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題名：建構實證醫學系統之導入模式：符號互動觀點
作者：邱文宏 引用關係
作者(外文)：Wen-Hung Chiu
校院名稱：國立雲林科技大學
系所名稱：管理研究所博士班
指導教授：鄭博文
學位類別：博士
出版日期：2008
主題關鍵詞：知識管理；紮根理論；符號互動；技術擴散；實證醫學（EBM）；grounded theory；knowledge management；technological diffusion；symbolic interaction；evidence-based medicine (EBM)
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實證醫學整合最佳研究證據、臨床專業知識與病患價值，以應用於病患照顧之實務工作中。為改善醫療品質以及提昇競爭優勢，醫院導入實證醫學的議題持續受到極大的關注。由於實證醫學的範疇與內容相當繁複，為發揮系統之最大績效，必須考量資訊科技的應用與跨部門團隊合作。然而，現今少有文獻在探討醫院實證醫學的完整導入方法論。本論文發展ㄧ個兩階段式的實證醫學導入架構。在第一階段中，基於技術擴散理論，進而提出實證醫學系統的導入方法論，並將本研究協助中台灣某區域教學醫院，導入實證醫學系統的實務工作提出經驗分享；所提之導入方法論將導入過程區分為啟動、採用、適應、接受、制度化以及融入等六階段，在此階段中所有的考量均著重於組織層次的導入活動。然而，若我們未能充分了解使用者的認知，則此實證醫學系統的成效將會因而折損。因此，第二階段的研究重點在於詮釋使用者層次的互動行為。在第二階段中，本研究是從符號互動觀點，詮釋醫院成員在使用實證醫學系統時，其思想傾向的深層意義，並運用參與式觀察法以及深度訪談法，收集受訪醫師之實證醫學系統使用經驗，受訪之個案醫院的次級資料亦是另ㄧ資料來源，而分析資料則是運用紮根理論之技巧。本研究針對受訪者與實證醫學系統互動經驗，共歸納出六個符號為醫學助手、學習促進者、溝通平台、工作豐富化促進者、負面主義以及變異。藉由詳細地將這些符號與實務醫療活動和中介活動之關聯性進行分析，因而歸納出以下六個命題。
命題一：實證醫學實現對於醫師實務醫療活動或中介活動上，不僅產生功能上的影響，亦會產生情感上的影響。
命題二：實證醫學實現對於醫師實務醫療活動上，不僅造成直接影響，亦會造成間接影響。
命題三：實證醫學實現所造成情感上的影響，必須藉由中介活動間接影響醫師實務醫療活動。
命題四：實證醫學實現會帶給醫師既正面且負面效應，因而既正向且負向影響其活動成效。
命題五：實證醫學實現會影響組織層級與個人層級之活動。
命題六：實證醫學實現與中介活動或實務醫療活動之間，其關係會受干擾因素擾動。
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.
References
1.Arthur Anderson Business Consulting, 1999, Zukai Knowledge Management, Keizai Inc., Tokyo.new window
2.Bartkowiak, B.A., 2004, “Searching for Evidence-based Medicine in the Literature. Part 1: The start”, Clinical Medicine & Research, Vol. 2, No. 4, pp. 254-255.new window
3.Bartkowiak, B.A., 2005a, “Searching for Evidence-based Medicine in the Literature. Part 2: Resources”, Clinical Medicine & Research, Vol. 3, No. 1, pp. 39-40.new window
4.Bartkowiak, B.A., 2005b, “Searching for Evidence-based Medicine in the Literature. Part 3: Assessment”, Clinical Medicine & Research, Vol. 3, No. 2, pp. 113-115.
5.Bicer, V., Kilic, O., Dogac, A. and Laleci, G.B., 2005, “Archetype-based Semantic Interoperability of Web Service Messages in the Health Care Domain”, International Journal of Semantic Web and Information Systems (IJSWIS), Vol. 1, No. 4, pp. 1-23.new window
6.Blumer, H., 1969, Symbolic Interactionism, Prentice-Hall Inc., New Jersey.
7.Brown, G.C., Brown, M.M., and Sharma, S., 2000, “Health Care in the 21st Century: Evidence-Based Medicine, Patient Preference-Based Quality, and Cost Effectiveness”, Quality Management in Health Care, Vol. 9, No. 1, pp. 23-31.new window
8.Burrell, G. and Morgan, G., 1979, Sociological Paradigms and Organizational Analysis, Heineman Educational Books, London.
9.Calabrese, F.A., 2000, A Suggested Framework of Key Elements Defining Effective Enterprise Knowledge Management Programs, Doctoral dissertation, The George Washington University, Washing, D.C.
