臺灣博碩士論文加值系統

背景與目的：近來醫療市場競爭激烈、醫療糾紛頻傳，以快速且精準的反應市場變化以及建構更安全的就醫環境已成為醫院保有競爭優勢、有效改善醫院經營成效的關鍵。因此本研究欲進一步針對國內醫療院所員工進行實證分析，釐清醫院市場導向發展之構面(顧客導向、競爭者導向、跨功能協調)與病人安全氣候(安全程序氣候、管理者安全性作業氣候、安全資訊流氣候、安全優先氣候)之相關性。
方法：本研究採橫斷面研究設計，以國內二家區域醫院之護理人員為實證研究對象，共得有效問卷343份。進一步應用描述性分析、驗證性因素分析、t-test、單因子變異數分析、皮爾森相關、複迴歸分析及路徑分析，以實證本研究所提列之假設。
結果：本研究結果顯示，醫院市場導向構面中之顧客導向，直接正向影響病人安全氣候各構面與整體病人安全氣候之認知，其中，對病人安全程序氣候之影響最大(β=0.47)；而競爭者導向僅對病人安全資訊流氣候產生顯著正向影響(β=0.17)。在院方對員工的支持程度方面，亦對整體病人安全氣候呈正向影響，其中，又對病人安全資訊流氣候之影響最大(β=0.43)。進一步於相關矩陣中發現，院方對員工的支持程度同時與市場導向三構面呈正相關，尤其與競爭者導向及跨功能協調的相關性甚高，據此，本研究輔以路徑分析進一步探討院方對員工的支持程度之中介效果，研究結果顯示競爭者導向及跨功能協調確實會透過院方對員工的支持程度正向影響病人安全氣候。
結論：本研究透過實證資料分析發現，醫院應妥善利用顧客導向的理念，讓醫院員工以病患為中心的角度來進行醫療服務內容的設計與服務方式的改善，進而創造良好的病人安全氣候。另外，當醫院在發展競爭者導向及跨功能協調時，雖無法直接影響病人安全氣候，但透過院方於員工從事以病患為中心之相關活動時，給予員工實質與充分的支持，能有效強化病人安全氣候，可見醫院致力於提升病人安全時，市場導向三構面著實是不可忽視的重要因素。

Background and Objectives: Recently, facing to the extreme competition of medical market and frequent medical disputes, hospitals must make rapid and accurate responses to market changes and make medical environment more safe to maintain competitive advantages and improve business performances. Therefore, this study selected hospital staffs as samples and tried to clarify the correlations between the dimensions of market orientation (customer orientation, competitor orientation, and inter-functional coordination) and patient safety climate (safety procedures, perceived managerial patient safety practice, safety information flow, and priority of patient safety).
Methods: The study was based on cross-sectional design and selected hospital staff nurses from two regional hospitals as samples in Taiwan. In all 343 valid samples were obtained. We adopted descriptive analysis, confirmatory factor analysis (CFA), Student’s t-test, One-Way ANOVA, Pearson correlation, multiple regression, and path analysis to analyze the data.
Results: The findings indicated that customer orientation, one dimension of market orientation, has positive effects on each dimensions of patient safety climate and overall patient safety climate, and it has the most influence on the climate of patient safety procedures (β=0.47). However, competitor orientation only has a positive effect on the climate of patient safety information flow (β=0.17). In addition, hospital support for staffs also has the positive effect on overall patient safety climate, and has the most influence (β=0.43) on the climate of patient safety information flow. Based on the result of correlation matrix analysis, we found that hospital support for staffs has a positive effect on three dimensions of market orientation, especially on competitor orientation and inter-functional coordination. Therefore, we further used path analysis to explore the mediating effect of hospital support for staffs. Results of path analysis showed that competitor orientation and inter-functional coordination would affect patient safety climate positively through mediating effect of hospital support for staffs.
Conclusions: Hospitals should implement the concepts of customer orientation to create patient-centered perspective and ask staffs of hospital to improve medical service design and delivery according this perspective. Then, a better of patient safety climate would be built. In addition, although competitor orientation and inter-functional coordination would not affect patient safety climate directly, hospital still could effectively strengthen supports for staffs to engage in patient-centered activities and further improve patient safety climate. Therefore, when hospitals are committed to improving patient safety climate, three dimensions of market orientation should not be ignored.

