醫院策略強調對醫師專業自主影響之跨層次分析：層級線性模式的應用_

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題名：	醫院策略強調對醫師專業自主影響之跨層次分析：層級線性模式的應用
書刊名：	人力資源管理學報
作者：	汪秀玲／黃俊英
作者(外文)：	Wang, Hsiu-ling／Huang, Jun-ying
出版日期：	2010
卷期：	10:4
頁次：	頁33-54
主題關鍵詞：	專業自主；策略強調；報償誘因；跨層次研究；層級線性模式；Professional autonomy；Strategic emphasis；Compensation incentive；Cross-level research；Hierarchical linear modeling
原始連結：	連回原系統網址
相關次數：	被引用次數:期刊(2) 博士論文(0) 專書(0) 專書論文(0) 排除自我引用:2 共同引用:197 點閱:45

目標：從系絡觀點檢視台灣導入總額支付制度後，醫院策略強調對醫師專業自主之衝擊。材料與方法：針對參加自主管理方案245家醫院，便利抽樣84家區域級以上醫院，於2008年發出84份主管問卷和1,280份醫師問卷，採暗記方式將隸屬同一醫院的醫師予以彙總，有效樣本計43份主管及409份醫師資料，代表醫院和醫師回收率爲51.19%、31.95%。結果：專業自主四個次向度（管理監督、掌控處置、組織地位及工作負荷）的層級線性模式分析顯示，當醫院執行成本抑制策略，對醫師感受管理監督有正向系絡直接影響(0.179, p<.01)，對掌控醫療處置及地位的感受有負向系絡直接影響(-0.191, -0.096, p<.05)，反之，收入創造策略對三個次向度則有相反方向的系絡效果(-0.103, 0.130, 0.174, p<.05)。風險承擔的變動報償會增加管理監督感受但未達顯著水準(0.189, p>.05)，層級別（醫學中心vs.區域醫院）對工作負荷(0.117, p<.05)，健保區域別（北部vs.其他）對掌控醫療處置(-0.362, p<.05)皆有系絡效果。個體層次變項中，專科別、教育程度對自主感受有預測效果。整體而言，個體層次變項解釋專業自主12.89%-30.98%群內變異，組織層次變項解釋55.20%-75.37%群間變異。結論：本文實證組織系絡會形塑醫師自主的感受，也不應忽視個人特徵的影響。

以文找文

Objectives. To examine the contextual effects of hospital strategic emphasis on physician professional autonomy after Hospital Global Budgeting (HGB) implemented. Methods. We chose 84 teaching hospitals participated at the HGB and sent survey packages to these hospitals in 2008. Each package contained copies of physician questionnaire and a manager questionnaire. A total of 409 usable physician surveys and 43 manager surveys were analyzed, a number representing approximate response rates of 51.19 percent for the hospitals and 31.95 percent for the physicians. We conducted hierarchical linear modeling using individual reported autonomy as the outcome variable. Results. Implementation of cost containment strategy increased physician's recognition of administrative supervision, and decreased physician's control over his/her work and status in hospital (0.179, p<.01; -0.191, p<.05; -0.096, p<.05), whereas a strategy of revenue generation disclosed reverse influence on above-mentioned perceptions (-0.103, 0.130, 0.174, p<.05). The variable compensation level based on risk taking leads to physicians perceived administrative restrictions but not significantly (0.189, p>.05). Also, the hospital rank and location had a contextual effect on physician's work loading and control treatment separately (0.117, -0.326, p<.05). At the individual level of analysis, our findings show that physician's specialty and education degree also had a significant impact on their perceived autonomy. Overall, the individual-level factors explained 12.89%-30.98% within-hospital variance on autonomy and hospital-level factors explained 55.20%-75.37% between-hospital variance. Conclusions. We demonstrated that organizational factors have a significant cross-level influence on physician’s perceptions of professional autonomy.

