某醫學中心員工病人安全文化與相關因素之初步探討

Abstract

病人安全文化為組織文化重要的一環，它影響組織內成員的行為、思考模式 及處理工作的態度，是促進病人安全的相關因素。本研究旨在探討北部某醫學中心之病人安全文化及其影響因素。採橫斷式調查法（Cross-Sectional Survey） ，研究對象為某醫學中心之員工，於107年10月1日至107年10月31日期間收集資料，共發出7,044份問卷，有效問卷份數為3,579份 (回收率為50.8%)。研究工具為研究對象之醫院品管及相關部門參考文獻所擬定之結構式問卷，包括病人安全文化 (六個構面，李克特五分量表)、員工滿意度(六個構面，李克特五分量表)及員工自覺壓力量表。本研究之主要結果如下： (1) 病人安全文化各構面中「對壓力認知」構面正向程度最高 (76.8%)，「工作狀況」構面次之 (57.4%)；「單位安全風氣」構面 (35.3%) 及「團隊合作」構面 (42.5%) 正向程度最差。 (2) 員工自覺壓力程度總分平均4.97分，66%員工自覺壓力程度屬於一般程度，表示多數員工身心適應情況良好。 (3) 員工整體滿意度(0-100分)平均為79.11分，「組織認同」構面得分最高，「薪資福利及升遷制度」構面最低。 (4) 員工基本屬性與病人安全文化統計上達到顯著差異的包括性別、年齡、年資、教育程度、是否擔任主管職、職務類別等。病人安全文化正向程度男性較女性高， 主管教非主管高。 (5)員工自覺壓力程度與病人安全文化呈現顯著負相關；員工滿意度與病人安全文化呈現顯著正相關。 (6) 病人安全文化重要的預測因子包括員工基本屬性、自覺壓力程度與員工滿意度，可解釋整體變異量達80.4%。員工滿意度對病人安全文化有最強的解釋力，員工滿意度的解釋力可達69.2-79.7%。尤其員工滿意度「組織認同」構面是病人安全文化最重要之預測因子，解釋力可達60.8-72.8%。 本研究發現員工滿意度是預測病人安全文化有最重要的因素，尤其是組織認同構面。結果可提供醫院主管作為日後提升病人安全文化之參考。

Background: Patient safety culture (PSC) is one of the important parts of organization culture and also the main related factor in improving patient safety because it affects employees’ behaviors, though and attitudes in working procedures. Purpose: The purpose of this study was to investigate the related factors of PSC in a medical center. Materials & Methods: From Oct 1st to Oct 31th in 2018, we conducted a cross-sectional hospital-wide survey in a medical center by means of structured questionnaires including 6 domains of PSC, employees’ self-assessed stress level and 4 domains of job satisfaction, using a 5-point Likert scale for each domain. Of 7044 questionnaires sent, totally 3579 were returned (response rate of 50.8%). Result: (1)The levels of the 6 domains of PSC were “Stress Recognition” (76.8%), “Working conditions” (57.4%), “Job satisfaction” (54.3%), “Perception of management”, “Teamwork Climate” (42.5%) and “ Safety Climate” (35.3%) in descending order. (2)The mean score of all items about employees’ self-assessed stress level was 4.97. Totally 66% employees’ stress level revealed good coping strategies in the majority of employees. (3)The final score (0-100) of job satisfaction was 79.11. Of 4 domains of job satisfaction, the mean score of “Organizational Identity” was the highest, whereas “salary and promotion” was the lowest. (4)The PSC related demographic data of employees showed that males had higher positive PSC attitudes than females, and directors higher than subordinate staffs. (5)The score of PSC got significantly negative correlation with that of employees self-assessed stress level (p<0.05). The score of PSC got significantly positive correlation with job satisfaction (p<0.05). (6)The important predictive factors in PSC were job satisfaction, employees’ stress level and demographic data of employees in descending order because stepwise regression analysis showed that these variables could estimate about 80.4% of the variance (PSC).The mean score of “Job satisfaction” could estimate the variance of 6 domains of PSC in around 69.2-79.7%, and its "organizational Identity” domain could predict the variance of PSC to 60.8-72.8% Conclusions: (1)“Job satisfaction” is the most important predictive factor for PSC, especially significant in “Organizational Identity” domain. (2)The outcome of this study may provide managers of health care organization information for improving PSC