近年來，台灣醫療院所的規模及數量不斷的普及擴增，醫療院所間相互的競爭，帶來了不少的壓力，各醫療院所透過各種品管計畫，希望能加強本身的醫療水準、降低醫療成本、提昇醫療照護品質，進而達到醫院的經營效率。
本研究目的是探討南部某醫學中心醫護人員對推行「台灣醫療品質指標計畫」的認知、重視程度及其對醫療品質的影響。
研究方法為針對該南部某醫學中心指標收案之六個臨床部科：急診部、外科、加護醫學科、婦產部、護理部、精神部的醫護人員作全面問卷調查，於96年4月1日至7日發出428份問卷，於四月三十日回收，有效回收率為86.9％。本研究採用SPSS統計軟體來進行分析，以描述性統計分析樣本的分佈情形，以卡方檢定、變異數分析等方法，探討醫護人員不同的特質變項對醫院醫療品質的影響。
本研究主要結論如下：
一、醫護人員對「台灣醫療品質指標計畫TQIP」不瞭解者仍占52.4%，以護士、住院醫師、總醫師占的比例居多。瞭解者占47.6%以護理師、主治醫師較多。不同職稱的醫護人員對「台灣醫療品質指標計畫TQIP」的認知瞭解程度是有顯著差異。
二、醫護人員對「台灣醫療品質指標計畫TQIP」的重視程度分數為4.08，介於稍微重視的階段，不同職稱的醫護人員對「台灣醫療品質指標計畫TQIP」的重視程度無顯著差異。
三、被受訪者認為「台灣醫療品質指標計畫TQIP」內之指標項目可評估單位的醫療品質占64.1%，所以單位所選擇的指標是適切、且適當的。
四、單位對「台灣醫療品質指標計畫TQIP」之結果，約有69.4%的醫護人員認為具備及進行品質的改善對策者，對醫院醫療品質的服務品質上會有正面的影響。
五、整體而言，醫院參加「台灣醫療品質指標計畫TQIP」對醫療品質是有提升的效益；對醫院有正面的影響依序為：對品質觀念的提升、可瞭解院內品質狀況、協助發現單位品質之問題、可提升單位醫療服務品質、解決問題的能力進步、可促進作業流程之改善、資料收集之手法進步、可促進團隊合作、可加速院內資訊電腦化、單位間的協調溝通能力之改善。
六、該院對於「醫療品質指標之監測作業」製訂標準化流程，公告於該院之院內網路供執行單位查詢，且歷年來之監測指標數據資料，亦將納入該院管理資訊系統(Management Information System, MIS)供管理部門主管作及時之查詢與參考。
依本研究結果分析並提出五項建議：
一、醫院屬於教學醫院層級對於醫護人員的養成教育應再加強，並將醫療品質相關的課題納入並持續推動，因為其認知瞭解的程度對醫療品質所持的態度與行為是有所影響的。
二、指標相關的訊息應運用在電腦化資訊系統，因醫護人員的工作量繁重，在有限的資源上如何運用電腦化作業使收案過程簡易，是資訊部門可納入考量的年度計畫。
三、各臨床單位如何運用有限的人力下，設置指標專責人員，並由單位主管階層者主動帶領，讓參與醫療品質活動的理念能貫徹醫院全體員工。
四、對於不重視的原因，其中一項是「推行指標對醫師無實質回饋」，可建議單位給予指標專責人員行政獎勵外，亦可納入該院推動績效獎金分配的考量項目之一。
五、另外是如何提高醫護人員對醫療品質認知與共識，此部份牽涉的問題十分複雜，除了需與醫療專業人員不斷溝通，整合人力及持續推動教育訓練，並針對問題作改善方案外，其學習參考國內、外的成功經驗也是個有效率的方法。

Recently, the health care services in Taiwan have rocket booming both in scale and in quantity. The competition among these health care service organizations are forging these facilities into cost effective systems through, promoting various quality control programs, elevating clinic & treatment capabilities, and improving quality of health care services.
This study is to investigate how the medical staffs’ recognitions are, and at what priority to initiate proper actions, while promoting Taiwan Quality Indicator Project in a medical center in southern Taiwan and its relative influences in clinic quality. The method is to conduct a survey of four hundred and twenty eight (428) clinic personnel from six (6) departments – Emergency Dept., Surgery Dept., Intensive Care Unit, Obstetric & Gynecology Dept., Nursing Dept. and, Psychlogical Dept. - of the sampled medical center. A total of 428 copies of inquires were released to the sampled clinic personnel on April 1st, 2007; and those were collected back with a returning rate of 86.9%, on April 30th, 2007. Software package SPSS is applied to analyze the distribution of this survey. And methods of chi-square test, ANOVA are used to investigate the influence to health care quality caused by various different personnel characteristics.
