| 摘要: | 背景與目的：藉由外部評鑑機制，經常是醫療機構投入改善醫療從業人員的工作環境、提昇工作服務效率，並積極塑造安全文化、改善醫療品質，同時確保病人安全的重要手段。本研究旨在透過某個案醫院，探討參與國際醫院評鑑(Joint Commission International Accreditation,JCI)期間，對醫療從業人員病人安全文化態度的影響。
研究方法：本研究採用問卷調查法，擷取四年度新版病人安全態度問卷(New Safety Attitudes Questionaire,New-SAQ)之次集資料。研究對象為南部某醫學中心院內之醫師、護理人員、其他醫事人員(醫技、藥劑、復健)、行政人員，次級資料樣本為 2015 年、2016 年、2017 年、2018 年。統計分析以 SPSS 22 統計套裝軟體進行描述性統計、獨立樣本 T 檢定、單因子變異數分析 ANOVA、複迴歸分析等。
研究結果：研究發現樣本特性不同，包括年齡、職務類別、教育程度、院工作年資、單位年資對病人安全文化態度呈顯著差異(p <0.05)，而性別、是否擔任主管(含副主管)對病人安全文化態度呈部分顯著差(p<0.05)；JCI評鑑前、後對病人安全文化態度呈部分顯著差異(p <0.05)。經複迴歸分析後顯示，JCI評鑑在「團隊合作｣與「單位安全風氣｣構面無顯著，其餘皆由評鑑後病人安全文化態度高於評鑑前。整體而言，以兩年為觀察期時，JCI 評鑑對病人安全文化態度呈現顯著改善的影響。
結論與建議：個案醫院在執行第一次JCI評鑑後，使醫院整體對病人安全文化態度有部分提升的影響。而安全文化需要不斷學習及改善，透過參與JCI評鑑之過程中去發現缺失及改進，也讓各單位有更廣泛的連結，此評鑑制度成為了協助的面向，使醫院保持病人安全文化有正向提升。本研究亦依據研究提出相關政策與管理建議，以供後續各界參考之用。
Background and purpose：Implementations of former accreditation mechanisms are often seen as healthcare organizations’ strategies to improve healthcare professionals’working environment,enhancing service efficiency,intermediately,
cumulating safety culture,engaging investment in medical quality and promoting focusing on well patient safety. The research purpose is to explore the impacts of implementing JCI Accreditation (Joint Commission International Accreditation) on healthcare professionals’ attitude toward patient safety culture within a medical center in southern Taiwan.
Methods：We conducted a longitudinal survey research. The research subjects were healthcare staff in the medical center in southern Taiwan, including physicians, nurses, other medical staffs (paramedical staff,pharmacists,rehabilitationists), administration staffs. Data was collected among 2015 and 2018 with a well-constructed questionnaire “New Safety Attitudes Questionnaire(New-SAQ)”. Research analysis was used by a package software of SPSS 22 to conduct the descriptive statistics, independent t-test, one-way ANONA, and multiple linear regression analysis.
Results：The result shows statistically significances between sample characteristics and attitude toward patient safety culture, including age, job category,education level,hospital work years,and unit seniority (with p<0.05)meanwhile, a partially statistical differences were found in gender,supervisor (including the deputy director), and JCI (with p<0.05). With multiple linear regression analysis, it showed that JCI Accreditation made non-statistically significance only on "teamwork climate" and "safety climate".Overall, JCI makes a statistical improvement on healthcare professionals’ attitude toward patient safety culture based on a two-year observation time frame.
Conclusion：After the implementation of the first JCI Accreditation, the case hospitals had partially affected the healthcare professionals’ attitude toward patient safety culture. We proposed that continuous involvement on improving safety culture can be reached by implementations of former accreditation mechanisms. Finally, we provide several suggestions for further research and policy making. |
