バングラデシュ医療プロジェクトにおける人間関係トレーニングの効果に関する考察 : トレーニングから組織開発（OD)への枠組み変換の必要性

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(1)人間関係研究（南山大学人間関係研究センター紀要）, 5, 101-122.. . .

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(57) ol' pqrcs . . tu&+,*vwl'x V4`yz!{|N. }& Table 1. ᒰࡊࡠࠫࠚࠢ࠻ߦ߅ߌࠆ HRT ታᣉߩᵹࠇ㧔 ‫ޤ ޣ‬ౝߪᵴേ⋡⊛㧕 ╩⠪߅ࠃ߮ࡊࡠࠫࠚࠢ࠻஥ߩᵴേ. MCHTI ஥ߩᵴേ. ‫ޣ‬HRT ታᣉߦ㑐ߔࠆࠦࡦ࠮ࡦࠨࠬᒻᚑ‫ޤ‬ 2002 ᐕ. - 7 ฬߩ MCHTI ࠬ࠲࠶ࡈ߇ෳട. - HRT ࠺ࡕ࡮ࡢ࡯࡚ࠢࠪ࠶ࡊ㧔4 ᣣ㑆㧕. 9᦬ - ੹ᓟ‫ޔ‬MCHTI ߦߡ HRT ࠍዉ౉ߒߡ޿ߊߎߣߢวᗧ ‫ޣ‬HRT ࡈࠔࠪ࡝࠹࡯࡚ࠪࡦ࡮ࠬࠠ࡞ߩ㙃ᚑ‫ޤ‬ 2003 ᐕ 2 ᦬㨪3 ᦬. - “Basic course of HRT”㧔6 ᣣ㑆ࡢ࡯࡚ࠢࠪ࠶ࡊ㧕. - 21 ฬߩ MCHTI ࠬ࠲࠶ࡈ߇ෳട. - “Facilitator Training”㧔7 ᣣ㑆ࡢ࡯࡚ࠢࠪ࠶ࡊ㧕. - ࡈࠔࠪ࡝࠹࡯࠲࡯8 ฬ߇㙃ᚑߐࠇߚ. - 8 ฬߩࡈࠔࠪ࡝࠹࡯࠲࡯߇੹ᓟߩ HRT ࠍ MCHTI ࠬ࠲࠶ࡈߦኻߒߡታᣉߒߡ޿ߊߎߣߢหᗧ 2003 ᐕ -JICA 㐳ᦼኾ㐷ኅߦࠃࠆⷰኤഥ⸒ߣࠨࡐ࡯࠻ 4 ᦬㨪8 ᦬ ‫ޣ‬HRT ߩࡕ࠾࠲࡝ࡦࠣ߅ࠃ߮ࠬ࡯ࡄ࡯ࡆ࡚ࠫࡦ‫ޤ‬ 2003 ᐕ 8᦬. - ⥃ᐥࠬ࠲࠶ࡈ㧔කᏧ࡮⋴⼔Ꮷ㧕ߦኻߔࠆ 3 ᣣ㑆 HRT ࡢ࡯࡚ࠢࠪ࠶ࡊ5 ࿁㧔⸘ 83 ฬߩෳട⠪㧕. - ࠬ࡯ࡄ࡯ࡆ࡚ࠫࡦ 㧔⥃ᐥࠬ࠲࠶ࡈߦኻߔࠆ╙ 5 ࿁ HRT㧕 - “Advanced Facilitator Training”㧔4 ᣣ㑆ࡢ࡯࡚ࠢࠪ ࠶ࡊ㧕. 2003 ᐕ 11 ᦬. - ੐ോࠬ࠲࠶ࡈߦኻߔࠆ 3 ᣣ㑆 HRT ࡢ࡯࡚ࠢࠪ࠶ -JICA 㐳ᦼኾ㐷ኅߦࠃࠆⷰኤഥ⸒ߣࠨࡐ࡯࠻. 2004 ᐕ. ࡊ㧔18 ฬߩෳട⠪㧕 - ࠨࡐ࡯࠹ࠖࡦࠣ࡮ࠬ࠲࠶ࡈߦኻߔࠆ 2 ᣣ㑆 HRT. 3 ᦬㨪8 ᦬. ࡢ࡯࡚ࠢࠪ࠶ࡊ5 ࿁㧔⸘ 100 ฬߩෳട⠪㧕 - ࠬ࡯ࡄ࡯ࡆ࡚ࠫࡦ. 8᦬. 㧔ࠨࡐ࡯࠹ࠖࡦࠣ࡮ࠬ࠲࠶ࡈߦኻߔࠆ╙ 5 ࿁ HRT㧕 - ࡕ࠾࠲࡝ࡦࠣߣᦨ⚳⹏ଔ. - ዁᧪ߩᣇะᕈߦ㑐ߔࠆ⼏⺰. 㧨2004 ᐕ 8 ᦬ᧃߦߡᒰࡊࡠࠫࠚࠢ࠻⚳ੌ㧪 * ࠨࡐ࡯࠹ࠖࡦࠣ࡮ࠬ࠲࠶ࡈ㧦Aya㧔ࡌ࠶࠼࡮ࡔࠗࠠࡦࠣ߿੺ഥࠍᜂᒰ㧕 ‫ޔ‬᝹㒰ᜂᒰ‫ޔ‬㐷⇟‫઀⛎ޔ‬ᜂᒰߥߤߩࠬ࠲࠶ࡈ. jkw `T jkl[f ~\*5

