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探索医院居家医疗团队的内部冲突与协作:一种扎根理论方法。

Exploring Internal Conflicts and Collaboration of a Hospital Home Healthcare Team: A Grounded Theory Approach.

作者信息

Tai Pei-Chun, Chang Shofang

机构信息

Department of Quality Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.

Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy & Science, Tainan 71710, Taiwan.

出版信息

Healthcare (Basel). 2023 Sep 7;11(18):2478. doi: 10.3390/healthcare11182478.

Abstract

An aging society is on the rise, leading to a variety of caregiving issues. The Taiwanese government has been implementing a home healthcare integration plan since 2015, aimed at integrating and forming interdisciplinary care teams with medical institutions. This study explores the internal conflict factors among hospital home healthcare team members at a district teaching hospital in Taichung, Taiwan, and it seeks a better collaboration model between them. Semi-structured in-depth interviews were conducted with seven hospital home healthcare team members. Data analysis was based on grounded theory, with research quality relying on the triangulation and consistency analysis methods. The results show that "work overload", "resource overuse", "inconsistent assessment", "limited resources", "communication cost", and "lack of incentives" are the major conflicts among the team. This study proposed the following collaboration model, including "identifying the internal stakeholders of a home healthcare team" and "the key stakeholders as referral coordinators", "patient-centered resource allocation", and "teamwork orientation". The study recommends that within a teamwork-oriented home healthcare team, its members should proactively demonstrate their role responsibilities and actively provide support to one another. Only through patient-centered resource allocation and mutual respect can the goal of seamless home healthcare be achieved. The content of the research and samples were approved by the hospital ethics committee (REC108-18).

摘要

老龄化社会正在兴起,引发了各种护理问题。台湾政府自2015年起实施居家医疗整合计划,旨在与医疗机构整合并组建跨学科护理团队。本研究探讨了台湾台中区一家教学医院的医院居家医疗团队成员之间的内部冲突因素,并寻求他们之间更好的协作模式。对七名医院居家医疗团队成员进行了半结构化深度访谈。数据分析基于扎根理论,研究质量依赖于三角验证和一致性分析方法。结果表明,“工作负担过重”“资源过度使用”“评估不一致”“资源有限”“沟通成本”和“缺乏激励措施”是团队中的主要冲突。本研究提出了以下协作模式,包括“确定居家医疗团队的内部利益相关者”以及“关键利益相关者作为转诊协调员”、“以患者为中心的资源分配”和“团队合作导向”。研究建议,在以团队合作导向的居家医疗团队中,其成员应积极履行各自的角色职责,并积极相互支持。只有通过以患者为中心的资源分配和相互尊重,才能实现无缝居家医疗的目标。研究内容和样本已获得医院伦理委员会批准(REC108 - 18)。

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