從組織文化觀點探討醫務社會工作人員之專業自主性∼以企業型財團法人醫院為例

論文摘要　　醫務社工一直以來以「輔助」之角色，存在於醫療機構中，但醫院之科層性質，卻使專業者與組織間存在著微妙的互動關係，此時社會工作者在醫院中專業自主性的擁有程度與因應之道，自然是值得探討的，再加上台灣醫療環境走向集團化、市場化、管理化的今日，「企業型財團法人醫院」已是台灣醫療機構中相當特殊且具有亮眼表現的醫院型態代表，醫務社工在此種強調管控與成本取向的醫療機構中，要如何擁有專業自主性？且如何因應組織各種要求，則令社工界所好奇，因此本研究針對台灣地區「企業型財團法人醫院」之醫務社工為對象，進行專業自主性研究，並透過組織文化觀點，探索此類型醫院之「組織文化與管理制度」，瞭解其對於醫務社工「專業自主性之影響性與因應之道」，以作為未來醫院、社會工作者、政策制訂之參考。　　本研究採取質性研究方法，以立意抽樣方式，選取全台六間企業型財團法人醫院之十一名醫務社工進行訪談。並採取「深度訪談」與「焦點團體」進行資料蒐集，得到以下研究結果：一、組織文化與管理制度方面：發現此類型醫院普遍具有「善於經營管理」的組織文化，且在「價值信念、管理方式、共識與凝聚力、成功之道」等組織文化面向中，也得知具有著重效率及管理擅長、靈活反應之組織文化特點。管理制度上，則發現院方對於社工部門在「績效管理、工作流程、成本管控」上，均多有要求，社工單位也會因此要求，受到正負向影響與產生各種回應方式。二、醫院特色與屬性方面：「濃厚企業色彩」與「內外在資源豐富」仍是此類型醫院的重要特色，並且院方會在與母企業合作、規模大小、資源多寡、知名度上展現。三、專業自主性與因應之道方面：醫務社工在此類型醫院內專業自主性的擁有狀況，並非如想像中受限，反而會在臨床個案處遇上獲得自主，但在行政管理上遭受干擾，干擾源來自「管理者、專業間、自身」等三方面，但醫務社會工作者仍會根據其專業知識與堅持發展出「積極與被動兼具」的因應方式。四、跨院比較方面：發現本研究受訪醫院：「Ａ醫院與Ｄ醫院」，在組織文化、管理制度、專業自主性上，均呈現出「對立」狀況，值得未來研究者繼續分析研究。五、結語：整體而論，若企業型財團法人醫院之組織文化越強烈，則對於醫務社工之專業自主性之影響，將更趨嚴重，不過即使如此，多數受訪者對於在此類型醫院中從事社會工作之想法仍是衝突與認同兼具的，　　基於以上研究發現，研究者於文末中進行諸多討論，並針對「醫院、社工、制度」三層面提出建議與未來研究方向，供後續研究者與讀者參考。

關鍵字

醫務社會工作；組織文化；企業型財團法人醫院；專業自主性

並列摘要

Abstract Nowadays, medical social workers act as an important supporting role in hospital. Under the bureaucratic system within the hospital, there is a delicate relationship between a profession and the organization. Therefore, this paper will mainly discuss on how much professional autonomy the medical social workers possess and how they deal with this kind of situation in hospital. As our medical environment gradually extended to grouplization, marketization and managerialism; non-profit proprietary hospitals invested by the enterprise has becoming a special and well recognized in all of Taiwan medical organizations. Under a medical organization which emphasizes the management and the cost control; can the medical social workers maintain their professional autonomy? How do they fulfill the various requirements by the organization? Hence, this study is aiming at the medical social workers of the non-profit proprietary hospitals invested by the Enterprise. To understand the professional autonomy in more depth, this study will explore the organizational culture and management system in this kind of hospital and to learn how it affects the medical social workers. Adopting the qualitative research method and the way of purposeful random sampling, this study chose 11 medical social workers from six non-profit proprietary hospitals invested by the enterprises in Taiwan. “Focus group” and “in-depth interview” were used to collect data, and the following results were obtained: 1. In terms of organizational culture and management system: We found that “good management system” within the hospital needs to possess “the belief of ones value, the way of administration, consensus, cohesion and the way to success”. These were the four main factors proving the efficiency, flexibility and the good management system of an organizational culture. Regarding the management system, the hospital require social worker unit much on their “performance, working procedures and the cost controlling”. As a result, social workers were positively and negatively affected and produced different coping styles.. 2. In terms of features and attributions of the hospitals: Through the cooperation with the parent company, its scale, resources and the reputation have influenced greatly on “strong corporate philosophy” and ”abundant resources”. 3. In terms of Professional Autonomy and Coping styles Instead of being restricted, social workers have its own autonomy when dealing with clinic case. However, they are often interfered by “the manager, profession and themselves” under the management. Therefore, medical social workers will eventually develop their own positive and passive attitudes base on their own professional knowledge. 4. In terms of comparison: After interviewing hospital A and hospital D, this study found that they are completely different within the organizational culture, management system and professional autonomy. For the researcher in the future, further study on this project is necessary. Conclusion: Overall, the stronger the organizational culture, the more it effects on the professional autonomy of the medical social worker. Even though, many interviewees hold the same view but at the same time, may also have some conflicts. Base on the above results of this study, further details will be discussed in the following report. On the subject of “the hospital, social workers and the regulation”, this study also proposed different opinions and future research directions for future studies.