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急診醫師疲勞相關因素探討及其對離職意願之影響 台灣大學 醫療機構管理研究所 蔡依倫 98 年 7月
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急診醫師疲勞因素及對離職之影響
1.
急診醫師疲勞相關因素探討及其對離職意願之影響 台灣大學
醫療機構管理研究所 蔡依倫98年7月
2.
本研究的對象為在急診部門工作的急診專科醫師,包括已通過急診專科醫師考試但尚未升任主治醫師的研究醫師(fellow) 研究方法為橫斷性問卷調查法,共發出問卷840份,回收有效問卷528份
3.
性別
4.
年齡
5.
工作年資
6.
上班時數
7.
每月班數
8.
夜班比例
9.
計薪方式
10.
醫院等級
11.
醫院屬性
12.
醫院位置
13.
本研究五大構面 相互關係示意圖 +
+ + – + + + – – –
14.
影響醫師工作疲勞因素之重要性
15.
影響醫師服務疲勞因素之重要性
16.
影響醫師離職意願因素之重要性
17.
研究結果討論
18.
急診醫師的「工作疲勞」指數平均為57.9,約為2004 年全國受僱者調查結果的兩倍 「服務疲勞」指數平均為48.5,也比2007
年台北市調查結果更高
19.
五十歲以上急診醫師的「要求總分」、「工作疲勞」、「服務疲勞」最低 急診醫師的工作年 資與「工作疲勞」、
「服務疲勞」、 「每月班數」皆呈 負相關,「每月班 數」與「工作要求」 呈正相關
20.
單身無子女的醫師在「工作疲勞」和「服務疲勞」分數均高於已婚有子女者 單身有子女者的「離職意願」最高
21.
夜班比例為60-80%的急診醫師「工作要求」和「服務疲勞」分數較高,夜班比例小於20%者的「工作資源」最高
22.
計薪方式為「無底薪純績效」的急診醫師「工作疲勞」和「離職意願」較高
23.
醫學中心急診醫師的「要求總分」最高,地區醫院的「工作疲勞」最低 公立醫院醫師的「工作疲勞」和「離職意願」比私立醫院醫師高 東部急診醫師的「要求總分」和「離職意願」最低,南部醫師的「服務疲勞」的分數比中部和東部高
24.
預測「工作疲勞」的多元迴歸模式中,「醫療糾紛」具有最佳的解釋力,其次為「工作─家庭衝突」、「臨床教學」、「工作參與」、「輪班工作」、 「工作保障」、「學習成長」、 「年齡」
25.
預測「服務疲勞」的多元迴歸模式中,「臨床教學」具有最佳的解釋力,其次為「醫療糾紛」、「回饋」、「年齡」、「學習成長」、「家庭支持」、「工作保障」 預測「離職意願」的多元迴歸模式中,「工作疲勞」具有最佳的解釋力,其次為「服務疲勞」、「工作環境」、「工作氣氛」
26.
對醫療機構管理者的建議
27.
提供急診醫師更彈性的計薪方式、上班時間和排班方式,或醫師自行討論後,再與管理者商議實行,以增加急診醫師的工作參與,更人性化的排班方式 也有助於減少醫師的 工作─家庭衝突
28.
對中年的急診醫師,考慮減少臨床工作的比例,依醫師的興趣和專長,調整到教學或研究工作,並比照臨床工作給予適當的薪資報酬 這樣可以增加中年醫師的工作保障,而年輕醫師在資深醫師的指導下,有更多學習成長機會,同時能減輕年輕醫師在臨床教學方面的壓力
29.
急診部門可設置諮詢或支持團體,促進醫師工作或生活上的相互交流(例如醫療糾紛的困擾或生涯規劃),也可以增進年長醫師與年輕醫師在各方面的經驗傳承 藉由營造良好的工作環境和氣氛,凝聚急診部門的向心力,同時降低急診醫師的離職意願
30.
增加急診與其他科交流互動(如學術研討會或工作人員輪替) 積極發展急診特有次專科(如毒物學、野外醫學、創傷醫學) 以提昇各科對急診醫師的尊重互信,讓急診醫師對自己的工作更有回饋感和成就感
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