新制醫院評鑑與護理品質管理

The New Hospital Accreditation and the Nursing Quality Management

本文旨在討論新制醫院評鑑改變與護理品質管理，首先描述國內外醫院評鑑之發展，我國是全世界第四，亞洲第一個實施醫院評鑑的國家。新制醫院評鑑目前分為醫學中心與社區醫院之評鑑。改革之重點是建立以病人為中心的評鑑制度、結構面轉變為過程面及結果面，其核心價值是「顧客；社區；貢獻」，建立安全、有效、以病人為中心、適時、效率、公正優質的評鑑機制。新制醫院評鑑對護理品質提升之方向包括一、加重在過程與結果品質，但未忽視結構品質。二、由病人之感受方面來訂定指標。三、指標亦考量護理人員之感受與福利。四、指標加強在護理管理。五、指標強調病人安全及感染管制。六、指標強化持續性照護及長照護理之重要。護理界對護理品質所面臨之困境筆者認為包括一、基層護理人力之不穩定造成資深及管理階層之疲憊不堪。二、由於缺乏留才策略，因此護理人事資源管理亦無法做好擇才及育才，而成為護理品質管理之隱憂。三、新制醫院評鑑之改革造成護理主管更重之負荷。結論是護理界應以實證基礎建立護理照護品質管理的資料，應用於護理成本、護理人力資源及護理照護系統作合理的管理，專業團體則應用社會與政治力量來改善護理環境。

The purpose of this article is to discuss how the new hospital accreditationstandards will effect nursing quality management. From the history of hospitalaccreditation aspect, our country is the fourth in the world and the first in Asia tohave implemented hospital accreditation. The new hospital accreditation is dividedinto medical centers and community hospitals. The new standards focus on patientcenteredcare, and change the structure indicators into the process and outcomeindicators. The core values are customer, community and contribution. The accreditationmechanism is established to promote safety, effectiveness, patient-centeredcare, efficiency and justice in health care. The new hospital accreditation standardsshould improve nursing quality by: 1.emphasizing process and outcome while notneglecting structure; 2.establishing indicators from the patients perception; 3.consideringthe nurses perception; 4.increasing nursing management; 5.strengtheningpatients' safety and infection control indicators; 6.enhancing the importance of continuingnursing and long-term care. The difficulties in improving nursing qualityare: 1.burn- out of managers and experienced nurses, which results from the undependabilityof new nurses; 2.the lack of a strategy to keep nurses in the workplace;3.the new hospital accreditation standards are increasing the nurses manager'sworkload. Conclusion: nurses should establish evidence-based quality managementdata concerning cost, manpower, and management, then linking social andpolitical forces in order to improve the nursing environment.