| 摘要: | 人口老化會帶來相當程度的身心障礙盛行及後續的照護需求，如此快速的發展趨勢，加上現今疾病型態轉型、家庭結構的變化等社會變遷現象，將導致國人對長期照護的需求日益殷切；由於入住的住民大多為年邁、有多重疾病、易受傷害的群體，其所接受到的照護品質值得大家關心，又評估護理之家品質對於護理之家管理、照護及有效的長期照護政策是重要的關鍵，因此，重視我國護理之家的照護服務品質是一重要議題。 本研究以品質機能展開法（QFD）透過焦點團體、參考相關文獻及學者建議，設計「護理之家服務品質感受與重要度評價問卷」，內容包括：醫療照護、環境及硬體設備、行政作業、服務態度及其他服務等五個服務品質構面及45項要求品質要素；以署立台中醫院附設護理之家全數住民家屬為研究個案，有效份數共85份，希望藉由住民家屬選擇護理之家所考量的因素與條件，進行評估與分析。 研究結果發現：以病患要求品質缺口而言，正向服務品質（預期服務品質小於滿意服務品質）在45項品質要素中佔29項，負向服務品質（預期服務品質大於滿意服務品質）佔16項，顯示署立台中醫院附設護理之家所提供的許多項目仍需進行改善；而要求品質前五項服務品質依序為「入住費用合理」、「當住民有所需求時，醫師能探視住民」、「餐飲營養並色香味俱全」、「醫師具備專業知識」、「餐飲能按時送達」。住民要求品質相對於護理之家服務品質要素，以重要度佔5%以上者共計八項，為「專業能力與技術」、「醫療服務的效率性」、「人員充足性」、「在職教育訓練」、「成本控制妥善度」、「醫療服務的即時性」、「危機處理能力」、「餐飲衛生情況」；而護理之家服務品質相對於需要優先改善的部門，按業務重要度佔5%以上者為「醫護人員部門」、「行政管理部門」。 本研究以不同於以往的分析手法，真實反應出住民內心需求，可因瞭解住民需求及選擇因素，進一步得知護理之家該先行改善的重心與針對缺失業務部門進行管理，使住民得到最良好的照護品質，也讓護理之家能提供的服務更有效率。; It is suggested that a growing need for long-term health care is a result of the society changes, such as diseases evolutions and changes in family structure as well as the increased probability of the mental and physical frailties and needs of extended care services due to the population aged. Given that the major customers of long-term care services are the elders, serious disability and vulnerable groups, attentions to the care quality have been drawn, which on the other hand, plays a key role for the assessment of long-term care policy and management within the nursing home. It is therefore, understood that the quality of long-term health care becomes an important issue in Taiwan. In consideration of our intention and the research purpose, the self administration questionnaire - Residents’ Perceptions of Service Quality and Importance Evaluation within a Nursing Home - designed based on the focus group, literature review and related experts’ suggestions is applied to our investigation. The questions are about five service quality dimensions provided by a nursing home - medical care, facilities and environment, administrative support, staff attitudes and other services as well as forty-five residents’ demanded quality elements. Eighty-five participants in this study came from the family members of current residents at Nursing Home of Taichung Hospital, and Quality Functions Deployment (QFD) was used to analyze the collected data. First of all, the research found the gaps in expectations and perceptions within the demanded quality elements. The positive gap scores indicating that perceptions exceeded expectations were found within 29 elements while the negative gap scores indicating that perceptions fell short of expectations were within 16 demanded qualities, which underlines that an extra effort on demanded qualities improvement is required. Meanwhile, according to the importance evaluation, five high on the priority list of demanded quality elements are reasonable charge, physician’s response to resident’s needs, foods standard, physician’s professional competence, and meals provided at appointment time. Finally, the importance evaluation of demanded qualities versus nursing home’s service quality dimensions presents that eight elements - physicians/staff professional competence, health care efficiency, manpower, continuing staff education/training, cost management, in-time health care service, crisis handling, foods conditions were valued more than 5% while two departments — medical staff and administrative departments were found being valued over 5% within the importance evaluation of nursing home’s service quality dimensions versus departments needed to be strengthened. This study is intended to address the residents’ needs within a nursing home through an exploratory analysis with an attempt to understand better the need and decision elements utilized by nursing home residents and their families, which serves as a tool to assist the nursing home to build and promote a program based on the findings and suggestions presented in this paper to imp |
