從單雙環學習模式看醫療團隊執行新實務的學習成效

Investigating the learning performance of teams adopting a new medical practice by the Single-Loop and Double-Loop Learning Models

目標：健康－－照護產業近年來的發展已由醫護個人經驗或獨特秘技主導的局面轉向依靠臨床驗證有效而公開發表的最佳實務。此一趨勢導致醫院必須不斷學習新實務，方能避免落後他院，進而提升醫療水準。儘管醫學文獻對於最佳實務的規範嚴謹清楚，但是醫院導入新實務後，在結果面上仍會發生醫療品質不佳的問題。對此關鍵議題，本文主張雙環學習模式有助新實務學習成效的提升。方法：本文選取兩個分屬不同醫院的同質開刀團隊，執行相同新實務，作為研究對象。以開刀團隊的學習曲線，作為衡量學習成效的指標。結果：透過對兩開刀團隊成員問卷施測及統計分析，發現兩團隊在使用單、雙環學習模式的程度上存在顯著差異，影響開刀團隊執行新實務的學習成效。結論：此研究結果顯示團隊行動效能的提升確實可透過雙環學習模式來達成，且其提升效果遠勝於單環學習模式。在實務面，建議醫院經營者不應只倚賴醫學文獻的管理和專業實務者的知識，可考慮營造有利雙環學習模式運作的情境，才是提升醫療品質理想的作法。

Objectives: The health-care industry has recently been transformed from one emphasizing medical practitioners' personal experiences or unique skills into one that depends on new medical practices that are evidence-based. This trend has resulted in hospital staffs continuously learning and implementing new medical practices to improve the quality of health-care. In spite of the fact that the medical literature has provided clear standards for best practices, when new medical practices have been introduced in hospitals, the quality of treatment results has often been poor. The aim of this study was to determine if double-loop learning models could effectively decrease the number of problems with poor quality treatment. Methods: As subjects, the study selected two homogeneous operation teams which were required to implement new medical practices in different hospitals. Learning curves served as indicators of performance in implementing the new medical practices. Results: Based on the statistical analysis of questionnaire completed by members of the two teams, a significant difference was found between single-loop and double-loop learning models. Conclusions: In order to improve the quality of care, hospital managers should introduce double-loop learning models to stimulate interaction among team members rather than relying on documentary files and individual knowledge.