10.Carter, Jr., F.J., Jambulingam, T., Gupta, V.K. and Melone, N., 2001, “Technological Innovations: A Framework for Communicating Diffusion Effects”, Information & Management, Vol. 38, pp. 277-287.
11.Chengalur-Smith, I. and Duchessi, P., 1999, “The Initiation and Adoption of Client-server Technology in Organizations”, Information & Management, Vol. 35, pp. 77-88.
12.Chua, A., 2004, “Knowledge Management System Architecture: a Bridge Between KM Cnsultants and Technologists”, International Journal of Information Management, Vol. 24, pp. 87-98.
13.Cohen, A.M., Stavri, P.Z. and Hersh, W.R., 2004, “A Categorization and Analysis of the Criticisms of Evidence-based Medicine”, International Journal of Medical Informatics, Vol. 73, pp.35-43.
14.Cooper, R.B. and Zmud, R.W., 1990, “Information Technology Implementation Research: a Technological Diffusion Approach”, Management Science, Vol. 36, No. 2, pp. 123-139.
15.Covell, D.G., Uman, G.C. and Manning, P.R., 1985, “Information Needs in Office Practice: Are they Being Met?”, Annals of Internal Medicine, Vol.103, pp. 596-599.
16.Davidoff, F., Haynes, B., Sackett, D. and Smith, R., 1995, “Evidence-based Medicine”, British Medical Journal, Vol. 310, pp. 1085-1086.
17.Davis, F.D., 1989, “Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology”, MIS Quarterly, Vol. 13, No. 3, pp. 319-339.
18.Delvenne, C. and Pasleau, F., 2003, “Organising Access to Evidence-based Medicine Resources on the Web”, Computer Methods and Programs in Biomedicine, Vol. 71, pp.1-10.
19.Denzin, N., 1978, The Research Act : A Theoretical Introduction to Sociological Methods, McGraw-Hill, New York.
20.Earl, M., 1997, Knowledge as Strategy. In L. Prusak (Ed.), Knowledge in Organization, Butterworth-Heinemann, Boston.
21.Eddy, D.M., 2002, “Evidence-based medicine: What It Is, Why to Use It, and How to Incorporate It into Decision-making”, Formulary, Vol. 37, pp. 525-530.
22.Eichelberg, M., Aden, T. and Thoben, W., 2005, “A Distributed Patient Identification Protocol Based on Control Numbers with Semantic Annotation”, International Journal of Semantic Web and Information Systems (IJSWIS), Vol. 1, No. 4, pp. 24-43.new window
23.Eisenberg, J.M., 1999, “Then Lesions for Evidence-based Technology Assessment”, The Journal of the American Medical Association, Vol. 282, pp. 1865-1869.
24.Eppler, M.J. and Sukowski, O., 2000, “Managing Team Knowledge: Core Processes, Tools and Enabling Factors”, European Management Journal, Vol. 18, No.3, pp. 334-341.
25.Evidence-Based Medicine Working Group, 1992, “Evidence-based Medicine: A New Approach to Teaching the Practice of Medicine”, The Journal of the American Medical Association, Vol. 268, pp. 2420-2425.
26.Feinstein, A.R. and Horwitz, R.I., 1997, “Problems in the “Evidence” of “Evidence-based Medicine””, The American Journal of Medicine, Vol. 103, pp. 529-535.
27.Fine, G.A., 1992, “Agency, Structure and Comparative Contexts: Towards a Synthetic Interactionism”, Symbolic Interaction, Vol. 15, No. 1, pp. 87-107.new window
28.Gambrill, E., 1999, “Evidence-based Clinical Behavior, Evidence-based Medicine and the Cochrane Collaboration”, Journal of Behavior Therapy and Experimental Psychiatry, Vol. 30, pp. 1-14.
29.Gilbert, M. and Cordey-Hayes, M., 1996, “Understanding The Process of Knowledge Transfer to Achieve Successful Technological Innovation”, Technovation, Vol. 16, No. 6, pp. 301-312.
30.Glaser, B.G. and Strauss, A., 1967, The Discovery of Grounded Theory: Strategies for Qualitative Research, Aldine, New York.
31.Gopal, A. and Prasad, P., 2000, “Understanding GDSS in Symbolic Context: Shifting the Focus from Technology to Interaction”, MIS Quarterly, Vol. 24, No. 3, pp. 509-546
32.Gray, J.A., 1997, Evidence-based Health Care: How to Make Health Policy and Management Decisions, Churchill Livingstone, New York.
