跳到主要內容

臺灣博碩士論文加值系統

(3.236.110.106) 您好!臺灣時間:2021/07/29 17:37
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:賈凱翔
研究生(外文):Kai-HsiangChia
論文名稱:品質意識與品質活動對於提升病人安全之探討
論文名稱(外文):An Empirical Study on the Relationship among Quality Conscious, Quality Activities and Patient Safety
指導教授:呂執中呂執中引用關係
指導教授(外文):Jr-Jung Lyu
學位類別:碩士
校院名稱:國立成功大學
系所名稱:工業與資訊管理學系碩博士班
學門:商業及管理學門
學類:其他商業及管理學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:82
中文關鍵詞:品質意識品質活動病人安全
外文關鍵詞:Quality ConsciousQuality ActivityPatient Safety
相關次數:
  • 被引用被引用:1
  • 點閱點閱:396
  • 評分評分:
  • 下載下載:101
  • 收藏至我的研究室書目清單書目收藏:2
現今醫學技術的突飛猛進,讓醫療產業越來越被社會所重視。近幾個月,台灣許多間醫院發生醫療疏失,也引起了消費者對於醫療服務品質的重視,更讓病人安全的重要性浮上檯面。由於醫療產業是需要高度的專業技巧,必須要長期培育醫護人員,醫院內部的各項資訊往往不透明,也讓一般民眾無法正確了解如何追求好的醫療服務品質,更讓病人安全的問題漸漸產生。
本研究是採用實體問卷的方式進行發放。問卷填寫對象為台灣通過醫院評鑑的區域醫院及醫學中心當中的醫護人員、醫技人員及行政人員。本研究的資料分析是採用結構方程式,透過各項的分析可以驗證假設一,醫院導入品質活動對於病人安全意識的提升是有正面顯著影響,接著進一步想了解假設二,在品質活動對於病人安全有正面影響的情形下,品質意識在其中是否扮演有效的干擾因子,透過結構方程式的分析結果,品質意識在本研究中確實為一項有效的干擾因子,其原因為醫院在推行品質活動的過程中,會間接的影響醫護人員的品質意識,進而讓醫院內的病人安全可以更加有保障。
除了兩大假設外,本研究也進一步探討不同的品質活動當中,使用敘述性統計後,可以發現在FMEA及THIS指標系統這兩個方面,在對於醫院提升病人安全的成效不彰,其他的四項品質活動對於病人安全意識則是有顯著影響。最後從醫院類型來做分析,醫學中心在導入各式的品質活動過程中,成效皆會比區域醫院來的佳,這也代表掌握較多資源的醫學中心,導入狀況比區域醫院來的優異。

With medical technology improving, the health care industry is increasingly valued by the society. Many studies have shown that medical workers with a good sense of quality will have an impact on hospital operations, but also can promote the professional medical staff for patient care. Above all, this research wants to find the relationship among quality conscious, quality activities and patient safety.
This study used quality activities separately to discuss with patient safety. After analysis, doing the quality activities had significant impact on developing patient safety consious. Besides, this study also found another conclusion. When the quality activities had impact on patient safety, quality conscious was a good confounding factor.
On the other side, when using the descriptive analysis, the study also found that Failure Model & Effect Analysis and Taiwan Healthcare Indicator Series system had no impact on patient safety increasing, but the other four activities did well on that. Finally, from the type of hospital to do the analysis, the medical center in the process of import a variety of quality activities, the effectiveness was better than regional hospital. It represented that medical center has more resources to improve patient safety.

