醫院卓越計畫實施後對主治醫師工作生活品質影響之意見調查

The Effects of Payment System to Quality of Work Life among Attending Physicians under “Hospital Excellent Program”

本研究目的在於評估醫院卓越計劃實施後對主治醫師工作生活品質影響及探討與工作生活品質有關之個人因子及組織因子。本研究以自填式問卷收集資料，問卷包含個人屬性、組織屬性資料及工作生活品質量表兩個部份。依照醫院評鑑等級分層抽樣，共選取中台灣有加入「醫院卓越計劃」的18家醫院，並完成310位主治醫師的有效問卷，有效問卷回收率為51.7%。結果顯示，醫院實施「醫院卓越計劃」後，主治醫師自覺工作生活品質降低許多。在15題所組成的工作生活品質量表中，以「社會地位」、「薪資」、「福利制度」及「專業自主性」等4題分數降低最多。複迴歸分析顯示，在影響主治醫師工作生活品質之有關因子方面，以對「醫院卓越計劃」持負向態度、領變動薪、在私立醫院服務及年紀輕者之工作生活品質比較低。建議醫院管理者加強向主治醫師宣導新的健保政策，並且在敘薪方式加強溝通以達成共識，以及宜提出相關措施以改善年輕醫師的工作生活品質。此外，建議未來研究繼續追蹤主治醫師之工作生活品質變化情形，並分析其對醫療品質之影響。

The purpose of this study was to evaluate the effects on quality of work life (QWL) among attending physicians after implementation of hospital excellent program (HEP) and to explore the individual and organizational factors associating with QWL. We conducted with a self-administered questionnaire to collect data. The questionnaire includes two parts: one is individual and organizational variables, and the other is a rating scale for QWL. According to hospital accredited level, a stratified sampling method was applied to select 18 hospitals which participated in HEP and were located in central Taiwan. A total of 310 questionnaires were completed with a valid response rate of 51.7%. The results showed that QWL of attending physicians was much lower under HEP. Especially the scores of four items including “social status”, “income”, “welfare” and “professional autonomy” decreased most among all 15-item scale of QWL. After the analysis of multiple regressions, the results indicated that attending physicians who had negative attitude toward HEP, received floating salary, worked in private hospitals and were young had lower QWL. This study suggests that the hospital managers should enhance to conduct the new policy used to deal with health insurance, communicate with attending physicians to achieve a consensus on physicians’ salary structure, and take action to improve QWL of younger physicians. Moreover, further study should be continued to follow up the change of QWL among attending physicians and to evaluate whether QWL affects medical quality in the future.