臺灣博碩士論文加值系統

病人安全近幾年來儼然成為各國醫療界關注的議題，病人安全目的係避免、預防及改善健康照護過程中所產生不良反應與傷害，但過去議題都在探討醫療錯誤、用藥錯誤、不良事件等問題，較少探討醫院病人安全文化之現況。本研究欲探討衛生署署立醫院護理人員對病人安全文化的知覺與安全行為之相關性，瞭解護理人員個人及工作特質對安全文化的知覺與安全行為差異性，並檢驗國內醫院使用Hospital Survey on Patient Safety Culture (HSOPS)量表的信度、效度與美國醫院原先使用HSOPS量表的比較。
本研究利用結構式問卷進行研究調查，實際發放400份問卷，回收207份的有效問卷，回收率52.0％。資料分析方法包含敘述性統計分析、因素分析、信度分析、效度分析、t檢定、單因子變異數分析、相關分析、結構方程模式，以驗證本研究假說。
經實證研究結果顯示，護理人員病人安全文化的知覺對安全行為亦有正向關係；護理人員之年齡越大、服務年資越高、擔任主管及身為正職人員皆有較強的病人安全文化知覺；護理人員之年齡越大及服務年資越高皆有較強的安全行為。驗證病人安全文化之量表，結果顯示平均萃取變異量範圍為0.401-0.808，但組合信度範圍為0.662-0.918，仍表示具有良好的內部一致性，且各變數平均萃取變異量平方根均大於任一變數間之相關係數，故可推論HSOPS 量表在本研究樣本施作之收斂效度與區別效度尚屬可接受範圍。研究結果之管理意涵、研究限制及未來研究方向，也在最後提出討論。

In recent years, patient safety, as the avoidance, prevention, and melioration of adverse outcomes or injuries stemming from the processes of healthcare, has become a major issue in the health care industry all over the world. At present most studies explore issues surrounding medical errors, medication errors, adverse events and so on, but few studies discuss the patient safety culture within hospital environments. The aims of this study are: to examine the relationship between patient safety culture and safety behavior of nursing staff; to investigate the effects of nursing staff’ Pearsonal characteristics on safety culture in DOH hospitals; to examine the underlying dimensions and psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPS) in DOH hospitals hospital settings; and to compare these results with the original questionnaire used in the USA hospital settings.
Data were collected using a structured questionnaire. There were 400 copies of questionnaires sent out to subjects, and 207 copies of questionnaires were returned, resulting in a response rate of 52.0%. Statistical techniques used for data analysis include descriptive statistics analysis, factor analysis,
reliability analysis, variance analysis, t test, ANOVA, correlation analysis, and SEM (structural equation model).
Confirmatory Factor Analysis (CFA), as applied in testing the factor structure of HSOPS, provided three key results from this study. The study shows that: (1) nurses’ perception of patient safety culture can be used to predict safety behavior, with significant positive correlation; (2) nursing staff with higher age, greater seniority, holding a management position, or working full time have higher patient safety culture perception; and (3) nursing staff with higher age or greater seniority, are more likely to self-report better safety behavior than younger or junior colleagues. Finally, the management implications, limitations, and contributions of this study are discussed.

