以整合性科技接受模式觀點探討醫療機構員工對異常 事件通報系統使用行為之研究──以某區域級教學醫院為例

A Study of Incident Reporting Behavior by Health Care Facility Employees from the Perspective of the Integrated Technology Acceptance Model - a District-Level Teaching Hospital as an Example

目的：了解醫療機構員工使用異常事件通報系統處理方式，以期改善醫院異常事件通報系統，增進醫院員工對異常事件通報系統之使用。方法：以某區域教學醫院為例，採兩階段研究，首先以整合性科技接受模式為基礎，質性訪談30位受訪者，再輔以第一階段所獲得之相關資訊，修正成適合本研究之結構式問卷，共發出1,000份問卷，回收有效問卷747份，有效問卷回收率74.7％。結果：「電腦自我效能」、「績效期望」、「社會影響」、「促進條件」會顯著影響「使用意願」；「電腦自我效能」會影響「付出期望」；「使用意願」會影響「使用行為」；「經驗」在「付出期望」、「社會影響」、「促進條件」與「使用意願」間具有干擾效果。結論：本研究顯示影響「使用意願」的因素以「電腦自我效能」最具影響力，其次為「社會影響」，再其次為「績效期望」。因此建議醫院應優先加強宣導異常通報系統使用及員工教育訓練，其次，建議通報以單位為主，建立學習組織，讓員工認為通報不再是個人問題，並給予通報者鼓勵與支持。再其次可促進員工瞭解異常通報系統之有用性，並提高獎勵金，以增進員工通報動力。此外，針對不同使用「經驗」者，可提供不同改善策略，以提高醫療機構員工使用異常通報行為。

Purposes: To understand how health care facility employees use the incident reporting system in order to improve the system in hospitals, and to prompt health care facility employees to use it. Methods: A two-stage study method was adopted in a district-level teaching hospital. Using the integrated technology acceptance model (TAM) as the framework, 30 qualitative interviews were conducted. The results of these interviews in combination with relevant information collected during the first-stage of the study were modified to produce a structured questionnaire. A total of 1,000 copies of the questionnaire were distributed and 747 (74.7%) were returned. Results: “Computer self-efficiency”, “performance expectation”, “social influence”, and “facilitating elements” were significant influences on “willingness to use”. “Computer selfefficiency” affected “expectation after efforts are made”. “Willingness to use” affected “users’ behavior”. “Experience” had moderating effects on “expectation after efforts are made”, “social influence”, “facilitating elements’, and “willingness to use”. Conclusions: This study showed that, of all factors that affected interviewees’ “willingness to use”, “computer self-efficiency” was the most important, followed by “social influence” and “performance expectation” in that order. We recommend that hospitals place a high priority on advocating for the use of the incident reporting system and provide education and training for employees. Second, we recommend that hospitals make incident reporting a group task and form study groups so that employees stop considering incident reporting as an individual task. Encouragement and support can also be given to employees who report an incident. Hospitals can motivate employees to understand the usefulness of the incident reporting system by providing honoraria to encourage employees’ to report incidents. Different strategies could also be used with employees with different kinds of “experiences” to promote improvement. Implementation of these recommendations should result in improvement in incident reporting by health care facility employees.