醫學中心急診部不同階段作業顧客服務不滿意項目探討及分析

Abstract

隨著全台急診病患就診人數及平均每家醫院每日急診服務量增加之趨勢，使急診室呈現人滿為患的狀況，甚至因病患或家屬的不滿而產生急診暴力的問題，顯示當前之急診室滿意度有再深入探究的空間及必要。 本研究在臺大醫院急診部現場針對病患家屬進行一對一之人員訪談，並在不同階段作業流程下進行訪談，探究在急診不同階段作業流程下，使病患家屬不滿意之項目及構成其不滿意之因素。 大多數病患家屬對臺大醫院急診部之報到階段（進入急診部、檢傷、掛號）感到滿意。此階段的服務速度快，且透過志工人員的協助，降低病患家屬剛到急診室時的不安。 對於候診時間感到不滿的主要原因包括，病患家屬因擔心病患身體狀況使候診時間顯得格外地長、未曾來過臺大急診部之病患家屬對於候診時間缺乏較符合現況的合理預期、部分病患家屬不了解檢傷分類等級與看診次序之間的關係。在診斷過程中，草率的看診、不夠詳盡的解說使病患家屬感到極為不滿。 對服務提供階段（檢查、治療、留觀）的等候過程感到不滿的原因包括，等候過程具備過程前等候（Pre-process wait）、不確定的等候（Uncertain waits）、未被解釋的等候（Unexplained waits）、個人等候（Solo waits）的特性，使等候時間感覺比實際要長，醫護人員無法在告知病患家屬的等候時間內準時提供服務，且缺乏創造In-process waits等候環境的實體設備，使病患家屬無從得知系統超載、人員忙碌狀況，故傾向將長時間等候解讀為院方疏忽而非院方不可控制的結果，加深病患家屬的不滿。在服務提供階段，當醫生使病患家屬感受到服務之確實性（Assurance） 及可靠性（Reliability）不足時，將使病患家屬感到相當不滿；對於護理人員所提供的服務，病患家屬在確實性（Assurance） 及可靠性（Reliability）上的要求沒有像對醫生所提供的服務要求那麼高，但會重視護理人員服務中的反應性（Responsiveness）與同理心（Empathy）。在服務提供階段病患家屬常須陪伴病患在急診室暫留較長的時間，因此環境設備的優劣對病患家屬的感受有較明顯的影響。

With the trend of increasing number of patients at emergency room and average daily number of patients at emergency room in every hospital in Taiwan, we saw over-crowdedness and even emergency room violence arising from dissatisfied patients or families, which shows the necessity and room for improvement of current emergency room satisfaction. The study conducted one-on-one personal interviews toward patients’ family members at emergency room in National Taiwan University Hospital (NTUH), and the interview took place at different stages of emergency room operation processes. The study aimed to investigate the dissatisfaction items and factors of patients’ family members at different stages of processes. Most of the patients' family members are satisfied with the stage of check-in (enter into the emergency room, triage and registration). The study showed that the service speed was fast under this stage, and the volunteers’ assistance reduced the anxiety of patients’ family member when they just arrived at the emergency room. The main reasons of dissatisfaction with waiting times for physician diagnosis included that anxiety and worries about patients made waits seem longer, those family members who had not been to NTUH lacked reasonable expectation of waiting times which is more in line with the current situation, and some patients’ family members did not understand the relationship between the triage level and order of physician diagnosis. When being seen by a doctor, hurried diagnosis, poor explanation made patients’ family members dissatisfied. The reasons of dissatisfaction at service delivery stage (examination, treatment, and observation) included that the waiting process had the characteristics of pre-process waits, uncertain waits, unexplained waits and solo waits, which made waiting times seem longer, and staff let patients’ family members wait longer than the time period that staff had promised them. In addition, lack of device to create in-process waits waiting environment so that patients’ family members have no way of knowing the system was overloaded and staff were busy, which caused the tendency for them to interpreted the situation as the carelessness of the hospital rather than something the hospital couldn’t control, therefore, deepened the dissatisfaction of the patients’ family members. Under service delivery stage, patients’ family members were dissatisfied when the physician service didn’t perform enough assurance and reliability, regarding the services provided by nurses, patients’ family members didn’t require high level of assurance and reliability, but valued responsiveness and empathy of the services. In addition, patients’ family members often have to accompany patients in the emergency room for longer time, so the good and bad of environmental equipment had a more significant impact on the feelings of patients’ family members.