病人安全文化之探討-以中部某區域教學醫院為例

A study on Patient Safety Culture in a Regional Teaching Hospital in Central Taiwan

葉宇泰(YEN YU TAI)

指導教授 ： 楊志良

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

「病人安全」議題已成為近年來各國醫療改革的重點，如何減少醫療錯誤、提升病人安全，創造民眾安全的就醫環境，是目前世界各國推動各項病人安全工作的目標；國內外相關研究文獻皆指出組織文化是醫療院所維護病人安全理念的關鍵因素，而積極塑造病人安全文化，亦成為醫療院所投入病人安全工作之首選。
本研究係透過問卷調查法，採用翁豊榮（2005）翻譯自美國健康研究暨品質機構(Agency for Healthcare Research and Quality, AHRQ)所建構發展的醫院病人安全文化調查量表（Hospital Survey on Patient Safety Culture）為研究工具，針對中部某區域教學醫院全體從業人員為研究對象進行普查，探討個案醫院病人安全文化之現況；共計發出1,025份問卷，回收757份有效問卷，有效回收率為73.9%。
根據實證分析結果，獲得之主要結論與建議如下：
一、主要結論：
(一)整體而言，個案醫院從業人員在病人安全文化認知與成效表現各面向均屬中上程度，
惟「非懲罰性的環境」及「醫院交班及換班」兩面向的認知較差；
(二)工作年資愈長對病人安全文化的認知愈趨正向；
(三)主管較非主管對病人安全文化的認知及成效表現上愈正向；
(四)醫師在病人安全文化認知及成效表現上較其他從業人員低；
(五)外包單位人員在安全文化成效的表現上較正式單位人員低；
(六)從業人員對病人安全文化認知越正向、在安全文化成效表現上越佳。
二、對個案醫院之建議：
(一)鼓勵非懲罰、營造通報好環境；
(二)檢視交換班、修正作業缺漏失；
(三)凝聚齊共識、強化主管積極性；
(四)誘發參與度、提升病安改善率；
(五)合力可斷金、促進團隊競爭力；
(六)鎖定醫師群、建立病安新主張。
三、對後續研究之建議：
(一)擴大研究範圍、納入其他影響變項；
(二)縱斷研究設計、確立變項因果關係。

關鍵字

病人安全、組織文化、病人安全文化

並列摘要

Lately, “Patient Safety” has become one of the most important issues in healthcare reform worldwide. Considerations like to keep medical mistakes to the minimum, to enhance patient safety during receiving treatments, and to create a new clinic environment safer than ever before to the general public are some prominent targets to aim at currently by many countries zealously promoting this issue. International and domestic literature on relevant studies pointed out that organizational culture was the key factor for medical institutions to upkeep of the idealism of patient safety, and thus actively formulating a so-called “Patient Safety Culture” has become the number one task of those institutions engaging in the campaign.
In this study we went through a questionnaire survey using a special form named “Hospital Survey on Patient Safety Culture” that was originally constructed and developed by Agency for Healthcare Research and Quality (AHRQ) of the USA and then introduced and translated into Chinese by Mr. 翁豊榮 in 2005 as a viable tool for this kind of study. Our chosen study subjects were the entire rank and file staff of certain regional teaching hospital in Central Taiwan. One at a time, we interviewed them separately to find out the status quo of safety culture of that individual hospital worker. Altogether we have given out 1,025 copies of the questionnaire during the study and recovered 757 of them with legitimate answers (an effective recovery rate of 73.9%).
After careful data verification and analytical steps, we came up with
the following principal conclusions and recommendations:
1. Major conclusions:
(1) Generally speaking, all the interviewed healthcare workers scored “better than average” in their recognition and outcome of patient safety culture. However, in two particular facets of the issue, namely “Nonpunitive Response to Error” and “Hospital Handoffs & Transitions,” their knowledge appeared to be not that ideal.
(2) It seemed that worker with higher seniority would score more
positively in terms of recognizing patient safety culture.
(3) Executive personnel scored more positively in both recognition and outcome of patient safety culture than non-executives did.
(4) Physicians scored lower in recognition and outcome of patient
safety culture than the rest healthcare workers.
(5) Contracted workers from outside the institution scored lower in both recognition and outcome of patient safety culture than regular or official employees of the institution.
(6) The more positive the healthcare worker was in his or her recognition of patient safety culture, the better he or she would
perform in the safety culture outcome as well.
2. Recommendations to the individual hospital studied:
(1) Preferring encouragement instead of punishment to build up a good
notification environment.
(2) Inspecting the course of work shift transfers to correct incidents of operational mistakes, missing out, and deficiencies.
(3) Agglomerating the recognition of all individual staff members and
also to reinforce the executive’s motivation.
(4) Inducing everyone’s willingness to participation and enhancing the improving rate leading toward patient safety.
(5) Cooperation can make one group invincible, so promoting
teamwork by all means.
(6) Aiming at physicians in particular to establish a new concept of
patient safety.
3. Recommendations for future studies:
(1) Enlarging the range and scope of study by adding more other
influential variables.
(2) Designing vertical study scheme to make certain the causation
relationships between all variables.

並列關鍵字

patient safety, organizational culture, patient safety culture

參考文獻

3.余錦美（2007）：病人安全文化初探-以臺北市某醫院為例。臺北醫學大學醫務管理學研究所碩士論文，臺北。

8.李茂興譯（2001）：組織行為，p. 348。臺北：揚智文化事業股份有限公司。

10.侯勝茂、陳欣欣（2004）：提昇病人安全的新作為。台灣醫學，8(4)，504-509。

1.王茹瑩（2005）：台北市西醫與中醫診所之醫師對病人安全的認知與態度。臺北醫學大學醫務管理學研究所碩士論文，臺北。

9.李應宗（2002）：組織文化與知識分享之研究-以臺北縣國民小學為例。國立臺北師範學院國民教育研究所碩士論文，臺北。