組織特質、管理風格、與長期照護品質之關係

The Relationship among Organizational Characteristics, Management Style, and Nursing Home Quality

台灣地區老年人口的快速成長導致長期照護的需求增加。長期照護的提供需要投入大量的病患服務員人力，因而病患服務員的穩定性、滿意度及照護的品質便成為關注的焦點。本研究探討護理之家的組織特質 （組織大小、生命週期、是否為連鎖型、護理之家的型態）、管理風格、組織效能 （流動率、穩定率、工作滿意度）、和病患結果 （跌倒、壓瘡、再入院的比率） 之間的關連性。具體的研究問題涵蓋 （1） 護理之家病患服務員的流動率及穩定率為何？ （2） 護 理之家的組織特質是否會直接影響到組織的效能 （員工流動率、穩定率、病患服務員之工作滿意度） 及病患結果 （跌倒、壓瘡、再入院）？ （3） 護理之家的 組織特質是否與管理風格 （中介變數） 有相關？ （4）護理之家的組織特質，是 否會透過管理風格的中介 （mediating ） 作用而影響組織的效能 （員工流動率、穩定率、病患服務員之工作滿意度及病患照護品質） ？ （5）病患服務員之工作 滿意度與病患照護品質的關係為何？
本研究收集高雄市34問護理之家及209位病患服務員。研究的方法以結構方程模型分析為主。高雄市護理之家的病患服務員之平均流動率偏低，穩定率約在45.7%，顯示病患服務員之人力資源較為穩定。組織的特質會直接影響到照護品質、員工流動率、及穩定率。然而病患服務員的工作滿意度不受任何組織特質的影響，反倒與管理的風格較相關。組織特質中僅有規模大小 （床數的多寡） 會影響到管理風格。管理風格並不能被稱為重要的中介因素，而去影響組織特質與組織效能間的作用。而病患服務員的工作滿意與病患的照護品質明顯的是相互（reciprocal）影響的作用。建議未來若有更多護理之家可以參與研究時，應再次檢查管理風格的中介作用。

The growing elderly population has driven the need of long term care. The major manpower in long term care is nurse aides. Thus, the issues of turnover, stability and job satisfaction of nurse aides in long term care needs attention, particularly, the relationship between the staffing of long- term care and quality of care. The aim of this research is to examine the relationships among nursing home characteristics (defined as organizational size, organizational life cycle, ownership, and nursing home type), nursing home management style, job satisfaction, turnover, stability, and patient outcomes (rate of falls, pressure ulcers, readmission to hospitals). The research questions are: 1) What are the turnover and stability rates of nurse’s aides in nursing homes? 2) What are the relationship among the organizational characteristics, nurse aides’ satisfaction, and patient outcomes? 3) What is the relationship between the organizational characteristics and management style? 4) Does management style exert a significant mediating effect among the organizational characteristics, nurse aides’ satisfaction, and patient outcomes? 5) What is the relationship between nurse aides’ satisfaction and patient outcomes? We collected primary information on 34 nursing homes of Kaohsiung as well as 209 nurse aides. We used the structural equation modeling to attain the research purposes. The average turnover of these nursing homes was pretty low. Average stability was around 45.7%. Different organizational characteristics have direct effects on the quality of care, turnover, as well as stability. The main effect for nurse aides’ satisfaction was management style instead of the organizational characteristics. In addition, management style was not the mediator to mediating the effect between organizational characteristics, stability, turnover, and patient outcomes. We also found the reciprocal causation between nurse aides’ satisfaction and patient outcomes. It is strongly recommended to examine the management style as a mediator again once the more nursing homes could participate.