醫院與社區互動經驗之研究-醫務社工的觀點

A research on the interactive experience of the hospital and the community-Medical Social worker's perspective.

翁乙馨(Yi-Hsin Weng)

指導教授 ： 陳武宗

高雄醫學大學/健康科學院/醫學社會學與社會工作學研究所/碩士(2009年)

摘要

醫院投入社區工作、參與社區關係經營是近年來新興的議題，醫療服務方式也由被動等待病患主動求醫，轉為主動積極走入社區，醫院社工者在醫院社區關係經營中扮演重要的角色。本研究之主要目的為了解醫院社工者在社區關係經營中，與組織內部（醫院）、外部（社區）互動經驗，並分析醫院社工者在社區關係經營的困境與突圍，最後將研究結果作為社區實務工作者、社會工作專業社群以及醫院經營者未來社區服務工作及社區關係經營之參考。

本研究採質性之深度訪談法進行資料蒐集，共計訪談六位高雄縣市地區層級以上醫院之社區實務工作者，以了解醫院社工者參與社區關係經營樣貌。本研究結果如下：
一、社工與組織內部（醫院）互動經驗方面，醫院在服務範疇選定會考量到地理位置、醫院層級差異、醫院政策與資源分配考量等；社區服務方式的發展傾向於點線面的擴張；醫院社區關係經營特色上，社工會針對各家醫院之特點加以發揮；醫院在社區中為醫療照護者、衛教諮詢者、資源統合者、倡導充權者、教育培力者等角色；醫院經營良善社區關係的必要性，包含醫院經營理念、善盡社會責任、增加醫院營收、提昇醫院形象、因應評鑑要求、配合政府政策、提高社區認同等；醫院組織內部主管的支持、團隊合作與認同、志工成員的支持與肯定以及社區經費充足，屬於正向互動經驗，在組織內部互動的過程中，單打獨鬥與主管機關要求等負向互動經驗。

二、社工與組織外部（社區）互動經驗方面，研究結果發現醫院社工與社區互動，關係經營是漸進式分階段的；醫院、社工部門與社區三者之間的是動態、夥伴及利益交換的關係；醫院有計畫且主動進入社區（認識階段）、持續地參與社區（維繫階段），透過社區關係經營，對醫院、社工部門與社區皆有益處。另外，研究發現社工者是醫院與社區的媒介，連結雙方資源，醫院與社區的互動呈現一種夥伴關係，互動時會涉及利益交換、權力結構與政治角力的問題。社工者與社區互動過程中，產生正向互動經驗有助於工作推動和社區建立關係也較為順利，負向互動經驗影響社區關係經營與推動。

關鍵字

社區 ； 醫務社工 ； 夥伴關係

並列摘要

Abstract
Devotion into community work and participation community relationship management from hospital has been the emerging issues in recent years. The method of medical service has transformed from reactively waiting patient request for treatment to proactively entering community. In fact, social workers of hospital play very important roles in community relationship management. The main purpose of this research is to study the interactive experience between hospital and community. Also, the research analyzes how social workers face the dilemma and make the breakthrough in relationship management. Finally, we hope to provide the result as the reference for community practical worker, professional community of social work and hospital manager to deal with community service and relationship management.

The research adopt qualitative method to perform data collection. We had interviewed 6 community practical workers from the above regional hospital in KH in order to clarify the way that hospital social workers involve in community relationship management.

The research results are as follow：

First, in the perspective of interactive experience between social workers and hospital, hospital manager will consider the location, the difference of hospital level, hospital policy and resource allotment to decide service scope. The development of community service method intends to expand in point-line-plane. ; On the character of relationship management between community and hospital, social workers will leverage the distinguishing characteristic of every hospital to deliver services. In the community, hospital plays the roles as medical health care, health education consultant, resource integrator, empowerment initiator, and educational enabler etc. The necessity of excellent community relationship management of hospital include vision of hospital, accomplishing social responsibility, increasing hospital income, promoting hospital image, responding to the appraisal , fitting cooperating government policy and increasing community identification. Managers’ support from the inner organization of hospital, teamwork and identification, volunteer members’ support and approval, and abundant community budget belong to positive interactive experience. In the process of internal interaction of organization, social worker worker shortag and authority requests are negative interactive experience.

Secondly, in the perspective of interactive experience between social workers and community, The result discovered that the interaction between hospital social worker and the community, the relational management is advancing gradually with stages. The relationship among hospital, the social worker department and community is dynamic, partnership and benefit exchange. It is good for hospital, social worker department and community that hospital enters community in managed and proactive manner, persistently involve in community and maintain community relationship. Besides, the research found social workers are the mediators and link the resource between hospital and community. It is a kind of partnership in the interaction between hospital and community. During the interaction there will have benefit exchange, power of structure and politics issues. When social worker interact with community, producing positive experience is good for job delivery and community relationship establishment. The negative experience will affect the community relationship management and promotion.

並列關鍵字

community ； medical social worker ； partnerships

參考文獻

參考書目

中文期刊、書籍部分

王俊文(1999)，健保新時代醫療產業之生態與因應，醫院，32(2)，17-31。

成亮（2003）。社區健康營造。醫院雜誌，36（5）：1-11。

朱文洋、葉淑娟（2001）。中小型醫院經營策略與營運績效之探討－以平衡計分卡觀點分析，醫務管理期刊，2（2）：109-138。