Conclusions are as follows:
1.The results demonstrate that 52.4% clinic personnel do not fully understand about TQIP. And among them, Nurses, Resident Doctors and, Chief Doctors are the most. While the clinic personnel completely understand TQIP are mostly Registered Nurses and, Attending Physicians. Obvious differences of understanding about TQIP exist, apparently, per different job titles.
2.The importance of TQIP given by the sampled persons is 4.08, categorized as ‘important’. Without discrimination, same importance is indicated by all clinic personnel of different job titles.
3.The index/indicators of TQIP are accepted as capable to evaluate health care quality of their unit/department by 64.1% of the sampled personnel. Thus, the index/indicator chosen are adequate and proper.
4.69.4% of sampled clinic personnel agree that quality improvement policies are prepared and are realized in their unit/department. The results of TQIP in those units/departments illustrate positive quality improvements of health care service.
5.On the whole, after participating TQIP, the sampled hospital finds quality improvement in health care. The positive influences in health care are, sequentially from more to less, elevating concept of quality control, understanding quality status of the hospital, assessing quality problem of clinic service unit/department, improving health care service quality, improving capabilities in problem solving, improving operation processes & procedures, improving in methods of data collection, better team work, accelerating information computerization in the hospital, better communication and coordination among unit/department.
6.The sampled hospital standardized the “Monitoring & Testing Procedures of Health Care Quality Index/Indicators”. The details of operation procedures are posted on the intra-net for unit/department’s inquiring and following. Annual data of index/indicators collected are to be introduced in the hopistal’s MIS System for top managements’ inquiry and references.
Five (5) recommendations after analyses:
1.The sampled hospital is graded as medical center hospital holding the responsibilities in education. The education in quality control shall be promoted and continuously initiate improving programs in health care quality, due to in depth knowledge affects the attitude and behavior in health care quality performed.
2.Clinic personnel have heavy work loads. Computerized Index/Indicator related information should be easy to access on the information system. Thus, the programmer/engineer of the information center shall simplify the procedures/ processes as year planning even the resources are limited.
3.Unit/department requires specific person to handling index /indicator. Thus, the department management can lead daily jobs down to the ground, actively involving in quality improvement programs within the unit/department.
4.One of the opinions of ‘not important’ category is that ‘no solid benefit for doctors following up index/indicators. The suggestion to top management is to elevate the morale by rewarding the participants with monetary efficiency bonus instead of just merits.