摘要.............................................................................................................................................................. I
英文摘要..................................................................................................................................................... II
目錄............................................................................................................................................................III
表目錄.........................................................................................................................................................V
圖目錄......................................................................................................................................................VII
第壹章 緒論..................................................................................................................................................1
第一節 研究背景及動機.........................................................................................................................1
第二節 研究目的....................................................................................................................................3
第貳章 文獻探討........................................................................................................................................5
第一節 病人安全....................................................................................................................................5
第二節 安全文化與安全氣候...............................................................................................................10
第三節 病人安全文化...........................................................................................................................13
第四節 安全行為...................................................................................................................................16
第參章 研究方法與步驟...........................................................................................................................17
第一節 研究架構...................................................................................................................................17
第二節 變數關係與假說建立...............................................................................................................18
第三節 衡量工具...................................................................................................................................21
第四節 問卷設計與預試.......................................................................................................................26
第五節 研究對象與資料收集方法.......................................................................................................28
第六節 資料分析方法...........................................................................................................................29
第七節 同質性檢定與共同方法變異問題之處理...............................................................................31
第肆章 研究結果......................................................................................................................................37
第一節 樣本基本資料分佈情形...........................................................................................................37
第二節 因素分析與信度分析...............................................................................................................43
第三節 效度分析...................................................................................................................................48
第三節 差異分析...................................................................................................................................54
第四節 相關分析...................................................................................................................................58
第五節 結構方程模式之建立...............................................................................................................60
第伍章 討論..............................................................................................................................................63
第一節 資料的品質...............................................................................................................................63
第二節 研究結果與討論.......................................................................................................................66
第陸章 結論與建議..................................................................................................................................69
第一節 結論..........................................................................................................................................69
第二節 研究建議...................................................................................................................................71
第三節 研究限制...................................................................................................................................73
參考文獻....................................................................................................................................................75
附錄一 專家效度名單...............................................................................................................................85
附錄二 探索性因素分析-步驟一..............................................................................................................86
附錄三 探索性因素分析-步驟二..............................................................................................................89
附錄四 正式問卷......................................................................................................................................92

一、中文文獻
于廣濤、王二平（2004）。安全文化的內容、影響因素及作用機制。心理科學發展，12(1)，89-95。
石崇良、林志豪、翁德怡、江文莒（2006）。急診醫療不良事件之流行病學研究。行政院衛生署九十五年委託研究計畫，DOH95-TD-M-113-032。
行政院衛生署病人安全資訊網（2007）。95年醫院病人安全執行現況調查報告。
行政院衛生署（2008）：http://www.doh.gov.tw。線上檢索時間：2008年12月16日。
李茂能（2009）。圖解Amos在學術研究之應用（初版）。台北：五南。
何曉琪（2001）。醫療錯誤之國際發展與研究取向之優劣術－美國、澳洲、英國及台灣之 實證分析（碩士論文，台灣大學，2001）。全國博碩士論文資訊網，089NTU01593015。
吳聰智（2001）。台灣中部四類製造業安全氣候與安全績效之相關研究。（博士論文，彰化師範大學，2001）。全國博碩士論文資訊網，089NCUE0037002。
吳聰智、康自立（2002）。安全氣候之調查研究-以中台灣四類製造業為例。醫護科技學刊，4(3)，203-223。
邱皓政（2003）。結構方程模式-LISREL的理論、技術與應用。台北：雙葉。
邱皓政（2006）。量化研究與統計方法-SPSS（第三版）。台北：五南。
施貞伶（2005）。醫院病人安全文化初探─醫事人員對病人安全風氣知覺與其促進病人安全行為表現之關聯性探討。未發表碩士論文。台灣大學，台北。
財團法人醫院評鑑暨醫療品質策進會（2005）。網址：
http://www.patientsafety.doh.gov.tw/big5/default.asp
郭建志、曹常成（2004）。內外控信念，主管支持與不安全行為：臺灣營造業之研究。中華心理學刊，46(4)，293-305。
黃芳銘（2007）。結構方程模式-理論與應用（第五版）。台北：五南。
彭台光、高月慈、林鉦棽 (2006)。管理研究中的共同方法變異：問題本質、影響、測試和補救。管理學報，23(1)，77-98。
謝美鳳（2003）。探討安全氣候影響安全績效之研究-以國道客運駕駛員為例。（碩士論文，成功大學，2003）。全國博碩士論文資訊網，091NCKU5119011。
二、英文文獻
Bagozzi, R., & Yi, Y. (1988). On the evaluation of structural equation models. Journal of the Academy of Marketing Science, 16(1), 74-94.
Baker, G. R., & Norton, P. (2002). Patient Safety and Healthcare Error in the Canadian Healthcare
System a Systematic Review and Analysis of Leading Practices in Canada with Reference to Key
Initiatives Elsewhere: A Report to Health Canada: Health Canada.
Battles, J. B., & Lilford, R. J. (2003). Organizing patient safety research to identify risks and hazards.
