主治醫師離職因素探討—以某私立區域醫院為例

The Factors Influencing Visiting Staff Turnover in A Private Municipal Hospital：Case study

張冠群(Kuan-Chun Chang)

指導教授 ： 李弘暉

元智大學/管理學院/管理研究所/碩士(2007年)

摘要

主治醫師離職直接影響病人的權利，對醫療品質的周全、醫療過程的延續，必然大打折扣；而離職對醫師個人專業、組織效率、醫院的經營績效及醫療機構的聲譽，也有一定程度的影響。全民健保的實施，使得台灣醫療產業生態大幅改變，尤其私人醫院為求生存，對此自有因應。而主治醫師對變革的心態與反應，和經營者之理念是否有所衝突，將決定醫師的去留。
本研究對象醫院經歷醫院遷移、擴大轉型，其間發生多次高階主管異動，加上健保支付方式改變，引起院內薪資調整等等，衍生了為數頗多的主治醫師離職，最多有30%之多，其中不乏本院資歷十年以上者，大部份均為五年以上之中階主管、主治醫師，故對私人區域級醫院醫師離職因素，有必要加以探討。
本研究以深度訪談法配合參與觀察法，直接訪問個案，了解其離職想法，並與醫院管理策略作比較。分析其中最重要的原因，應以院方與醫師間互信不足為主。而互信基礎變差的原因，乃醫院因應健保制度改變，所作出的一連串變革所引發。其中新經營者的策略最受爭議，領導方式也備受批評。離職醫師對領導者的誠信及尊重度備加質疑，而對醫療環境及健保制表示悲觀，也認清變革是現實使然，而獎酬公平及派系不公的心理影響，也是有一致的看法，經營者對於高階主管把個人利益放在組織利益之上，也表達不容許。在雙方理念衝突之下，離職是必然。引進新團隊後，新領導者是「強而有力，凝聚力夠強」，在大量新血注入後，使人事趨於穩定，業務也漸至佳境。
總結起來，從此番離職潮及訪談結果，我們可以得到，對醫師來說，以病人為中心，注重醫療品質以及終身學習，才是價值之所在。對醫院來說，注重誠信、公平，加強內部控菅，重視品質提昇，並形成自身文化，才能永續經營。對於健保制度，仍應定位清楚，加強醫療品質監控、落實轉診，不再空談、作表面功夫，才是全民之福。

關鍵字

主治醫師 ； 離職

並列摘要

Resignation of visiting staff will have a direct impact on patient's rights. It will certainly induce some detrimental effects on medical qualities and medical treatment processes. Moreover, resignation will also make bad influence on doctor’s personal professionalism, organization efficiency, hospital’s business performance as well as institution’s reputation. The implementation of National Health Care Insurance policy in Taiwan has significantly changed the environment of medical industries, particularly in private hospitals. As the result, the discrepancy between administrator’s philosophy and attending doctor’s attitude towards changing will seriously affect doctor’s decision in resignation.
The hospital conducted in this study has experienced relocation, expanding, and reformation. During the course, its top managements have been changed several times. In addition, the salary system of the hospital has been adjusted due to variations in health care insurance payments. All these reasons have caused many attending doctors to resign, approximately 30% at most. Among those resigned, some have been worked in the hospital for more than 10 years, but most of them have more than 5 years of experience. The main purpose of this study is to investigate the reason of resignation for doctors in private hospitals.
The study uses semistructured interviews and participant observation method to visit the cases directly in order to understand their thoughts about resignation. The results have been compared to the hospital’s management strategies. The analyses have indicated that the mistrust between doctors and hospital is the main reason for resignation. The mistrust was induced by a series of reformations employed by the hospital owing to the alteration in heath care insurance system. Among those reformations, the policies as well as the leadership of the new administrator have been criticized the most. Resigned doctors have doubts about the integrity and respectfulness of the administrator. They feel pessimistic about the medical environment and the health care insurance system. Most of them also feel that the rewarding systems among different groups are unfair. On the other hand, the administrator does not agree the way top managements place their personal benefits over the organizational benefits. As the result of these conflicts, resignation is inevitable. After introducing new personnel into the hospital, the new administrator stabilizes the conflict; consequently, the business gradually returns to normal.
In summary, we believe the doctors should think mostly about their patients. They must pay attention to medical quality as well as lifetime learning. For hospitals, however, they must take integrity, fairness, internal management, quality improvement, as well as forming self-culture into consideration in order to have a sustainable business. As for the health care insurance system, we must establish clear definitions for its employment and enhance the medical quality monitoring in order to bring benefits to our entire nation.

並列關鍵字

Visiting Staff；Turn over

參考文獻

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