5.It is very complicated about how to increase knowledge and consensus in health care quality. Besides sufficient communication with clinic personnel, man-power integration, and continuous education and on job training, problem solving and quality improvement programs are necessary. Learning from the successful experience of other health care facilities, within the country or from foreign countries, is also an efficient method.

第一章緒論………………………………………………1
第一節研究背景……………………………………….1
第二節研究動機……………………………………….2
第三節研究問題……………………………………….3
第四節研究目的……………………………………….4
第二章文獻探討…………………………………………5
第一節醫療品質指標的定義………………………….5
第二節醫療品質指標發展的趨勢……………………12
第三節醫療品質指標評估的方法……………………12
第四節台灣醫療品質指標系統………………………14
第五節醫護人員對品質指標的認知…………………20
第三章研究材料與方法………………………………...23
第一節研究步驟及流程………………………………23
第二節研究架構………………………………………25
第三節研究設計………………………………………26
第四節研究工具與研究對象…………………………26
第五節研究變項之名稱………………………………30
第四章研究結果………………………………………...32
第一節描述性統計分析………………………………32
第二節推論性統計分析………………………………45
第五章結果討論………………………………………...48
第六章結論與建議……………………………………...52
第一節研究結論………………………………………52
第二節研究限制與未來方向…………………………53
第三節研究貢獻………………………………………54
第四節建議……………………………………………54
參考交獻………………………………………………...56

中文部份
石曜堂(1992)．建立我國醫院醫療品質保證計畫模式之研究．行政院衛生署八十年委託研究計畫研究報告。
石川馨著、鍾朝嵩譯(1992)．日本式品質管制-全公司品質管制（CWQC）的經粹．先鋒企管發展公司。
行政院衛生署(2004)．二代健保規劃．台北-行政院衛生署。
吳肖琪(1999)．評估醫院醫療品質指標．行政院研究發展考核委員會。
林彥克(1997)．醫師對醫療品質的認知與態度之研究-以某醫學中心為例．未發表的碩士論文．台北：國立台灣大學醫療機構管理研究所。
林威宇(2000)．醫院醫療事物部門實施績效獎金制度前後，對員工的認知、態度及工作滿意度度改善之相關研究．未發表的碩士論文．台北：國立台灣大學醫療機構管理研究所。
林恆慶、楊長興、張文英、張文麗(2002)．美國Medicare確保醫療品質計畫之發展．慈濟護理雜誌，1(2)。
林富滿(2000)．台灣醫療品質指標系統的建立與十家醫療機構可行性測試結．未發表的碩士論文．私立台北醫學大學碩士論文。
林齊宣(2003)．指標計畫的實施與推行．醫療品質指標理論與應用．財團法人醫院評鑑暨醫療品質策進會：105。
M. Porter．競爭策略：產業分析方法（周華旭譯）．天下文化出版社．民國八十六年。
邱文達(2003)．醫院品質實務管理．台灣醫務管理學會叢書．合記圖書出版社。
柯貞伊、黃興進(2005)．探討醫院品質指標資訊系統導入之研究．福爾摩莎醫務管理雜誌，1(2)，151-163。
洪新原、李易璉(2004)．線上學習應用於醫師在職教育之實證研究：以國內醫學中心為例．Electronic Commerce Studies，2(4)，461-479。
徐孟竹(2004)．醫院員工對於委託經營行政介入前後之認知、態度與行為意向研究．未發表的碩士論文．台北：國防醫學院公期衛生學研究所。
財團人醫院評鑑暨醫療品質策進會編著（2003）．醫療品質指標理論與應用．台北：合記。
黃品惟(2004)．某醫學中心護理人員工作滿意度與「磁力醫院」認知及態度相關性探討．未發表的碩士論文．台北：國防醫學院公共衛生學研究所。
陶阿倫、薛亞聖 (2004)．急救加護專科醫師對「非計劃性重返ICU指標」認知、態度與行為之調查研究．台灣醫療品質指標計畫。
郭乃文(2003)．指標計畫的實施與推行．醫療品質指標理論與應用．財團法人醫院評鑑暨醫療品質策進會編著(1-11)．台北：合記。
郭英調(2005)．醫療品質概論．台灣醫學，9(3)，392-394。
陳秀玲、鍾國彪、洪幼珊(1999)．臨床品質指標簡介，醫院，30（6），37-45。
陳佩妮、鄭守夏、鍾國彪、林王美園(1997)．台灣地區醫療品質指標適用性之探討．中華衛誌，16（2），133-141。
陳楚杰(1992)．醫院組織與管理．宏翰文化事業公司。
莊逸洲、黃崇哲(2001)．財務、研究、品質暨設施管理．台北：華杏。
董鈺琪、楊銘欽、林奇霆、郭耕溢、朱子斌、邱文達(2006)．參加台灣醫療照護品質指標系列(THIS)之醫院實施現況及意見調查．醫護科技學刊，8(4)，307-317。
楊哲銘、王鳳君、洪啟宗、邱文達(2000)．區域醫院推動馬里蘭醫療品質指標計劃之實證經驗．醫院雜誌，33(6)，17-25。
楊國樞等編(1989)．社會及行為科學研究法．台北：東華書局社。
詹遠華(1987)．醫院管理實務．台北：合記圖書出版社。
廖熏香、楊漢湶（2000）．淺談台灣醫療品質指標計畫．醫院雜誌，33（4），7-11。
廖熏香(2003)．台灣醫療品質指標計畫介紹．醫療品質指標理論與應用．財團法人醫院評鑑暨醫療品質策進會編著(31-51)．台北：合記。
廖鳳池（1990）．認知治療理論與技術．台北：合記。
鍾國彪(2003)．指標計畫的實施與推行．醫療品質指標理論與應用．財團法人醫院評鑑暨醫療品質策進會編著(13-30)．台北：合記。
謝慧敏(2001)．醫療品質與醫師參與相關性之研究．未發表的碩士論文．嘉義：國立中正大學企業管理學研究所碩士。
戴蘭祺(2003)．參與台灣醫療照護品質指標系列(THIS)醫院對其門診指標認知一致性評估．未發表的碩士論文．台北：國防醫學院公期衛生學研究所碩士。
韓揆(1994)．醫療品質管理及門診服務品質定性指標．中華衛誌，13(1)，35-53。
薛亞聖(2005)．台灣醫療品質指標計劃(TQIP)實施5年之成效評估-以非計劃性重返指標為例．台灣醫療品質指標計畫。
藍毓莉(1999)．醫院主管對 ISO品保制度的認知及推行態度之探討．未發表的碩士論文．台北：國立臺灣大學醫療機構管理研究所。
藍忠孚(2005)．醫療品質管理學．台北：華杏。
蘇喜(1996)．醫院評鑑評量表指標及配分之適切性研究．中華衛誌，15(3)，228-248。

英文部份
Bandura,A.(1977). Social learning theory. Englewood Cliffs.NJ: Pret Hall.
