衛生署實施區域聯盟制度對署立醫院主管士氣之影響

目的：本研究目的在瞭解署立醫院實施區域聯盟、及歷經幾次組織變革後，對署立醫院主管士氣的變化情形，並探討影響現階段自覺工作士氣之因素。方法：本研究採橫斷性問卷調查法，士氣問卷包含工作滿足和認同醫院（亦即支持醫院）兩構面，兩構面內部一致性(Cronbach' α)分別爲0.93和0.84，統計分析以SPSS 120版進行分析。研究樣本爲32家署立醫院之主管，問卷發放對象爲署立醫院內之主管，估計研究的目標樣本爲1,062位，最後問卷共計回收892份，有效問卷爲763份（回應率爲72%）。結果：在組織變革過程中，主管士氣呈現下降之趨勢，尤以區域綜合醫院及精神專科醫院之護理主管最爲明顯，背景爲醫師之主管在區域聯盟前後和規模改變皆無差異。主管士氣重要預測因子（依標準化B值）依序爲：職位滿意程度、健康狀況、年齡、目前職位。結論：署立醫院主管整體士氣以醫師最高、護理人員最低，政策制定者或高階管理者必需了解不同專業人員的士氣改變且採取因應措施來避免組織變革對醫療服務成效造成負面的影響。此外醫院應有員工健康促進計劃，以增強醫院工作者的士氣。

關鍵字

署立醫院；組織變革；區域聯盟；士氣

並列摘要

Purposes: This study examined the impact of the implementation of regional configurations or alliances on the morale of Department of Health (DOH) hospital executives and identified the predictors of morale scores. Methods: The study employed a cross-sectional survey design and the sample comprised 32 DOH hospital executives. The morale questionnaire included job satisfaction and recognition of hospital. The internal consistencies of the Cronbach α values for both dimensions were 0.93 and 0.84, respectively. Totally, 892 out of 1,062 DOH executives completed the survey, and the final sample included 763 valid questionnaires (representing a 72% valid response rate). SPSS for Windows was used for all analyses. Results: the morale scores exhibited a decreasing trend, especially for executives with nursing profession backgrounds who were working at regional hospitals and psychiatric specialty hospitals. Executives with a physician background exhibited constant morale scores over time. The predictors of overall morale score included satisfaction with current position, health status, age and current position. Conclusions: Executives with a clinician background had better morale scores than executives with a nursing background. Policy makers or hospital top administrators need to understand the morale changes between different professions affected by the organization change and to solve the problem to protect hospital service quality.