the people, matters, time, place, and things that occurred to avoid the formality of written audits. The oath and attitude of patient safety culture are fundamental. 7. In terms of resource input: The input of resources needs to be appropriately distributed. Planned resource allocation can prevent excessive concentration of resources over shifted into a unit or a medical project.

並列關鍵字

patient safety ； patient safety culture ； abnormal events

參考文獻

何長穎(2018)，《醫院員工病人安全文化認知對醫療品質態度的影響-以個案醫院為例》。中山醫學大學醫療產業科技管理學系碩士論文，未出版，台中市。

吳宛蕙、侯紹敏、吳永隆、葉宜珍、黃鈺茹、王拔群、于卓然(2008)，《利用團隊資源管理提升機構病人安全文化》醫療品質雜誌, 2(5), p84-87。

吳信宏(2017)，《從安全態度量表談論病人安全文化》，醫療品質，53(8)，p26-30。

吳萬益、郭幸萍、彭奕龍(2002)，《醫學中心組織文化、管理模式、競爭優勢與經營績效之互動相關影響研究》醫務管理期刊，3(3)，p17-38。

吳麗蘭(2008)，《醫院員工對病人安全之認知與態度調查》，北市醫學雜誌 ， 5(1)， p75–85。