新制醫院評鑑對區域醫院與地區醫院在人力資源管理影響之探討

目的目前醫療界面臨醫院評鑑與全民健康保險的雙重影響因素，使得管理面臨不確定性及收支壓力更甚以往。最近增修勞工退休金條例及醫療法加重醫院人力成本之負擔，加上新制醫院評鑑實施後對醫院更是倍感經營困難。為探討新制醫院評鑑對人力資源管理改善上差異性，故本研究目的為：1.探討區域醫院與地區醫院在新制醫院實後對人力資源管理改善上差異之比較。2.探討不同屬性醫院在新制醫院評鑑對人力資源管理改善上差異之比較。3.探討不同醫院層級及屬性之高階主管對新制醫院成效之看法及成效看法差異之比較。方法本研究主要採用問卷調查研究方法，以95年度底衛生署及醫策會公佈通過新制醫院評鑑暨教學醫院及精神科醫院評鑑合格者共92家之高階主管為問卷發放的對象，整體問卷回收率為58.69%。使用統計方法包括描述性統計、t檢定、單因子變異數分析（one-way ANOVA）及三因子變異數分析（three-way ANOVA）。結果本研究結果發現，在區域醫院與地區醫院在新制醫院評鑑實施後對人力資源管理改善上未呈現顯著的差異；在不同屬性醫院（公立醫院、私立醫院、財團法人醫院）在新制醫院評鑑對人力資源管理改善有顯著的差異，以公立醫院改善程度高於私立醫院；不同醫院層級及屬性之高階主管對新制醫院評鑑成效之看法，在整體構面中不同屬性的醫院與不同職位的高階主管達顯著性差異，職位院長及人資部主任對新制醫院評鑑看法認同度高於其他人員。討論與建議：本研究發現新制醫院評鑑實施後對人力資源管理，確實在不同屬性的醫院對人力資源管理可達改善的目的，藉以強化醫院內部管理，讓人盡其才，物盡其用，以達成醫院整體目標。建議衛生主管機關，加強重視醫院評鑑在人力資源過程及結果指標之審查，並將評鑑資料依序整理，建構完整資料庫，以利於後續者研究。

關鍵字

新制醫院評鑑；人力資源管理；問卷調查法

並列摘要

Objective：The dual influential factors of the hospital accreditation and the national health insurance make the problems of uncertainty and the pressure of revenue and expenditur administration faced worse than before. The recent modified Pension Funds and Medical Care Act increase the burden on the cost of labor power and the practice of assessment of theormed hospital accreditation refmake the operation of hospital more difficult. To explore the difference the new system hospitals did to improve the human resource management, this research is made to achieve the following goals: 1. to compare the difference of administration of human resource management between regional hospital and local hospital after the new system application. 2. to compare the difference of improvement of human resource management among different kinds of hospitals after the new system application. 3. to explore the viewpoints of different level hospital CEO on efficiency of new system-hospital. Methods：The methods this research uses is survey research. This survey research is based on viewpoints of CEO of 92 teaching and psychiatric hospitals qualified on new system hospital assessments published by Department of health executive yuan and Taiwan joint commission on hosptial accreditation at the end of 2006. The percentage of the collection of response rate 58.69%. The statistic method this research used includes descriptive statistics, t-test、one-way ANOVA and three-way ANOVA. Results：This research find out that the regional hospital and local hospital did not present obvious difference on the human resources management improvement after the new system hospital assesment been put into practice. There are obvious difference among hospitals, such as public hospitals, private hospitals and proprietary hospital about new system hospital assessment on human resource management improvement: the public hospital improved better than private hospitals. There are obvious differences among the viewpoints of CEO of different positions and different level hospitals: The viewpoints of new system hospital assessment between hospital directors and executive of human resources are similar. Discussion and suggestion：This research find out new system hospital assessment does help different hospital to improve the human resource management and new system hospital assessment is also good to hospital interior management. The new system hospital assessment makes the staff perform better and helps the hospital to reach the goal more easily. This research suggests the central competent health authority reinforce the assessment on the performance of human resource management by the hospital assessment, put the assessment date in order and establish complete databases and that will good for the further research.