| 摘要: | 高齡化社會的來臨，使得眾多長輩對長期照顧的需求與日俱增，長期照顧成了目前與未來很受重視的一個議題。為了使長輩在長期照顧機構，能受到良好的對待與照護，有必要對長期照顧機構嚴格推行品質管理。本研究的目的是以全面品質管理的觀點，探討長期照顧機構實施全面品質管理內涵之現況與缺口，並進一步分析，各長期照顧機構評鑑法規與全面品質管理內涵之缺口。
本研究採用質性研究方法，根據文獻整理出全面品質管理的內涵，以設計訪談大綱，訪談對象為長期照顧領域專家與機構管理人員，共15名為對象其中有3位長期照顧領域專家與12間機構管理人員，進行半結構式深度訪談，訪談每位屆時40~120分鐘。資料分析採用紮根理論與內容分析法，研究品質則以研究者三角驗證法、一致性分析法與Lincoln 和Guba （1985）提出的研究品質要點為依歸。
結果發現各機構型態在全面品質管理內涵中，實踐較多的是顧客中心，其次為職訓制度與持續改善，而其中全員參與是最缺乏的。發現缺口情形最嚴重的為全員參與，其次為優質領導與持續改善。可見對於長照機構而言，全員參與、優質領導與持續改善不易落實。法規缺口方面，全員參與與職訓制度為較缺乏明訂之全面品質管理內涵。長照機構對於法規的實踐困難為財務困難與人力缺乏，此困難影響到機構提供的照顧品質。 本研究建議機構內部可以實施品管圈、讀書會、導入管理系統、策略聯盟…等方法，來改善機構之內部流程，以提供更好的品質給住民們。管理者亦需瞭解員工們的需求，並鼓勵員工在職進修，培養第二專長以利生涯規劃，強化大家對機構之向心力，使大家有共同為住民們著想之目標。
With the advent of an ageing society, the needs of many elders for long－term care have increased. Long－term care has become an issue that is highly valued for the present and the future. In order for elders to be well treated and cared in long－term care institutions, it is necessary to strictly implement quality management for long－term care institutions. The purpose of this study is to explore the status and gaps in the implementation of quality management by long－term care institutions from the perspective of total quality management（TQM）. Also, the gap of current evaluation regulations of the long－term care institutions and TQM philosophy is analyzed.
The study used qualitative methods. According to the literature, interview outlines were designed. Interviews were conducted by experts and institutional managers in the field of long－term care. Totally 15 deep interviews were conducted, including 3 long－term care professionals and 12 institutional managers each lasting 40 to 120 minutes. Data analysis used grounded theory and content analysis. The research quality is based on the researcher's triangulation, consistency analysis, and Lincoln and Guba （1985）’s research quality points.
The results found that the most implemented is the customer center, followed by the vocational training and continuous improvement, the full participation is the lowest. The most serious gaps were found in full participation, followed by quality leadership and continued improvement. It can be seen that for long－term care institutions, full participation, quality leadership, and continuous improvement are not easy to implement. Regulatory gap, the full participation and vocational training are essential gap in TQM perspectives. Long－term care institutions implementing regulations difficulties are financial difficulties and lack of human resources. This difficulty affects the quality of care of the institutions.
This study suggests that the institutions can implement quality management circles, reading clubs, import management systems, strategic alliances, etc method. Improving the internal processes of the institutions can provide better quality. Managers also need to understand the needs of employees, and encourage employees to take up training. Besides developing second expertise for career planning, strengthening the centripetal force of everybody. Can make employees to build a common goal for the inhabitants. |