總目錄
口試通過證明書 I
摘要 II
Abstract III
誌謝 IV
總目錄 V
表目錄 VII
圖目錄 VIII
第一章 緒論 1
第一節 研究背景與動機……………………………………………………...1
第二節 研究目的……………………………………………………………...3
第三節 研究範圍……………………………………………………………...3
第四節 研究流程……………………………………………………………...4
第二章 文獻探討 6
第一節 品質意識………………………………………………………..…….6
2.1.1 品質意識定義 6
2.1.2 品質運用於醫療產業 8
第二節 品質活動…………………………………………………………….10
2.2.1 品管圈 10
2.2.2 失效模式與效應分析 12
2.2.3 根本原因分析 14
2.2.4 台灣醫療品質指標計畫 15
2.2.5 醫療團隊資源管理 17
第三節 病人安全…………………………………………………………….20
2.3.1 病人安全定義 20
2.3.2 病人安全重要性 21
第四節 病人安全文化量表………………………………………………….24
第三章 研究方法 26
第一節 研究架構…………………………………………………………….26
第二節 研究假說…………………………………………………………….27
3.2.1 品質活動與病人安全 27
3.2.2 品質意識與病人安全 28
第三節 問卷設計…………………………………………………………….29
3.3.1 品質意識 29
3.3.2 品質活動 30
3.3.3 病人安全 31
第四節 前測與資料分析…………………………………………………….32
3.4.1 前測 32
3.4.2 資料收集 37
3.4.3 資料分析方法 37
第四章 資料分析 41
第一節 基本資料分析及敘述性統計分析…………………………………41
第二節 信度分析…………………………………………………………….46
第三節 衡量模式 – 測量模式分析………………………………………...49
4.3.1 收斂效度分析 49
4.3.2 區別效度分析 50
第四節 衡量模式 – 結構模式分析………………………………………...51
4.4.1 各構面之測量系統 51
4.4.2 品質意識、品質活動與病人安全模式之探討 52
4.4.3 各構面影響關係之檢驗 55
第五節 迴歸分析…………………………………………………………….58
第六節 醫院類型背景分析………………………………………………….60
第七節 小結………………………………………………………………….62
第五章 結論與建議 64
第一節 研究結論…………………………………………………………….64
第二節 未來研究方向與建議……………………………………………….66
參考文獻 67
附錄 73

中文文獻
1.呂執中,(2010),國際品質管理,臺中市:滄海。
2.財團法人醫院評鑑暨醫療品質策進會,(2006),醫院評鑑制度及新制改革重點介紹
3.洪欣妏、蕭宇伶、楊玫蓉、劉中賢、陳誠仁、嚴元鴻,(2011),導入醫療團隊資源管理(TRM)對提升醫療品質效應初探-以某區域醫院住院病人滿意度為例,醫療品質雜誌,第5卷,第3期,48-56
4.邱皓政,(2010),量化研究與統計分析(五版),台北:五南圖書出版股份有限公司。
5.蕭文龍,(民98),多變量分析:最佳入門實用書SPSS+LISREL(二版)。台北:碁峯資訊股份有限公司。

英文文獻
AlKhenizan, A., & Shaw, C. (2010). Assessment of the accreditation standards of the Central Board for Accreditation of Healthcare Institutions in Saudi Arabia against the principles of the International Society for Quality in Health Care. Annals of Saudi Medicine, 30(5), 386-389.
Allen, S. (2009). Developing a safety culture : The unintended consequence of a‘one size fits all’ policy.
Apkon, M., Leonard, J., Probst, L., DeLizio, L., and Vaitale, R. (2004). Design of a safer approach to intravenous drug infusions: failure mode effects analysis. Quality & Safety in Healthcare, 13(4), 265-271.
Baker, D. P., Amodeo, A. M., Krokos, K. J., Slonim, A., & Herrera, H. (2010). Assessing teamwork attitudes in healthcare: development of the TeamSTEPPS teamwork attitudes questionnaire. Quality & Safety in Health Care, 19(6).
Battles, J. (2010). TeamSTEPPS Teamwork Perception Questionnaire Manual. American Institutes for research.
Barclay, D., Thompson, R., & Higgins, C. (1995). The partial least squares (PLS) approach to causal modeling: Personal computer adoption and use as an illustration: Technology Studies.
Bonnabry, P., Cingria, L., Sadeghipour, F., Ing, H., Fonzo-Christe C., and Pfister, R. E. (2005). Use of a systematic risk analysis method to improve safety in the production of paediatric parenteral nutrition solutions. Quality & Safety in Healthcare, 14(2), 93-98.
Bosch, M., Halfens, R. J. G., van der Weijden, T., Wensing, M., Akkermans, R., & Grol, R. (2011). Organizational Culture, Team Climate, and Quality Management in an Important Patient Safety Issue: Nosocomial Pressure Ulcers. Worldviews on Evidence-Based Nursing, 8(1), 4-14.
