- 學位論文
以調適結構理論與差異事件觀點探討醫院導入資訊系統過程之衝突與抗拒-以導入PACS為例
An Investigation On Conflicts And Resistance In The Hospitals’ Implementation Of Information System Based On Adaptive Structuration Theory And Discrepancy Events: A Case Of PACS Implementation
摘要
醫院導入系統的歷程是影響系統成功或失敗的重要期間，學者曾以調適相關理論來探討組織對於新科技資訊的適應過程，但卻忽略了導入過程階段長時間歷程(Longitudinal)的觀點及過程關於人性的行為及態度面的影響(如抗拒、衝突)，其可能導致系統導入計畫失敗或延宕。而綜觀國內外探討醫療院所資訊系統導入之相關文獻，鮮少同時對抗拒及衝突作探討，因此，本研究輔以調適結構理論與差異事件觀點，並加入時間歷程之概念(系統導入前、中、後階段)，以醫院導入PACS資訊系統為例，藉由個案研究方式深入觀察分析其調適過程所產生的社會互動情形，以瞭解抗拒及衝突是為什麼、如何產生及兩者如何交互影響。整析資料歸納出個案導入前、中、後過程共有六個適應階段(Appropriation)，結果顯示最後的適應結構較最初的現存結構更適配該新資訊科技。對於調適過程所產生的差異事件，於導入中階段較密集顯現，導入後事件呈現快速下降，而以「系統管理」類差異事件較其他事件出現頻繁。另外，對於影響醫院導入PACS系統的關鍵角色有醫院、資訊部門、放射部門、醫師、PACS供應商。上述關鍵角色於系統導入過程所產生的社會互動有其相當影響程度，產生的抗拒與衝突也容易造成系統導入計劃的失敗或延宕。本研究亦分析出多項導入前、中、後階段中，造成個人抗拒與組織衝突的關鍵因素。研究結果也發現，當抗拒發生於部門主管時，由於其單位領導人的特殊身分，因此會將個人之行為由「個人」層面轉變為「組織」層面，也就是說主管個人抗拒行為往往會成為組織(部門間)衝突。除上述相關發現，本研究也提出數個未來研究議題，以供後續研究。
並列摘要
The process of system implementation in hospitals is critical to determine t he successfulness of a system implemented. Scholars have examined the process of adopting of new information technologies based on adaptation related theor ies; however, they have neglected the longitudinal aspect of the implementati on as well as relevant impacts from human behavior and attitude, such as resi stance and conflicts.These factors may cause system implementation to fail or to be delayed. In the literature relating to hospitals’ system implementation, very few studies have investigating resistance and conflicts at the same time. Therefore, this study, based on a perspective of adaptive structuration theory and discrepancy events as well as a longitudinal perspective (three stages:bef ore, during, and after system implementation) to study the hospitals’ implemen tation of PACS information system in order to observe and analyze social inter action derived from the process of appropriation using the case study method.T he main purpose of this study is to understand what causes resistance and conf licts, how resistance and conflicts arise, and how resistance and conflicts in teract. A total of six appropriations stages were found before, during, and af ter the system implementation, and the result suggested that the final appropr iation structure is more suitable for the new information system than the init ially existing structure. More discrepancy events were found during the implem entation, and the number dropped quickly in the later stage of the implementat ion. Those system related events occurred more frequently than other types did. In addition, the critical roles in the implementation process are the hospitals themselves, the information department, the radiology department, medical docto rs, and PACS suppliers. Social interaction derived from these parties during th e system implementation has substantial impacts on causing resistance and confl icts behaviors and may lead to system implementation failure or delay. This stu dy summarized several critical factors for causing personal resistance departme ntal conflicts before, during, and after system implementation. This study also found that when department managers express resistance, their position as the l eader of the department would transform the resistance from “ personal ” level to “ organizational” level. In other words, managers’ personal resistant behavi or often ends up with organizational (between departments) conflicts. This stud y also proposed several issues for future research.