探討醫院對於發生內部災難時可能選擇合作對象之影響因素---以台北市醫院為例

Abstract

本研究之研究目的為：1）瞭解北市醫院之平時合作關係網絡，並輔以矩陣與圖形呈現其組成結構；2）探討影響醫院在發生內部災難時選擇合作對象之因素。 本研究以台北市通過等級評鑑之47家醫院為資料收集對象，以郵寄問卷與電訪訪談兩種方式進行。回收45家醫院問卷，回收率95.74％。 本研究之分析單位為醫院遭遇情境災難事件所選擇之合作對象，從三個側面評估合作傾向1）跨行政區域；2）跨醫院層級；3）合作經驗。從三個面向評估影響合作傾向的原因：1）「內部環境因素」，以評鑑等級、權屬別、病床數、災難經歷和防災訓練頻率為測量指標；2）「情境決策因素」，以醫院求援之考量題目問卷進行因素分析得三因子，資源豐富取向、關係信任取向和地理距離取向為測量指標；3）「外部網絡因素」，以核心性程度為測量指標。 研究結果顯示，在醫院發生內部災難時之合作傾向部分，多數的醫院當需求援時其對象醫院以所在相鄰地區、不同層級醫院、且半數以上在近一年來曾有過有合作經驗為主。 針對研究假說考驗的結果發現，內部環境因素、情境決策因素、外部網絡因素皆會影響醫院發生內部災難時之合作傾向。

This study has two purposes: (1) use matrix and graph to demonstrate the peacetime cooperative relationship network of Taipei hospitals; (2) find the key factors which influence hospitals’ decision to choose the cooperative one when facing internal emergency. The study subjects are 47 hospitals accredited as medical centers, regional hospitals, district hospitals, and psychiatric hospitals located in Taipei. The administrators of those hospitals are interviewed by mailed, structured questionnaire which was developed by the researcher. A telephone interview was also conducted to remind them to send back the questionnaires. In the end, there were 45 hospitals sending back and the response rate was 95.74%. This study analyzes the hospital’s cooperative tendency from three perspectives: 1) across administrative area; 2) across hospital accreditation; 3) hospitals’ cooperative experience. The study also found out the influential factors which affect the cooperative tendency from three perspectives: 1) internal environment factor—using accreditation level, ownership, beds of hospitals, disaster experiences and frequency of emergency simulation training as measure indicators; 2) situation decision factor—using resource oriented, trust oriented, and distance oriented as measure indicators where were from the questionnaires; 3) external network factor—using “degree centrality” as the indicator. The result showed that when facing internal emergency and decide which hospital to cooperate with, most hospitals would take its distance, accreditation and whether they have cooperative experiences before into consideration. The study concluded that internal environment factors, situation decision factors and external network factors influence hospitals’ cooperative tendency when facing internal emergency.