Establishing the Implementation Model of an Evidence-based Medicine System: A Symbolic Interactionism Perspective

• Main Authors: Wen-Hung Chiu, 邱文宏
• Other Authors: Bor-Wen Cheng
• Format: Others
• Language: en_US
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/46893824904566293530

博士 === 雲林科技大學 === 管理研究所博士班 === 96 === Evidence-based medicine (EBM) highlights the integration of the best research evidence, clinical expertise and patient values into the practice of patient care. In order to improve medical quality and promote competitive advantage, the issue of implementing of EBM is receiving substantial attention. Since the scope and content of EBM is so complicated, the application of information technology and cross-functional team work had better be considered to achieve the system’s fullest potential. However, there were few studies concerning an integrated methodology to implement EBM in hospitals. In this dissertation, a two-phase EBM implementation framework is developed. In Phase 1, a methodology for implementing an EBM system based on the technological diffusion approach is proposed and the empirical experiences in assisting a district teaching hospital in central Taiwan to implement an EBM system are shared. The proposed implementation methodology consists of six stages: initiation, adoption, adaptation, acceptance, routinization and infusion. The considerations in Phase 1 are focused on organization-level actions. However, if we fail to understand what users think, the EBM system performance will be undermined. Thus, user-level interactions are centered on Phase 2. In Phase 2, the deeper meanings of the physicians’ mindset towards using the EBM system from the perspective of symbolic interaction are interpreted. The participant observation and in-depth interview methods are used to gather the physicians’ meaningful experiences with EBM realization. The secondary data of the hospitals is an additional source. Then the collected data is analyzed using the techniques of grounded theory. The multiple symbols associated with EBM realization are induced and categorized as are medical assistant, learning encourager, communication platform, job enricher, negativism and variation. Through carefully associating the symbolisms with practically medical activities and intermediary activities, there are six propositions induced from the analysis and shown as follows. Proposition 1: EBM realization has not only functional but also emotional impact on physicians towards their practically medical activities or intermediary activities. Proposition 2: EBM realization results in not only direct but also indirect impact on physicians towards their practically medical activities. Proposition 3: Through passing intermediary activities, the emotional impact resulted from EBM realization is just able to be forwarded to influence practically medical activities. Proposition 4: EBM realization brings both positive and negative consequences for physicians and hence both positively and negatively influence the outcome of their activities. Proposition 5: EBM realization influences both organization-level and individual-level activities. Proposition 6: There exist interference factors violating the relationship between EBM realization and intermediary activities, or practically medical activities.