臺灣博碩士論文加值系統

品質促進是管理性照護政策帶動下的醫療市場，被視為是控制成本、提昇效率、增進照護服務品質的重要途徑，而不論從理論、研究或實務等方面，均強調品質促進團隊在組織發展之品質促進活動中，扮演了能因應快速環境變化、有效掌握機會的角色及提昇競爭力之主要利器。
本文目的旨在探討介入品質促進團隊後，對團體成員的工作滿意度、工作士氣、組織承諾及庫存管理績效的成效。本研究為類實驗研究設計模式，採縱貫性研究方法，針對台北市某醫學中心的麻醉部護理人員46人為實驗研究對象，在上級主管之支持下，介入品質促進團隊，藉由帶領團隊運作品管手法操作，解決單位中的各項品質問題，與在同樣工作環境下手術室護理人員50人作對照比較，分階段檢視二組成員在工作滿意度、工作士氣、組織承諾及庫存管理績效等評量指標之改變情形。
本研究應用了SAS　8.0版統計軟體中之GEEs 回歸檢視模式，控制了相關人員之年齡、婚姻、教育程度、職位及年資等屬性變項後，結果呈現實驗組在工作滿意度及組織承諾二方面有顯著之介入成效，而在工作士氣方面，由於二組間前測差異太大，致介入未達顯著差異，實驗組仍有漸次提昇之情形。在庫存管理績效方面，在專案團隊運用相關品管手法之努力下，衛材庫存金額由每月874586元下降至每月657906元，下降率為24.8%，展現相當之改善成效。
在驗證了品質促進團隊之良好成效後，建議各單位主管思考應用文中之結果，持續提升自主性、組織政策及同仁互動等重要滿意度影響因子，方能提昇品質團隊能有效的持續性運作。

In health care market, quality improvement has been treated as a critical pathway to control cost、improve efficiency and promote service quality。 From theoretical foundation, clinical practice and research data, quality improvement team has been proven as an important role to adapt the changing health environment and enhance the competition through the improvement processs.
The purpose of this study was to explore members’ job satisfaction、morale、organizational commitment and inventory management through quality improvement team intervention in the anesthesiology department. This study is a quasi-experimental and longitudinal design。The subject involves 46 anesthesia registered nurses and 50 operation room registered nurses in the same Medical Center hospital in Taipei. Under the chief administrator’s support, the quality improvement team has been initiated and implemented by using quality improvement process for 8 month。 .
Applying GEEs (Generalized Estimating Equations) model to exam and compare the data between the two different group。After control the age, marriage, education, position and nursing experience, the data present the natural growth effect on quality improvement team. The result revealed the experimental group had significant positive effects on the job satisfaction and organizational commitment after the intervention. The morale scale was no significant difference between the two groups. About the inventory management, experimental group has been successfully decreased the stockage of materials from NT$874586 to NT$657906 per month, the descending rate was 24.8%.
The study has been tested and proven that the quality improvement team as the best effect on nurses’ job satisfaction; such as promote autonomy; organizational policy and member positive interaction; furthermore, it could control cost、improve efficiency and promote service quality。