Quality & Safety in Health Care, 12 Suppl 2, ii2-7.
Britain, G. (1993). Advisory Committee on the Safety of Nuclear Installations: Human Factors Study
Group Third Report: Organizing for Safety(ACSNI) London: HMSO.
Colla, J., Bracken, A., Kinney, L., & Weeks, W. (2005). Measuring patient safety climate: a review of
surveys. Quality and Safety in Health Care, 14(5), 364-366.
Cooper, D. (1998). Improving safety culture: A practical guide. England: John Wiley & Sons.
Cooper, J. B., Gaba, D. M., Liang, B., Woods, D., & Blum, L. N. (2000). The National Patient Safety
Foundation agenda for research and development in patient safety. MedGenMed, 2(3), E38.
Cooper, M. D. (2000). Towards a model of safety culture. Safety Science, 36(2), 111-136.
Cooper, M. D. (2002). Safety Culture: A Model for Understanding & Quantifying a Difficult Concept.
Professional Safety, 47(6), 30-36.
DeJoy, D. M., Gershon, R. R. M., & Schaffer, B. S. (2004). Safety Research Safety Climate: Assessing
Management and Organizational Influences on Safety. Professional Safety, 49, 50-57.
Diaz, R., & Cabrera, D. (1997). Safety climate and attitude as evaluation measures of organizational
safety. Accident Analysis and Prevention, 29(5), 643-650.
Feng, X., Bobay, K., & Weiss, M. (2008). Patient safety culture in nursing: a dimensional concept
analysis. Journal of Advanced Nursing, 63(3), 310-319.
Firth-Cozens, J. (2001). Cultures for improving patient safety through learning: the role of teamwork.
Qual Health Care, 10 Suppl 2, ii26-31.
Flin, R., Burns, C., Mearns, K., Yule, S., & Robertson, E. M. (2006). Measuring safety climate in health
care. Quality and Safety in Health Care, 15(2), 109-115.
Flin, R., Mearns, K., O'Connor, P., & Bryden, R. (2000). Measuring safety climate: identifying the
common features. Safety Science, 34(1-3), 177-192.
Flin, R., & Yule, S. (2004). Leadership for safety: industrial experience. Quality and Safety in Health
Care, 13(Suppl II), 45-51.
Fornell, C., & Larcker, D. (1981). Evaluating structural equation models with unobservable variables and
measurement error. Journal of marketing research, 18(1), 39-50.
Frick, K., Jensen, P., Quinlan, M., & Wilthagen, T. (2000). Systematic occupational health and safety
management: perspectives on an international development. New York: Pergamon Oxford.
Garavan, T. N. (2001). An investigation into the relationship between safety climate and safety behaviours
in Irish organisations. Irish Journal of Management, 22, 141-170.
Gershon, R., Karkashian, C., Grosch, J., Murphy, L., Escamilla-Cejudo, A., Flanagan, P., et al. (2000).
Hospital safety climate and its relationship with safe work practices and workplace exposure
incidents. AJIC: American Journal of Infection Control, 28(3), 211.
Ginsburg, L., Norton, P. G., Casebeer, A., & Lewis, S. (2005). An educational intervention to enhance
nurse leaders' perceptions of patient safety culture. Health Services Research, 40(4), 997-1020.
Glendon, A., & Stanton, N. (2000). Perspectives on safety culture. Safety Science, 34(1-3), 193-214.
Guldenmund, F. W. (2000). The nature of safety culture: a review of theory and research. Safety Science,
34(1-3), 215-257.
Havold, J., & Nesset, E. . (2009). From safety culture to safety orientation: Validation and simplification
of a safety orientation scale using a sample of seafarers working for Norwegian ship owners.
Safety Science, 47(3), 305-326.
Hofmann, D., & Morgeson, F. (1999). Safety-related behavior as a social exchange: The role of perceived
organizational support and leader-member exchange. Journal of Applied Psychology, 84(2),
286-296.
Hofmann, D. A. (1996). A cross-level investigation of factors influencing unsafe behaviors and accidents.
Pearsonnel Psychology, 49(2), 307.
