運用推拉繫住力理論探討醫療從業人員對於線上與行動病人安全通報之轉換意圖

由於多起因醫療錯誤而產生的傷害與死亡事件增加，各國開始建立通報制度而發展病人安全通報系統，期盼從通報事件中學習，了解可能造成異常事件發生的因素，透過不斷改善與學習來降低錯誤的發生。但網頁通報的實施後，也出現網站導覽不清楚、網頁出現不必要的資訊等問題，阻礙安全通報進行，除此之外，也受到個人電腦的擺放位置限制而無法及時通報。隨著科技發展，智慧型手機、平板電腦等行動化裝置由於體積小、便於隨身攜帶以及獨特的行動功能特性(如：隨拍隨傳、行動定位及語音輸入等)在醫療機構中被廣泛使用，本研究認為，發展行動通報系統能改進病人安全通報的即時性不足問題，但目前尚未知曉醫療從業人員對於行動通報系統的接受程度。因此，本研究將採用人口遷徙理論中的推拉繫住力理論模型，來探討醫療從業人員對線上通報與行動通報間的轉換意圖，並了解各因素之間的關係。本研究之研究對象包含為全台灣醫療機構(醫學中心、區域醫院、地區醫院及基層診所)需進行病人安全通報的醫療從業人員，採用網路問卷方式收集資料，有效樣本共計164份，運用SPSS 22.0版及PLS 3.0版進行描述性統計與假說檢驗，分析結果發現，(1)一階模型中的十個變數皆顯著影響醫療從業人員對行動通報的轉換意圖；(2)推力效果中的通報缺失、拉力效果中的功能特性及繫住力效果中的低轉換成本為最顯著的影響因素；(3)在推拉繫住力三種效果中，僅推力效果對轉換意圖的影響不顯著；(4)在繫住力效果的調節作用中，繫住力效果分別對推力效果與拉力效果和轉換意圖間的關係不具有顯著的調節作用，依此結果本研究在文末提出對未來的管理意涵與建議。

關鍵字

病人安全通報；行動通報系統；推拉繫住力理論；轉換意圖

並列摘要

As a result of the increase of injuries and deaths caused by medical errors, many countries began to implement patient safety reporting systems, and look forward to learning from reporting incidents to understand the factors that may cause incidents and reduce the occurrence of errors through continuous improvement and learning. However, after the implementation of an online reporting system, problems such as unclear website guidance and unnecessary information on the web page also hinder online reporting. In addition, it is also restricted by the location of personal computers and cannot timely report. With the development of science and technology, smart phones, tablets and other mobile devices are small in size, easy to carry and have unique mobile functions (e.g. as capture input, location detect (GPS), and speech input, etc.) are widely used in medical institutions. We consider that the development of mobile reporting system can improve the shortage problem of immediacy of patient safety reporting; however, it has not been known the acceptance of medical practitioners for mobile reporting system. The push-pull-mooring framework from human migration theory is adopted in this study to explore the medical practitioners on the switching intention between the online reporting system and mobile reporting system, and understand the relationship between various factors. The subject of this study must be a medical practitioner working in a Taiwanese medical institution (medical centers, regional hospitals, district hospitals, and clinics) and have experience in using a patient safety reporting system. A total of 164 valid samples were collected from the online survey. SPSS version 22.0 and PLS version 3.0 were used for descriptive statistics and hypothesis testing. The results show that (1) all the ten variables in the first-order model have significant influences on the switching intention of medical practitioners to mobile reporting system; (2) reporting mistakes in push effect, functional characteristics in pull effect, and low switching cost in mooring effect are the most significant influencing factors; (3) among the three effects of push-pull-mooring, only the push effect has no significant impact on the switching intention; (4) in the moderating effect of mooring, mooring effect has no significant effects on the relationship between switching intention and the push ef-fect/pull effect. Based on the result, this study discusses the management implications and suggestions for the future.