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研究生:郭昱廷
研究生(外文):Yu-Ting, Kuo
論文名稱:醫師對病人安全文化認知與行為之關聯-以台灣某醫學中心之醫師為例
論文名稱(外文):Physicians’ Perception of Patient Safety Culture and Practices in a Tertiary Care Hospital in Taiwan
指導教授:王惠玄王惠玄引用關係
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:152
中文關鍵詞:病人安全文化病人安全行為醫師醫師認知
外文關鍵詞:Patient safety culturePatient safety behaviorPhysicianPhysician’s perception
相關次數:
  • 被引用被引用:17
  • 點閱點閱:663
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:10
1999年“To Err Is Human”的出版,引發美、英、澳各國病人安全運動的興起,我國也隨後跟進。然而其成效並不如預期彰顯,與病人安全文化未深植醫療作業環境有關。醫師在醫療照護扮演著關鍵性的角色,因此本研究欲探討醫師對病人安全文化的認知程度與通報行為,及其差異與醫師科別、職級的關連。
本研究以北部某醫學中心除了中醫、精神科與牙科科別之醫師為研究對象,透過問卷調查,瞭解醫師在病人安全文化及結果的認知、通報行為與工作特性,並收集其自由意見表達。總計回收有效問卷317份,有效回收率25.48%。
重要研究結果有五:(1)多數安全文化與結果面認知有50%以上的正面認同度,僅「人力配置」、「錯誤發生時的非懲罰性」與「工作單位對錯誤類型的通報頻率」的正面認同度較低。(2)不同科別在安全文化認知、行為與工作滿意度的差異有統計上顯著意義。(3)主治醫師與住院醫師之職級別僅在「單位主管對於病人安全的預期與實際支持行為」上有所差異。(4)組織內「領導者的支持程度」、「溝通開放程度」與「人力配置」,與病人安全認知及結果有高度正向關連。(5)工作特性中,執業模式為科內共同決定、工作單位年資在11年以上者,其安全認知與結果面皆較為正向;而每週工作時數超過80小時者,其安全認知與結果面皆較為負向。許多受訪者關切錯誤通報與相關刑責的問題。
建議衛生主管機關與司法部門協商,尋求醫療錯誤刑責與通報之平衡點,以落實通報制度。醫療機構除將病人安全議題列為教育訓練與成員晉升考核的重點外,亦應評估醫師之合理工作時數與負荷,擬定人力聘僱原則;在錯誤學習上,應跨越不同科別與類型醫療專業人員限制,以共同參與方式進行。後續研究建議擴及不同類型之醫院與專業人員病人安全文化與結果認知之探討,以瞭解醫院特性及專業人員特性與病人安全的關連。
The publication of “ To Err Is Human ” in 1999 sent the waves of patient safety movement throughout U.S.A., Great British, Australia. Taiwan followed. However, the series of activities did not bring about much of the expected outcome, partly due to the lack of patient safety culture in healthcare settings. As physicians play a key role in the provision of healthcare, they are the targets of this study. The purposes of the study include: 1) to explore physicians’ perception of patient safety culture and related behavior; 2) to understand the relationship between physicians’ specialty, rank, and perception of patient safety culture.
Physicians’ perception of patient safety culture and related outcome, practicing characteristics, and opinions on patient safety culture are collected. Three hundred and seventeen valid questionnaires were obtained with a response rate of 25.89%.
Major results of the study are as followed:(1)More than half of the respondents hold positive perception of patient safety culture and related outcomes in their work settings, except in staffing; non-punitive response to error, and frequency of events reported. (2)Specialties bear statistically significant difference in the perception of patient safety culture and outcomes. (3)Visiting staff and residents differ only in their perception of ” Supervisor/manager expectations and actions in promoting patient safety ”. (4)Physicians’ perception of patient safety culture corresponds positively with ”leaders’ degree of support”, “openness of communication“, and “staffing”.(5)Team-based clinical decision making, seniority over 11 years relate positively with physicians’ perception of patient safety culture. However, for those who work over 80 hours per week, his perception of patient safety and related outcomes is more likely to be low. Many respondents expressed concerns in legal liability following error reporting.
The suggestions include: 1) the health authorities should consult with the legal departments in finding the balance between criminal responsibility and error reporting, 2) in addition to making patient safety the focal point in staff training and promotion, healthcare institutions should assess work loading and human capacity in physician staffing, 3) lessons of medical error should be learned jointly by different kinds of professional personnel across specialties. Finally, future research may include different kinds of hospital and medical professional personnel, to learn the possible impacts from institutions and professions.
第一章 緒論1
第一節 研究背景與動機1
第二節 研究目的4
第三節 預期貢獻4
第二章 文獻探討6
第一節 病人安全6
第二節 國內外推廣病人安全活動之政策9
第三節 組織文化14
第四節 國內外病人安全文化相關實證研究17
第五節 文獻小節20
第三章 研究方法21
第一節 研究問題與架構21
第二節 資料來源與收集方法24
第三節 研究工具24
第四節 研究變項與操作型定義28
第五節 資料處理與分析36
第四章 研究結果39
第一節 基本資料分析39
第二節 病人安全文化認知與結果面45
第三節 病人安全文化差異分析58
第四節 病人安全文化認知之相關影響因素70
第五章 討論113
第一節 安全文化認知面與行為113
第二節 科別、職級在安全文化認知面與結果面之差異116
第三節 醫師特性、安全文化認知面與結果面之相關性119
第四節 受訪者自由回應部分之討論123
第五節 研究限制125
第六章 結論與建議127
第一節 結論127
第二節 建議129
參考文獻131
附錄137
附錄一 五大專科別137
附錄二 問卷138
附錄三 專家效度名單144
附錄四 專家內容效度之評分項目與意見145
中文部分
石崇良(2003),「病人安全之國際趨勢」,醫策會會訊4(1):8-10。
何曉琪(2001),「醫療錯誤之國際發展與研究取向之優劣分析-美國、澳洲、英國及台灣之實證研究」,國立台灣大學衛生政策與管理研究所碩士論文。
吳聰智(2000),「工作場所安全氣候」,工業安全衛生月刊(1):13-25。
張必正(2003),「醫師對於病人安全相關議題的認知、看法與因應行為之研究-以北部醫院醫師為例」,國立台灣大學醫療機構管理研究所碩士論文。
鄭伯壎、郭建志、任金剛(2001),「組織文化員工層次的分析」,遠流出版社。
賴俊裕(2002),「以危機管理建構醫療糾紛預防之模式」,雲林科技大學工管所碩士論文。

行政院衛生署(2005):病人安全相關網頁,取自
http://www.doh.gov.tw/
財團法人醫院評鑑暨醫療品質策進會(2005):病人安全專區。取自http://www.tjcha.org.tw/safe/safe.asp







英文部分
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Agency for Healthcare Research and Quality (AHRQ)
http://www.ahrq.gov
Institute of Medicine (IOM)
http://www.iom.edu/
http://www.ama.assn.org/med-sci/npsf/research/research.htm/
Joint Commission on Accreditation of Healthcare Organization (JCAHO)
http://www.jcaho.org/
National Patient Safety foundation(NPSF)
http://www.npsf.org/
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