以文找文

期刊論文
1.	Meyers-Levy, Joan、Sternthal, Brian(1993)。A Two-Factor Explanation of Assimilation and Contrast Effects。Journal of Marketing Research，30(3)，359-368。
2.	黃國哲、陳怡樺、張蕙芝、張雅容、溫信財、邱瓊萱(20070800)。總額支付制度實施後醫院的適應策略分析。臺灣公共衛生雜誌，26(4)，283-291。延伸查詢
3.	Robinson, J. C.(2001)。Theory and Practice in the Design of Physician Payment Incentives。The Milbank Quarterly，79(2)，149-177。
4.	莊念慈、黃國哲、許怡欣、郭乃文、魏中仁(20040400)。醫院因應總額支付制度之策略方案及其相關因素探討。臺灣公共衛生雜誌，23(2)，150-158。延伸查詢
5.	吳文祥、林進財、彭廣興(20090600)。醫院因應總額預算支付制度之適應策略評選--以新竹市醫院為例。健康管理學刊，7(1)，79-92。延伸查詢
6.	Ferron, J.、Dailey, R. F.、Yi, Q.(2002)。Effects of Misspecifying the First-level Error Structure in Twolevel Models of Change。Multivariate Behavioral Research，37(3)，379-403。
7.	Sharma, A.(1997)。Professional as Agent: Knowledge Asymmetry in Agency Exchange。The Academy of Management Review，22(3)，758-798。
8.	汪秀玲、黃俊英(20060600)。醫院內醫師報償契約設計--代理、交易成本、資源依賴及制度理論之詮釋。醫院，39(3)，28-39。延伸查詢
9.	Robinson, William S.(1950)。Ecological Correlations and the Behavior of Individuals。American Sociological Review，15(3)，351-357。
10.	Vancouver, J. B.、Millsap, R. E.、Peters, P. A.(1994)。Multilevel analysis of organizational goal congruence。Journal of Applied Psychology，79(5)，666-679。
11.	MacCallum, R. C.、Austin, J. T.(2000)。Applications of structural equation modeling in psychological research。Annual Review of Psychology，51(1)，201-226。
12.	Liao, H.、Chuang, A.(2004)。A multilevel investigation of factors influencing employee serviced performance and customer outcomes。Academy of Management Journal，47(1)，41-58。
13.	Conrad, D. A.、Sales, A.、Liang, S. Y.(2002)。The Impact of Financial Incentives on Physician Productivity in Medical Groups。Health Services Research，37，885-906。
14.	Klein, Katherine J.、Kozlowski, Steve W. J.(2000)。From micro to meso: Critical steps in conceptualizing and conducting multilevel research。Organizational Research Methods，3(3)，211-236。
15.	Fornell, Claes、Larcker, David F.(1981)。Evaluating Structural Equation Models with Unobservable Variables and Measurement Error。Journal of Marketing Research，18(1)，39-50。
16.	邱皓政、溫福星(20070300)。脈絡效果的階層線性模型分析：以學校組織創新氣氛與教師創意表現為例。教育與心理研究，30(1)，1-35。延伸查詢
17.	林鉦棽、彭台光(20061200)。多層次管理研究：分析層次的概念、理論和方法。管理學報，23(6)，649-675。延伸查詢
18.	Hofmann, D. A.(1997)。An overview of the logic and rational of hierarchical linear models。Journal of Management，23(6)，723-744。
19.	Hinkin, Timophy R.(1998)。A Brief Tutorial on the Development of Measures for Use in Survey Questionnaire。Organizational Research Methods，1(1)，104-121。
20.	Benstetter, F.、Wambach, A.(2006)。The treadmill effect in a fixed budget system。Journal of Health Economics，25，146-169。
21.	Burdi, M. D.、Baker, L. C.(1999)。Physicians' perceptions of autonomy and satisfaction in California。Health Affairs，18，134-145。
22.	Caronna, C. A.(2004)。The misalignment of institutional 'pillars': Consequences for the U. S. health care field。Journal of Health and Social Behavior，45(Extra Issue)，45-59。
23.	Alexander, J. A.、Hearld, L. R.、Jiang, H. J.、Fraser, I.(2007)。Increasing the relevance of research to health r care managers: Hospital CEO imperatives for improving quality and lowering costs。Health Care Management Review，32，150-161。
24.	Balotsky, E. R.(2005)。Is it resources, habit or both: Interpreting twenty years of hospital strategic response to prospective payment。Health Care Management Review，30，337-346。
25.	Curran, P. J.(2003)。Have multilevel models been structural equation models all along?。Multivariate Behavioral Research，38，529-569。
26.	Harrison, S.、Ahmad, W. I. U.(2000)。Medical autonomy and the UK state 1975 to 2025。Sociology，34，129-146。
27.	Kurunmaki, L.(2004)。A hybrid profession -- The acquisition of management accounting expertise by medical professionals。Accounting, Organizations and Society，29，327-347。
28.	Langfred, C. W.(2000)。The paradox of self-management: Individual and group autonomy in work groups。Journal of Organizational Behavior，21，563-585。
29.	Langfred, C. W.(2007)。The downside of self-management: A longitudinal study of the effects of conflict on trust, autonomy, and task interdependence in self-managing teams。Academy of Management Journal，50，885-900。
30.	Lewis, J. M.、Marjoribanks, T.(2003)。The impact of financial constraints and incentives on professional autonomy。The International Journal of Health Planning and Management，18，49-61。
31.	Harrison, S.、Dowswell, G.(2002)。Autonomy and bureaucratic accountability in primary care: What English general practitioners say。Sociology of Health & Illness，24，208-226。
32.	Doolin, B.(2002)。Enterprise discourse, professional identity and the organizational control of hospital clinicians。Organization Studies，23(3)，369-390。