33.Hadrich, T. and Priebe, T., 2005, “A Context-based Approach for Supporting Knowledge Work with Semantic Portals”, International Journal of Semantic Web and Information Systems (IJSWIS), Vol. 1, No. 3, pp. 64-88.new window
34.Haines, M., 1996, “Libraries and the R&D Strategy: A Way Forward”, Health Libraries Review, Vol. 13, pp. 193-201.
35.Hall, R. and Andriani, P., 2002, “Managing Knowledge for Innovation”, Long Range Planning, Vol. 35, pp. 29-48.
36.Haynes, R.B., 2002, “What Kind of Evidence Is It That Evidence-based Medicine Advocates Want Health Care Providers and Consumers to Pay Attention to?”, BMC Health Services Research, Vol. 2, No. 1, p. 3.new window
37.Hewitt, J.P., 1988, Self and Society: A Symbolic Interactionist Social Psychology, Allyn & Bacon, Boston.
38.Hill, G.B., 2000, “Archie Cochrane and His Legacy: An Internal Challenge to Physicians autonomy?”, Journal of Clinical Epidemiology, Vol. 53, No. 12, pp. 1189-1192.
39.Hoffrage, U., Lindsey, S. and Hertwig, R., 2000, “Medicine Communicating Statistical Information”, Science, Vol. 290, pp. 2261-2262.
40.Huff, S.L. and Munro, M.C., 1985, “Information Technology Assessment and Adoption: A Field Study”, MIS Quarterly, Vol. 9, No.4, pp. 327-340.
41.Hurwitz, S.R., Tornetta, P. and Wright, J.G., 2006, “How to Read the Literature to Change Your Practice: An Evidence-based Medicine Approach”, The Journal of Bone & Joint Surgery, Vol. 88A, No. 8, pp. 1873-1879.
42.Kerssens-Van Drongelen, I.C., Weerd-Nederhof, P.C. and Fisscher, O.A.M., 1996, “Describing the Issues of Knowledge Management in R & D: Toward a Communication and Analysis Tool”, R & D Management, Vol. 26, No. 3, pp. 213-230.
43.Kwon, T.H. and Zmud, R.W., 1987, “Unifying the Fragmented Models of Information Systems Implementation in Boland and Hirschheim (Eds.)”, Critical Issues in Information System Research, John Wiley, New York.
44.Lado, A.A. and Zhang, M.J., 1998, “Expert Systems, Knowledge Development and Utilization, and Sustained Competitive Advantage: A Resource-Based Model”, Journal of Management, Vol. 24, No. 4, pp. 489-509.
45.Lahti, R.K. and Beyerlein, M.M., 2000, “Knowledge Transfer and Management Consulting: A Look at The Firm”, Business Horizons, Jan-Feb, pp. 65-74
46.Lai, V.S. and Mahapatra, R.K., 1997, “Exploring the Research in Information Technology Implementation”, Information & Management, Vol. 32, pp. 187-201.
47.Lee, S.M. and Hong, S., 2002, “An Enterprise-wide Knowledge Management System Infrastructure”, Industrial Management and Data Systems, Vol. 102, No. 1, pp. 17-25.new window
48.Lincoln, Y.S. and Guba, E.G., 1985, Naturalistic inquiry, Beverly Hills, Sage Publications, Inc., CA.
49.Lisa, W., 2007, “Role of Information Technology in Evidence Based Medicine: Advantage and Limitations”, International Journal of Healthcare Administration, Vol. 4, No. 2, pp. 5.
50.Lowenhaupt, M., 2005, “Evidence-based Medicine Grows Up”, Health Management Technology, June, pp. 8-12.
51.Lytras, M.D. and Pouloudi, A., 2006, “Towards the Development of a Novel Taxonomy of Knowledge Management Systems from a Learning Perspective: An Integrated Approach to Learning and Knowledge Infrastructures”, Journal of Knowledge Management, Vol. 10, No. 6, pp. 64-80.
52.Maxwell, J.A., 1996, Qualitative Research Design: An Interactive Approach, Sage, London.
53.Mead, G.H., 1934, Mind, Self and Society, University of Chicago Press, Chicago.
54.Merriam, S. B., 1988, Case Study Research in Education. Thousand Oaks, Sage, CA.
55.Mitra, A., Brown, M. and Hackney, R., 2005, “Evolutionary Knowledge Management: A Case of System Development within the Manufacturing Industry”, International Journal of Technology Management, Vol. 31, Nos. 1/2, pp. 98-115.new window
56.Naeve, A., 2005, “The Human Semantic Web Shifting from Knowledge Push to Knowledge Pull”, International Journal of Semantic Web and Information Systems (IJSWIS), Vol. 1, No. 3, pp. 1-30.new window
57.Nonaka, I. and Takeuchi, H., 1995, The Knowledge-Creating Company, Oxford Press, New York.
