A Study of Professional Teamwork and Resource Network in Long-term Care in Taiwan.

[[abstract]]盱衡我國近年人口老化、勞動參與及家庭結構的變遷趨勢，失能老人與身障者照顧問題的迫切性亟須獲得正視。失能者多元複雜的照顧問題與需求，須藉由照顧管理制度協調整合其所需的服務與資源，避免服務輸送的囿限與疏漏，而照顧管理制度的實踐乃植基於專業團隊的協調合作與周延完整的資源網絡，其間亦涉及公私部門的共同治理與夥伴關係。循此，本研究之主題聚焦於長期照顧十年計畫架構下，跨專業團隊的合作與資源網絡的建構，希冀探究二者的運作現況與影響因素，繼之參酌相關理論觀點，檢視與驗證契約委託關係下公私部門的互動關係。 研究者分別藉由次級資料分析以及跨縣市長照業務承辦人員與主管之深度訪談，歸納整理出若干研究結論，諸如在「專業團隊運作」部分，目前距離專業角色、知識與技能相互調適且融合互補的「跨專業」團隊工作模式，以及有效專業團隊運作的特徵，仍有努力與改善空間；其次，在「資源網絡建構」部分，服務供需之間仍存有極大落差，且資源網絡的服務輸送仍存有充足性、適當性、可近性不足，以及缺乏整合與連續性等問題。上述專業團隊運作與資源網絡建構之現況與困境，背後實隱含諸多結構、過程、文化、結果與品質面向之影響因素。再者，現行長照體系中公私部門的合作與互動過程，仍缺乏溝通對話與政策倡議的平台，民間單位契約委託過程的參與度不足，且公私部門仍存有上對下的權力不對等關係。是以公私部門仍須努力在平等、互惠、互賴、互助的基礎上，營造相互信任、尊重的夥伴關係，並避免陷入「治理失靈（governance failure）」的危機。 最後，研究者依循問題討論與研究結果，提出多項未來長照體系專業團隊運作、資源網絡建構與公私部門合作之政策與實務面具體建議。[[abstract]]Taiwan is currently experiencing aging population, labor participation and changes in family structure. The problem of taking care of senior citizens and people with disability is so desperate that it requires immediate attention. The range of complicated problems and needs that those with disability have require that the service and resource needed are coordinated and integrated into the care management system in order to prevent the limits and negligence of service delivery. The implementation of the care management system depends on the cooperation of a professional team in a well-coordinated manner and a well-planned and complete network of resource, which involves the governance and partnership between the government and private sector. For this, this study was focused on the establishment of a cooperation mechanism across multiple professional teams and a resource network under the framework of the Ten-Year Long-term Care Program. The purpose was to investigate the current operations and factors of influence for both and examine and test the interactive relationship between government and private sector in contract from the theoretical point of view. The study started with analysis of secondary data and in-depth interviews with cross-administration persons in charge of long-term care business and certain conclusions were reached. For example, for the “professional team operations,” there is still room for improvement for the “interprofessional” teamwork model that professional roles, knowledge and skills are coordinated to be harmonic and complement to one another as well as the traits of operations of an effective professional team. Next, for the “establishment of resource network,” there is still a large difference between the supply and demand of service, and the service delivery of the resource network still requires improvement in terms of lack of adequacy, appropriateness, accessibility, integration and continuum. Multiple factors of influence in structure, process, culture, result and quality are hidden behind the current status and difficulties of professional team operations and establishment of resource network. Furthermore, a platform for communications, dialogues and policy initiatives is missing for the process of cooperation and coordination between the government and private sector involved in long-term care system. The private contractors do not participate in the contract negotiation, and there is always the asymmetry in power from the government at the top to the contractors at the bottom. Therefore, both sides need to build a partnership of trust and respect on the foundation of equality, mutual benefit, reliance and assistance and keep themselves from falling into the crisis of “governance failure.” Finally, based on the discussion of problems and research results, solid suggestions were proposed from the policy and practical points of view for the professional team operations, resource network establishment and cooperation between government and private sector for the long-term care system in the future.[[note]]博