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研究生:張碩芳
研究生(外文):Sho-fang Chang
論文名稱:以知識流觀點探索醫療知識分享、醫療知識整合與醫療品質影響因子之研究
論文名稱(外文):Exploring the Influencing Factors Associated with Medical Knowledge Sharing, Medical Knowledge Integration and Medical Quality- from the Perspective of Knowledge Flow
指導教授:林清河林清河引用關係譚伯群譚伯群引用關係
指導教授(外文):Chinho LinBertram Tan
學位類別:博士
校院名稱:國立成功大學
系所名稱:企業管理學系碩博士班
學門:商業及管理學門
學類:企業管理學類
論文種類:學術論文
畢業學年度:92
語文別:英文
論文頁數:288
中文關鍵詞:知識流醫療知識分享醫療品質醫療知識整合
外文關鍵詞:knowledge flowmedical knowledge sharingmedical qualitymedical knowledge integration
相關次數:
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摘要
「知識」近年來在策略上被認為是提升組織競爭優勢的重要資源。在知識密集的機構,尤其是絕大多數的資源都是以知識為基礎的健康照護組織,知識更顯得重要。另一方面,醫療照護的不確定性,不同學派的思路模式以及專科和次專科的發展也造成醫療照護的高度變異性,並可能對醫療品質帶來傷害。因此,對於醫療照護產業而言,當務之急是如何將各種醫療知識分享與整合為醫師所建議的最佳治療模式。本研究欲建立兩個模式。模式一首先以探索知識流的障礙出發,討論醫療知識分享與醫療知識整合的影響因子。此外,本研究以先前探討出的模式為基礎,在模式二中進一步討論上述因素與醫療知識分享、醫療知識整合、醫療決策品質以及醫療品質的關係。
基於上述議題文獻之闕如,本研究定位為探索性的質性研究。研究過程分為三階段。第一階段,利用文獻探討及深度訪談,從知識流的障礙面探討醫療知識分享與醫療知識整合的影響因子,並從研究結果中建構初步影響模式。第二階段,利用問卷調查式的個案研究方法驗證第一階段研究所建構的初步影響模式,並將初步影響模式擴展為討論醫療知識分享、醫療知識整合、醫療決策品質與醫療品質關係的模式。第三階段,以德菲法試探第二階段擴展後模式一般化的可能性。
研究結果大致上支持本研究所提出的兩個模式。醫療知識流影響因子為知識源、知識接受者、知識特性、知識流情境與組織情境。這五個因子相互影響,並且進一步影響醫療知識分享、醫療知識整合、醫療決策品質與醫療品質。此外,根據研究結果,本研究另發展出醫療知識流五個個別因子如何影響前述醫療知識分享等構面的第三個模式。人為因子如知識源和知識接受者影響醫療決策品質最大,而情境因子如知識流情境與組織情境影響醫療品質最甚。最後,對於現正推行知識管理的醫療機構,本研究結果期待可以作為其檢討實行成果之工具;對於未來對醫療知識管理與醫療品質管理有興趣的學術界與實務界,此研究期望可以提供其在研究與推行相關議題時,能有一完整且多元的思考模式可供參考。
ABSTRACT
Strategies have recognized knowledge as a key source of competitive advantage. No where is it more important than in knowledge-intensive firms like healthcare organizations, where resources are almost exclusively knowledge-based. In another aspect, the uncertainty of medical care, the “school of thought” between physicians and the development of clinical specialties as well as sub-specialties all lead to the variability of medical care, which could hurt medical quality. Consequently, the most imperative issues for healthcare industry are the diffusion and incorporation of medical knowledge into patterns of treatment recommended by physicians. Two models are proposed in this study. The first model reveals the influencing factors of medical knowledge sharing and medical knowledge integration through exploring the barriers of knowledge flow. The second model further discusses the associations between medical knowledge sharing, medical knowledge integration, medical decision-making quality and medical quality.
