影響醫師工作績效因素之研究-以南部某市立醫院為例

目的:醫師個人工作績效好壞與醫院收入成長有密不可分的關係，醫院管理者可藉由本篇研究了解影響醫師績效好壞之因素，便能有效的運用這些因素進而提升醫院營運績效。本研究目的如下: 一、運用社會人口學變項及環境變項進行問卷調查，探討不同變項是否影響醫師的工作績效。二、進行深度訪談了解與工作績效相關的影響因素。方法:本研究採用混合方法研究，結合問卷調查法及深度訪談法，以獲得客觀的真實資料。調查問卷對象為個案醫院102年10月以前報到之現職醫師(不包含機關首長、支援醫師、特約醫師)，調查問卷共發出40份問卷，問卷回收40分，經整理後有效問卷為40份，由研究者親自於院務會議及門診發放回收，並利用SPSS 18.0版進行進行分析。深度訪談對象為40位醫師中各邀請具代表性主治醫師兩名及主任醫師兩名，最後整合質性與量化之分析結果，進行比較及對照。結果:問卷結果顯示人口學變項「包括性別、年齡、職務、教育程度、科別、本院服務年資及醫師執業總年資」對於醫師工作績效並無顯著的影響，而環境變項「醫療設備、診療環境、行政流程、醫療糾紛、繼續教育、升遷管道及獎勵金制度」除了升遷管道有顯著(p<0.05)影響醫師的工作績效外，其於六項均無顯著影響；經深度訪談分析後發現上述七項環境變項對於醫師而言對於工績效是有影響的，影響層面如下:在醫療設備部分醫院必須建立定期更新、評估及汰換設備的機制，避免影響醫師治療持續性，可增加病人就診信心。在診療環境對於醫師而言會影響醫師、病人的醫療品質，而醫療作業系統軟體整合對醫師而言最為重要。在行政流程部醫師重視組織工作氣氛、作業流程簡化、垂直及平行的內部溝通協調以及科與科之間的同儕配合度。在繼續教育部份須和醫師本身專長相關或是有切身經驗的課程較佳，針對醫療技術課程送訓時機為五年一次較不會造成醫師負擔。醫療糾紛對於醫師會造成醫師不願意收治病人，因此對於醫院而言應建立一套完善的醫療糾紛支持系統幫助醫師給予協助。醫院應重視獎勵金的公平性以及制度是否合理。醫院須積極培育或網羅次專科醫師人才，並寫與醫院發展策略做結合，發揮最大的邊際效益。良好的醫療行銷能協助醫師收治病人，醫院應強化醫師專業度及醫院特色優點，並且多舉辦與民眾健康之相關活動，積極推廣醫院醫療特色提升醫院能見度。結論: 本研究使用混合方法研究，藉由三角校正設計收集質性的資料及量化數據後進行差異比較及對照，進而得出量化資料無法詮釋的真實原因，期望透過此研究結果供未來的醫療機構管理者參考與改進，以利提升醫師工作績效。

關鍵字

醫師；工作績效；醫師績效；醫療機構績效；混合方法研究

並列摘要

Purpose: The individual job performance of physicians is closely related to the income growth of hospitals. The hospital administrators may understand positive and negative factors influencing performances of physicians based on the research and further take good advantage of these factors to increase hospital operating performances. The research purpose was described as below: 1. Adopt social demographic and environmental variables to conduct the survey and explore whether different variables may influence job performances of physicians. 2. Conduct thorough interviews to understand influential factors relating to job performances. Method: The research adopted mixed methods of the survey and thorough interviews to receive objective authentic information. The respondents were current physicians (excluding the head of authority, supporting physicians and special physicians) of the case hospital registering before October 2013. 40 surveys were sent out and retrieved in departmental affair councils and medical appointments by the researcher personally, and 40 surveys were valid after being arranged and were analyzed through SPSS 18.0 version. The interviewees of thorough interviews were 40 physicians comprising 2 representative attending physicians and 2 chief physicians separately, and the analyzed qualitative and quantitative results were integrated for comparison and contrast. Result: The results of the survey indicated that demographic variables “including gender age, post, education, department, years of services, total years of practice” had no significant influence on job performances of physicians, and environmental variables “medical equipments, clinic environment, administrative procedures, medical malpractice, continuing education, promotional channels and incentive systems”had no significant influence except promotional channels had significant influence (p<0.05) on job performances of physicians; according to the analysis of the thorough interview, 7 environmental variables mentioned above influenced job performances of physicians, and the influential aspects were as blow: In terms of medical equipments, the hospital should establish a system of regular renovation, evaluation and replacement to prevent physicians from being influenced regarding the continuity in medical treatment as well as increase patients’ confidence in visits. In terms of clinic environment, it would influence the treatment quality of both physicians and patients, and the integration of medical operational system and software was what physicians cared the most. In terms of administrative procedures, physicians emphasized working phenomena in the organization, simplification of operational procedures, vertical and horizontal internal communication and coordination, and the departmental cooperation among colleagues. In terms of continuing education, courses relating to specialties or personal experiences of physicians should be better applicable, and the training timing of medical technical courses should be scheduled as once in 5 years to reduce physicians’ burdens. In terms of medical malpractice, physicians would refuse to accept patients, so hospital should set up a thorough system to provide physicians support given medical malpractice. In terms of incentive systems, hospital should focus on the impartiality and rationality of incentives, actively train or recruit talents with sub-specialties, and coordinate with hospital development strategies to maximize the marginal benefit. Proper medical marketing may help physicians treat patients; thus, hospital should enhance professionalism of physicians and featured strengths of the hospital hold more activities related to the public health, and positively promote medical features so as to increase the visibility of the hospital. Conclusion: With the mixed method research, the research received the real reasons for uninterpretable quantitative information from the comparison and contrast in quantitative data and qualitative information collected and designed through triangulatioon, hoping to provide the future medical institution administrators with references and improvement for the purpose of increasing job performances of physicians based on the results of the research.

並列關鍵字

Physician ； Job Performance ； Performance of Physicians ； Performance of Medical Institutions ； Mixed Methods Research

參考文獻

史麗珠、黃怡樺、邱孟君、陳寧、林雪蓉(2012)。桃園地區職能與物理治療師在健保總額預算支付制度期間工作壓力之初探。臺灣職能治療研究與實務雜誌。(8)1，15-26

卓佳慶、劉順仁、 James C. Romeis(2012)。Health Service Quality and Financial Performance: Findings from Renal Clinics in Taiwan。管理學報。(29)1，61-80

汪秀玲、羅永欽、洪純隆(2011)。財務誘因與台灣區域醫院醫師服務績效之跨層次分析。臺灣公共衛生雜誌。(30)4，337-346

葉燉烟、鄭景俗、彭群堂(2006)。模糊績效評估模式－以住院醫師為例。人力資源管理學報。(6)2，71-87

賴美嬌、程春美、蔡武德(2011)。員工休閒活動與健康促進生活型態對醫院績效之影響。商業現代化學刊。(6)1，31-52

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影響醫師工作績效因素之研究-以南部某市立醫院為例

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