第壹章 緒 論
第一節 研究動機與重要性
第二節 研究目的
第三節 名詞界定
第貳章 文獻查證
第一節 品質促進團隊之概念及決定因素
第二節 品質促進團隊之成效
第三節 績效評量之內容
第參章 研究架構與假設
第一節 研究架構
第二節 研究問題與假設
第肆章 研究方法
第一節 研究設計
第二節 研究對象
第三節 介入活動
第四節 研究工具
第五節 研究步驟
第六節 資料統計及分析
第伍章 研究結果
第一節 樣本屬性與分佈
第二節 工作滿意度之差異情形
第三節 工作士氣之差異情形
第四節 組織承諾之差異情形
第五節 庫存管理績效之差異情形
第陸章 討論
第一節 工作滿意度之評量成效
第二節 工作士氣之評量成效
第三節 組織承諾之評量成效
第四節 庫存管理之評量成效
第柒章 結論與建議
第一節 結論
第二節 研究貢獻
第三節 研究限制
第四節 研究建議
第捌章 參考文獻

于克瑞、郭春花（1999）．病房醫材管理改進方案．醫院，32(2)，48-56。
王銘杰、林永福（1997）．醫院經營績效評估模式．北市衛生，35，15-18。
王蘭（1998）．醫院員工領導型態、工作滿意度、組織承諾及離職傾向之研究．未發表的碩士論文，高雄：高雄醫學院。
江蕙娟、張麗惠（1998）．以持續性品質改善理念改善抽吸瓶消毒方式之探討．醫院，31(4)，55-62。
李允傑（1999）．公部門之績效評估．人事月刊，29（4），4-14。
李采珍（2001）．手術室品質促進團隊績效評量之研究－以臺北市某市立醫院為例．未發表的碩士論文，台北：國防大學。
李品珠（1999）．麻醉護理人員工作壓力與工作滿意度之研究---以北部醫學中心為例．麻醉醫學雜誌，增刊
李惠齡、鍾國彪、陳慧敏、陳美華、林瑞明（2001）．以品管圈活動降低健保抽樣送審資料不完整率．醫院，34(6)，54-68。
李得璋（1996）．公共工程執行績效評估系統之研究．行政院國科會。
吳淑惠、溫信財、何國章（1999）．利用品管圈活動縮短現場掛號病歷調閱時間之研究．醫院，32(2)，54-60。
吳鴻明（1997）．員工對企業內人力資源管理的滿意度與員工工作士氣之相關研究－以台電協和火力發電廠為例．未發表的碩士論文，新竹：國立交通大學。
余嘉鵬（2000）．高績效團隊應用於南部某一區域醫院水質檢驗室實例探討．醫院，33(2)，56-59。
林建欣（1998）．提昇組織承諾之研究：團隊建立的觀點．未發表的碩士論文，台北：國立政治大學。
周美鑫、胡庭禎（2001）．新入院病患環境介紹改善之成效評估．醫院，34(3)，9-18。
周鴻儒、陳淑樺、蕭世榮、王蓉敏（2001）．醫院員工之工作滿意度及組織承諾調查－以某家地區醫院為例．醫院，34(6)，45-53。
洪正芳、王麗菁曹淑珍石錦鑾林宜怡（1999）．全面品質管理對員工工作滿足感、組織認同感與組織管理原則認知之探討．醫院，32(4)，41-53。
洪正芳、詹志賢（1999）．以戴明之管理原則－評估醫院全面品質管理實施的障礙．醫院，32(1)，11-21。
洪正芳、羅志明、魏政雄（1998）．運用團隊學習及品管手法來改善醫院管理．醫院，31(1)，37-47。
邱文達、楊哲明、郭乃文、陳依琪&陳香蓉（2001）．品管圈推動情境因素及成效評估探討．醫務管理期刊，2(3)，85-94。
邱瑞深（1994）．領導行為、工作士氣與工作績效之關係研究．未發表的碩士論文，台北：文化大學。
陳福基（1998）．全面品質管理(TQM)與醫療院所經營績效之關係研究。
黃嘉嘉（1999）．團隊建立之研究：一個組織的觀點．未發表的碩士論文，台北：私立文化大學。
黃慶祥、曾瑪珊（1999）．醫院護理部醫材管理之研究．醫療資訊雜誌，9，39-70。
黃緯莉（1994）．醫院員工組織承諾、工作滿足、工作投入與士氣之研究．未發表的碩士論文，台北：私立淡江大學。
曾琇瑩（1999）．績效評核項目構建之研究：以中華電信北區分公司為例．未發表的碩士論文，新竹：國立交通大學。
廖茂宏、黃雪麗、楊長興、李偉立、黃寶玉(1999)．耕莘醫院推行品質改善小組之探討－以醫事室住院組為例．醫院，32(2)，37-47。
廖華立（1998）．創新團隊能力、工作滿足、組織承諾與創新績效的關係．未發表的碩士論文，台北：銘傳大學。
孫本初（1999）．組織發展．台北：空大。
孫本初（1998）．公共管理．台北：智勝。
陳楚杰（1998）．醫院資材管理概論．台北：宏翰。
鄧小雅（1998）．地區教學以上醫院推行品管圈活動之主觀成效及其影響因素之探討．未發表的碩士論文，台北：國立臺灣大學。
鄭美花、劉子悌、賴美嬌、蔡武德、鄭雪容＆陳清軒（2000）．醫院急診室的品質管理個案．醫務管理期刊，創刊號，82-89。
鍾國彪、潘憶文（2000）．醫品圈的推行現況．醫院，33(6)，9-16。
蘇惠卿、王淇俐、劉德鴻（2000）．某醫院降低開刀房專用衛材
庫存成本之成效探討．醫院，33(5)，31-43。
Allison,M.J.(1996).A quality Improvement Team on Autologous and Directed-Donor Blood Availability.Journal on Quality Improvement,22(12),801-810.
Ashley,J.S.(2000).People Behind the Health Care Delivery System:The Key to Quality Improvement and Expense Reduction. Nursing Aministration Quarterly,24(4),1-10.
