以紮根理論探討醫院常規的形成與演化機制

本研究目的旨在以紮根理論探討醫院常規形成與演化的動因與動力。研究結果有以下幾點發現：第一，組織常規的形成可以分為來源、形成、執行與結果四個部份。常規的來源有組織內與組織外兩個構面。形成與管理者和體制規定密切相關，分為組織內「從無到有的創新」以及「執行面創造形式面」，以及組織外的「標竿學習」與「完全服膺體制規範」四種。執行是常規形式面與執行面的互動過程，有循規蹈矩、陽奉陰違、創造與修正三種互動類型。結果是執行的產出，當常規的執行面與形式面能充分契合時，對組織運作產生正面效應。反之，當兩者背離程度愈大時，常規會進行廢止或重新修正，構成常規形成與演變的交互循環。第二，常規改變的動因與動力同時受醫院組織內部與醫療體制外部兩個層次的影響。第三，「需要層級理論」可以解釋組織內部改變常規的有效作為背後的動力；「體制理論」的強制、規範與模仿則可提供體制影響醫院常規改變動力的強力註解。最後討論研究結果在理論與實務上的意涵，提供積極有效的常規管理策略供醫療實務者參考。

關鍵字

常規；紮根理論；需要層級理論；體制體論

並列摘要

This study applies grounded theory to examine the forces involved in the establishment and evolution of hospital routines. Several major findings are obtained, as follows: (1) there are four aspects to the formation of organizational routine-source, formation, execution, and result. The routine's resource divides into two perspectives-internal and external organization perspectives. Execution refers to the interaction between routine formation and execution. This interaction comprises three types: following rules, feigning compliance, and creating/modifying rules. The result refers to the outputs of the performative aspect, and involves a dynamic interaction between the ostensive and performative aspects. This interaction circulates routine formation and evolution. (2) The variation of hospital routine is influenced not only by internal factors, but also by external medical institutes. (3) From the perspective of Hierarchy of needs theory and Institutional theory, safety, love, membership, and the need for respect are an effective motivation for change; force, regulation, and imitation are three motive forces exerted by the institute. Finally, discussion of the results of this research has implications for both theory and practice.