| 摘要: | 近年來由於科技產業技術不斷進步，為因應人口結構呈現高齡化趨勢漸趨嚴重，醫療產業紛紛導入資訊與通訊技術，遠距照護服務的發展已然成為未來健康照護服務產業的新趨勢。遠距照護服務需要許多相關領域的利害關係人的參與，然而，當前遠距照護服務的相關研究鮮少以各個利害關係人之角度架構出完整的服務模式。因此，本研究欲探討推行遠距照護服務之相關利害關係人在權力-利益方格中的定位；再提出遠距照護服務之特定利害關係人建議之管理策略。
本研究分兩階段進行。第一階段透過權力-利益方格，瞭解遠距照護服務利害關係人的定位及重要性，針對國內13家實施遠距照護服務之機構，包括北、中、南、東七家醫院、三家護理之家、兩家養護中心及一家長期照護中心的遠距照護服務和相關單位參與人員，發出問卷共73份、回收問卷共66份，有效回收率達90.4%。回收資料採用EXCEL散佈圖繪製遠距照護服務之利害關係人在權力-利益方格中之群眾 、隸屬關係、脈絡因素及關鍵參與者中的定位。結果發現最關鍵參與者有醫師、政府相關單位、照護端、護理人員、個案、營運端、個案管理師、藥師及家屬，次關鍵參與者為醫療設備及器材業、系統管理 、資訊系統工程人員、其他醫療人員及照顧服務員。
第二階段以立意抽樣的方式針對遠距照護服務相關領域的主管共十位，藉以深度訪談的方式以及語幹分析的方法，探討實施遠距照護服務之想法與建議。結果發現，對於最關鍵參與者如照護端、營運端、醫師、護理人員、個案管理師及藥師，應使其給予適當報酬與獎勵以及整合性照護；服務流程資訊化對於營運端、護理人員及藥師在照護工作效率有強化作用；另外，提升服務價值對於營運端、醫師、護理人員、個案管理師、藥師、家屬及個案是最重要的；而政府相關單位需瞭解其他利害關係人需求面，才能給予其真正的支援。
本研究建議，照護端、營運端與政府相關單位應加強推廣及宣導遠距照護服務，使民眾更能瞭解此服務模式；法規面上應採開放性的角度實施，將使服務的層面較廣闊；最後，對於相關參與人員應給予適當的獎勵與補助，使其更有意願參與。
本研究期望在有限資源下能對遠距照護服務利害關係人做最有效的管理，使得遠距照護服務發揮最大效益。
In recent years, the technology industry develops rapidly, to cope with the issues of aging population, the development of telecare services, which imported information technology as the service platform, have become a new trend of health care industry.Telecare service requires the participation of many relevant stakeholders in the field. However, the current telecare services research rarely explores the viewpoints of the various stakeholders and construct an integrated model. Therefore, this study is to investigate in the positioning of stakeholders in telecare services by using power-interest grid, and to propose the relevant strategies for managing the stakeholders of telecare services.
There are two phases in the study. In the first study, 13 institutions, including seven hospitals from northern, central, southern, eastern areas in Taiwan, which have been implementing telecare servicesparticipated the study. A total of 73 questionnaires, were mailed, and a total of 66 questionnaires returned, the effective response rate of 90.4%. EXCEL scattering diagram was employed to construct a power - interest grid of the stakeholders in telecare services. The results showed that physicians, government units; the caregivers, nurses, cases, the operating units, case managers, pharmacists and family members are positioned as the primary key players. Medical devices and equipment industry, system management corporations, information systems engineering personnels, medical staff and care attendants are secondary key players.
The second-phased study conducted 10 deep interviews with chief conductors of telecare divisions in various organizations. Content analysis was used to analyze the qualitative data obtained from interviews.The results showed that for the primary keyplayers, such as caregivers, the operating units, physicians, nurses, case managers and pharmacists, they should be reimbursed with appropriate rewards and incentives, and mechanisms to integrate telecares are also needed. e-process service is helpful for operating units, enhancing work efficiency and strengthening the roles provide incentivevs for nurses and pharmacists. In addition, enhancing service value is the most important for the operating units, physicians, nurses, case managers, pharmacists, family members and cases. The government needs to understand the needs of other stakeholders and provide support.
This study suggests that caregivers, the operating units and the government units should strengthen the promotion and advocacy of telecare services to enable people to better understanding of this mode of service. Deregulations are requisite for the market expansions. Lastly, morestakeholder participation in strategic planningshould be encouraged upon appropriate incentives and subsidies.
This study expects to manage stakehodlers of telecare servies in a most efficient way. |
