臺灣醫院評鑑基準之多元公平與共融主題分析

A Thematic Analysis of Diversity, Equity, and Inclusion (DEI) in Taiwan’s Hospital Accreditation Standards

目的：本研究旨在分析 2024年臺灣醫院評鑑基準中多元、公平與共融(Diversity, Equi-ty, Inclusion, DEI)原則的實踐現況，識別其與國際標準的接軌程度及本土化特色。

方法：採用質性文件分析法，針對《113年度醫院評鑑基準及評量項目（醫學中心適用）》共 195條基準進行演繹式與歸納式主題分析。

結果： 61條基準(31.28%)具 DEI相關性。多元性體現於肯認差異與服務調適：雙語環境、手語等溝通(1.1.7,1.6.1)、性別友善職場 (1.2.8)、特殊需求門診(2.4.30)。公平性著重消除障礙與資源正義：無障礙設施(1.5.2)、弱勢優先服務(1.6.2)、以及偏鄉支援任務（醫學中心任務指標二）。共融性透過賦權實踐：利害關係人參與決策(1.1.1)、醫病共享決策(2.1.3)、末期自主(2.1.3,2.1.4)、職場心理安全（防暴力1.2.10、醫糾關懷1.7.3）等。

結論：臺灣已形成一套「隱含式」DEI框架，呈現「結構導向優先於文化形塑」特徵：評鑑指標多聚焦設施與標竿流程等結構性規範，對文化謙卑與偏見覺察訓練等深層文化要求相對不足，且多項共融相關條文僅列為「優良項」或「試評項」，顯示文化共融仍停留在鼓勵而非強制階段。建議將 DEI納入醫院使命並建立監測機制，以推動醫療體系從結構合規邁向實質文化共融。

 

Purpose:This study analyzed how the principles of diversity, equity, and inclusion (DEI) are embedded in Taiwan’s 2024 hospital accreditation standards and identified their localized characteristics and alignment with international benchmarks.

Method:We conducted a qualitative document analysis of 195 items in the 2024 Hospital Ac-creditation Standards (Applicable for Medical Centers). Combined deductive and inductive thematic analysis was employed to identify DEI-related content.

Result: Sixty-one items in the standards (31.28%) were identified as DEI-relevant. Diversity was refected by diference recognition and service adaptations, including bilingual environments, sign language communication (1.1.7 and 1.6.1), gender-friendly workplaces (1.2.8), and specialized clinics for patients with special needs (2.4.30). The items concerning equity focused on eliminating barriers and promoting distributive justice, such as by providing accessible facilities (1.5.2), providing priority services for vulnerable populations (1.6.2), and implementing rural health-care support missions (Task Indices for Medical Centers II). Inclusion was practiced through empowerment mechanisms, including stakeholder participation in governance (1.1.1), shared decision-making (2.1.3), end-of-life autonomy (2.1.3, 2.1.4), and safeguarding of psychological safety in workplaces(e.g., violence prevention, 1.2.10, and support following medical disputes, 1.7.3).

Conclusion: Taiwan has developed an implicit DEI framework with a “structural orientation takes precedence over cultural cultivation” profile. The accreditation indicators assessed in this study emphasize structural regulations, such as facilities and benchmarked processes; explicit requirements for deeper cultural change, such as cultural humility and bias-awareness training, remain limited, and many inclusion-related elements are designated as “excellent” or “pilot” rather than being mandatory. Integrating DEI explicitly into hospital missions and establishing monitoring mechanisms may help Taiwan’s health-care system progress beyond structural compliance toward substantive cultural inclusion.