護理人員內部控制認知、內控機制接受度與醫院經營風險之關聯性研究

曾慧婉

內部控制 ； 風險管理 ； COSO ； internal control ； risk management

電腦稽核

31期（2015 / 01 / 30）

95 - 107

繁體中文

醫療產業是專業、人力密集且富含風險的產業。醫療照護過程中產生的各項資訊、對資源的需求及配置，不僅關乎病人健康安全，也考驗團隊整合決策能力。本研究希望了解醫院護理人員在照護作業活動中對各項資材、設備管理的認知、執行與醫院經營風險的關係。本研究以深度訪談方式進行，採用COSO（Committee of Sponsoring Organizations of the Commission）企業風險管理－整合架構為基礎，以醫療照護、設施與財產管理、庫房管理三大主題，分析個案醫院護理各項作業與內部控制之關聯。結果發現：護理人員內部控制的認知與內控機制接受度有正向關聯，且執行面與認知間存在不同程度的落差。另外護理人員因角色職責與經驗值的差異，對於各項風險的評估與回應相對影響醫院醫療作業風險及經營財務風險。結論：建議醫院管理者針對各項潛在風險因子建構風險胃納、引進護理資訊系統善用e化作業、同時對人員成本管理的教育及委派行政專職人員執行。

Background: The medical industry has a complex, multi-disciplinary and high-risk characteristics. The Information, resource requirements and arrangement in the process of healthcare not only threatening the health and safety of patients, but also become a challenge for operation team to integrate and decision-making, The purpose of study: In this study, we expect to understand the relationship between nursing staff's' perception to materials and equipment management implementation and business risks of hospital. Methods: The study design was conducted in-depth interviews and based on the Committee of Sponsoring Organizations of the Commission (COSO) proposed the Enterprise Risk Management-Integrated Framework,, used of three main themes included healthcare, facilities and property management, and warehouse management to analyze the relationship between the nursing staff and the operation of internal controls. Results: The results of this study showed nursing staffs' perception of internal control has a significant correlation with acceptance of control mechanism, and there are varying degree of difference between the implementation and perception. In addition, Nursing staffs' positions and work experience affect hospital medical operational risk and financial risk management Conclusions: We suggestions hospitals managers should construct control mechanisms of potential risk factors, to introduction of Nursing Information System to facilitate the electronic operations, strengthen nursing staffs' cost management education and hire staff to perform the affairs.

1. 古步鋼，2011，風險管理實務，中華民國統計資訊網，www.stat.gov.tw/public/Attachment/1699341871.ppt
2. Robert, S.(1999).How risky is your company?.Harvard Business Review,May-June,85-94.
3. Scandizzo, Sergio(2005).Risk Mapping and Key Risk Indicators in Operational Risk Management.Economic Notes
4. Yoder-Wise, P. S.(1999).Leading and managing in nursing.St. Louis, MO:Mosby.
5. 林柄滄(1998)。內部稽核與經營管理。華信金融季刊，1，53-62。
6. 林柄滄(1997)。經營風險之評估與內部控制之檢核。會計研究月刊，143，75-81。
7. 馬秀如譯(1998)。內部控制－整體架構。財團法人中華民國會計研究發展基金會。
8. 高淑清(2008)。質性研究的十八堂課：揚帆再訪之旅。高雄:麗文文化。
9. 陳月枝、鄒慧韞、陳玉枝、張媚、尹裕君、陳玟秀(1999)。護理行政學。台北:文芳。
10. 傳蘭英(2012)。醫療機構內部控制制度實務。社團法人台灣醫務管理學會。

1. 黃惠珠,黃平芳,游鄉柔,陳文鈴,林瑞香,吳佩蓉(2020)。提升整形外科護理人員計價完整率。志為護理-慈濟護理雜誌，19(5)，97-109。