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(102) Table 2. MCHTI ࠬ࠲࠶ࡈߦኻߔࠆࠗࡦ࠲ࡆࡘ࡯㗄⋡㧔ታ㓙ߪࡌࡦࠟ࡞⺆ߦ⠡⸶ߒߚ਄ߢታᣉ㧕㗄⋡ 1.‫ޣ‬MCHTI ߢߩ HRT ߩᔅⷐᕈ‫“ޤ‬Is it necessary for MCHTI staff to have more HRT in future?” 㗄⋡ 2.‫ޣ‬዁᧪ߩ HRT ߳ߩෳടᗧᕁ‫“ޤ‬Do you want to participate in HRT in future, and do you want to learn more?” 㗄⋡ 3.‫ޣ‬HRT ታᣉߦࠃࠆᄌൻ‫“ޤ‬Does HRT make any differences in your current daily fieldwork?”. !3 >. KL#½8 5¾Ù»&uÚ. Ëw ) O^_Û1 O~#b&Ü

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(106) ! . ! Oã[äå)æç{èéêGëì1 C#láâ ! &' ! Cî. sCíÈF. sCíÈFC# ! [. MN ß O¢&ïWC#3 > #&' ! [ ®ðñ2òC^_Û3 > ïWC#& H [# Table 3. 㗄⋡ 1㧔MCHTI ߢߩ HRT ߩᔅⷐᕈ㧕ߦኻߔࠆℂ↱㧔⥄↱࿁╵㧦ࠞ࠹ࠧ࡝࡯ൻߪ╩⠪ߦࠃࠆ㧕 ࠞ࠹ࠧ࡝࡯. ෻ᔕᢙ㧔ੱᢙ㧕 ෻ᔕ଀ ∛㒮ߩะ਄‫ࠍࠬࡆ࡯ࠨ޿ࠃࠅࠃޔ‬ឭଏߔࠆ‫ࠬࡆ࡯ࠨޔ‬. a. ∛㒮ߩࠨ࡯ࡆࠬߩะ਄. n=10(2/8)*. b. ࠴࡯ࡓࡢ࡯ࠢะ਄. n=4 (3/1). c. ୘ੱߩⴕേߩะ਄࡮ᄌ㕟. n=7 (6/1). d. ࠃࠅቇ߱ߚ߼. n=4 (0/4). ࠃࠅቇ߱ߚ߼‫ޔ‬૕㛎ߩߚ߼ߦ‫ࠍ⚦⹦ࠅࠃޔ‬⍮ࠆߚ߼. e. ᦝߥࠆ࠻࡟࡯࠾ࡦࠣߩᔅⷐᕈ. n=9 (5/4). HRT ߩᤨ㑆ߪਇలಽ‫ޔ‬ౣᐲߩ࠻࡟࡯࠾ࡦࠣ߇ᔅⷐ. f. HRT ⥄૕ߩะ਄ߩᔅⷐᕈ. n=5 (4/1). ߩࠕ࠶ࡊࠣ࡟࡯࠼‫ޔ‬ᚒ‫ߩ߳ޘੱߪ࡯࠻࠶ࡕߩޘ‬ᄺ઀ ࿅⚿ߒߡ௛ߊߎߣ‫޿ࠃࠅࠃޔ‬㑐ଥࠍ૞ࠆ ⴕേࠍᄌ߃ࠆߎߣ߇ᔅⷐ‫ޔ‬㒮ౝߢߩⴕേߩะ਄‫ޔ‬ᚒ‫ޘ‬ ߩ⺋ߞߚᘒᐲߩୃᱜ. ࠃࠅ㜞޿⾰ߩ HRT ታᣉ߇ᔅⷐ‫ޔ‬ᣂߒ޿ࡃ࡯࡚ࠫࡦߩ HRT‫ ߩߢࠬࠢ࠶ࡇ࠻ߩઁޔ‬HRT. g. ৻ㇱߩࠬ࠲࠶ࡈߦᔅⷐ. n=3 (2/1). ৻ㇱߩකᏧߦᔅⷐ‫ޔ‬ૐ޿⡯ጀߢߩታᣉ߇ᔅⷐ. h. ‫ޟ‬ᔅⷐߥߒ‫ޠ‬. n=2 (0/2). ⥄ಽߪᣢߦ HRT ࠍฃߌߚ‫⥄ޔ‬ಽߪలಽቇࠎߛ. * ᜝ᒐౝߩᏀ஥ߪ⥃ᐥ㧗੐ോࠬ࠲࠶ࡈߩਛߢߩ෻ᔕᢙ‫ޔ‬ฝ஥ߪࠨࡐ࡯࠻࡮ࠬ࠲࠶ࡈߩਛߢߩ෻ᔕᢙ. ó. Ëw )ôõö@Z÷ø1. sC$3 >. \Õôõ @Zxb&Ü

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(113) Table 5. 㗄⋡ 2㧔዁᧪ߩ HRT ߳ߩෳടᗧᕁ㧕ߦኻߔࠆℂ↱㧔⥄↱࿁╵㧦ࠞ࠹ࠧ࡝࡯ൻߪ╩⠪ߦࠃࠆ㧕 ࠞ࠹ࠧ࡝࡯. ෻ᔕᢙ㧔ੱᢙ㧕 ෻ᔕ଀. a. ࠃࠅቇ߱ߚ߼. n=14(2/12)*. b. ઀੐ߩะ਄. n=11 (5/6). c. ⥄Ꮖߩะ਄. n=10 (5/5). d. ᦝߥࠆ HRT ߩᔅⷐᕈ. n=7 (6/1). e. ᣂߚߥ HRT ߩ႐ว. n=4 (3/1). f. ‫ޟ‬ෳടߒߚ޿ߣߪᕁࠊߥ޿‫ޠ‬. n=6 (5/1). ࠃࠅቇ߱ߚ߼‫ੱޔ‬㑆㑐ଥࠍቇ߱ߎߣߦ㑐ᔃ޽ࠅ‫ޔ‬HRT ࠍࠃ ࠅ⍮ࠆߚ߼‫ࠆߥᦝޔ‬૕㛎ߩߚ߼ ࠃࠅࠃ޿ࠨ࡯ࡆࠬߩឭଏ‫ޔ‬Ფᣣߩ઀੐ߩᡷༀ‫ޔ‬ᖚ⠪ߣߩ㑐ଥ ߩะ਄‫∛ߩߎޔ‬㒮ࠍࠃߊߔࠆߚ߼ ⥄Ꮖ⊒㆐‫⥄ޔ‬ಽߩ㑆㆑޿ߩୃᱜ‫⥄ޔ‬ಽߩᘒᐲࠍᄌ߃ࠆߚ߼ ቇ߮ߦߪ⚳ࠊࠅߥߒ‫⥄ޔ‬ಽ߇ᔓࠇߚߎߣࠍᕁ޿⿠ߎߔߚ߼‫ޔ‬ HRT ߪ 1 ᐕߦ 1 ࿁ߪᔅⷐ ߽ߒ߽ᣂߒ޿࡟࠶ࠬࡦ߇ឭଏߐࠇࠆߥࠄ‫ޔ‬ᣂߒ޿⺖㗴ߥࠄ ߫‫߫ࠄߥ࡞ࡌ࡟࡮ࠬࡦࡃ࠼ࠕޔ‬ ⑳ߪలಽߦᄌࠊߞߚ‫ޔ‬HRT ߦߟ޿ߡߪోߡቇࠎߛ‫ߪߦ⑳ޔ‬ ᔅⷐߥߒ‫ޔ‬ㅌ⡯߇ㄭ޿߆ࠄ. * ᜝ᒐౝߩᏀ஥ߪ⥃ᐥ㧗੐ോࠬ࠲࠶ࡈߩਛߢߩ෻ᔕᢙ‫ޔ‬ฝ஥ߪࠨࡐ࡯࠻࡮ࠬ࠲࠶ࡈߩਛߢߩ෻ᔕᢙ.