目錄
中文摘要........................................I
ABSTRACT........................................III
致 謝...........................................V
第壹章 緒論.....................................1
第一節 、研究背景與動機.........................1
第二節 、研究目的...............................6
第貳章 文獻回顧.................................7
第一節 、病人安全與病人安全氣候.................7
第二節 、市場導向(MARKET ORIENTATION)...........23
第三節 、市場導向與病人安全氣候之相關性.........36
第四節 、控制變數...............................40
第參章 研究方法.................................43
第一節 、研究架構...............................43
第二節 、研究假設...............................44
第三節 、研究樣本與資料收集.....................45
第四節 、資料代表性分析.........................46
第五節 、研究構念之定義與衡量...................48
第六節 、問卷效度與信度.........................53
第七節 、分析方法...............................55
第肆章 研究結果.................................56
第一節 、樣本之基本特性描述性分析...............56
第二節 、病人安全氣候與市場導向描述性分析.......58
第三節 、病人安全氣候與市場導向之測量模式.......63
第四節 、T-TEST與ONE-WAY ANOVA 分析結果.........75
第五節 、皮爾森相關檢定.........................80
第六節 、複迴歸模式診斷及分析結果...............83
第七節、研究假設驗證結果........................93
第伍章 討論.....................................94
第一節 、護理人員知覺病人安全氣候現況...........94
第二節 、護理人員知覺市場導向現況...............96
第三節 、控制變數對病人安全氣候之影響...........97
第四節 、市場導向構面對病人安全氣候之影響.......101
第陸章 結論與建議...............................109
第一節、結論....................................109
第二節、實務意涵與建議..........................111
第三節、理論意涵與貢獻..........................114
第四節、研究限制與未來研究建議..................116
參考文獻........................................117
附錄一 問卷....................................127


表目錄
表 1安全氣候之定義.…………………………………………………………10
表 2病人安全氣候構面及其相關研究.………………………………………15
表 3過去學者對市場導向定義彙整表.………………………………………26
表 4研究假設.…………………………………………………………………44
表 5前測之Cronbach’s α係數.…………………………………………….48
表 6市場導向之衡量題項.……………………………………………………49
表 7病人安全氣候之衡量題項.………………………………………………50
表 8控制變數之操作型定義.…………………………………………………52
表 9參與專家效度之學界與實務專家.………………………………………54
表 10樣本特性分佈情形.…………………………………………………….57
表 11病人安全氣候構面與題項之描述性分析.…………………………….60
表 12市場導向構面描述性分析.…………………………………………….62
表 13測量模式適配度之衡量標準.………………………………………….64
表 14 CFA模式適配度分析結果.…………………………………………….65
表 15病人安全氣候CFA結果.………………………………………………..70
表 16市場導向 CFA結果.…………………………………………………….72
表 17病人安全氣候t-test分析結果.……………………………………….77
表 18病人安全氣候One-Way ANOVA分析結果.…………………………....78
表 19各變項間描述性分析與Pearson相關係數矩陣.………………………82
表 20病人安全氣候複迴歸模式分析結果.…………………………………..90
表 21院方對員工的支持程度複迴歸模式分析結果.………………………..92
表 22研究假設驗證結果.……………………………………………………..93

圖目錄
圖 1 市場導向概念圖………………………………………………………..25
圖 2 病人安全氣候一階CFA………………………………………………...66
圖 3 醫院市場導向一階CFA ………………………………………………..67
圖 4 病人安全氣候二階CFA………………………………………………...73
圖 5 醫院市場導向二階CFA………………………………………………...74

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