醫療品質教育訓練對於醫療組織評鑑透明化的管理應用

Abstract

醫療組織評鑑在維持醫療品質、促進改善並客觀呈現醫療成果方面佔有重要角色。但評鑑工作繁雜，其過程與結果公開程度有限，以及缺乏對利害關係人的溝通，致使臨床醫療人員的反彈。不少專家認為醫療品質透明化能促進臨床人員與機構從事品質改善，因此本研究探討醫療組織內部利害關係人對於透明化的看法及影響因素，以提出提升醫療組織評鑑透明度的管理應用。 雖然目前共識已為醫療品質設置相對明確的定義，醫療品質仍屬於質的概念，須經由各種相關參數的量測，間接評估該項醫療品質，因此促使各種醫療品質之指標系統的發展。在醫療組織評鑑中，指標被廣泛用於說明或佐證醫療品質成效，並作為醫療成果的客觀比較，然而，現有的醫療品質指標系統各因不同因素而有透明度不足的問題。 透明化一直是專家們用以呼籲組織提升聲譽、修整與利害關係人間信賴的利器。多數研究同樣指出醫療品質透明化會促使專業機構與人員的行為改變，促進醫療品質改善活動。然而，資訊提供者必須依據不同情境、目的與接受者背景，提供符合所需的資訊，才能有效提升透明度；單純提供大量資訊反而稀釋透明度。 本研究利用問卷調查中部某醫院員工對於該院透明化的感知及其影響，研究設計以醫療品質教育活動參與程度為自變數；所感受的組織透明化現況為中介變數；以醫療品質指標的運用及影響為依變數。經分析後發現:內部透明化明顯有助於強化內部關係人對組織的信賴感，並正向影響其對品質改善與決策運用的態度；相較於個人特性，制度因素對於透明化感知的影響更關鍵；教育訓練能透過內部透明化進一步促進醫療品質指標的實務運用。 根據研究結果，本文建議建議評鑑教育課程應幫助內部利害關係人從制度層面理解評鑑的重要性與合理性，進而提升其透明化感知與實務參與動機；主管機關應研訂具體的透明化推進原則，如標竿揭露規範、資料公開倫理準則等，並建立跨機構協作平台，促進互學與經驗分享，並結合各組織、學會參與制度評估與優良實務推薦，以提升整體制度的公信力與推動效率。

Accreditation of healthcare organizations plays a vital role in maintaining healthcare quality, promoting quality improvement, and objectively presenting healthcare outcomes. However, the accreditation process is complex, with limited transparency in both the procedure and outcomes, and a lack of communication with stakeholders, which has led to resistance from clinical staff. Many experts believe that transparency in healthcare quality can motivate clinicians and institutions to engage in quality improvement. Therefore, this study explores the perceptions and influencing factors of internal stakeholders regarding transparency, in order to propose management applications that enhance the transparency of healthcare organization accreditation. Although there is a growing consensus on the relatively clear definition of healthcare quality, it remains a qualitative concept that must be indirectly assessed through the measurement of various related parameters. This has driven the development of multiple healthcare quality indicator systems. In healthcare organization accreditation, indicators are widely used to demonstrate or support healthcare quality performance and to enable objective comparisons of outcomes. However, existing healthcare quality indicator systems face transparency issues due to various influencing factors. Transparency has long been a key strategy advocated by experts to enhance organizational reputation and rebuild trust with stakeholders. Numerous studies have also indicated that transparency in healthcare quality can lead to behavioral changes among professionals and institutions, thereby promoting quality improvement activities. However, information providers must tailor the content to specific contexts, purposes, and the backgrounds of recipients in order to truly enhance transparency. Merely providing large amounts of data may dilute transparency instead of improving it. This study employed a questionnaire survey to investigate the perceptions and impacts of transparency among employees of a hospital in central Taiwan. The research design used participation in healthcare quality education activities as the independent variable; perceived organizational transparency as the mediating variable; and the use and impact of healthcare quality indicators as the dependent variable. The analysis revealed that internal transparency significantly strengthens stakeholders’ trust in the organization and positively influences their attitudes toward quality improvement and decision-making. Compared to individual characteristics, institutional factors have a greater influence on perceptions of transparency. Additionally, educational training can further enhance the practical application of quality indicators through improved internal transparency. Based on the study’s findings, the study suggests that accreditation-related educational programs should help internal stakeholders understand the importance and rationale of accreditation from a systemic perspective, thereby increasing their perception of transparency and motivation for practical engagement. Regulatory authorities should develop concrete principles to promote transparency, such as benchmarking disclosure standards and ethical guidelines for data openness. Furthermore, a cross-institutional collaboration platform should be established to facilitate mutual learning and experience sharing. Involving various organizations and professional societies in system evaluations and best practice recommendations can also enhance the credibility and efficiency of the overall accreditation system.