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(115). !-./01$234+56789:; <=>?@A<BCDEFGHB:; I8JK 6. !LMNO+ PQLMRSTUVWXY9CDEF Z[. . Table 6. 㗄⋡ 3㧔HRT ታᣉߦࠃࠆᄌൻ㧕ߦኻߔࠆ෻ᔕ㧔ࠞ࠹ࠧ࡝࡯ൻߪ╩⠪ߦࠃࠆ㧕 ࠞ࠹ࠧ࡝࡯. ෻ᔕᢙ㧔ੱᢙ㧕 ෻ᔕ଀. a. ૗ࠄ߆ߩᄌൻ. n=7 (7/0)*. ዋߒᄌࠊߞߚ‫ޔ‬ᄌൻࠍ߽ߚࠄߒߚ‫ޔ‬୘ੱߩⴕേ‫ޔ‬etc. b. ቇ߮ߩᔕ↪. n=6 (3/3). ቇࠎߛߎߣࠍᔕ↪‫⥄ޔ‬ಽߩⴕേࠍᄌ߃ࠃ߁ߣ⹜ߺࠆ‫ޔ‬etc.. c. ࠣ࡞࡯ࡊࡢ࡯ࠢ. n=11 (3/8). දജ‫ޔ‬࿅⚿‫⚿޿޿ޔ‬ᨐߪ޿޿ࠣ࡞࡯ࡊࡢ࡯ࠢ߇߽ߚࠄߔ‫ޔ‬etc.. d. ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ. n=5 (3/2). ᖚ⠪ߣߩࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ‫ઁޔ‬⠪ߩᛒ޿ᣇ‫ޔ‬etc.. e. ࠨ࡯ࡆࠬߩ⾰. n=5 (0/5). ⥄ಽߩࠨ࡯ࡆࠬߩะ਄‫ࠍࠬࡆ࡯ࠨ޿ࠃࠅࠃޔ‬ឭଏ‫ޔ‬etc.. f. ౝ⋭⊛ߥᘒᐲ. n=6 (4/2). ᗵฃᕈ‫ޔ‬ᵈᗧജ‫ޔ‬ᔋ⠴ᒝߐ‫ޔ‬₂り‫⥄ޔ‬ಽߩ㑆㆑޿ࠍ⹺߼ࠆߎߣ. g. ࠬ࠲࠶ࡈ㑆ߩ㑐ଥ. n=3 (3/0). ࠕࡗࠍࠃࠅℂ⸃ߒߚ‫޿ࠃࠅࠃޔ‬㑐ଥ‫∛ઁޔ‬᫟ߩࠬ࠲࠶ࡈߣખ߇ᷓ߹ߞߚ. ߘߩઁ㧔ߘࠇߙࠇߩ෻ᔕߪ n=1㧕. - ⥄ಽߩኅᐸ↢ᵴߩᄌൻ. - ઀੐߳ߩ㑐ᔃ߇Ⴧߒߚ. - ࠃࠅ਄ߩࠬ࠲࠶ࡈߦᓥ߁ߎߣ. - ઁ⠪ࠍ߿ࠆ᳇ߦߐߖࠆߎߣ. * ᜝ᒐౝߩᏀ஥ߪ⥃ᐥ㧗੐ോࠬ࠲࠶ࡈߩਛߢߩ෻ᔕᢙ‫ޔ‬ฝ஥ߪࠨࡐ࡯࠻࡮ࠬ࠲࠶ࡈߩਛߢߩ෻ᔕᢙ. \]^_à 8 bc deCDEFfg7 :; I8H` 6CDEF hi89:j_89 :k$lC