58.Osheroff, J.A., Forsythe, D.E., Buchanan, B.G., Bankowitz, R.A., Blumenfeld, B.H. and Miller, R.A., 1991, “Physicians Information Needs: Analysis of Questions Posed during Clinical Teaching”, Annals of Internal Medicine, Vol.114, pp. 576-581.
59.Pace, S., 2004, “A Grounded Theory of the Flow Experience of Web Users”, International Journal of Human-Computer Studies, Vol. 60, pp. 327-363.
60.Palacios-Marqués, D. and Garrigós-Simón, F.J., 2005, “A Measurement Scale for Knowledge Management in the Biotechnology and Telecommunications Industries”, International Journal of Technology Management, Vol. 31, Nos. 3/4, pp. 358-374.
61.Porter, M.E., 1985, Competitive Advantage, Free Press, New York.
62.Prasad, P., 1993, “Symbolic Processes in the Implementation of Technology Change: A Symbolic Interactionist Study of Work Computerization”, Academy of Management Journal, Vol. 36, No. 6, pp. 1400-1429.
63.Preece, D.A., 1991, “The Whys and Wherefores of New Technology Adoption”, Management Decision, Vol. 29, No. 1, pp. 53-58.new window
64.Rogers, E. M., 2003, Diffusion of Innovations, 5th edition, Free Press, New York.
65.Sackett, D.L., Richardson, W.S., Rosenberg, W.M. and Haynes, R.B., 1997, Evidence-based Medicine: How to Practice and Teach EBM, Churchill Livingstone, New York.
66.Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B. and Richardson, W.S., 1996, “Evidence Based Medicine: What It Is and What It Isn’t”, British Medical Journal, Vol. 312, pp. 71-72.
67.Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W.M. and Haynes, R.B., 2000, Evidence-based Medicine: How to Practice and Teach EBM, 2nd ed., Churchill Livingstone, London.
68.Scalise, D., 2005a, “Evidence-based Medicine”, Trustee, Vol. 58, pp. 24-28.
69.Scalise, D., 2005b, “The Case for Evidence-based Medicine”, Hospitals & Health Networks, Vol. 79, No. 9, pp. 56-59.
70.Short, D., Frischer, M., and Bashford, J., 2004, “Barriers to the Adoption of Computerized Decision Support Systems in General Practice Consultations: A Qualitative Study of GPs’ Perspectives”, International Journal of Medical Informatics, Vol. 73, pp. 357-362.
71.Simon, H., 1965, The Shape of Automation: For Men and Management, Harper & Row, New York.
72.Simpson, J., Kingston, J. and Molony, N., 1999, “Internet-based Decision Support for Evidence-based Medicine”, Knowledge-Based Systems, Vol. 12, pp. 247-255.
73.Sinkula, J.M., Baker, W.E. and Noordewier, T., 1997, “A Framework for Market-Based Organizational Learning: Linking Values, Knowledge and Behavior”, Journal of the Academy of Marketing Science, Vol. 25, No. 4, pp. 305-318.
74.Strauss, A. and Corbin, J., 1990, Basics of Qualitative Research: Grounded Theory Procedures and Techniques, Newbury Park, Sage Publications, CA.
75.Strauss, S.E., Richardson, W.S., Glasziou, P., and Haynes, R.B., 2005, Evidence-Based Medicine: How to Practice and Teach EBM, 3rd ed., Elsevier Churchill Livingstone, Philadelphia.
76.Swan, J.E. and Bowers, M.R., 1998, “Service Quality and Satisfaction: The Process of People Doing Things Together”, Journal of Service Marketing, Vol. 12, No. 1, pp. 59-72.new window
77.Taylor, S.J. and Bogdan, R., 1998, Introduction to Qualitative Research Methods: A Guidebooks and Resource, 3rd ed., Wiley, New York.
78.Turkle, S., 1984, The Second Self: Computers and the Human Spirit, Simon & Schuster, New York.
79.Turner, B.A., 1986, “Sociological Aspects of Organizational Symbolism”, Organization Studies, Vol. 7, pp. 101-115.
80.Verkasalo, M. and Lappalainen, P., 1998, “A Method of Measuring the Efficiency of the Knowledge Utilization Process”, IEEE Transactions on Engineering Management, Vol. 45, No. 4, pp. 414-423.
81.Warren, K.S. and Mosteller, F., 1993, Doing More Good Than Harm: The Evaluation of Health Care Interventions (Vol. 703), Academy of Science, New York.
82.Zou, K.H., Fielding, J.R. and Ondategui-Parra, S., 2004, “What Is Evidence-based Medicine?”, Academic Radiology, Vol.11, No. 2, pp. 127-133.
 
 
 
 
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