組織文化與醫學中心建立病人安全系統之相關性探討

The Exploring on the Relationship between Organizational Culture and Building Patient Safety System in Medical Centers

潘韋翰(Wei-Han Pan)

指導教授 ： 邱瓊萱

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2005年)

摘要

病人安全議題已受到全世界的重視，其起因於美國醫學機構（Institute of Medicine, IOM）於1999年所公佈的報告書” To Err Is Human: Building a Safer Health System”，指出醫療系統近年來已產生了許多重大的醫療誤失。而許多文獻均認為組織文化是醫療院所改變與朝向病人安全的關鍵因素。故本研究目的即：（1）探討組織文化與我國北部地區醫學中心在建立病人安全系統上之相關性。（2）瞭解行政與醫療兩部門員工對醫院建立病人安全系統的評價與瞭解程度。 本研究方法包含質性研究與量性研究兩部份，在質性研究方面，針對4位於醫院（或機構）內與病人安全相關之關鍵人士進行深入訪談，以建構醫院建立病人安全系統評估量表。量性研究部分，研究對象包含北部五間醫學中心內之醫師、護理人員、醫事人員與行政人員，以結構式問卷調查員工特質、組織文化與醫院建立病人安全系統中之領導力、團隊合作、異常事件通報機制與病人安全教育訓練等，以瞭解醫學中心員工對組織文化之認知與醫院建立病人安全系統之評價與瞭解程度，問卷共發出563份，回收問卷181份，回收率為32.1％。 本研究之主要結果為：（1）多數醫學中心員工認為所屬醫院組織文化為層級型文化。（2）行政人員在醫院建立病人安全系統措施上之瞭解程度、領導力評價、團隊合作評價與病人安全教育訓練評價等平均分數，均低於醫師、護理人員以及醫事人員。（3）理性型文化對領導力有負向影響，發展型、共識型與層級型文化對領導力有正向影響。（4）共識型文化對團隊合作有正向影響。（5）理性型文化對醫院異常事件通報機制有負向影響，發展型與層級型文化則會有正向影響。（6）共識型文化對醫院病人安全教育訓練有正向影響。 根據研究結果，本研究建議：（1）醫院主管應重視行政人員與病人安全系統中所扮演的角色，應重視其感受與參與性。（2）醫院主管應融合發展型、共識型與層級型文化之特質，建立一個能促進醫院建立病人安全系統之多元文化。

關鍵字

病人安全系統 ； 組織文化

並列摘要

According to the report “To Err Is Human: Building a safer Health System” issued by Institute of Medicine (IOM) in 1999, patient safety became an important issue because most medical errors were caused by the medical system itself. According to many literatures, focused to patient safety was raised and most scholars concluded that the key ingredient of successful patient safety was organizational culture. Therefore, the purpose of this study was to (1) explore the relationship between organizational culture and building patient safety system in medical centers within northern Taiwan. (2) know how well administrative staff and medical staff in the medical centers understand the patient safety system and their comments. Research designs included qualitative and quantitative data collection and analysis. For exploratory purpose qualitative data was obtained through interviewing four key persons who set up patient safety practices in their hospitals, so that we got four important constructs to formulate the questionnaire. In the other hand, we administered questionnaire to hospital employees according to their professions, such as physicians, nurse, paramedical staff, and administrator. 563 questionnaires were distributed and 181 were returned, response rate was 32.1%. Descriptive statistics, factor analysis, t test, one-way ANOVA, correlation analysis, and multiple regression analysis were used in data analysis. Results of this study were: (1) most respondents reported that the culture of their working organization was tended to be hierarchical. (2) The degree of understanding patient safety system, leadership, teamwork, and patient safety training were lower within administrator groups than physicians, nurses, and paramedical staff. (3) Rational culture had negative association with leadership; developmental culture, group culture and hierarchical culture were then positive relationship with leadership. (4) Group culture had positive impact to teamwork. (5) Rational culture had negative association with reporting system; developmental culture and hierarchical culture were positive relationship with reporting system. (6) Group culture had positive impact to patient safety training. Based on these results, there were two suggestions: (1) Managers should pay more attention to the roles that administrator groups play in patient safety system as to make them feel involved. (2) Manager should combine features of developmental culture, group culture and hierarchical culture to build a multi-organization culture for improving patient safety system.

並列關鍵字

Patient safety system ； Organizational culture

參考文獻

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