Berman,S.;Miller,C.;Rosen,C.& Bicchieri,S.(2000). Assessment Training and Team Functioning for Treating Children With Disabilities.Arch Phys Med Rehabil, 81,628-633.
Beyer,M.,Gerlach,F.M.& Breull,A.(1999).Promoting quality and quality circles from the viewpoint of established physicians-representative Bremen and Saxony-Anhalt results. Zeitschrift fur Arztliche Fortbildung und Qualitatssicherung, 93(9),677-87.
Bing,M.;Abel,R.L.;Gillentine,A.D.Brandes,L.Pendergrass,P.& McCauley,C.(2000).Continuous auality improvement and process of care interventions for acute myocardial infarction.Abstract Book/Association for Health Services Research,16,328.
Bishop,J.W.(1998).Performance and retention of professional employees who work in teams: the effects of commitment and support.Clinical Laboratory Management Review,12(3),150-8.
Briscoe,G.& Arthur,G.(1998). CQI Teamwork:Revaluate, Restructure,Renew.Nursing Management,29(10),73-76,78,80.
Cain,H. & Mueller,C. (2001).Quality Improvement Efforts in Minneesota Nursing Facilities.Journal of Nursing Care Quality, 15(3),1-6.
Caldwell,C.,Komaromy,D.& Lynch,F.(2000).Working together to improve record keeping.Nursing Standard,14(47),37-41.
Calomeni,C.A.,Solberg,L.I.& Conn,S.A.(1999).Nurses on quality improvement teams:how do they benefit?Journal of Nursing Care Quality,13(5),75-90.
Chan,T-C.L.& Ho,S.J.(1997).Continous Quality Improvement : Asurvey of American and Canadian Health Care executives. Hospital and Health Service Administration,42(4),525-544.
Cox,K.B.(2001).The effects of unit morale and interpersonal relations on conflict in the nursing unit. Journal of Advanced Nursing,35(1)17-25.
Drain,M.(2001).Quality Improvement in Primary Care and the Importment of patient percettions.Journal of Ambulatory Care Management,24(2),30-46.
Evanoff,B.A.,Bohr,P.C.& Wolf,L.D.(1999).Effects of a participatory ergonomics team among hospital orderlies. American Journal of Industrial Medicine,35(4),358-65.
　　French,W.L.,&Bell,C.H.(1995).Organization development: behavior science intervention for organization improvement. New Jersey:Prentire-Hall.
Gandhi,T.K.,Puopolo,A.L.,Dasse,P.& Haas,J.S.(2000). Obstacles to collaborative quality improvement :the case of ambulatory general medical care.International Journal for Quality in Health Care,12(2),115-23.
Gibson,B.,Freeman,R.,& Ekins,R.(1999).The role of dental nurse in general practice.British Dental Journal,186(5), 213-5.
Harrington-Mackin,D.(1994).The Team Building Tool Kit:Tips,Tactics,and Rules for Effective Workplace Teams.New York:Amacom.
Harvey,G.(1999).The RCN dynamic Quality Improvement Network.Nurseing Standard,13(34),31.
Herman,J.E.,Reichelt,P.A.(1998).Are first-line nurse managers prepared for team building?Nursing Management (Chicago),29(10),68-72.
Hetherington,L.T.（1998）.Becoming Involved:the nurse leader’s role in encouraging teamwork.Nursing Administration Quarterly,23(1),29-40.
Higgins, S. E.& Routhieaux, R. L.(1999).A multiple-level analysis of hospital team effectiveness.Health Care Supervisor,17(4),1-13.
Hoff,T.J.(2000).Professional commitment among U.S. physician executives in managed care.Social Science & Medicine,50(10),1433-44.
Ingersoll,G.L.;Kirsch,J.C.;Merk,S.E.& Lightfoot,J. (2000).Relationship of organizational culture and Readiness for change to Employee Commitment to the Organization. JONA,30(1),11-20.
Joint Commission on the Accreditation of Health Care Organization.(1992).Striving toward improvement :Six Hospital in search of Quality.Oakbrood Terrace,IL:Author.
Katzenbach,J. R., & Smith,D.K. (1993).The Wisdom of team:Creating the high performance organization. Boston: Harvard Business School Press.
Laschinger,H.K.,Finegan,J.,Shamian,J.& Casier,S.(2000). Organizational Trust and Empowerment in Restructured Healthcare settings.JONA,30(9),413-425.
Laschinger,H.K.;Finegan,J.;Shamian,J.& Wilk,P.(2001). Impact of Structural and Psychological Empowerment on Job Strain in Nursing Work settings. JONA,31(5),260-272.
