管理主義下的醫務社會工作專業之研究

The Impact of Managerialism on Medical Social Work in Taiwan

侯建州(Chien-Chou Hou)

指導教授 ： 黃源協

國立暨南國際大學/人文學院/社會政策與社會工作學系/博士(2017年)

摘要

1970年代的石油危機與1980年代後的經濟動盪，形成了管理主義的思潮，其亦影響健康照顧領域，故醫務社會工作也難以迴避。然在績效邏輯、市場原則下，醫務社會工作受影響的面貌為何？醫務社會工作又是如何回應？醫務社會工作該如何定位？此些為本研究之目的。本研究採質化研究取向，針對5個研究個案醫院分別訪談醫院主管、社工主管、社工人員3種成員，再加上3位社會工作專業團體成員，共計18位受訪者。
本研究發現，管理主義對於醫務社會工作的影響有：（1）財務成本面（如員額控管等影響）、（2）管理制度面（如顧客導向、績效管理等影響）、（3）專業臨床面（如專業者間的期待落差、自由裁量權受限等影響）。
醫務社會工作對上述影響之回應策略包括：（1）積極模式：以醫院的一員自居、採取自我績效要求、發揮專業能力、運用管理主義的邏輯、穩固社工內部、拉大參與格局、釐清相同處、種下改變的種子等策略；（2）消極模式：避開壓力感、轉嫁壓力值、合理化必然性等策略。
基於研究發現，本研究建議包含：（1）社會工作人力方面（如結合醫院利益考量來倡導醫務社會工作人力之增聘）、（2）專業臨床與醫療團隊方面（研發管理主義下所需的社會工作專業能力）、（3）養成教育方面（如加入管理主義相關單元於醫務社會工作養成教育中）、（4）專業組織與政策倡導方面（如繼續運用專業組織能量來規範醫務社會工作的服務內容）、（5）專業發展與自我定位方面（如決定醫務社會工作未來的發展路線）。

關鍵字

醫務社會工作 ； 管理主義 ； 專業主義 ； 社會工作專業發展 ； 健康照顧

並列摘要

Managerialism had appeared since the Oil Crisis in the1970s and the unstable economy after the 1980s. Managerialism then affected the health care, as well as the medical social work. However, based on the performance logic and the market principle, this study intents to explore what the situation of medical social work is under the impact of managerialism. Also, how should the medical workers cope with it? What are the positions of the medical work? These are the objectives of this research. This dissertation is a qualitative study that researches into five hospitals as the cases. Eighteen interviews were conducted during the research. There were fifteen interviewees from the hospitals, which included the hospital director, the social work director, and the social worker in each hospital. In addition, another three members from the professional social work organizations were chosen to be interviewed.
This research shows that managerialism affects medical social work in three dimensions: (1)financial and cost, (2)management strategies, and (3)professional practice.
The research concludes the findings with two models with which the medical social workers and social work directors use to react the impact of managerialism. The first model is the Positive Model. It includes identifying oneself as the hospital member, working hard for performance management, performing professional abilities, utilizing managerialism logic, caring social work department, broadening their vision, distinguish the common elements, and cultivating opportunities for change. The other one is the Passive Model. It refers to avoiding the pressure, transferring the pressure, and rationalizing the inevitable situations.
According to the research results, this dissertation offers some suggestions in five dimensions: (1)the number of social worker, (2)professional practice and medical teams, (3)education, (4) professional organization and policy advocacy, and (5)professional development and self-positioning.

並列關鍵字

medical social work ； managerialism ； professionalism ； social work development ； health care

參考文獻

中文部分

丁時達等（2004）。紮根理論研究。於潘慧玲（編），教育研究的取徑：概念與應用（頁297-328）。臺北：高等教育。

中華民國社會工作師公會全國聯合會（2006）。社會工作倫理守則。http://nusw.warehouse.com.tw/html/front/bin/ptdetail.phtml?Part=news_970528。上網日期：2008/12/08。

中華民國社會工作師公會全國聯合會（2008）。任務。http://nusw.warehouse.com.tw/html/front/bin/ptlist.phtml?Category=100967。上網日期：2008-12-08。

中華民國醫務社會工作協會（2008）。宗旨及任務。http://www.mswa.org.tw/about/purpose.htm。上網日期：2008-08-13。