(116) ,-./01$234

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(122) j_®¯{¤A²³O¥¦ ´ ¬7 µ¶µ¥¦WpB:;;{¶µ¶wC·¸y4¹; I8 ;>{ºE»¼L½¾¿Àbc ¤A²³O8 >WÁÂa I8 B: CDEF¤Aa TH=Ã, NOW°±a I889 . ¥¦ÃÄ RSTUn$04"ÅÆWpB ÇÈRÉ8ÊËÉ<= ¤A6ÌÍ; Î8Ï5Ð*< ¤A9:y4Dl/$ B:·$DW Ñ¤A8Ò$#WXYa { ÓÐ* y4Dl/¡$ B:o4Ô#Õy4Dl/$7y4Dl/$ W9¿ÀÀÖ`½×ØW¤Aa y4Dl/$ ´ ¬Ù7y4Dl/$¹; W Úa Table 7. ᖚ⠪ߦኻߔࠆࠗࡦ࠲ࡆࡘ࡯㗄⋡㧔ታ㓙ߪࡌࡦࠟ࡞⺆ߦ⠡⸶ߒߚ਄ߢታᣉ㧕 a-1. Did your doctor behave to you kindly and gently? 㧔කᏧߪⷫಾߦ߿ߐߒߊᝄ⥰ߞߚ߆㧫㧕 1. no. 2. very few. 3. sometimes 4. often. a-2. Did your doctor listen to you with patience? 1. no. 2. very few. 5. always. 㧔කᏧߪᔋ⠴ᒝߊ⡬޿ߡߊࠇߚ߆㧫㧕. 3. sometimes 4. often. 5. always. b-1. Did the nurses or FWVs behave to you kindly and gently?㧔⋴⼔Ꮷߪⷫಾߦ߿ߐߒߊᝄ⥰ߞߚ߆㧫㧕 1. no. 2. very few. 3. sometimes 4. often. b-2. Did the nurses or FWVs listen to you with patience? 1. no. 2. very few. 5. always. 㧔⋴⼔Ꮷߪᔋ⠴ᒝߊ⡬޿ߡߊࠇߚ߆㧫㧕. 3. sometimes 4. often. 5. always. c. Did Ayas in this hospital behave to you kindly, and respond to you friendly? 㧔ࠕࡗߪⷫಾߢ෹ᅢ⊛߆㧫㧕 1. no. 2. very few. 3. sometimes 4. often. 5. always. d. Are you satisfied with this hospital about staffs’ behavior? 㧔ࠬ࠲࠶ࡈߩⴕേߦኻߔࠆో૕⊛ߥḩ⿷ᐲߪ㧫㧕 1. Not at all 2. satisfied a little 3. mildly satisfied 4. quite satisfied. 5. very satisfied. Û Ü8BÊÝ½¾¿ÀÞ Ý½¾¿À·$DWÇÉßÊËÉb àÆÀßáâã ä»å4D$ Ò4C7báâ¤Aæçè,¡é8T HB:;;¤A;{>Ñêëa ìípH`Bêë a îïðñò89:óH . ¤Ay4Dl/$¥¦^_8ôõ b;:CDEFTH=Ãa ¤Ahib à²³Oö ;I8W°±a {¿ÀW÷¾ ø89ZùúûüýüþWpB >^_W Úa. ―108―.