Lee,L.C.,Yang,K.P.& Chen,T.Y.(2000).A quasi-experimental study on a quality circle program in a Taiwanese hospital. International Journal for Quality in Health Care,12(5)413-418.
Lee,M.B.(2001).Creating Knowledge Through Partnerships in Global Education: Using Small-Group Strategies with Large Groups.Journal of Nursing Education,40(5),222-224.
Mauck,M., & Hingtgen,C.(1999).Turnover Times:Perception vs. Reality.Surgical Services management,5(1),36-40.
McNeese-Smith,D.K.(2001).A Nursing Shortage:Building Organizational Commitment Among Nurses.Journal of Healthcare Management,46(3),173-187.
Millward,L.J.& Jeffries,N.(2001).The team survey: a tool for health care team development.Journal of Advanced Nursing, 35(2),276-287.
Morahan,L.(2002).Wide Application of CQI in Home Care.Journal of Nursing Care Quality,16(3),36-49.
Morris,S.;Willcocks,G.& Knasel,E. (1995).How to Lead a Winning Team.London:Pitman publishing.
Mosher,S.,& Colton,D.(1999).Quality Improvement in the curriculum:Asurvey of AUPHA Programs.Unpublished manuscript.
Mowday,R.T.,Steers,R.M., & Poter,L.M.(1979).The measurement of organizational commitment.Journal of Vocational Behavior,14,224-247.
Patel,V.L.;Cytryn,K.N.Shortliffe,E.H.&Safran,C.(2000).Teaching and learning in medicine,12(3)117-32.
Perra,B.M.(2001).Leadership:The Key to Quality Outcomes.
Journal of Nursing Care,15(2),68-73.
　 Poter,L.W.,Smith,F.J.(1970).The Etiology of Organizational Commitment.Unpublished paper,University of California,Irvine.
Quinn,D.C.;Graber,A.L.Elasy,T.A.Thomas,J.Wolff,K.Brown,A.(2001).Overcoming turf battles:developing a pragmatic, collaborative model to improve glycemic control in patients with diabetes.Joint Commission Journal on Quality Improvement, 27(5),255-64.
　 Rantz,M.J.(2000).Setting Thresholds for Quality Indicators Derived from MDS Data for Nursing Home Quality Improvement Reports:An Update.Journal on Quality Improvement, 26(2),101-110.
Risser,D.T.,Rice,M.M.,Salisbury,M.L.,Simon,R.,Jay,G.D. & Berns,S.D.(1999).The Potential for improved teamwork to reduce medical errors in the emergency department.Annals of Emergency Medicine,34(3),373-83.
Rogowski,J.A.,Horbar,J.D.& Plsek,P.E.etc.(2001). Economic implications of neonatal intensive care unit collaborative quality improvement.Pediatrics,107(1),23-9.
Rudman,W.J.,Gumbita,L.(1995).Research review:the effect of barriers to communication on job satisfaction and perceived work productivity.Topics in Health Information Management, 15(4),70-80.
Salive,M.E.(1997).Preventive medicine physician satisfaction and its relation to practice characteristics. American Journal of Preventive Medicine,13(4),303-8.
　　Smith,P.,Adam,D.,Bersante,S.& Kalma,S.(1994).Planning for patient care redesign:Success through Continious Quality Improvement.Journal Nursing care Qual,8(2),73-80.
Takase,M.; Kershaw,E.& Burt,L.(2001).Nurse-environment misfit and nursing practice.Journal of Advanced Nursing, 35(6),812-818.
Todd,C.J.,Farquhar,M.C.& Camilleri-Ferrante, C.(1998). Team midwifery,14(4),214-24.
Tzeng,H.M.& Ketefian,S.(2002).The Relationship between Nurses’ Job Satisfaction and Inpatient Satisfaction:An Exploratory Study in a Taiwan Teaching Hospital.Journal of Nursing Care Quality,16(2),39-49.
Walter,B.M.(1996).Home Healthcare Nurse,14(8),609-13.
Wheelan,S.A.,Burchill,C.(1999).Take teamwork to new heights.Nursing Management(Chicago),30(4),28-32.
Weisser,P.,Harter,M.& Tausch,B.(2000).Family practice quality circle between goals and reality-an interaction analysis. Zeitschrift fur Arztliche Fortbildung und Qualitatssicherung,94(1),4-10.
Whorley,L.W.(1996).Evaluating health care team performance:assessment of joint problem-solving action.Health Care Supervisor,14(4),71-6.
Willems,S.(1998).Employee empowerment through team building and use process control methods.Topics in Health Information Management,18(3),32-9.
Zangaro,G.A.(2001).Organizational Commitment: A Concept Analysis.Nursing Forum,36(2),14-21.