醫院人員對新制醫院評鑑制度內容之認知探討

Exploring Hospital Staff’s Perceptions of the Revised Hospital Accreditation Scheme

陳麗屏(Li-Ping Chen)

指導教授 ： 黃國哲

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(2009年)

https://doi.org/10.6831/TMU.2009.00151

摘要

本研究之目的為瞭解參與『新制醫院評鑑制度』之醫院人員，對新制醫院評鑑基準內容的重要性、相關性、難易度及執行成效之認知。
本研究以全體普查方式，針對台北縣某財團法人區域醫院的全體員工共1,217位人員進行資料收集及分析。使用t檢定(T-test)及單因子變異數分析(one-way ANOVA)來分析研究對象之人口學特性及醫院評鑑相關工作經驗等變數，與新制醫院評鑑基準內容及新制醫院評鑑執行作業面認知之關連性。另一方面，使用複迴歸分析來檢定上述自變項對於新制醫院評鑑基準內容及執行作業面認知等應變項之預測能力。研究結果顯示，年齡、性別、最高學歷、員工職位、職務別、從事醫療工作總年資及從事本院工作年資等人口學特質及醫院評鑑相關經驗等變數，皆會影響受訪者對新制醫院評鑑基準內容及評鑑作業執行面的認知。
本研究發現醫院人員相當認同醫院評鑑對提升醫療品質之幫助，且有參與評鑑經驗及接受過相關教育訓練者，對評鑑的認同度愈高。因此建議衛生主管機關：(1)多舉辦有關醫院評鑑相關之教育訓練。(2)持續努力於簡化評鑑作業流程及減少非必要性文件之方式，並將實地評鑑的重點強調在評鑑病人實際照護過程，以追索(Tracer Methodology)醫療照護過程的方式來評量醫療服務品質。(3)未來能將訂定A、B、C、D、E等級達成項目之說明皆能列示更完整。(4)於每次評鑑結束後，將評鑑委員判定醫院在各項評鑑基準之評分等級回饋給受評醫院，以利醫院同時參考委員評核意見外，也能更清楚醫院受評定的項目達成情形。(5)應持續加強評鑑委員與醫院員工訪談時之提問問題共識。(6)建議醫策會於評鑑委員評鑑核心課程訓練時，加強委員對夜間訪查的項目之共識。
建議個案醫院：(1)針對員工自覺較困難之評鑑項目，加強輔導及教育訓練。(2)加強對年齡在29歲以下、最高學歷為大學及研究所以外者、在本院工作年資為1-9年等員工，進行評鑑基準內容之輔導教育訓練，並且加強行政人員對新制醫院評鑑基準能提升醫院醫療品質等觀念之建置。(3)對內可分行政、醫療、護理等不同對象分別舉辦內部教育訓練，或是依員工認知較困難項目、以病人為中心思維等議題提供獎勵方案進行提案或品管競賽活動，以加強員工對評鑑項目與提升醫療品質之認知。

關鍵字

新制醫院評鑑 ； 醫療品質

並列摘要

The purpose of the study is to understand the perceptions of staffs in hospitals that participated in the “New System Hospital Accreditation Scheme”, regarding the importance, the correlation, the difficulty and the implementation effectiveness of the new system hospital accreditation benchmark.
The study adopted a full scale survey and targeted at one organizational district hospital with 1,217 staffs to conduct the data collection and analysis. T-test and one-way ANOVA were adopted for the analysis of the researched subject’s variables in terms of demographic characteristics and hospitals evaluation related work experiences, as well as the correlation between the new system hospital accreditation benchmark and the accreditation implementation process. On the other hand, multiple regression analysis was adopted to check the predictive abilities of the above variables for the dependent variables such as the new system hospital accreditation benchmark and the perceptions of implementing the accreditation process. The research results demonstrated variables of demographic characteristics such as age, gender, highest level of education, the staff’s appointment, job position, service seniority at work in healthcare and service seniority at work in this hospital etc. and relevant experiences in hospital accreditation, all could affect the perceptions of surveyed staffs regarding the new system hospital accreditation benchmark and the implementation of accreditation process.
The study found hospital staffs well recognized the help from hospital accreditation to bring-up healthcare quality, and staffs with experiences in participating in the evaluation and receiving relevant educational training were in higher degree of recognition to the accreditation. Therefore, it is suggested for the health competent authorities: (1) to sponsor more educational training in relevance to hospital accreditation; (2) to continue working on the way to simplify the accreditation process flow and to reduce non-mandatory documents, and to put the actual accreditation key points on emphasizing the accreditation of actual patient care procedures by Tracer Methodology to evaluate the healthcare quality; (3) to establish more complete guideline regarding the items to be achieved for the A, B, C, D, E classifications; (4) to feedback to the hospital under accreditation with the accreditation benchmark score and classification of each items evaluated by the accreditation committee members, so that the hospital could clearly understand its situation on achieving the accredited items in reference to the committee members’ comments; (5) to continue to strengthen the consensus between the accreditation committee members and hospital staffs during the visiting dialogue; (6) to suggest to Taiwan Joint Commission on Hospital Accreditation to strengthen the consensus on survey items in night time visits during the educational training of key accreditation courses for the accreditation committee members.
It is suggested for the subject hospital: (1) to enhance the consultation and educational training regarding the accreditation items that the staffs felt more difficult about; (2) to strengthen the consultation and educational training on the accreditation benchmark for staffs under age 29, with highest level of education other than from university and graduate school, service seniority at work in this hospital between 1 – 9 years, and to strengthen building perception to administrative staffs regarding the new system hospital accreditation benchmark could bring-up hospital healthcare quality; (3) the internal educational training can be divided between administrative, medical treatment, and nursing staffs, or according to the staffs’ perception of more difficult items, and center the thoughts on the issues of patients for proposal and quality control by way of competition activities under the provision of incentives, so as to strengthen the staffs’ recognition on the accreditation items and the increase of healthcare quality.

並列關鍵字

New System Hospital Accreditation ； Healthcare Quality

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