麻醉部品質促進團隊之績效評量

Performance Evaluation of Quality Improvement Team in an Anesthesiology Department

背景：品質促進活動，在管理性照護政策的帶動下，成為醫療市場的風潮。然而品質促進之工作並非個人所能完成。學者們發現有許多醫院利用專業團隊來進行品質促進活動，更能因應環境的快速變化而有效地提高醫療照護的品質、減少成本並提高士氣及滿意度。本文是研究在品質促進團隊介入麻醉部品管後，與對照組在工作滿意度、工作士氣、組織承諾及庫存管理績效等方面之差異情形。方法：本研究以某總醫院之麻醉部及手術室護理人分成兩組：實驗組45人（麻醉部）及對照組50人（手術室）進行研究前後測之縱貫性研究。對照組維持原先之單位活動與運作，而實驗組則有品質促進團隊活動之介入。比較二組間在介入前及介入四個月及八個月後評量各指標成效之差異，如多項標準作業流程之建立，特殊器材之配置和問題發掘及品質促進團隊之成立等。評量指標工具包括工作滿意度，問卷內容包括有薪資、自主性、工作需求、專業地位、人際互動、及組織政策等六個評量構面。工作士氣，測量每一個成員對工作因素所抱持的態度。組織承諾，問卷分為團隊認同、努力意願與團隊凝聚力三方面。問卷資料收集後，以GEEs(Generalized Estimating Equations)模式檢定介入之成功與否。另外，以庫房衛材盤點表作每個月庫存金額下降率來評量庫房管理績效。結果：二組人員屬性分佈除教育程度呈現統計上之顯著差異外（實驗組的大學比例高於對照組，而對照組的五專比例則高於實驗組）。其餘如年齡、婚姻狀態、護理及單位年資及職位類別等均無顯著差異。在品質促進團隊介入後，經GEEs分析，控制組別差異變項“教育程度”後，實驗組在工作滿意度之評價及組織承諾方面，在四個月後及八個月後均顯示介入之成效。但在工作士氣方面，品質促進團隊之成效則並不顯著。實驗組（下降24.8％）在最後之庫存金額下降率也遠高於對照組（上昇16.9％）。結論：本研究結果在品質促進團隊介入後八個多月，麻醉部護理人員之工作滿意度在與對照組的比較之下，呈現顯著的提昇。驗證品質促進團隊與麻醉部護理人員工作滿意度間之正向關係。其中以自主性、組織政策及同仁互動三個構面呈現顯著成效，而薪資、工作本身及專業地位等，較不易受品質促進團隊之改變。而本研究對象中以高職學歷者之組織承諾明顯高於大學學歷者。在維持組織正常運作下，實驗組最後之庫存金額下降率高大於對照組。由此可看出品質促進團隊介入之成效標。

Background: In health care community, quality improvement pathway has always been treated as critical index to control cost, improve efficiency and promote service quality, particularly in the last decade. From theoretical standpoint, clinical practice as well as research data, quality improvement team has been demonstrated to play an important role in the adaptation to the changing health environment and enhancement of the competition through the improvement process. The purpose of this study was to explore members' job satisfaction, morale, organizational commitment and inventory management through quality improvement team intervention in a department of anesthesiology. Methods: This study was of a quasi-experimental and longitudinal design. The subjects involved 45 nurse anesthetists (the experiment group, intervention of quality improvement team) and 50 operation room nurses (control group) in a general hospital. The quality improvement team had been initiated and implemented pursuant to the quality improvement process for 8 months. GEEs (Generalized Estimating Equations) model was used to examine the differences in job satisfaction, morale, organizational commitment, and the inventory management was also examined between two groups. Results: After control of all variables, except education background, such as age, marital status, education, position and nursing experience, a natural growth effect was observed on quality improvement team. The results revealed that the experimental group showed significant positive effects on both job satisfaction and organizational commitment after the intervention. The morale scale did not differ significantly between two groups. In the inventory management, the experimental group successfully decreased the monthly consumable materials stock with a descending rate of 24.8%, while in the control group, the inventory was increased 16.9% in the basal stock instead. Conclusions: As other previous reports did, the present study also demonstrated that intervention of the quality improvement team improves the nurse anesthetists' job satisfaction, such as promotion of autonomy, organizational policy and positive member interaction. Moreover, it improves work efficiency, service quality as well as control of the stock inventory.