臨床人員的領導模式對醫療異常事件通報意願的相關性

The Correlation Between Leadership Styles and Health Care Providers' Intention to Report Medical Adverse Events

許超(Chao Hsu)

指導教授 ： 許怡欣

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(2011年)

摘要

為了讓醫療照護變得更安全，醫療人員行使醫療錯誤回報對於提升病人安全為一個重要的策略。發現錯誤是預防錯誤發生重要的第一步，藉由錯誤的揭露，進而探討造成錯誤的根本原因或系統性失誤，才能研擬降低錯誤發生的策略方法，也能從錯誤的解析中獲得人員教育訓練的方向和方式，進而降低人員犯錯機率，使醫療錯誤不會在未來重複發生。然而，要讓醫療人員有行使醫療錯誤回報意願，醫療人員對其領導者所知覺的領導行為會是重要的一環。領導者的領導風
格直接或間接影響工作者的期望和動機，會影響員工重覆或壓抑特定的行為，因此員工認知的領導風格會影響其安全的行為。
本研究主要目的是探討臨床人員知覺其主管的領導模式對於醫療異常事件通報意願的影響，以台北市某醫院之臨床人員為研究對象，並以結構式問卷進行調查。發放663份問卷，回收417份，有效問卷為338份，有效回收率50.9%。
本研究之主要結果如下：
一、 臨床人員對於主管領導模式的知覺以轉換型領導和交易型領導
偏高，而自由放任領導偏低。
二、 臨床人員通報與自己相關的異常事件之意願較高，而對於愈嚴
重的事件，其通報的意願愈高。
三、 臨床人員會因法律問題與處罰而不通報異常事件的帄均數偏
低，檢定結果發現醫師較護理人員易受法律問題和處罰而不通
報異常事件。
四、 「法律問題」與「交易型領導」對於「醫療異常事件通報意
願」和「通報與他人相關的異常事件之意願」皆為重要的影響
因素，而「通報與自己相關的異常事件之意願」中，傴交易型
領導為影響因素。

根據研究結果，本研究提出下述建議：
一、 建議直屬主管對異常事件通報提供明確的獎酬機制，給予適當
的鼓勵，並以轉換型領導之方式，向部屬闡述通報異常事件之
目的與重要性。
二、 建議後續研究者在研究設計上可加入信任作為中介變項，考慮
臨床人員對異常事件通報的經驗與認知、組織文化等變項對於
通報意願的影響，並調查實際上的通報行為與通報意願是否有
落差。

關鍵字

領導模式；異常事件通報；醫院；意願

並列摘要

Ensuring patient safety has always been important for health care institutions, and health care providers are the front line of defense to intercept and report medical adverse events. Thus, learning from errors by relying on voluntary error reporting is the strategy to improve patient safety and to modify system vulnerabilities.
Since leadership styles are increasingly recognised as important for the safety performance, a body of literature has examined the correlation in industry. However, leadership in relation to self-reported intention has rarely been examined in hospital. This study empirically evaluates the leadership in the context of hospital.
This study present the results of a questionnaire-based study about 663 health care providers from a hospital in Taipei, in which we assessed their intention to report medical adverse events. The number of returned valid respondents was 338, and valid respondent rate was 50.9%. Hierarchical regression analysis was used to examine the correlation between leadership styles and health care providers’ intention to report medical adverse event.

Several key findings are as the following:
1. Among the health care providers’ perception of leaders’ leadership style, the mean score of transformational and transactional leadership were higher than laissez-faire leadership.
2. The health care providers had higher intention to report medical adverse events associated with themselves and serious medical adverse events.
3. Even if there were barriers, law concerns and punishment, with reporting medical adverse events, health care providers still had higher intention to report, and nurses’ intention to report medical adverse events was significantly higher than physicians’.
4. Transactional leadership is positive related to both the intention to report self-related and others-related events, and law concerns has negative influence on the intention to report others-related events.

Based on the findings, there are three suggestions as the following:
1. For transformational leadership to be effective, the supervisors of health care providers must first build trust and follower responsiveness on the basis of tangible, transactional processes perceived as fair.
2. Further study can add other variable, such as trust, organizational culture, experience, cognition to clarify the relevance between leadership styles and health care providers’ intention to report medical adverse events. And also can investigate that if there wre a gap between intention and behavior among health care providers regarding the reporting of medical errors.

並列關鍵字

leadership styles ； adverse event reporting ； hospital ； intention

參考文獻

石崇良(2006)。急診醫療不良事件之流行病學研究。台灣大學醫療機構管理研究所碩士論文。

石崇良、林仲志、廖熏香、楊漢湶、翁惠瑛(2007)。台灣病人安全通報系統三年經驗。臺灣醫學，11(3)，298-305。

石崇良、侯勝茂、薛亞聖、鐘國彪、蘇喜、廖薰香(2005)。異常事件通報系統與通報障礙。台灣醫學，9(1)，8。

呂欣茄、李麗傳、黃庭邦、李美璇(2002)。台灣地區護理主管領導特質之因素分析。慈濟護理雜誌，1(3)，78-87。

侯勝茂、陳欣欣、石崇良(2005)。病人安全通報系統之國際趨勢。臺灣醫學，9(1)，6。