科技部專題研究計畫主持人
MOST-105-2410-H-002-189-SS3
發展品質管理推行之動態模式與品管專案推行後效果之驗證
Dynamic Implementation Model of Quality Management and Verirfication of Quality Project after Implementaion Effect
科技部
Ministry of Science and Technology
國立台灣大學
National Taiwan University
鍾國彪
Chung,Kuo-Piao
公共衛生學院 健康政策與管理研究所
The Institute of Health Policy and Management
鍾國彪
教授
02-33668065
kpchung@ntu.edu.tw
計畫執行期間起:2016-08-01
計畫執行期間迄:2019-07-31
2016-11-17
2019-07-28
長期推行且參與HQIC的醫院
1
007
01,05
品管活動動態推行模式;品質改善後效應;模式建構;量表發展
quality improvement dynamic implementation model;quality improvement sustainability effect;model building;instrument development
台灣的醫院在全民健保下,競爭激烈,品質管理專案在醫院已經行之有年,維持專案持續推動背後,能否找出品管運作機制及建構動態推行模式?過去文獻顯示,即使專案後效應的特性及內涵有被討論,但僅止於概念性的描述,大多文獻對影響品質改善專案後效應的因素做探討,僅部份量測工具被開發,很少針對品質改善專案後效應的內涵來探討。 本研究以三年時間,達成研究目的:收集文獻以及品質管理之推行歷程以及影響後續效應模式相關資料;提出或建構品質管理推行動 態模式及影響後續效應模式之雛形;從品質管理推行動態模式及影響後續效應模式中,發展量表或測量工具;以實證研究與調查來修正量表以及相關的模式內容。 本研究為混合研究。第一年針對醫療品質獎主題類及突破品質系列之醫院作合作樣本的篩選,參考整合推行架構,草擬訪談大綱,完成個人深度訪談(16位院長/副院長或品管中心主任/副主任),及舉辦6場焦點團體座談會(27位品質改善團隊領導人和成員),並已將16題訪談內容做因素歸類,整理文字過程以NVivo作為輔助,除方便文字編碼與搜尋外,亦能協助計算各因素之題目及次數。 第二年研究團隊透過密集的討論並參考相關文獻與模式,根據第一年彙整之因素,逐步發展為「品質管理推行之動態模式架構」、「品質改善活動之推行歷程」、以及「品質改善活動後效應維持之概念模式」三個架構圖,就其中的主要概念進行文字定義,並藉由兩場專家會議,共邀請8位專家進行架構圖之修正,包含名稱內容與相關構面間的順序等,更進一步將「品質改善活動之推行歷程」加以重整,針對其中60個品質改善活動歷程中的影響因素,發展成量表,量表題項係經由研究團隊依受訪者的陳述內容所擬定,最終形成初版問卷,共計140題。 第三年共進行兩份問卷的收集,第一份是推行歷程問卷,以參加醫策會舉辦國家醫療品質獎主題類10屆以上的醫院來參與研究;第二份推行後效應則是近五年參與醫策會主辦突破系列改善的醫院參與研究。第一份問卷主要內容有前中後三階段,共51題;第二份問卷包含五層面,也是51題,經專家效度後,以網路問卷方式收集問卷,進行探索因素分析、驗證性因素分析、信度分析,檢視各量表之建構效度,以及使用因徑分析找出各影響因素間的直接與間間關係建構此理論模式。結果第一份問卷有28家醫院同意參與,分別回收509份有效問卷,第二份問卷有21家醫院同意參與回收450份有效問卷。最後再經專家會議討論後,修正並確認研究結果。 本研究完成品質管理動態推行模式的雛形,共有五部分,包含萌芽(開始)期、擴展期、成熟期等三個延續堆疊的過程,受到外在因素與內在因素的影響,其中外在因素與內在因素都分別包含四個構面,而萌芽期與擴展期都包含三個構面、成熟期包含五個構面。本研究發現品質管理活動推行歷程包含改善前、改善中、改善後的三階段,分別包含四個、三個和兩個構面。最後,提出9個構面間的13個研究假說,呈現不同構面間的各種關係。
This is a three-years study to develop dynamic implementation model and after implementation framework; to validate newly developed instrument from empirical survey. Mixed methods will be adopted for the study. Consolidation Framework for Implementation (CFIR) will be adapted into interview outline. We had done 16 in-depth interviews for hospital leaders. Six focus groups for team leaders and team members were held in northern and central Taiwan hospitals. Data was recorded and transcribed into codes and themes or categories and then input in qualitative software of N-Vivo for analysis purpose. In the second year, we develop the prototype of dynamic implementation model for hospital quality management. The micro-view of implementation process for quality improvement activities was developed, too. The third model was developed for sustainability of after-implementation effect in quality improvement activities. Two expert meeting were held for thorough discussion of the prototype model, the definition and the relationship among different concepts. Eight experts showed up to provide their experiences and comments. We conduct data collection for two parts of questionnaire in the third year. There are 51 questions in the before interim- after period of improvement journey, and 51 questions in five domains of sustainability effect. Internet survey was conducted after expert validity for those two questionnaire. Exploratory factor analysis and confirmatory factor analysis were done for checking construct validity. Cronbach\'s alpha was done for internal consistence. Path analysis was major approach for model building to find all possible direct and indirect relationship. We collect 509 questionnaire from 28 hospitals in improvement journey and 450 questionnaire from 21 hospitals in sustainability effect. One more expert meeting was conducted to verify and revise the model we propose. We propose the dynamic implementation model in the third year with revision of second year results. It covered five major parts including external factors, internal factors,initiation phase, extension phase, and mature phase. There are four dimensions in both external and internal factors, three dimensions in initiation and expansion phase and five dimension in mature phase. The more specific part of journey of implementation covered the before-improvement period, interim and after-improvement period. There are four, three and two dimensions in those three periods,respectively. We also propose thirteen research hypotheses from empirical data testing to show interrelationship among 9 different dimensions. Regarding the quality improvement sustainability model, we propose three phase of sustainability initiation, sustainability actions, and sustainability impacts. There are two, four and three dimensions in each part, respectively. We also propose thirteen research hypotheses from empirical data testing to show interrelationship among 9 different dimensions. We provide specific recommendations to hospital administrators, department leaders and policy makers in central government. On the one side, hospital administrators with willingness to implement might do quality management continuously and obtain sustainability effects. On the other, getting support,financially or non financially,will provide good momentum for hospital quality improvement.
否,無直接識別資料
除檢查有無可識別個人身份資料外,另檢查個案編號是否重複、變項及選項數值說明是否與問卷一致或未被定義,發現前述狀況時,將於確認後協助修改。
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