| 摘要: | 背景與目的：近來醫療市場競爭激烈、醫療糾紛頻傳，以快速且精準的反應市場變化以及建構更安全的就醫環境已成為醫院保有競爭優勢、有效改善醫院經營成效的關鍵。因此本研究欲進一步針對國內醫療院所員工進行實證分析，釐清醫院市場導向發展之構面(顧客導向、競爭者導向、跨功能協調)與病人安全氣候(安全程序氣候、管理者安全性作業氣候、安全資訊流氣候、安全優先氣候)之相關性。
方法：本研究採橫斷面研究設計，以國內二家區域醫院之護理人員為實證研究對象，共得有效問卷343份。進一步應用描述性分析、驗證性因素分析、t-test、單因子變異數分析、皮爾森相關、複迴歸分析及路徑分析，以實證本研究所提列之假設。
結果：本研究結果顯示，醫院市場導向構面中之顧客導向，直接正向影響病人安全氣候各構面與整體病人安全氣候之認知，其中，對病人安全程序氣候之影響最大(β=0.47)；而競爭者導向僅對病人安全資訊流氣候產生顯著正向影響(β=0.17)。在院方對員工的支持程度方面，亦對整體病人安全氣候呈正向影響，其中，又對病人安全資訊流氣候之影響最大(β=0.43)。進一步於相關矩陣中發現，院方對員工的支持程度同時與市場導向三構面呈正相關，尤其與競爭者導向及跨功能協調的相關性甚高，據此，本研究輔以路徑分析進一步探討院方對員工的支持程度之中介效果，研究結果顯示競爭者導向及跨功能協調確實會透過院方對員工的支持程度正向影響病人安全氣候。
結論：本研究透過實證資料分析發現，醫院應妥善利用顧客導向的理念，讓醫院員工以病患為中心的角度來進行醫療服務內容的設計與服務方式的改善，進而創造良好的病人安全氣候。另外，當醫院在發展競爭者導向及跨功能協調時，雖無法直接影響病人安全氣候，但透過院方於員工從事以病患為中心之相關活動時，給予員工實質與充分的支持，能有效強化病人安全氣候，可見醫院致力於提升病人安全時，市場導向三構面著實是不可忽視的重要因素。
Background and Objectives: Recently, facing to the extreme competition of medical market and frequent medical disputes, hospitals must make rapid and accurate responses to market changes and make medical environment more safe to maintain competitive advantages and improve business performances. Therefore, this study selected hospital staffs as samples and tried to clarify the correlations between the dimensions of market orientation (customer orientation, competitor orientation, and inter-functional coordination) and patient safety climate (safety procedures, perceived managerial patient safety practice, safety information flow, and priority of patient safety).
Methods: The study was based on cross-sectional design and selected hospital staff nurses from two regional hospitals as samples in Taiwan. In all 343 valid samples were obtained. We adopted descriptive analysis, confirmatory factor analysis (CFA), Student’s t-test, One-Way ANOVA, Pearson correlation, multiple regression, and path analysis to analyze the data.
Results: The findings indicated that customer orientation, one dimension of market orientation, has positive effects on each dimensions of patient safety climate and overall patient safety climate, and it has the most influence on the climate of patient safety procedures (β=0.47). However, competitor orientation only has a positive effect on the climate of patient safety information flow (β=0.17). In addition, hospital support for staffs also has the positive effect on overall patient safety climate, and has the most influence (β=0.43) on the climate of patient safety information flow. Based on the result of correlation matrix analysis, we found that hospital support for staffs has a positive effect on three dimensions of market orientation, especially on competitor orientation and inter-functional coordination. Therefore, we further used path analysis to explore the mediating effect of hospital support for staffs. Results of path analysis showed that competitor orientation and inter-functional coordination would affect patient safety climate positively through mediating effect of hospital support for staffs.
Conclusions: Hospitals should implement the concepts of customer orientation to create patient-centered perspective and ask staffs of hospital to improve medical service design and delivery according this perspective. Then, a better of patient safety climate would be built. In addition, although competitor orientation and inter-functional coordination would not affect patient safety climate directly, hospital still could effectively strengthen supports for staffs to engage in patient-centered activities and further improve patient safety climate. Therefore, when hospitals are committed to improving patient safety climate, three dimensions of market orientation should not be ignored. |
