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研究生:楊雅惠
研究生(外文):Ya-Hui Yang
論文名稱:醫院品管推行模式與成功因素之初探─以醫療品質獎得獎醫院為例
論文名稱(外文):A Preliminary Study of Quality Management Implementation Framework and Successful Factors: The Case of Winning Hospitals in Healthcare Quality Improvement Campaign
指導教授:鍾國彪鍾國彪引用關係
口試委員:王惠玄許惠恒
口試日期:2018-06-15
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:健康政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:106
中文關鍵詞:品管推行模式成功因素醫療品質獎個人深度訪談焦點團體訪談NVivo
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背景:我國醫療機構品質管理發展已逾二十年,然而,仍缺乏發展本土醫院品管推行架構之研究。醫策會自2000年起舉辦的「醫療品質獎」已成為國內醫界之盛事,冀以藉由累積多年參賽與得獎醫院的經驗,進行我國醫院品管推行之初探。
目的:本研究旨在瞭解醫療品質獎表現優良醫院的品質管理運作模式,及收集相關影響因素以提出醫院品管推行模式概念圖,並探討推行品管之主要成功因素。
方法:本研究將歷年醫策會醫療品質獎主題類(主題改善組、主題改善菁英組)與系統類競賽獎項予以給分,計算參賽醫院第一屆至第十八屆得獎表現之累積得分,依據參賽與得獎狀況選取個案醫院,邀請各醫院管理階層進行個人深度訪談,至資料飽和即停止邀請受訪者,亦分別邀請品質改善團隊領導人與成員參與焦點團體訪談(於北中南各舉辦一場,共六場),藉此分別獲取不同層級人員的觀點。採用NVivo軟體輔助訪談資料之整理與分析,以區辨主要的成功因素,研究者亦根據訪談資料對各子因素作定義說明,並採受訪者的訪談陳述作為佐證。
結果:本研究訪談11家醫院共16位管理階層(包含院長/副院長、品管中心主任/副主任)、12位品質改善團隊領導人(圈長/組長)、以及11位團隊成員(圈員/組員)。在品管推行模式方面,除將各個案醫院之內容作摘要外,研究者亦根據收集的資料繪製品管推行模式概念圖,呈現院內多個層級間的相關影響要素及其關聯。本研究亦提出7個推行品管之成功因素,分別為「醫院文化與氛圍」、「領導」、「健全的品管架構與制度」、「資源與支援的投入」、「品質改善活動的特性」、「品質改善團隊的運作」、「同仁的特質」,係經33個子因素歸類後所形成。其中,以因素「領導」總提及人次最多,為主要成功因素,其子因素以「領導者的支持」為本研究受訪者主要提及之成功因素。本研究更進一步針對不同受訪對象、醫院層級、醫院權屬分別進行因素比較,則以子因素「主管的認知」為三種區分法下共有之因素。
結論:本研究所提出之醫院品管推行模式概念圖及成功因素,與過去國內外文獻對照有其異同之處,研究結果可提供本土醫療機構在品管推行實務上參考,品管推行模式概念圖亦可作為續研究驗證或發展架構圖之基礎。
Background: Hospital quality management has developed for more than 20 years in Taiwan. However, there are few local studies of hospital quality management implementation framework. Since Healthcare Quality Improvement Campaign (HQIC) was launched in 2000, it has become a great event in healthcare.
Objective: The purpose of this study are: (1)to understand the quality management implementation framework of the winning hospitals in HQIC; (2)to explore the influential factors and then draw the concept map of quality management implementation, and (3)to find out what is the main successful factor.
Methods: Qualitative interview method was adopted for the study. The sampling of hospitals was based on their previous HQIC performance on the subjects of Quality Improvement Project and Quality Improvement System. The individual in-depth interview and focus group interview were separately adopted for the executives (e.g., superintendent, director of qulity management center) and quality improvement team representatives (i.e., team leaders and members). Six focus group were done. Both QI leaders and QI members were divided into three groups. Qualitative data were analyzed by NVivo software.
Results: There are 39 interviewees from 11 hospitals participated in the study, including 16 executives, 12 team leaders, and 11 team members. The concept map of quality management implementation is organized based on the level of the hospital system and covers internal and external influential factors. Furthermore, there are 7 successful factors, which are composed of 33 subfactors. In terms of which successful factor is mentioned by most interviewees, the main successful factor is ‘leadership’, and the subfactors is “leader’s support”. In addition, the results of cross examining (couducted within the type of interviewees, hospital ownership, and accreditation level) show that the common subfactors is ‘director’s QI cognition’.
Conclusion: The successful factors and the concept map of quality management implementation have the potential to guide the application of QI methods in healthcare. The concept map also provides a foundation to support further studies to test and refine the framework and advance the field of QI science in Taiwan.
致謝 I
中文摘要 II
Abstract III
目錄 IV
表目錄 VI
圖目錄 VII
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
第二章 文獻回顧 4
第一節 醫療品質獎 4
第二節 醫院品質管理推行模式 6
第三節 醫院推行品質管理之成功因素 13
第四節 質性訪談研究方法 18
第三章 研究方法 21
第一節 研究設計與研究對象 21
第二節 研究工具 26
第三節 資料收集 27
第四節 資料處理與分析 29
第五節 研究嚴謹性與研究倫理 31
第四章 研究結果 32
第一節 受訪者背景資料及其代號 32
第二節 推行品管之內、外部促進與阻礙因素 39
第三節 醫院品管推行模式 44
第四節 推行品管之成功因素 51
第五章 討論 76
第一節 研究方法之討論 76
第二節 醫院品管推行模式之討論 79
第三節 品管推行成功因素之討論 81
第四節 研究限制 85
第六章 結論與建議 86
第一節 研究結論 86
第二節 建議 87
參考文獻 89
附錄一 醫療品質獎第1-18屆主題類累積得分前20名 96
附錄二 醫療品質獎第7-18屆系統類累積得分排名 97
附錄三 訪談邀情函 98
附錄四 受訪者同意書 99
附錄五 訪談大綱 103
附錄六 IRB審查通過證明 104
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