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  • 學位論文

公立醫院組織變革系統分析-個案研究

System Analysis on Organizational Change in a Public Hospital:A Case Study

指導教授 : 黃英家
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摘要


本研究針對個案醫院進行了資料收集與深度訪談,試圖全面性挖掘個案醫院組織變革內容與績效表現,藉以將組織變革與績效結合,找出其中的相關性,同時研究組織變革的相關內涵。 結果發現組織變革過程中存在一段關鍵時期,這個關鍵時期對之後醫院的組織變革方向與確立組織目標產生重要的影響;而有了明確的組織目標是該醫院日後組織變革成功的重要基礎。在組織變革的類型上,有三種類型配合著組織目標同時並存在於變革過程當中,它們分別是「產品、服務及科技」、「策略與結構」、「人員與文化」。而本研究分析認為「策略與結構」的變革是組織變革的主要力量,藉此對其他的變革類型產生良好的控管。 另外,在研究中也發現「個案醫院領導人的特質」以及「個案醫院與其總院之間的合作機制」對該醫院的組織變革也有關鍵性的影響,它們影響了組織變革腳步與醫師人力資源的可取得性。相對地,在變革阻力方面,由於關鍵時期確立目標的良好基礎,以及接手前後的經營者權屬都同是公家體系,使得前身醫院內部固有成員對於接管者所推動的組織變革阻力較小;但由於組織變革結果涉及當地醫療市場的競爭,相對於內部變革阻力而言,反而外部對於該院組織變革的阻力較大。 個案醫院在啟動組織變革後的績效表現上,資料顯示服務量逐年提升,雖然病患滿意度尚未達到適當的水準,但相當程度上已經改變了當地民眾的就醫選擇。另外透過資料包絡分析,我們發現在醫師與病床投入數與服務量產出年度相對效率兩方面有逐年提高的趨勢,但在護理人員投入效率表現方面則較為不佳。 在組織變革與績效表現相關性來看,「產品與服務及科技變革」對服務量增加有正相關,而「人員與文化變革」的內容有效支持著「產品與服務及科技變革」的內容,而透過「策略與結構變革」的內容可以對以上兩類變革做有效的控管,所以推論變革內容與績效表現存在直接或間接相關。

並列摘要


This study analyses organizational change of a public hospital in central Taiwan. We interviewed the key men and collected necessary data systematically for getting a holistic view of organizational change and administrative performance of the observed hospital. The results and conclusions reveals as below. First, the observed hospital had a critical time in its organizational change period, which was very helpful to set up the organizational goal and to adjust its direction. Second, beyond product/service/technology change and personnel/culture change, strategy/structure change was the major force that impelled the organizational change. And it also directed the above two kinds of change forces when the hospital ownership was transformed from a provincial one to the recent one. Based on the personnel/culture change, the product/service change made the medical service more. Third, because of maintaining the public hospital ownership, there is little reluctance to the change among the original personnel. But there are more obstacles among the outside stakeholders, due to the impact of the local medical service market. Fourth, the observed hospital leader’s characteristics and his position in the university hospital cooperation system both influence the accessibility of the physician manpower, and they are also key successful factors of organizational change. . Fifth, according to the increasing medical service, the performance after the organizational change becomes better and better. Although it is not good enough in the customer satisfaction, more and more local patients ask for the service of the observed hospital now. Using data envelope analysis, we found that the relative efficiency getting better year by year for the input of physicians or beds, but not nurses.

參考文獻


蔡文正、龔佩珍(2003)。提升公立醫院經營績效與評估指標之研究(行
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