Braithwaite, J., Westbrook, M. T., Robinson, M., Michael, S., Pirone, C., & Robinson, P. (2011). Improving patient safety: the comparative views of patient-safety specialists, workforce staff and managers. Bmj Quality & Safety, 20(5), 424-431.
Califf, R. M. (2007). The cycle of quality as a model for improving health outcomes in the treatment of hypertension. European Heart Journal Supplements, 9(B), B8-B12.
Chin, K. S., Chan, A., and Yang, J. B. (2008). Development of a fuzzy FMEA based product design system. International Journal of Advanced Manufacturing Technology, 36(7-8), 633-649.
Chin, W. W. (1998). The Partial Least Squares approach for Structural Equation Modeling Modern Methods for Business Research. Mahwah: Lawrence Erlbaum Associates.
Crosby, P. B. (1979). Quality is free : The art of making quality certain McGraw-Hill Book Co.
Curran, E., Harper, P., Loveday, H., Gilmour, H., Jones, S., Benneyan, J., et al. (2008). Results of a multicentre randomised controlled trial of statistical process control charts and structured diagnostic tools to reduce ward-acquired meticillin-resistant Staphylococcus aureus: the CHART Project. Journal of Hospital Infection, 70(2), 127-135.
Das, A., Pagell, M., Behm, M., & Veltri, A. (2008). Toward a theory of the linkages between safety and quality. Journal of Operations Management, 26(4), 521-535.
Dollinger, M. (2010). Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction. Business Horizons, 53(2), 229-230.
Donabedian, A., (1989). The End Results of Health Care: Ernest Codman's Contribution to Quality Assessment and Beyond. The Milbank Quarterly, Vol. 67, 2, 233-243.
Donabedian A. (1998). The quality of care: how can it be assessed? JAMA, 260, 1743-1748
Dowlatshahi, S. (2011). An empirical study of the ISO 9000 certification in global supply chain of maquiladoras. International Journal of Production Research, 49(1), 215-234.
Dreyfus, L. P., Ahire, S. L., & Ebrahimpour, M. (2004). The impact of just-in-time implementation and ISO 9000 certification on total quality management. Ieee Transactions on Engineering Management, 51(2), 125-141.
Duwe, B., Fuchs, B. D., and Hansen-Flaschen, J., (2005). Failure mode and effects analysis application to critical care medicine. Critical Care Clinics, 21(1), 21-+.
El-Jardali, F., Jamal, D., Dimassi, H., Ammar, W., & Tchaghchaghian, V. (2008). The impact of hospital accreditation on quality of care: perception of Lebanese nurses. International Journal for Quality in Health Care, 20(5), 363-371.
Evan & Lindsay, (2010). The management and control of quality, Thomson South-Western.
Garcia, P. A. A., Schirru, R., and Melo, P. F. F. E. (2005). A fuzzy data envelopment analysis approach for fmea. Progress in Nuclear Energy, 46(3-4), 359-373.
Garcia-Cordoba, F., Garcia-Santos, J. M., Diaz, G. G., Garcia-Geronimo, A., Zambudio, F. M., Hernandez, F. P., et al. (2008). Decrease of Unnecessary Chest X-Rays in Intensive Care Unit: Application of a Combined Cycle of Quality Improvement. Medicina Intensiva, 32(2), 71-77.
Gaski, J. F., & Nevin, J. R. (1985). The differential-effects of exercised and unexercized power sources in a marketing channel. Journal of Marketing Research, 22(2), 130-142.
Gowen, C. R., Mcfadden, K. L., Hoobler, J. M., & Tallon, W. J. (2006). Exploring the efficacy of healthcare quality practices, employee commitment, and employee control. Journal of Operations Management, 24(6), 765-778.
Gruber, M., Bertran, N., and Botter, M. (2006). An innovative approach to improve quality and efficiency in an outpatient oncology setting: Creative application of Failure Mode and Effects Analysis (FMEA) and best practices. Oncology Nursing Forum, 33(2), 444-444.
Hair, J. F., Black, W. C., Babin, B., Anderson, R. E., & Tatham, R. L. (Eds.). (2006). Multivariate Data Analysis. Upper Saddle River: NJ: Pearson Education.
