財團法人醫院組織文化、領導型態與財務績效之相關探討

The Relationship of Organizational Culture and Leadership Style with Financial Performance among Foundation Hospitals

林美吟(Mei-Yin Lin)

指導教授 ： 陳金淵

長榮大學/健康科學學院/醫務管理學研究所/碩士(2009年)

摘要

目的： 國內財團法人醫院數量約占全國私立醫院之15%，而病床數、醫事人員及醫療服務量卻占過半，顯見其在我國醫療服務的提供體系中扮演著重要之角色。值此全民健保支付制度趨於嚴謹之際，其營運績效亦當受到嚴峻考驗，而其營運績效是否一如其它產業機構般受到組織文化與領導風格之影響，目前尚無相關研究可供參考。
本研究以國內財團法人醫院為對象，探索其領導型態與組織文化模式，並進一步檢測領導型態及組織文化模式二者與醫院財務績效表現之相關性，期冀所得結果能提供醫院管理者作為經營策略上之參考。

方法： 本研究為橫斷性研究設計，研究對象為國內69家財團法人醫院。透過問卷調查法收集醫院之基本資料、領導型態與組織文化等資料。領導型態之評量採用MLQ-5X簡式量表，分為轉換型領導與交易型領導二大類別；組織文化之評量可分為組織認同、創新發展、嚴格監督與年資長老文化等四構面。財務績效表現則使用行政院衛生署網站公告之54家「財團法人醫院財務指標」資料。經排除專科醫院（3家）、診所（2家）、安養機構（1家）、未有醫療收入（6家）及未公告財務指標資料（11家）之機構後，計有31家醫院為問卷發放對象。所得資料以SPSS統計軟體進行資料描述、差異性及相關性檢測與複迴歸模式建立。

結果： 問卷回收占發放家數之93.5％（29家）。在財務績效方面，「醫院層級」、「醫院屬性」之變項分別對「藥品成本占醫療成本比率」、「財務槓桿度」有顯著影響。
領導型態方面，以平均分數區分屬於「高轉換（18家）、低交易（20家）」型態居多數。「高轉換型」醫院之「人事成本占醫療成本比率」低於「低轉換型」醫院。「交易型領導」、「權變獎賞」分別與「流動比」具中度相關（r＝0.42、0.51）。
組織文化方面，「組織認同」與「財務槓桿度」、「現金流量比」有中度相關（r＝0.39、r＝0.48），「創新發展」、「嚴格監督」與「資產報酬率」有中度相關（r＝0.39、r＝0.37）。
組織文化之「組織認同」、「創新發展」、「嚴格監督」與轉換型領導達到中度相關性。

結論與建議： 在本研究之財團法人醫院族群中，醫院領導型態與組織文化在不同醫院層級與屬性間無顯著差異性。如欲提昇財務績效，醫學中心之經營管理者應在藥品成本多加管控，以降低醫院經營成本；屬宗教型醫院者，宜謹慎運用財務槓桿度以維持財務結構之穩定。在領導型態方面，建議轉換型與交易型領導並行，以應付不同的管理情境。至於組織文化方面，宜強調組織認同、創新發展與嚴格監督等構面，不鼓勵年資長老文化，醫院組織宜以穩固的醫院文化面對外界環境的變化。

關鍵字

領導型態 ； 組織文化 ； 財務績效 ； 財團法人醫院

並列摘要

Objective: The number of foundation hospitals accounts for about 15% of the total number of private hospitals in Taiwan, while their number of beds, medical personnel and medical services contribute more than half in volume, showing that foundation hospitals play an important role in our healthcare system. As the National Health Insurance payment system has become restricted, the operational performance of hospitals becomes more challenging too. However, there are limited studies examining whether organizational culture and leadership style have impact on healthcare provider performance as in other industries.

The subjects of the study are foundation hospitals in Taiwan. We explored their leadership style and organizational culture to further test the relevance of these two factors and hospital financial performance, with the hope that the results can provide hospital administration with valuable management strategies.

Methods: The study was cross-sectional in design with a sample of 69 foundation hospitals in Taiwan. Survey questionnaires were used to collect basic information on hospitals, their leadership style and organizational culture. The Multifactor Leadership Questionnaire (MLQ-5X/Short Form) was used to assess the leadership style by dividing the categories into transformational leadership and transactional leadership; the organizational culture assessment was categorized into four main areas comprising organizational identification, innovation and development, strict supervision, and long length of employment. Financial performance was evaluated according to the information "financial indicators of 54 foundation hospitals” published online by the Department of Health, Executive Yuan. After excluding specialized hospitals (3), private clinics (2), nursing home (1), institutions with no medical income (6), and organizations with undisclosed accounting data and financial indicators (11), 31 hospitals were included in the study and subjected to the questionnaire. Data were analyzed using SPSS statistical software to perform data description, detect relevance and differences, and construct multiple regression models.

Results: A total of 29 hospitals returned the questionnaire, representing an overall response rate of 93.5%. In financial performance, " Hospital level" and "Hospital property" of the variables have a significant impact on the "Ratio of drug cost to medical cost " and "Degree of financial leverage", respectively.

In leadership style, " High transformation (18), low transaction (20)" occupies a majority of the leadership behaviors as determined by the average score. Transactional leadership and "Contingent Reward" show a moderate correlation with "Current Ratio" (r = 0.42, r = 0.51).

In organizational culture, "Organizational identification" has a moderate correlation with "Degree of financial leverage" and "Cash flow ratio" (r = 0.39, r = 0.48); "Innovation and development" and "Strict supervision" has that with "Return On Investment " (r = 0.39, r = 0.37). In addition, "Organizational identification", "Innovation and development" and "Strict supervision" have correlation coefficient of 0.60 (p<0.001), 0.37 (p<0.05), and 0.54 (p<0.001), respectively, with "transformational leadership".

Conclusions and recommendations: In the study group of foundation hospitals, there is no significant difference between the properties of hospital leadership style and organizational culture in different hospital levels. In order to enhance financial performance, medical center management should take a proactive approach in controlling drug cost for the reduction of operating cost. Non-religious hospitals can take advantage of the financial leverage to enhance organizational effectiveness. In leadership style, we suggest a parallel adoption of transformational and transactional leadership to adapt to various management situations. As for the organizational culture, the dimensions of organizational identification, innovation and development, and strict supervision should be emphasized, while long length of employment could be less encouraged. Thus, hospitals would have strong leadership and culture to respond to fast changing medical environment.

並列關鍵字

leadership style ； organizational culture ； financial performance ； foundation hospitals

參考文獻

王美慧、陳瑞龍、林憬、江克儉（2005）。醫療績效衡量之研究－花蓮某區域醫院為例。顧客滿以度學刊，1（2），107-130。

吳萬益、郭幸萍、彭奕龍（2002）。 醫學中心組織文化、管理模式、競爭優勢與經營績效之互動關係影響研究。台灣醫務管理期刊，3(3) ，17-37。

董林洲（2006）。領導型態、組織文化、工作環境與經營績效之關係研究-以台灣區傳統汽機車相關產業及光電產業為例。國立成功大學高階管理碩士在職專班碩士論文。

蔡富川（2008）。透析中心護理主管領導風格與經營績效及醫療品質之相關探討。長榮大學所碩士論文。

陳富強、方顯光、劉世彥（2007）。探討國防主財人員對領導型態、組織文化、工作滿意與組織承諾關聯性之認知。多國籍企業管理評論，1（2），67-86。