非營利組織策略制定過程之研究—從長期照顧1.0到長期照顧2.0

本研究焦點在於長期照顧1.0到長期照顧2.0的制度變化，對非營利組織的策略制定過程及其決策受到的影響及效應進行探討，基於建構論研究哲學典範，本研究採取質性研究方法，針對八家非營利組織及11位的關鍵決策者進行訪談。資料分析發現，長期照顧制度環境直接影響組織內部環境，以及彼此交互作用之下，非營利組織內部的組織管理及策略制定過程，確實開始產生變化，並存在一些現象。研究主要發現如下：一、首先是關於非營利組織策略管理的現況。屬地色彩的地區型非營利組織，比較少採取正式的策略制定程序，不過在長期照顧2.0實行後，管理階層主觀感知環境的變化，於此同時，組織內部對於正式的策略制定程序的需求性也開始浮現，而當非營利組織擁有足夠的管理階層人力與參與，對建立正式性策略制定程序是有所幫助的。不過，關於策略制定過程與決策，組織內部溝通面向及訊息回饋機制仍然有待建立。二、長期照顧制度的改變，包括長期照顧制度環境之框架尚未完備，即容易產生長期照顧服務性質定位不清、採滾動式決策模式、中央與地方政府對法令的解讀不一致等等情況、長期照顧給付增加、長期照顧服務導入競爭機制，其結果對非營利組織策略制定、決策過程與組織管理產生正、反面的影響。三、非營利組織組織內部環境對外部環境產生反應，本研究依研究主題，四項關鍵要素，以瞭解長期照顧2.0對組織內部環境的影響，四項內部環境的關鍵要素分別為組織文化、組織結構、人力資源及領導者。首先，本研究發現經濟利益對非營利組織有吸引力，但原有組織文化對組織行為的影響力更大；其次，組織結構朝向複雜化、正式化及分權化的方向發展，不過發展尚不成熟，跟不上組織規模擴展的速度；第三，長期照顧人力召募困難，造成人力的排擠，卻也讓組織積極進行人事佈局；最後，民主領導風格，有利回應外部環境的變化，而非營利組織的特性對組織營運若越有益，如專業化程度高，董事會治理功能則越不易發揮，執行長將扮演主要領導者的角色及功能。四、非營利組織具體回應外部環境衝擊，透過積極參與制度推動聯盟，以取得有利資訊並擴大影響力，並透過服務差異化、市場區隔，來強化非營利組織本身的競爭力。根據上述研究發現，本研究針對與組織管理有關之建議，非營利組織應基於社會目的，儘量取得社會目的與經濟手段的協調與平衡、集眾組織之力，發展區域性聯盟，增加市場競爭及與政府對話的資本、非營利組織領導者應學習逐步放手、分散權力，並視實務需求使用權力、提升組織各層級管理者的管理知能，依需要採取企業化管理方式、掌握環境的各種訊息及可能趨勢、依需要將策略管理納入組織議程，定期確認策略行動與使命的一致性、建構完整的信息溝通機制及流程，及釐清董事長與執行長治理的職責，應予適當的授權。同時本研究亦給予政策一些建議：應清楚定位長期照顧服務的公共性、重新檢視並調整導入市場原則的問題與程序、加強公、私部門之溝通與重建溝通管道、並加強照顧服務員訓練，並重點發展與照顧相關的教育系統，以營造一個優質長期照顧制度環境。

關鍵字

非營利組織；策略管理；策略制定；策略制定過程；長照2.0

並列摘要

This study focuses on the impact of the system change from Long-term Care 1.0 to Long-term Care 2.0 on the strategy-making process and decision-making of non-profit organizations. Based on the research philosophy and paradigm of constructivism, this study adopts a qualitative research approach and interviews 8 non-profit organizations and 11 key decision makers. Analysis of the data reveals that the environment of the long-term care system directly affects the internal environment of an organization. Under the effect of their interaction, the organizational management and strategy-making process within the non-profit organization does begin to change, and some phenomena appear. The main findings of this study are as follows: 1.First, on the current state of strategic management of non-profit organizations. Regional non-profit organizations with a local flavor are less likely to adopt a formal strategy-making process. However, after the implementation of Long-term Care 2.0, the management level subjectively perceived changes in the environment, and at the same time, the need for a formal strategy-making process within the organization began to emerge. And when a non-profit organization has sufficient human resources and involvement on the management level, it is helpful to establish a formal strategy-making process. However, there is still a need to establish communication and feedback mechanisms within the organization regarding the strategy-making process and decision-making. 2.The changes in the long-term care system, including the incomplete framework of the environment of the long-term care system, may result in unclear positioning of the nature of long-term care services, the adoption of a rolling decision-making model, inconsistent interpretation of laws and regulations by the central and local governments, the increase in long-term care payments, and the introduction of competition mechanism into long-term care services, which may have both positive and negative effects on the strategy-making and decision-making process and organizational management of non-profit organizations. 3.The internal environment of nonprofit organizations reacts to the external environment. In this study, according to the topic of research, four key elements are examined to understand the impact of Long-term Care 2.0 on the internal environment of organizations. The four key elements of the internal environment are organizational culture, organizational structure, human resources, and leadership. Firstly, this study finds that economic benefits are attractive to non-profit organizations, but the original organizational culture has a greater influence on organizational behavior. Secondly, the organizational structure is developing towards the direction of complexity, formalization and decentralization, but the development is not mature enough to keep up with the expansion of the organization. Thirdly, the difficulty in recruiting workers for long-term care has led to ineffective use of workers, but it has also made organizations active in adjusting the arrangement of human resources. Lastly, a democratic leadership style is conducive to responding to changes in the external environment. The more the characteristics of a non-profit organization are beneficial to the operation of the organization, such as a high degree of professionalism, the less likely it is that the board of directors will perform its governance function, and the CEO will play the role and function of the primary leader. 4.Non-profit organizations respond concretely to the impact of the external environment. By actively participating in alliances to promote certain systems, organizations obtain favorable information and expand their influence. Through service differentiation and market segmentation, non-profit organizations strengthen their own competitiveness. Based on the above research findings, the study recommends that non-profit organizations should base themselves firmly on their social objectives and try to achieve a balance between social objectives and economic means. The efforts of all organizations should be pooled together to develop regional alliances and increase their capital for market competition and dialogue with the government. Leaders of non-profit organizations should learn to gradually let go of and decentralize power, using power according to practical needs. Organizations should also enhance the management knowledge of managers at all levels of the organization, adopt an entrepreneurial approach according to needs, keep abreast of various information and possible trends in the environment, incorporate strategic management into the organization’s agenda according to needs, regularly confirm the consistency of strategic actions with the organization’s mission, and establish a complete information communication mechanism and process. The responsibilities of the chairman of the board of directors and CEO should be clarified, and appropriate authority should be given to them. This study also offers some policy recommendations: the public nature of long-term care services should be clearly defined, the problems and procedures of introducing market principles should be re-examined and adjusted, the communication between public and private sectors should be strengthened and the communication channels should be rebuilt, and the training of caregivers should be enhanced, with emphasis on the development of care-related education systems in order to create an environment for a quality long-term care system.