Hsu, S., Lee, C., Wu, M., & Takano, K. (2008). A cross-cultural study of organizational factors on safety:
Japanese vs. Taiwanese oil refinery plants. Accident Analysis and Prevention, 40(1), 24-34.
Huang, D., Clermont, G., Sexton, J., Karlo, C., Miller, R., Weissfeld, L., et al. (2007). Perceptions of
safety culture vary across the intensive care units of a single institution. Critical care medicine,
35(1), 165-176.
Hudson, P. (2003). Applying the lessons of high risk industries to health care. Quality & Safety in Health
Care, 12, i7.
Kaissi, A., Johnson, T., & Kirschbaum, M. S. (2003). Measuring teamwork and patient safety attitudes of
high-risk areas. Nurs Econ, 21(5), 211-218.
Kingston, M. J., Evans, S. M., Smith, B. J., & Berry, J. G. (2004). Attitudes of doctors and nurses towards
incident reporting: a qualitative analysis. Medical Journal of Australia, 181, 36-39.
Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To Err Is Human: Building a Safer Health System:
National Academy Press.
Komaki, J., Barwick, K., & Scott, L. (1978). A behavioral approach to occupational safety: Pinpointing
and reinforcing safe performance in a food manufacturing plant. Journal of Applied Psychology,
63(4), 434-445.
Leape, L. L. (1994). Error in medicine. JAMA, 272(23), 1851-1857.
Mohr, J. J., Barach, P., Cravero, J. P., Blike, G., Godfrey, M., Batalden, P., et al. (2003). Microsystems in
Health Care: Part 6. Designing Patient Safety into the Microsystem. Joint Commission Journal on
Quality and Patient Safety, 29(8), 401-408.
Mossholder, K., Bennett, N., Kemery, E., & Wesolowski, M. (1998). Relationships between bases of
power and work reactions: The mediational role of procedural justice. Journal of Management,
24(4), 533.
Mottel, W., Long, J., & Morrison, D. (1995). Industrial safety is good business: The Dupont story. New
York: Van Nostrand Reinhold.
Neal, A., & Griffin, M. A. (2002). Safety Climate and Safety Behaviour. Australian Journal of
Management, 27(2).
Nieva, V. F., & Sorra, J. (2003). Safety culture assessment: a tool for improving patient safety in
healthcare organizations. Quality and Safety in Health Care, 12 Suppl 2, ii17-23.
Nunnally, J. (1979). Psychometric Theory: Secon d Edition. Applied Psychological Measurement, 3(2),
279-280.
Parker, S., Axtell, C., & Turner, N. (2001). Designing a safer workplace: Importance of job autonomy,
communication quality, and supportive supervisors. Journal of Occupational Health Psychology,
6(3), 211-228.
Podsakoff, P., MacKenzie, S., Lee, J., & Podsakoff, N. (2003). Common method biases in behavioral
research: A critical review of the literature and recommended remedies. Journal of Applied
Psychology, 88(5), 879-903.
Podsakoff, P., & Organ, D. (1986). Self-reports in organizational research: Problems and prospects.
Journal of Management, 12(4), 531.
Polit, D., & Hungler, B. (1999). Nursing Research Principles and Methods(6thed). Philadelphia:
Lippincott-Raven.
Pronovost, P., & Sexton, B. (2005). Assessing safety culture: guidelines and recommendations. Quality
and Safety in Health Care, 14(4), 231-233.
Pronovost, P. J., Weast, B., Holzmueller, C. G., Rosenstein, B. J., Kidwell, R. P., Haller, K. B., et al.
(2003). Evaluation of the culture of safety: survey of clinicians and managers in an academic
medical center. Quality Safety Health Care, 12(6), 405-410.
Reason, J. (2000). Human error: models and management. West J Med, 172(6), 393-396.
Reason, J. T. (1997). Managing the risks of organizational accidents: Ashgate Brookfield, Vt., USA.
Richter, A., & Koch, C. (2004). Integration, differentiation and ambiguity in safety cultures. Safety
Science, 42(8), 703-722.
Scherer, D., & Fitzpatrick, J. J. (2008). Perceptions of patient safety culture among physicians and RNs in
the perioperative area. AORN J, 87(1), 163-175.
