新制醫院評鑑與病人安全文化－－以某醫學中心為例

Reformed Hospital Accreditation and Patient Safety Culture - Survey of a Medical Center

背景和目的：藉由問卷調查，了解醫護人員病人安全態度，並探討安全文化與新制醫院評鑑之間的聯動性。方法：採用安全態度量表（SafetyAttitudesQuestionnaire,SAQ）於新制醫院評鑑前後評量某醫學中心醫護人員病安態度改變的情形。SAQ量表涵蓋五個構面，包括：「團隊合作」、「單位安全的風氣」、「對工作的滿意」、「對管理的感受」、及「工作狀況」。研究比較不同單位或不同人口學特徵醫護人員構面的得分，並使用複回歸分析，探討影響構面分數的因子，最後縱貫性比較醫護人員前後兩次測量構面分數的差異。結果：前後測分別有424及417位受訪者，問卷回收率分別為79.1%及68.8%，SAQ問卷內部一致性Cronbach’salpha分別為0.73-0.83及0.69-0.90。擔任主管、年齡大於40歲、工作年資大於10年者都得到較高的分數，醫師得分也高於護理人員。新制評鑑後，醫護人員的「團隊合作」、「單位的安全風氣」及「工作狀況」得分都有明顯的改善（70.3vs.77.3、71.1vs.75.9、71.4vs.73.8,p<0.05）。結論：應用SAQ問卷進行病人安全文化調查，可瞭解醫院工作人員對安全文化的認知，也反映安全文化可以透過新制醫院評鑑的推動而有所改善。

Objectives: Using structured questionnaire, the objectives of this study are to investigate the patient safety attitude among hospital employees and to explore the impacts of reformed hospital accreditation on patient safety culture. Methods: The Safety Attitudes Questionnaire (SAQ) was used in this cross-sectional survey study to assess 5 dimensions of patient safety attitude from hospital employees, including teamwork climate, safety climate, job satisfaction, perception of management, and working condition. Dimension scores were compared between age, gender, work unit, job type, and career experience groups using GLM. Multivariate regression models are used to investigate the factors that may affect the patient safety attitude. In addition, we also compared the scoring differences in pre-post investigation. Results: There were 424 and 417 participants in pre-post investigation, and the response rate was 79.1% and 68.8%, respectively. The cronbach’s alpha in SAQ ranged from 0.73 to 0.83 in pre-study and 0.69 to 0.90 in poststudy. Staffs with managerial job, aged more than 40 years-old, and employment years more than 10 years had higher score in all dimensions, respectively. Comparing with scores in pre-post investigation, there is significant progress in teamwork, safety climate, and work condition (70.3 vs. 77.3, 71.1vs. 75.9, 71.4 vs. 73.8, p<0.05). Conclusions: The SAQ survey data provide patient safety attitude information of our institute. With the induction of safety strategies accompanied with reformed hospital accreditation, patient safety culture can be more improved as well.