病人安全評估模式之發展與應用

Development and Application on Patient Safety Evaluation Model

周蕙苓(Hui-Lin Chou)

指導教授 ： 李元墩 ； 王正華

長榮大學/管理學院/經營管理研究所/博士(2015年)

https://doi.org/10.6833/CJCU.2015.00133

摘要

病人安全的評估對於病患，醫生和管理人員至關重要，因為對於醫療品質的提升以及防止非醫療錯誤的能力甚為重要。從系統觀點來看，一個組織內的整體安全性評價包括綜合人力和機械（技術）系統的評估，許多相關標準與病人安全有關。隨著人因工程應用於病人安全領域的重要性逐漸被認知，任何對於人因工程於病人安全上的應用將被支持。本研究整合質性與量化的方法，探討病人安全評估模式中所包含的重要屬性。
本研究目的乃欲提出一個模糊多準則評估模式，期望能提供台灣醫院醫療品質的評價之應用。本研究調查主要分為兩部分，第一部分邀請五位醫療領域的專家從人因工程觀點，進行病人安全重要屬性之探討，其中運用了模糊TOPSIS評估法進行屬性評比；之後再針對四家醫院病人安全委員會中委員進行初步調查。第二部分調查則針對衛生福利部所屬醫院之員工進行資料蒐集，欲從員工觀點蒐集病人安全實施成效。
本研究結果辨明出病人安全所包含之重要屬性，瞭解到在競爭環境中，醫院高階管理者的承諾以及整體病人安全提升能力將是影響病人安全成效重要的因素。本研究主要以人因觀點為基礎，建立病人安全評估模式，此模式可供未來研究者與實務上更為有效進行探討醫院實務與病人安全結果關係之探討，並可應用於醫療品質之改善方向。

關鍵字

病人安全 ； 人因工程 ； 醫療品質 ； 模糊TOPSIS評估法 ； 重要─表現程度分析法

並列摘要

Quality patient safety evaluations are critical for patients, doctors, and managers because they determine the capability of a hospital to enhance medical quality and prevent nonmedical errors. From a systemic perspective, the evaluation of the overall safety within an organization involves the assessment of integrated human and mechanical (technical) systems. There are many related criteria in regard to patient safety. Since the awareness of the importance of Human Factors and Ergonomics (HFE) in patient safety domains has significantly increased. Therefore, every effort should be made to support HFE applications in patient safety. This study presented a method that combines qualitative and quantitative criteria and accounts for the importance of each criterion in the evaluation process.
The purpose of this study was to propose a fuzzy multi-criteria evaluation model to measure the quality of patient safety in hospitals in Taiwan. The investigation for this study included two main sections. In the first section, five experts were invited to indicate the importance attributes of the patient safety from the human factors perspective. Fuzzy TOPSIS method was applied during this phase. And then committees of patient safety committee from hospitals were invited to evaluate these indicators. The second part of the investigation collected information from respondents through a survey focusing on employee perspectives of patient safety quality.
The results of this study clarified the critical attributes of patient safety and how the patient safety enhancement capabilities of hospitals should be considered in a competitive environment. This study established a specific example of HFE-based evaluation model for patient safety. The result showed that HFE can be used in a variety of domains. This model could allow healthcare researchers, practitioners to more effectively examine the relationship between the practice of healthcare and patient safety outcomes.

並列關鍵字

Patient Safety ； Human Factors and Ergonomics (HFE) ； Medical Quality ； Fuzzy TOPSIS ； Importance–Performance Analysis

參考文獻

Alberty, S., & Mihalik, B. (1989). The use of importance–performance analysis as an evaluative technique in adult education. Evaluation Review, 13(1), 33–44.

Allsup, S. J., Gosney, M., Regan, M., Haycox, A., Fear, S., & Johnstone, F. C. (2001). Side effects of influenza vaccination in healthy older people: a randomized single-blind placebo-controlled trial. Gerontology, 47(6), 311-314.

Avery, A. J., Dex, G. M., Mulvaney, C., Serumaga, B., Spencer, R., Lester, H. E., & Campbell, S. M. (2011). Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method. British Journal of General Practice, 61(589), 526-536.

Azzopardi, E. & Nash, R. (2013). A critical evaluation of importance–performance analysis. Tourism Management, 35, 222–223.

Bacha, E. A. (2007). Patient safety and human factors in pediatric cardiac surgery. Pediatric Cardiology, 28(2), 116–121.