在面對資訊爆炸的時代，民眾隨時上網搜尋相關病徵資訊已成常態，隨著醫療科技進步，琳瑯滿目的治療照護選項，使得病人不知道如何為自己做出最合適的選擇；在面對高度複雜的疾病，仍容易因為未知與無助，感到焦慮不安。「以病人為中心」已是全球醫療照護奉行的典範，醫病共享決策（Shared Decision Making, SDM）實現長久以來所提倡「以病人為中心」、「病人參與」之策略，病人透過參與自身的醫療決策，補足了實證醫學所無法體現的個人價值。透過臨床現場實踐過程，考量醫療照護系統實務層面之問題，有效將其制度納入臨床實務，體現醫病共享決策之價值。

透過文獻回顧，本研究將醫病共享決策之價值主張定義為「讓病人共同參與醫療決策」，並以質性研究中的個案研究法，探究南部某區域教學醫院導入醫病共享決策制度的過程。研究者透過長時間觀察研究個案醫院利害關係人之間的互動，並以服務主導邏輯（Service-Dominant Logic）觀點，分析服務系統之間的關鍵情境，原本各自作業的專業知識領域，透過資源交換與整合的過程，產生具有意義的互動，創造個別與共同的價值。當相互依賴的強度增加，就會不斷增加彼此共同合作的機會，形成一個價值生態系統，有效發揮醫療品質管理的價值。

本研究結果表明，醫病共享決策制度提供了一個良好的概念思維，讓醫療人員透過執行經驗的累積，將其精神融入臨床作業當中，為確保有效運作，管理單位重視病人的個人價值和醫療人員的群體價值。透過「服務」的觀點，為研究個案提供強化以人為本概念思維的理論基礎，價值共創的概念能夠實踐「以病人為中心」的醫療照護。醫療品質為醫療價值的起點，醫療品質是由醫療從業人員的行為所產生，而醫療價值是由病人或家屬所判定的；透過重新定義醫療品質與價值的提供方式，可以作為未來管理者推動醫療品質相關計畫時思考的重要面向。

Shared decision making (SDM) has achieved patient-centered and patient engagement strategies that have been advocated for a long period of time. Patients make up for individual values that cannot achieved in evidence-based medicine (EBM) through medical decision making. In this study, case study research in qualitative research was used to examine the process of promoting SDM in a regional teaching hospital the perspective of service-dominant logic was used to analyze the critical scenarios between service systems in which originally independent professional knowledge fields generate meaningful interactions through resource exchange and integration to create individual and common values. These values constitute a value ecosystem to utilize the value of medical quality management. The service viewpoint was used to provide theoretical bases for enhancing people-oriented concept for study cases.

The results of this study showed that internal co-creation must be first carried out for effective SDM. Internal co-creation is not a top-down task assigned by the management, resource provision, or management by objective (MBO) but is rather a focus on the needs of the collaboration partners, exchanging and integrating each other’s resources, to jointly solve each other’s problems. Medical staff incorporates the spirit of SDM in other clinical operations through accumulating SDM experience. Therefore, in the medical industry that is highly dependent on manpower, stable manpower is essential for improving quality and population value can only be created by decreasing interaction breaks.

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