33.	Kitchener, M.、Caronna, C. A.、Shortell, S. M.(2005)。From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems。Social Science &. Medicine，60，1311-1322。
34.	Gross, Revital、Tabenkin, Hava、Brammli-Greenberg, Shuli(2007)。Factors affecting primary care physicians' perceptions of health system reform in Israel: Professional autonomy versus organizational affiliation。Social Science & Medicine，64(7)，1450-1462。
35.	Hadley, J.、Mitchell, J. M.(2002)。The growth of managed care and changes in physicians' incomes, autonomy, and satisfaction, 1991-1997。International Journal of Health Care Finance and Economics，2，1991-1997。
36.	Ezzamel, M.、Burns, J.(2005)。Professional competition, economic value added and management control strategies。Organization Studies，26，755-777。
37.	Floyd, S. W.、Kramer, J. A.、Born, P. H.(2005)。Institutional forces in the acceptance of managed care practices by physicians。Health Care Management Review，30，237-250。
38.	Marjoribanks, T.、Lewis, J. M.(2003)。Reform and autonomy: Perceptions of the Australian general practice community。Social Science &. Medicine，56(10)，2229-2239。
39.	Holmstrom, B.、Milgrom, P.(1991)。Multitask principal-agent analyses: Incentive contracts, asset ownership, and job design。Journal of Law, Economics, and Ownership，7(Special Issue)，24-52。
40.	Reschovsky, J. D.、Hadley, J.、Landon, B. E.(2006)。The effects of compensation methods and physician group structure on physicians' perceived incentives to alter services to patients。Health Services Research，41，1200-1220。
41.	Hsiao, W. C.(2008)。When incentives and professionalism collide。Health Affairs，27，949-951。
42.	McClellan, M.(1997)。Hospital reimbursement incentives: An empirical analysis。Journal of Economics & Management Strategy，6，91-128。
43.	Kenny, D.、Adamson, B.(1992)。Medicine and the health professions: Issues of dominance, autonomy and authority。Australian Health Review，15，319-334。
44.	McKinlay, J. B.、Stoeckle, J. D.(1988)。Corporatization and the social transformation of doctoring。International Journal of Health Services: Planning, Administration, Evaluation，18，191-205。
45.	Kilic, M.、Arslan, M.、Leblebici, D. N.、Aydin, M. D.、Oktem, M. K.(2008)。Managerial control vs professional autonomy: An empirical study on perceptions and expectations of physicians at teaching hospitals in Turkey。Journal of Medical Systems，32，157-165。
46.	Ye, J.、Marinova, D.、Singh, J.(2007)。Strategic change implementation and performance loss in the front lines。Journal of Marketing，71(4)，156-171。
47.	Mittal, V.、Anderson, E. W.、Sayrak, A.、Tadikamalla, P.(2005)。Dual emphasis and the long-term financial impact of customer satisfaction。Marketing Science，24(4)，544-555。
48.	Wickizer, T. M.、Lessler, D.(2002)。Utilization management: Issues, effects, and future prospects。Annual Review of Public Health，23(1)，233-254。
49.	Prechel, H.、Gupman, A.(1995)。Changing economic conditions and their effects on professional autonomy: An analysis of family practitioners and oncologists。Sociological Forum，10，245-271。
50.	Rust, R. T.、Moorman, C.、Dickson, P. R.(2002)。Getting return on quality: Revenue expansion, cost reduction, or both?。Journal of Marketing，66(4)，7-24。
51.	Sacchini, D.、Leonardo, A.(2000)。The professional autonomy of the medical doctor in Italy。Theoretical Medicine，21，441-456。
52.	Samuel, S.、Dirsmith, M. W.、McElroy, B.(2005)。Monetized medicine: From the physical to the fiscal。Accounting, Organizations and Society，30，249-278。
53.	Schlesinger, M. J.、Gray, B. H.、Perreira, K. M.(1997)。Medical professionalism under managed care: The pros and cons of utilization review。Health Affairs，16(1)，106-124。
54.	Schulz, R.、Harrison, S.(1986)。Physician autonomy in the Federal Republic of Germany, Great Britain, and the United States。The International Journal of Health Planning and Management，1，335-355。
55.	Shen, J.、Andersen, R.、Brook, R.、Kominski, G.、Albert, P. S.、Wenger, N.(2004)。The effects of payment method on clinical decision-making。Medical Care，42，297-302。
56.	Stoddard, J. J.、Hargraves, J. L.、Reed, M.、Vratil, A.(2001)。Managed care, professional autonomy, and income: Effects on physician career satisfaction。Journal of General Internal Medicine，16，675-684。
57.	Warren, M. G.、Weitz, R.、Kulis, S.(1998)。Physician satisfaction in a changing health care environment: The impact of challenges to professional autonomy, authority, and dominance。Journal of Health and Social Behavior，39，356-367。
58.	Wynia, M. K.、Latham, S. R.、Kao, A. C.、Berg, J. W.、Emanuel, L. L.(1999)。Medical professionalism in society。The New England Journal of Medicine，341，1612-1616。

