署立醫院領導風格、組織文化與技術效率之相關性

The Relationship of Organizational Culture and Leadership Style to Technical Efficiency among the DoH Affiliated Hospitals

郭怡貞(Yi-Chen Kuo)

指導教授 ： 陳金淵

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2013年)

https://doi.org/10.6833/CJCU.2013.00189

摘要

目的 一直以來署立醫院有著讓民眾詬病的守成型文化，加上近年來財團法人醫院興起，引進企業經營方式，無形中對署立醫院帶來了威脅。此外，一般研究也發現，主管的領導風格與組織績效表現有顯著的相關性。近年來署立醫院積極推行改革，提升各院的經營自主權，讓各院院長依照醫院所在地理環境及使命特性等，擬定適合的經營方針。令人好奇的是，這些改革是否使得院長的領導風格以及舊有的守成文化有所改變了呢？若有改變，是否也影響到其經營績效？因此，本研究旨在探討署醫經過組織重塑後，其組織文化與領導風格是否有改變？並探討組織文化、領導風格各屬性與績效間的關係。
方法 本研究利用問卷方式調查署立醫院之領導風格以及組織文化，問卷包含 MLQ及組織文化量表。母群體包含28家署立醫院，回收26家醫院；個人問卷326份，回收246份，醫院樣本與個人樣本之回收率分別為92.86%、75.46%。使用衛生署提供之2007年醫療院所服務量與現況調查資料庫作為績效評比的資料來源，內容包含醫事機構現況檔與醫事機構服務量檔。
結果 本研究發現署立醫院的領導風格與組織文化彼此呈現高度相關；且署立醫院的領導風格大多為「高轉換/低交易」型，進一步將層級與區域聯盟納入分析，其結果一致。在組織文化部份，署立醫院的文化表現，以「積極創新」為最高表現，其次依序為「組織認同」、「嚴格監督」「年資長老」。使用迴歸方法，得到領導風格對效率具有顯著影響力，而組織文化則僅有「嚴格監督」構面對效率具顯著影響力。
結論 綜述之，署立醫院之領導風格與組織文化，並非單一風格或單一文化，往往伴有兩種以上的文化與領導風格。研究發現屬於高轉換型的醫院，其醫院績效表現大部分落在固定報酬與規模報酬遞增之間，相較之下，屬於高交易型的醫院，其績效表現大多落在規模報酬遞減與固定報酬之間。面對不同類型的領導風格與文化，管理者可以依照組織的目標，配合適當的領導風格，輔以合宜的組織文化，才可以發揮組織的最大效益。

關鍵字

組織文化 ； 領導風格 ； 經營績效 ； 資料包絡法

並列摘要

Objective The hospitals of Department of Health (DoH) have long been criticized by the public for its conservative organizational culture. The emergence of numerous non-profit proprietary hospitals and their introduction of business management has posed a threat to DoH hospitals. Studies have also shown that an organization’s performance is positively related to its leadership style. In recent years, DoH hospitals have launched a series of management reforms to increase the managerial autonomy of each hospital, allowing the president of each hospital to develop management strategies according to geographical characteristics and missions of their hospital. However, have these reforms also helped change the leadership styles and conservative culture in DoH hospitals？ If positive, have these reforms affected the performance of these hospitals? The purpose of this study is to investigate if there is any change in organizational culture and leadership style after organizational re-engineering of DoH hospitals as well as the relationship between organizational culture, leadership styles, and performance.
Method A questionnaire survey was conducted to explore the leadership styles and organizational culture in DoH hospitals. MLQ and the organizational culture questionnaire were used. These questionnaires were distributed among 28 DoH hospitals and 326 staffs in these hospitals, and 26 hospitals and 246 staffs returned their responses. The response rates of hospital and individual respondents were 92.86% and 75.46% respectively. Two of DoH’s 2007 databases, including Health Resources of Medical Facilities and Health Services Utilization of Medical Facilities, were employed for evaluation of hospital performance.
Results Leadership style and organizational culture were highly related among DOH hospitals, and the “high transformational/low transactional” leadership style was practiced in most of them. Consistent results were obtained when hospital levels and regional alliances were considered in the analysis. In terms of organizational culture, “innovation” ranked highest, followed by “organizational culture”, “strict monitoring”, and “seniority”. Further regression analysis found a significant influence of leadership style on efficiency, and the influence of organizational culture was significant only on the “strict monitoring” dimension of organizational culture.
Conclusion In sum, multiple leadership styles and organizational cultures existed in each DoH hospital. The performances of hospitals with high transformational leadership tended to fall between fixed returns and increasing returns to scale, while those of hospitals with high transactional leadership tended to fall between decreasing returns to scale and fixed returns. When dealing with a different leadership style or culture, hospital managers should adopt appropriate leadership strategies with consideration of the organization’s goals and culture so as to maximize the of the organization.

並列關鍵字

organizational culture ； leadership style ； technical efficiency ； data envelopment analysis

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