中文版安全態度量表之信效度評估與應用-某醫學中心病人安全文化之初探

Evaluation of Reliability and Validity of Safety Attitude Questionnaire in Chinese Version : An exploratory study of Patient Safety culture in a Medical Center

簡淑芬(Shu-Feng Chien)

指導教授 ： 張淑惠 ； 戴政

共同指導教授 ： 李偉強(Wui-Chiang Lee)

國立臺灣大學/公共衛生學院/流行病學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.00597

摘要

目的：病人安全已成為全球醫療體系最關注的議題，隨著國際社會重視及推動病人安全的努力，應用量表評估醫療機構員工對安全的態度認知，已是國際近年來之趨勢，本研究引入由Dr. Bryan Sexton等人設計之安全態度問卷（Safety Attitude
Questionnaire，SAQ）作為研究工具進而發展中文版SAQ，並驗證中文版安全態度問卷（SAQ）之工具信度與效度，據以評估醫療機構內員工對安全態度的認知現況，瞭解醫療機構內工作人員的個人及工作特質對安全態度認知之差異。
方法：本研究為一橫斷性研究，以北部某醫學中心4873位員工為調查對象，以普查方式進行，在普查之前本研究經原作者的授權先進行SAQ中文化，並通過內在一致性檢測。研究使用驗證性因素分析的最大概似估計法對測量模型進行估計假設模式與實際資料是否契合，進而考驗工具的信度與效度。
結果：回收問卷2926份，問卷回收率為71.1％，以護理人員的回收率最高，信度分析顯示：潛在變項的組合信度（CR）介於.77-.93，具有理想的內部一致性，但潛在變項的平均變異量抽取值（AVE）介於.40-.71，團隊合作風氣（.46）、安全風氣（.40）、對管理的感受（.44）未達標準。效度分析顯示：三十項測量變項的標準化因素負荷量估計值（ ）皆達統計水準，整體模式適配度檢核結果為
2801.323 (p=.00＜.05)，RMR=.038；RMSEA=.055；GFI=.905；TLI(NNFI)=.917；CFI=.926顯示假設模式與樣本資料適配程度良好六個構面的模式適配度均達可接受的程度，且具有相當良好的收斂及區別效度。六個構面除「對壓力認知」之外，其它構面間均有顯著的相關性（r=0.67~0.93）。經比較假設模式（六構面）與修正
模式（五構面）整體模式之適配度，評鑑結果以修正模式較為理想且符合模式簡約原則。醫療機構內人員對其服務醫院的安全態度認知以「團隊合作風氣」構面（70.99±18.45分）為最高，「對管理的感受」（58.81±19.06分）為最低，工作人員對安全態度的認知集中於「中立」到「有些同意」之間。經單變量變異數分析結果發現，機構中工作人員的性別、年齡、教育程度等個人特質因素以及醫院服務年資、不同專業人員別、任管理職位與否等工作特質因素對於安全態度的評價和看法是有顯著差異的。
結論：中文版SAQ具有可接受的信度與效度，可以提供台灣醫療機構做為評量醫療人員對病人安全態度的工具，並可適切反應該機構的安全文化。研究建議持續推廣安全教育、實施主管走訪安全模式，降低彼此對安全管理認知上的差距，並且積極建立醫事人力評估機制等，從系統性改善來落實病人安全政策。

關鍵字

病人安全 ； 安全文化 ； 安全態度問卷 ； 團隊合作 ； 安全風氣 ； 工作滿意度 ； 對壓力認知 ； 對管理的感受 ； 工作的狀況

並列摘要

Objectives: The Safety Attitude Questionnaire (SAQ) has been used in several countries to measure healthcare workers’ attitudes toward patient safety. It has not been validated in Taiwan, however. The objective of this study was to develop and validate a Chinese version of the SAQ and determine the extent to which safety attitudes varied among different types of staffs in a single hospital.
Methods: The original SAQ was translated into Chinese in October 2006. There were 30 core items, measuring six domains of an organization’s safety culture: Teamwork Climate(TC), Safety Climate(SC), Job Satisfaction(JS), Stress Recognition(SR), Perceptions of Management(PM), and Working Conditions(WC). A hospital-wide safety attitude survey was conducted in one medical center in Taipei in April 2007. The reliability and validity of the SAQ were examined by confirmatory factor analysis. They rated their agreement with the items using a 5-point Likert scale. Each scale was scored by converting the 5-point Likert scale to a 100-point scale. Responses to each item in a scale were summed then divided by the number of items in that scale to create a mean score that ranged from 0 to 100. Differences in the mean scores of each scale were examined by analysis of variance among physicians, nurses, pharmacists, technicians, and non-medical staffs.
Results: The overall response rate was 71.1%. The internal consistency of each domain was high (composite reliability: 0.77-0.93). The explanatory abilities of two-thirds (21/30) of the core items are considered important for the corresponding domains (squared multiple correlation [SMC] ≥ 0.5). The standardized factor loadings (λ) for most core items were statistically meaningful (λ = 0.38-0.90). The model fit was satisfactory for the six domains and for the safety culture via structural equation models. Except for Stress Recognition, all domains were highly correlated to one another (correlation coefficients: 0.67-0.93). The overall model fit was increased after removal of the SR scale. For all staffs, the mean±SD score was 70.99 ±18.45 for TC, 68.74±16.88 for SC, 68.68±22.50 for JS, 70.19±22.82 for SR, 62.84±18.95 for PM, and 65.87±18.52 for WC. There were statistically significant variations in safety attitudes among different types of staffs.
Conclusions: The Chinese version of the SAQ is reliable and valid in measuring frontline workers’ safety attitudes in this healthcare organization in Taiwan. Appropriate revision of the SAQc could be considered by removing the stress recognition scale for better model fit than the original version. Significant variations in safety attitudes existed among different types of staffs within the hospital.

並列關鍵字

Patient Safety ； Safety Culture ； Safety Attitude Questionnaire ； Teamwork Climate ； Safety Climate ； Job Satisfaction ； Recognition of Stress ； Perceptions of management ； Working Conditions

參考文獻

施貞伶(2005)•醫院病人安全文化初探─醫事人員對病人安全風氣知覺與其促進病人安全行為表現之關聯性探討•未發表碩士論文•台北•台灣大學。

翁豐榮(2004)•醫療從業人員對醫院安全文化之認知•未發表碩士論文•高雄•高雄醫學大學。

黃榮村(1995)•邁向開放系統的本土心理學•本土心理學研究•4，329-344。

潘韋翰（2004）•組織文化與醫學中心建立病人安全系統之相關性探討•未發表博士論文•台北•台北醫學大學.

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochaslaski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job satisfaction. Journal of American medical Association, 288, 1987-1993.