組織文化變革對營運之影響
—以S聯合牙醫診所為先導個案研究

1995年全民健康保險制度的實施，促成牙科產業基層化的發展，全國基層牙醫診所爆炸式的增加，依循策略脈絡發展，基層牙醫診所著墨在經營模式上之進程，單獨執業診所、牙醫聯合診所至牙醫連鎖聯盟診所因應而生；時至今日，牙醫聯合診所成熟立足於產業，經營超過十年的牙醫聯合診所卻紛紛遭逢營運困頓之難題，源自外部環境抑或內部組織，值得深究。本質化研究，以文獻分析法，從產業面觀點(Outside-In)，探究基層牙醫診所在經營模式上的組織變革，再從公司面觀點(Inside-Out)，依從資源基礎理論，分析基層牙醫診所在經營模式組織變革之內涵，進階探尋醫療產業在各構面組織變革之組織績效，最終假設以病患為導向、知識管理和學習型組織組合之組織文化，最適合運用在牙醫聯合診所之組織變革上，而導入個案研究。本先導研究，以S聯合牙醫診所之牙科助理為個案對象，透過知識管理、組織學習和組織溝通之程序，執行「專業知識學習」、「處裡病患抱怨流程」、「牙科助理間相處」和「年度考核」之四個變革活動，端正原先組織潛在的信任危機，重拾的團隊合作信任，延伸至信任的醫病護關係，而創造2018年10月至2019年9月四個季度顯著的營運績效。本質化個案研究，依「內部行銷」、「知識管理」、「學習型組織」、「組織領導」和「組織文化穩固變革」之相關量化實證，驗證四個變革活動和解釋其背後的管理意涵，再依變革模型分析整個S聯合牙醫診所之組織變革。本研究旨在說明醫療產業本質是個人本關懷的產業，經營者投入資源的切入點，最終都應確保醫病互信關係的暢通，此是該產業最核心的經營治本之道，尤其是面對產業動盪危機時，最無法被取代和掠奪的核心競爭力，亦是展現經營者「立足小放眼寬」的經營智慧。

關鍵字

牙醫診所組織文化；組織變革；資源基礎理論； Lewin變革模型

並列摘要

Since the implementation of National Health Insurance system in 1995, dentistry has developed more into primary care levels. The number of primary care dental clinics has grown exponentially nationwide. The strategic and contextual development of primary care dental clinics has transitioned from practicing alone to group practices and dental clinic with strategic alliance. Nowadays, group practices dental clinics have matured their development in the industry; however, some group practices dental clinics operating for more than 10 years encountered difficulties in operation. Whether external environmental or internal organizational factors caused such difficulties are worthy of exploration. This qualitative study used literature analysis methods to explore organizational change in operation modes of primary care dental clinics from an outside-in perspective. Subsequently, this study adopted an inside-out perspective and resource-based theory(RBT) to analyze the implications of organizational change in operation modes of primary care dental clinics. Furthermore, the organizational performance of organizational change in various dimensions in dentistry was investigated. In the final step, this study introduced a case study based on the hypothesis that a patient-oriented organizational culture combining knowledge management and learning-oriented organization was most suitable for organizational change of group practices dental clinics. This pilot study recruited dental assistants in S Group Practices Dental Clinic as participants. Through the procedure of knowledge management, organizational learning, and organizational communications, four reform activities, namely, “professional knowledge learning”,” procedure for handling patient complaints”, “interaction between dental assistants”, and “annual assessment”, were performed to correct potential trust crisis in the organization, regain teamwork and trust, and develop committed dentist¬–patient–assistant relationships. From October 2018 to September 2019, the operational performance in the four quarters was notably improved. In this qualitative case study, relevant quantitative evidence in internal marketing, knowledge management, learning-oriented organization, organization leadership, and stable reform of organizational culture was employed to verify the four reform activities and explain the corresponding management implications. Subsequently, the organizational change of the S Group Practices Dental Clinic was analyzed using the Lewin’s organization change theory. This study aimed to elaborate that dentistry itself is a humanistic care industry. The purpose of resources investment is to ensure the mutual trust and unobstructed communications between dentists and patients. This is the core resolutions to management difficulties in dentistry. Particularly in crises, humanistic care is not only the core competitiveness that cannot be replaced and taken away, but also a factor demonstrating operators’ visionary management strategies.