(123) Table 8. ฦ䉟䊮䉺䊎䊠䊷㗄⋡䈮ኻ䈜䉎∛㒮䈗䈫䈱ᐔဋ୯䈍䉋䈶৻ర㈩⟎ಽᢔಽᨆ⚿ᨐ n mean Tukey HSD S.D. F value possibility MCHTI 84 4.12 1.07 1.05 3.29 p<.05 㪓㪸㪈㪕㩷කᏧ䈱ⷫಾ䈘 ዊⷙᮨ౏┙∛㒮 91 4.33 * ᄢⷙᮨ౏┙∛㒮 82 3.90 1.16 MCHTI 83 4.01 1.25 1.21 2.30 p<.10 㪓㪸㪉㪕㩷කᏧ䈱⡬䈐ᣇ ዊⷙᮨ౏┙∛㒮 91 4.14 ᄢⷙᮨ౏┙∛㒮 82 3.76 1.13 MCHTI 77 3.64 1.19 1.20 2.74 p<.10 + 㪓㪹㪈㪕㩷⋴⼔Ꮷ䈱ⷫಾ䈘 ዊⷙᮨ౏┙∛㒮 78 3.60 ᄢⷙᮨ౏┙∛㒮 82 3.26 1.03 MCHTI 75 3.64 1.20 㪓㪹㪉㪕㩷⋴⼔Ꮷ䈱⡬䈐 ዊⷙᮨ౏┙∛㒮 77 1.13 2.19 n.s. 3.87 ᣇ ᄢⷙᮨ౏┙∛㒮 69 3.46 1.21 MCHTI 72 3.10 1.48 ዊⷙᮨ౏┙∛㒮 80 3.34 1.29 6.36 p<.01 * 㪓㪺㪕㩷䉝䊟䈱ⷫಾ䈘 ** ᄢⷙᮨ౏┙∛㒮 67 2.54 1.35 MCHTI 84 3.74 1.16 㪓㪻㪕㩷䉴䉺䉾䊐䈮ኻ䈜䉎 ዊⷙᮨ౏┙∛㒮 91 3.44 1.23 2.69 p<.05 + ో૕⊛䈭ḩ⿷ᐲ ᄢⷙᮨ౏┙∛㒮 82 3.32 1.23 + p<.10 * p<.05 ** p<.01. .

(124)

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(445) pp Outcome. Outcome. Mothers use MCHTI more.. Knowledge of mothers increases.. Safety delivers have increased in the suburbs of MCHTI.. Safety delivers have increased in rural community.. Outcome. Outcome. Organization (MCHTI) change like “Women Friendly Hospital”. FWV etc. improve their relationship with mothers.. Outcome. [in future]. Outcome. #3. [Human relations between staff and patients] Staff in MCHTI improve their behavior with patients.. [human relations among staff] Team-work among staff have been built through HRT. Outcome. Outcome. FWV etc. motivate and learn more, and they improve knowledge and skills.. Communication ability of FWV etc. is improved. Their knowledge and skills are improved.. Output The facilitators continue to conduct HRT in MCHTI.. Output. Output. Output. #2. Other trainings are conducted by participatory way.. [the end of this project]. BCC training can implement adapted HRT.. #1. Facilitation skills for HRT are developed. *2-3. Activities HRT for FWV as BCC. Output & Basis of HRT Team-work among the facilitators is built for team-teaching.. Output & Basis of HRT The facilitators improve their sensitivity, attitude & behavior.. Activities. [during this project]. The facilitators conduct HRT in MCHTI. Through their experience of HRT facilitation, outputs as above occur (experiential learning).. Input Introduction of HRT / Facilitator Training for HRT Supervision of HRT / Suggestion how to adapt HRT to BCC Supporting and Encouraging HRT Activities by Long-Term Expert. Appendix 1.. ᒰࡊࡠࠫࠚࠢ࠻ߦ߅ߌࠆ HRT ⻉ᵴേߩࡠࠫ࠶ࠢ࡮ࡕ࠺࡞ Nakamura et al.(2004)ࠃࠅᒁ↪ #1, #2, #3. ―121―. The 3 core objectives of HRT activities.