公立醫院組織再造經營權屬決策-績效導向評估模式

A study of Decision Making on the Ownership of Public Hospitals under Reorganization-A performance-based Assessment Model

陳月英(yuen-yin Chen)

指導教授 ： 陳金淵

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2012年)

https://doi.org/10.6833/CJCU.2012.00139

摘要

目的 因應公立醫院面臨轉型困境又適逢政府積極推動組織改造之際，為解決公立醫院之經營困境，並顧及區域內之整體醫療資源的統籌規劃及發展，署立醫院組織再造經營權屬決策成為中央與地方政府之一大挑戰。本研究旨在對於新設直轄市區域內的公立醫院組織再造經營權屬的議題進行探討，不僅考量以往一般的績效評估模式，也涵蓋公立醫院之特殊政策任務使命及區域整合，期能建立一套較務實的績效導向「組織再造經營權屬決策評估模式」，提供較客觀的評估機制，以做為決策者參考用。
方法 本研究採用問卷調查研究法（survey research）。以平衡計分卡概念初擬評估構面及指標，再選定15位專家學者以德菲法（Delphi method）進行問卷調查，回收有效問卷13份，回收率86.7%。最後應用層級分析法（analytic hierarchy process, AHP）以南部某新設直轄市區域公立醫院及衛生局人員為對象，發放30份問卷，回收有效問卷29份，回收率為96.7%。回收問卷經整理後，以SPSS及EXCEL為工具，進行平均數、標準差、一致性及權重比等統計分析。
結果 在七項核心價值構面中，「組織結構構面」、「顧客構面」、「政策使命構面」三項獲得受訪者100%的同意，另外「財務構面」、「內部流程構面」、「學習與成長構面」、「社會責任構面」四項，則有5.5%表達不同的意見。在主要核心價值構面權重值整體排序為「顧客構面」（0.198）所佔的權重最大，「內部流程構面」（0.110）所佔的權重最小。次要評估指標整體排序為「依醫療法聘用合格之專業員工數」（0.056）所佔的權重最大，「內部建檔資料」（0.009）所佔的權重最小。整體而言，獲受訪者普遍認同並值得做為公立醫院組織再造經營權屬決策評量之參考。
結論 「公立醫院組織再造經營權屬決策評估模式」7項核心價值構面及49項次要準則評估構面指標，獲得多數受訪者的一致認可，並足以做為公立醫院評估指標構面。本研究提出的構面可作為「公立醫院組織再造經營權屬決策模式」的評估架構，使其兼具專業與區域治理的精神。必要時可聘請專家學者依醫院之屬性決策策略進行規劃評估，提出適當的評估構面指標之權重比值。

關鍵詞：經營權屬、組織再造、營運績效、公立醫院

關鍵字

經營權屬 ； 組織再造 ； 營運績效 ； 公立醫院

並列摘要

Objective The reorganization of ownership affiliation for the Department of Health (DoH) hospitals has been a challenge for government due to the bottleneck in transition and governmental policies. This study focused on the issues of affiliation of ownership for the emerging public regional hospitals. Based on the general performance evaluation model in combination with consideration of healthcare resource allocation policy, a new approach to decision making on ownership affiliation of DoH hospitals will be established to serve as a practical and objective guideline for policy makers.

Methods The survey research was adopted for this study. The Balanced Scorecard concept was applied to assess the dimensions and indicators. 15 experts were invited to the Delphi survey and 13 questionnaires responded with a response rate of 86.7%. The analytic hierarchy process (AHP) was conducted to the participants at one DoH hospital. 30 questionnaires were distributed with 29 valid responses. The statistical analyses and computation of relative weights for AHP were executed with the aid of SPSS and EXCEL sofeware packages.

Results Three out of seven categories of core value, organizational structure dimension, the customer dimension and policy mission dimension, reached 100% positive agreement among respondents. The other four categories, financial perspectives, internal process perspective, learning and growing perspective and social responsibility dimension, received a 5.5% disagreement. The relative weights showed that the highest category was the customer dimension (0.198) and the lowest category was the internal process perspective (0.110). The secondary assessment indicators showed that the highest weight was the percentage of qualified professional staff (0.056) and the lowest was the internal filing (0.009). Overall, most of the respondents were in good agreement and the new model is worth as a public hospital ownership decision making reference.

Conclusions In summary, the overall 49 indicators in 7 core values showed that all respondents were in good agreement. We believe that these results can provide objective evaluation references for public hospitals. The assessment model can also be adjusted depending on the specialty of hospitals, and regional autonomy.

Keywords: Operating ownership, Organizational restructuring, Operating performance, Public hospitals

並列關鍵字

Operating ownership ； Organizational restructuring ； Operating performance ； Public hospitals

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