Berwick, D.M.(1991). “Controlling Variation in Health Care: A Consultation from Walter Shewhart. “Medical Care, 29(12),1212-1225
Berwick, D.M.(1989).”Continuous Improvement As an ideal in Health Care.” New England Journal of Medicare ,320(1),53-56
Berwick, DM.(1998). “Physicians as Leaders in improvement Health Care: A New Series in Annals of Internal Medicine.”Annals of Internal Medicine,128(4),289-292
Davenport, T.H. &Prusak, L. (1998).“Working knowledge: How organizations manage what they know”.Boston: Harvard Business School Press.
Davenport, T.H. &Delong,W.&Beers,C.(1998). “Successful Knowledge Management Projects”.Sloan Management Review, Winter, 43-75
Decker, Kendall D. (1991).Strategy for data collection in bilingual communities. Horsleys Green; 23(31),243-48
Dingman, S.K., Williams, M., Fosbinder, D., & Warnick, M. (1999).Implementing a caring model to improve patient satisfaction .J Nurs Adm,29(30),7
Donabedian,A(1978).“The Quality of Medical Care.” Science, 200, 856-864
Donabedian,A(1980). “Explorations in Quality Assessment and Monitoring” Health Administration Press, 1(1),3
Donabedian,A(1988)”The Quality of Care: How can it be assessed？”.JAMA, 260(12), 1743-1748
Donabedian,A(1998).”The Definition of Quality and Approaches to its Assessment.”Explorations in Quality Assessment and Monitoring Vo1Ι Health Administration Press Ann Arbor.Michigan.
Gavin, Mo (2000).”Judging goodness must come before judging quality-but what is the good of health care?”. international society for quality in health care,12 (5),389-394
James,B.C.(1991).”How Do You Involve Physicians in TQM?”. Journal of Quality improvement”. Frontiers of Health Services Management ,10(1),3-37
James,B.C.(1993).”Implementing practice guidelines through clinical quality improvement”. Frontiers of Health Services Management ,10(1),3-37
Joint Commission of American Healthcare Organization.(1998).IMSystem Performance Measures,Online Available.
From http://www.jcaho.org/perfmeas/ims/imsystem_pmd.htm
John, J.(1992).The impact of past experience. Journal of Health Care Marketing, 12,56-64
Leist J.C.&Konen, J.C.（1996）.”Four Factors of Clinical Decision Making A Teaching Model. “Academic medicine ,71(6),644-646
Mayer-Oaks SA, & Barnes, C.(1997). Developing indicatiors for the Medicare Quality Indicator System (MQIS): Challenges and Lessons learned. The Joint Commission Journal on Quality Improvement, 23(7),381-390
Nonaka, I. & Takeuchi, H. (1995).“The knowledge-creating company”.New York： Oxford University Press.
Nonroe, K. B.(1991). Pricing Marketing Profitable Decision. New York, McGraw-Hill.
Weingart ,S.N. (2001).international Journal for Quality in Health Care, 13(5),357-365
Shortell, S.M.＆Bennett, C.L.＆Byck, G.R.（1996）.Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What it will take to accelerate progress？”.The Milbank Quarterly, 76 (4),593-624
Valente ,C. ＆Taylor, A.＆ Stanhope, N. (1998). Framework for analyzing risk and safety in clinical medicine. British Medical Journal; 316,1154-1157
Weiner,B. ＆Shortell, S.＆ Alexander, J. （1997）.”Promoting Clinical Involvement in Hospital Quality Improvement Efforts: The Effects of Top Management.Board and Physician Leadership.”. Health Services Research ,32 (4),491-510