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

A Cross-Level Analysis of Hospitals Strategic Emphasis on Physician Professional Autonomy: An Hierarchical Linear Modeling

汪秀玲(Hsiu-Ling Wang) ； 黃俊英(Jun-Ying Huang)

《人力資源管理學報》 10卷4期 (2010/12) Pp. 33-54

https://doi.org/10.6147/JHRM.2010.1004.02

摘要

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.

關鍵字

專業自主 ； 策略強調 ； 報償誘因 ； 跨層次研究 ； 層級線性模式

並列摘要

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.

並列關鍵字

professional autonomy ； strategic emphasis ； compensation incentive ； cross-level research ； hierarchical linear modeling