| Summary: | 碩士 === 長榮大學 === 醫務管理學系碩士班 === 98 === Objectives The medical incident reporting system is one of the effective methods to reduce medical error, negligence and the disputes aroused; however, the low reporting rate is the major problem faced by hospitals, which also varies by hospital level. This study adopts the PRECEDE-PROCEED model as the theoretical framework, and examines the differences in behavioral intention towards the medical incident reporting system among nursing staffs at different levels of hospitals.
Methods Based on a cross-sectional design, this study used a random sampling strategy to select licensed clinical nursing staffs from four teaching hospitals across three different levels in Tainan area. A structured questionnaire was developed to collect participants’ demographical information and responses to the predisposing factors (perception of and attitude towards the reporting system), enhancing factors (personal experiences), motivating factors (organizational reporting culture), and behavioral intention. During the time period from April 13th to 28th in 2009, 330 copies of questionnaires were distributed and 318 effective copies were collected (a response rate of 98.1%). The data analyses were performed by descriptive statistics, one-way ANOVA, Pearson product-moment correlation, and hierarchical regression modeling.
Results Nurses at different levels of hospitals presented different behavioral intentions with regards to medical incident reporting; in particular, nurses at district hospitals had lower reporting rates. Variations also existed among perceptions of and attitudes towards the reporting system; for example, personnel at medical centers had more accurate perceptions of incident reporting while personnel at district and regional hospitals usually reported incidents only when injuries occurred. In addition, reporting cultures in organizations were also different as medical centers had a more integrated reporting mechanism than district hospitals. To sum up, predisposing, enhancing, and motivating factors were all positively correlated to reporting behaviors and intentions. In particular, personal experiences under enhancing factors of “educational training,” “previous experiences of reporting,” “failure to reporting,” “previous experiences of drafting incident reports,” “punishments for reporting,” and “attribution of reporting responsibility” all significantly affected individuals’ reporting intentions. Besides, individuals’ perceptions, attitudes and organizational cultures concerning reporting also had impacts on each other. Among all the factors associated with reporting behaviors and intentions, predisposing factors accounted for 35.7% of the explanatory power. The explanatory power was elevated to 41.3% after incorporating enhancing factors, and to 42.3% after incorporating motivating factors.
Conclusion and Suggestion The differences in reporting behaviors and intentions across different levels of hospitals may largely result from organizational reporting culture. While medical centers reveal a higher reporting rate, lower level hospitals depend more on the reporting culture to encourage reporting behaviors and intentions. The results hope to provide for hospital managers as references for designing the medical incident reporting system and for developing relevant education training activities.
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