醫院關係品質之前置及調節變項之研究

Research on Antecedent and Moderator Variables of Hospital Relationship Quality

李怡慶(Yii-Ching Lee)

指導教授 ： 何雍慶

國立中正大學/管理學院/企業管理學系/博士(2014年)

摘要

現今醫療機構面臨嚴峻且多變的經營環境，加上醫療資源相當有限的競爭環境下，有效的調整策略與戰術，提高醫病關係是重要的經營策略之一。本研究以基於社會交換理論之關係行銷為基礎，以關係行銷之關係連結觀點，探討病人與醫院雙方互動過程之關係，了解影響病人感激、醫院與病人間關係品質之相關重要因素，並論其就醫類別及醫院醫療服務人員之調節效果。
本研究採兩階段之方法，第一階段質性訪談部分，針對工作時需與病人互動頻率高且年資在十年以上之醫療服務人員34位進行結構式訪談，以釐清先前研究無法確認之變項間關係或其角色，以利進一步於第二階段之量性研究中驗證；第二階段量性研究部分，依據文獻探討中之假設及第一階段所得之結果，建構本研究之研究架構，並以台灣地區曾經至醫院就醫之民眾為研究對象，共調查769份有效樣本，以驗證本研究架構及目的。
第一階段結果顯示，醫療服務之社會性、結構性、財務性及專業能力關係連結努力，皆會加強病人與醫院間之關係，但是除了財務性連結外，其餘連結方式皆會對醫院感到感激；醫院關係連結面向應包含社會性、結構性及專業能力連結；病人知覺醫療服務人員之人格特質和其就醫類別會扮演著關係連結型態與感激間之調節角色。
第二階段結果發現，本研究之理論模式與觀察變數的配適度理想、符合SEM模式，使用相同的母群體的另一群獨立樣本進行複核效化驗證，結果其各標準迴歸係數，各測量項目可被因素所解釋之能力足夠，無需再進行修正，本研究可推論至醫院關係連結、感激及關係品質之完整整合影響模式。本研究之主要結果為，「關係連結」對於「感激」與「關係品質」皆具正向影響。關係連結經由感激而影響關係品質之路徑效果，大於關係連結至關係品質該路徑。醫院之關係連結構面為：社會性、結構性及專業能力連結，且專業能力連結對於關係連結貢獻最大，其次為結構性連結，最後則為社會性連結。關係品質中之信任貢獻效果最大，其次才是承諾及滿意度。在樣本之教育程度、年齡及職業為其控制變數下，就醫類別對於關係連結與感激間並無調節效果。關係連結中之「社會性連結」對於這家醫院之感激程度會受到知覺醫療服務人員人格特質之「嚴謹性」所調節，是為「負向」調節；而關係連結中之「專業能力連結」對於這家醫院之感激程度會受到知覺醫療服務人員人格特質之「開放性」所調節，且為「正向」調節。
對於如何提高醫院與病人間之關係？進而提升顧客忠誠或再度就醫意願，醫院經營或行銷管理當局應優先強化關係連結之運用、適時、適當採用最佳之關係連結方式，重視病人就醫服務過程、增加或提升所有病人對於感激及關係品質之正面態度，以提高民眾再度就醫之意願，有良好的醫療服務市場競爭力，永不被這市場所淘汰。

關鍵字

知覺醫療服務人員人格特質 ； 專業能力 ； 關係連結 ； 感激 ； 關係品質

並列摘要

Medical institutes nowadays face severe and changing business environment. In the competitive condition with limited medical resources, how to effectively adjust strategy to enhance doctor-patient relationship is an important business strategy. The study is based on relationship marketing derived from social exchange theory. From the perspective of relational bond in relationship marketing, it will explore the process of interaction between patient and hospital to understand the relevant significant fac-tor for patient’s gratitude, and for quality of relationship between hospital and patient. It will also discuss the type of medical service and the modulate effects of health care provider in the hospital.
The study adopts two-stage method. The first stage is the part on qualitative in-terviews, which involve structured interview conducted among 34 health care provid-ers whose job requires frequent interaction with the patient, and whose working his-tory is more than 10 years. To clarify moderator variable relationship or its role, that cannot be verified by previous studies, so as to facilitate the verification in quantita-tive research for the second stage. The part on quantitative research in the second stage is based on hypothesis in literature review and result from the first stage to con-struct the framework of research for this study. The research subjects are people who had sought medical help from hospitals in Taiwan. The effective samples of survey amount to 769. They serve to verify the structure and purpose of this study.
The outcome of the first stage indicates that efforts on relational bonds in terms of social bond, structural bond, financial bond, and professional competence will all enhance relationship between patient and hospital. Except bond of financial bond, all other ways of bond result in gratitude towards hospital. Aspects of hospital relational bonds should include social bond, structural bond and professional competence bonds. The awareness of health care provider's personality traits as well as patient’s type of medical service play the modulate role between relational bonds type and gratitude.
The outcome of the second stage research discovers that theory model and obser-vation variable are ideal matches and in accord with SEM model in this study. Anoth-er group of independent sample using the same population to proceed with cross-validation verification. The outcome shows that their respective standardized regression coefficients, their respective measurements can be explained by factors. No further amendment is necessary. The study can be deduced with respect to fully inte-grated impact model among hospital relational bonds, gratitude and relationship qual-ity. The main result of this study is, "relational bonds" has positive effect on "grati-tude" and "relationship quality". Relational bonds via gratitude affects outcome of path for relationship quality, whose effects are greater than the path from relational bonds to relationship quality. The structural facades of hospital relational bonds are social bond, structural bond and professional competence bonds. Moreover, profes-sional competence bond contributes most to relational bonds. The next contributor is structural bond. The last contributor is social bond. Trust contributes most to rela-tionship quality. Commitment and satisfaction come next. As the control variables are educational background, age and profession, type of medical service has no modulate effect on relational bonds and gratitude. Degrees of gratitude towards this hospital for "social bond" of relational bonds are to be modulated by "conscientiousness" in awareness of health care provider's personality traits. It is "negative modulation". De-grees of gratitude for "professional competence bond" of relational bonds are modu-lated by "openness to experience" in awareness of health care provider's personality traits. It is "positive modulation".
How do we enhance relationship between hospital and patient? In doing so, en-hance customer loyalty and willingness to revisit. The hospital business or marketing authority should put priority on enhancing application of relational bonds, and adopt-ing the best way of relational bonds at the best time. It is important to care about pro-cess of medical service received by the patient, advance the positive attitude of the patient towards gratitude and relationship quality, so as to improve people’s willing-ness to revisit. With competitiveness in medical service market, one will never be eliminated.

並列關鍵字

awareness of Health Care Provider's Personality Traits ； Professional Competence ； Relational Bonds ； Gratitude ； Relationship Quality

參考文獻

方世榮，陳建成、周文瓊(2004)，買賣方關係涉入之研究，朝陽商管評論，3(1)，77-100。

江弘基、李蘭(2003)，管理式醫療照護下的醫病信任議題，醫學教育，7(2)，95-105。

池進通，李鴻文，陳芬儀(2008)，五大人格特質與工作績效關係之研究，經營管理論叢，14(2)，1-9。

吳志明、朱素玥、方文昌(2006)，供應鏈關係中信任與承諾影響因素之研究-交易成本及社會交換理論觀點，資訊管理學報，13，91-118。

吳明隆(2003)，SPSS統計應用學習實務(p.1-23)，台北：知城數位科技股份有限公司。