醫院因應嚴重急性呼吸道症候群（SARS）策略及其相關因素探討

Factors Associated with Strategic Management of Hospitals Response for Severe Acute Respiratory Syndrome (SARS)

沈孝梅(Hsiao-Mei Shen)

指導教授 ： 溫信財 博士

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(2005年)

摘要

2003年4月台灣經歷SARS無情的侵襲，當時SARS就像滾雪球般在全台竄燒，造成社會大眾極度的不安，而和平醫院的『封院事件』更是造成極大震撼，不僅造成民眾的恐慌，更暴露出醫院之危機處理能力，雖然SARS風暴已平息，然而前車之鑑，可為後事之師，因此本研究欲探討臺灣地區各醫院，面對SARS之因應策略及相關因素，希望藉此寶貴經驗作為醫院決策者應對SARS再度來襲時之參考，以期做出更有效、正確的決策。 本研究依據Shortell的理論架構，將醫院的因應策略分為機構層面、管理層面、及技術層面三類，採量性研究，以全國醫院為研究對象，運用自擬結構式問卷為研究工具，經內容效度測試及完成預試，問卷共發出475份，回收之有效問卷為174份，無效問卷6份，總回收率為37.9。 研究結果顯示：在機構層面醫院權屬別（p=0.001）、評鑑等級（p=0.001）、實際開放使用之ㄧ般床數（p=0.001）、是否收治SARS病人（p=0.001）、負壓隔離床（p=0.017）、是否為專責醫院（p=0.008）、造成衝擊程度（p=0.002）、處理緊急應變滿意程度（p=0.003）有顯著差異。管理層面在醫院權屬別（p＝0.006）、評鑑等級、實際開放使用之ㄧ般床數（p＜0.001）、負壓隔離床（p=0.008）、是否為專責醫院（p=0.002）、是否收治SARS病人（p=0.003）、造成衝擊程度（p=0.037）有顯著差異。技術層面在醫院權屬別（p=0.002），評鑑等級（p=0.001），實際開放使用之ㄧ般床數（p=0.004）、是否為專責醫院（p=0.007）、是否收治SARS病人（p＜0.001）、造成衝擊程度（p=0.021）、處理緊急應變滿意程度（p=0.024）有顯著差異。複迴歸分析結果顯示，(1) 影響機構因應策略層面之顯著變項為：醫院開放一般病床中的51-100床及101-200床、門診服務量減少21-30％、住診服務量減少31-40％、急診服務量減少51-70％（R2=0.341，P＜0.05）。(2) 影響管理因應策略層面之顯著變項為：醫院評鑑等級、開放一般病床、門診服務量減少31-40％、住診服務量減少11-20％、21-30％、70％以上（R2=0.496，P＜0.05）。(3) 影響技術因應策略層面之顯著變項為：急診服務量減少11-20％及減少21-30％（R2=0.385，P＜0.05）。 根據研究結果，本研究提出下述建議： 一、對衛生主管機關的建議： 衛生主管機關秉持SARS相關經驗，落實規劃之感染控制政策，並持續管控監測醫院成效。持續進行與加強民眾教育宣導，並建立疑似病患的監控機制。 二、對醫院管理者的建議： 醫院積極落實人員感染控制，管理者除醫院的經營外，員工的心理建設，亦不容忽視。 三、對後續研究者建議： 可針對醫護人員照顧SARS病患壓力，如少數醫護人員拒絕返院照護病患及家屬抗爭的脫序行為等，做進一步探討。

關鍵字

嚴重急性呼吸道症候群 ； SARS ； 策略管理

並列摘要

In April 2003 is no doubt one of the most unforgettable month to all human beings living in this global village. Taiwanese was not fortunate enough to be the exception. The society was deeply shaken by acute respiratory syndrome (SARS). The calamity of SARS swept off the island with unexpected overwhelming speed. Furthermore, from the day when all patients, hospital workers and visitors were quarantined within the building of Ho-Pin hospital, no one on this island could escape from the dreadful SARS nightmare. SARS not only took high social medical cost but also exposed the problem of Taiwan hospitals’ emergency problem-solving ability. We hope SARS or other similar tragedy will never return. However, we should take the lesson and the story of SARS should be wisely investigated. Well —structured and thoughtful research is expected to serve as a preparation that if SARS return it can be used as proper reference. In this paper, we classify hospitals’ response strategy according to the theory of Shortell. There are three aspects analyzed: organization, management and technical aspects. We target on all hospitals in Taiwan and investigated them by implementing self-made structural surveys. After testing the effectiveness and completion pretest of the answering surveys, there are 475 surveys been sent out, 174 surveys returned and 6 surveys counted as invalid. The total rate of return is therefore 37.9 percent. The result of the analysis reveals that there are significant differences between different level of organization (p=0.001), accreditation level（p=0.001）, acturally general ward（p=0.001）, to accept SARS patient（p=0.001）, a isolation ward（p=0.017）, responsibility hospital（p=0.008）, level of impact（p=0.002）, and the satisfaction of emergency response ability（p=0.003）. On the aspect of management, there are also notable differences between different level of organization（p＝0.006）, accreditation level、acturally general ward（p＜0.001）, a burden isolation ward（p=0.008）, responsibility hospital（p=0.002）, to accept SARS patient（p=0.003）, and level of impact（p=0.037）. On the aspect of technique,different level of organization（p=0.002）, accreditation level（p=0.001）, acturally general ward（p=0.004）, responsibility hospital（p=0.007）, to accept SARS patient（p＜0.001）, and level of impact（p=0.021）, and the satisfaction of emergency response ability（p=0.024）. When we run the regression analysis, three main critical points are revealed. First, several significant variables that affect the response strategy of the organization are listed as follows: In general hospital 51-100 ward and 101-200ward,OPD service decrease 21-30 percent,IPD service decrease 31-40 percent,emergency service decrease 51-70 percent（R2=0.341, P＜0.05）. Secondly, main variables that influence management response strategy are as follows: ranking,general ward,OPD service decrease 31-40 percent, IPD service decrease 11-20 percent、21-30 percent、above 70 percent（R2 =0.496, P＜0.05）.Thirdly, significant variables on the issue of technical response strategy are emergency service decrease 11-20 percent and decrease 21-30 percent（R2=0.385, P＜0.05）respectively. According to the above research analysis, three critical suggestions are strongly recommended. （1）Recommendation to Taiwan’s main departments of health: They should take the lesson of SARS and work on the strategy of limiting transmission, and keep monitoring the performance of all hospitals. Educating the public and establishing a system that can effectively control potential SARS patients are both indispensably required. （2）Recommendation to chief executive officers of hospitals: Not only focus on contagious disease Control among hospital workers is crucial, thoughtful psychological communication between hospitals and their workers are also substantial. （3）Recommendation for future literature Future analysis can be further built on investigating hospital worker’s pressure when they face a dilemma between their career duty, moral problem and their own fear. For example, during the SARS period there were some hospital workers refused to be called back on duty, and some protests had been held by the families of people quarantined.

並列關鍵字

Severe Acute Respiratory Syndrome (SARS), ； Strategic management

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