臺灣博碩士論文加值系統

研究動機：美國國家科學研究院附屬研究機構(National Academy of Science, Institute of Medicine)於1999年出版的To Err is Human: Building a Safer Health System中發現在許多醫療院所發生之病人安全意外事故，在金額及人數對醫療產業都造成極大的損失。在IOM提出具體建議後，國際之間開始正式到病人安全之重要議題。國內病人安全議題受到重視，始於2002年起陸續發生重大之醫療不良事件，引起社會大眾及媒體的重視，而使得國人開始重視國內醫療安全的問題。因此政府為提升醫療品質並且保障病患就醫之安全，行政院衛生署邀請產官界相關學者於2003年2月成立「病人安全委員會」，研擬病人安全政策方案並致力推行病人安全教育，並且鼓勵形塑良好之病人安全文化。

研究背景：病人安全文化乃是個人及群體對病人安全之價值、態度、知覺、能力以及其行為之產物。然而在病人安全之推動及教育目標中，持續強化病人安全文化之營造一直都是重要之目標，推動的重點除了持續鼓勵與推動病人安全的通報外，最重要的是要能建立從錯誤中學習的文化，在機構內不同部門間或跨院際間，分享這些經驗，讓知識能夠累積，擴大影響範圍，避免病患因人為因素而受害並且減少高額的經濟損失及醫療成本之不必要浪費。但有鑑國內病人安全之研究當中，大部份皆由醫療過程適當性及成效來進行研究，卻缺乏統整性之病人安全文化之研究，因此本研究欲針對台灣醫療院所病人安全文化之形成因素及其績效進行探討，期盼透過本研究能夠對台灣醫療院所之病人安全文化做出貢獻。

研究工具與對象：本研究將利用組織文化(官僚文化、支持文化及創新文化)、病人安全文化認知以及病人安全績效等量表測量國內42間醫療院所，788名受訪者。透過多層次模型之概念，探討群體層次之組織文化對個體層次之病人安全文化及病人安全績效之關係。本研究應用SPSS 14.0 for Windows、Amos 7.0 、HLM 6.06等統計工具進行資料之分析、量表之信效度驗證及階層模型之分析。

研究結果：組織文化對於病人安全活動乃是扮演一重要角色，建構正向之病人安全文化認知需要從組織文化開始，而病人安全績效受到個體成員及組織文化之影響。因此，病人安全之觀念鑲嵌在組織文化之中，病人安全文化必須經由組織高層明白清楚宣示對病人安全之承諾，並將其轉換為全院各階層之價值、信念及行為，並且透過資源、人力整合及有效之溝通，視病人安全為第一優先，以及永遠對錯誤保持著開放態度，以組織學習之態度持續由醫療失誤中學習而不是將錯誤歸咎於個人，這些都是在建置病人安全文化時必須特別留意之處。第二、管理者的支持與承諾，管理階層在推動病人安全中扮演重要的角色，不論是醫院管理階級或是各部門之管理者若能有效分配資源、硬體設備、充份溝通並且激勵員工為病患提供良好之醫療品質。第三、將醫療照護之各環節納入病人安全之研究及實務管理，從內部員工到社區民眾及病患皆包含至病人安全之建構中，鼓勵從內在之價值觀建立一個良好的病人安全觀念才能真正提升病人安全之績效，公開醫院管理資訊以提供病患參考並加強民眾參與病人安全活動。成功的健康照護環境是能夠為員工、社區民眾及病患提供良好的服務，此乃未來建構病人安全文化真正的價值及目標。

Objective：Patient safety in health care organization has received much attention following the Institute of Medicine report “To Err Is Human: Building a Safer Health System” (IOM, 1999). The patient safety movement was rooted in the mid 1970s and 1980s, when medical malpractice claims were both high in number and severity (Johnson & Hudson, 2004). In Taiwan, the healthcare organization authorities, government and media initiated some attention to patient safety since 2002. Those several medical adverse events forced healthcare organizations and clinical manger started some movement including the recognition of healthcare risk management as a profession, adoption by health care leaders of continuous quality improvement principles, and advancement of the role of the hospital setting.

Background：Patient safety culture as the product of individual and group values, attitudes, perceptions, competencies and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s safety management. An organization with a ‘safety culture’ is open and fair with staff when incidents happen, learning from mistakes and, rather than blaming individuals, looking at what went wrong in the system. Through those actitives couls avoid unnecessary harm of patient and cost of healthcare organizations. The previous studies lacked systematic research on patient safety culture, therefore, it is important for health care organizations to assess their culture regarding patient safety in order to improve patient safety within the health care process.

Methodology：The authors measured organizational culture (bureaucratic, supportive and innovative culture), patient safety culture and performance from 788 hospital workers among 42 hospitals in Taiwan. Multilevel analysis was applied to explore the relationship between organizational culture (group level) and patient safety culture and patient safety performance (individual level). In this research, the authors used SPSS 14.0 for Windows, Amos 7.0 and HLM 6.06 tools to estimate and evaluate the relationship among those variables.

Conclusion： Overall, organizational culture plays an important role in patient safety activities. Safety performance of hospital staffs are influenced by the prevailing cultural norms in their organizations and work groups, building a safety culture for healthcare system which might understand the how organizations shaping their culture and how its work in safety issue. Constructed patient priority from management commitment to leadership is necessary, learning from and holding an open mind about mistake. For academic and management implications, research on patient safety should consider safety perception and consequence of hospital staffs, and furthermore consider those aspects in patient side. These factors are important for understanding the barriers and the possibilities embedded in patient safety.

書名頁 ……………………………………………………………………….. i
論文口試委員審定書 ……………………………………………………….. ii
授權書 ……………………………………………………………………….. iii
中文提要 …………………………………………………………………….. iv
英文提要 …………………………………………………………………….. vi
誌謝 ………………………………………………………………………….. viii
目錄 ………………………………………………………………………….. ix
表目錄 ……………………………………………………………………….. x
圖目錄 ……………………………………………………………………….. xiii
第一章 前言 ………………..……………………………………………..... 1
第一節 研究背景動機 ……………..………………………………....... 1
第二節 研究目的 ……………………………………………………..... 3
第二章 文獻探討 ………………………………………………………….. 4
第一節 病人安全文化之定義與內涵 ………………………………….. 4
第二節 病人安全文化之研究取徑 …………………………………….. 20
第三節 病人安全文化之相關研究 …………………………………….. 45
第三章 研究方法 …………………………………………………………. 60
第一節 研究流程 ……………………………………………………….. 60
第二節 研究架構 ……………………………………………………….. 61
第三節 研究假設 ……………………………………………………….. 62
第四節 構念衡量與資料收集 ………………………………………….. 66
第五節 資料分析方法 ………………………………………………….. 73
第四章 統計分析結果 …………………………………………………….. 77
第一節 信效度分析 …………………………………………………….. 77
第二節 頻次分析 ……………………………………………………….. 90
第三節 相關性分析……………………………………………………… 106
第四節 假設驗證 ……………………………………………………….. 131
第五章 結論與建議 ………………………………………………………. 191
第一節 病人安全發展在台灣…………………………………………… 191
第二節 研究結論 ……………………………………………………….. 198
第三節 管理與研究意涵 ……………………………………………….. 216
第四節 研究限制與未來研究發展 …………………………………….. 223
參考文獻 …………………………………………………………………….. 225
附錄一：本研究之操作型定義……………………………………………… 243

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