Halbesleben, J. R. B., Cox, K. R., & Hall, L. (2011). Transfer of crew resource management training. Leadership in Health Service, 24(1), 19-28.
Helmreich R.L., Merritt A.C., Sherman P.J.,Gregorich S.E., & Wiener E.L. (1993). The Flight Management Attitudes Questionnaire (FMAQ). NASA/UT/FAA Technical Report, 93-94.
Huang D.T., Clermont G., Sexton J.B., Karlo C.A., Miller R.G., Weissfeld L.A., et al. (2007). Perceptions of safety culture vary across the intensive care units of a single institution. Crit Care Med, 35 (1): 165-76.
Hyer, N. L., Wemmerlov, U., & Morris, J. A. (2009). Performance analysis of a focused hospital unit: The case of an integrated trauma center. Journal of Operations Management, 27(3), 203-219.
Karsh, B. T., Holden, R. J., Alper, S. J., & Or, C. K. L. (2006). A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional. Quality & Safety in Health Care, 15, I59-I65.
Kathleen L. McFadden, Gregory N. Stock, Charles R. Gowen III, (2006) . Implementation of patient safety initiatives in US hospitals. International Journal of Operations & Production Management, 26(3), 326-347
Lang, B., Ruppert, M., Schneibel, W., & Urban, B. (2010). Team training in helicopter emergency medical services. Aeromedical crew resource management - A European training program for optimization of flight and patient safety in air rescue. Notfall & Rettungsmedizin, 13(5), 368-+.
Lundmark, E., & Westelius, A. (2006). Effects of quality management according to ISO 9000: A Swedish study of the transit to ISO 9000 : 2000. Total Quality Management & Business Excellence, 17(8), 1021-1042.
Makai, P., Klazinga, N., Wagner, C., Boncz, I., & Gulacsi, L. (2009). Quality management and patient safety: Survey results from 102 Hungarian hospitals. Health Policy, 90(2-3), 175-180.
Makeham, M. A., Kidd, M. R., Saltman, D. C. Mira, M., et al. (2006). The Threats to Australian Patient Safety (TAPS) study: incidence of reportederrors in general practice. Medical Journal of Australia, 185 (2), 95-99.
Martinez-Costa, M., Choi, T. Y., Martinez, J. A., & Martinez-Lorente, A. R. (2009). ISO 9000/1994, ISO 9001/2000 and TQM: The performance debate revisited. Journal of Operations Management, 27(6), 495-511.
Mcelroy, J. C., Morrow, P. C., Crum, M. R., & Dooley, F. J. (1995). Railroad employee commitment and work-related attitudes and perceptions. Transport journal, 34(3), 13-24.
McFadden, K. L., Henagan, S. C., & Gowen, C. R. (2009). The patient safety chain: Transformational leadership's effect on patient safety culture, initiatives, and outcomes. Journal of Operations Management, 27(5), 390-404.
Minor, R. L., Skowronski, J., Lichty, J., Boiles, T., & Polnow, K. (2011). Impact of Team Resource Management on Carotid Artery Stenting Procedures. Journal of the American College of Cardiology, 57(14), E1958-E1958.
Miller, M. R., Pronovost, P., Donithan, M., Zeger, S., Zhan, C. L., Morlock, L., et al. (2005). Relationship between performance measurement and accreditation: Implications for quality of care and patient safety. American Journal of Medical Quality, 20(5), 239-252.
Nair, A., & Prajogo, D. (2009). Internalisation of ISO 9000 standards: the antecedent role of functionalist and institutionalist drivers and performance implications. International Journal of Production Research, 47(16), 4545-4568.
Naveh, E., Katz-Navon, T., & Stern, Z. (2005). Treatment errors in healthcare: A safety climate approach. Management Science, 51(6), 948-960
Niquille, A., Ruggli, M., Buchmann, M., Jordan, D., & Bugnon, O. (2010). The Nine-Year Sustained Cost-Containment Impact of Swiss Pilot Physicians-Pharmacists Quality Circles. Annals of Pharmacotherapy, 44(4), 650-657.
Neuman, L. W. (Ed.). (2000). Social research methods: qualitative and quantitative approaches. Boston: Allyn and Bacon
Rath, F. (2008) Tools for developing a quality management program: Proactive tools (process mapping, value stream mapping, fault tree analysis, and failure mode and effects analysis). International Journal of Radiation Oncology Biology Phisics , 71(1), S187-S190 .