Since literature regarding these issues is rare, this research is with exploratory and qualitative nature. The study consists of three phases. In Phase I study, literature review and in-depth interviews were conducted to explore medical knowledge flow barriers. In Phase II study, a questionnaire was developed and a case study using a survey approach was employed. It aims to test the model established in Phase I study, and meanwhile to construct an extended model, which integrates the prior model with medical decision making quality and medical quality. In Phase III study, a Delphi method was used for validating and probing the generazability of the extended model.
The results basically support the two proposed models. Medical knowledge flow is composed of five factors including knowledge source, knowledge receiver, knowledge transferred, knowledge flow context and organizational context. These factors are correlated with each other, and they greatly affect medical knowledge sharing, medical
knowledge integration, medical decision-making quality and medical quality. Furthermore, a third model was constructed according to the findings regarding how the individual medical knowledge flow barrier affects other research constructs. Human factors including knowledge source and knowledge receiver largely influence medical decision-making quality, while contextual factors including knowledge flow context and organizational context affect medical quality most. For those healthcare managers who are carrying out knowledge management, our models can be adopted as a tool for examining the implementation performance. For those who are interested in studying or introducing knowledge management in healthcare industry, this research is expected to provide a comprehensive framework and serve as an essential reference for the academy and the practice.
CONTENTS
CHAPTER I INTRODUCTION… …………………………………1
1.1. Research Background & Motivation……………………1
1.1.1. The essential position of knowledge sharing and knowledge
integration in knowledge management (KM) ……………2
1.1.2. Exploring the influencing factors of KM from the perspective
of knowledge flow …………………………4
1.1.3. Medical knowledge as the object of the study …………5
1.2. Theoretical Foundation …………………………7
1.3. Research Purpose ………………………………10
1.4. Research Process ………………………………11
1.5. Organization of the Dissertation ……………………14
CHAPTER II LITERATURE REVIEW …………………………… 15
2.1. Human Activity Theories. ………………………15
2.1.1. Theories concerning the determinants of human activities …15
2.1.2. Cultural Historical Activity Theory (CHAT)………… 16
2.1.3. CHAT applied to knowledge low…………………… 20
2.2. Knowledge Flow……………………………… 21
2.2.1. Determinants and barriers of knowledge flow …………22
2.3. Knowledge Sharing …………………………… 30
2.3.1. The definition of knowledge sharing ………………30
2.3.2. Measurement of knowledge sharing outcome …………….32
2.4. Knowledge Integration ………………………… 34
2.4.1. The definition of knowledge integration ……………34
2.4.2. Measurement of knowledge integration outcome ………… 35
2.5. Medical Knowledge, Medical Knowledge Sharing & Medical Knowledge
Integration…………………………………35
2.5.1. The characteristics of medical knowledge ……………36
2.5.2. Typologies of knowledge and medical knowledge …………39
2.5.3. Medical knowledge sharing and integration …………41
2.5.4. Medical knowledge flow facilitating medical knowledge sharing
………………………………………42
2.5.5. Medical knowledge flow facilitating medical knowledge
integration ……………………………44
2.6. Medical Quality & Medical Decision Making Quality ………45
2.6.1. Quality of health care ……………………… …45
2.6.2. Dimensions of medical quality ……………………46
2.6.3. Medical decision making quality………………… 47
2.6.4. Medical decision making facilitating medical quality ……48
2.6.5. Medical knowledge sharing & medical knowledge integration
facilitating medical decision making quality & medical
quality ……………………………… 48
CHAPTER III METHODOLOGY …………………………………50
3.1. Research Framework……………… ……………50
3.2. Study Design & Data Collection Method ……………… 54
3.2.1. Phase I study …………………………… 55
