- 學位論文
透析中心護理主管領導風格與經營績效及醫療品質之相關性探討
The Releationship of Head Nurse Leadership Style with Technical Efficiency and Dialysis Quality among Dialysis Centers in Taiwan
摘要
背景：為了抑制透析費用的成長，健保局於2003年將醫院門診透析與西醫基層透析合併為單一總額，此舉促使透析機構彼此間之競爭更趨激烈－一方面須設法節省成本支出以達成經營績效目標，另一方面也必須設法提升所提供醫療照護的品質。有研究指出，在一般機構中，組織之經營績效及服務品質與主管之領導風格具有顯著相關性。對透析中心而言，護理主管之領導風格與經營績效及透析品質是否也具有顯著相關性呢？目前相關文獻仍付之闕如。 方法：本研究採問卷調查法，針對全國透析中心護理主管進行領導風格認知之調查，並蒐集經營績效及透析指標等相關數值。共發出418份問卷，回收141份，扣除無效問卷後，有效問卷114份（有效回收率為27.3%）。領導風格之評量採用MLQ量表，分別以四種不同類型（高轉換/高交易、高轉換/低交易、低轉換/低交易及低轉換/高交易）與轉換型、交易型之高/低傾向作為分類，經營績效以資料包絡分析法所計算出之效率值為代表，透析品質則選用Kt/v、Albumin及Hct等三項透析結果指標。並以配對t檢定、Pearson相關分析及單因子變異數分析檢測本研究之假設。 結果：整體而言，在經營績效方面，四種不同類型領導風格對經營績效並無顯著差異性；若以較具對比性之高轉換/低交易及低轉換/高交易進行分析，發現低轉換/高交易較高轉換/低交易之領導型態有較佳之經營績效表現（p=0.049）。就轉換型之高、低傾向而言，低轉換較高轉換有較佳之表現（p=0.042）。在透析品質方面，四種不同類型領導風格之間具有顯著差異性（p=0.047）；以較具對比性之高轉換/低交易及低轉換/高交易進行分析，發現高轉換/低交易較低轉換/高交易有較佳之Kt/v結果（p=0.018）。就交易型之高、低傾向而言，低交易較高交易也有較佳之Kt/v結果（p=0.014）。依層級區分透析中心，在區域級以上醫院之高轉換較低轉換有較佳之Kt/v結果（p=0.011）；診所層級之低交易較高交易有較佳之Albumin結果（p=0.032）。 結論：根據本研究分析結果，提供實質的獎勵報酬並隨時注意部屬的工作行為，將比透過激發動機以及精神鼓勵之方式，具有較佳的績效表現；相反地，激勵部屬自我目標實現之動機，將比獎酬方式，具有較佳的透析品質結果。故透析中心如欲提升經營績效，護理主管可考慮採行具有獎懲方式之低轉換/高交易領導風格；若欲提升透析品質，則可考慮採用具有激發動機意義之高轉換/低交易模式。
並列摘要
Background: To contain the growth of dialysis expenditures, Bureau of National Health Insurance put an expenditure cap on primary care clinics as well as dialysis clinics in 2003 through global budget. The policy contributed to the high competitiveness among the dialysis facilities. The dialysis facilities, on the one hand, strived to control the costs, so that they might achieve the performance goals. On the other hand, the facilities had to ameliorate their quality of care. Literature review showed that leadership style is significantly correlated with organizational performance and quality of service. However, a lack of literature addressed the correlations between the leadership styles and business performance, and between leadership styles and healthcare quality in dialysis facilities. Therefore, the survey aimed at investigating the correlations between the leadership styles of nurse managers in dialysis facilities and business performance, and between leadership styles and healthcare quality. Methods: The survey questionnaire, sent to the nurse managers of the nationwide dialysis facilities, explored their perceptions of leadership style. Of 418 questionnaires delivered, 141 were returned. 114 were valid with the net returned rate, 27.3 percent. Leadership style was measured by Multifactor Leadership Questionnaire. Data Envelopment Analysis was employed for the assessments on business performance. Healthcare quality was evaluated by Kt/v, Albumin and Hct. Paired t-test, Pearson correlation as well as one-way ANOVA were used to test the hypothesis. Results: There was no significant correlation between overall leadership styles and business performance. The low-transformational-but-high-transactional leadership had significantly better effects on business performance than high-transformational-but-low-transactional leadership did (p= 0.049). The business performance was significantly better in low transformational leadership than in the high (p= 0.042). The healthcare quality was significantly different among the four leadership styles (p= 0.047). The Kt/ v showed the significantly better outcomes in high-transformational-but-low-transactional leadership than in the low-transformational-but-high-transactional (p= 0.018). The outcomes of Kt/ v were significant better in low transactional leadership than in the high (p= 0.014). The outcomes of Kt/v were significantly better in the district hospitals and medical centers which adopted high transformational leadership than in those which adopted low transformational leadership (p= 0.011). For the primary clinics, the results of Albumin were significantly better in the primary clinics implementing low transactional leadership than in those implementing high transactional leadership (p= 0.032). Conclusions: The findings in the survey suggested that providing tangible rewards and paying attention to the behavior of the subordinates might contribute to better performance than inspiring motivations and intangible encouragements might. Motivating the subordinates to achieve their goals might result in the better quality of dialysis than rewards. As a result, the nurse managers might adopt the low-transformational-but high-transactional leadership involving rewards and punishments to raise the business performance of dialysis facilities. On the other hand, high-transformational-but-low-transactional leadership might be applied to help increase the quality of dialysis.