Robert N. Rodriguez, (2010), It’s All About Variation: Improving Your Business Process with Statistical Thinking, BI Forum/Business Intelligence.
Roesser, K. (2007). Decreasing the risk of chemotherapy errors through a failure modes and effects analysis (FMEA) and a focus PDCA (plan, do, check, act) quality improvement model. Oncology Nursing Forum, 34(2), 510-510.
Sack, C., Scherag, A., Lutkes, P., Gunther, W., Jockel, K. H., & Holtmann, G. (2011). Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37 000 patients treated by 73 hospitals. International Journal for Quality in Health Care, 23(3), 278-283.
Sanuri, S., Mokhtar, M., & Yusof, R. Z. (2010). The influence of top management commitment, process quality management and quality design on new product performance: A case of Malaysian manufacturers. Total Quality Management & Business Excellence, 21(3), 291-300.
Sexton, J. B., & Thomas, E. J. (2003). The Safety Attitudes Questionnaire (SAQ) Guidelines for Administration. The University of Texas Center of Excellence for Patient Safety Research and Practice.
Sexton, J. B., Helmreich, R. L., Neilands, T. B., 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.
Sokovic, M., & Pavletic, D. (2007). Quality improvement - PDCA cycle vs. DMAIC and DFSS. Strojniski Vestnik-Journal of Mechanical Engineering, 53(6), 369-378.
Steel, R. P., & Shane, G. S. (1986). Evaluation Research on Quality Circles - Technical and Analytical Implications. Human Relations, 39(5), 449-468.
Stock, G. N., McFadden, K. L., & Gowen, C. R. (2007). Organizational culture, critical success factors, and the reduction of hospital errors. International Journal of Production Economics, 106(2), 368-392.
Sunol, R., P. Vallejo, et al. (2009). Impact of quality strategies on hospital outputs. Quality & Safety in Health Care, 18, I62-I68.
Tanaka, J. S. (1987). How big is big enough? Sample size and goodness of fit in structural equation models with Latent Variables. Child Development, 58(1), 134-146.
Tayie, S. (2005). Research method and writing research proposals Cairo: Center for Advancement of Postgraduate Studies and Research in Engineering Sciences, Faculty of Engineering-Cairo University
Wakeham, M., M. Christensen, et al. (2009). Pediatric critical care physicians’ knowledge and practice of national quality and patient safety initiatives. Critical Care Medicine. 37(12), 643
Weiner, B. J., Alexander, J. A., Baker, L. C., Shortell, S. M., & Becker, M. (2006). Quality improvement implementation and hospital performance on patient safety indicators. Medical Care Research and Review, 63(1), 29-57.
Weir, E., N. d'Entremont, et al. (2009). Applying the balanced scorecard to local public health performance measurement: deliberations and decisions. Bmc Public Health, 9, 277-295
Wold, H. (1982). Systems under indirect observation using PLS. In Fornell (Ed.), A second generation of multivariate analysis. New York: Praeger., 325-347
Yang, Z. L., Bonsall, S., and Wang, J. (2008). Fuzzy rule-based Bayesian reasoning approach for prioritization of failures in FMEA. Ieee Transactions on Reliability, 57(3), 517-528.
Zohar, D. (2010). Thirty years of safety climate research: Reflections and future directions. Accident Analysis & Prevention, 42(5), 1517-1522.
Zupa, E., Abbotoy, J., and Koester, D. (2006). Using Failure Mode Effect Analysis (FMEA) to improve medication safety. Oncology Nursing Forum, 33(2), 417-417.

參考網站
1.世界衛生組織 http://www.who.int/patientsafety/en/
2.美國醫療研究機構 http://www.iom.edu/
3.美國國家病患安全基金會 http://www.npsf.org/
4.病人安全資訊網 www.patientsafety.doh.gov.tw
5.財團法人醫院評鑑暨醫療品質策進會 http://www.tjcha.org.tw/quality
6.台灣醫護管理會 http://www.tche.org.tw/
7.醫療品質委員會http://www.chimei.org.tw/main/right/right01/cmh_department/59001/index.html

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關論文