Sexton, J., Helmreich, R., Neilands, T., Rowan, K., Vella, K., Boyden, J., et al. (2006). The Safety
Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research.
BMC Health Services Research, 6(44), 1472-6963.
Shih, C. P., Chang, L. Y., Chen, J. C., Ng, C. J., Reinfeld, W., & Hsu, K. H. (2008). The Factors
Influencing Safety Behavior of Medical Staffs in Emergency Room of a Medical Center in Taiwan.
管理學報, 25(4), 451-465.
Siddins, M. (2002). Audits, errors and the misplace of clinical indicators: revisiting the Quality in
Australian Health Care Study. ANZ J Surg, 72(11), 832-834.
Singer, S. J., Gaba, D. M., Geppert, J. J., Sinaiko, A. D., Howard, S. K., & Park, K. C. (2003). The culture
of safety: results of an organization-wide survey in 15 California hospitals. Quality Safety Health
Care, 12(2), 112-118.
Sorra, J., & Nieva, V. (2004). Hospital survey on patient safety culture. (Prepared by Westat, under
Contract No. 290-96-0004). Rockville, MD: Agency for Healthcare Research and Quality; AHRQ
Publication No. 04-0041.
Sorra, J., Nieva, V., Famolaro, T., Dyer, N., (2007). Hospital Survey on Patient Safety Culture: 2007
Comparative Database Report. (Prepared by Westat, under Contract No. 233-02-0087). Rockville,
MD: Agency for Healthcare Research and Quality; AHRQ Publication No. 07-0025. Retrived
from: http://www.ahrq.gov/qual/hospsurveydb/hospsurveydb1.pdf
Stanhope, N., Crowley-Murphy, M., Vincent, C., O'Connor, A. M., & Taylor-Adams, S. E. (1999). An
evaluation of adverse incident reporting. Journal of Evaluation in Clinical Practice, 5(1), 5-12.
Thomas, E. J., Studdert, D. M., Burstin, H. R., Orav, E. J., Zeena, T., Williams, E. J., et al. (2000).
Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado. Medical Care,
38(3), 261.
Thompson, P. A., Navarra, M. B., & Antonson, N. (2005). Patient safety: the four domains of nursing
leadership. Nursing Economics, 23(6), 331-333.
Uribe, C. L., Schweikhart, S. B., Pathak, D. S., Dow, M., & Marsh, G. B. (2002). Perceived barriers to
medical-error reporting: an exploratory investigation. Journal of Healthcare Management, 47(4),
263-279.
Vincent, C., Neale, G., & Woloshynowych, M. (2001). Adverse events in British hospitals: preliminary
retrospective record review. BMJ: British Medical Journal, 322(7285), 517-519.
Vincent, C., Taylor-Adams, S., & Stanhope, N. (1998). Framework for analysing risk and safety in
clinical medicine. BMJ: British Medical Journal, 316(7138), 1154.
von Thaden, T., Wiegmann, D., Mitchell, A., Sharma, G., & Zhang, H. (2003). Safety culture in a regional
airline: Results from a commercial aviation safety survey. Paper presented at the To be presented
at the 12th International Symposium on Aviation Psychology, Dayton, OH.
Vredenburgh, A. G. (2002). Organizational safety: which management practices are most effective in
reducing employee injury rates? Journal of Safety Research, 33(2), 259-276.
Weingart, S. N., Farbstein, K., Davis, R. B., & Phillips, R. S. (2004). Using a multihospital survey to
examine the safety culture. Joint Commission journal on quality and safety, 30(3), 125-132.
White, G. (2002). Patient safety: An ethical imperative. Nursing Economic, 20(4), 195-197.
Wilson, R. M., Harrison, B. T., Gibberd, R. W., & Hamilton, J. D. (1999). An analysis of the causes of
adverse events from the Quality in Australian Health Care Study. Medical Journal of Australia
170, 411-415.
Zohar, D. (1980). Safety climate in industrial organizations: Theoretical and applied implications. Journal
of Applied Psychology, 65(1), 96-102.