3.2.2. Phase II study …………………… ………56
3.2.3. Phase III study………………………… ……58
3.3. Data Analysis Method ……………………………61
CHAPTER IV PHASE I STUDY ……………………………… 64
4.1. Research Method for Phase I Study ………………… 64
4.2. Results and Discussions for Phase I Study …………… 67
4.2.1. Respondent profile ………………………… 67
4.2.2. Medical knowledge sharing ………………………70
4.2.3. Medical knowledge integration ……………………74
4.2.4. Barriers of medical knowledge flow ……………… 79
4.2.5. Knowledge flow, medical decision making & medical quality …103
4.3. Conclusions for Phase I Study …………………… 104
4.3.1. Medical knowledge flow barrier ………………… 104
4.3.1.1. Classification of medical knowledge barriers ………104
4.3.1.2. Associations between the medical knowledge flow barriers 105
4.3.2. Medical knowledge sharing & medical knowledge integration …109
4.3.2.1. Current status of medical knowledge sharing and medical
knowledge integration ……………………… 109
4.3.2.2. The association between medical knowledge sharing and
medical knowledge integration ………………… 110
4.3.3. Impacts of medical knowledge flow barrier on medical knowledge
sharing………………………………… 111
4.3.4. Impacts of medical knowledge flow barrier on medical knowledge
integration ……… ………………………112
4.3.5. Relationships between medical knowledge flow barrier and
medical decision making quality as well as medical quality 113
4.3.6. Relationships between medical knowledge sharing and medical
decision making quality as well as medical knowledge sharing
and medical quality ………………………113
4.3.7. Relationships between medical knowledge integration and medical
decision making quality as well as medical knowledge
integration and medical quality …………………114
4.3.8. Some other findings regarding medical knowledge flow … …115
CHAPTER V PHASE II STUDY…………………………………120
5.1.Research Method for Phase II Study…….…………… 120
5.2. Results and Discussions for Phase II Study ……………122
5.2.1. Sample characteristics & non-response analysis ……… 122
5.2.2. Factor analysis, reliability and validity test for research
constructs…………………………………125
5.2.3. Linkages between research constructs ……………… 135
5.2.4. Current status of medical knowledge flow …………… 156
5.2.5. Perceptions of research constructs by physicians with different
characteristics …………………………159
5.3. Conclusions for Phase II Study ……………………167
5.3.1. Medical knowledge flow barrier ………………… 167
5.3.2. Medical knowledge sharing vs. medical knowledge integration 168
5.3.3. Impacts of medical knowledge flow barrier on medical knowledge
sharing, medical knowledge integration, medical decision making
quality and medical quality ……………………169
5.3.4. Impact of medical decision making quality on medical quality171
5.3.5. Impacts of medical knowledge sharing on medical decision making
and medical quality …………………………171
5.3.6. Impacts of medical knowledge integration on medical decision
making and medical quality ……… ………………172
5.3.7. Current status of medical knowledge flow …………… 172
5.3.8. Perceptions of medical knowledge flow barrier, medical
knowledge sharing, medical knowledge integration, medical
decision making quality and medical quality by distinct
physician characteristics ……………………174
CHAPTER VIPHASE III STUDY …………………………………180
6.1.Research Method for Phase III Study …………………180
6.2. Results and Discussions for Phase III Study …………… 183
CHAPTER VIIFINAL CONCLUSIONS & MANAGEMENT IMPLICATIONS…………… 198
7.1. Discussions & Conclusions ………………………198
7.2. Management Implications …………………………209
7.3. Research Limitations and Future Works ………………215
REFERENCES………………………………………… .217
APPENDIX …………………………………………… 234
Appendix 1. Interview Guide for Phase I Study ………………234
Appendix 2. Questionnaire for Phase II Study…………………237
Appendix 3. Invitation Letter and Answering Instructions for Delphi
Investigation ……………………………243
Appendix 4. Questionnaire for the First-round Delphi Investigation … 247
Appendix 5. Questionnaire for the Second-round Delphi Investigation 255
Appendix 6. Responses from Delphi Investigation ………………268
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