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題名:醫院組織治理結構、決策行為及決策產出關係之研究
作者:盧介祥
作者(外文):Lu,CHIEH-HSIANG
校院名稱:國立中正大學
系所名稱:企業管理系研究所
指導教授:鍾憲瑞
學位類別:博士
出版日期:2018
主題關鍵詞:治理組織決策
原始連結:連回原系統網址new window
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近年來由於台灣醫療環境的快速變遷、以及民眾對醫療服務品質要求日漸提高,醫院經營管理在外部環境除了要面對醫療技術上的要求外,還需因應同業競爭以及醫療保險給付體制等課題的挑戰;另一方面,醫院的內部管理,也必須面對組織持續擴大的發展計畫而會使組織在功能設計上日漸複雜,這些事務使得醫院管理者必須面臨來自內部管理與外在環境兩方面壓力的挑戰。由於醫院組織在社會上的獨特地位,這樣的組織涵括了許多不同領域的利益相關人,例如具有高度自主性的專業醫療人士以及一般的行政事務人員,而且通常缺乏明確的商業目的。公司組織和治理的準則如果轉換到醫院的組織和治理上就需要經過特別小心的調整,故現今所發展的公司治理模式有多少價值可以用來反映醫院的治理模式,是值得思考的議題。縱使兩者的脈絡相當的差異性,但是現有公司的組織和治理理論架構仍然可以提供醫院治理有完整的參考價值。醫院組織面對的體制、及組織本身的治理,會影響到組織因應內外部環境挑戰的能力,醫院組織在面對醫療收入以及醫療品質的衝突時如何來做衡量和調整因應,實為值得探討的議題。醫院的經營管理除了經濟動機外,也受到社會動機和成就動機的驅動。本研究認為欲促使醫療經營管理達成正確決策,必須要探討醫療企業決策架構與決策過程中應考量之變數,如道德倫理問題情境等價值判斷列入決策參考。
本研究發現台灣存在宗教意識主導、市場意識主導、科層主導等多種類型的醫院組織體制,這些不同種類的醫院體制,對於決策制訂過程及產出的影響,是相當複雜的。既有直接的影響、也存在著中介的影響、更有調節因素的作用。
醫院組織體制對於醫院的營運會造成系統性的影響,本研究對此進行了細部的剖析,發現宗教意識主導的專業組織,比起市場主導的專業組織,會更容忍無利潤的服務。由此可以了解到宗教體系創立的醫院都是由服務和傳愛出發,照顧弱勢族群與服務偏鄉為主。過去有信徒、教友和教會的奉獻支持,現在則受到外在健保環境的影響,或許服務的層面會縮減但是其基本精神仍然不變。另外,宗教意識主導的專業組織,比起科層主導的專業組織,會更重視以專業服務建立品牌形象。對於組織的道德規範和品牌形象的建立會有更高的要求。有認同綜效的醫院組織,對於願景、宗旨、經營策略、組織文化有較高的共識,所以在晉升的部分較易由內部選材進用。高體制綜效的專業型組織,採取預應式策略的可能性較高。對於政策的延續性較高,對於環境變化的衝擊影響也都有做長期的觀察和預測的機制,故而採取預應式策略的可能性較高。
本研究有以下幾項限制:1.本研究採用質性研究法,以深度訪談之方式進行調查,但在醫院的選取上尚未跨及公立醫療體系,故在普遍性方面可能不足。2.本研究以個案研究法進行,並受限於時間、人力與物力,僅能選擇數個醫院的高階治理團隊的部分成員進行訪談,並加以歸納、推理。3.在台灣的醫療制度中健保是最大醫療保險體制,幾乎涵蓋台灣超過九成九以上的醫療機構。對於醫療環境限制以及反應的同質性較高,與其他產業一般常面臨之各種不同的環境以及制度面的風險明顯不同,也與其他國家的醫療機構所面臨的環境和制度不同。故建議後續研究可將之納入研究範圍中,以詳加探討因應不同環境與制度面的差異所需的策略,為更多的醫療機構國際化提供建議。
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