學位論文
1.	陳宏恩(2005)。醫院醫療資源耗用管理及醫師醫療自主性對主治醫師工作生涯滿意度相關性之探討。國立台灣大學。延伸查詢
2.	鄭瑛琳(2004)。台灣醫院西醫師執業之專業權與生涯滿意度探討。中國醫藥大學。延伸查詢

圖書
1.	Fiske, S. T.、Taylor, S. E.(2007)。Social cognition: From brains to culture。New York：McGraw-Hill。
2.	Freidson, Eliot(1994)。Professionalism reborn: Theory, prophecy, and policy。The University of Chicago Press。
3.	Kreft, Ita G. G.、De Leeuw, Jan(1998)。Introducing Multilevel Modeling。Sage。
4.	Raudenbush, Stephen W.、Bryk, Anthony S.(2002)。Hierarchical linear models: Applications and data analysis methods。Sage。

圖書論文
1.	Hofmann, D. A.、Griffin, M. A.、Gavin, M. B.(2000)。The application of hierarchical linear modeling to organizational research。Multilevel theory, research, and methods in organizations。San Francisco, CA：Jossey-Bass。
2.	Luke, R. D.、Walston, S. L.(2003)。Strategy in an institutional environment: Lessons learned from 1990s 'revolution' in health care。Advances in health care organization theory。San Francisco：Jossey-Bass。

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